Inspection on 20/08/09 for Strensham Hill

This inspection was carried out on 20th August 2009.

CQC 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 CQC judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Strensham Hill 19/08/08

Strensham Hill 20/02/08

Strensham Hill 10/05/07

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 17/02/2010.

Key inspection report CARE HOME ADULTS 18-65 Strensham Hill 1 Strensham Hill Moseley Birmingham West Midlands B13 8AG Lead Inspector Amanda Lyndon Key Unannounced Inspection 20 and 24th August 2009 08:25 th Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Strensham Hill DS0000016874.V377208.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) Servol Acting Manager in post Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8) of places Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Mental disorder, excluding learning disability or dementia (MD) 8 The maximum number of service users who can be accommodated is: 8 19th August 2008 Date of last inspection Brief Description of the Service: 1 Strensham Hill provides care and accommodation for up to eight people between the ages of 18 and 65 years with mental health disorders. People of any cultural background are welcome at the home however, there is specific focus on the needs of Caribbean people. The home is situated in a residential area of Moseley bordering with Balsall Heath. It is close to public transport links and is within walking distance of a range of local amenities such as shops, parks, places of worship, a library, swimming baths, doctors’ surgery and dentist. Accommodation is spread over two floors and upper rooms are accessed via a stairway, a passenger lift is not provided. In addition there are steps leading to and from both the front and rear entrances of the building. This means that the home is not suitable for people with mobility problems. All bedrooms offer single occupancy and an en suite facility of a toilet and shower are provided in one bedroom. All other people have access to shared toilet and bathing facilities. There is a communal lounge and a separate kitchen/diner which includes individual storage facilities for each person living there. The home is a non smoking environment and people that choose to smoke, do so outside. There is a private garden to the rear of the home which is suitable for all people to use Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 5 and off road car parking is provided at the rear of the garden. There is also car parking space on the road outside the front of the home. There is a range of leisure activities both within and outside of the home, on offer to people living there. In the reception area there is some information that may be of interest along with photographs of recent events. A copy of the statement of purpose and service user guide are available, so that people can read them if they choose. A copy of our last inspection report was not available and this will prevent people from accessing this information. Details of fees charged to live at the home are available from the home on request. The accommodation fee does not include leisure activities, toiletries and clothing. Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is zero star. This means that people who use this service experience poor quality outcomes. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice, and focuses on areas that need further development. The visit to the home was undertaken by one inspector over two days. The home did not know that we were visiting on either of the days. There were four people living at the home during our visits. Prior to the visit taking place, we looked at all of the information we had received, or asked for. We received an Annual Quality Assurance Assessment (AQAA). This tells us how the home think they are performing in order to meet the needs of people living there. It also gives us some numerical information about staff and people living at the home. We had to send a chaser letter to the home as they had not completed and returned the AQAA within the given time scale. This was completed by the acting manager in good detail and returned to us within the extended deadlines. We had not received any complaints about the service provided. We sent out surveys to all four people who live at the home, four relatives, and five staff members, in order to obtain their views about the service provided. Two people who live at the home and one staff member returned surveys to us, and their comments are included in this report. Two people were case tracked. This involves talking to them and discovering their experiences of living at the home. We focus on the outcomes for these people. We also spent time observing care practices and speaking to five staff members about the care they provided to these people. We gave all people living at the home the opportunity to be involved in the inspection. We sampled care, staffing, and health and safety records. We looked around the areas of the home used by people case tracked to make sure it was warm, clean, and comfortable for them. There were no visitors to speak with on either of the days that we were at the home. What the service does well: Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 7 People told us that they were happy living at the home and that they were able to choose how they spend their time. People have some opportunities to be involved in the running of the home. The home is sensitive to peoples’ cultural needs so that they are supported to live their lives pursuing what is important to them. People are supported to keep in touch with their families and friends so that they do not lose relationships that are important to them. People told us: “We sit here in the lounge, chat to the staff or go to our room, it’s up to us. I am going into town, I have a little drink at the pub”. “People get up when they like.” “My son came for the barbeque. We sat in the garden and in the lounge”. What has improved since the last inspection? There are opportunities for people to do things for themselves, go out often, have a chance to develop new skills, and stay as independent as possible. People living at the home have been involved in refurbishing the lounge so that it is a comfortable room to relax in. Quality monitoring visits are undertaken by external senior managers so that any areas for improvement can be identified for the benefit of people living at the home. People told us: “The senior manager will come and checks up with no warning”. “The staff build my confidence”. “We are looking forward to going on a trip to Stourport tomorrow.” “I enjoy going out with the college. We are going to learn IT in September.” Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 8 What they could do better: People do not have all of the information that they need to enable them to decide if they want to live at the home. Prior to coming to stay there, people cannot be confident that the home will be suitable to meet their needs. People cannot be confident that they receive any private correspondence meant for their attention as it arrives at the home. People do not always have access to snacks at the times they require in order for them to remain healthy and well. People cannot be confident that they consistently receive the care and support at the times that they require. People living at the home cannot be confident that they are protected from harm. Facilities and equipment provided at the home do not meet the assessed needs of all people living at the home. People should be able to benefit from the home being well managed. Staff must receive all the training they need to meet peoples’ individual and collective needs. Arrangements must be made so that people are supported to promote their independence whilst maintaining their safety. Systems should be improved in order to determine whether people are consistently eating a healthy and nutritious diet. People cannot be confident that their meals are stored and prepared in a hygienic manner. Systems in place for the auditing of money belonging to people living at the home held for safekeeping should be reviewed, so that people can be confident that all money spent on their behalf is accounted for. A review of staff work patterns should be undertaken in order to ensure that people living at the home can be confident that they are being supported by an effective staff team at all times. Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 9 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 10 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.V377208.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be confident that their care and support needs will be met. Admission procedures do not protect people living at the home. EVIDENCE: Information in the AQAA and statement of purpose identified that the home provides a holistic and personalised approach to prepare people for resettlement in to the community with the support that is necessary to maintain independence. However, we found that during our inspection there were four people living at the home and all had lived there for between nine and sixteen years. A statement of purpose and service user guide had been produced. However these did not identify the full range of services and facilities that the home provides, including long term care. This will prevent people looking for a care home from having this information to help them decide if the home is suitable for their needs and whether they would like to live there or not. We saw that these are produced in a normal sized print format. However the acting manager stated that they could be produced in Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 12 other formats and languages on request, so that more people could access the information. Information about the fees charged to live at the home are available from the home on request. In addition to this, we saw that people living at the home had signed comprehensive contracts that included information about what the fees cover so that they were aware of this information. There had not been any new admissions for a long period of time. However the acting manager told us that a person was due to come to the home for an overnight trial visit on the evening of day one of our inspection. We asked to sample the pre admission assessment for this person. The acting manager showed us information that had been obtained about this person from health professionals who were involved in their care, and evidence that this person had been to the home on two occasions during day time hours. However, stated that the pre admission assessment would be completed during the overnight trial visit. We were concerned to find that during day two of our inspection, the pre admission assessment had not been completed as previously stated, despite being told that this person was due to return to the home for a second overnight visit. This means that the home may not be able to meet this person’s needs and does not safeguard people living at the home. We brought this to the attention of the senior external manager for action. In addition to this, it was of concern that additional support had not been arranged for the staff member working alone on the “sleep in” shift in order for an assessment of the suitability of the home to meet this person’s needs to be undertaken. This was brought to the attention of the acting manager who arranged for additional staff cover to be provided. Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that live in the home receive support to make choices and decisions about their day to day lives, so that they lead lifestyles that meet their needs and expectations. EVIDENCE: Assessments of peoples’ individual physical, emotional, and social care needs are undertaken on admission to the home and are reviewed periodically throughout their time at the home. Care plans are derived from this information. These are individual plans written with the involvement of people and their representatives about what people can do for themselves, and in what areas they require support. Not all people living at the home are able to read so the acting manager stated that she is looking to introduce a Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 14 computerised care planning system so that more people will be able to have access to this information. She said that this will include a speech activated programme. One person said “I have a care plan. They read it out and I am involved in it”. We found that the vast majority of care plans were personalised, included peoples’ preferences regarding their daily lives and identified what the person could and couldn’t do for themselves. They also gave instructions for staff about the support to be provided and it was evident from our discussions with people living at the home that the majority of them were involved in writing and reviewing these. This is important so that people are encouraged to maintain their independence and means that their preferred routines can be maintained whilst living at the home. The home completes risk assessments for people so that consideration is given to supporting them to take responsible risks, and promote their independence. From discussions with staff and people who live in the home, it was evident that people are encouraged to maintain and develop their independence as able. We saw that risk assessments had been written for people with behaviours that can be challenging to others and these included details of the support required by staff at these times. Each person living at the home has two key workers and both staff and people living at the home met during the visit had a good understanding of this system. This means that people should be supported by staff who are familiar with their care needs. People met were able to tell us who their key workers were and that they were satisfied with the level of support provided by these people. We saw that regular care reviews are undertaken involving people living at the home, people important to them and their key workers. This provides people with the opportunity to put forward any suggestions for improvements to the service provided and assess whether their care needs were being met. We saw that during these reviews, achievable goals are set, agreed with people living at the home in order to promote their independence. Written records identified that the success of these are reviewed and new goals are set in order for people to develop further skills. People told us that they can choose how they spend their time and we saw that following risk assessment, they are able to go outside of the home on their own as they choose. One person said “We sit here in the lounge, chat to the staff or go to our room, it’s up to us. I am going into town, I have a little drink at the pub”. One staff member said “People get up when they like” People told us that staff support them to buy clothing that is appropriate for their age, gender, culture and the time of year. Two people told us that they were looking forward to going on a shopping trip with staff to buy new clothes for their day trip tomorrow. Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 15 From discussions with people living at the home and our observations on the day, we saw that people are supported in a respectful manner and interactions between staff members and people living at the home were good. This will promote peoples’ self-esteem. It was of concern, however, that we saw that unopened correspondence for the attention of people living at the home had been put away in a cupboard and none of the staff on duty were aware that it was there. This will prevent people from having letters that are meant for them. There are some systems in place to capture the view of people living at the home. Group meetings are arranged for people living at the home and we sampled the minutes of a recent meeting, however these were not on display. This will prevent people who did not attend the meeting from having this information. People told us that they were involved in planning social events in response to suggestions made during group meetings. Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 16 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): This is what people staying in this care home experience: 11, 12, 13, 14, 15, 16 & 17 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home experience a meaningful lifestyle that promotes their independence and is reflective of their individual needs and interests. EVIDENCE: From our observations during the visit and sampling of records we identified that there is a range of activities provided for people to participate in, if they choose to do so. These include both group and individual activities, both within and outside of the home and people told us that they have a say in arranging these. People told us that they are arranging a party to celebrate a forthcoming birthday and that they are looking forward to going on holiday later in the year. One person said “We are looking forward to going on a trip to Stourport tomorrow”. On day two of our inspection, people told us that they Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 17 had thoroughly enjoyed the trip, despite the bad weather. Since our last visit a weekly exercise session has been arranged in order to promote a healthier lifestyle for people living at the home. One person met during the visit told me us that she enjoyed this. Staff encourage people to do things for themselves in order to promote their independence, and develop life skills. We saw that activity records are reviewed during key worker reviews so that activities arranged are specific in line with peoples’ personal goals. One person said “I vacuum my bedroom every day”. We also saw other people undertaking household duties during our visits to the home. People are supported to maintain links with the community thus lead fulfilling lifestyles. All people living at the home attend local colleges and day centres. This provides people with the opportunity to meet with like minded people and develop their social skills. One person said “I enjoy going out with the college. We are going to learn IT in September”. People told us that the home is sensitive to their cultural needs which means that support is provided in an understanding manner. All people living at the home are Caribbean and the culture mix of staff reflected that of people living at the home. Examples of this included the choice of meals provided, beauty and personal care regimes, the decorative style of the home and support to find activities linking in with other people of the same cultural background. Arrangements are in place so people can follow their religious beliefs if they wish. This means that people can pursue interests and beliefs that are important to them. People are encouraged to maintain contact with their family and other people important to them. They told us that their visitors were made to feel welcome at the home. One person said “My son came for the barbeque. We sat in the garden and in the lounge”. There were no visitors at the home during our visits, however we saw that one person had gone out to spend time with her family. Staff prepare communal meals for people living at the home three times a week and we saw that these included a variety of healthy and Caribbean meal options. People are responsible for preparing meals and snacks at other times, with varying levels of support from staff as required. This promotes peoples’ independence in this area. One person said “I have my own cupboard for cooking. The staff does cooking but if you like you can do your own”. Risk assessments sampled identified that people living at the home do not always choose to buy foods that are healthy and this means that they are at risk of having an unbalanced diet. Staff told us that they provide support in this area and assist a number of people living at the home with their food shopping. This means that people can be encouraged to choose healthy Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 18 options, whilst still being able to exercise control over their food shopping. In addition to this, picture guides of healthy food options were on display in the kitchen so that people could refer to these when planning their meals. As previously identified at our last visit, we were still not able to determine whether people receive a healthy diet as food records were incomplete. This is of concern being as a number of people living at the home have special dietary requirements. It was of concern that the acting manager told us that the kitchen is locked at 10pm and snacks are not permitted in peoples’ bedrooms. This may mean that people do not have any means of obtaining snacks after this time. This is of particular concern for people at the home with diabetes who require a regular food intake in order for their blood sugar to remain within safe limits, and consideration to this had not been given. From discussions with people living at the home and the staff team, conflicting information was given about whether or not people have access to snacks overnight so this must be reviewed in order to protect people living at the home. Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems in place do not always meet peoples personal and health care needs, and this places them at risk of harm. EVIDENCE: The majority of people living at the home required minimal assistance from staff to meet their personal care needs and we saw that people were clean, hair was neatly styled and people were wearing clothing appropriate to their age, gender, culture and the time of year. We looked at the personal care plans of two people living at the home. These included information about peoples preferences regarding a choice of bath or shower and we saw that people were involved in the planning of these. From discussions with people living at the home, these reflected the support provided by staff on the day of our visit. Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 20 We asked to sample the health plans of two people living at the home and found that these included some information about their health needs, however, as identified during our previous visit to the home, these had not been produced in a format that the majority of people living at the home could understand. The acting manager showed us a health plan that included pictures so that the information could be understood by people living at the home, however this was dated October 2008 and health plans for the other people living at the home had not been completed since that date. We saw that staff had recognised that the care needs of one person had increased over the past year and a review had been undertaken with external professionals, with a decision being made that the person would like to remain at the home, with extra support from staff. From discussions with the person, staff, from our observations and from sampling of records, we could not evidence that this person is receiving the additional support required, in particular during night time hours. Staff told us that they required further training in order to meet the person’s health care needs and there were conflicting accounts from staff about the support they provide to this person. A care plan or risk assessment had not been written in order to instruct staff about the specific support to be provided to this person during night time hours. A care plan relating to diabetes did not identify all support required by staff and as previously identified it was of concern that snacks are not always available for this person overnight. It was also of concern that despite this person requiring support overnight, they had no means to summons the assistance of staff as a call facility was not provided in the home. The “sleep in” staff member is located on a different floor of the home and there was no written evidence that staff are undertaking night checks. Staff met during the visit stated that this person would on occasions come out of the bedroom at night and felt that this person is not safe to do so on their own. This does not maintain the person’s health and safety People can retain their own doctor on admission to the home, if the doctor is in agreement and, if able, people are encouraged to attend the doctors surgery in person, with the support of staff. In addition advice can be sought as needed from a range of other health and social care professionals. We saw that staff had obtained information from an organisation specialising in services for people who are blind in order to improve the quality of life of a person living at the home. We looked at the system in place for the management of medication and found that this was well organised and that medication administration charts were well maintained, A system for ensuring that people received their medication as prescribed was in place and the majority of staff had undertaken recent training in this area. Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are limited systems in place to listen to people living at the home, so that people can not be confident that their views are listened to. Systems in place do not always protect people from harm. EVIDENCE: Since our last visit we have not received any complaints about the service provided at the home. The complaints procedure was not on display in the home and we saw that the service user guide included two different complaint procedures, both being out of date. This will prevent people from having current information about how to raise any concerns that they may have. Since our last visit, we saw that a “Suggestions Box” is located in the reception area of the home, however the acting manager said that they had not received any feedback from this. Since our last visit the home have not received any complaints about the service provided there. During our last visit to the service, we suggested that the agenda of group meetings of people living at the home should include time for people to raise any concerns that they may have. The minutes of recent group meetings did not identify that this had been done and a system for recording low level Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 22 concerns had not been implemented in order to evidence that actions had been taken in response to these. We asked people living at the home if they knew how to make a complaint. One person said “I would talk to the manager if I wasn’t happy. All the staff are all right”. Since our last visit we have not received any information about safeguarding issues at the home. We saw that there was a comprehensive adult protection policy in place and local multi agency guidelines were available, however, the absence of a staff training and development plan at the previous two inspections meant that we have not been able to verify whether staff had undertaken recent training in this area. A number of staff members spoken with during our inspection said that they had not had recent training in this area and they stated that they would report any allegations of abuse to their acting manager. It was of concern, however, that senior staff members’ knowledge in this area was limited, and this will result in the correct procedures not being followed in order to safeguard people living at the home. As previously identified, it was of concern that additional staff cover had not been arranged whilst a person who was looking to come to live at the home was being assessed on an overnight trial visit. This may not protect people living at the home. Additional staff cover was provided after this was brought to the attention of the acting manager. Staff do not manage the personal finances of people living at the home however individual support is given to people regarding budgeting as required. Receipts of some items purchased out of peoples’ money were available however the system in place for the auditing of this was unclear and this should be reviewed in order to ensure that all money spent is accounted for. Staff help people to manage their money. There is a system in place for the safekeeping of small amounts of money held on behalf of people living at the home. Money is kept in a locked facility. Receipts were available however were not clearly documented. This means that it was difficult to establish whether all money spent on peoples’ behalf was accounted for. Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all people at the home live in an environment that meets their assessed needs. EVIDENCE: The home is situated in a residential area of Moseley. There are a range of shops, leisure activities, and public transport links nearby. This is important to the people who live there as they make regular use of these amenities. The upper floors of the home are accessed via a stairway and people have to negotiate steps leading to and from both the front and rear entrances of the building into the garden. This means that the home is not suitable for people with mobility problems. Information about this is included within the statement Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 24 of purpose so that people are aware of this when choosing whether to live there or not. The rear garden is spacious and private, and people told us that they enjoy using this area. Smoking is not permitted within the building and people that choose to smoke, do so in the garden. There is one communal lounge and one television, with a “Freeview” facility in the home for people to share. The acting manager told us that three of the people living at the home had made a request to have their own televisions in their bedrooms and that she was currently looking into this. Since our last visit, a new carpet, window blinds and furniture had been provided in the lounge and people living at the home told us that this was now a comfortable room to relax in. We saw, however, that a number of areas of the home were still in need of redecoration, and we saw that the carpet in one bedroom was extensively stained. All bedrooms offer single occupancy and one of these has an en suite toilet and shower facility. Communal toilet and bathing facilities are accessible to other people living at the home. As identified during our last visit, bathrooms and toilets though fit for purpose and functional, would benefit from modernisation. We looked at the bedrooms of people case tracked and saw that they have personalised their bedrooms to reflect their age, gender, interests and culture. People met during the visit stated that they were happy with their rooms. It was of concern, however that a person living at the home who had been assessed as requiring support from staff during the night, had, from her bedroom, no means of summoning assistance from staff at this time. It was evident that this was an ongoing situation and no actions had been taken to address this, placing this person at risk of harm. People have the option of having a key for their bedroom door so that they can keep their personal items private and secure. One person told us that they choose to do this. We saw that people living at the home and the staff team are responsible for undertaking cleaning duties at the home, and rotas had been devised so that people are aware of their individual responsibilities on a daily basis. In addition, a cleaner is employed twice a week. People living at the home told us that they were satisfied with the standards of cleanliness at the home and we found that in general the home was clean and fresh. We did, however identify some areas of the home that were below an acceptable standard of cleanliness within the kitchen and en suite and this was brought to the attention of the acting manager for action. Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35 & 36 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be confident that staff have all the skills and knowledge they need to meet their needs. EVIDENCE: The acting manager said that staff turnover was low, there were no staff vacancies and that “bank” staff cover periods of staff sickness and holidays in order to ensure continuity of support for the people living at the home. It was evident that a good rapport had built up between the staff team and people living at the home, and we saw that staff spend time sitting and talking to people living there. From discussions with the staff team and sampling of the staffing rotas, we identified that the staff member undertaking the “sleep in” shift worked the early shift the following day, until 4.30pm. This is of concern as staff told us that the person on duty overnight is required to provide regular waking Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 26 support to at least one person living at the home. We brought this to the attention of the senior external manager who stated that this poor practice should not have continued, however staff members met during the visit confirmed that they were still expected to work this shift pattern. Following our visit, we referred our concerns to Social Services for further investigation. The acting manager told us that since our last visit there had not been any new staff members employed at the home however staff had been transferred from other services within the organisation. We were, therefore, unable to sample staff recruitment files on this occasion. During our last two visits to the home, we found that a staff training matrix had not been developed, despite it being identified on the action plan that this had been done. During this visit, we found that this was still the case and with the absence of training certificates on staff files and a “training book” being incomplete, we were unable to determine what training staff had received recently. From discussions with the staff team we established that staff had received training in safe working practices, however now required refresher training in order to support people in a competent manner. The acting manager told us that she was liaising with the organisation about arranging this. As previously identified, staff told us that they required training about specific medical and care issues in order to meet the individual needs of people living at the home. Information on the AQAA identified that all staff employed at the home are trained to a National Vocational Qualification Level 2 in care (NVQ 2) and most are working towards NVQ 3. This should mean that they have some of the skills and knowledge necessary to provide a good standard of care to people living at the home. Since our last visit, a system for formal staff supervision has been implemented and we saw that detailed records are maintained about this. Staff met during the visit confirmed that this was taking place so that they have an opportunity to discuss their personal development needs. Records identified that staff meetings are held regularly. This means that staff have the opportunity to be involved in the running of the home, however feedback received during the visits identified that the staff team in general did not always feel that their ideas were acted upon. This will result in low staff morale and may have a negative impact on the lives of the people living at the home. Strensham Hill DS0000016874.V377208.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 & 43 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems in place do not ensure that the service is run in the best interests of the people using it. People cannot be confident that their health and safety is maintained at the home. EVIDENCE: The acting manager has been in post for the past twelve months and is yet to apply for her registration with us. During the previous visit to this service, we identified that the acting manager had not been in post long enough to address Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 28 a number of issues raised, however we found that a number of these were still outstanding at the time of this visit. Prior to the inspection, we had to send a reminder letter to the home as they had not completed and returned the Annual Quality Assurance Assessment (AQAA), within the given time scale. This was completed and returned to us within the extended deadlines. It included details about the home, staff, and people who live there, and what the service hoped to achieve for the benefit of the people living there. We did evidence, however that some of the information included within the AQAA did not reflect our findings during our visits and this means that it doesn’t give us a reliable picture of the service provided at the home. In addition, information in the statement of purpose did not give us an accurate description of the services provided at the home. Senior external managers undertake regular quality monitoring visits at the home, and there was evidence that people living there are involved in these visits. One staff member said “The senior manager will come and checks up with no warning”. We saw that service satisfaction questionnaires had recently been sent out to people living at the home in order to seek their views about the service provided there. The vast majority of feedback was positive, however a report based on the findings of this had not been written so people would not be aware of the results of these and actions being taken. From records sampled we identified that regular checks are taken on equipment to ensure that it is safe to use. We saw that a fire drill had been undertaken recently, involving people living at the home so that people were aware of the actions to be taken in the event of a fire. We found that other records held at the home, such as staff training records were incomplete. We saw that one person living at the home carried the vacuum cleaner down the stairs in order to put it away in the cleaning cupboard, placing her at risk of falling. A risk assessment had not been completed regarding this and the acting manager stated that the staff team should be responsible for putting equipment away, however they had not done so on this occasion. In addition to this, we saw that the cleaning cupboard containing cleaning products had been left open placing people living at the home at risk of harm. Each person living at the home has a designated space in the fridge/freezer and a lockable cupboard in which to store their food. The action plan following our last visit to the home stated that systems were under review so that appropriate food checks are undertaken to ensure that people do not store food that is past its sell by date. During our visit we saw that this was not effective, as a number of food items were past their sell by date and a system for labelling and correctly storing opened food products had not been implemented. Staff met during the visit did not have adequate knowledge about the importance of this in order to advise people living at the home about Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 29 this in a competent manner. This does not safeguard people living at the home and may lead to incidences of food poisoning. The acting manager told us that food hygiene training for staff was booked. In addition to this, we saw that one of the fridges containing a person’s food was dirty. We asked to see the last environmental health report undertaken at the home however details about this were not provided to us. We have identified throughout this report areas of concern relating to the management of services provided at the home. These present risks of harm to people living there and ways in which to manage these concerns must be implemented in order to improve the outcomes for, and maintain the safety of the people living there. Strensham Hill DS0000016874.V377208.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 1 2 1 3 2 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 2 26 3 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 X 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 2 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 3 X 1 1 2 X X 1 1 Version 5.2 Page 31 Strensham Hill DS0000016874.V377208.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14 Requirement Assessments of peoples’ care and support needs must be undertaken prior to coming to stay at the home. This is in order to determine the suitability of the home to meet peoples’ individual needs and protect those people currently living at the home. Arrangements must be made so that people have access to snacks at the times they require. Timescale for action 30/09/09 2 YA17 12(1) 30/09/09 3 YA19 12(1) 4 YA23 13(6) This is in order to ensure that people remain healthy and well. Systems must be in place so that 30/09/09 people receive the care and support at the times they require in order to meet their assessed needs. Arrangements must be in place 30/11/09 so that staff receive training about the protection of vulnerable people. This is in order to safeguard people living at the home. Arrangements must be made to ensure that facilities and DS0000016874.V377208.R01.S.doc 5 YA24 23 31/10/09 Strensham Hill Version 5.2 Page 32 equipment provided at the home meet the assessed needs of all people living there. This is in order to maintain the health and safety of all people living there. Staff must receive appropriate 31/12/09 training so they have the skills and knowledge to support people who use the service. Arrangements must be made so 15/10/09 that a registered manager is employed at the home. This is in order to ensure that the home is managed by a person competent to do so, in the best interests of the people living there. Arrangements must be made in order to minimise the risks involved to people living at the home whilst undertaking their daily duties. This is in order to maintain the health and safety of people living at the home. 6 YA35 18(1) 7 YA37 S11 CSA 2000 8 YA42 13(4) 30/09/09 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 identify all services and facilities provided at the home so that people have this information when choosing a care home. Arrangements should be in place so that all private correspondence of people living at the home is distributed to them without delay. This is so they receive any information that is meant for their attention. DS0000016874.V377208.R01.S.doc Version 5.2 Page 33 2 YA7 Strensham Hill 3 YA8 4 5 6 YA17 YA19 YA22 7 YA23 8 YA24 9 10 YA33 YA35 11 YA39 12 YA42 Minutes of group meetings should be accessible to all people including those unable to attend, so that they are aware of matters discussed and any actions to be taken as a result of this. A system should be in place so that it is possible to determine whether people living at the home have a consistently healthy diet. Systems should be in place so that more people living at the home are involved in devising health care plans. Systems should improve so that people are encouraged to voice any concerns that they may have about the service provided at the home, and a record of this should be kept so that people can see what actions have been taken in response to these. Systems in place for the auditing of money belonging to people living at the home held for safekeeping should be reviewed in order to ensure that all money spent is accounted for. Arrangements should be made so that all areas of the home are clean and in a good state of repair and decoration so that people are provided with a safe and comfortable place to live. A review of staff work patterns should be undertaken in order to ensure that people living at the home are supported by an effective staff team at all times. A staff training matrix and development plan should be developed in order to identify any gaps in staff knowledge. This is to ensure that staff have the knowledge and skills they need to do their jobs. A report based on the findings of service satisfaction questionnaires and actions taken as a result of these should be produced, in order for people to be confident that their suggestions have been acted upon. Arrangements should be made so that an acceptable standard of food hygiene is maintained. Strensham Hill DS0000016874.V377208.R01.S.doc Version 5.2 Page 34 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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