Inspection on 24/01/08 for 79 Slade Road

This inspection was carried out on 24th January 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

79 Slade Road 22/01/09

79 Slade Road 02/12/06

79 Slade Road 15/02/06

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Slade Road, 79 Erdington Birmingham West Midlands B23 7PN Lead Inspector Sarah Bennett Unannounced Inspection 24th January 2008 09:30 Slade Road, 79 DS0000065020.V356259.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 Slade Road, 79 DS0000065020.V356259.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. Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Slade Road, 79 Address Erdington Birmingham West Midlands B23 7PN 0121 326 7152 F/P 0121 326 7152 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) www.CareTech-uk.com CareTech Community Services Ltd Vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd December 2006 Brief Description of the Service: 79 Slade Road is a care home, registered to provide care and support to four people with a Learning Disability. At the present time the home accommodates three men, who also have some behaviours that challenge. The home is staffed 24 hours a day; overnight staff provision is one waking night staff and one staff sleeping in on the premises. The home has four single bedrooms. Three are on the first floor, and people require full mobility to access this area of the home. There is also a bathroom and staff office/sleep in room on the first floor. On the ground floor there is a communal lounge, dining room, kitchen, WC, and laundry area. The home has one ground floor bedroom, also fitted with an en suite. The home is located in Erdington, Birmingham and is located close to local facilities and is conveniently sited for access to public transport. The manager said that the fees had not yet been stated in the service users guide, as they change in the new financial year. The last inspection report is available in the home for visitors who wish to read it. Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection took place over one day by one inspector and was unannounced. This is the home’s key inspection for 2007-08. The inspector met the people living at the home, spent time observing support and interactions from staff, looked at care records, health care records and medication management. Health and safety records and staffing records were also assessed. All information looked at was used to determine whether people’s needs are being effectively met. Due to peoples communication needs discussions with some people was limited. Two people were identified for close examination this included reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as “case tracking” where evidence is matched to outcomes for the people living there. Questionnaires were given to the people living there and staff as part of the fieldwork for this inspection. These were completed by all the people living there and two staff. What the service does well: The people living there said that staff listen to them and act on what they say. The people living there have the information they need about living at the home and what they can expect from the service that is provided. This information also included pictures making it easier to understand. Before people move into the home an assessment is done to make sure the person’s needs could be met there and staff know how to help them. The people living there are helped to keep in touch with their family and friends and the people that are important to them. The people living there said that the staff treat them well and that they are happy living there. Each person had their own bedroom and these contain the things that are important to each of them. Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 6 Senior managers from the company visit the home every month and write a report about this. This shows that they are aware of their responsibilities and take them seriously. What has improved since the last inspection? What they could do better: Health records must be better to make sure that people’s health needs are met so that they are well. More staff must work there and they must have training so they know how to meet the needs of the people living there. The gate at the front of the home must be fixed to make sure the people living there are safe. Water temperatures must be regularly recorded and monitored to make sure that the people living there are not scalded. Staff need to follow what it says in individuals care plans to make sure they help people to meet their needs. The people living there should often be offered activities in the community and do the things they enjoy doing. The people living there should be offered a healthy diet that ensures their health and well being. Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 7 The medication that people have should be managed better so that people have the medication they need at the right time. The home should be redecorated where needed and broken furniture fixed or replaced so it is homely and comfortable for the people living there. The boiler should work well so that there is hot water when people want it so they can wash in warm water. There should be more staff meetings and staff should have regular supervision. This will make sure they know how to help the people living there. The company should consider providing a computer with an email facility for the home. This would help the staff and the manager to make sure that the home is better run. The manager should make sure that the electrical wiring in the home is safe for the people living there. 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. Slade Road, 79 DS0000065020.V356259.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 Slade Road, 79 DS0000065020.V356259.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available so that prospective service users can make a choice as to whether or not they want to live there. The assessment process ensures that individual’s needs are assessed before they move in so it is clear whether or not they can be met at the home. EVIDENCE: Each person had a copy of the service users guide to the home. This was produced using pictures and written in an easy read style making it easier to understand. The manager said that the fees had not yet been stated in the service users guide, as they change in the new financial year. When the current fees are known these should be added so that people know how much it costs to live there. Since the last inspection one person had moved into the home. Their records included an assessment of their needs completed by the manager so it was clear as to whether or not they could be met at the home. The person’s social worker also completed an assessment before the person moved in. Before they moved in a planning meeting took place involving their family, the community Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 10 nurse, social worker and the manager of the home. The manager said as the person was in hospital it was not possible to visit the home for an overnight stay as the hospital could not re-admit them once they had been discharged overnight. The manager said that a person would usually visit for an overnight stay and a weekend before they move in. Sadly, one person living in the home has died since the last inspection. Therefore, there remains a vacancy for one person. The manager said they had received a referral for someone to move in and would be starting the assessment process to see if their needs can be met there. Slade Road, 79 DS0000065020.V356259.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, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff have the information in care plans and risk assessments so they know how to support the people living there to meet their needs, achieve their goals and ensure their safety. However, staff do not always follow these to ensure individual’s needs are met. The people living there are not often offered the opportunity to make choices and decisions about their day-to-day lives. EVIDENCE: The manager said that in the next couple of months individual’s care plans are to be developed further to ensure they include all needs and goals of the individual. The records of two of the people living there were looked at. These included an individual care plan. These stated how staff are to support the person with Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 12 their personal care, mobility, communication, going out in the community, nutritional needs, health needs and their behaviour. The care plan was detailed so that staff had the information they needed to support the individual in the way they wanted. Regular reviews of individual’s care plans had been completed and the person was present at their review so they could have an opportunity to say what they wanted. Care plans included goals that the person wanted to achieve and when they wanted to do these by. Some records sampled showed that staff are not following individual’s care plans so it is not always clear that their needs are being met. This is detailed further under the ‘Lifestyle’ and ‘Personal and Healthcare Support’ sections of this report. One person has an advocate and their records showed that they attend their care plan reviews so they can ensure that the views of the person are being listened to. Records included the minutes of two meetings with the people living there in 2007. People talked about clothes they wanted to buy, what they wanted for Christmas, food, buying new furniture for their bedroom, what colour to paint the lounge and where they wanted to go on holiday. A record using pictures was in place for recording ‘Talk Time’ between the person and staff so they had an opportunity to talk about the things they wanted to do. Records sampled included only a few completed records of this indicating that these do not happen very often. Records sampled included individual risk assessments. These stated how staff are to support the person to do things whilst minimising the risks to their safety and well being. These included using electrical equipment, going out in the community, using the kitchen, medical conditions, health needs, personal care, using vehicles, locking the front door, during the night, crossing the roads, household tasks, bathing, inappropriate behaviours, abuse, personal finances and activities in the home. Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are not always sufficient to ensure that the people living there experience a meaningful lifestyle. Arrangements do not ensure that all the people living there are offered a healthy diet to ensure their health and well being. EVIDENCE: One person used to go to college but unfortunately the funding for their course had recently been withdrawn so staff were now looking for an alternative meaningful activity for them. One person goes to college two days a week and said that they enjoy going. A Community Options Officer had been involved with one person living there to look at possible options of activities they could do. Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 14 One person’s care plan stated that they disliked staying in for consecutive days. Their records sampled showed that in twenty days they had been out of the home five times. Some records stated that the home was short of staff so the person could not go out. Individual’s records included a ‘life and leisure experiences plan’ that stated what the person wanted to do in each month. One person’s record stated that during January 2008 they wanted to visit the theatre or cinema, go for a walk in the local community, go for a bus ride or drive in the car and have their haircut. Their records stated that up to the date of the visit they gone for a bus ride or drive in the car twice but had not achieved any of the other activities. Records did show that the people living there were supported to go to the barbers, shopping, to the cinema, to pubs and to restaurants but it was not evident that these activities always happened as much as the person would want them to. People are supported to use public transport or to walk to do local activities. Records showed and the manager said that one person had booked to go to Blackpool and another to Wales for a long weekend with staff support. The other person had not yet decided where and when they wanted to go on holiday. Records sampled showed that where appropriate the people living there are supported to keep in contact with their family and friends. This is through visits to them, visits from them, telephone calls and buying gifts and cards for special occasions. The manager said that contact had recently been made with one person’s relative after a number of years. It was evident that the manager was sensitive as to ensuring that the contact was appropriate so it was positive for the person living there and their relative. Records sampled showed that people are involved in household tasks regularly, which would help them to develop their independence skills. These include cleaning, helping to prepare meals, shopping and doing their laundry. Smoking is not allowed in the home. This is stated in the service users guide so that the people living there are aware that they can only smoke in the garden. The front door is locked as it had been assessed that leaving it unlocked would present an unacceptable risk to the people living there. A written risk assessment is in place for this that is reviewed regularly to ensure that it is still necessary to safeguard the people living there. Food records showed that culturally appropriate foods were provided to individuals. One person’s review meeting minutes stated that staff were going to encourage the person to be more involved in choosing what cultural foods they wanted by pictures and photographs of different types of food. People said that they go shopping for food with staff and have a chance to choose the foods they like to eat. One person’s food records sampled showed that staff Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 15 are following the advice of the dietician to ensure the person’s nutritional needs are met. Food records sampled for one person showed that in six days they had eaten chips three times. However, their care plan stated that to manage their weight and encourage healthy foods they should only have chips a maximum of twice a week. The manager said that she has weight watchers recipes that she is going to bring in and there is a healthy eating booklet in the home. The manager said she would encourage staff to use these so they have the information to provide a healthy diet for the people living there. Slade Road, 79 DS0000065020.V356259.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, 20, 21 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living there are well supported with their personal care but their health needs are not always well met. The management of the medication systems are not always sufficient to ensure that people get the medication they need when they need it. The death of a person living there had been handled with respect. EVIDENCE: Care plans detailed how individual’s are to be supported with their personal care. The people living there had been well supported with their personal care. People were dressed appropriately to the weather, their age, gender and the activities they were doing. This is good for their self esteem and well being. One person said they go with staff to buy their clothes and enjoy doing this. Records sampled showed that health professionals are involved in the care of individuals when needed to advise as to how their health needs should be met. Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 17 One person’s records showed they had a blood test and as their blood sugar was slightly high their GP had recommended that they have an ‘after fasting’ blood test. There was no record of this happening. Individual health action plans had been started. This is a personal plan about what a person needs to stay healthy and what healthcare services they need to access. The manager said they are going to develop these and then they would include outcomes of appointments and what action has been taken to follow the advice of professionals and ensure individual’s health needs are met. One person’s care plan stated that to monitor their weight and ensure their health and well being they should be weighed weekly. Their weight chart showed they had been weighed on 5th January but not since. Another person had been weighed weekly as stated in their care plan. Their weight chart showed that their weight was stable indicating that their nutritional needs are being met. The manager said that dental and optician appointments are booked in the next couple of weeks for the people living there and chiropodist appointments the week after that. All the people living there are also having an annual health check over the next few weeks to ensure that any health needs are detected so they can be met. Staff were observed responding to individual needs and giving them a painkiller tablet when needed to ensure their well being. The area manager looked at the medicine management systems as part of their monthly audit being completed at the same time as this inspection. They said that weekly audits of medication had been completed to ensure people are having their prescribed medication. Medication had been given as prescribed although some pain killer tablets had not been signed for when given. One person is prescribed two different PRN (as required) medications. A protocol was in place for each one that stated when, why and how much of the medication should be given to the person. However, it was not clear which one would be more effective at different times. They both seemed to be prescribed to help the person when they are agitated if distraction techniques did not work. Records showed that PRN medication was not often given to the person as other techniques helped to calm them down. The area manager suggested it would be helpful to have a rationale of which one to use and when and the manager said that she would seek advice from the community nurse and the psychiatrist. Sadly, since the last inspection one person had died suddenly at the home. Records sampled showed that the other people living there had been supported through the grieving process. Where necessary health professionals had been involved in supporting them through this. Staff records also showed that staff had been given an opportunity to talk about the person’s death and had been Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 18 supported by the manager. Records showed that individuals and their relatives had been consulted on their wishes when they die and these had been written down. Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 19 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, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements generally ensure that the views of the people living there are listened to but action is not always taken to ensure individual’s well being and safety. EVIDENCE: The complaints procedure was produced using pictures making it easier for the people living there to understand how to make a complaint if they wanted to. The Commission had not received any complaints about the home since the last inspection. There had been one complaint received by the home from a neighbour about noise made by one of the people living there. In response to this the area manager had asked staff to keep a record of how much noise the person makes and for how long. Staff had kept a record when the person had made a noise but had not recorded the duration of this. The area manager asked them to do this so appropriate action could be taken if necessary to resolve this. A record of individual’s personal belongings was kept but these had not been regularly updated when the person had bought new things. This helps to ensure that people’s property can be tracked and is easier to find out what each person has if something should go missing. The area manager looked at two people’s finance records as part of their monthly audit being completed at the same time as this inspection. Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 20 She stated that the cash balances were correct and the transactions on the records added up correctly. This indicated that staff are spending individual’s money appropriately so they are not at risk of financial abuse. The AQAA stated that all staff have attended training in adult protection and the prevention of abuse. This ensures that they know how to help the people living to be safeguarded from abuse and harm. The people living there can sometimes display behaviour that can be challenging. One person’s records sampled showed that their behaviours had been assessed in January 2006. Recommendations had been made as to how their behaviour could be managed so that they, the other people living there and staff were not at risk of harm. These included communication guidelines to be drawn up, behavioural guidelines to be reviewed and all staff to have challenging behaviour and intervention training. These recommendations had and were continuing to be met. One recommendation was that the person took part in some physical activity twice daily. There was no indication that this had been met and as stated under the ‘Lifestyle’ section of this report their opportunities for activities were limited. This could have a negative impact on their behaviour, which could result in their safety and that of the other people living there being compromised. The person’s behaviours were detailed and four incidents had been recorded in 2007 on their behaviour observation chart. All the behaviours stated were observed during the inspection so it is not clear whether behaviours are still being recorded on this chart. There was one occasion recorded where staff had to use physical intervention to prevent the person hurting themselves and others. This had been recorded appropriately and in line with the Department of Health guidelines on physical intervention. Individual behaviour management strategies were in place and had been regularly reviewed. Where necessary they had been updated to ensure they are still effective in managing individual’s behaviour so to ensure their safety and that of others. Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 21 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, 26, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements had been made to the environment but more are needed to ensure that people live in a homely, comfortable and safe environment. EVIDENCE: Since the last inspection the bathroom had been refurbished so it was pleasant to use and clean. The flooring had also been replaced in the bathroom. The hall and stairs carpets had been replaced. The dining room is homely but needs repainting to make it more comfortable. A new cooker had been provided in the kitchen. This and the ground floor toilet also needed repainting to ensure they are clean and comfortable for the people living there. Bedrooms were decorated according to individual tastes and interest and contained personal pictures and photograph. There was a strong odour of urine in one person’s bedroom but the manager said that the flooring is being Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 22 replaced in this room to attempt to eliminate this. Since the last inspection one person had a new bed and new furniture had been purchased for bedrooms. The front gate was broken and staff said it had been broken for months. They had requested a maintenance visit to repair it and were told it would be done that week but they had not been to repair it by Thursday evening. The lounge had recently been redecorated but it needed to be done again as it had not been decorated properly by the contractors, paint was peeling off the walls and the ceiling paper was coming off. One of the chairs in the lounge was broken. The manager said they had ordered another one and were waiting for it to be delivered. The manager said that new net curtains had recently been bought for the lounge. There is a large walk-in cupboard off the hall on the ground floor where cleaning materials are kept and the washing machine and tumble dryer are stored. The manager said that she had asked for the tumble dryer to be put on top of the washing machine so that these are more accessible and there is more room there. This would benefit the people living there as they help to do their washing but presently space is limited for them to be supported to do this. New windows had recently been fitted in the dining room, kitchen, bathroom and one of the bedrooms making these rooms warmer and more comfortable. Staff said that the boiler is very old and the water is often not hot and very tepid in the bath. Water temperatures had not been recorded in all rooms but it was clear that in some areas the water was cool. Staff said that the budgets and the money allocated to do work in the home seem to be about what is available not what the people living there need or want. The area manager told the manager during the inspection that £1,500 had been allocated for work in the kitchen in May 2008. The manager said the kitchen cupboards were recently replaced so it was not clear what this money had been allocated for. The manager is not aware what is in the home’s budget for maintenance. The area manager said individual home budgets are being implemented and maintenance would be visiting in the next couple of weeks to prioritise works and compile a schedule of works. The area manager said she hopes that a cyclical plan would also be developed to make budgeting more effective. The home was clean and the people living there are involved in cleaning their home. With the exception of one bedroom in which the flooring is being replaced the home was free from offensive odours making it a pleasant place to live. Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements do not always ensure that the people living there are supported by staff that they know and who are qualified and competent to meet their needs. This could impact on their quality of life. The recruitment practices protect the people living there so they are safeguarded from harm. EVIDENCE: The AQAA stated that all of the staff would be working towards achieving their National Vocational Qualification (NVQ) at some point. At present two members of staff are working towards their NVQ 2 and one is working towards their NVQ 4. Two staff are doing their Learning Disability Qualification (LDQ) and another two are about to start this. One person living there requires two staff to support them during the waking hours. In the morning there were three staff plus the manager on duty and in the afternoon there were three staff on duty. At night there is one waking night staff and one person sleeping in on the premises. The manager said there are vacancies for three full time and one part time staff and that one of Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 24 the night staff would soon be leaving. Agency staff are employed to fill the vacancies and several agency staff work there often so they get to know the people living there. Staff said that the use of agency staff could impact on how the needs of the people living there are met and often they receive only basic care. Staff meeting minutes showed that in the last twelve months there had been four meetings. Staff said that the service provided would be better if these were held more regularly. There should be at least six staff meetings in a year to ensure that staff are kept updated with ‘best practice’ and the changing needs of the people living there. Staff had signed to say they had read minutes so if they were not able to attend the meeting they knew what was discussed. Three staff records were looked at. These included the required recruitment records including evidence that a Criminal Record Bureau (CRB) check had been undertaken to ensure that the people living there are safeguarded. Staff said that the required checks were completed before they started working at the home. Training records sampled showed that staff had received training in autism, equal opportunities, medication, health and safety, food hygiene, moving and handling, and physical intervention. All staff have received or are booked to have training in adult protection and the prevention of abuse. Staff records showed that staff had completed the Learning Disability Qualification (LDQ) so they know how to support the people living there. Records sampled showed that they had completed an induction when they first started working at the home. Some staff said that this did not cover all the information they needed to work with the people living there and know how to support them. Rotas showed that staff are booked to receive further training in the next month. Staff said that they do not always get the training that is relevant to their role to help them develop and better meet the needs of the people living there. The manager and two members of staff have completed training the Mental Capacity Act 2005. This Act came into force in April 2007. This legislation requires an assessment of people’s capacity to be done if there is any doubt that the person does not have the capacity to make a decision about their health and welfare. If they are assessed as not having the capacity an Independent Mental Capacity Advocate (IMCA) can be appointed to help them with this. The manager said that other staff are to have this training and the Act is available in the home so that staff can read and know how it may affect the people living there. Some staff said that training is not always available so they can keep updated with new legislation. Records sampled showed that not all staff had received regular supervision sessions with their manager to ensure they were supported in their role and kept updated with how to meet the needs of the people living there. Staff said that supervision needed to be more regular and this would help them feel supported. Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 25 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, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management and record keeping arrangements are not sufficient to ensure that the people living there benefit from a well run home. The people living there can be confident that their views underpin all self-monitoring, review and development by the home. Arrangements are not always sufficient to ensure that the health, safety and welfare of the people living there is promoted and protected. EVIDENCE: The manager has been in post since March 2007. The manager works part of the week as part of the rota. This could impact on the time that she has to do management tasks and as previously stated staff do not receive regular supervision. The manager has not yet made an application to be registered Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 26 with the CSCI but said that she plans to do this soon. The statement of purpose stated that the manager has achieved the Registered Managers Award and NVQ level 4 so they have the required management skills and knowledge. The manager said she is not aware of the budget for the home although the company had recently appointed a Finance Officer who had recently visited and talked about each home having their own budget. This will help ensure that the manager can plan expenditure and budget efficiently so the home can be well run. The manager said that she uses her own laptop to work on producing the needed documents and records, as there is not a computer at the home. They have asked for a computer to be installed with an email facility so they can easily contact the other homes within the company and the Regional Office staff for advice when needed. This would aid communication within the company and ensure the home is better run. The company had provided a printer, scanner and fax machine. Staff said that this was needed to improve communication and provide the necessary tools for them to do their job. Since the last inspection the company had appointed a Quality and Performance Manager. Part of their role is to listen to the views of the people living there about how they want to be supported. They have also implemented a quality assurance system and complete quality audits of the service provided. The area manager visits the home monthly to complete an audit and a report of this is made. These showed that the views of the people living there are considered and how staff are supporting people to make choices. Not all daily records had been completed. In a period of twenty days sampled for one person in January 2008, seven had not been completed in the afternoon and three had not been completed in the morning. Another person’s daily records had not been completed twice in the afternoon in a period of two weeks sampled. These could mean that important information about meeting individual’s needs could be missed, which could impact on their health and well being. Staff said that recording of information about the people living there could improve. The manager said that staff had been nominated to do report writing training. The area manager looked at the fire records as part of their monthly audit. They asked the manager to schedule in a date for reviewing the fire risk assessment in February to ensure that action taken to reduce the risk of a fire are still appropriate. The monthly test of emergency lighting to make sure it is working was overdue by a week. The manager said this would be done. Regular fire drills take place to ensure that staff and the people living there would know what to do if there was a fire. All staff had recently had fire safety training so they know how to prevent fires from starting. Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 27 The date for the testing of the electrical wiring installation to make sure it is safe could not be found so it was not clear if this met with current electrical safety standards. Records showed that a Corgi registered engineer had tested the gas equipment in November 2007 and stated that it was safe to use. Some water temperatures had been recorded as being tested regularly. The records for testing the temperature of the bath were not recorded but staff said they had tested these. It is important to record and monitor all temperatures so that people are not at risk of being scalded. The temperature in the kitchen sink is very hot however a notice was displayed indicating this and the kitchen is locked so the people living there can only go in there supervised by staff. The water in one person’s sink was recorded as being cool but staff said that the person does not wash in there but in the bathroom. Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 28 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 3 2 3 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 3 2 X 3 X 2 2 X Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 29 Yes, one 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 YA19 Regulation 12 (1) (a) Requirement Health appointments and their outcomes must be recorded appropriately to ensure that individuals’ health needs are met. Suitable qualified, competent and experienced staff must be working in the home in such numbers as are appropriate to the health and welfare of the people living there. The employment of staff on a temporary basis must not prevent the people living there from receiving continuity of care as is reasonable to meet their needs. Outstanding from last inspection. The gate at the front of the home must be repaired to ensure the safety of the people living there. Water temperatures must be regularly recorded and monitored to ensure that the people living there are not at risk of being scalded. DS0000065020.V356259.R01.S.doc Timescale for action 28/02/08 2. YA33 18(1)(a)(b) 31/05/08 3. YA42 13 (4) (a-c) 26/02/08 4. YA42 13 (4) (a-c) 26/02/08 Slade Road, 79 Version 5.2 Page 30 5. YA42 13 (4) (a-c) The manager must ensure that the electrical wiring installation meets with current safety standards so it is safe for the people living there. 09/03/08 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. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Refer to Standard YA1 YA6 YA7 YA12 YA13 YA17 YA19 YA19 YA20 YA20 YA22 YA23 Good Practice Recommendations The service users guide should include the fees charged so that people know how much it costs to live there. Staff should ensure that they follow individual’s care plans to ensure their needs are met. The people living there should be offered more opportunities to talk about what they want to do so they can be supported to make more choices in their lives. Staff should continue to explore options available for individuals to take part in meaningful activities. The people living there should be offered regular opportunities to go out in the community and do the things they enjoy doing. The people living there should be offered a healthy diet that ensures their health and well being. Individual health action plans should be developed further to ensure that staff know how to support individuals to be healthy and well. Where it is stated that individuals’ should be weighed regularly this should happen and be monitored to ensure that people are receiving the nutrition they need. As required (PRN) medication protocols should be clearer to ensure that the people living there have the appropriate medication when they need it. All medication should be signed for as it is given to ensure people are getting the medication they need at the right time. In response to the complaint made staff should keep a record of how long the person makes a noise for so that necessary action can be taken to resolve this. Recommendations as to how individual’s behaviour should be managed should be followed. If not this could have a negative impact on their behaviour, which could result in DS0000065020.V356259.R01.S.doc Version 5.2 Page 31 Slade Road, 79 13. YA23 14. 15. YA24 YA24 16. YA24 17. YA24 18. YA33 19. YA35 20. YA36 21. YA37 22. 23. YA37 YA41 their safety and that of the other people living there being compromised. Staff should regularly update individual’s personal belongings records. This helps to ensure that people’s property can be tracked and is easier to find out what each person has if something should go missing. The home should be redecorated where needed to ensure it is homely and comfortable for the people living there. The broken chair in the lounge should be replaced so that there is sufficient comfortable seating for the people living there. The laundry room should be re -organised so that there is room for the people living there to be supported safely to do their own laundry. The boiler should be sufficient to ensure that there is hot water available so the people living there can comfortably maintain their personal hygiene. There should be at least six staff meetings in a year to ensure that staff are kept updated with ‘best practice’ and the changing needs of the people living there. All staff should receive relevant training to their role so they know how to better meet the needs of the people living there. All staff should have regular supervision sessions with their manager to ensure they are supported in their role and kept updated with how to meet the needs of the people living there. The company should consider providing a computer with an email facility for the home. This would enable the staff and the manager to ensure that the home is better run and provide improved communication systems within the company. The manager should apply for registration with the CSCI to ensure the home is well run for the people living there. Records should be completed to ensure that important information about meeting individual’s needs is not missed, which could impact on their health and well being. Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Slade Road, 79 DS0000065020.V356259.R01.S.doc Version 5.2 Page 33 - 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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