Inspection on 20/02/08 for Strensham Hill

This inspection was carried out on 20th February 2008.

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

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 3 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 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 09/07/2008.

CARE HOME ADULTS 18-65 Strensham Hill 1 Strensham Hill Moseley Birmingham West Midlands B13 8AG Lead Inspector Gerard Hammond Unannounced Inspection 20th February 2008 09:10 Strensham Hill DS0000016874.V360071.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.V360071.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.V360071.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 Vacant Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8) of places Strensham Hill DS0000016874.V360071.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. 10th May 2007 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 service should be contacted directly for up to date information about fees and charges. Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. This was the home’s second key inspection of the current year 2007-8. Information was gathered from a range of sources to inform the judgments made in this report. This includes previous inspection reports and notifications received from the home. A visit was made to the home and records including personal files, care plans, staff files, safety records and other documents were looked at. We spoke with the residents, and also the Manager and staff on duty. A tour of the building was also completed. What the service does well: What has improved since the last inspection? What they could do better: Information about what the service provides needs to be updated. This is so people have current information to help them decide if the service is right for them. Contracts also need to be brought up to date, so that it is clear what people’s responsibilities are. Care plans would be better if they were more detailed and “person-centred”. This means that they should focus more on each individual and what their Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 6 goals are. It should be possible to see clearly whether or not people’s goals are being met. This would make sure that people get the support they want in ways that suit them. Plans should also include all of the important information that staff need to know to help people stay safe. Records about the activities people are able to do need to improve. These should be more detailed so that it’s clear how activities have been chosen and what people get out of doing them. Doing this will help to make sure that people can do the things that are important to them, and achieve their goals. People’s healthcare could be managed better if all of the records were kept in one place. Each person should have a Health Action Plan to make sure they get all the support they need to stay healthy and well. A number of jobs need to be done around the house to make sure that it is well maintained and looked after. This will help to make sure that residents can feel comfortable and safe in their home. The staff team could be better supported. Vacant posts should be filled, and training and supervision better organised. This would make sure that staff have the knowledge, skills and support they need to do their jobs well. The way in which the home is managed needs to be improved. The Manager should be properly supervised so that she gets the equipment and support she needs to do her job. Action should be taken to make sure that the views of the people who use the service guide the way in which it is developed. 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.V360071.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Documents about what the service provides need updating. This is so that people have all the necessary information to help them decide if the service is right for them. Residents’ support needs are assessed, so that their care can be properly planned. People should be given up to date contracts. This is so that it is clear to all concerned how much the service costs, and what each person is responsible for. EVIDENCE: There have been no admissions since the last inspection visit in November 2007, and there are currently five people living here. Two residents’ personal files were sampled, and it was noted that their needs assessments had been updated recently. At the last key inspection, it was reported that people had received copies of the Statement of Purpose and Service Users’ Guide. These documents were sampled and are now in need of updating. It was also noted that there was no contract in place on one of the files sampled: the other file did have a contract, but it was not current. Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans need developing to make sure that people’s needs are met and risks are fully assessed. This will mean that they get the care they need in ways they like, and be supported to stay safe. EVIDENCE: Two residents’ care plans were sampled. Previous inspection reports have referred to lack of evidence showing people’s direct involvement in their care planning. Some efforts have been made to address this since the last inspection visit in November 2007. Plans are being updated and there is evidence of goal setting, involving the residents in the process. The resident and supporting staff had signed the plans examined. It was noted that there was little information regarding personal care. Conversations with staff showed that this is because support is generally limited to prompts or supervision. The care plan needs to say this, so that clear guidance is given about how individuals are supported in ways that suit them. However, it should be acknowledged that work has been done to improve care planning, and this Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 10 should now be built upon and developed further. Plans showed preferences expressed by individuals, for example Caribbean food and attending a particular church. Some of the goals set are clearly written by staff (for example “stop hoarding”, “improve personal hygiene”) though there are others where the individual expressed a wish (for example “establish contact with other children”). It is suggested that developing the use of person-centred approaches will help staff to improve goal-setting further. As previously reported, goals should have outcomes that can be clearly measured. Some efforts have been made to do this (for example “cook at least one meal per week on her own”, and with a date when this should be achieved) but other goals could be better defined, and say how they are to be achieved. Currently goals are defined as short term (by the next review) and long term (outcomes in the next two years) One long-term goal said “move on to a more independent place” but does not suggest how this will be achieved, or what work is planned to bring this about. Similarly, “establish contact with other children” gives no indication about how this is going to happen. The goal to cook a meal on her own at least once a week should be supported with a detailed care plan. This should show clearly what she is currently able to do independently, and outline what support she needs to learn new skills, recipes, using kitchen equipment and so on. If the objective is to support her to live more independently than she does at present, then the care planning needs to address specifically what needs to be done to achieve this. Another resident (who lives in a self-contained flat within the home) is said to have made good progress since moving to Strensham Hill. It is anticipated that he will move on in the not too distant future. However, his care plan does not show how he is being supported to achieve this goal. He is very self-sufficient, but one of his goals is to show he is ready for independent living by managing his finances properly. It is suggested that he should have an independent living plan. This should highlight any areas in which he needs support, and say what is to be done to address these. He should be supported to develop his own budget plan, to help him take responsibility for managing his money effectively. Plans show that residents are involved in day-to-day activities around the house, helping with cooking, cleaning and laundry, according to their individual abilities. Staff were observed asking people what they wanted to do, supporting them to get lunch and make choices about what they wanted to eat and drink. They went out to the shops to buy groceries. Residents said that staff helped them to clean and tidy their rooms, and to cook things they liked. Risk assessing is also in need of further development. Records show that potential hazards have been identified, but it is not always clear what action is planned to minimise or eradicate the risk of occurrence. It is still not always easy to link risk assessing and care planning, and it has been suggested that simple indexing and cross-referencing could help to improve this. It is important that where a potential hazard is identified, the measures to prevent it are clearly included in the care plan. One person’s assessment shows that Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 11 she hoards papers, magazines and other potentially flammable materials, which may be a fire risk. Staff say that that this is monitored by regular checks on her room, but this is not reflected in her care plan. She is also identified as being at risk of financial abuse. Conversations with staff suggest that they do what they can to support her to prevent this happening (such as accompanying her to the bank to withdraw and deposit money, encouraging her not to carry more cash than she needs, and so on), but this is not recorded in her care plan. Her records also indicate that she needs to be accompanied away from the home. However, it is clear that she does access local shops and familiar places in the vicinity of the home independently. Her care plan should show this specifically, and the supporting risk assessment should show how judgements about this have been reached. Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are able to do things they value and go to places they like, but opportunities could be better planned and organised. Doing this will help people to achieve their goals and promote their independence. EVIDENCE: Examined records showed that residents attend local day centres and colleges if they wish, go out shopping, and get involved in jobs around the house such as laundry, cooking and cleaning. It was noted at the last inspection visit that recording about people’s daily activities was in need of improvement, and this continues to be the case. As previously reported, people’s activity opportunities are a prime indicator of their quality of life. What they do should be clearly linked to their assessments, care plans and agreed goals. At the moment it is difficult to establish those links on the basis of available evidence. Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 13 However, conversations with residents provided some evidence that they are able to do things that they value. One man is very independent. He has recently obtained a qualification in football coaching and hopes to find work in this area in the future. He also attends music classes at a local college and says he enjoys these very much. His abilities are such that he can access community facilities unsupported, so he comes and goes very much as he pleases. Staff say that he always lets them know when he is going out. He said that he is able to keep in touch with his family and girlfriend, and visits them regularly. Another resident said that she enjoys going to the day centre and to college, where she is able to meet with her friends. She said that she likes to go out shopping, but needs support to go to unfamiliar places. She said that she also enjoys going to a local disco and karaoke, which she is able to do regularly. Staff support her to go out shopping for groceries each week. Members of her family come and visit her most weekends. As reported above, making care plans more “person-centred” and developing individuals’ agreed goals have the potential to improve their quality of life. In this way activities can be planned specifically to meet people’s goals and ensure that they are getting the opportunity to do more things that they see as important. This needs to be addressed systematically, to ensure that people are consulted regularly about the things they want to do, and action taken to make sure they can achieve their goals. In order to support planning effectively, recording needs to improve. It should be sufficiently detailed to show how choices and decisions have been made, and describe what the person got out of doing the activity. Opportunities for people to do things in the evenings and at the weekend need to be improved. Staff explained the system in place for cooking and mealtimes. Residents choose what to have each day for breakfast and lunch (if they are at home) and prepare this, with staff support if required, according to individual needs. Staff cook a communal main meal four days a week. On the other days, residents prepare and cook a meal individually, again with support as necessary. Staff support residents to shop for their groceries, so that they get to choose the food they buy. Each person has a lockable cupboard and designated space in the fridge / freezer in which to store their food. A record is now being kept of the meals that people eat each day. This shows that plenty of variety is available: the Manager reported that people are encouraged to eat healthily, but that healthy options are not always the most popular. Food stocks were examined: these were plentiful and included fresh produce. One resident said, “the food is lovely, rice and peas, jerk pork, salt fish – I can have what I like” Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s personal care needs are met, but the management of their healthcare needs to improve. This is to ensure that they get all the support they need to stay healthy and well. EVIDENCE: Direct observations of interactions between staff and residents showed that support is given with warmth and respect, and in a friendly manner. Residents said, “staff are lovely” and “I’m happy with the support I get”. People were dressed appropriately and had received support in their personal care. Concerns were expressed at the time of the last inspection about the quality of support people receive to ensure that their healthcare needs are being met. Information on people’s files showed that other professionals are involved in residents’ healthcare. There are appointment letters from Consultant Psychiatrists and General Practitioners and Community Nurses. One resident spoke of the good support he has received from the Community Psychiatric Team during the time that he has been at Strensham Hill. There is a general health record for detailing other appointments with Opticians, Dentists, Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 15 Chiropodists, and for blood tests, hearing and “other”. Records contained information of indicators that might alert staff to impending mental health breakdown or relapse. The Manager advised that health appointments are put in the diary, or reminders put on the board in the office, so that staff know when these should happen. It is suggested that the way in which residents’ healthcare needs are planned and monitored is in need of early review. The process needs to be more systematic, in order to ensure that people’s healthcare needs are met fully. It is currently difficult to make fully informed judgements about this because of the way information is processed and stored in people’s records. It was reported that a named member of staff has responsibility for monitoring and recording residents’ weights. The Manager said that these were recorded in a book, but this record could not be found on the day of the inspection visit. It was noted that when staff accompany people to medical appointments, the record of the outcome is written in the daily notes. There is a risk that doing this will lead to important information being “buried” and subsequently difficult to find. It was also noted that there was no risk assessment in place for the person who takes his medication with him when he visits his family. Available records do not demonstrate that people’s healthcare is managed in an appropriately structured way. It is recommended that Health Action Plans be developed for each person, and that all information relating to the planning, monitoring and delivery of their healthcare be stored in the same location on their personal records. Health Action Plans should show clearly what individuals’ health needs are, and include plans showing specifically how these are to be met. As with general care plans, these should have clear goals, with measurable outcomes and designated time limits. The focus should be proactive rather than reactive – that is “what needs to be done to promote this person’s good health and wellbeing”, rather than just “what needs to be done when a problem arises”. It should be acknowledged that elements of these were present in sampled care plans (for example, encouraging exercise, eating healthily) but more structure is required. This is to ensure that things that can be done to promote people’s good health actually get done, and that the situation is kept under regular review. Medication is managed through the Boots Monitored Dosage System. Previous inspection reports show that staff have completed training in the safe handling of medication. Records included sample signatures of staff and copies of prescriptions. The Medication Administration Record (MAR) had been completed appropriately. A requirement made at the time of the last key inspection is now being met. Daily checks of the temperature of the medication fridge have been made and a written record kept. The medication cupboard was clean and tidy, and secure. Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some residents are confident that their concerns are listened to and taken seriously. Others may need more support to be sure that any concerns they have are raised and dealt with. People are protected from abuse, neglect and self-harm. EVIDENCE: The complaints record was examined: this shows that no complaints have been received since the last key inspection. The last recorded complaint was in December 2006. We have not received any complaints in respect of this service, or notifications of any safeguarding referrals. Although there are no recorded complaints, it would be good to see some clear evidence of development of a more open “complaints culture” in the home. An absence of formal complaints does not necessarily mean that people are completely happy with the service they receive. It is important that the service is proactive about finding out what people think and checking with them on a regular basis that they are happy. It is suggested that this could be a standing item for residents’ meetings. The range of abilities of people currently living at the home is wide. It is important that those who might be unsure or reticent about “speaking up” are supported and encouraged to do so. By developing the complaints culture in this way, everyone can benefit. People using the service can be empowered; hearing their opinions can help the service plan for the future and grow. However, two of the residents said that they knew they could complain if they were upset about anything or had any concerns. One Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 17 said “ I haven’t made any complaints but I know I can go to the Manager if I want”. Another said, “If I wasn’t happy I would tell staff – I would be comfortable doing that”. Staff said that they had received training in the protection of vulnerable adults from abuse. They demonstrated their understanding of the importance of reporting any incident of actual or suspected abuse. It was not possible to verify staff training in this area, as the staff training and development plan was incomplete (see “Staffing” below). Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 28 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The house is generally clean and tidy, but decoration and maintenance in some areas need attention. This is to ensure that residents enjoy the benefit of living in a house that is comfortable, homely and safe. EVIDENCE: A tour of the building was completed. It was reported at the time of the last visit to the home in November 2007 that some of the requirements made at the last key inspection had been met. The laundry room had been refurbished and redecorated and floor coverings replaced. Soap for washing of hands was available as required. However, the tumble drier was not working: this should be repaired or replaced without delay. The Manager said that this had been reported. Shared spaces in the house include the lounge and the kitchen / dining area. These are generally well decorated, comfortable and homely. However, it was noted that no action had been taken over the damaged settee in the lounge. Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 19 This detracts from the overall comfort of the residents, and should be replaced without delay. This has added significance, as residents have no other communal space in the house. The Manager advised that most people tend to congregate in this room, when they are in the home. It was noted that two chairs in the downstairs hallway were also in need of a good cleaning or reupholstering. All but one of the residents’ bedrooms were seen. These were individual, and personal possessions and effects in evidence. However, the décor in these is now looking “tired” and in need of refurbishment. The floor covering in room 8 is damaged and in need of replacement. The carpet on the steps by this room is also in need of repair before it becomes a trip hazard. The ceiling above the main stairwell is damaged and in need of repair. This may be the result of a leak in the roof (the damaged paintwork is very damp) and should be investigated quickly. The Manager said that this matter had been reported to the landlord. The house was generally clean and tidy, with an acceptable standard of hygiene maintained. Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements are needed to the arrangements for staffing in this home. Vacant posts should be filled and proper arrangements put in place to manage and supervise staff effectively. This will ensure that staff have the support, knowledge and skills they need to do their jobs well. EVIDENCE: Two staff files were sampled. Both contained completed job applications, two written references and evidence of checks with the Criminal Records Bureau (CRB). One file (of a more recently appointed member of staff) also contained evidence of an appropriate process of induction (workbook). However, two files for current staff team members were not available when requested. The Manager advised that these were away at Head Office being updated. Required records relating to all staff working in the home should be available for inspection at all times. There are currently five regular members of staff working in the home. The Manager advised that there are currently two full time posts vacant. These are being covered by staff working overtime and by regular agency staff. It was Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 21 noted that the person covering the late shift (3.00pm – 11.00pm) then does the sleep-in and the following days early shift (8.30am – 4.30pm). This does not represent best practice. It was also noted that the Manager works “on rota” whenever she is on duty. The Manager said that over 50 of the staff team are qualified to NVQ level 2 or above. She was asked for the staff training and development plan. It was recommended at the last visit to the home in November 2007 that a spreadsheet or chart be set up for this purpose. This should show (for each member of staff) training completed and qualifications gained (with dates), gaps in training including “refreshers”, and dates when outstanding training is to be delivered. It was suggested that doing this could provide her with an effective tool for monitoring and updating the training and development needs of the team. Some work has been done towards this. The Manager produced a book listing what courses people have done. This exercise is not yet complete. The Manager advised that staff have attended training in awareness of mental health issues, as required at the last key inspection. Staff interviewed said they had done training recently in infection control, fire safety, food hygiene, health and safety and adult protection. Staff spoken to said that members of the team get on well and work hard to support each other. It was noted at the time of the last visit to the home in November 2007 that arrangements for formal supervision of staff needed to improve significantly in order to meet the current minimum standard of six times in any twelve month period (pro rata for part time staff). No records were available to show that formal supervision is taking place as required, and the Manager acknowledged this. Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not currently well run, which means that the quality of care given to people using the service is put at risk. EVIDENCE: The home is still without a Registered Manager. No application has been received in respect of the current Manager: she advised that she is waiting for the return of up to date clearance from the Criminal Records Bureau (CRB) so that her application can be submitted. Staff spoken to say that the Manager is approachable. They also said that she is supportive and that she encourages staff to learn and to take responsibility. As noted above, she is “on rota” whenever she is on duty. She was unable to say how much of her time is set aside or protected to enable her to fulfil her management responsibilities. She was also unable to provide any evidence Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 23 that she has received formal supervision from her line manager. There were no copies of reports required under Regulation 26 (Care Homes Regulations 2001) of visits that should be made on behalf of the Registered Provider. These visits should be unannounced and take place each month, ensuring that the Registered Provider can make an informed judgement about the standard of care provided in the home. Although there is evidence that some work has been done to tidy up the office and improve the organisation and maintenance of essential records, there is still more to do to bring these things up to a satisfactory standard. At the last visit to the home it was noted that the office computer system was not fully functional, as the printer was not working. Three months later this equipment is still out of commission. On this occasion the Manager advised that she had in fact purchased the printer out of her own money, as the organisation had not provided one. The Registered Provider should ensure that equipment essential to the proper running of the office is duly supplied and kept in serviceable condition. A recommendation was also made at the last inspection that a system for evaluating the quality of the service provided should be established and implemented. The Manager and staff reported that they had completed questionnaires and supported residents to do theirs also. They said that these had been returned to Head Office but were unable to report any further outcome. The findings of this exercise should be published and made available to all interested parties. It should be borne in mind that the desired outcome for this should be that the views of people using the service underpin its review and development. Safety records were sampled. A fire risk assessment is in place, but this document has no date of implementation or review. The fire alarm and emergency lighting systems and fire-fighting equipment have all been serviced. Regular checks have been carried out on all of these, and written records maintained. Fire evacuation drills have also been completed. Fridge and freezer temperatures have been monitored daily. Certificates for gas and electrical installations are in place as required. Accident records were examined. It was noted that there had been a recent incident where one of the residents had been found on the floor: she was subsequently taken to hospital. Appropriate action was taken to safeguard the resident’s best interests following this incident. However, no Regulation 37 report (Care Homes Regulations 2001) had been made in respect of this incident, as required. The Manager reported that she had sought advice about this matter but had been told not to send a report. The information shown above throughout this report gives rise to concerns about the quality of the conduct and management of this service. The current Manager, though experienced in working in this field at a Senior Care level, does not have management experience prior to taking up her current position. Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 24 She does not have designated time to deal with the management of the home. Available evidence does not suggest that she is being appropriately supported by senior managers. Formal supervision, appraisal and training of staff are not as structured and organised as they should be. Though progress has been made in some areas, the organisation of the office, maintenance of records and management of people’s care is still in need of improvement. Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 2 29 x 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 1 X 2 X 2 3 x Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 26 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 YA36 Regulation 18 (2) Requirement Timescale for action 30/04/08 2. YA37 9(1)(2) 3. YA39 26 You must ensure that staff receive formal supervision so that they have the support they need to do their jobs well You must ensure that a 30/04/08 completed application to register a manager is submitted so that the home is managed effectively in the best interests of the residents. You must ensure that monthly, 30/04/08 unannounced visits are made to the home on behalf of the Registered Provider, and a report written on the outcome of each visit. This is so that an informed judgement can be made about the quality of care provided in the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 27 1. 2. 3. YA1 YA5 YA6 4. YA9 5. YA13 YA14 6. YA19 7. YA22 8. YA24 9. 10. 11. YA33 YA35 YA36 You should update the home’s Statement of Purpose and Service Users’ Guide so that current information is available to prospective service users. You should update contracts so that all parties are clear about what they are responsible for. You should ensure that all care plans reflect people’s personal goals, which should have outcomes that can be clearly measured. This is so that people can see whether or not goals set have been achieved, when plans are reviewed. Develop the use of person-centred approaches in order to make this happen. You should ensure that important information from risk assessments is included in people’s care plans. Clear indexing and cross-referencing would help to make sure this happens. This is so that the risk of hazards occurring is kept to a minimum, and people are properly supported to stay safe. You should ensure that recording of people’s activities is done in sufficient detail to show how choices were made, the purpose of the activity and what was gained from it. Show clear links between activity opportunities and people’s agreed goals and care plans. Doing this will help people achieve their goals and improve their quality of life. You should develop Health Action Plans for each individual, to make sure that their health care is planned and provided for systematically. This is to make sure that people receive all the support they need to stay healthy and well. You should ensure that everyone using the service is actively encouraged to voice any concerns. Having this as a standing item on the agenda for residents’ meeting could help to achieve this. This is so that the service can make sure that concerns are being addressed. You should ensure that maintenance, repair and refurbishment detailed in the main body of this report, is carried out without delay. This is to make sure that residents can enjoy living in a house that is comfortable, homely and safe. You should recruit to vacant posts in order to bring the care team up to complement, so that continuity of care is promoted for the residents’ benefit. You should complete a training and development plan for the staff team, to ensure that staff have the knowledge and skills they need to do their jobs. You should ensure that all members of staff receive regular formal supervision, with written records kept of each meeting. Staff should also receive an annual appraisal of their performance. This is to make sure that they get the DS0000016874.V360071.R01.S.doc Version 5.2 Page 28 Strensham Hill 12. YA39 support they need to do their jobs well. You should ensure that the system for evaluating the quality of the services at the care home is fully implemented, and a written report of the outcomes made available to all interested parties. This is so that it can be seen that the views of people who use the service underpin the way in which it is reviewed and developed. Strensham Hill DS0000016874.V360071.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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