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Inspection on 13/11/06 for Petersfield Care Home

Also see our care home review for Petersfield Care Home for more information

This inspection was carried out on 13th November 2006.

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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There is a good standard physical environment presenting a comfortable homely feel to the home. It is furnished along domestic lines and is well appointed with quality furniture and fittings and is well maintained. The daily living routines and relationships between residents and staff provide a large family unit, residents able to express their views in a free and open way. The Manager and staff "live" with the residents and provide a protective family experience which residents seem comfortable with. This may not be the preferred type of service for other people but current residents seem to benefit from the experience. There is a safe and well documented medication system in place. There is undoubtedly a high level of staff commitment to resident care.

What has improved since the last inspection?

Some improvements have been made in the areas of care planning, risk assessment and health care recording. . These need to be continued to develop a better system of recording across those areas. Risk assessments and care plans are now reviewed every 6 months. All records are now signed by staff and also by residents. Clearer guidance on how residents prefer personal care need to be met have been improved. Use of part self-medication by a resident has been risk assessed as required. Details of CSCI contacts have been added to the complaints procedure. Residents are consulted on an ongoing basis about sharing bedrooms. Only family members were providing care at the time of the last inspection. External appointments have now been made. There has been staff training in Food Hygiene. Loose rugs on tiled and laminate floors have been secured. Fire doors are no longer wedged-open. Three new magnetic self-closing devices have been fixed to door surrounding the communal areas.

What the care home could do better:

Moving & Handling assessments should be carried out for all residents. Improvements in the recording of health care issues and interventions with outcomes are required and future appointments recorded and monitored. The continued development of care plans should continue. Skills to promote the social skills and dignity of residents should be put into place for 2 residents. A risk assessment must be provided for residents using the cooker.The Adult protection policy requires additional details to be added. Staff training is required in First Aid and Fire Safety. The person managing the home should submit an application to the Commission for registration. Fire drills must be carried out regularly and include staff and residents. COSHH data sheets must be completed for all items used. New staff should only be employed following satisfactory POVA or CRB checks.

CARE HOME ADULTS 18-65 Petersfield Care Home 60 St Peters Road Handsworth Birmingham West Midlands B20 3RP Lead Inspector Peter Dawson Unannounced Inspection 13 November 2006 14:00 th Petersfield Care Home DS0000017053.V313399.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 Petersfield Care Home DS0000017053.V313399.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. Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Petersfield Care Home Address 60 St Peters Road Handsworth Birmingham West Midlands B20 3RP 0121 515 1654 F/P 0121 515 1654 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) Ms Vinette Campbell Ms Vinette Campbell Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. 5 adults, under 65, with learning difficulties (5 LD) Showers must be replaced with either Mira Advance or Triton Millennium showers, which do not reach a higher temperature than 43 degrees C, on or before 31 March 2004 Window restrictors must be fitted to all first floor windows on or before 28 February 2004. All bedroom doors must be fitted with a master key system on or before 31 March 2004 A full fire alarm system conforming to BS5839; Part 1, 2002, to L1 standard is fitted on or before 31 March 2004. That other matters arising from the Fire Officer’s report dated 22 December 2003 are met as stated in the action plan submitted to the NCSC on or before 29 February 2004 The star lock on the door of the first floor bedroom must be removed and the door must comply with fire safety standards prior to a service user moving into the room. A satisfactory report is received from Environmental Health and any outstanding matters will be met within the agreed timescales. 1st December 2005 Date of last inspection Brief Description of the Service: Petersfield Care Home is situated in Handsworth close to Perry Barr shopping centre. The home offers care to five adults with a learning disability. There are currently five people living in the home. The home is well situated for access to local shops, pubs, places of worship and transport links to Birmingham city centre. Members of the owners family staff the home. There is no off road parking. There is one bedroom with an en-suite facility on the ground floor. Other bedrooms are provided on the first floor of the property and comprise of two single and one shared room. The home has a large open plan lounge and dining room and a very spacious kitchen/dining area which is also used for socialising. The home has an enclosed well laid out rear garden. The furniture and fittings are of a high standard. Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector on one day from 2 – 8 pm. A pre-inspection questionnaire had been completed and returned to the Commission prior to the inspection and forms part of the information in this report. Feedback forms had not been given to residents or visitors. There was an inspection of the whole of the communal areas and two bedrooms were seen. Documents relating to the inspection process were inspection including: care plans, risk assessments, staff files and rota, statement of purpose, medication records etc. The home provides a service to 5 residents. All were seen and spoken to together an separately during the inspection. All were keen to make a positive contribution to the inspection process. Four residents are over 52 years of age. All have been resident for periods of between 2 and 10 years. They all have a mild learning disability and are of low-dependency. One has no speech, understands all that is said to him and quite able in non-verbal communication to indicate his responses to questions. All four members of staff were seen, including a care worker employed at Petersfield over the past 8 months. Fees chargeable by the home are in the range of £317 - £679.47 per week. At the time of the last inspection 25 requirements were made relating to areas of improvement required in the following: Care plans, risk assessments and recording of health care issues. Staffing and staff training issues and some environmental matters including some relating to fire safety. Progress has been made in many of these areas, with some requiring more work. Six are further requirements of this report having been either not met or partially met. The Managers are keen to comply with requirements and have spent significant sums of money in “buying in” packages such as new care planning format, quality assurance recording system and policies and procedures. What the service does well: There is a good standard physical environment presenting a comfortable homely feel to the home. It is furnished along domestic lines and is well appointed with quality furniture and fittings and is well maintained. The daily living routines and relationships between residents and staff provide a large family unit, residents able to express their views in a free and open way. The Manager and staff “live” with the residents and provide a protective family experience which residents seem comfortable with. This may not be the Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 6 preferred type of service for other people but current residents seem to benefit from the experience. There is a safe and well documented medication system in place. There is undoubtedly a high level of staff commitment to resident care. What has improved since the last inspection? What they could do better: Moving & Handling assessments should be carried out for all residents. Improvements in the recording of health care issues and interventions with outcomes are required and future appointments recorded and monitored. The continued development of care plans should continue. Skills to promote the social skills and dignity of residents should be put into place for 2 residents. A risk assessment must be provided for residents using the cooker. Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 7 The Adult protection policy requires additional details to be added. Staff training is required in First Aid and Fire Safety. The person managing the home should submit an application to the Commission for registration. Fire drills must be carried out regularly and include staff and residents. COSHH data sheets must be completed for all items used. New staff should only be employed following satisfactory POVA or CRB checks. 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. Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 The quality of this outcome is good. This judgement is made using available evidence and a visit to the service. There is sufficient information available to make a choice about the home. EVIDENCE: There is a statement of purpose and service users guide in the home available for prospective residents and visitors. The documents have both recently been updated and provide all the necessary information to make and informed choice about the home. There are 5 residents the last was admitted 2 years ago. Appropriate introductions and assessments would be carried out in the event of there becoming a vacancy in the home. Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6-9 The quality of this outcome is adequate. This judgement is made using available evidence and a visit to the service. Progress has been made in the quality of care plans further work needs to be done. Risk assessment recording has improved but further work also required. Decision making in daily life could be extended further. EVIDENCE: Requirements were made in the last report to extend the information in care plans, to describe how assessed needs can be met and must be reviewed on a regular basis. Some terminology in care plans was vague and indeterminate and could be improved particularly in risk assessments. Some progress has been made in this area. In an effort to address the requirements made, the home have purchased a new care planning format (Karkex system) which is expensive but gives an easily identifiable summary of residents needs and how they can be met. The existing system provided some more detailed information in relation to aspects of social and health care needs. Together the two system can synchronise . One providing an overall view of identified need, the other more detailed information about history, health care and daily living needs. The Manager was reassured about the Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 11 validity of the information contained in the documents with together with regular reviews will monitor whether needs are being met. There is still some way to go in this area but progress has been made and needs to continue. Daily notes were not recorded for residents previously. Since the last inspection this has been done and further advice was given about how to extend that information and to record the daily activities that residents are engaged in. New risk assessments have been carried out and are part of the new care planning format. There has been some improvement in the quality of risk assessments and identifying control measure which can be put into place to reduce risk. A sample of care plans and risk assessments were seen to review the changes made. Risk assessments relating to moving & handling required in the last report have not been done. The reason being that there are no apparent moving & handling requirements for residents as personal care is not given directly by staff. It is necessary to objectively review the moving & handling risks in relation to residents and to state there are no risks, if that is the case. A requirement was made at the last inspection to provide risk assessments for two residents who go out alone to the local shops. This is done without crossing roads but other risks are inherent. This has been done with only minor omissions which the Manager will add. Discussions with a resident revealed that she does prepare snacks and drinks and sometimes uses the cooker with supervision. There was no risk assessment in place relating to her use of the cooker and this is required. A requirement to sign date and review care plans made at the time of the last inspection has been carried out. All care records seen were signed and dated by staff and also signed by residents. Review dates are fixed every 6 months. One resident is able to read care plans with some assistance. In relation to the 4 other residents, the care plan is read and explained to them and they then sign to confirm agreement and understanding. There was evidence of residents making decisions. A resident previously attending college courses over a long period of time had reduced gradually from 5 days to 1 day. She ultimately decided she did not wish to attend. The issue was not pressed and the Manager stated “shoe does not have to go if she does not want to”. Arrangements are made at this time to provide activity and occupation both inside and outside the home for her. There are no staffing implications for these changes. On the day of inspection the resident was out Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 12 shopping with the Manager and Deputy. When she returned she related many times where they had been for lunch, what they had bought, who they met etc. She was clearly relaxed and enjoying life. The question of further attendance at college will to re-discussed with her in future but staff are adamant she will not be pressurised. Residents were seen to be consulted and making decisions about food choices, whether they preferred to watch TV in the lounge or spend time in their bedrooms, whether to have a bath or just relax. Everyday choices were being made. Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11 - 17 The quality of this outcome is adequate This judgement is made using available evidence and a visit to the service. Opportunities for personal development could be further developed. Daily routines are flexible. There are few family links and whilst there are many external visits - links are not formed with community groups or friendships with peers outside the home. There is a very strong protective family identity in the home. EVIDENCE: There are 5 residents in the mainly older age range – 4 residents are over 52 years. Two attend a day-centre 5 days each week one attends college on 4 days another regularly attends a drop-in centre usually once per week. One previously attended a day centre 5 days which has diminished and now refuses to go at all. She has attended for 10 years whilst living at Petersfield. At the start this unannounced inspection (2pm) one resident was at home and was seen making a sandwich and tea for herself and later had a long 2 hour bath she enjoys on alternate days. She has her own en-suite bathroom and proudly displayed her range of bath oils. She had declined an offer to go out. Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 14 One member of staff was on duty in the home The Manager and Deputy had taken another resident shopping and out for lunch. The 3 other residents were at college/day centres. All arrived home around 4 pm and spoke openly about “work” (day services) relating the events of the day to staff and each other. The resident returning with Manager and Deputy related in detail several times going shopping, buying new plates and visiting a café where she is known and given special cake and tea. The picture resembled a normal large family group returning home, talking about the days experience then proceeding to prepare for the main hot meal of the day, residents input comprising only table laying but not involved in cooking. The “family” then enjoyed the evening meal together before all gathering in the large lounge area with widescreen TV deciding which programmes to watch. The Manager had prepared the evening meal then sat with the residents enjoying the TV. The inspection was carried out with the Deputy Manager until 8pm. These events clearly typified a day in the life of residents of this home. There was an open dialogue with excellent engagement between residents and staff. Many natural expressions of affection on both sides being demonstrated throughout the evening. It was initially a little alarming to hear all residents referring to the Manager as “mum”. It became clear that this was a well established practice and residents later spoke about “my real mum” (generally deceased). In the context described above and with the later explanation the term became less concerning. Transport is readily available to residents. The Manager who lives on-site has 5-seater vehicle, the Deputy has a 7-seater car. Both are available together or separately for residents use and there is no charge whatsoever for residents. Residents talked about trips out in the car re-enforcing the regular use of those vehicles. Resident may sometimes pay for taxis, sharing the cost if this, usually to supplement a car for an external visit. Residents spoke about visiting Pizza Hut, McDonalds, local pub for meals or having a take-away as they chose. Generally all residents go out together for meals etc. They go to cinema and shopping on a regular basis. The group go on holiday together relating that they had been to Spain, Disneyland Florida, Butlins etc. Last year all residents and 3 staff (Manager and her 3 daughters who both work in the home) went on all-inclusive holiday to Jamaica for 2 weeks, residents spoke about the air travel and wonderful food readily available over 24 hours. Two residents had not flown before and related how they enjoyed the experience. Next years plans are being talked about – maybe Tobago. Two requirements were made in the last report under these outcomes: To consult residents about activities and offer opportunities to prepare their own food subject to risk assessment. There was evidence of residents being consulted and making some choices about activities. Preparation of food is an area which can be further developed. Some residents seen and said that they Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 15 prepared some drinks and food. One resident uses the cooker with supervision and a requirement made in this report to provide a risk assessment. There was no evidence of residents being involved in the cooking of the evening meal. They did assist with table preparation and two were seen preparing sandwiches/drinks earlier. A resident said she had “been to work and taken sandwiches she had made” Two residents were seen eating their evening dinner with spoons, one eating a pork chop with her fingers. Staff said this was their established practice and they would not use knives/forks. A requirement is made to make progress in this area, in the interests of social skills and dignity (residents go to restaurants, cafes and hotels to eat). There was evidence of flexibility of routines. Residents said they got up at particular times when going to work but did not at weekends etc. One resident said she watched films (DVD’s) in her bedroom until 1 am. Another spends time in her room listening to music. – All rooms have TV, DVD, music facilities. All clearly enjoy without any pressure sitting together in the comfortable lounge watching programmes of their choice. Staff sitting with them. There are a range of the usual indoor activities provided for those not attending day centres and for all during weekends. It was concerning to learn that only one of the 5 residents has relatives/visitors. Two have had visitors but not in the last 12 months. There are therefore no representatives to consider the interests of residents apart from staff. At the time of the last inspection there was concern that only 3 staff were working in the home and all from the same family. This has changed, two new staff appointed, although one has since left. There is at least another dimension. Advocates were discussed and have apparently been used in the past but not currently involved. One resident does not have speech but demonstrably able to express his views. Staff would refer any matters of concern or major decision making to the Advocacy service. Four residents go to day centres and have allocated key workers there (there are reviews also) and it was clear that residents speak to day centre staff about relationships there. Sexual needs were discussed and although some residents have relationships in day service centres, no friends same or opposite sex visit the home. The inspector was assured that all friends would be welcomed and residents are encouraged to ask their friends to visit. All residents have bank accounts and have benefits etc. paid direct into accounts. They have standing orders to Social Services for care payments. Three residents visit the bank weekly, take passports as evidence of ID draw money and use it as they wish. No monies are held on behalf of residents who have a lockable facility in the bedroom for cash. Two residents go to the cashpoint or bank and need some assistance from staff in drawing money. All retain their own bank books and have knowledge of monetary denominations and some very aware/astute about the cost of items. Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 - 21 The quality of this outcome area is adequate. This judgement is made using available evidence and a visit to the service. Identification and recording of health care needs and interventions must be improved. There is a safe system of medication administration in the home. EVIDENCE: Residents do not require direct personal care support from staff. There are no needs arising from any physical disability. Some residents need oversight and some supervision only relating to personal hygiene. Moving & handling needs are not required, but risk assessments should be carried out and recorded in support of this. Care plans did not clearly state the health care needs of residents, interventions of health professionals with recorded outcomes. This was a requirement of the last inspection report. Some records were not completed. It was clear that a system for such recording was not in place on this visit. Discussion revealed that annual health checks and reviews of medication had taken place, that residents had been referred for cervical/breast screening checks but these had not been recorded. A further outpatient appointment relating to a resident was seen only in letter- form from the hospital but not recorded in notes for the future providing a means of easy identification and monitoring Weighing of residents is spasmodic, one had been weighed only Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 17 once this year. It is important to compile a health care record for each resident with diagnosed conditions, interventions by health care professionals with outcomes and identification of future appointments to monitor health care needs. This is a requirement of this report. Medication is supplied by Boots Chemists in MDS form (blister packs). The system was inspected and all required records had been adequately and accurately completed. Training has been undertaken with Boots Chemists by all staff administering medication. It was stated (but not recorded) that regular reviews are carried out with the GP/at surgery for medication. Two residents have medication to control epilepsy. There have been no seizures in recent years. A risk assessment has been provided (requirement of the last report) for a resident using inhalers. She was seen with inhalers in her bedroom and had clear understanding about their appropriate use. Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 - 23 The quality of this outcome area is adequate. This judgement is made using available evidence and a visit to the service. Amendment to the complaints procedure is required and also an amendment to the Adult Protection policy. In the absence of visitors there are limitations on protecting residents interests. EVIDENCE: At the time of the last inspection there were concerns that residents would have to make complaints to staff members who were all from the same family. This has been changed with the appointment of 2 new staff, although one has recently left. This does add an additional safeguard. A requirement to include details of the role of CSCI in the complaints procedure was made in the last report. This has not been done and is repeated in this report. The complaints procedure is available in the home and included in the Service Users Guide. Some residents can read this with assistance, others cannot and staff state they read and explain the procedure to those residents. There is only one relative/visitor who would have access to this. There are no other visitors to the home and the concerns are that advocacy for residents in this area is limited. Attendance at day centres does provide an alternative opportunity for making complaints. No complaints have been received by the home or the Commission since the last inspection. Two residents said that if they were unhappy they would talk to staff or someone at “work”. There is a policy/procedure relating to Adult abuse. A requirement to add contact details for CSCI and Social Services has not been added and repeated Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 19 as a further requirement in this report. A copy of the local Vulnerable Adults procedure was posted in the office area of the home. Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 – 30 The quality of this outcome area is good This judgement is made using available evidence and a visit to the service. Service users live in a homely, comfortable, safe environment. Bedrooms are spacious comfortable, well equipped and personalised. Standards of hygiene are high throughout the home. EVIDENCE: This large Victorian terraced house provides spacious accommodation for the 5 residents and Proprietor/Manager who lives there too. There is an exceptionally large lounge/dining room, separate large kitchen with dining facilities for 6. There is a also a laundry, toilet and office area on the ground floor. There are two single and two shared bedrooms on the first floor, bathroom, toilet and Proprietors accommodation. All areas are well decorated and maintained. There is high quality furniture, fittings and décor throughout the home. Standards of hygiene are similarly high. Two residents showed their bedrooms to the inspector with some pride. The single en-suite bedroom on the ground floor was very spacious, exceptionally Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 21 well fitted with integral wardrobes housing many clothes and there was a double bed and quite adequate space for access. The room was well personalised reflecting the individuality of the resident. The other bedroom seen on the first floor was a shared bedroom. The resident showing this bedroom stated that she liked her room and person she shared with. They were “good friends” and “got on well together” She was more that happy to share and when asked if she would prefer to a single room, she said that she “would prefer sharing a room with someone”. These questions were asked as a check upon a requirement of the last report to ensure that resident should be included in ongoing discussion about their satisfaction about sharing a room. The room was spacious, had privacy curtain – the reason known to and understood by the residents, but little used. Both bedrooms contained TV/DVD/CD etc. The shared room had duplicates of all. Personalisation was excellent. Residents said that they cleaned their bedrooms, changed bedding, took clothing to the laundry etc. There is a small garden to the rear which is pleasant and safe and has adequate seating. Relationships with neighbours are cordial. House of owner of local shop directly faces rear garden, knows residents and he and others in the vicinity reported to “look out” for residents when they are in the community. Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 – 35 The quality of this outcome area is adequate. This judgement is made using available evidence and a visit to the service. Staff have the competencies and skills required to support residents. Staff recruitment procedures must be strengthened and staff training is required in two areas of statutory training. EVIDENCE: Two new staff have been appointed since the last inspection. This dilutes the former family-only staffing of the home. A new member of staff was seen who has worked 35 hours per week for the past 8 months. She has no qualifications but is hoping to commence NVQ training soon. This was confirmed by the Deputy Manager who said the timeoff and fees would be borne by the home. Staffing records relating to this person were seen. Application, references and proof if identity had been obtained and copied, including passport. However it was noted that a CRB had not been obtained until several months after the appointment. A requirement is made that new staff must only commence duties when either a POVA or CRB check has been obtained. Training needs identified in the last report were subject to requirements. Some training has been done but still outstanding is First Aid training which Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 23 the Manager was advised cannot be provided by means of video/questionnaire and Fire Training which has, in fact been arranged for 5/12/06. The staffing rota was seen and identified as Week 1 and Week 2. The Manager was advised that weekly rota’s must be compiled to reflect the actual staff members and number of hours worked. These records are required to be kept for 3 years. The rota identified that 120 staffing hours were provided each week. Additionally the family (Provider and her 2 daughters) have a continued presence in the home. The family who own and run the home see the residents as part of their family group and operate and engage as a family unit. The staffing arrangements appeared adequate for the dependency levels of the current resident group. Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 - 42 The quality of this outcome area is adequate This judgement is made using available evidence and a visit to the service. Management responsibility for the home must be clarified to the Commission. There is an open and inclusive atmosphere in the home. A quality assurance system is being applied. Record keeping to protect residents requires action in care planning information and recruitment procedures for staff. Statutory training for staff must be completed. Fire drills must be arranged regularly for staff and residents. EVIDENCE: This home is operated by a family with the recent employment of non-family member. The home is run along family lines and resembles a large family domestic environment. Very positive support is given to all residents who seem confident and comfortable as part of the family group. The Registered Manager (also Proprietor) has relinquished the majority of her role to her daughter who is the Deputy Manager. She has stated her intention Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 25 of making application for registration as the person managing the home. This has not been done but is now required. The Deputy Manager has recently completed the Registered Managers Award, in fact her sister, also working in the home has also completed the RMA. The home has been open for the past 10 years and operated successfully by the family members, providing a service to people with learning disabilities. There were 7 requirements made at the time of the last inspection relating to these outcomes: Loose rugs on tiled floors secured. Fire doors must not be wedged open. Emergency lighting tested monthly. Develop fire risk assessment for safe placement of residents. Fire drill to include service users and records maintained. Date sheets completed for COSHH products use. The first five requirements have been addressed. The last two have not. Magnetic self-closing devices have been fitted to 3 doors in the lounge area. Fire records showed that the last fire drill was January 2006 and did not include residents. A requirement is made to provide regular fire drills which are recorded to include the names of residents and staff involved in the drills. A further requirement is made to provide data sheets for all COSHH items used. There has been regular testing of the fire alarm system and emergency lighting system as required. Training for all staff is required in First Aid to ensure that a trained person is on duty at all times. Fire safety training is required for all and a date fixed for 5/12/06. A quality assurance system is not operational at this point, but the manager has purchased a Quality Assurance system (£300) which has commenced and will ultimately provide information covering: Resident satisfaction feedback, fabric and building, medication, employment audit check etc. An annual Health & Safety audit check has already been done. This is an indication of the Managers determination to meet QA standards. Moving & Handling risk assessments will be carried out for all residents. Policies and procedures are in place as required – again the Manager has purchased these to ensure that all required policies are in place and are comprehensive. Radiator guards are fitted in all areas. Regular hot water outlet temperatures are reported to be checked weekly (not seen). Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 26 No notifications have been received by the Commission under Regulation 37 – There have been no accidents or incidents in the home since the last inspection. Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 2 x LIFESTYLES Standard No Score 11 2 12 2 13 2 14 3 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 2 3 3 3 2 2 x Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 28 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 YA9 Regulation 13(5) Requirement Timescale for action 30/11/06 2 YA19 3 YA23 4 YA35 Moving & Handling risk assessments must be in place for all residents. Previous requirement not met. 12(1)(a) Chronological recording of health care interventions with outcomes and future appointments must be recorded to monitor health needs. Previous requirement not met. 13(6) The Adult Protection policy must include details of CSCI and Social Services. Previous requirement not met. 18(1)(a)(c) Staff training must be provide in (i) First Aid and Fire Safety. Previous requirement not met. 8 (1) (2) The person managing the home must submit application for registration to CSCI. Previous timescale not met. Fire drills must be conducted regularly and include named staff and residents. Previous timescale not met. Data sheets must be completed for each COSHH product used within the home. DS0000017053.V313399.R01.S.doc 30/11/06 30/11/06 31/12/06 5 YA37 31/01/07 6 YA42 23(4)(e) 30/11/06 7 YA42 13(4)(C ) 30/11/06 Petersfield Care Home Version 5.2 Page 29 8 YA6 15(1) 9 YA11 12(1)(4) Continue to develop care plans to incorporate all information to record how residents needs in respect of health and welfare can be met. Changes in need must be reflected in plans. Promote social skills and dignity of residents by the use of appropriate cutlery. Complete risk assessment for resident using cooker. New staff must only be employed following satisfactory POVA or CRB checks. A copy of the weekly duty rota must be kept in the home and retained for 3 years. 30/11/06 30/11/06 10 11 12 YA9 YA34 YA41 13(4) 19(1) Sched 2 17(2) Sched 4 14/11/06 30/11/06 14/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Petersfield Care Home DS0000017053.V313399.R01.S.doc Version 5.2 Page 30 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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