Inspection on 08/02/06 for Radnor House

This inspection was carried out on 8th February 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Radnor House 14/08/07

Radnor House 08/11/06

Radnor House 27/07/05

Radnor House 19/01/05

Radnor House 09/08/04

Radnor House 05/02/04

Radnor House 01/10/03

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Radnor House 29/31 Radnor Road Handsworth Birmingham West Midlands B20 3SP Lead Inspector Sean Devine Unannounced Inspection 8th February 2006 09:40 Radnor House DS0000016871.V282659.R01.S.doc Version 5.1 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 Radnor House DS0000016871.V282659.R01.S.doc Version 5.1 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. Radnor House DS0000016871.V282659.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Radnor House Address 29/31 Radnor Road Handsworth Birmingham West Midlands B20 3SP 0121 523 6935 0121 240 9051 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) Mr Leslie Latchman Mr Alfonso Latchman, Mrs Kamla Devi Latchman, Mrs Silvena Latchman Mr Leslie Latchman Care Home 29 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (29) of places Radnor House DS0000016871.V282659.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home can care for service users over 40 years of age for reasons of mental disorder including those who are over 65 years of age. The home must ensure that the changing care needs of the older service users can be met and that these care needs remain under regular review. The home can continue to care for 1 named service user who was under 40 at the time of admission. 19th January 2005 Date of last inspection Brief Description of the Service: Radnor House is a large detached house accommodating 29 residents in the Handsworth area of Birmingham. The home provides ongoing support for residents with enduring mental health needs and partly focuses on the rehabilitation of residents to be more independent. The home is close to shops, a public park, local health centre, community centres and various places of worship. There is a short walking distance to public transport links for Birmingham and West Bromwich. Whilst limited, off road parking is available. Facilities available at Radnor House include 27 single rooms and one double room. Communal facilities consist of three lounges and two dining rooms. Facilities are available to prepare hot drinks in the lounges. A passenger lift connects all floors of the home. There are three toilets on the ground floor one includes a bath. On the first floor there are two bathrooms and a shower room with toilet. The second floor has two shower rooms both with toilets. The bathroom on the first floor has provision for assisted bathing. All bedrooms have wash hand basins. The home has a large rear garden. Radnor House DS0000016871.V282659.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was conducted by one regulation inspector, it was on an unannounced basis over a one day period. One focus of this inspection was to assess progress against the requirements of the last inspection. The inspector was able to meet residents and some staff, sample three residents’ records pertaining to care provision and view some health and safety documents. Communal areas of the home were seen. It is recommended that the previous inspection report dated the 27th July 2005 is considered when reading this report. What the service does well: What has improved since the last inspection? Residents risk assessments have been further developed to include the risks of some residents who do smoke especially in their rooms. Equipment has been replaced in the kitchen and removed where no longer needed. The medicine policy has been updated to include all current practices. Residents have been provided with additional furniture in their rooms to ensure they do not need to put kettles on the floor. Locks on bathrooms have been checked and repaired where necessary. Staff are receiving ongoing training to keep them up to date and competent in all safe working practices, such as fire safety. The care staff are receiving regular and frequent supervision from the management team. Radnor House DS0000016871.V282659.R01.S.doc Version 5.1 Page 6 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. Radnor House DS0000016871.V282659.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Radnor House DS0000016871.V282659.R01.S.doc Version 5.1 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 the following standard(s): 2 Information is not fully gathered to ensure that the immediate and ongoing needs of residents are fully assessed prior to admission. EVIDENCE: The file for a resident recently admitted to the home included some information from other agencies, these were a relapse management plan in respect of mental health, a report from a clinical psychologist and a care programme approach report. The management team confirmed that they had met with social workers and nurses prior to confirming admission. A basic assessment of the residents needs in respect of activities of daily living was not available. Radnor House DS0000016871.V282659.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 9 Residents’ needs are generally met through consultation and the care planning process, risks are mostly identified and strategies to promote safety implemented. Minor improvements are needed to ensure this is fully completed. EVIDENCE: Individual plans are completed from a detailed assessment of activities of daily living. The plans are descriptive to staff and inform them in how to support residents. Plans do include evidence of consultation with residents, however as plans are amended to meet the changing needs of residents there was little evidence of consultation. One residents’ file identified needs in respect of relationships and social needs, however there was no corresponding care plan Care plans and risk assessments are completed that fully describe a management plan to promote the safety of residents including managing aggression, self medication and personal care. The registered manager is aware that some older residents now require more in depth assessments such as nutritional screening, tissue viability and risk of falls and is in the process of developing these. One resident has recently needed to have bed rails attached to the bed, the management team are also Radnor House DS0000016871.V282659.R01.S.doc Version 5.1 Page 10 aware of the dangers of such equipment and confirmed a risk assessment is to be completed. Radnor House DS0000016871.V282659.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 Residents’ needs to ensure they are involved in appropriate activity and supported with maintaining contact with important people in their lives are met by the home. EVIDENCE: Detailed assessments in respect of appropriate and fulfilling activities are completed in consultation with residents, some residents discussed what they enjoyed doing and this included maintaining their faith and in-house activities such as bingo and reading. All residents’ comments were positive about how staff support their choice of activity. As identified in standard 6, the relationship and social needs of residents are assessed. This includes maintaining contact with family and friends, developing new friendships and social occasions with other residents at the home. One residents’ file included the support needed to develop and maintain personal relationships. Residents care plans are then developed and describe how staff are to support the identified needs. Radnor House DS0000016871.V282659.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 20 Residents’ personal care and the management of their medicine is fully assessed and their needs generally met. Minor improvements are needed to ensure this is always safe. EVIDENCE: The level of support needed to meet the personal care of residents varies. Some residents are fully independent whilst others are fully reliant on the support from the staff team. A full assessment of these individual needs are completed and care plans implemented. One residents’ assessment identified areas of concern. A detailed care plan was in place however a risk assessment did not adequately describe how staff would help reduce such risk. The management of residents medicine is good, some areas do need improving including signing for all administrations, ensuring the directions of dosage on the medication administration record fully reflect the GP prescription and completing an individual protocol for each resident who has “as required” medicine. Policies have been further developed to guide staff in the administration of “as required” medicine. Storage of medicines is safe, staff are well trained and residents are supported to safely self-administer their medicine where this is possible. Radnor House DS0000016871.V282659.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Residents and their representatives are supported to raise areas of concern and complaint, when needed this is managed effectively. Residents’ money is not adequately protected to ensure its safety from possible abuse. EVIDENCE: A complaints policy is available and visible for residents and their representatives; information is also included within the statement of purpose and residents guide. A log of complaints is available; no further complaints have been received since the last inspection. The commission has not received any complaints in the past twelve months. The manager has been unable to assist all residents to open individual bank accounts, due to processes external to the home and involving how Social Care and Health make such payments. In order to ensure the safety of residents money held at the home a detailed risk assessment is needed with clear measures identifying how their money will be protected and how they can access their money when needed. Radnor House DS0000016871.V282659.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 The environment is homely but not fully comfortable for residents, improvements are needed to ensure furniture offers adequate support for residents. EVIDENCE: The manager has commenced refurbishing toilets and bathrooms throughout the home, those seen were completed to a good standard with the next phase of replacing flooring due to commence. The furniture in the dining room and lounge areas remains fit for purpose, however consideration needs to be given to replacing some items due to the needs of residents, such as dining room chairs do not have any arms. Most furniture mainly seating in the dining room and lounge areas is “tired” and should be replaced. Radnor House DS0000016871.V282659.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 Residents are supported to have their needs met by good numbers of staff, improvements are needed to ensure records of staff on duty are fully maintained. EVIDENCE: The manager has changed the duty rota to ensure that one of the management team is normally on duty at weekends; this is a positive move and allows for the leadership, development, performance and supervision of care staff that predominantly work at the weekend. The staff duty rota was found to be incomplete in that the full names of some staff and their role was not always included and where managers had been working at the weekend this had not been recorded. Radnor House DS0000016871.V282659.R01.S.doc Version 5.1 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Residents are supported by a competent, well trained and experienced manager who has a focus on positive outcomes. Quality monitoring systems are not in place and residents are not informed of the homes successes or failings. Areas of health and safety need to improved to maintain the well being of residents. EVIDENCE: Residents’ opinions of the manager were altogether positive, they expressed such comments as “he is always here”, “we see him regularly” and “he does talk to us”. Two staff were informally interviewed and felt the manager was approachable, knowledgeable, a good listener and a good trainer. The staff felt he is fair in his decisions and that the home is run well. As outlined in previous reports the manager is well trained, competent and has in excess of 20 years experience of managing the home. The manager confirmed that a quality assurance system has not been fully implemented, however he advised of plans to develop a system. He advised Radnor House DS0000016871.V282659.R01.S.doc Version 5.1 Page 17 that many processes were already in place to gather information and to undertake audits; such as regular residents meeting, care plan reviews and staff meetings. The health and safety tests, checks and maintenance records were sampled. Fire safety is fully completed however the fire risk assessment is due a review. There was concern that the lounge door had been wedged open behind an armchair, this was made safe at the time of inspection. The gas landlord safety checks had been completed and certified as safe. The manager advised that the three yearly testing of electrical installation was in the process of being completed. Radnor House DS0000016871.V282659.R01.S.doc Version 5.1 Page 18 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 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 2 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 X 2 X 3 X 1 X X 2 X Radnor House DS0000016871.V282659.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? Yes 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) Requirement Residents must only be admitted to the home following an assessment by a suitable qualified or trained person. Timescale for action 28/02/06 2 YA6 A copy of the assessment must be available. 15(2)(c)(d) Amendments to individual residents care plans must include evidence of consultation with the residents. Care plans must be completed for residents if a need from assessment is identified, including relationships and social needs. 13(4)(b)(c) Risk assessments and management plans for the use of bed rails must be completed. 12(1)(a) Risk assessments to ensure that 13(4)(c) appropriate actions are taken to reduce risks identified for personal care must be completed. 13(2) All as required medicine must have a written protocol to guide staff and residents in respect of how much medicine and when it can be administered. DS0000016871.V282659.R01.S.doc 28/02/06 3 4 YA9 YA18 16/02/06 28/02/06 5 YA20 16/02/06 Radnor House Version 5.1 Page 20 6 YA20 13(2) Previous timescale of 31/10/06 not fully met, this requirement is carried forward. All medicines must be signed for when administered. 16/02/06 7 YA23 13(6) The medication administration records guidance on administration, including dosage must fully correspond with GP prescriptions. A risk assessment detailing what 28/02/06 is done to adequately protect residents’ money where it is paid into an account in the name of the home must be implemented. A risk assessment detailing how residents can access their money when needed must be implemented. Residents needs in respect of seating must be assessed and where identified appropriate seating provided. Staff duty rotas must be accurately and fully completed. The home must develop and audit a system of Quality Assurance. Previous timescale of 31/8/05 not met, this requirement has been carried forward. Fire doors must not be wedged open. The fire risk assessment must be reviewed and comment made on compliance and findings. 8 YA24 12(1)(a) 16(2)(c) 17(2) Sch 4(7) 24 31/03/06 9 10 YA33 YA39 28/02/06 31/03/06 11 12 YA42 YA42 23(4)(c)(i) 23(4) 11/02/06 31/03/06 Radnor House DS0000016871.V282659.R01.S.doc Version 5.1 Page 21 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 YA3 YA24 Good Practice Recommendations The manager needs to consider the impact of ageing on the current service users and how the home will respond to the potential changes in residents needs in the future. It is recommended that tired and heavily worn furniture mainly seating in the dining area and lounges be replaced. 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