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Inspection on 16/05/07 for Pia - 45 Old Hinckley Road

Also see our care home review for Pia - 45 Old Hinckley Road for more information

This inspection was carried out on 16th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 4 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

Good care plans are in place for people, containing plenty of helpful information to enable staff to meet people`s needs properly. The care plans include information about people`s routines so that staff can fall in with people`s living patterns and provide them with the support they need in the way they like to receive it. Overall the home is comfortable and clean and most of the bedrooms are on the ground floor, so people who have difficulties walking do not have to climb the stairs. There are walk in shower facilities, which provide space for people to be supported by staff where necessary. Staff were seen to be friendly and respectful and the people at the home looked happy and at ease when seeking the support of staff. People were well groomed and dressed in age appropriate clothing. People are supported to shop for their own clothing and to make choices about what they wear and everyday matters that affect their lives, such as if they want to lie in later on their days off. The staff team includes men and women so that people have support form staff of the same gender where they prefer it. There have been no complaints at the home since the last inspection. Staff at the home are provided with training so that they know how to report any suspicions of abuse or any concerns they may have about the running of the home. The home provides three members of staff on duty and the manager stated that this would increase to four staff, most of the time, when the next person moves in, so that people`s needs continue to be met properly. Staff are provided with a very good range of training courses to equip them for their work. As well as courses to support safe practice and sensitive care, staff are also being provided with courses that are designed to help them recognise people`s individuality e.g. equality and diversity training and sexuality training.

What has improved since the last inspection?

What the care home could do better:

CARE HOME ADULTS 18-65 Pia - Old Hinckley Road, 45 45 Old Hinckley Road Nuneaton Warwickshire CV10 0AA Lead Inspector Kevin Ward Key Unannounced Inspection 16th May 2007 09:30 Pia - Old Hinckley Road, 45 DS0000004277.V335031.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 Pia - Old Hinckley Road, 45 DS0000004277.V335031.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. Pia - Old Hinckley Road, 45 DS0000004277.V335031.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pia - Old Hinckley Road, 45 Address 45 Old Hinckley Road Nuneaton Warwickshire CV10 0AA 02476 382960 02476 640146 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) People in Action Mrs Elizabeth June Barrett Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Pia - Old Hinckley Road, 45 DS0000004277.V335031.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 45 Old Hinckley Road may also care for the person named in the variation application dated 17 November 2006. The number of service users may increase to seven to include the above service user until such time as a more appropriate placement is found. The Registered Manager, (JB), must complete the Registered Managers Award by 30 November 2008. 11th April 2006 2. Date of last inspection Brief Description of the Service: 45 Old Hinckley Road is a registered care home for six people with learning disabilities. The house is a converted detached building within walking distance of Nuneaton town centre. The majority of rooms and facilities are on the ground floor. There is a ground floor flat for one service user who has been assessed as benefiting from a degree of separateness from the rest of the home, although he is encouraged to interact with the rest of the home at appropriate times. One service user has a bedroom upstairs, which is also where the staff sleeping-in room is located. There is a large garden area at the rear and car parking area at the side of the building. The garden has been made secure for the benefit of the single resident who lives on the ground floor flat. People In Action provide 24 hour care and personal support to the young adults living in the home. The fees for individuals in the home currently range from £574 to £1704 per week. People have to pay for personal items, such as clothing toiletries and costs and leisure. Pia - Old Hinckley Road, 45 DS0000004277.V335031.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents’. The inspection focused on assessing the main key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. A pre inspection questionnaire was also sent to the manager to complete to provide more information about the home before the inspection site visit. The manager explained that the questionnaire was returned to her by us by mistake and consequently was not available to the inspector prior to the inspection. Questionnaires were returned by two people who live at the home and two people’s relatives, giving their views of the service. The inspection included meeting with the people who live at the home. Most of the people living at the home have high communication needs and had not met the inspector before so it was not possible to gain their views on many aspects of the service. However two people were happy to speak openly about life at the home. The inspection also included case tracking the needs of three people that live at the home. This involves looking at people’s care plan and health records and checking how the person’s needs are met in practice. Discussions took place with 3 staff on duty at the home as well as the manager for the home. A number of records, such as care plans, complaints records, staff training certificates and fire safety records were also sampled for information as part of this inspection. What the service does well: Good care plans are in place for people, containing plenty of helpful information to enable staff to meet people’s needs properly. The care plans include information about people’s routines so that staff can fall in with people’s living patterns and provide them with the support they need in the way they like to receive it. Overall the home is comfortable and clean and most of the bedrooms are on the ground floor, so people who have difficulties walking do not have to climb the stairs. There are walk in shower facilities, which provide space for people to be supported by staff where necessary. Pia - Old Hinckley Road, 45 DS0000004277.V335031.R01.S.doc Version 5.2 Page 6 Staff were seen to be friendly and respectful and the people at the home looked happy and at ease when seeking the support of staff. People were well groomed and dressed in age appropriate clothing. People are supported to shop for their own clothing and to make choices about what they wear and everyday matters that affect their lives, such as if they want to lie in later on their days off. The staff team includes men and women so that people have support form staff of the same gender where they prefer it. There have been no complaints at the home since the last inspection. Staff at the home are provided with training so that they know how to report any suspicions of abuse or any concerns they may have about the running of the home. The home provides three members of staff on duty and the manager stated that this would increase to four staff, most of the time, when the next person moves in, so that people’s needs continue to be met properly. Staff are provided with a very good range of training courses to equip them for their work. As well as courses to support safe practice and sensitive care, staff are also being provided with courses that are designed to help them recognise people’s individuality e.g. equality and diversity training and sexuality training. What has improved since the last inspection? What they could do better: There is a need to improve procedures for assessing people’s needs before they move in. There is little information on people’s files to demonstrate that their needs are properly assessed before they move in, to show that the home is able to meet their needs. Overall the care plans are very good but there is scope for providing some people with copies in a different format, (e.g. illustrated or audio tape) so that they can have their own version for personal safekeeping. Pia - Old Hinckley Road, 45 DS0000004277.V335031.R01.S.doc Version 5.2 Page 7 People at the home pay a contribution to the hire of a car to get them out and about but this is not mentioned in people’s contracts with the home. Hence there is a need to amend the contracts and to arrange for the contracts to be signed by people, with support from their relatives or advocates, to demonstrate that their rights are properly represented. A door switch is in place that controls access through the main corridor of the home. One person at the far end of the home is unable to operate the door switch without help, which stops him from entering the main living unit. Hence the switch needs to be removed so that he is not unnecessarily restricted form entering the main communal areas. People are supported to get out locally but there is scope for increasing the variety of leisure options available to people. The manager has agreed to review the community leisure activities offered to people so that they can have a better range of experiences that they enjoy. There have been seven medication errors reported to us since January this year. The manager is addressing this problem. All staff are attending medication training again and all medication is now checked at the start and end of each shift to increase staff accountability and reduce the likelihood of further errors. The manager said that she has plans to improve the décor in the lounge as this is very dull and that she aims to improve the furniture in this area of the home. The manager also plans to move a wall at the rear of the home and build a larger conservatory to give people more room to relax in. The manager was advised to agree the works with the Building Control section of the Local Authority so that new fire safety certificate may be issued when the works are completed. The home needs to set up a process for seeking the views of people and visitors to the home, about the way in which the home is run, so that their opinions may affect future changes at the home. There is a need to ensure that the fire alarms and lights are tested at the correct intervals so that everyone at the home is properly protected by the home’s fire safety measures, in the event of a fire. 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. Pia - Old Hinckley Road, 45 DS0000004277.V335031.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 Pia - Old Hinckley Road, 45 DS0000004277.V335031.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): 2 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are shortfalls in the home’s admission paperwork, necessary to demonstrate people’s needs are fully assessed before they move in. Omissions in the people’s contracts fail to make clear the charges for transport, which could compromise their rights. EVIDENCE: Since the last inspection two people have moved into the home. The manager confirmed that people are encouraged to visits the home to meet the people that live there so that they can make an informed decision about moving in to the home and to assess their needs when they visit. One person who has recently moved in confirmed that she had been able to visit the home and had also been given a service user guide, containing information about the home. The Statement of Purpose and service user guide has been illustrated with pictures to help people to better understand the information. The manager said that she intends to review and update this information shortly to take account of changes at the home, e.g. new staff. There is a shortage of information on both people’s files to verify that people’s needs have been fully assessed as part of the admission procedure. Neither Pia - Old Hinckley Road, 45 DS0000004277.V335031.R01.S.doc Version 5.2 Page 10 person has a social work assessment in place or a written assessment by the home, or notes detailing the process of admission visits and reviews by Social Services. The manager explained that there is not currently a formatted assessment by which the home assesses people’s needs. However care plans are in place for both people. One person has transferred from another home run by People in Action and their care plan and social work review paperwork has moved with them, containing valuable information about the person’s needs. Decorating has recently commenced to a bedroom. The manager explained that a new person referred to the home has visited and chosen the colours for her bedroom, indicating that the home supports people to personalise their bedrooms to help them to feel at home. The manager explained that the people living at the home make a contribution to the hire of a lease car to enable them to venture out into the community. However there is no mention of this in the service user contract on people’s files or in the service user guide. This is necessary to demonstrate that people have agreed to these payments and so that their rights can be upheld. Pia - Old Hinckley Road, 45 DS0000004277.V335031.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 good. This judgement has been made using available evidence including a visit to this service. People’s needs are well planned for and reviewed so that they can be supported and cared for in a safe and appropriate manner. EVIDENCE: Three people’s care plans were examined. Overall the care plans provide high levels of clear detailed information to enable staff to understand and meet people’s needs properly. In addition to detailing people’s personal needs, communication needs and likes and dislikes. The care plans contain good personal histories so that people’s life experiences, before they came to the home are recognised. People’s daily routines are recorded (e.g. breakfast and evening routines) and include a great deal of helpful information to enable staff to carry out people’s care according to the order in which they like things done. This is particularly important as many of the people that live at the home have autism and depend heavily on a structured routine to the day. This also a good way of ensuring that known likes and choices of people with high Pia - Old Hinckley Road, 45 DS0000004277.V335031.R01.S.doc Version 5.2 Page 12 communication needs are understood and respected by staff. The care plans have been dated to indicate that the information has been recently reviewed. The dates were seen to coincide with social work reviews that took place earlier in the year. People’s review notes indicate that their relatives are encouraged to attend their reviews to lend support and represent their interests. Staff were seen to ask people to choose what they wanted for their breakfast and one person chose to stay in bed later as it was her day off from day service. A person living at the home confirmed that she had chosen her bedroom décor colours and was supported to go shopping to choose clothes and other personal items. People’s files were seen to contain a good range of risk assessments (car safety, kitchen safety, unfamiliar places, behaviours). e.g. so that they are supported to go about their everyday lives safely with correct levels of support from staff. Guidelines are also in place in some people’s files, to enable staff to assist people with mental health / emotional needs or behaviours that may be associated with their autism, so that they are supported sensitively. Pia - Old Hinckley Road, 45 DS0000004277.V335031.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): 12,13,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is scope for increasing the range of community activities that people enjoy. People’s food choices and dietary requirements are properly considered so they are provided with well-balanced meals that they enjoy. EVIDENCE: Everyone at the home attends a day service between 3 and 5 days per week and staff are available in the home to support people on their days off. Comments by two people at the home confirmed that they enjoy going to day services and the activities that are provided. One person explained that she is planning to go to Blackpool on holiday shortly with another person from the home and a member of staff The manager and staff also explained that plans are in place for 4 other people to go on holiday to the Lake district at the end of June. Pia - Old Hinckley Road, 45 DS0000004277.V335031.R01.S.doc Version 5.2 Page 14 Comments by two people confirmed that they are supported to go shopping for personal items and go on trips out in the car. A scrapbook was seen containing some outings that have taken place during the last year, including pubs, zoo, beach party and train station. Good work has also taken place to support some people to take part in a fun run. Comments by the manager and people at the home confirm that people have regular opportunities to venture out locally to parks and short walks. Whilst people are supported to get out locally there tends to be little variety in the community activities recorded for people. The manager agreed to review and increase the leisure options available to people at the home. The contact details of people’s relatives were seen on their files and entries in people’s care review notes indicate that they are encouraged to attend and provide support at these meetings. Comments in two questionnaires that were completed by relatives indicate that they are kept properly updated of important events in people’s lives. Five staff have previously been provided with sexuality training and the manager explained that she is planning to send more staff on this training, so that staff are better equipped to respond appropriately to people’s expressions of sexuality and to advise them on personal relationship issues. People are supported to maintain friendships and attend celebrations of friends they have in other homes, e.g. photographs were seen of people sharing in the Birthday celebrations of a person at another home. Comments by staff and a person living at the home confirmed that encouragement is provided for people to take part in everyday living activities, such as shopping, cleaning, and food preparation and making packed lunches. One person was seen to do a very good job of cutting up mushrooms to go in an omelette at lunchtime. One person has a gerbil that they keep in their bedroom and clean out the cage with support from staff. One person has a bedroom and separate sitting room at the far end of the home. The manager explained that this enables him to retreat and get away from people, in keeping with his care planned needs. A door-opening switch is in place, which has to be pressed to open the door between the two areas of the home. The manager explained that this was installed to stop people wandering into the space of the person concerned. However this devise also restricts this person from freely entering the main area of the home. The manager explained that minor building alterations that are planned to take place would include the removal of this device. A 4-week menu was seen containing a reasonably varied range of mealtime options. The manager explained that she plans to review the menu again to take account of the wishes of two new people at the home and with a view to including more low fat meals. People’s dietary intake is also recorded on a sheet in their daily diary records. These notes indicate that people are appropriately provided with alternatives to the meals on the menu, in keeping Pia - Old Hinckley Road, 45 DS0000004277.V335031.R01.S.doc Version 5.2 Page 15 with their choice and preferences. Comments by two people at the home confirmed that they are happy with the meals that are provided and are able to have access to snacks and fruit between main meals. The home has made use of a speech and language therapist to carry out dysphagia assessments for people (these assessments are necessary to avoid the risk of people choking due to swallowing difficulties). People’s care plans also contain individual guidelines concerning the support that people require when eating. Staff were seen to provide caring assistance at breakfast time and people were encouraged to choose what they wanted. Entries in people’s notes confirmed that dietician advice has been sought where necessary and people’s weight is being monitored, to determine any dietary changes that may be required. Pia - Old Hinckley Road, 45 DS0000004277.V335031.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall people are provided with the care and support they require to meet their personal and healthcare needs well. Steps are being taken to reduce the risk of medication errors. EVIDENCE: Comments by two people at the home indicate that they are very happy with the care and support they receive and enjoy the company of the staff at the home. Similarly comments by two relatives who returned questionnaires, as part of this inspection confirm that they are satisfied with the care that is provided by staff at the home. Staff were seen to pay attention to people and to approach them in a friendly caring manner. People were dressed in welllaundered age appropriate clothing. One person had recently had her haircut dyed and cut into a modern style and two women had been supported to apply make up, indicating people are encouraged to take pride in their appearance and maintain a good self image. As previously noted one person decided to have a lie in as it was her day off from day service, indicating people are able top exercise a level of control over their daily routine. Comments by staff on duty demonstrated a good awareness of people’s individual care needs. Pia - Old Hinckley Road, 45 DS0000004277.V335031.R01.S.doc Version 5.2 Page 17 There are three female staff and two males, which allows people to receive personal care from staff of the same gender where they prefer it. People’s wishes on this matter are recorded in a signed agreement on their care plan files. Information contained in people’s health notes indicate that people are supported to receive access to support and advice from relevant health professionals to meet their health needs, such as dietician, speech therapist, community nurse, dietician, continence nurse, consultant psychiatrist and psychologist. One person’s records verified that a psychologist had recently visited to assist staff to devise new guidelines to assist with their care. Similarly entries in people’s records confirm that the home’s assists people to benefit from regular health checks and examinations, e.g. well person’s clinic, dental checks, chiropody and opticians. People’s medication is safely stored in a lockable cabinet. There have been 7 notifications of medication errors made to us between January and April this year. The manager explained that she has made arrangements for all staff to have updated medication training and has set up a daily audit of medication records to account for everyone’s medication several times daily. The manager explained staff are also observed and assessed by the manager (written assessment seen) on three occasions before they are allowed to give out medication unsupervised. Staff also verified this. People’s medication is counted and recorded at the start and end of every shift so that any mistakes can be picked up very quickly. An examination of current medication sheets indicates that people’s medication is being properly recorded and no anomalies were identified. It is the policy of the home to ask the GP / consultant to sign the medication records when any amendments are made to verify medication changes. A stock record is kept of medication received at the home and a book was seen recording all medication returned to the chemist. The pharmacist had appropriately signed the record. Written medication protocols were seen on the medication file, giving the reasons and circumstances under which specific medications may be given, to reduce the risk of medication being given inappropriately. Pia - Old Hinckley Road, 45 DS0000004277.V335031.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable arrangements are in place for respond to people’s concerns and complaints and staff are being trained to recognise and respond to suspicions of abuse so that people are protected form harm. EVIDENCE: There have been no complaints made to us since the last inspection and the manager stated that there have been no complaints made at the home during the same time period. The manager explained that people’s relatives are provided with a copy of the service user guide, from head office, containing the complaints procedure when people are considering moving to the home. Comments by two relatives who completed questionnaires indicate that they have been made aware how to raise concerns and complaints at the home. Two of the staff on duty said that they had received prevention of adult abuse training and the information contained in staff training records confirmed that this training has been provided to the majority of staff. Comments by a member of staff demonstrated a good appreciation of the different types of abuse and a satisfactory understanding of the procedures for reporting any concerns. Abuse and whistleblowing procedures are available in the office at the home for staff to refer to. Staff training records demonstrate that staff are provided with access to positive approaches training so that they are equipped to respond sensitively to behaviour challenges that may be presented by people on occasions and the home make use of the psychology service to help in devising safe behaviour management guidelines for people. Pia - Old Hinckley Road, 45 DS0000004277.V335031.R01.S.doc Version 5.2 Page 19 A file was seen containing people’s expenditure records to account for their money. The record is signed by staff and checked and signed by the manager to confirm that the expenditure is appropriate. Receipts were also seen to account for people’s money. People’s care plans contain a good summary of the procedure for withdrawing people’s money from their savings accounts when this is done on their behalf. This includes the signatures of two people, including the manager, as named on their savings account books. Pia - Old Hinckley Road, 45 DS0000004277.V335031.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. 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 home is maintained in a clean condition and work is ongoing to improve the communal areas so that people benefit from a more attractive comfortable environment. EVIDENCE: The manager explained that since the last inspection the hall, stairs and landing have been decorated and all except one of the bedrooms has been improved to make them nicer for people. The manager explained that she has plans for the lounge to be decorated this year and to improve the furniture to make this area more comfortable and appealing for people. The manager also stated she has plans to build a larger conservatory and move a wall at the rear of the home to create more space for people. There is also a small lounge area upstairs that has been comfortably equipped so that people can spread out and find space for themselves. This particularly important as the majority of the people at the home have autism and benefit from a quiet space. Pia - Old Hinckley Road, 45 DS0000004277.V335031.R01.S.doc Version 5.2 Page 21 Since the last inspection good work has taken place to create a wet room with grab rails for people to shower in safely. There is also a second smaller ensuite wet room that is shared between two people at the home. People’s bedrooms are comfortable and clean and people have been supported to personalise these areas with pictures, music players, lights and other personal belongings. Staff were seen to make use of protective clothing and gloves to carry out domestic tasks. Bags are available for carrying the small amount of continence laundry that is generated at the home. There is also a large sink and sluice settings on the washing machine for use where necessary. Staff training records show that three staff including the manager have recently had infection control training to support good hygiene practices in the home. A cleaning prompt sheet was seen so that new staff are clear about the cleaning tasks that need to be carried out. Overall the home looked clean and tidy. Pia - Old Hinckley Road, 45 DS0000004277.V335031.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are properly recruited and provided with a good range of training opportunities so that people benefit from a team of suitable staff who are well trained to meet their needs. EVIDENCE: The manager stated that there are typically 3 staff on duty at the home when everyone is at home. This was verified by an examination of the staff rota. The manager also explained that the staffing levels would increase so that there will be 4 staff on duty most of the time when the next person moves into the home. This will enable staff to provide a combination of individual and group support to people, in keeping with their assessed needs. The current staff team consists of three female staff and two males. This enables the home to provide people with care from staff of the same gender where they prefer it. Two staff files were examined to assess the home’s recruitment procedures. Each file contained a completed application form and evidence to demonstrate that people are interviewed and provided with proper contracts of employment. Both files contained evidence to confirm that suitable checks are carried out to Pia - Old Hinckley Road, 45 DS0000004277.V335031.R01.S.doc Version 5.2 Page 23 ensure that people are suitable to work at the home, including Criminal Record Bureau checks and two references. Comments by three staff on duty indicate that they are provided with a satisfactory range of training opportunities. This was further verified in comments by the manager and by viewing training records and certificates. Staff are being provided with access to Health and Safety related training courses, such as food hygiene, moving and handling and first aid and adult abuse. Staff are also attend a good range of care courses to equip them to meet the needs of the people at the home. Examples of short courses include, equality and diversity, healthy eating, nutrition, understanding learning disabilities, autism, positive approaches to communication and behaviour, medication training, mental health needs, dysphagia, sexuality training. New staff attend Learning Disability Award Framework induction training and are sent on National Vocational Qualification courses to equip them for their work and career progression. Pia - Old Hinckley Road, 45 DS0000004277.V335031.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall the home is managed satisfactorily and staff are provided with good support and supervision to carry out their work. The home’s quality assurance system would be improved by seeking relevant people’s views about the home. EVIDENCE: Since the last inspection the manager has been registered as required. The manager also explained that she has now completed the Registered Managers Award and is awaiting written confirmation and for the training certificate to be issued to her. The manager is also a qualified nurse and has started the National Vocational Qualification level 4 in Care. The manager holds seven years experience working with people with learning disabilities. A number of checks are being carried out to support quality assurance in the home. The manager checks and signs the expenditure records regularly and Pia - Old Hinckley Road, 45 DS0000004277.V335031.R01.S.doc Version 5.2 Page 25 staff audit people’s medication at the start and end of each shift. A shift diary and communication book is used by staff to pass on important information and plan appointments so that work is picked up and actioned. A list of daily routines, including domestic tasks was seen. The manager explained that this was set up to support new staff to carry out their work. Comments by staff confirm that they are being provided with regular planned supervision and are able to access managerial support when required. This was verified by information contained in two staff member’s supervision records. A senior manager is carrying out regular monitoring visits at the home. The findings of these visits are reported to the manager who responds with an action plan to rectify any shortfalls that are identified (seen on file in the office). The manager has drafted a list of objectives for the home (development plan). However there is currently no formal process for getting the views of people at the home, their relatives and visiting professionals about the way in which the home is run, which could contribute to future developments in the home. The fire safety log was examined. The log indicates that emergency lights are being tested on a 3 monthly basis and the home has fallen into the routine of testing the fire alarms fortnightly instead of weekly. Certificates were seen, verifying that gas and electrical appliances have been checked to ensure they are safe to use. A hot water monitoring log is in place and indicates that hot water is being maintained at a safe level to reduce any risks of people being scalded. Other records are in place detailing checks of stepladders, vehicles and other safety equipment, indicating that appropriate measures are being taken to support a safe working and living environment. Pia - Old Hinckley Road, 45 DS0000004277.V335031.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 x 2 2 3 x 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 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 3 33 x 34 3 35 4 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 2 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 3 x x 2 x Pia - Old Hinckley Road, 45 DS0000004277.V335031.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 YA2 Regulation 14 (1) Timescale for action Review the admission procedures 14/07/07 and ensure that a written assessment forms part of the admission procedure and social services are involved in assessing people’s needs and formally agreeing their placement. Arrange for people’s contracts to 01/07/07 be amended to recognise all payments charged for care hire / car mileage and to be signed with support from relatives or advocates, to demonstrate that people’s rights are properly represented. Remove the door switch that 01/07/07 controls access through the main corridor of the home so that people are not unnecessarily restricted from moving between the two areas of the home. Ensure that fire alarms are 24/06/07 tested weekly and that lights are tested monthly to ensure that the equipment is working properly, so that the people that live and work at the home are properly protected by the fire safety procedures. DS0000004277.V335031.R01.S.doc Version 5.2 Page 28 Requirement 2 YA5 5 3 YA16 12 4 YA42 23(4)(c) (v) Pia - Old Hinckley Road, 45 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations It is recommended that work on making service user plans and guides, including communication aids, more accessible continues, and involves staff and service users as much as possible. It is recommended that action be taken to seek the views of the people at the home, their relatives and other visitors so that these views may be considered in the home’s development plan. 2 YA37 Pia - Old Hinckley Road, 45 DS0000004277.V335031.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Pia - Old Hinckley Road, 45 DS0000004277.V335031.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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