Inspection on 29/01/08 for Swiss House

This inspection was carried out on 29th January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Swiss House 06/03/09

Swiss House 22/05/07

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Swiss House 41-43 Brierley Hill Road Wordsley Stourbridge West Midlands DY8 5SJ Lead Inspector Mr Jon Potts Unannounced Inspection 29th January 2008 09:30 Swiss House DS0000069592.V352823.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 Swiss House DS0000069592.V352823.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. Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Swiss House Address 41-43 Brierley Hill Road Wordsley Stourbridge West Midlands DY8 5SJ 01384 573110 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) Select Health Care (2006) Limited Mrs Linda Power Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Learning Disability (LD 7) The maximum number of service users to be accommodated is 7. 2. Date of last inspection 22nd May 2007 Brief Description of the Service: Swiss House is situated in a cul-de-sac off Brierley Hill Road in Wordsley. The home opened in 1993 following the conversion of an existing residential property. Swiss House is close to local facilities and bus routes, allowing easy access to shops and surrounding areas. There are gardens to the front and rear of the property, although the rear patio is mainly used due to the busy road at the front of the house. There is a communal lounge and dining room with a conservatory, which overlooks the rear patio and another house owned by the same owners. There is a lift, which enables access to the first floor. Service users accommodation consists of seven single bedrooms. There are no ensuite facilities. The Home provides care for persons with a range of disabilities including profound and multiple learning disabilities, severe learning disabilities with complex communication and health care needs, although the building does not always prove suitable in respect of provision of a service to wheelchair users. A statement of purpose and service user guide are available to inform residents of their entitlements. The charges for accommodation are not currently stated within these documents and as such are not available to prospective residents within them. Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people that use this service experience adequate quality outcomes. This unannounced inspection was carried out over two days and involved the inspector assessing the homes performance primarily against the key national minimum standards for younger adults. Evidence was drawn from a number of sources and including case tracking the care for two residents (this involving looking at all the documentation in respect of their care and cross checking this with outcomes), observation of practice, discussion with senior staff and the Responsible Individual, staff and review of management records. There was some limited discussion with the residents. Information was also supplied pre inspection by the home and comment cards were received from four relatives of residents. The residents and staff are to be thanked for their assistance with the inspection. What the service does well: Residents are able to have some choice in respect of daily routine such as when to get up and when they wish to go to bed. There is a stable staff group who know residents’ individual likes and dislikes with regard to food, allergies and other daily routines, this assisting with the consistency of the care provided. Staff were seen to be knowledgeable and skilled in encouraging residents with feeding and providing a varied and balanced diet. We saw that bedrooms were pleasantly decorated according to resident’s individual tastes. Staff enable residents to maintain important links with their families. All the relatives (four in total) who completed comment cards stated that residents were well looked after stating that: • I’m very happy with the way my (relative) is treated, they take good care of her. • Looking after and loving all the (residents) in their care. • The staff here are brilliant – I would not want (X) to go anywhere else. • I think the staff cope very well with the diverse needs of those in their care. I am sure they do all they can for each individual. Through out the inspection visit management and staff were very helpful and assisted with the inspection process wherever possible. Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Despite some improvements there is still much to be done, the following the main areas where improvement is needed: • Individual and person centred care plans must be accurate, up to date and cover all residents’ needs in respect of their health, wellbeing, preferences and social stimulation so that appropriate personal support can be provided to each individual. There also needs to be clear evidence of the involvement of residents and/or their representatives in respect of such. • There needs to be more opportunities for service users to engage in local, social and community activities, which must be based on their individual preferences and needs - thereby promoting and making proper provision for their health and welfare, the provision of the same hampered by the lack of sufficient staff. Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 7 • • • • • • • Key procedures and information needs to be developed in suitable formats for residents understanding and more information needs to be included in the service users guide in respect of the fees the homes charges in respect of residency and in regard to additional charges such as meals out of the home (the latter needing to be within the contract as well). Clear and detailed communication passports for residents need to be completed to encapsulate staff knowledge in this area. There is scope for improvement in respect of risk assessments so that all hazards are as far as possible identified and eliminated. Any resultant limitations on residents as a result of the former also need to be fully identified and agreed within multidisciplinary forums. The home’s overall record keeping and document management needs to improved as this hampers access to some records. Areas of specific concern include staff files, personal inventories of resident’s property, and the organisation of policies and procedures. There needs to be a copy of the new medication policy in use. There are some key areas of improvement needed on the building including privacy locks on toilets and bathrooms, replacement of the back bedroom window (that is draughty) and completion of a safety check on the electrical hard wiring in the building. There are areas where staff training needs to be improved, not least the planning in respect of the same so as to ensure that the most important training is provided first. Staff supervision and appraisal also needs to be better. 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. Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 5 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who may use the service and their representatives can have access to information, which may not be in appropriate formats. Robust assessment tools should assist the home to ensure that individuals needs can be met prior to admission although more robust support through key staff would assist a smooth admission. EVIDENCE: The service has developed a statement of purpose, this reviewed since the last inspection so as to update some of the information contained within it so that it contains the range of information required, with this supplemented by a service users guide. Whilst the service user’s guide provides useful information to prospective and existing residents, there needs to be details of funding arrangements and the home’s scale of charges as well as all additional costs which may be incurred by the resident. The service’s users guide is only available to individuals in a standard format however and needs to be personalised with use of such as photographs, so that it is in a format suitable for residents. The area manager told us that there are plans to do this and there has been discussion as to how these documents could be personalised further. Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 10 The home has previously been registered to provide care for people who also had physical disabilities. This category of registration was removed at the point that the new owners took over because the building is not wholly suitable. The provider is looking to make improvements so as to address issues where possible although there will still be some areas, which will not be entirely suitable for wheelchair users, and structural changes may not be viable. These limitations have been referred to in the statement of purpose following recent revision. We saw that residents have been issued with contracts these fairly informative although needing specific details regarding additional charges (such as what the home will contribute to meals outside of the home). There was seen to be some detail as to the fees paid within these, this not the case previously. These contracts are supplemented by some pictorial information as to contractual terms and conditions. There have been no admissions to the home for a number of years this fitting with the homes aim to provide longstanding accommodation to the service users, this however meaning that assessment of the homes admission processes was based on procedure and the knowledge of staff. The home has generally robust and comprehensive assessment tools that staff have put into place for existing residents this to assist with updating residents care plans. The home was seen to have an admissions procedure that is supplemented by other procedures in respect of trial visits to the home. Sourcing these procedures was protracted as access was hampered by the structure of the homes policies and procedures manual, with staff seen to have some difficultly finding all policies and procedures related to the admission process. It was noted whilst the stated procedure generally meets the expectations of the NMS there was no reference found to use of a key worker in the admissions process which would be central in ensuring continuity and ensuring the prospective resident has an established point of contact, essential when considering that prospective residents may need someone who understands how they communicate. Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments have improved in part and in some instances contain better guidelines for staff regarding how to support residents although there are instances where they require update. There is still scope for improved involvement of individuals and their representatives in decisions about resident’s lives and planning the care and support they receive. EVIDENCE: The staff at the home have completed assessments on the new providers assessment formats and this has helped with formulation of care plans although there was limited evidence to show that residents or their representatives have been actively involved within this process. There were also issues where resident’s needs had changed since the assessment and the care plan had not been updated to reflect these changes this leading to some lack of clarity in the understanding of staff as to what some of the resident’s current requirements were and what may constitute a risk. In addition the way Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 12 the care plan is written needs to be specific as to exactly what the actions are needed with comments such as “receive care 24hrs a day” and checks on a ‘regular basis’ vague and unclear as to what is expected. In contrast to this there were areas of need identified in the plan that were clear, that staff consistently understood and were seen from observation to follow through into the care practice we saw carried out at the home, this evidence of improvement. Problems were apparent in the fact that whilst the staff have received some guidance in completing care plans from the Area Manager there has been no formal training and staff spoken to indicated that they felt they would benefit from such. This was reflected in the fact that some care plans were of a better standard than others, this reflecting key worker’s confidence and ability and also the time they had available to complete the plans. One comment was that it was “a matter of grab five minutes when can” in respect of care planning, this echoed by other staff comments which is clearly not conducive to involvement of individuals or their representatives in the process. When the homes policies and procedures were examined for a procedure on care planning that staff were able to refer to (with possible examples of well completed care plans) this was not found, and staff were unaware of any such procedure. There were person centred plans that were partly completed (these based on changing days documents). The information in some instances related to such as communication did differ to care plans and discussion with staff evidenced that they were yet to receive training on person centred planning. Discussion with staff evidenced that they have a fair understanding of communication and how this is to be applied in practice with residents who in many cases use non verbal communication and body language to express themselves, this information captured in some care plans and followed in practice as we observed. This process needs to be built on and improved with use of assessments by such as the profound learning disability team used to develop very clear communication passports for residents. There was some confusion as to methods of communication based on discussion with staff although the suggestion that one resident was not able to sign has been clarified by the deputy consulting with the resident’s relative. There was however the suggestion that one resident uses electronic communication aids that are retained at the daycentre although it was not known whether these were the individual’s possessions or equipment that was lent to them. If it is the residents then the home needs to clarify why it does not accompany them when they return back home. Development of a focus on equality issues in respect of a resident’s gender (including gender identity), age, sexual orientation, race, religion or belief or disability needs to be promoted with use of such as diversity training for staff which has not to date been widely provided. Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 13 Risk assessments were seen to have been completed but these are in the main focused on issues of safety. There was some evidence of improvement in that there were basic risk assessments related to such as use of bed rails although there was no assessments in respect of individual’s capacity and the impact this had in respect of limitations on rights and choices, this in accordance with the Mental Capacity Act 2005 guidelines which the home was now seen to have a copy of, this supplemented by a training package which the Area Manager stated staff would be completing. The home has sought consent from representatives in respect of some issues such as withholding door keys and opening mail although these decisions should be reviewed on a regular basis as part of six monthly reviews, this as they were agreed in cases a number of years ago. Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14, 15,16 & 17 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Whilst there has been some improvement in respect of residents access to social, leisure and recreational activities this is sporadic at best and hampered by staffing, lack of sensory facilities and reliable transport. Support is readily available for residents in maintaining links with their families and a choice of diets are provided with sensitive assistance from staff with feeding. EVIDENCE: Based on information in case files there has been some attempt to identify the activities and pastimes that residents enjoy with staff spoken to aware that reactions of the residents to stimuli (where they have little verbal communication) is critical. Those spoken to were able to identify what nonverbal communication indicated pleasure and what was dissatisfaction. The Area Manager stated in the AQAA that the home was ‘Providing a better Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 15 variety of choice and enabling participation in activities previously inaccessible due to staffing and funding issues’. Evidence indicates that there have been attempts made to improve the level of stimulation available with the some trips out and a holiday having been provided since the last inspection. In addition residents meetings have been held to discuss leisure activities. There was however difficulty assessing the current level of activity as records of the same, whilst commenced are now not up to date and in cases not completed and those records seen indicated that many in house activities were of a sendentary nature such as ‘relaxing in the lounge’. There was evidence of individual activity programmes in case files with some basis on documented likes and dislikes although there was still scope for improvement in respect of providing a greater range of activities, in particular those that may be provided through the availability of a sensory room. Attempts have been made to take residents to ‘pear tree’, which offers such facilities although some trips there have been cancelled due to lack of staffing. Whilst this sensory facility has not yet been provided discussion with senior staff and the Area Manager indicated there were clear plans to utilise the conservatory for this purpose. It was stated that one resident may contribute towards the cost of facilities for their own sensory equipment. This agreement needs to be fully rationalised and documented preferably through such as the multi disciplinary review process. It is positive that the senior management are aware of the need to improve the range of activties available (when discussed at the inspection visit) and are looking to improve the transport available, although this needs to be activeley pursued to ensure there is consistent improvement in this area. Community involvement, beyond attendence at daycentres, is currently hampered by staffing levels and the fact that the mini-bus following a service now needs work done. Staffing levels are not always sufficent to allow time to be spent with residents, many of whom would need support. There was discussion as to how the home maintained contact with the daycentres and it was stated there are communication books that travel with the resident for messages in addition to staff attendance at reviews at daycentres. We did suggested that keyworkers attendence at daycentres with service users may assist the communication process and consistency in the provsion of care and stimulation to the individual. There was clear evidence that residents are able to maintain links with their families as was confirmed by those relations that responded to CSCI questionnaires with comment that residents were helped to keep in touch and they were kept up to date with important issues. Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 16 Opportunities for residents to be involved in food shopping would be dependent on the availability of staff and the minibus, which as previously stated are currently problematic at times. The home makes use of pictures to assist with illustration of meal choices of which two are available every day. During interviews staff could clearly identify how they were able to tell which foods residents preferred and how their stated preferences were identified, this in many cases through observation of foods they enjoyed or chose not to eat. During the course of the inspection visit we observed two residents been assisted with their breakfasts and in both cases the way this was carried out showed sensitivity in the way they were encouraged to eat and demonstrated that they were allowed to make choices through staff picking up on non verbal cues. The way residents were assisted in this area was also in accord with their care plans. New menu sheets for the recording of meals have been introduced recently these clearer than pervious records although it was noted that the documentation of suppertime snacks/meals is still not been consistently recorded. Nutritional assessments have been drawn up for all residents and reference is made in respect of dietary input related to heath concerns (i.e. high fibre diets) although it was noted that reference to the use of supplements as documented was possibly not accurate as discussion with staff gave the impression that the resident in question no longer used these. Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. More clarity in care planning is needed to ensure residents’ receive personal support in a way that meets their individual needs and preferences, although interaction between staff and residents was seen to be positive. There are overall good systems in place to monitor most of the health care needs of residents. Medication management generally offers suitable safeguards to residents so that they receive their medication safely. EVIDENCE: Records showed that resident’s preferences in respect of the times they rise and retire have been identified and plans carry reference to the reasoning behind why some residents go to bed at certain times (issues in respect of safety and behaviour). There were issues identified at the time of the last inspection in respect of the need for night time care plans and there was still no evidence found in respect of specific guidance in respect of how often residents needed to be checked during the night in response to their specific Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 18 needs, this meaning there is still a need for a review of these. There was still reference in one resident’s care plan indicating that they needed constant supervision although staff stated that this was no longer the case and there was no necessity for such close supervision although this was not thought to be the case by all staff. This once again highlights the need to ensure that care instruction in plans is accurate so that personal support is provided in the way that resident’s prefer or indicate is their preference through non verbal cues. Staff were observed interacting with residents throughout the inspection and this was in all cases positive with discussion initiated with residents and any conversations including residents. Resident’s responses to the staff were seen to reflect what care plans and related information identified as positive. There was also noted to be specific information in respect of resident’s individual oral care and residents had received visits from dentists recently. There remain issues in respect of the sufficiency of technical aids and equipment so as to promote residents to independence (see environment), although changes have been made in respect of one resident’s wheelchair so as to promote their safety (and reduce the possibility of their falling out of the chair). Overall health care management was seen to be proactive with residents receiving regular eye tests, dental checks and hearing checks. There are also regular appointments with doctors and district nurses and staff spoken to stated that residents are able to attend the doctor’s surgery (as was seen to be the case from documentation). Residents are receiving monthly weight checks this showing that their weights are fairly stable (from the last six months records). Seniors explained that they have sought the advice from the epilepsy nurse and we saw Epilepsy management plans for residents as needed. Discussion with staff evidenced that they had a good understanding of these in respect of the triggers and precursors that may indicate a possible seizure. We saw that residents have ‘Priority for Health Screening’ booklets but were told and saw that these are not yet fully completed. Whilst the Area Manager has made contact with the relevant agencies to request their assistance with completion of this booklet staff still indicated there was a lack of clarity as to whether they were to be completed by visiting health professionals, the staff advised to pursue clarification from local primary care trust. District nurses were now seen to be entering written detail of their visits in the homes records. A medicine policy was available which was accessible to staff although was lacking in some areas and requires review. The Area Manager during Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 19 discussion did state that this policy had been reviewed although was yet to be introduced to the staff at the home. The home has a good record of compliance with the receipt, administration, safekeeping, and disposal of controlled drugs. The majority of staff have completed and passed an appropriate medication course. Medication storage was seen to be well managed as was the recording of medicines handled and administered by staff at the home although there was one issue where there had been a change to the dosage of medication for a resident with staff stating they were still awaiting written confirmation of this change from the prescriber. Directions documented were stated to be following the verbal instructions they had been given from a health professional. Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents and their representatives have access to a robust complaints procedure, and concerns that are raised by relatives are addressed. There are procedures in place to protect residents from abuse, and there is recent evidence to show the home takes the appropriate action to safeguard residents, although there is scope for some improvement in terms of staff awareness. EVIDENCE: The home has a comprehensive complaints procedure and this has been reproduced in a pictorial format for residents, as we saw to be on display in the home on the second day of the visit. Three relatives who completed comment cards stated that they were aware of the homes complaints procedures and that when concerns are raised they were dealt with appropriately. In addition they all stated that the home helped the residents keep in touch with them. It was positive to see that resident’s meetings are now taking place and minutes from these meetings are documented. Staff spoken to were also clear as to non verbal behaviours that would indicate dissatisfaction and there was clear evidence that residents have access to other social and health care staff on a regular basis either through attendance at day centres and contact with health care professionals, giving the opportunity for others to monitor residents progress and wellbeing as well as general satisfaction. Complaints made and the actions taken in response to them are fully recorded. One Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 21 complaint has been received at the home since the last inspection from neighbours (in respect to staff smoking outside the home during their breaks). The management was seen to have responded appropriately to this matter. There has been one safeguarding referral since the time of the last inspection and the management promptly referred this incident to the Local Authority as part of the local safeguarding procedures. Practice by the home indicates that it is open and transparent when discussing incidents with external bodies and takes appropriate action to safeguard the residents. We saw that the owners have also introduced new policies and procedures regarding vulnerable adult abuse. There was also a copy of the latest edition of the Local Authority multi-agency procedures ‘safeguard and protect’ available at the home. During interviews most staff gave appropriate responses as to how they would deal with any potential incidents of abuse and although it was noted that not all staff have received training in vulnerable adult abuse awareness, or in cases are due an update. There are care plans in place regarding behavioural management strategies but there are still issues in respect of them not been reviewed as identified at the time of the last inspection, with limited evidence that the strategies advised have been discussed and agreed within a multi-disciplinary team. We looked at residents’ finances and carried out an audit of money, which tallied with the records maintained. The recording and accounting systems are satisfactory and there is now an internal auditing system. Residents have personal inventories containing details of their valuable and personal belongings. We saw that dates had been entered when these were updated in most cases but not all and the home needs to ensure that this practice is consistent with entries when items are purchased or destroyed, this to make auditing easier. Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29 & 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The premises are homely but there are insufficient aids and adaptations to fully meet peoples’ needs although the owners were seen to be actively trying to improve this situation in some areas, but have been hampered by the number of issues that require addressing. There has been noticeable improvement in addressing areas related to immediate safety and infection control however. EVIDENCE: Sight of most of the rooms in the building evidenced that improvements were still continuing, building on those previously made, with new items of furniture purchased to complement the redecoration of areas of the home. Redecoration of further bedrooms was seen to be in progress. Since the provider has taken over the home in the first half of 2007 the hallway has been redecorated with new carpet fitted to the stairs and landing and more recently the dining area has been redecorated (this now a lighter and more appealing area) as well as a number of the bedrooms. Audits have been completed with regard to the Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 23 furniture and furnishing contained within residents’ bedrooms and whether or not they meet the National Minimum Standards (NMS) requirements. The double bedroom has been changed to a single bedroom, which means that the existing resident will not have to share their space with someone else. The cellar has had new flooring and been decorated. The home has received a number of visits from the fire prevention officer and whilst some issues were identified at the time of the first visit these have now (as confirmed by the fire service) been addressed. Sampling of certificates for servicing of equipment and fixtures showed that checks had been carried out as needed and where necessary the management had responded to matters of concern (such as replacing a gas boiler). The only safety check not carried out was that for the hard wiring, the last one out of date. The Area Manager stated that this would be addressed. The provider has agreed not to accept any new residents with a physical disability. However all existing residents have some physical disability and five require the assistance of a wheelchair inside the home. The building has major shortfalls such as narrow corridors and doorways that make the use of a wheelchair problematic, uneven floors and a number of ramps that represent a tripping hazard to residents, access to the lift is either down two steps or inappropriately and contrary to infection control guidance, through the kitchen. The Area Manager has kept CSCI informed of development within the home and whilst they have identified areas that need attention the priorities highlighted were the provision of a sensory room, conversion of the upstairs bathroom to a floor level shower room and replacement of the broken specialist bathing facility sited downstairs. The Area Manager has confirmed post inspection that the later has now been replaced. A new set of sit on scales has been purchased which has made accurate weighing of residents possible. There are still a number of areas (that were requirements) that remain outstanding from previous inspections and these were previously changed to recommendations as the new owners gave an undertaking that these will be carried out and they are expected to keep CSCI informed as to development and changing priorities. When we looked at residents’ bedrooms we saw that these were decorated to a good standard (or are been re decorated) and the immediate concerns identified in respect of bedrails would seem to have been addressed since the last inspection. The replacement of the metal-framed window in the back upstairs bedroom would be advisable as this was found to be very draughty during the visit. Concerns in respect of odour control in one resident’s room were found to have lead to an improvement. Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 24 Generally the home was clean and infection control issues identified at the time of the last inspection were seen to have been addressed. The home has appropriate infection control procedures available and the staff spoken to were able to identify practices that would promote the control of infection, also confirming that there were adequate supplies of personal protective equipment (i.e. gloves and overalls). It was however noted that there is an area of the laundry flooring that needs attention due to the removal of a toilet bowl. Swiss House DS0000069592.V352823.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33, 34, 35 & 36 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The organised provision of staff training is hampered by the lack of an up to date and programmed training plan in order to meet the range of specialist training which is needed to meet residents’ complex needs. Current staffing levels impact upon the quality of life for some residents. EVIDENCE: The home currently employs fourteen support staff plus one driver/ handyperson and a manager. Sight of the homes training plan showed that this is in need of urgent review, not having been updated since the companies training officer left. There are a number of areas where staff would benefit from further training including updates in mandatory areas (such as safeguarding, 1st aid, health and safety and such like) as well as incontinence awareness, tissue viability and diversity. As already stated staff need training in care planning and person centred planning as well as the Mental Capacity Act 2005 (this to be provided through a CD – ROM training package that the home has recently obtained) Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 26 The senior area manager informed CSCI around the time of the last inspection that a training assessment was to be carried out for the whole staff team although there was no evidence available of this at the home during the course of the visit. On a more positive note the qualification of staff in vocational qualifications has continued and 7 now hold a level 2 NVQ (with another stated to be awaiting their certificate). This was evidenced by sight of certificates in staff files which does not concord with the statement in the AQAA that 10 staff hold an NVQ level 2. Relatives have also in comment cards indicated that they have confidence in the staff team (and management). Staff have been provided with job descriptions and copies of codes of conduct and in discussion stated they have also received handbooks from the company that detailed core policies and referenced staffing matters. We looked at duty rotas, these compared with staffing levels at the time of the visit. There has been no change in staffing levels despite concerns being raised as previous inspections. There are still only three or four staff on duty per daytime shift which whilst sufficient for meeting the basic needs of residents and ensuring their safety does not allow sufficient time to provide holistic care that meets all residents needs. All seven residents have been assessed as high dependency and all require one to one support when in the community, some also need this within the home. Of further concern was the fact that there were instances according to the rota for January 2008 where there was only two staff on duty for periods up to 3 hours. Attempts had been made to cover these shifts but this information was recorded in the dairy and not on the rota. Staff comments indicated that there was difficultly providing suitable activities due to staffing levels and other staff referred to finding it difficult to maintain such as care plans due to the lack of available time. There is no doubt that the current levels of staff sickness plus the one staff vacancy are compounding the challenges current staffing arrangements present. The Area Manager told us that discussion with the funding authority had lead to the allocation of 20 additional hours for a temporary period although this was perceived to be unsatisfactory and it was stated that further negotiations were to be pursued. There is still only one waking member of night staff – supported by a sleep in – this of concern, as a number of residents need physical assistance from staff with transfers. Improvement in staffing levels is to be seen as a priority and there is no doubt that it impacts on the homes performance in a number of areas. The files for two recently employed staff were examined (as well as for other staff to a lesser extent) and overall showed reasonably robust recruitment checks although there were omissions as detailed: • One did not have full employment history documented. DS0000069592.V352823.R01.S.doc Version 5.2 Page 27 Swiss House • • • The statement in regard to a staff member’s medical health was not signed. The statement as to whether a staff member had any convictions was not signed although they had not been employed until the home had received a POVA and enhanced criminal records bureau check. There were two references for both staff although the management had not obtained a reference from the one staff member’s last social care employer. The home was seen to have a copy of the common induction standards although these had not been competed for a recent employee and they confirmed that they had not been pursuing these, and also had not been appraised of’ or involved with LDAF (learning disability award framework). From discussion with staff and examination of records induction consisted of a basic appraisal of the homes procedures and introduction to residents combined with learning from existing staff as an additional person to rostered staffing levels. Staff supervision sessions take place although not at the expected frequency, this applicable to newer staff who would be expected to need more support during their induction period. This has no doubt been hampered by the longterm sickness of the manager and discussion with seniors indicated that they felt the provision of training in staff supervision maybe helpful. There was some evidence that some staff have received an annual appraisal although this was not consistently the case. Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 28 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 adequate This judgement has been made using available evidence including a visit to this service. Although some improvements are starting to be seen, there are still weaknesses in the day-to-day management systems, which have led to some compromise of residents’ health, safety and welfare. EVIDENCE: The manager has worked in care since 1988 and has an NVQ IV in care. She had not attained management qualification but the Area Manager has told us that she has now been enrolled on a suitable course, which will be starting in May 2008. It was not possible to have a discussion with the manager as she was off on long term sick, with the home been managed by the deputy and senior team Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 29 with off site support from the Area Manager. Due to the nature of the possible long term sickness of the manager there was however no arrangement to support the home with use of another manager or providing an additional senior to support the deputy in the management role. Despite this the seniors and deputy were clearly motivated and showed a keen interest in development of the service, although were also were frustrated by the pace of improvement that was hampered by issues such as staffing and the environment (provision of a suitable bathing facilities, poor quality transport etc). At the point of the last inspection the manager stated that she was aware of gaps in her knowledge, not least current legislative changes and developments as detailed in inspection for better lives. Discussion with staff did however indicate that seniors had knowledge of the Mental Capacity Act (despite not having had training yet) and were fully aware of the outcomes form the last inspection when the home was judged to be poor. Discussion with seniors showed an awareness of some equality issues and comments from four relatives supported the fact that the staff and management did well in providing for the diverse needs of the residents. The provision of training in diversity would however assist the development of their knowledge in this area. The provider has introduced a new set of policies and procedures at the point they took over the running on the home last year and sight of these and discussion with staff indicated that they were trying to update themselves by reading the same but were having difficulty due to the number of policies/procedures and the time available to them. Whilst there was discussion with the Area Manager about how she was looking to introduce systems that would improve the monitoring of practice and compliance with the plans, policies and procedures of the home, more work is need to ensure that staff understand these and also are able to better access them. One simple way of doing so is in respect of their presentation so that they are broken down into easier to manage sections and all procedures from related areas are grouped together. At present many were stored in plastic A4 page holders meaning you had to take the procedure out to read it in many cases, there was no page numbering and the size of the folder presented some difficulties. The use of supervision, staff meetings and training to underline staff understanding of procedures is to be encouraged. All sections of the AQAA were completed and the information gives a reasonable picture of the current situation within the service, giving a good indication of what the service has achieved over the last 12 months and where it was felt improvement was needed. Some limited comments were however a little misleading as to the actual progress made. The data section of the AQAA was completed fairly accurately. Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 30 The Area Manager and staff are aware of the need to promote safeguarding and have developed a health and safety policy that generally meets health and safety requirements and legislation. The Management has highlighted areas where they need to make improvements and this was shown to have worked well in response to concerns raised from the last fire service inspection, these promptly addressed to the fire prevention officer’s satisfaction. There was evidence that (see earlier comments) a number of issues in respect of safe working practices have been addressed by the home although there are still areas where this needed to be continued in regard to such as training updates for staff. As indicated earlier in the report the record keeping within the home shows weakness in a number of areas, not least in respect of care planning and care documentation where the volume of non current documentation can be seen to hamper access to current information. The Area Manager did indicate that there is to be improvement in the storage and access to information with support of I.T. (computer) at the home, although the provision of some administrative support for the home, even on a temporary basis would be useful. Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 31 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 3 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 1 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 2 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 X 1 1 X LIFESTYLES Standard No Score 11 X 12 1 13 1 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 3 2 X 1 X 2 X 1 2 X Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 32 YES 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 YA6 Regulation 15 Requirement The Registered persons must ensure that the individual care plans in place are accurate, up to date and cover all residents’ needs in respect of their health, wellbeing, preferences and social stimulation so that appropriate personal support can be provided to each individual. There must also be clear evidence of the involvement of residents and/or their representatives in respect of care planning. The registered persons must provide more opportunities for service users to engage in local, social and community activities, which must be based on their individual preferences and needs - thereby promoting and making proper provision for their health and welfare. This is a repeated requirement that was to have been met in full by 1/9/07. A new target date has been identified as the home has Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 33 Timescale for action 31/07/08 2. YA13 16(2)(m) 31/05/08 part met the requirement. 3. YA33 18(1) a The registered persons must ensure that there is sufficient staff so as to provide for the full range of resident’s needs. There was evidence that staffing levels are at present preventing the home providing care that meats residents social welfare and on odd occasions dropping to possibly unsafe levels. 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The Registered Persons should develop all key policies and procedures (such as the service users guide) and care records (such as care plans, activity records) in pictorial or alternative formats that allow easier understanding by the residents. The Registered Provider should ensure that the range of fees that a prospective resident may pay are detailed within the home’ s service user guide or statement of purpose. The Registered Provider should ensure that the contract contains detail as to all possible additional charges including what contribution the home makes towards meals outside of the home. The Registered Persons should continue to introduce and complete a person centred approach (such as essential life style planning) and reproduce care plans in formats suitable for service users. And should ensure that care plans are reviewed at least six monthly, or as and when residents’ needs change with the involvement of the resident, relative, advocate and other significant professionals. The Registered Persons should continue to pursue referrals DS0000069592.V352823.R01.S.doc Version 5.2 Page 34 2. YA1 3. YA5 4. YA6 5. YA7 Swiss House to speech and language therapists with regard to support in establishing communication passports for all residents. Care plans should contain aim and objectives with regard to how residents are supported in making decisions and choices. The Registered Persons should review, update and expand written risk assessments to ensure that any unnecessary risks to the health and safety of residents are identified and so far as possible eliminated for example with regard to the use of wheelchairs (advice given by the MHRA should be incorporated into these assessments). The Registered Persons should fully implement all of the recommendations made by the Therapy and Enabling service and the Profound and Multiple Learning disability team with regard to relaxation and stimulation including purchasing a wider range of sensory equipment. They should also obtain a pictorial activities board. The Registered Persons should ensure that any restrictions on choices that are negotiated with all individual service users and advocates are reviewed regularly: for example the decision to not to provide bedroom door keys, front door keys, and the opening of service users mail. If residents cannot give their consent, then staff should consider making decisions in their best interests as in compliance with the Mental Capacity Act 2005. The Registered Persons should give more consideration as to how residents can be actively involved in the shopping and preparation of their food. To ensure the supper option chosen by residents is more consistently recorded. To ensure that nutritional screening tools are accurately completed. The Registered Persons should continue to pursue other professionals to assist in the completion of Priority for Health screening tool (and for support staff to complete relevant sections of the booklet where required). The Registered Persons should ensure that the medicine policy to be introduced is consistent with good practice guidance and updated when needed to ensure that the health and welfare of service users taking medication are safeguarded. The Registered Persons should ensure that residents’ personal inventories consistently include the dates when the items are purchased, and when they are destroyed or removed from the home. DS0000069592.V352823.R01.S.doc Version 5.2 Page 35 6. YA9 7. YA12 8. YA16 9. YA17 10. YA19 11. YA20 12. YA23 Swiss House 13. 14. YA23 YA24 The Registered Persons should review and update behavioural management strategies and where necessary and discuss these within a multi-disciplinary team. The Registered Persons should update assessments of the premises, aids and adaptations in order to identify whether any further equipment or alterations are needed in order to meet the needs of the existing residents who have a physical disability. To replace window frame in the former shared bedroom where seal has perished. To fit pass/privacy locks to all toilets and bathrooms. To make good the area of flooring in the laundry where the toilet bowl has been removed. To ensure that the hard wiring in the building receives the appropriate 5 yearly wiring check. The Registered Persons should provide staff with a range of specialist training in: Incontinence awareness, cerebral palsy, epilepsy, tissue viability, the Mental Capacity Act 2005, person centred care planning and diversity training. The Registered Persons are to ensure the following is carried out in respect of new staff. • • • To ensure their full employment history is documented. Statements in regard to the staff member’s medical health are signed. That a reference is sought from the staff members last social care employer. 15. YA32 16. YA34 17. YA35 The Registered Persons should provide all newly employed staff induction and foundation training by an accredited learning disability awards framework (LDAF) provider. To complete an up to date training needs assessment for the staff team and establish a training and development plan. A copy to be forwarded to the Commission. To establish an up to date training and development assessment and profile for each member of staff. The Registered Persons should continue to increase the frequency of staff supervision to six a year, one of these to include an annual appraisal. 18. YA36 Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 36 19. YA39 The Registered Persons should continue to fully implement effective quality assurance and quality monitoring systems based on seeking the views of service users, stakeholders, families and advocates. The results of surveys should be analysed and published and made available to people. There should be an annual development plan for the home based on a systematic cycle of planning-action-review. The registered persons should ensure that staff are able to better understand the homes policies and procedures this so that then can better put them into practice. 20. YA39 Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Swiss House DS0000069592.V352823.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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