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Inspection on 06/02/08 for Petersfield Care Home

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

This inspection was carried out on 6th February 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 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

What has improved since the last inspection?

There have been improvements to the records required by regulation for the protection of residents. For example new care planning systems have been introduced, health care records are improving and activity records now give an insight into the quality of life residents receive. The home has been using a consultancy service to help in these areas for which it should be commended. Work should continue in these areas.Since the last inspection the acting manager has held a residents meeting (the first at the home) as another way of supporting residents to make choices. She explained to us that she is going to undertake these every couple of months. The homely remedy policy has been agreed with the general practitioner (meeting a previous requirement), as is good practice. The home has also obtained the CSCI guidance `Medication training for care staff` and `Administration of Medication in Care Homes` from its website to ensure the practices and systems within the home meet current good practices guidelines. Staff had recently attended adult abuse, moving and handling and first aid training in order to extend their knowledge.

What the care home could do better:

All of the residents manage their own finances with assistance. Although information regarding this was found to be in place in residents` records none contained sufficient detail. As we explained to the acting manager, care plans and risk assessments must contain sufficient information to protect people from harm. No training has been provided to any staff in relation to the specific needs of people with learning difficulties. This was identified at the previous inspection but no action has yet been taken to address it. A family member is named on staffing rotas as `bank`. Discussions with the acting manager and examination of rotas indicate that this person has not undertaken shifts at the home for a considerable time. This person does nothold any qualifications and their recruitment records do not comply with legislation. As we explained to the acting manager a decision must be made either to ensure this person is suitably qualified and has all the required recruitment records maintained in the home, or the home must cease employing them in any capacity. We informed the acting manager that another visit to the home would be undertaken shortly to assess if action has been taken with regards to this person. If at this point recruitment and training records do not demonstrate sufficient protection further action may be considered by the CSCI. Although improvements have been made with care planning and risk assessment and health care records, further work is needed to ensure residents needs can be met and monitored. We informed the acting manager that another visit to the home would be undertaken shortly to assess if the additional information has been put into place. If at this point documentation does not demonstrate residents` needs are being identified, managed and met further action may be considered by the CSCI. A full list of actions needed by the home is contained at the back of this report.

CARE HOME ADULTS 18-65 Petersfield Care Home 60 St Peters Road Handsworth Birmingham West Midlands B20 3RP Lead Inspector Lesley Webb Key Unannounced Inspection 6th February 2008 09:00 Petersfield Care Home DS0000017053.V355819.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.V355819.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.V355819.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.V355819.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 5 adults, under 65, with learning difficulties (5 LD) Date of last inspection 6th August 2007 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.V355819.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1star. This means the people who use this service experience adequate quality outcomes. One inspector undertook this visit over one day with the home being given no prior notice. During the visit time was spent talking to residents, staff, examining records and observing practices and interactions between people before giving feedback to the acting manager. The people who live at this home have a variety of needs. This was taken into consideration by the inspector when looking at the records of two individuals. For example the people chosen have differing communication and care needs, and were of different gender. Four residents’ surveys were completed and returned to the Commission for Social Care Inspection (CSCI). Information from these and from documentation supplied by the home prior to the inspection was also used when forming judgements on standards of service provided. Information about fees charged for living at the home was not available during the inspection. Interested parties should contact the provider directly for this information. The inspector was shown full assistance during the visit and would like to thank everyone for making her welcome. What the service does well: Observations made during the inspection indicate residents are happy with the activities they are supported to undertake. For example on arrival at the home two residents were waiting for transport to arrive to take them to a local daycentre (which they call work), both appearing eager and confirming their enjoyment at this venue. Staff were observed encouraging residents to make choices about day-to-day matters, such as what to wear, and what they wanted to do on that day. As one resident explained to us, “I’m going to go shopping for a new coat, X is going to help me, she took me the hairdressers last week, I had my hair cut but not washed, I like to do that at home”. As at previous inspections the atmosphere and routines seen within the home reflect a normal large family group. The home is owned, managed and staffed by a family (apart from one person who is not related), with the owner living on the premises. This has created a family environment with residents forming part of the family circle. Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 6 This large Victorian terraced house provides spacious accommodation for residents. All areas are well decorated and maintained. There is high quality furniture, fittings and décor throughout the home. What has improved since the last inspection? There have been improvements to the records required by regulation for the protection of residents. For example new care planning systems have been introduced, health care records are improving and activity records now give an insight into the quality of life residents receive. The home has been using a consultancy service to help in these areas for which it should be commended. Work should continue in these areas. Since the last inspection the acting manager has held a residents meeting (the first at the home) as another way of supporting residents to make choices. She explained to us that she is going to undertake these every couple of months. The homely remedy policy has been agreed with the general practitioner (meeting a previous requirement), as is good practice. The home has also obtained the CSCI guidance ‘Medication training for care staff’ and ‘Administration of Medication in Care Homes’ from its website to ensure the practices and systems within the home meet current good practices guidelines. Staff had recently attended adult abuse, moving and handling and first aid training in order to extend their knowledge. What they could do better: All of the residents manage their own finances with assistance. Although information regarding this was found to be in place in residents’ records none contained sufficient detail. As we explained to the acting manager, care plans and risk assessments must contain sufficient information to protect people from harm. No training has been provided to any staff in relation to the specific needs of people with learning difficulties. This was identified at the previous inspection but no action has yet been taken to address it. A family member is named on staffing rotas as ‘bank’. Discussions with the acting manager and examination of rotas indicate that this person has not undertaken shifts at the home for a considerable time. This person does not Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 7 hold any qualifications and their recruitment records do not comply with legislation. As we explained to the acting manager a decision must be made either to ensure this person is suitably qualified and has all the required recruitment records maintained in the home, or the home must cease employing them in any capacity. We informed the acting manager that another visit to the home would be undertaken shortly to assess if action has been taken with regards to this person. If at this point recruitment and training records do not demonstrate sufficient protection further action may be considered by the CSCI. Although improvements have been made with care planning and risk assessment and health care records, further work is needed to ensure residents needs can be met and monitored. We informed the acting manager that another visit to the home would be undertaken shortly to assess if the additional information has been put into place. If at this point documentation does not demonstrate residents’ needs are being identified, managed and met further action may be considered by the CSCI. A full list of actions needed by the home is contained at the back of this report. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Petersfield Care Home DS0000017053.V355819.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.V355819.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally people who may choose to live at this home and their representatives have the information needed to decide if it will meet their needs. EVIDENCE: The home has a Statement of Purpose and Service User Guide as sources of information about services provided by the home. We found both of these to contain out of date information. The acting manager explained that there are other versions of these documents but was unable to locate them. We advised that up to date information should be available at all times in order to inform and advise people. As at the previous inspection there have been no new admissions to the home. We examined the homes admission policy in order to assess if actions would ensure prospective residents needs would be fully understood. The policy states that a comprehensive assessment, history and care plan will be put in place before offering a place to new residents (as is good practice). It also states that introductory visits will consist of visits‘ perhaps for tea or maybe the whole day’. We advised the acting manager that this should be reviewed to cover all aspects of Standard 4 of the National Minimum Standards for Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 10 Younger Adults in order that people have greater opportunities to sample services provided by the home before deciding on its suitability. All four of the people living at the home completed questionnaires that were returned to the Commission for Social Care Inspection (CSCI) prior to us visiting the home. All confirm they were asked if they wanted to move into the home and that they received enough information about the home before they moved in so that they could decide if it was the right place for them. A questionnaire was also received from a day centre that two of the residents attend. This states that in their opinion the home ‘always’ meets the needs of residents. Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. 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 planning is improving, offering greater assurances to residents that their needs will be met by the home. People are supported to take control of their lives and to make their own decisions and choices. EVIDENCE: Since the last inspection new care planning documentation has started to be implemented and if completed in full should meet requirements made at the previous inspection. The new documentation includes an assessment of needs, information regarding outside agencies and professionals involved in the care of individuals, a personal profile for physical and mental abilities, health and hygiene, relationships, eating, physical health and improving quality of life. The acting manager demonstrated a commitment to ensuring the new care planning systems are fully operational, agreeing that these would be given priority. We informed the acting manager that another visit to the home would be undertaken shortly to assess if the additional information has Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 12 been put into place. If at this point care planning documentation does not demonstrate residents’ needs are being identified, managed and met further action may be considered by the CSCI. Since the last inspection two of the four residents have been formally reassessed by the funding authority to ensure they are living in an environment most suitable to meet their needs. A recommendation that staff receive further guidance in the compilation of daily records in order that they reflect individual residents choices, wellbeing and care is now met. We were informed that staff are due to receive training from an external provider regarding care planning and that a new format for recording has been implemented. We found the new format allows staff to record residents health, behaviour, meals, activities and visitors but that the majority of records are completed by a member of staff who is on duty from 10am to 2pm resulting in evening meals and activities after this time not being recorded. We also noted that daily records are not completed when the above member of staff has a day off. Action should be taken to ensure records are completed on a daily basis by all staff on duty to ensure they reflect the care and support residents have received. Evidence gained through discussions with residents, indirect observation of care practices and discussions with staff confirms that in the main residents are supported to make decisions and encouraged to participate in making choices relating to the home and the support they receive. As at previous inspections members of staff were observed encouraging residents to make choices about day-to-day matters, such as what to wear, and what they wanted to do on that day. As one resident explained to us, “I’m going to go shopping for a new coat, X is going to help me, she took me the hairdressers last week, I had my hair cut but not washed, I like to do that at home”. Since the last inspection the acting manager has held a residents meeting (the first at the home) as another way of supporting residents to make choices. She explained to us that she is going to undertake these every couple of months so that residents will become familiar with the process and use them to voice opinions. The new care planning systems also include assessment of risk. These include assessments for nutrition, moving and handling and medication. As with care plans we found that these have not been completed in full but once fully operational should ensure risks to residents are reduced whilst not restricting activities. Petersfield Care Home DS0000017053.V355819.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. 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. Residents are able to make choices about their life style. Social, educational and recreational activities meet individuals’ expectations. EVIDENCE: Work has been undertaken to improve records of activities that residents participate in, with the home now able to evidence residents have a choice of activities to suit their individual needs and tastes. For example one residents records detail attendance as venues such as a local daycentre, visits to a shopping centre, meals at a public house and visits to a local club. Another residents detail outings on a one to one basis, visits to the hairdresser, shopping and meals out. Both residents’ records also detail in-house activities such as playing cards, watching films and undertaking life skills such as cleaning bedrooms and helping to prepare meals. It was also pleasing to find that records also include evidence of a resident joining in first aid training that staff were undertaking, supporting the individuals understanding of action to Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 14 be taken in the event of an accident. Observations made during the inspection indicate residents are happy with the activities they are supported to undertake. For example on arrival at the home two residents were waiting for transport to arrive to take them to a local daycentre (which they call work), both appearing eager and confirming their enjoyment at this venue. Another resident brought some knitting for us to look at explaining that staff help her to do this. She informed us she was knitting a scarf for another person also living at the home. As at previous inspections the atmosphere and routines seen within the home reflect a normal large family group. The home is owned, managed and staffed by a family (apart from one person who is not related), with the owner living on the premises. This has created a family environment with residents forming part of the family circle. Residents call the owner ‘mum’ and other staff ‘aunt’. Concern has been raised in previous inspections regarding this, however residents are able to distinguish between staff paid to support them and biological relatives, reducing concerns about this practice. As the acting manager explained residents are involved in all aspects of family life for example attending weddings and going on holidays, with those who have little contact with their own families appearing to value the inclusion in to the owners family. Efforts are made to ensure daily routines are flexible. For example, residents were seen to get up at a time of their choosing and chose when to go to their own rooms for some privacy. There is unrestricted access to all communal areas. Residents were seen to be at ease in their own surroundings and were also able to wander in and out of the conservatory (office space), sitting down and chatting to staff at will. The acting manager informed us that every effort is made to ensure routines are flexible, for example if a resident does not want to attend ‘work’ they do not have to, explaining, “if they don’t want to they shouldn’t be forced, they have the same rights as you or me”. Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 15 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. Improvements to health monitoring offer greater protection to residents. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Residents require minimal support with personal care. Staff were observed during the visit offering support and advice that promoted individuals dignity. For example one resident was encouraged to wash their face before going out of the home and another reminded to brush their teeth. Residents were seen to be dressed appropriately for the weather and choices of clothing appeared to reflect their personal tastes. One resident currently requires greater assistance with personal care due to an accident they incurred earlier in the year. The home have arranged for additional equipment to be provided, such as a hospital bed that can have its height altered, in order that the resident can maintain as much independence as possible. When the resident was discharged from hospital they had an area of broken down skin tissue, which improved due to the care and attention given by the home. Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 16 A requirement made at the previous inspection to ensure chronological recording of health care interventions with outcomes and future appointments has now become a recommendation due to work undertaken to address this. As already mentioned in this report new care planning systems have been introduced that once fully operational should ensure effective monitoring takes place. The new documentation includes recording sheets for appointments with general practitioners; district nurses, dentists, chiropodists and opticians, along with review form that link to care plans and associated documentation. Improvements to the management of medication have taken place, offering protection to people living at the home. For example the drugs cupboard was seen to be clean and tidy and records are in place for medication entering, being administered and leaving the home. Since the last inspection the homely remedy policy has been agreed with the general practitioner (meeting a previous requirement), as is good practice. The home has also obtained the CSCI guidance ‘Medication training for care staff’ and ‘Administration of Medication in Care Homes’ from its website to ensure the practices and systems within the home meet current good practices guidelines. It is recommended that competency assessments be undertaken to ensure staffs’ practices are monitored and reflect good practice. Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 17 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. Generally residents are able to express their concerns, are protected from abuse and have their rights protected. EVIDENCE: There have been no formal complaints made at the home. As already mentioned earlier in this report the acting manager has carried out a residents meeting (the first of its kind), where residents were asked if they had any concerns. As the acting manager explained she is hoping this venue will encourage residents to raise issues informally, and offer assurances that views are listened to and acted upon. The next meeting is arranged for March 2008. All questionnaires completed by residents state they are aware of the homes complaints procedure and that they know whom to approach to raise concerns. The home has safeguarding policies and procedures in place to offer protection to residents and staff have recently attended adult abuse training, with certificates in place. All of the residents manage their own finances with assistance. All residents have bank accounts and have benefits etc. paid direct into accounts. They have standing orders to Social Services for care payments. 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 by the home. Some residents go to the cash point or bank and need some assistance from staff in drawing Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 18 money. All retain their own bankbooks and have some knowledge of monetary denominations. Although information regarding this was found to be in place in residents’ records none contained sufficient detail. As we explained to the acting manager, care plans and risk assessments must contain sufficient information to protect people from harm. Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 19 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a comfortable and well-maintained environment that encourages independence. EVIDENCE: This large Victorian terraced house provides spacious accommodation for up to 5 residents and Proprietor who lives there too. There is an exceptionally large lounge/dining room, separate large kitchen with dining facilities for 6. There is also a laundry, toilet and office area on the ground floor. There are two single and a shared bedroom 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. All questionnaires completed by residents and returned to the CSCI state ‘the home is always fresh and clean’. The Environmental Health Department carried out an inspection of the premises in 2005 stating that it will carry out future Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 20 assessments via computer due to the low risks posed as no issues have been identified. A tour of the premises was undertaken including the viewing of residents’ bedrooms with their consent. As at previous inspections residents indicated that they liked their bedrooms and could choose their own décor. They were individualised with personal possessions, photographs, televisions and stereo equipment. The single en-suite bedroom on the ground floor was very spacious, exceptionally well fitted with integral wardrobes. All parts of the home were seen to be clean and hygienic. There is a small domestic laundry. It was observed during the day that residents access this area and help with the laundering of their own clothes. Since the last inspection the home has obtained updated guidance ‘Infection Control Guidance in Care Homes’. It is recommended that staff read the contents of this (and sign to say they have done so) to ensure systems for the management of infection protect residents. Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 21 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 and 35. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Relationships between residents and staff are good. Further training for staff will ensure appropriately qualified staff support residents. Shortfalls in recruitments procedures have the potential to place residents at risk. EVIDENCE: There are four people including the registered proprietor who care and support the residents living at this home, three of whom are members of the proprietor’s family. All have been involved in supporting residents for a number of years. During discussions with staff they demonstrated knowledge regarding residents’ likes and dislikes and their preferred routines, as observed during the visit. As at the previous inspection all of the questionnaires completed by residents and returned to the CSCI state staff ‘always’ treat them well. Of the four people employed at the home one holds a National Vocational Qualification (NVQ) at levels 2 and 3 and one is in the process of completing level 2. Another member of staff holds the Registered Managers Award (RMA). Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 22 We explained that this person should also undertake a NVQ in care as the RMA is a management qualification and does not cover care elements. The proprietor does not hold any formal qualifications however she has many years experience as a proprietor who has played a direct role in the care and support residents receive. No training has been provided to any staff in relation to the specific needs of people with learning difficulties. This was identified at the previous inspection but no action has yet been taken to address it. It is strongly recommended that training in relation to learning disabilities such as Learning Disability Qualification (LDQ) accredited training be provided to ensure staff have the required knowledge to meet residents needs. The staffing rota shows that there is one person on shift between the hours of 8am to 9pm Monday to Friday and 9am to 9pm of a weekend. On some days an additional member of staff is put on duty in order to meet the needs of residents, for example if they have an appointment to attend. As mentioned earlier in this report the proprietor lives at the home and as such can be called upon during the night if assistance is needed. In addition to the four permanent staff another family member is named on staffing rotas as ‘bank’. Discussions with the acting manager and examination of rotas indicate that this person has not undertaken shifts at the home for a considerable time. This person does not hold any qualifications and their recruitment records do not comply with legislation. As we explained to the acting manager a decision must be made either to ensure this person is suitably qualified and has all the required recruitment records maintained in the home or the home must cease employing them in any capacity. We informed the acting manager that another visit to the home would be undertaken shortly to assess if action has been taken with regards to this person. If at this point recruitment and training records do not demonstrate sufficient protection further action may be considered by the CSCI. There have been no new staff employed at the home since the last inspection with all but one person being members of the proprietors family. The records of all five members of staff were examined to assess if the homes recruitment practices protect residents. All contained evidence of an Enhanced Criminal Records Bureau (CRB) disclosure, however it was noted that three are over three years old. It is strongly recommended that CRB disclosures are renewed every three years to offer continued protection to residents. It was identified at the previous inspection that none of the recruitment files for staff contain the required information as detailed in the Care Home Regulations 2001. We were informed by the acting manager that action is being taken to address this including obtaining references for the newest person to start working at the home. We informed the acting manager that another visit to the home would be undertaken shortly to assess if the additional information has been put into place. If at this point recruitment records do not demonstrate sufficient protection further action may be considered by the CSCI. Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management practices have improved, offering further safeguards to residents. The health, safety and welfare of residents is promoted. EVIDENCE: The registered manager has relinquished the majority of her role to her daughter who is the deputy manager. A requirement was made at the last inspection for the deputy manager to apply to the CSCI for registration as the homes manager. Evidence was supplied to us during the inspection that the acting manager sent an application to the CSCI. CSCI have no record of receiving this despite the acting manager having sent this recorded delivery (and obtaining a signature). The acting manager agreed to send another application in order that the registration process can be undertaken. She holds Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 24 NVQ’s level 2 and 3 and the Registered Managers Award. We recommend that the acting manager undertake learning disability training to compliment the knowledge she has of the service user group she manages. As at the previous inspection the atmosphere throughout the inspection was relaxed and informal, with interactions between management and residents open and inclusive. A formal quality assurance system is still not operational. It is acknowledged that the service is a small family run unit with everyone involved in the management and support of residents for several years and it is a positive that the acting manager has introduced residents and staff meetings as a way of obtaining people views. However we recommended that that effective quality monitoring systems be introduced based on obtaining the views of people in order that the home can measure if it is achieving its aims and objectives and to evidence it its complying with its Statement of Purpose. As mentioned throughout this report there have been improvements to the records required by regulation for the protection of residents. For example new care planning systems have been introduced, health care records are improving and activity records now give an insight into the quality of life residents receive. The home has been using a consultancy service to help in these areas to which it should be commended. Work should continue in these areas. The management of health and safety appears appropriate in this home. Records evidence that a five year electrical wiring certificate was issued October 2006, that the fire alarm system was serviced December 2007, that small electrical items were tested for safety September 2007 and that gas appliances were serviced September 2006. Records confirm that all staff and residents participated in a fire drill August 2007 and that four of the five people working at the home undertook fire training in December 2006 (the fifth person being the ‘bank’ worker – see staffing section of this report). We recommend that staff sign the fire drill record as confirmation not only of their attendance but also of their understanding of actions to be taken in the event of a fire. Of the four permanent staff working at the home three hold up to date certificates for moving and handling. The acting manager informed us that food hygiene training had been arranged for everyone but was cancelled by the trainer and is now due to take place 12/02/08 and that everyone completed first aid training 21/01/08, but are awaiting certificates. In addition to this she informed us that health and safety training has been arranged for 04/03/08. We discussed whether the health and safety training would include infection control, however the acting manager was unable to confirm this. We recommended that enquiries be made with the training provider regarding this Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 25 and if infection control is not included further training be arranged, to promote good infection control measures. Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 26 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 2 3 x 4 2 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 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 1 35 2 36 x 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 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 2 x 2 x X 2 x Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 27 No. 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 YA34 Regulation 19 Requirement The home must decide if it is going to continue employing the named bank worker. If so recruitment records must be in place that offer protection to residents. Recruitment records must be in place for all persons working at the home as detailed in the Care Home Regulations 2001 to ensure residents are not placed at risk. Timescale for action 20/03/08 2 YA35 18(1)(a) The home must decide if it is going to continue employing the named bank worker. If so they must undertake all required training in order that they have the knowledge to support residents. 01/06/08 Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA1 YA4 Good Practice Recommendations An up to date Statement of Purpose and Service User Guide should be available at all times in order to inform and advise people. The admissions policy should be reviewed and cover all aspects of Standard 4 of the National Minimum Standards for Younger Adults in order that people have greater opportunities to sample services provided by the home before deciding on its suitability. Care plans should continue to be completed for all identified needs to ensure residents can be confident that the home will meet these. Care plans should continue to be reviewed on a regular basis in order any changes in residents needs are acted upon by the home. Care plans should contain sufficient detail to enable staff to understand how to meet residents’ needs. Action should be taken to ensure records are completed on a daily basis by all staff on duty to ensure they reflect the care and support residents have received. That residents meeting continue to take place to support residents in decision-making. Risk assessments should continue to be completed for any identified need to enable residents to take responsible risks based on their individual strengths and needs. Risk assessments should continue to be reviewed on a regular basis to ensure residents’ needs are met. Chronological recording of health care interventions with outcomes and future appointments should continue to be recorded to monitor health needs of residents and to demonstrate that the health needs of residents are being met. That competency assessments be undertaken to ensure staffs’ practices are monitored and reflect good practice. DS0000017053.V355819.R01.S.doc Version 5.2 Page 29 3 YA6 4 5 6 YA6 YA7 YA9 7 YA19 8 YA20 Petersfield Care Home 9 10 YA23 YA30 11 YA32 12 YA33 13 14 YA34 YA37 Financial care plans and risk assessments must contain sufficient information to protect people from harm. That staff read the contents of the updated infection control guidance and sign to say they have done so, to ensure systems for the management of infection protect residents. All persons working at the home must either hold a NVQ or equivalent or be working towards this to ensure staff are suitably qualified for their role. That training in relation to learning disabilities such as Learning Disability Qualification accredited training is provided to ensure staff have the required knowledge to meet residents needs. That CRB disclosures are renewed every three years to offer continued protection to residents The person managing the home must submit application for registration to CSCI. That the acting manager undertakes learning disability training to compliment the knowledge she has of the service user group she manages. Quality assurance systems should be introduced based on obtaining the views of people in order that the home can measure if it is achieving its aims and objectives and to evidence it is complying with its statement of purpose. Sufficient numbers of staff must receive training in health and safety, infection control, and food hygiene in order that at least one person on each shift is suitably qualified to support and promote residents’ health and welfare. That staff sign the fire drill record as confirmation not only of their attendance but also of their understanding of actions to be taken in the event of a fire. 15 YA39 16 YA42 17 YA42 Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Petersfield Care Home DS0000017053.V355819.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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