CARE HOME ADULTS 18-65
Primrose Place 34 Somerset Road Handsworth Birmingham B20 2JD Lead Inspector
Joe OConnor Unannounced 20 June 2005 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 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 Stationary 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. Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Primrose Place Address 34 Somerset Road Handsworth Birmingham B20 2JD 0121 554 0440 0121 241 2597 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr David Cobley Mr David Cobley Care Home 5 Category(ies) of Younger Adults, Learning Disability, Sensory registration, with number Impairment of places Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Residents must be aged under 65 years Date of last inspection 3 March 2005 Brief Description of the Service: Primrose Place is a Victorian style semi-detached house located in Handsworth Wood. It lies in a quiet residential neighbourhood, close to local amenities including shops, parks and bus routes. The service offers quality accommodation for up to five adults with sensory impairment and/or learning disabilites. There is a comfortable service users lounge with sensory equipment and large separate diningactivites room with a piano. There is a kitchen, which service users can access. A separate laundry room is at the rear of the kitchen. There are five single bedrooms, three of which have en-suite facilites. Those service users who dont have these facilities have access to a bathroom and separate toilet. Off road Parking is available for one car at the front of the house. To the rear of the house is an easily accessible garden with a lawn, shrubs and trees. There is also an attractive blocked paved area leading to the summerhouse. The home is decorated in bright colours with touch indicators in the ledges and handrails to enable service users who are visually impaired to get around the premises.
Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place during the afternoon until early evening. All five service users were present and one was able to covey their views on life in the home. The other service users had limited verbal communication and were unable to contribute their views in full. Discussions were also undertaken with three members of staff. A limited tour of the premises was undertaken. Service users care plans and risk assessments were inspected. Staff recruitment and training records were examined and a number of health and safety records were also sampled. The Inspector had opportunity to talk to the Registered Manager. What the service does well:
Service users live in premises where its external features are similar in design and structure to that of neighbouring properties and its purpose as a care home is not distinguishable. The service has an accreditation with The Royal National Institute for The Blind. This means the service is suitable in meeting the needs of service users with what is known as sensory impairment and that specialist training is provided for staff so they have a better understanding around the issues of sight loss and how they should help service users with these difficulties. One service user was able to provide some of her views about life in the home. She stated that her favourite lunch provided by staff was corn beef hash. She also said the staff were nice and friendly. Staff demonstrated a good understanding of the needs of the current group of service users and during this inspection, was observed to provide friendly and professional support. Service users were relaxed in the presence of staff and were dressed appropriately for the climate of the day. It was evident that service users were able to choose what they wanted to do such as when to go to bed or when to get up and what kind of activities they wanted to do. Other means of communication are used by staff to help those service users who have limited verbal communication such as the use of pictures, symbols and sign language such as makaton. Service users are able to access various healthcare professionals including a GP, Optician, Dentist and Chiropodist. There was evidence the service maintains very good links with specialist support services such as a consultant psychiatrist. The manager has introduced individual Health Action Plans that set out how each service users’ healthcare needs are to be addressed. A sample of service users records found that there were detailed information with regard to how the needs of the service users were to be met. There were risk assessments covering a range of activities including movement and handling and how service users should be assisted in the community.
Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: 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. Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, & 5 Service users needs are known through detailed assessments covering all aspects of their daily living activities. The needs of the current user group are met through the maintenance of detailed care records and with a committed staff team who have knowledge of individual needs. Service users have a statement of terms and conditions that informs them of what they are paying for when they are admitted to the service. EVIDENCE: One service user was able to provide their views on life in the Home. Comments received from the service user was positive about the staff team and manager. The service user said she liked living in the Home because she was able to have her favourite meal of corn beef hash. Observations at the time of this inspection found that service users were dressed in clothing appropriate for the climate of the day and looked well cared for. Staff were observed to provide professional, but friendly support to service users. In conversation with staff they were able to demonstrate their knowledge around the needs of the current group of service users. Two service users care records were sampled and it was found each one had detailed assessments covering areas such as communication, life skills, behaviour and dietary needs. The assessment also covered areas such the level of sensory impairment affecting the service user.
Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 9 There was also evidence that social workers had provided the service with assessments and initial care plans prior to admission. Further examination of the service users care records found that each one had a written statement of terms and conditions and a three way agreement provided by the Local Authority. Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, & 9 How service users needs are to be met are set out in detailed care plans. These cover service users individual likes and dislikes and how their goals are to be achieved in a person centred approach. Staff encourage service users to make decisions with regard to their daily routine on a day to day basis, using other means of communication where appropriate. Service users have risk assessments in place that ensure staff are aware of how service users are to be escorted and transferred. EVIDENCE: Each service user has a detailed care plan that covers all aspects of their daily living. The care plans contained specific details about likes and dislikes. One care plan sampled had a detailed breakdown of one service users’ morning and evening routine. The manager has been developing Person Centred Plans that included the use of photographs with information about for example people who are important in the service user’s life. Further examination of the care plans covered teaching programmes where service users are able to develop particular skills such as using public transport, domestic and leisure activities. There was evidence to confirm that the care plans were being reviewed and that service users’ family were involved in the reviews and look at new goals to achieve.
Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 11 One example was for one service user to start working towards losing weight. There were detailed risk assessments covering escorting service users in the community and for bathing. Each service user has a behaviour management profile that clearly explains to staff how service users should be approached should any difficulties occur. There are no formal service users meetings and the process of decision making is made on a day to day basis with the support of staff. One service user is assisted to make decisions through the use of a photograph boards covering areas such as meals, activities and members of their family. Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14,15,& 16 &17 Staff encourage service users to develop their independence through appropriate means of communication for those with limited or non verbal means. Service users have access to leisure activities in the community that are age appropriate and also receive organised activities provided by other agencies. Service users routines are not subject to any unnecessary restrictions subject to their individual risk assessment. Service users are encouraged to maintain contact with family members and positive relationships are maintained with staff providing a relaxed atmosphere. Service users are provided with a nutritious varied diet that promotes healthy eating. EVIDENCE: Service users are assisted to communicate their needs in different ways. For those with limited or non verbal communication staff use sign language such as makaton. Service users’ care plans indicated that service users are encouraged to be independent in carrying out domestic tasks. For example one service user is working towards a goal in that he will empty his rubbish bin every week and go to the local re-cycling centre.
Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 13 Service users have access to daytime activities that are provided by the service and from other agencies. One service user had gone out swimming with the manager earlier in the day. The service user also had a daily programme of exercises to assist with reducing his weight. There is multi sensory equipment available in the building. Service users also go out into the community for shopping and for walks in the local park. Service users are able to maintain contact with relatives and friends. The manager advised that the service users would be going on holiday later this summer to Wales. Staff confirmed there were no unnecessary restrictions in place and that the service users were free to do what they pleased. Service users routines were known and respected. It was evident that staff maintains positive relationships with the service users. A sample of the menu book found that service users are able to have a choice of meals and a record is maintained of food and drink consumed by the service user. Specific dietary requirements are met. For example one service user is of the Sikh religion and there were guidelines in place to inform staff that the service user should not be served beef. Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 Service users receive support with personal care and choose when they require assistance. Service users are able to access community and specialist primary healthcare services through good recording systems. The development of Individual Health Action Plans for service users demonstrates good practice within the D.O.H white paper Valuing People. Medication management is good with some minor improvements required in ensuring good health of service users is promoted. EVIDENCE: One service user was able to state that she could get up and go to bed when she wanted to. A sample of service users daily living records referred to where assistance was given to service users with their personal care. There were risk assessments for the movement and handling of service users covering areas such as when they use the bath or shower. Service users are able to access healthcare services in the community such as the GP, Dentist, Optician and Chiropodist. There was evidence from a sample of service users records that good relationships are maintained with specialist services provided by the Primary Care Learning Disability Trust. The manager has recently introduced Health Action Plans for each service user in line with the government’s white paper on Valuing People.
Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 15 These covered an outline of the service user’s current state of health and what action is required to address any unmet needs. A record of service users’ weight is carried out every month. The management of medication was found to be good and there was evidence to confirm that the manager undertakes regular spot checks in monitoring staff competency when administering medication. There were written protocols in place for the use of rectal diazepam and for PRN or as required medication as it is known. Care must be taken however, to ensure that any medication being added to the Medicines Administration Records (MAR Charts) are booked in prior to administration. All staff have received accredited medication training. Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 A complaints procedure is in place for service users and neither their families and clearly sets out the process of the action to be taken when a complaint is made. Staff receives appropriate training in the protection of vulnerable service users backed up by appropriate policies and procedures. EVIDENCE: There is a complaints procedure that is clearly written and the service nor the CSCI has received any complaints since the last inspection. One service user who was able to contribute to the inspection stated she felt staff would listen to her if she were unhappy about support she was receiving. Staff training records examined found that the majority of staff had undertaken training in areas such as the abuse of vulnerable adults with a learning disability and managing challenging behaviour. One member of staff who had only been in post for just over two months was able to confirm her knowledge of the adult protection guidelines and stated that she would be able to report any poor practice to the manager. Service users personal allowances were not examined during this inspection and will be examined at the next visit. Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, & 29 The premises is maintained and cleaned to an acceptable standard. Appropriate use of colour co-ordination throughout the building enables service users with sensory impairments to access the premises without any apparent hazards. EVIDENCE: A tour of the premises was undertaken at the time of this inspection. The building was found to be clean, tidy and there was no presence of any offensive odour. The premises have grab rails in the corridors and there was good use of colour co-ordination to assist those service users with sensory impairment to be able to mobilise around the premises freely. The rear garden was found to be well maintained. There is a grab rail on the first floor bathroom to assist service users in getting in and out of the bath. A new window frame had been fitted in the kitchen since the last inspection and the manager stated that when the service users go on holiday later this summer two service users will have their bedrooms re-decorated and new carpet fitted. Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 & 36 Service users are supported by staff that are competent and qualified to meet their needs. Current staffing levels meet the needs of service users that provide adequate cover throughout the day with night wake support staff during the night. Staff recruitment records meet the requirements of the regulations ensuring the protection of service users. There is a programme of training and supervision that enables staff to undertake their duties effectively. EVIDENCE: Staff demonstrated an understanding around the needs of the current service users and provided positive interactions with the service users. Observations indicated that service users were comfortable when supported by staff. The levels of staffing were found to be appropriate at the time of this inspection. The service has a low turnover of staff and the manager stated that he was recruiting for temporary staff to cover two members of staff who were due to take maternity leave. Staff recruitment records were found to be clear and well structured. Three staff files were sampled and there was CRB checks, job application forms, job description, two references, proof of ID, personal details, photograph and contract.
Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 19 One file examined confirmed that the manager had obtained appropriate documentation with regard to one member of staff who had recently settled in this count from the EU and there was evidence of Home Office documentation in place allowing the individual to work. A record of staff training was found on staff members files sampled with evidence of certificates of training courses completed and evidence of qualifications. An examination of these records found that staff had inductions and had completed an induction checklist. The majority of staff had completed training in first aid, manual handling, food hygiene, accredited medication training and fire safety. Specialist training had also been completed in areas such as the use of rectal diazepam medication. The service has links with the Royal National Institute for the Blind where staff undertake distance learning training that is specific to working with service users who have sensory impairment. The manager stated that staff were being put forward to complete training towards the Learning Disability Award Framework or LDAF as it is known. The level of staff supervision was found to be frequent and occurring every two months. Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 41 & 42 Service users live in a home that is run by a competent manager. There is an open relaxed atmosphere that benefits service users and staff. The records were generally up to date for the safety of service users. The health and safety of service users is promoted with some improvements required. EVIDENCE: The manager was present during this inspection and demonstrated an understanding about the needs of the service users in his care. Comments made were received positively with the manager willing to improve upon good practice. The atmosphere was relaxed and friendly with staff expressing positive comments about the working relationships between colleagues and management team. Staff stated that there was good communication within the staff team and they could raise any concerns with the manager. Service users were observed to enjoy a relaxed atmosphere. Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 21 Records were found to be up to date and locked away in a secure facility. Health and safety records were to a certain extent satisfactory but it was noted that the monthly record for the testing of water temperatures had not been completed during May this year. There was evidence however, to confirm that records for the testing and servicing of fire fighting equipment were found to be up to date. A risk assessment for the prevention of fire was also in place. There was also a record to confirm that a fire drill had taken place prior to this inspection. An examination of the accident book found that there only four accidents since the last inspection. However, it was noted that two of these where an injury had occurred had not been reported to the Commission via Regulation 37 notification. Discussion with the manager also identified the need for an up to date Regulation 37 form. The main kitchen was found to be clean and tidy, although it was noted that the records for the refrigerators’ temperatures had not been completed on a daily basis. An examination of the first aid box found a number of sterile dressings to be passed their expiry date and action must be taken in setting up a monitoring system and check the first aid box every month. Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 x 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x 3 x Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Primrose Place Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x 3 2 x E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 23 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 20 Regulation 13(2) Timescale for action The Registered Person must From 20 ensure that medication is booked June 2005 in on the Medicines and Administration Records (MAR Ongoing Charts) prior to administration. The Registered Person must From 20 ensure that any accident in the June 2005 and care home is reported to CSCI without delay. Ongoing The Registered Person must 20 July undertake regular checks to 2005 ensure the first aid boxes have up to date sterile dressings. The Registered Person must From 20 ensure that records for the June 2005 refigerators are maintained on a and daily basis. Ongoing Requirement 2. 42 13(4) 37(1) 13(4) 3. 42 4. 42 13(4) 5. 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 Good Practice Recommendations Primrose Place E54 S16974 Primrose Place V231733 200605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Birmingham & Solihull Local Office 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham, B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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