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Inspection on 26/11/07 for Pia - Princes Street, 46

Also see our care home review for Pia - Princes Street, 46 for more information

This inspection was carried out on 26th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

Care plans are in place for people with guidance to enable staff to meet people`s needs safely. The care plans include information about people`s preferred routines so that care staff can give care support to them in the way they like. The care plans are being regularly reviewed and updated and social workers have been involved in reviewing the progress of new people that have moved into the home to make sure they are settling in well. The home provides support for people to gain access to health professionals to monitor their health needs, such as consultant psychiatrist, dietician and speech therapists and to attend routine check ups, such as opticians and dentists. The staff at the home are friendly and helpful. One relative reports, "My daughter is very happy and contented at Princes St. They are all excellent staff and they are brilliant to x in every way. I don`t worry about her care or welfare as it is excellent" People are assisted to get out and about locally and have been supported to go away on holiday. Three people attend church groups at the local Catholic Church, which supports their involvement in the local community as well as helping them to meet their spiritual requirements. There have been no complaints made to us about the home since the last inspection and no complaints have been made directly to the service. The people at the home have regular meetings where staff check if they have any concerns or complaints. Staff are trained to recognise and report any suspicions of abuse so that people are kept safe from harm. The home is clean and comfortably furnished and provides a homely environment for people to live in. One person has a budgie, which she said she enjoys looking after. One person`s bedroom is well equipped with hoisting equipment to enable safe transfers from bed to wheelchair. Staff are properly interviewed and vetted before they start work at home and are provided with access to a very good range of training courses to equip them to support people in a safe and supportive manner. There are a number of checks and audits carried out to make sure the home is running smoothly. A senior manager also visits the home each month to monitor the work of the home and identify areas of improvement, as necessary.

What has improved since the last inspection?

The manager checks the financial records on a regular basis and signs the records to verify that people`s money has been properly accounted for. Two people`s bedrooms have been decorated since the last inspection to improve them and a broken fence has been replaced.

What the care home could do better:

The service user guide does not currently provide details of the current fees and extra charges that people may be expected to pay. Hence there is a need to amend the service user guide to show this information The current contracts contain outdated information about the car mileage charges that people are required to pay for the use of the home`s transport. Hence there is a need to amend the contract so that it is up to date and accurate.The shower facilities in the downstairs bathroom are cramped and do not provide much room for staff to support people where necessary. The manager confirmed that there are plans to create a wet room to provide a more spacious and comfortable place for people to take a shower. It is not possible to adjust the temperature on most radiators without first removing the radiator covers, which are heavy and have to be lifted by two staff. This makes it difficult for staff to adjust the radiator temperatures to maintain a comfortable room temperature for people. It is recommended that thermostatically controlled radiator valves are fitted and that the radiator covers are adapted to enable staff to gain easier access to adjust the temperature, as required.

CARE HOME ADULTS 18-65 Pia - Princes Street, 46 46 Princes Street Nuneaton Warwickshire CV11 5NW Lead Inspector Kevin Ward Key Unannounced Inspection 26th November 2007 07:55 Pia - Princes Street, 46 DS0000004447.V355186.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 - Princes Street, 46 DS0000004447.V355186.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 - Princes Street, 46 DS0000004447.V355186.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pia - Princes Street, 46 Address 46 Princes Street Nuneaton Warwickshire CV11 5NW 02476 353581 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 Susan Sugars Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Pia - Princes Street, 46 DS0000004447.V355186.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC; to service users of the following gender: Either; whose primary care needs on admission to the home are within the following category: Learning Disability - Code LD. The maximum number of service users who can be accommodated is 7. 2. Date of last inspection 27th November 2006 Brief Description of the Service: 46 Princes Street is a registered care home for seven adults with learning disabilities. People in Action provides 24 hour care and support for the people living in the home. The home is located in the centre of the town of Nuneaton, North Warwickshire, and as such is close to all local services and facilities the town has to offer. It is a two-storey building with gardens to the front and rear of the property. There are 8 single bedrooms, one having a shower en-suite facility. One of the bedrooms is used as the sleeping/office for staff. Two of the bedrooms are located on the ground floor. The ground floor bathroom/toilet has a walk-in shower facility and bath, which has an electrically operated bath seat. There is another shower facility and separate toilet and bathroom/toilet located on the first floor. The shared facilities in the home consist of a large lounge, kitchen with dining area and well maintained garden to the rear of the property. The garden provides separate areas of privacy, has a greenhouse and a vegetable patch. Pia - Princes Street, 46 DS0000004447.V355186.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. The manager completed and returned an annual quality assurance questionnaire, containing helpful information about the home in time for the inspection. The seven people that live at the home, three health professionals and a person’s relatives, completed questionnaires giving their views of the service. An annual quality assurance questionnaire was completed and returned by the manager in time for the inspection, providing helpful information about the home. The inspection included meeting everyone living at the home and case tracking the needs of two people. This involves looking at people’s care plans and health records and checking how the person’s needs are met in practice. Other people’s files were also looked at in part to verify the healthcare support being provided at the home. Discussions took place with two staff and an assistant manager and the home manager. 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: Care plans are in place for people with guidance to enable staff to meet people’s needs safely. The care plans include information about people’s preferred routines so that care staff can give care support to them in the way they like. The care plans are being regularly reviewed and updated and social workers have been involved in reviewing the progress of new people that have moved into the home to make sure they are settling in well. The home provides support for people to gain access to health professionals to monitor their health needs, such as consultant psychiatrist, dietician and speech therapists and to attend routine check ups, such as opticians and dentists. Pia - Princes Street, 46 DS0000004447.V355186.R01.S.doc Version 5.2 Page 6 The staff at the home are friendly and helpful. One relative reports, “My daughter is very happy and contented at Princes St. They are all excellent staff and they are brilliant to x in every way. I don’t worry about her care or welfare as it is excellent” People are assisted to get out and about locally and have been supported to go away on holiday. Three people attend church groups at the local Catholic Church, which supports their involvement in the local community as well as helping them to meet their spiritual requirements. There have been no complaints made to us about the home since the last inspection and no complaints have been made directly to the service. The people at the home have regular meetings where staff check if they have any concerns or complaints. Staff are trained to recognise and report any suspicions of abuse so that people are kept safe from harm. The home is clean and comfortably furnished and provides a homely environment for people to live in. One person has a budgie, which she said she enjoys looking after. One person’s bedroom is well equipped with hoisting equipment to enable safe transfers from bed to wheelchair. Staff are properly interviewed and vetted before they start work at home and are provided with access to a very good range of training courses to equip them to support people in a safe and supportive manner. There are a number of checks and audits carried out to make sure the home is running smoothly. A senior manager also visits the home each month to monitor the work of the home and identify areas of improvement, as necessary. What has improved since the last inspection? What they could do better: The service user guide does not currently provide details of the current fees and extra charges that people may be expected to pay. Hence there is a need to amend the service user guide to show this information The current contracts contain outdated information about the car mileage charges that people are required to pay for the use of the home’s transport. Hence there is a need to amend the contract so that it is up to date and accurate. Pia - Princes Street, 46 DS0000004447.V355186.R01.S.doc Version 5.2 Page 7 The shower facilities in the downstairs bathroom are cramped and do not provide much room for staff to support people where necessary. The manager confirmed that there are plans to create a wet room to provide a more spacious and comfortable place for people to take a shower. It is not possible to adjust the temperature on most radiators without first removing the radiator covers, which are heavy and have to be lifted by two staff. This makes it difficult for staff to adjust the radiator temperatures to maintain a comfortable room temperature for people. It is recommended that thermostatically controlled radiator valves are fitted and that the radiator covers are adapted to enable staff to gain easier access to adjust the temperature, as required. 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 - Princes Street, 46 DS0000004447.V355186.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 - Princes Street, 46 DS0000004447.V355186.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 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Suitable procedures are in place for assessing and admitting people to the home sensitively. Amendments are necessary to the service user guide and contracts to ensure that everyone is clear about the fees and extra charges. EVIDENCE: A Statement of Purpose and service user guide is in place for the home, providing helpful information about the service. However the service user guide does not currently include the fees charged for the service. Contracts on two people’s files were checked and found to contain incorrect out of date information about the mileage charges levied for the use of the home’s transport. This was raised with the service manager following the site visit and she agreed to ensure that the service user guide includes the weekly fees and that contracts include an annual updated schedule of fees and extra charges. The records of two people recently admitted to the home were examined. In both cases there was evidence to indicate that people’s needs have been properly assessed as part of the admission process. Both files contained evidence of social work reviews having taken place to check that the people concerned were settling satisfactorily and update assessment information. A comprehensive assessment of people’s needs, carried out by the home manager was also seen on file. The manager explained that ordinarily people Pia - Princes Street, 46 DS0000004447.V355186.R01.S.doc Version 5.2 Page 10 would be introduced gradually but due to the urgent circumstances surroundings one person’s move, insufficient time had been available to arrange pre admission visits. Diary records demonstrated that the other person and their relatives had been provided with proper opportunities to visit the home before the move took place and an overnight stay had also been arranged. Pia - Princes Street, 46 DS0000004447.V355186.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 planned for and regularly reviewed and their choices are recorded and respected. EVIDENCE: The manager explained that the care plans are currently in the process of being written in a new format. This was reflected in the information on the two files that were examined, which are currently a mixture of old and new paperwork. Overall the plans contain satisfactory levels of information to enable staff to support people to meet their needs. This includes information about people’s communication needs and preferred care routines so that staff are able to provide care support to people in a sensitive manner. Care plans and risk assessments are being dated to demonstrate that they are being reviewed and updated. As previously noted the files of the two people recently admitted to the home include social work review notes, demonstrating the placements have been reviewed with the involvement of relatives. Pia - Princes Street, 46 DS0000004447.V355186.R01.S.doc Version 5.2 Page 12 People’s likes and dislikes are also recorded so that staff can carry out people’s wishes. This is particularly important information and a good way of helping the people with high communication needs to express their choices. Meetings are being held regularly each month to enable people to discuss issues in the home such as activities, holidays. Comments by people at the home confirmed that they are encouraged to make choices about where they want to go and what they wish to do. Pictures were seen on a person’s bedroom illustrating the clothing inside, to assist in choosing preferred clothing items each morning, in a stress free manner. Staff were seen to consult sensitively with a person at the home about his preferred day activity, as it was evident that the planned activity was causing him some anxiety. Risk assessments are in place for people covering advice on reducing the risks associated with range of everyday living hazards that people are likely to encounter. These documents have also been tailored to take account of individuals’ specific needs, such as risks associated with people’s physical disabilities and mental health needs, e.g. epilepsy, eating assistance, car travel, bathing/ showering and personal care. The manager explained that she has referred one person with swallowing difficulties for speech therapy assessment. Comments by staff confirmed that they use the food blender (seen in the kitchen) to dice meat for easy swallowing, in keeping with the guidance in the risk assessment. Pia - Princes Street, 46 DS0000004447.V355186.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 good. This judgement has been made using available evidence including a visit to this service. People’s preferences are taken into account when planning activities and meals so that they are provided with a suitable range of activities and meals they enjoy. EVIDENCE: The people living at the home either attend day services or receive support from staff to remain at home and go out places part of the week. On the day of the site visit two people who remained at home were supported to go shopping with staff. On person said that she enjoyed going shopping and visiting cafes and going to the hairdressers. Comments by a person attending day service indicated that he enjoyed a good range of activities, including horse riding, swimming, gardening, college and going to the gym. Examples of other activities provided by staff and other people at the home included, pictures, bowling, lunches out, theatre and day trips. Pia - Princes Street, 46 DS0000004447.V355186.R01.S.doc Version 5.2 Page 14 The activities records of a new person with high communication support needs, recently admitted to the home, indicated that to date there has been a limited variety of activities provided when the person concerned was not attending day services. A team leader and the manager commented positively on the manager in which the person concerned was seeking to communicate with others at the home. The manager said that she intended to devise a more structured timetable of more varied activities, to ensure that he receives the necessary time and attention to support this progress. One person has a vegetable patch in the garden and they explained how they had enjoyed growing vegetables during the summer, including, peppers, tomatoes, beans, peas and lettuce. Another person at the home has recently been supported to join a local line dancing class. A person at the home commented that she enjoyed attending a local Catholic church and the manager reports that to others also attend the church / associated groups in keeping with their wishes. People at the home were seen to take part in making their breakfast and returning their crocks where they are able to do so. Encouragement is provided for people to take part in light domestic tasks such as loading the dishwasher and sweeping the kitchen floor. Comments by staff and the people at the home confirmed that support is provided for people to maintain contact with relatives and to receive their support at care reviews. This was also verified in people’s dairy records and review notes. One person was celebrating their Birthday on the day of the site visits and enjoyed opening presents in the company of others at the home before going to day service. A party had been planned for the evening to which friends and relatives had been invited. Comments by staff and the manager confirmed that some staff have previously been provided with sexuality and personal relationship training to equip them to offer appropriate support and advice to people where necessary. The manager said that more staff are being put forward for this training this year. Good work has taken place to identify a seizure monitoring device that triggers staff if the person concerned has a seizure in bed at night. The device is less intrusive than the intercom systems that are commonly used for this purpose and improves their privacy. The home’s menus indicate that people are provided with a reasonably balanced and wholesome diet. People’s preferences are recorded in their care plans to help inform reviews of the menus. Comments by people at the home Pia - Princes Street, 46 DS0000004447.V355186.R01.S.doc Version 5.2 Page 15 confirmed that they like the food provided. Two people confirmed that they like to go shopping for groceries. A team leader said that consideration is given to encouraging healthier eating with the purchase of low fat produce and fresh fruit and vegetables, examples of which were seen in the cupboards, fridge and vegetable rack. The manager explained that the advice of a dietician has been sought for two people at the home. Written evidence of this was also seen in a person’s file. One person has been supported to reduce their weight by becoming more active. The manager said that she is also seeking access to suitable scales for another person who is a wheelchair user, to more effectively monitor their weight in a safe manner. Pia - Princes Street, 46 DS0000004447.V355186.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. The people living at the home are provided with the support they need to meet their personal care and health needs and suitable arrangements are in place for the safe administration of medication. EVIDENCE: The people living at the home were seen to rise in an unhurried fashion and to go about their breakfast routine in a relaxed manner. Staff are friendly and were seen to provide assistance in a caring, helpful way. The people at the home looked very comfortable and ease when approaching staff for help and advice. Their comments indicate they find the staff to be kind and helpful. One person said “the staff are nice” and another said “I am able to do what I want”. Staff were observed to provide sensitive, relaxed support where necessary when assisting people to eat, where required. As previously noted some people took an active part in pouring their own cereals and making their drinks at breakfast time with prompts and assistance where necessary. The people at the home were all well groomed and dressed in age appropriate, clean, modern clothing, indicating they are supported to maintain a good selfPia - Princes Street, 46 DS0000004447.V355186.R01.S.doc Version 5.2 Page 17 image. Several people confirmed they are supported to visit the local hairdresser for their haircut. Comments by people at the home confirmed that are supported to follow their own preferred bedtime routines and enjoy age appropriate bedtimes. One person likes to stay up till late and rise early. On the day of the site visit, one person decided to lie in a little longer than she would if attending her day service and took breakfast when she was ready. Questionnaires returned by three health professionals indicate that the home acts on the advice provided and has sought training input where necessary, e.g. mental health awareness. Safe practice protocols, signed by a consultant psychiatrist, were seen on the file of a person with epilepsy, to support staff in the safe administration of stesolid medication. A specialist bed and lifting equipment have been provided for a wheelchair user at the home, so that his needs are met correctly. Entries in people’s health records confirm that they are provided with access to routine check ups, such as well person checks, dental checks, eye tests and chiropody service. A member of staff demonstrated a good understanding of the home’s medication procedures. The manager and staff explained that they had received training in the safe handling of medication training. Certificates and workbooks were seen on staff files verifying this fact. Staff are trained and observed on a minimum of three occasions before they give out medication independently, records of which are retained on their files. The medication cabinet was tidy and well ordered. The manager confirmed that due to the high support needs of the people at the home no one currently holds their own medication. A sample of current medication sheets were checked and indicate that staff are recording people’s medication correctly. Medication records include guidance about how people like to take their medication so that it is administered sensitively. Medication is checked when staff handover to the oncoming shift members, to ensure that any potential errors may be picked up quickly. The manager signs a record to verify that she carries out medication audits but currently this is not underpinned by an audit checklist to show exactly what aspects of the medication system has been checked. The manager said that she would put a medication checklist in place for this purpose. Pia - Princes Street, 46 DS0000004447.V355186.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 procedures are in place for dealing with complaints and staff are trained to recognise and report suspicions of abuse to ensure that the people living at the home are kept safe from harm. EVIDENCE: There have been no complaints made to us since the last inspection and the manager reports that no complaints have been made directly to the home during the same period of time. The complaints log was examined and seen to contain evidence of the service manager’s signature where she monitors any complaints made to the home. An easy read version of the complaints procedure including pictures and symbols is available for people in the home and the service user guide contains a copy of the complaints procedure. The manager said that she intends to send out a copy of the service user guide to relatives again shortly to keep them updated. A questionnaire completed by a relative confirms that she has been informed how to raise any complaints with the home. Staff confirmed that they are provided with vulnerable adult abuse training. This was verified in a sample examination of staff training certificates and training records. Staff also confirmed that they had seen the adult abuse and whistleblowing procedures informing them how to report any suspicions of abuse or other concerns about the running of the home, should they need to do so. Two staff said they were booked to attend whistleblowing training the next day and this was also seen to feature on the staff training plan. Pia - Princes Street, 46 DS0000004447.V355186.R01.S.doc Version 5.2 Page 19 Lockable storage arrangements are in place for the safekeeping of people’s money. Two people’s expenditure records were checked. The records account for how people’s personal money is spent and receipts are being retained as evidence of items purchased. The money is checked each shift by the shift leader and a record is signed to verify that the money balances correctly and the manager also checks and signs the record regularly to verify that the expenditure records are correct. Periodic audits are also carried out by an officer of the organisation to check that people’s money is correctly accounted for. The manager said that all savings accounts are in people’s own names and two signatories (manager and finance officer) are required in order to withdraw money on people’s behalf. Pia - Princes Street, 46 DS0000004447.V355186.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 adequate. This judgement has been made using available evidence including a visit to this service. People are provided with a clean, comfortable home. The rating for this group of standards is compromised by the problems adjusting the radiator temperatures in the home to ensure that a comfortable room temperatures are consistently maintained. EVIDENCE: 46 Princess St provides accommodation for 7 people. The main lounge is comfortable and equipped with domestic style furniture. The lounge furniture is comfortable and two dining tables are in place to enable people to have space to sit and eat together comfortably. Overall the home is well decorated and in good condition. People’s bedrooms are clean and well furnished and people have been encouraged to choose the colours to match their personal tastes. Two bedrooms have recently been decorated to make them more comfortable and appealing. All the bedrooms contain evidence to show that people have been supported to personalise their Pia - Princes Street, 46 DS0000004447.V355186.R01.S.doc Version 5.2 Page 21 rooms to their own liking e.g. with photographs, pictures, TV’s music playing equipment and other personal possessions. A wheelchair user has a bedroom situated downstairs in the home. Good work has taken place to arrange for track hoisting to be fitted to support safe moving and handling practices. A specialist bed is also in place for this person and a very attractive, colourful mural has been painted on the ceiling. A downstairs bathroom also provides shower facilities. A shower chair is available for use by a wheelchair user. The space available in the shower for providing personal care support is very limited and the bathroom is looking drab and would benefit from refurbishment. The manager explained that builder’s quotes are being sought to convert the bathroom into a wet room with walk in shower facility. Several radiators were switched off and one person’s bedroom was very cool as a result. The manager turned on the radiator in this room with assistance from the inspector, to help remove the radiator cover. Most radiators have covers and it takes two staff to lift them off, to gain access to radiator valves, to adjust the temperature. The valve on one radiator had seized up and would not turn on. This situation makes it difficult for staff to adjust the room temperatures as the presenting weather conditions demand. The manager agreed to write a risk assessment to reduce the potential for people being scalded by the downstairs shower room radiator, as this does not have a radiator cover fitted currently. The manager explained that the radiator would be moved as part of the planned bathroom refurbishment at the home. Overall the home is clean and free from unpleasant odours. Suitable arrangements are in place for carrying soiled clothing to be laundered. A suitable waste disposal contract is in place at the home so that continence products can be disposed of hygienically. Protective aprons and gloves area available for staff to use when carrying out personal care tasks and the home has an industrial washing machine with sluice facilities. Training information provided by the manager and comments by staff confirm that they receive infection control training. Pia - Princes Street, 46 DS0000004447.V355186.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 well trained to equip them for their work and satisfactory recruitment procedures are in place to ensure that suitable staff are employed at the home. EVIDENCE: The manager reports that three staff have joined the team from other homes run by people in action and three staff have left the home. There is still a core team of staff that have remained constant at the home, supporting consistency of care for people. At night one member of staff sleeps in. A member of staff confirmed that in the past, extra staffing has been provided where people’s needs have required it, e.g. Extra support for a person experiencing a mental illness episode. On the day of the site visit there were four staff on duty including the manager providing care and support to the seven people at the home. Discussions with staff indicate that the home continues to maintain satisfactory staffing levels, which is typically three or four staff on each shift, including the manager. Pia - Princes Street, 46 DS0000004447.V355186.R01.S.doc Version 5.2 Page 23 Two staff recruitment files were sampled. Both files contained information to demonstrate that staff are properly recruited and vetted. The information included application forms and interview reports as well as records of Criminal Record Bureau checks and references taking place prior to staff starting work at the home. In the annual quality assurance questionnaire completed by the manager as part of this inspection she reports that 78 of staff have currently achieved National Vocational Qualifications (NVQ’s) at level 2 or above. All the staff spoken to confirmed that they have been provided with access to a very good range of training opportunities, including Learning Disability Award induction training and regular training updates in Health and Safety related subjects such as first aid, food hygiene, fire safety, moving and handling. Similarly staff have been provided with a good range of courses to support sensitive care practices, such as epilepsy, mental health awareness, communication, makaton, equality and diversity and adult abuse awareness. This information was verified in staff training records and samples of staff training certificates. As previously noted the manager said that she would be putting more staff forward for sexuality and personal relationship training. . Pia - Princes Street, 46 DS0000004447.V355186.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 suitable arrangements are in place for ensuring a quality service and good systems are in place for maintaining a safe living environment for people. EVIDENCE: The manager holds the Registered Mangers Award and has recently completed the National Vocational Qualification, level 4, in Care. Her qualifying certificates were seen on file at the home. These qualifications equip her for the role of Registered manager. The manager explained that she intends to send out questionnaires to service users, relatives and professionals in January to seek their views of the home. Meetings regularly take place each month involving the people at the home discuss day to arrangements, such as weekend relatives visits, activities and holidays. The notes of the meetings show that this is also used as an Pia - Princes Street, 46 DS0000004447.V355186.R01.S.doc Version 5.2 Page 25 opportunity to check if anyone has any concerns or complaints they wish to raise. Reports of monitoring visits, carried out by the service manager, are kept on file along with action plans that have been drawn up by the home manager to address any shortfalls that have been identified. As previously noted shift handover reports are signed by staff as evidence they have carried out checks of people’s money and medication. Staff confirmed that are provided with regular planned supervision to support them in their work and personal development. This was also verified in a sample of staff supervision records that were seen on staff files. The fire safety records were sampled. The log indicates that fire alarms are being tested on a weekly basis as required and periodic drills are carried out at the home. Maintenance records demonstrate that fire safety equipment is being properly maintained and checked a qualified contractor. The lights are currently being tested every 3 months instead of monthly as recommended by the fire safety officer. The manager explained that this is because the recording forms are formatted to prompt 3 monthly checks and agreed to increase the checks to monthly. Staff induction records show that new staff are taken through the fire procedures when they start work at the home. A landlord gas safety certificate provided evidence that gas appliances have been safety checked this year and electrical appliance testing records on file demonstrate that that electrical equipment has been checked and is operating safely. Risk assessments are in place providing staff with advice on the safe use of cleaning materials and hot water monitoring records were seen, demonstrating that hot water is being maintained at a safe temperature to avoid the risk of scalding. Records show that showerheads are being routinely de-scaled and flushed to reduce the potential risk of legionalla developing in the home. Dated maintenance stickers were seen on lifting equipment demonstrating that a suitable contractor has recently serviced this equipment. Pia - Princes Street, 46 DS0000004447.V355186.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 3 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 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Version 5.2 Page 27 Pia - Princes Street, 46 DS0000004447.V355186.R01.S.doc 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. Standard Regulation Requirement Timescale for action 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 YA5 Good Practice Recommendations Amend the service user guide to include the fees for the service and any additional extras. Amend the service user contracts to ensure that any extra charges levied for the use of the home’s transport or other services are accurate and are updated each year as they change. Arrange access to suitable scales to effectively monitor the weight of a wheelchair user on weight reducing dietary measures. Proceed with plans to put a medication checklist in place to underpin medication audits at the home, so as to make it clear what has been checked. Action should be taken to make it easier for staff to regulate the temperatures of radiators (e.g. by fitting thermostatically controlled valves) to ensure that comfortable room temperatures are maintained at all times. 3 4 5 YA19 YA20 YA24 Pia - Princes Street, 46 DS0000004447.V355186.R01.S.doc Version 5.2 Page 28 6 YA42 Proceed with plans to increase emergency lighting checks to once monthly. Pia - Princes Street, 46 DS0000004447.V355186.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 - Princes Street, 46 DS0000004447.V355186.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. Re-publishing this information is in breach of the terms of use of that website. 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