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Inspection on 30/04/07 for St Peters (Flat 1)

Also see our care home review for St Peters (Flat 1) for more information

This inspection was carried out on 30th April 2007.

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

The inspector found 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

St Peters is a comfortable domestic style home. There was a relaxed and welcoming atmosphere. People living in the Home freely accessed all areas of the Home and were supported by staff to listen to music or to do a game or puzzle the interactions between people living in the Home and staff were friendly and respectful. People living in the Home are supported to maintain contact with their family and friends and staff recognise the importance of personal relationships.

What has improved since the last inspection?

The manager had made good progress on actioning outstanding requirements indicating compliance with requirements and ensuring the home improved for the benefit of the people living there. Guidelines for the support people need at meal times had been kept under review with the Speech and Language Therapist so that people are supported safely and assessed needs met. Specialist dining chairs have been purchased so that peoples are comfortable and safe when eating their meals. Wheelchair guidelines are now in place so that people are safe when accessing their wheelchairs. People`s bedrooms have been really improved so that they are pleasant and comfortable and now are a nice room for people to relax in. Staff are now receiving regular supervision and staff training has improved so staff have the skills and knowledge to support people.

What the care home could do better:

There are Five things that must be done. 1 There must be an up to date support plan in place for each of the three people living in the House so that staff know how each of their needs will be met. 2 The manager must make sure that when staff are preparing and cooking food that they do this in a safe way so that people living in the Home are not put at risk. 3 People`s health needs and why they are having treatment from other professionals must be clearly recorded so that staff can make sure that people receive the support they need and understand why the treatment is being done. 4 People living in the Home should not pay for things that the Home should provide like special beds and mattresses. 5 When new staff come to work at the Home the manager must make sure that checks have been made on the person so that they are okay and safe to work at the Home. There are lots of other things that the Home should really think about making better this would really improve things for people living in the Home. People who live in the Home should be involved in putting their support plan together. There should also be individual person centred plans that are in a format that the person can understand and follow. This could be in picture format or on an audiotape. Staff who work in the Home should communicate with people in a way they can understand this could be using photographs and pictures or using signs that people understand. Staff should be trained so they know how to do this. When people living in the Home meet to talk about things in the Home there must be a way of checking out that things have been done and that they have been listened too. When people are checked at night by the night staff it must say how the person wants to be checked.The people who own the Home (MENCAP) need to talk to people about what they plan to do with the Home, so that people know what is happening and where they maybe living in the future. The manager needs to make sure that there is enough staff supporting people so they are safely supported and their needs met and so they can go out if they want to.

CARE HOME ADULTS 18-65 St Peters (Flat 1) College Road Saltley Birmingham West Midlands B8 3TF Lead Inspector Donna Ahern Unannounced Inspection 30th April 2007 & 11th May 2007 11:45 St Peters (Flat 1) DS0000017140.V335752.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 St Peters (Flat 1) DS0000017140.V335752.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. St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Peters (Flat 1) Address College Road Saltley Birmingham West Midlands B8 3TF 0121 328 4054 0121 328 2867 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.mencap.org.uk Royal Mencap Society Miss Yvonne Mae Thomas Care Home 3 Category(ies) of Learning disability (3) registration, with number of places St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years. Date of last inspection 25th July 2006 Brief Description of the Service: SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one long day returning on a second evening to complete the fieldwork. The inspector met all three people living at the Home, spent time observing support and interactions from staff, had a tour of the premises including peoples bedrooms, looked at care records and 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 peoples varied needs are being effectively met. Due to peoples communication needs discussions were limited however the inspector was able to use have brief discussions and used some makaton to St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 5 engage with people and spent time sitting in the lounge observing interactions and support given to people through the afternoon and evening. This included observing the evening mealtime. The three people living at the Home all returned a survey to CSCI known as “Have your say about…” it was recorded that staff had assisted people to complete the survey. A pre-inspection questionnaire was completed and returned by the manager. Information from this was used to inform the inspection. There were concerns at the previous Key inspection July 2006 and as a result of the fieldwork immediate requirements were made. The provider responded appropriately and immediately reviewed management arrangements and the management of health and safety systems in the Home. A Random unannounced inspection was made in November 2006. The focus of the fieldwork was to monitor progress on previous requirements the outcome of the visit was that there was evidence of improvements in health and safety and management arrangement so that peoples were not put at risk. What the service does well: What has improved since the last inspection? The manager had made good progress on actioning outstanding requirements indicating compliance with requirements and ensuring the home improved for the benefit of the people living there. Guidelines for the support people need at meal times had been kept under review with the Speech and Language Therapist so that people are supported safely and assessed needs met. Specialist dining chairs have been purchased so that peoples are comfortable and safe when eating their meals. Wheelchair guidelines are now in place so that people are safe when accessing their wheelchairs. St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 6 People’s bedrooms have been really improved so that they are pleasant and comfortable and now are a nice room for people to relax in. Staff are now receiving regular supervision and staff training has improved so staff have the skills and knowledge to support people. What they could do better: There are Five things that must be done. 1 There must be an up to date support plan in place for each of the three people living in the House so that staff know how each of their needs will be met. 2 The manager must make sure that when staff are preparing and cooking food that they do this in a safe way so that people living in the Home are not put at risk. 3 People’s health needs and why they are having treatment from other professionals must be clearly recorded so that staff can make sure that people receive the support they need and understand why the treatment is being done. 4 People living in the Home should not pay for things that the Home should provide like special beds and mattresses. 5 When new staff come to work at the Home the manager must make sure that checks have been made on the person so that they are okay and safe to work at the Home. There are lots of other things that the Home should really think about making better this would really improve things for people living in the Home. People who live in the Home should be involved in putting their support plan together. There should also be individual person centred plans that are in a format that the person can understand and follow. This could be in picture format or on an audiotape. Staff who work in the Home should communicate with people in a way they can understand this could be using photographs and pictures or using signs that people understand. Staff should be trained so they know how to do this. When people living in the Home meet to talk about things in the Home there must be a way of checking out that things have been done and that they have been listened too. When people are checked at night by the night staff it must say how the person wants to be checked. St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 7 The people who own the Home (MENCAP) need to talk to people about what they plan to do with the Home, so that people know what is happening and where they maybe living in the future. The manager needs to make sure that there is enough staff supporting people so they are safely supported and their needs met and so they can go out if they want to. 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. St Peters (Flat 1) DS0000017140.V335752.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 St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. These standards could not be fully assessed due to the Home having a stable group of people and no new admissions will be made to the Home. Information is available to inform people who live in the home and their relatives about Flat 1. EVIDENCE: The statement of purpose and service user guide was looked at and describes the services and facilities provided. The service user guide was available in an easy read and picture format so it is more accessible to the people who live at St Peters. It would be good if these documents were further developed so that the information is more meaningful and interesting and includes the comments and experience of people who live at the Home. Some updating and review of the information is required so that staff and management information reflects the current arrangements. Flat 1 had been deemed by CSCI at previous inspections as not fit for purpose. CSCI was informed that the organisation is in the process of seeking more suitable accommodation. An interim plan was to utilize an adjacent Flat for one person and reduce registered numbers in flat 1 from three to two, and improve St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 10 bedroom sizes by making some alterations. No progress had been made on this since the previous inspection July 2006. The inspector spoke to the Manager and staff about the future plans for the Home. The manager said that reassessments had been completed by Social Care and Health in October 2006 however the outcome of these were disappointing with less care hours identified for people than the provider expected. The manager said she has been chasing Social Care and Health since she received the outcome of the assessments but to date had not had a reply to a number of emails and phone calls. There have been no new admissions since the previous inspection. The three people who live at St Peters Flat 1 have lived there for many years (seventeen years). It was not possible to assess the pre admission assessment process. However, the admission procedure seen dated 2002 if this was followed would ensure that a full assessment would be completed prior to admission to the Home. There are no plans by the provider to make admissions to the service but plans to move people within the St Peters complex. St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s):6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A comprehensive support plan must be implemented for each person living in the Home detailing how his or her assessed needs will be met. EVIDENCE: Some further progress had been made since the previous inspection on developing peoples support plans. These tell staff how to support a person so their assessed needs can be met. The support plans had been developed using information that the Home has collated on the person over a number of years there was no evidence of a formal assessment tool. The support plans for all three people were still under development with some sections incomplete. They were being produced on the Homes computer system. This had enabled digital photographs to be added so that the support plan was more meaningful to the person. Each plan had information about how people should be supported with their healthcare, communication, personal care and social needs. St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 12 Lifestyle plans were seen and were dated September 2006 and had been completed in conjunction with the day centre that people attend during the week. It identified goals for the person such as a holiday to Disneyland, going to a live football match and having a massage, it was unclear if and how these goals would be met. The manager stated that Person centred Plans will be implemented once the new support plans have been completed. It is anticipated that this will provide people with a holistic plan in a format that meets their individual needs. Risk assessments were in place including bathing, eating, weight loss, wheelchair safety, managing own finances, safety in the event of a fire and transferring. These had a corresponding action sheet and had been kept under review (February 2007) to ensure that any control factors in place were still relevant. The waking night staff risk assessments says people checked every half hour doesn’t say how these checks are done. It is advised that these are developed further to include this information so it is clear about how, why and when support should be given. This protects people living in the home. Read and sign sheet were in place for staff to evidence that they have read and will follow the risk assessments which is good practice and is evidence that staff have committed to following people support plans. Two staff had consistently not signed records looked at. Daily records were looked at these were very repetitive and do not include response to care or how decisions are made. They include personal care and, gone to day centre watched TV. No problems etc. It is advised that these should be developed so that people’s care needs can be fully monitored through their care records. Service users meeting minutes were looked at and are held weekly. Minutes of the meeting held on 29/04/07 were read and indicate that items are discussed each week around what people want to eat and where they want to go. It is unclear how things are followed up in practice. Comments seen included “ J not able to understand the sign language we were using”. “ M Said he would like to see a play”. People were being asked what they want to do but it was unclear what had happened with the information and if things were followed through I practice. It is recommended that the minutes are developed to include this information as evidence that people have been listened to. Communication system and how people living in the home are supported to make choices and decisions require some considerable development. A staff member spoken with said he only has limited knowledge of makaton and this is what one of the people uses to communicate. They said they were really keen to do makaton training so that they could communicate with the person St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 13 more effectively. Minutes of the residents meetings made the following comment “ J not able to understand the sign language we were using”. Staff spoken with said there are plans in place to develop a board for menu choices and planning which would enable pictures to be used to enhance peoples communication. A large board has been positioned on the back wall of the lounge for this purpose. When talking to staff during the fieldwork they recognised that this could also be used to enhance communication and choice around activities. The pre-inspection questionnaire completed by the manager prior to the inspection identified that training was required in Makaton. Following the inspection the manager confirmed that a speech and language referral had been made and staff training is to be provided. Advocacy support was discussed with the manager she said a referral would be made for one person. This should ensure that people who live in the Home have an independent person to support them in representing their views. Staff during the fieldwork was observed interacting with people. One staff member was experienced and one was on induction, having worked only a few weeks in the Home. Staff asked people what they wanted to do; if they wanted to go out that evening but one of the people said no he wanted to watch T.V as the soaps he follows were on. St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s):12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Peoples varied and individual lifestyles are not being fully met. Communication systems must be developed so that people can make more meaningful choices about their lifestyle. Systems in place for ensuring safe food hygiene and infection control do not protect people living in the Home. EVIDENCE: The inspector observed the evening meal, which was served about 7.40pm. The person received support as identified in their support care plan and in accordance with SALT (speech and language guidelines reviewed January 2007). It was an immediate requirement at the previous Key inspection that the support and supervision given to this person was immediately reviewed. The Random inspection in November 2006 identified that all matters in relation St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 15 to this had been addressed as required. The person was supported to sit at the table in a chair that has been purchased to meet their assessed needs. Menus seen indicated that a variety of nutritional and cultural food is offered. The staff and manager said there are plans in place to develop a large menu board with photographs and pictures so that people who live in the home can be more involved in the meal planning process. Food and nutrition records were being kept for people. Food stocks looked at indicated that a choice of drinks and snacks were available. When checking the fridge mayonnaise, mint jelly was not dated when open and a piece of cheese was only partly wrapped up with again no date of opening recorded. The tumble drier was on during meal preparation and wet clothes waiting to go in the drier were on the floor on a broken laundry basket lid. Staff training records indicated that staff had received training on these matters and policies and procedures were available in the Home stating what is required by staff however these were not being implemented. The Systems in place for ensuring safe food hygiene and infection control practice should be reviewed so that people living at the Home are not placed at risk. People were observed in day to day tasks such as taking cups and plates to the kitchen, washing up and wiping the tables and it was positive that staff encouraged people to do this. When people came in from the day centre they relaxed in the lounge. One person wanted to watch T.V and another listened to music on their headphones later choosing to sit at the table playing connect four. The other person occupied themselves with two different puzzles which they selected from their bedroom and staff sat with them to help work on the puzzle There are concerns as already highlighted about the need to enhance communication systems for the people who live in the Home so that they can be fully involved in decision-making and so that they can participate in daily living opportunities such as what activities to do and when and quality of life issues. Daily records looked at indicated that in the month of April 2007 people had been to the cinema, a party “went out” and out for a meal. Discussions with staff and gleaning of records indicated that people are supported to take part in different activities however staffing levels do influence what can be done and when. During the week if one person is on shift then they are unable to go out. Staffing levels must be looked at, as raised in more detail under staffing standards so that there is adequate staff on duty to enable people to engage in activities of the choosing especially in the evening. Daily records looked at only gave brief information about activities that people had taken part in such as going to the cinema and going out for a walk or for a meal. The records lacked detail about how the decision was made and also how the person responds to the activity; if this information is recorded it could help with future planning for the person. St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 16 People seemed relaxed on the whole and freely accessed all areas of the home choosing to go to their own room the kitchen or sitting in the communal lounge. Two of the people go to stay with their family each weekend. One stays from Friday to Sunday and the other spends all day Saturday with their relative returning on the evening, which leaves one person at the Home who receives one to one staff support. The men had been on holiday recently to Blackpool. Two staff had supported three residents. The holiday had not gone as well as previous holidays. The manager said that when planning this years holiday consideration will be given to the individual needs of people and individual holidays as opposed to a group holiday will be explored. St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s):18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health care needs of people are not always consistently met. This may put the health care of people at risk. EVIDENCE: The medication is stored in the office in a metal cupboard that is usually secured to the wall but as it is only a stud wall the fittings had become unsecured and the cupboard was free standing on top of another cupboard. The manager said the cupboard would be secured to the wall as required. Policies for medication administration, self-administration and the control and use of medicines were seen. There is an audit of non blister pack medication and the record of these was looked at. All three-service users MAR sheets were looked at and the medication MAR sheet cross-referenced to what was on their care plan. There was a photograph of each person and details of their prescribed medication in front of their MAR sheet. People living in the Home are supported to access a range of health care professionals. Health action plans (HAP) were seen and were being actively St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 18 used for each person, these are a personal plan about what a person needs to stay healthy and what healthcare services they need to access. When updating information there were sometimes inconsistencies in recording, which could cause problem when monitoring people’s health care. The weight chart in X’s HAP these had not been completed since 19/10/06 however in the daily record chart the records had been completed in December 2006 and March 2007 although the persons support plan says that they should be every other month. Eating and drinking guidelines had been updated on the person support plan, in their hospital book, but not on the HAP. A review meeting for one person took place in September 2006 with representatives from the person’s day services, the care home and the person’s relative. Specific questions were asked by the relative regarding an ongoing nursing need requiring district nurse input. The minutes stated that the manager who was present at the meeting would find out and report back to the relative. The relative also raised this matter in the survey returned to CSCI (April 2007), which is seven months after their initial request. This query was tracked through the persons support plan and although there is information about how this need is cared for by the district Nurses the support plan does not state why or how this medical need occurred and the prognosis. This raises some concern about how medical needs are documented and the need to formally action request for information made by the relatives of the people living in the home. The manager confirmed that since the inspection took place this has now been formally addressed with the relative. The manager spoke about how another person’s health had deteriorated and this was observed during the fieldwork visit. Their mobility has deteriorated since the previous inspection. The case file confirmed that medical referrals have been made including a referral to community nurse to support the person through and to identify the cause of the change in needs. Peoples personal appearance was good and indicated that they receive good support to attend to their personal care needs. There is a good ratio of male carers, which is positive for the people who live in the Home who are all male so that on most shifts they receive support with personal care by a person of the same gender. A tissue viability assessment for one person had been actioned as required at the previous inspection. A risk assessment for the use of a wheelchair and lap strap had been implemented so that people receive support in a way that meets their assessed needs and in accordance to manufacture and safety guidelines. A record of the service of the person’s wheelchair was seen on his care plan file. St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 19 There was no evidence of an optician appointment on X’s file, the records seen said appointments were due in July 2007 and 2009. In feedback to the manager she stated that the person had attended previous optician appointments and this information would be recorded on the person health action plan. St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s):22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Complaints procedure if followed would ensure that people would be listened to. There are systems in place to safeguard people from physical harm and neglect however, the arrangements in place for the management of peoples finances do not ensure they are fully protected. EVIDENCE: The complaints procedure was available and on display on the notice board and people who live in the home have a copy in their bedroom. The complaints log was looked at and no complaints had been received. CSCI have received no complaints about this Home in the last twelve months. An easy read complaint format was available however people who live in the Home would require significant support from staff to raise a concern. Therefore staff training and awareness in this area is essential. Multi agency procedures advising staff what to do and who to contact were available on display on the notice board in the office. The organisations own policy on the protection of vulnerable people requires some minor amendments so that it makes it clear what the staff role is in reporting potential vulnerable adults issues. A copy of the whistle blowing policy was St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 21 forwarded to CSCI as requested and the manager said this has been made available to all staff that work in the Home. The staff member on duty was briefly spoken with regarding their understanding of emergency procedures and Protection procedures and they demonstrate a general awareness. They were able to identify where they would be able to access further information and guidance should this be needed. All but one staff member had received training in Respond and Respect which address issues around the protection of vulnerable people and in national training organised by Mencap. The training matrix looked at confirmed when this training had taken place. The manager showed me the future training plan for the Home and the staff member was booked on this for May 2007 and the inspector was advised that they had missed previous training due to illness. The Home has a system in place for the logging and recording of regulation 37 incidents, which are reportable to CSCI. This ensures the regulatory body is informed of significant events involving people living in the Home and action taken by the Home to ensure peoples welfare and safety is protected. When reading one persons case file there was receipts and documentation for the purchase of a mattress and nursing bed, which they had paid for themselves. This practice must be immediately reviewed and the person should be refunded. The Home should provide equipment to meet people assessed needs. St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home is not suitable to meet the needs of the people living in the Home. Improvements have been made to the physical environment so that it is a nicer, more comfortable and homely place for people to live. EVIDENCE: Flat 1 had been judged by CSCI at previous inspections as not fit for purpose. Previous reports have highlighted that the organisation is in the process of seeking more suitable accommodation for people. An interim plan was to utilize an adjacent flat for one person and to reduce numbers in flat 1 from three to two, and improve bedroom sizes by making some alterations. There has been no progress on these development plans. St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 23 At the random inspection in November 2006 some improvements in the environment were seen including new carpets and painting of the lounge. At this inspection a tour of the Flat was made. All three bedrooms have been painted and new furniture provided. Staff said that people were supported to choose the colour for the bedroom and also choose the bedcovers and finishing touches such as lamps and pictures. The bedrooms look really nice and the people indicated they were really pleased with how their bedrooms now look. New dining room table and chairs have been provided in the lounge. Two of the people had individual assessments for the dining chairs so they can be supported to sit safely at the table in accordance to their individual needs. The bathroom has limited space and is domestic in layout with limited space for people to move about and is restrictive especially for the one person with limited mobility. Some improvements had been made to the bathroom to make it a more pleasant environment for the people who live in the home however this area really needs refurbishment so that it meets the assessed needs of people. The inspector observed care practice and the support given to people throughout the fieldwork by sitting in the lounge area. The combined lounge dining room has limited space. People are continually moving around each other and the space restricts people mobility. The kitchen door opens out from the lounge area and noise and smells cause a constant disruption to the lounge /dining area. If the kitchen door is closed then staff cannot safely supervise people or check on the meal they are preparing whilst also supporting people. The kitchen is an enclosed room with no window and limited ventilation making it an uncomfortable area when cooking is taking place. There is no separate laundry area. The tumble drier was on during meal preparation and wet clothes waiting to go in the drier were on the floor on a broken laundry basket lid as previously raised. St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 24 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 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment procedures are not robust enough to ensure that people living in the Home are adequately protected. Staffing levels should be reviewed so that there is adequate staff on duty to meet peoples assessed needs. EVIDENCE: There was good interaction between people living in the home and care staff. Staff spoken to indicate they had an understanding of peoples support needs. They expressed some concern about the change in need of one person as previously highlighted. Previous reports have highlighted that the home has had an unsettled period with staff changes. This has been particularly problematic as the Home is staffed by a small staff team who frequently lone work. St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 25 The staff rota was examined and this indicated that there was one or two staff on at core times of the day when people are at home. Two staff have recently been recruited and are currently on the rota to work alongside an established staff member in either Flat I or one of the other neighbouring registered homes (Flat 24). The manager said the recent appointments would improve staffing levels across the week. At weekends there is one staff member on duty across the working day as one of the people goes home to their family. In light of peoples needs and the changing needs of one person in particular, there must be two staff on at all core times to meet people assessed needs and to ensure people are safe. There also needs to be adequate staff on duty to ensure people have the opportunity to go out in the evening when one person is on shift this is not possible. At night there continues to be one waking night staff member on duty. It is advised that a review of staffing arrangements takes place to ensure that staff resources will be utilised to best meet peoples needs. The Staff files of the two recently appointed staff were looked at. Checks of the person’s suitability to work in the home had been made; including satisfactory Criminal Records Bureau checks, completed application form and proof of identification. Concern was expressed about references that had been sought by the provider. One reference sought was from a senior care worker. The reference was sent to the senior cares home address not the address of the care home and a mobile number was used to check out the reference. The second reference was from another senior person in a care home, there was no details of the home worked in and again the reference was sent to the person’s home address and checked out on a mobile phone number. When asked the manager said she had not verified the reference with the registered manger of the services who would have access to any disciplinary information of previous employees. The manager must review the recruitment procedures to ensure the safety of the people who live in the Home is protected. The frequency of staff supervision was looked at across three staff files. These are one to one sessions when staff can discuss work related issues and personal development issues with their manager. Supervision records seen indicated that the frequency had increased with sessions taking place every one to two months and notes of the supervision sessions were on staff files. The training matrix and records were looked at and had been improved since the last inspection. All mandatory training was detailed and completed dates of training and dates for updates were recorded and copies of certificates were on file. It was easy to track the details of the staff member who had missed adult protection training and could evidence that this had been scheduled for May 2007. Training is clearly required on Makaton so that staff have the skills to communicate effectively with people living in the Home. The manager had identified this need in the Pre Inspection questionnaire completed and returned St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 26 to CSCI prior to the fieldwork and stated during feedback following the fieldwork visits that the Speech and Language therapist will be providing this training in the near future. St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Homes systems do not fully ensure that the safety and wellbeing of people living in the Home is promoted and protected. Opportunities for people to contribute their views in the running of the Home should be further developed. EVIDENCE: The manager was registered in May 2006 and oversees Flat 1,3 and 24. All are separate registrations with CSCI. A deputy manager was appointed in February 2007 and is mainly based in Flat 24. The previous Key inspection report highlighted significant concern with the management of the Home and systems in place to ensure the safety of people St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 28 living in the Home. The provider responded appropriately and management arrangements were reviewed and at a Random inspection in November 2006 there was evidence of improvement. The general administration of the Home has improved. Health and safety records were easy to find and generally well maintained. However the systems in place for the management of food safety and infection control must be reviewed to ensure staff are aware of their responsibilities within their day-today practice. The recruitment procedures must also be reviewed so that people living in the Home are protected by robust systems. A service manager supports the registered manager. Regular 26 visits are carried out and a summary of these reports is sent to CSCI office thus ensuring that the provider does take responsibility for monitoring the Home. Copies of these reports were in the Home at the time of the fieldwork. The continuous improvement plan was looked at. This is an improvement plan for the service developed by the manager. Information is gathered from a variety of sources including CSCI inspection reports and information from people who use the service and is then put into action points. This must include how the views and wishes of people who live in the Home are acted upon. The future plans for this Home have not been progressed since the previous inspection and it is advised that the provider informs CSCI of what its intentions are. The Provider undertook a comprehensive service review on 15th and 16th of January 2007 and a detailed report has been produced detailing what the Home is doing well and what needs to be developed. This was on display in the office and made available to the inspector. A number of quality of life, choice and autonomy issues were identified as requiring development. Safety checks were looked at including hot water checks, general risk assessments, shower cleaning, monthly safety audits (April, March, Feb. and January 2007) and Fire records which ensure regular testing and service of equipment take place as required, to protect the safety and well being of people living at the Home. A number of policies and procedures are available and were seen in the staff office. The provider is a large organisation and policies and procedures are reviewed at a senior level. The review date of these was discussed with the manager as many are dated 2002 and it is unclear if these are the most recent copies. It would be helpful if there were a list of policies and procedures detailing implementation dates and dates when they are due for review. The Gas safety check was dated 2004 however when in flat 24 there is a landlord certificate covering all three flats dated 2006. The manager needs to make sure there is an up to date copy at Flat 1 and agreed to do this at the time of feedback. St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 29 The general feel of the Home is that things are more organised however, the manager and staff team must look at how the Home can be further developed for the benefit of the people who live in the home in terms of quality of life opportunities, how choices are made and the involvement of people who use the service in the day to day running of their Home as highlighted with specific examples in this report. St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 N/A 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 2 STAFFING Standard No Score 31 X 32 3 33 2 34 1 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 X 2 2 X 2 X St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 31 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 YA6 Regulation 15 (1) (2) Requirement A comprehensive support plan must be in place for each person living in the Home detailing how his or her assessed needs will be met. Outstanding from the previous inspection July 2006. The Systems in place for ensuring safe food hygiene and infection control practice should be reviewed so that people living at the Home are not placed at risk. People’s health care needs and the reason for intervention from health care professionals must be clearly recorded on their support plan so that staff can support the person as required. People living in the Home should not have to pay themselves for essential items such as a nursing bed and mattress. This practice must be reviewed and the person reimbursed. Recruitment procedures must be reviewed so that the organisations procedures are fully implemented and people DS0000017140.V335752.R01.S.doc Timescale for action 31/07/07 2 YA30 YA17 16 (2) j 31/05/07 3 YA19 12 (1) b 31/05/07 4 YA23 13 (6) 30/06/07 5 YA34 Schedule 2 7,9 19 31/05/07 St Peters (Flat 1) Version 5.2 Page 32 living in the Home protected from harm. 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 YA1 Good Practice Recommendations The statement of purpose and service user guide should be updated so that information about the current service is clear to the people who live in the Home. It would be good if they were made even more accessible to the people who live in the Home and alternative formats considered. People who live in the Home should be supported to be involved in the development of their support plan. Person centred plans should be implemented in a format suitable for the individual so that it is meaningful and personal to them. Daily records should be developed so that peoples needs can be properly monitored. Communication systems within the Home must be developed so that people living in the Home receive the support and assistance they need. There should be evidence that peoples goals and aspirations have been followed through so that the Home can demonstrate that people have been listened to. Meetings with people who live in the home must be developed so that there is evidence that requests made have been listened to and acted upon. Risk assessment for the support people require at night should be developed further to include information about how, why and when support should be given. This protects people living in the home. The provider should keep the commission informed about the development of the service so that there is a plan about how shortfalls in the environment will be addressed and how future needs will be planned for. A revised staffing rota and staffing assignment details should be completed to indicate how staff resources would be utilised to best meet peoples needs. The manager must ensure that the home is further developed for the benefit of the people who live in the DS0000017140.V335752.R01.S.doc Version 5.2 Page 33 2 3 4 5 6 7 8 YA6 YA6 YA6 YA7 YA8 YA8 YA9 9 YA24 10 11 YA33 YA12 YA37 St Peters (Flat 1) 12 13 14 YA39 YA40 YA42 home. The quality assurance system must include the views and wishes of people living in the Home and how these will be acted upon. There must be evidence that policies and procedures are kept under review and reflect changing legislation and good practice. A copy of the up to date gas safety certificate must be available in the Home as evidence the safety checks have been completed. St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Peters (Flat 1) DS0000017140.V335752.R01.S.doc Version 5.2 Page 35 - 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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