Inspection on 10/05/07 for Strensham Hill

This inspection was carried out on 10th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Strensham Hill 20/08/09

Strensham Hill 19/08/08

Strensham Hill 20/02/08

Strensham Hill 11/10/06

Strensham Hill 05/04/06

Strensham Hill 12/10/05

Strensham Hill 27/04/05

Strensham Hill 11/11/04

Strensham Hill 24/05/04

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

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

CARE HOME ADULTS 18-65 Strensham Hill 1 Strensham Hill Moseley Birmingham West Midlands B13 8AG Lead Inspector Sean Devine Key Unannounced Inspection 10th May 2007 09:00 Strensham Hill DS0000016874.V336673.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 Strensham Hill DS0000016874.V336673.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. Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Strensham Hill Address 1 Strensham Hill Moseley Birmingham West Midlands B13 8AG 0121 442 4580 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) enquiries@servolct.org.uk Servol Post Vacant Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8) of places Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Residents must be aged under 65 years That the home can care for named service user over 65 years for reason of Mental disorder 1 MD(E). That the service user will have regular reviews to ensure that the home can continue to meet individual care needs. 11th October 2006 Date of last inspection Brief Description of the Service: The home is a large house on the corner of Strensham Hill Road. It is close to local amenities such as shops and places of worship. Moseley and Cannon Hill park are within easy walking distance where there is a range of facilities. Within the home residents have their own rooms, and there are communal living and kitchen areas, as well as a self contained flat which provides an opportunity for more independent living. Residents, share communal bathing facilities. The main lounge is bright and airy, and faces on to Strensham Hill. The kitchen is to the rear of the property and has individual storage facilities for each resident. There is a garden to the rear of the property, which is private, residents make good use of it in the summer months. To the rear of the garden there is space for some car parking. The home is geared towards providing rehabilitation to residents with enduring mental health issues with a specific focus on the needs of Afro-Caribbean residents. The current scale of charge for the home as indicated in the pre inspection questionnaire is £495.00 per week. The Servol Organisation provides the residents with four communal meals each week and each resident is given £22 each week for food. Residents pay for any other items such as toiletries, clothing and leisure pursuits. Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home was visited unannounced by a regulation inspector and it lasted for one day. Prior to the inspection visit the home had been sent an Annual Quality Assurance Assessment and comment / survey forms for residents, relatives and other health professionals to complete. This assessment had not been completed and returned to us, it was sent partially completed after the inspection visit. No survey forms had been returned from relatives or visiting health and social care professionals. Residents were able to complete comments cards that the inspectors had brought to the inspection, these are called “have your say about….”. In total four were returned explaining their experiences of living at the home. The inspector was able to meet with and talk with four of the six residents, who shared some of their opinions of what it is like to live in the home. A tour of the residents’ rooms and communal and service areas was completed and records about safety of equipment and the building were checked. Records about how staff are recruited, trained and supported were seen to help determine whether the staff have the skills to meet the needs of the residents. During the inspection the inspector followed the experiences of living at the home for two of the residents, including looking at their care records, conversations with them and viewing their rooms, this is referred to within the report as case tracking. In the past twelve months the home has received one formal complaint about care in the home. The home was found have failed to protect residents and because of these concerns immediate requirements at the time of the inspection and the following day in a letter to improve the areas about recruitment, health and accident recording were made. The home has a new Responsible Individual who has advised in writing of the improvements the home will make to protect the health and welfare of the residents. What the service does well: The home does have a well planned and successful process to help prospective residents decide on whether they would like to live there. This includes an assessment of need by a competent person (normally a social worker and the Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 6 mental health team), trial visits to the home and information about the home within the Statement of Purpose and Service Users Guide. What has improved since the last inspection? What they could do better: The home must include the choices and preferences of the residents that they have already gathered through assessment, when they write a care plan or a risk assessment with the residents. They need to discuss the care plans and risk assessments with the residents to see if they are meeting their needs. The home must ensure that risk assessments for individual residents are properly completed and that they are accurate, as risks and concerns have been overlooked due to poor risk assessing. The daily life of residents is not well planned, although many of the residents are very active people the care plans to support, learn and develop life skills are not good. This will have a negative effect on the rehabilitative side of their care at the home. The home must address concerns that the health needs of residents are not reported upon. Residents have been to hospital without any written record, this must improve for the health and welfare of residents. There remain concerns that complaints made by residents are not seriously considered, this has not improved and residents’ views and opinions are not listened to and acted on. The home has had information about a resident that may mean the resident has been at risk of abuse. This has not been reported to the local authority and the staff have failed to adequately safeguard this resident. The staff must Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 7 ensure this is reported quickly to ensure if needed the resident will be protected. The cleanliness of the home must be improved particularly in the laundry and in residents’ rooms. This will help improve the residents’ health and take some pride in their accommodation. There remain concerns that the recruitment practices at the home are poor, which presents a risk to the health and welfare of residents. This must be improved and all staff must have all required background checks before they commence any duties at the home. The staff have not received training to help meet the mental health needs of the residents; this does mean that all the staff are not appropriately trained and may not be competent to meet these specific needs for all six residents, which may put their health and welfare at risk. The home has failed in their duty to ensure that accidents are properly recorded and that we are notified of any event that will adversely affect the well-being or safety of the resident. This means they have not recognised their duty, failed to investigate concerns and have not made any changes that will improve the health and welfare of residents. 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. Strensham Hill DS0000016874.V336673.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 Strensham Hill DS0000016874.V336673.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): Standards 1, 2 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All areas of the residents’ life and needs are assessed prior to admission, which will result in the home being able to decide on whether they can meet these needs. Suitable information concerning the home is available to assist residents to make an informed choice. EVIDENCE: There have been no new admissions since the last inspection, where the outcomes for residents were judged as being good. The manager advises that there has been no changes to policy or practice as any new residents will receive an assessment, including visits to where they are currently living and several pre admission visits to the home. Residents who completed the “have your say about …” survey all indicated they were asked if they wished to move in and that they were given information about the home before they moved in, this included a Statement of Purpose and a Service Users Guide. Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. The home has not demonstrated it can meet residents’ needs through planning their care in an inclusive and safe manner. Omissions of residents’ choices and preferences may lead to institutional care practices and will have an adverse affect on the residents’ health and welfare. EVIDENCE: The survey information from the four residents was generally positive but no comments about how they are involved in planning their care was made. The majority recorded that they can make decisions about what they do each day, yet they also recorded that this is not always so during the evening and at weekends. Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 11 Three of the four residents who spoke with the inspector were pleased that they are not involved in planning their care, they felt it was a chore and did not need to be involved. A fourth resident did not wish to comment. Two residents were case tracked. One resident had many assessments that had identified areas of need. It was evident from the assessments that the choices of the resident had been recorded, such as spiritual, diet and personal care. Yet the care plans were not clear and concise and did not describe how the staff and the resident would meet the objective of the care plan. For example how the resident is supported to budget and manage money and how the resident accesses local community services. This may mean the residents’ needs are not being met. Throughout all care plans there was a lack of information about where the resident had made personal choices, this was confirmed in the residents surveys as they record that they do not always make decisions about what they do in the evening or at weekends. This may mean residents have limited opportunities to choose how they live. The resident had signed all the care plans indicating they had been consulted about the care plans. The care plans for this resident were frequently reviewed however the records did not indicate that the resident was consulted on whether the care plans were meeting the objective. The resident also had many assessments that had identified risks including self-care, mental health relapse and financial vulnerability. The risk assessments also included detailed management plans for the staff and resident to follow. The resident had signed all risk management plans but had not been involved when they were reviewed. There was some concern that the risk rating for financial vulnerability was higher than the home had recorded. More details are reported upon in the Concerns, Complaints and Protection section of this report. The second resident case tracked had care plans that were very basic and often recorded that if the resident identified a need the staff would be informed. This included any cultural, health or social care needs. There appeared to be very little continuous assessment by the staff, other than occasionally recording the residents’ whereabouts, which may put this resident at some risk. The risk assessments were basic and recorded that the resident was able to manage personal risk. This was a concern as due to a recorded incident this was clearly not the case. The resident had signed all care plans and risk assessments, yet there were no records that the resident has been involved in the reviews and any changes to the plans that are needed to meet changing needs and manage new risks. The lack of risk management plans and detailed care plan to manage risks and meet care needs will be detrimental to this residents health and welfare. Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 12 The staff described the care and support they offer residents. They advised they offer some support that is not recorded such as providing guidance, advice and some practical support with domestic skills. Strensham Hill DS0000016874.V336673.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): Standards 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. The home has not fully been able to demonstrate that it meets the lifestyle needs of the residents. The homes inability to assess, plan and monitor the lifestyle needs of residents will mean their health and welfare is being put at risk. EVIDENCE: Residents’ surveys indicate that during the daytime they make decision about how they lead their lives yet during the evening and at weekends they do not. The residents who were case tracked had some assessments in place about how they lead their lives for example, leisure pursuits, attending colleges, visiting family members and friends and also aspirations of moving into new accommodation. Up until April 2007 both residents had an activity programme about how they spend their days, some activities are recorded above, but they Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 14 also included home chores, access to local community facilities such as for shopping, restaurants and day centres. Unfortunately as recorded in the Personal Needs and Choices section of this report how residents are supported to take part in the activities is not well planned. Two residents in conversation with the inspector were pleased they are able to go out into the local community, one resident described meeting friends at college, another described the enjoyment he gets out of playing football competitively and another described in the residents survey about keeping fit at the local gym with friends. There were no formal activity programmes for May 2007. There were concerns that the daily life activities of residents were not being recorded in the daily records maintained by staff, they would often only record activities when they were in the home and did not always record what residents had been doing outside of the home. At times there were gaps of days where no records had been made about the events for each resident. Due to this there is not enough available evidence to confirm that residents do indeed take part in their chosen way of life and the home are not acting responsible. One resident explained that he found it difficult to manage his weekly food budget, which is £22 and felt this was not enough. This resident was unhappy that communal meals were not always available when he returned to the home. The manager advised that the meals are prepared four times a week by the staff and are available for all residents and that £30 is given each week to provide the six residents with four communal meals. Each resident has their needs assessed in relation to meals and mealtimes, the residents have a range of needs, examples include; helping residents budget for meals out of the home, some residents have meals at day centres, some residents are fully dependent on staff to plan, shop and cook meals and some residents eat out and do little cooking at the home. Other residents who spoke with the inspector advised that they enjoyed their meal and did not go short. Each resident has a lockable cupboard in the kitchen area and allocated spaces in the fridge and freezer. Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 15 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): Standards 18, 19 and 20. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has not demonstrated that it has the ability to meet the personal and healthcare needs of the residents. There is very limited information on records that residents receive the care they need and there are some poor practices that will jeopardise their health. EVIDENCE: During conversations with residents some confirmed that they are seen regularly by their community nurses and that they often have appointments to see their psychiatrist or when needed their GP to have their health monitored. On the day of the visit a nurse was in attendance who described the home as being good, quick to alert them to any health changes and also responsive to make changes to improve the health of residents. The healthcare records for the two residents who were case tracked were seen. For one resident general health care records included, mental health, dental care, outpatient appointment and refusal of a surgical test. There were no other records available. Staff advised that the resident had undergone a Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 16 procedure yet there were no records of this, which is very risky and may put the health of the resident at risk. This resident had health care plans detailing how support in such areas as personal hygiene (it did not record personal choices), reducing smoking, advice on the effects of alcohol and drugs and exploratory / screening tests. There was evidence including attending appointments and to attend mental health and dental appointments. The second resident had no general health care records, yet in the daily records there was evidence of an accident and sustained injury. There was one entry in the daily records of going to hospital and no other records. The home had not completed necessary documents, concerns about these omissions are further recorded later in the report in the Management and Administration section. Following the inspection and after discussion about the health related concerns with the Servol Responsible Individual the home was sent an immediate requirement letter stating they must ensure they maintain records about the health of residents who have received treatment, advice or any other services from any healthcare professionals. The abilities of two case tracked residents to meet their own personal care needs are assessed, and where required care plans had been written. Medication management was assessed for the case tracked residents. Both rely on staff mainly to manage and administer their medicines. Medicines storage is secure. The medicines fridge temperature is not monitored to ensure medicine is kept at a safe temperature. Stocks of medicines for both residents were found to be accurate. One resident manages medication when on leave, but does not do this when at the home. There has been no assessment whether the resident can manage and administer medication, which through poor health monitoring presents a risk for this resident and may not help prepare for more independent living. The nurse who visited and who visits frequently commented that she has no concerns about how medication is stored. All staff have completed training to ensure they are competent to manage and administer medication. The manager has not undertaken any medication audits and the last audit by the supplying chemist was in 2006. The lack of audits may mean concerns are not identified until there is a problem and residents may receive a poor service which could effect their health. Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 17 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): Standards 22 and 23. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has not been able to fully demonstrate it has the ability to ensure that complaints are effectively managed and that protection needs of residents have robust procedures to be implemented. This may mean that the welfare of residents is put at risk and improvements where needed are not made. EVIDENCE: The home does have a record of complaints; the last entry was a complaint from a resident in December 2006. The home has taken some actions including notifying the police yet there was no records of the complaint being acknowledged and findings post investigation to the complainant, as per the Servol complaints policy. One resident who spoke with the inspector is unhappy with the communal meals and the tumble dryer, yet these concerns that the manager is aware of have not been recorded. There is a lack of responsible actions taken by the manager to make improvements and record complaints properly. There have been no recent referrals to the local authority in relation to the protection of residents and we have not made any recent safeguarding referrals. For one resident who was case tracked there were records and the manager advised of financial vulnerability. We advised that staff inform social workers, and by the end of the inspection an imminent date for a case review had been Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 18 made The risk assessment rating for this resident regarding financial vulnerability was assessed as mild, we believe this is a high risk for the resident and there has been a poor response by the home to protect the resident. The training records of staff indicate that many of them have undertaken training regarding adult protection. The home does provide a safekeeping service for residents to deposit small amounts of money and in the short-term valuable items. At present only one resident uses this service as all other residents manage their own money and valuables. Records for this resident are available and comprehensively completed, they record money deposited and withdrawn, the balance was found to be correct. The resident has signed for most withdrawals but not all, the manager was advised that if this resident cannot sign for the transaction it should be at least be witnessed and signed for by two members of staff. There is a risk assessment for this resident but it does not include why the financial record cannot be signed. Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 19 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): Standards 24, 26, 28 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 has not demonstrated it has the ability to provide residents with an environment that is safe, comfortable and which will meet their needs. This may mean that for some residents they are put at risk and for some others it creates unhappiness and a state of ill-being. EVIDENCE: All residents who completed the survey felt that the home was always kept fresh and clean. Those residents who spoke to the inspector advised that they like their rooms and communal areas and that staff always respect their privacy. The communal areas being the lounge, dining area and gardens are well maintained, décor is bright and furnishings are generally in good condition. Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 20 However the settee in the lounge needs repair or replacement, as it appears springs are loose or broken. Three residents rooms were seen and improvements are required in all rooms, this includes cleaning curtains, repairing or replacing frayed carpets and cleaning them where stained. One resident lives in the flat where deeper cleaning is needed to remove dust and dirt from pipes, skirting and window frames, replace hallway and kitchen carpets and ensure the cover to the gas fire is secure. This presents a significant risk to the health and welfare of these residents and is not good enough. All residents’ rooms had been personalised and reflected their interests such as music, football memorabilia, exercise equipment, fashion and family pictures. All rooms had good storage and fittings, yet one resident may need to consider alternative storage of some items to ensure it is safe to move about in the room. Service areas including the kitchen and laundry area were seen. There has been no recent environmental health visit to assess safety in the kitchen, yet all areas appear to be clean and most units and work surfaces are new. Food is stored in cupboards and there are also fridges and freezers. The laundry requires urgent improvements in respect of cleanliness, as there is considerable dust debris on walls, cupboards and behind the tumble dryer and washing machine. The extraction unit may not work effectively as it to has a large build up of dust. The linoleum floor is not in good condition and has in large parts come away from the skirting boards preventing effective cleaning. There was no soap available for residents and staff to wash their hands. These concern present considerable risks to the health of residents and the staff who use the laundry. Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 21 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): Standards 32, 33, 34, 35 and 36. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has not been able to demonstrate that it provides the residents with staff who have been safely recruited, who are well trained and who are well supported. These significant failings in all cases put the health and welfare of the residents at risk. EVIDENCE: All residents’ surveys recorded that the staff at all times listen and act upon what they say. There were no comments about staff competencies or attitudes. The residents who spoke with the inspector were complimentary about the staff, they said that they get along well and that the staff can be helpful. One resident said “I enjoy talking to ____ as we get on well together”. The manager advised that in excess of 50 of the care staff have achieved NVQ level 2 in Care or above and three care staff have commenced the NVQ level 3. Staff do have some records on their files about the training they have Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 22 done, yet these files are not structured in anyway and evidence is difficult to find. The manager should structure files to allow her to assess the training needs of the staff and to develop a plan with the Servol organisation. For one member of staff who is a new appointee there is evidence on certificates that she has attended mandatory training including fire safety, health and safety, manual handling and food hygiene. This training was completed with a previous employer. The manager advised that the training within the Servol organisation continues and recently all staff have attended food hygiene, fire safety and health and safety, but as yet there has been no mental health training for staff; she also advised that further medication training is planned. This had been an ongoing concern that the staff are not trained to meet the mental health needs of residents and do not have the necessary skills to support them. This lack of investment in staff skills is not good enough and has put residents at risk through poor care practices such as not acting in their best interests. The staff rotas seen do indicate that adequate numbers of staff are supporting the residents, often a minimum of two on duty and sometimes three to meet the current needs of the six residents. To maintain these levels the manager has to book some agency care workers and some permanent staff are doing additional hours. At night a member of care staff is available until 11pm and then commences sleeping in duties and is available should resident need support during the night. The home has recruited one new care worker since the last inspection. The records of appointment were seen. The findings were concerning as the home had not done a POVA first check, they had not done a criminal records bureau disclosure check, there was no evidence of an induction and there were no records of supervision or appraisal. This member of staff had no correspondence or records on the file to confirm appointment and no terms and conditions of employment were available. Due to the potential risks presented to the residents the home was issued an immediate requirement to make sure the safety of the residents by ensuring all staff have a POVA first check completed before they are appointed. Further requirements about guaranteeing this staff member did not work unsupervised until the POVA first check had been completed were made to protect the residents. The manager advised that she has not recently been supervising staff. Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 23 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): Standards 37, 39, 41 and 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has not demonstrated that it is managed in an effective way to be inclusive and involve residents. There are some very serious concerns that put the health and welfare of residents in danger and there appears to be no competent and responsible person in charge of the home. EVIDENCE: Residents did not comment on the performance of the manager within the survey, however two residents in conversation with the inspector advised that she was a nice person and that they got on well with her. There are some serious concerns from this inspection that are similar to the last inspection and are requirements that have not been met, for example ensuring staff have POVA first checks before they are recruited, responding to Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 24 complaints from residents and supervising staff; not addressing these areas is disappointing and suggests that the current management and administration of the home is not good and is putting residents welfare at risk. The manager advised that the event recorded below about a residents’ accident did happen when she was away from the home, yet there appeared to be little acknowledgement that regardless of when it happened she had a duty to effectively do her duties, this manager identified who did manage the accident and she also advised that she did not recruit the member of staff who had no CRB or POVA first check. The manage advised that a process of quality assurance has been discussed with her senior manager and that it will be implemented, however as yet there has been no monitoring of the quality of service provided to residents at the home. The residents do have regular meetings, these are recorded and minutes show they generally discuss such items as holidays, house chores, health and safety in the home and using the Servol day centre. There are also regular staff meeting again records were seen and they often discussed key workers roles, residents holidays, shopping with residents and medication practices. It is evident that besides residents choosing where they have their annual holiday they are not invited to view their opinions about the home, how its managed, the quality of service and what they would like to see improved. As earlier recorded in this report there are some concerns about recordings staff make about the residents, known as daily records. It was often that staff do not make any entry and also often that when they did it was not descriptive of the daily events for each resident. There were often residents out of the home, yet no records of where they were had been made, there were few recordings of staff spending time with residents when the residents returned to see how they were and how their day had been. What is more concerning about record keeping is that a resident did have a accident and did suffer injury. No accident records were completed, no incident reports were made and we were not notified of the event under Regulation 37. Due to the serious concern the home was issued with a letter of immediate requirements advising them that they must maintain appropriately and complete records about residents who have had accidents and that they must give notification to us without delay of any event in the care home, which adversely affects the well-being of any resident. The concerns for this resident are such that the social worker and mental health team should have been informed, yet no records could be found. The manager advised that she was not at the home when it happened and a senior manager took responsibility. It is a concern that due to not informing these agencies the resident has been left at risk and since the inspection we have been notified of a similar accident regarding the same resident. There were further concerns about healthcare records as these were not available for a resident who had been to hospital and returned back to hospital for further tests, the staff were all aware of this but there were no records to detail the health events. This has been discussed with the new Responsible Individual who Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 25 confirmed in writing that he is taking and will be taking further immediate actions to ensure the health and safety of this resident. The manager completes a monthly health and safety form, where boxes need to be ticked about safety in the home. It is a concern that environmental issues as identified in this report were not identified and the process is more paper led than about improving the health and safety of residents and other people. There are some recordings on the form that residents are smoking in unauthorised places, yet nothing has been done, residents do not have smoking risk assessments with management plans, this presents a significant risk to the health and safety of all people in the building. There is a fire risk assessment for the home last reviewed in May 2006, it has not been reviewed to include the findings of the monthly health and safety form. The manager does maintain some comprehensive records about health and safety servicing, tests and maintenance of utilities and equipment. The staff team are regularly attending fire drills and the fire system and equipment is well serviced and tested. Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 1 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 2 X 1 X 2 X 1 1 X Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 27 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) Requirement Timescale for action 30/06/07 2 YA6 15(1) 3 YA9 13(6) 15(1) 4 YA19 13(1)(b) 17(1) sch 3. You must ensure that all residents have care plans when the assessment identifies a need. This care plan must be clear and concise for staff and resident to follow. You must ensure that all care 30/06/07 plans contain enough detailed information, which is clear and concise for staff and resident to follow. You must ensure that risk 30/06/07 assessment are adequately completed that appropriately indicate the level of risk to residents and include clear actions / measures for staff to take in order to reduce the risks. You must ensure that the 30/06/07 health needs of residents are accurately recorded to ensure who has been providing support, what the outcome was and when this was are reported upon. This will ensure upto date information is available about the residents health. DS0000016874.V336673.R01.S.doc Version 5.2 Strensham Hill Page 28 5 YA20 14(1)(2) 13(2) 6 YA20 13(2) 7 YA22 22(1)(3)(4 )17(2) sch 4(11). You must ensure that all 31/07/07 residents have an assessment to determine whether they can safely manage their own medicine, and if they can they must have the opportunity to do it, this will help develop self care skills and an understanding of their medication. You must ensure that 30/06/07 medication stored in the fridge is kept at a safe temperature so that it will be effective when administered to residents. You must ensure that 31/07/07 complaints made by individual residents or as a group are effectively recorded, managed and responded to. Previous timescale of 30/11/06 not met, this requirement is carried forward. You must ensure that where 30/06/07 there are concerns for the safety of a resident that the homes Adult Protection policy is followed by the manager and staff, that these concerns are reported without delay to all appropriate agencies. This will alert the people whose responsibility it is to safeguard the residents. You must ensure that the 31/07/07 damaged furnishings and fixtures as identified in the main body of the report are repaired or replaced to adequately promote the safety of residents. You must ensure that the 31/07/07 cleanliness of the home is improved including all the areas identified in the main DS0000016874.V336673.R01.S.doc Version 5.2 Page 29 8 YA23 13(6) 9 YA24 23(2)(b) 10 YA30 16(2)(j) 23(2)(d) Strensham Hill 11 YA34 body of this report. This must be maintained to a standard that is hygienic and promotes the safety of residents. 19(1)(a)(b)(i) You must ensure that all staff para 1 to 7 of who work at the care home Sch 2. have a POVA first check and a 13(6) CRB application completed as part of the recruitment process and before they are appointed. Previous timescale of 25/10/06, not completed this requirements has been carried forward. You must ensure that one named member of staff does not work unsupervised until the POVA first check has been completed. This will safeguard the residents at the home. 11/05/07 12 YA35 18(1)(c)(i) The application must be made by the 11/5/07. 30/06/07 You must ensure that all staff have received or have planned training to safely meet the specific needs of residents such as Mental Health Awareness. Previous timescale of 30/06/06 not met, this requirement is carried forward. You must ensure that a competent, qualified and experienced manager is appointed to effectively manage the home in the best interests of the residents. Previous timescale of 31/12/06, not completed this requirements has been 13 YA37 9(1)(2) 31/08/07 Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 30 carried forward. 14 YA41 17(1)(3) sch 3. You must ensure adequately detailed, clear and concise records for the residents daily life and health are available, upto date and that are in good order. This will provide upto date information for staff to be aware of and act upon in the course of their duty. You must ensure you appropriately complete records about residents who have had accidents and that these are available at the home. 30/06/07 15 YA42 17(1)(2)(3) sch 3 and 4. 30/06/07 16 YA42 13(4)(c) You must give notification to the Commission without delay of any event in the care home, which adversely affects the well-being of any resident. You must ensure that any 30/06/07 resident in the home who smokes in unauthorised areas has an individual risk assessment about the dangers of this and the actions the home has taken to reduce this risk. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA9 Good Practice Recommendations You should ensure that all care plans contain the choices and preferences of residents and that the residents are invited and take part in the reviewing of care plans. You should ensure that all risk assessments contain the considered choices and preferences of residents and that the residents are invited and take part in the reviewing of the risk management plan. DS0000016874.V336673.R01.S.doc Version 5.2 Page 31 Strensham Hill 3 YA12 YA13 YA15 YA16 You should ensure that the chosen lifestyles of residents have a care plan where a need has been identified that describes how the staff support each individual to take part. This should include education, local community links, relationships, daily routines and meals and mealtimes. 4 YA17 YA20 5 6 7 YA23 YA36 YA39 8 YA42 9 YA43 You should ensure that regular audits of medication are undertaken, that the results are recorded and that any discrepancies are fully investigated recorded along with actions taken to make improvements. You should ensure that records kept about residents money are always signed by two people, one of whom would preferable be the resident. You should ensure that staff receive regular supervision and support, which will help them carry out their jobs. You should ensure that the home establishes and maintains a system for evaluating the quality of the services at the care home. This will involve residents to improve the quality of service they receive. You should use the information gathered at the monthly health and safety check to inform other risk assessments, for example the risks about residents smoking in authorised areas. There should be a business and financial plan for the home and the service, available to CSCI for inspection and reviewed annually. Not assessed at this inspection and is carried forward. Strensham Hill DS0000016874.V336673.R01.S.doc Version 5.2 Page 32 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 Strensham Hill DS0000016874.V336673.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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