Inspection on 04/09/07 for Talbot Court

This inspection was carried out on 4th September 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Talbot Court 15/01/07

Talbot Court 10/05/06

Talbot Court 30/12/05

Talbot Court 22/02/05

Talbot Court 22/06/04

Talbot Court 03/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

Ravenhurst

Polesworth Group 64 Long Street

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

CARE HOME ADULTS 18-65 Talbot Court 1-3 Jervoise Street West Bromwich West Midlands B70 9LU Lead Inspector Jayne Fisher Unannounced Inspection 4th September 2007 09:15 Talbot Court DS0000004780.V349600.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 Talbot Court DS0000004780.V349600.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. Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Talbot Court Address 1-3 Jervoise Street West Bromwich West Midlands B70 9LU 0121 525 3508 0121 525 3508 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) Milbury Care Services Limited Mrs Ruth Bailey Care Home 10 Category(ies) of Learning disability (10), Physical disability (10) registration, with number of places Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only Care Home with nursing only - Code N To service users of the following gender Both whose primary care needs on admission to the home are within the following category Learning Disability - Code LD (maximum number of places 10). Physical Disability code PD (maximum number of places 10) The maximum number of service users who can be accommodated is 10. 15 January 2007 2. Date of last inspection Brief Description of the Service: Talbot Court is a purpose built bungalow that originally operated as two units, each for five service users. Recently the unit has been operating as one, with the occupants of the home sharing a communal lounge and separate dining area. Internally the two areas are linked. The home provides nursing care for up to ten people with learning and physical disabilities. The unit also offers kitchen, laundry and bathing facilities. The bathrooms have been adapted to offer sensory stimulation. The bungalow comprises of ten single rooms in total, three of which offer an en-suite shower facility. An adapted minibus is available, at an extra cost. This is charged in addition to the weekly fees with the intention of enabling service users to access wider community facilities. A Statement of Purpose and service user guide are available to inform residents of their entitlements. Information regarding fee levels was provided by the manager on 4 September 2007 which are between £810 and £2,694.39 per week. There are additional charges for aromatherapy, toiletries and hairdressing. Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place between 09.15 a.m. and 7.30 p.m. and was undertaken by one inspector with the home being given no prior notice. We met all of the ten residents who live at the home. Formal interviews were not appropriate so we relied upon brief chats and observations of body language and interactions with staff. We spoke with the registered manager and five members of staff. Four questionnaires were received from relatives and four from visiting professionals. We looked around the home, examined records and observed care practice. We also looked at all of the information that we have received about this home since it was last inspected. What the service does well: What has improved since the last inspection? Our inspection visit found that this care home continues to improve and provides residents with a consistent and well organised environment. Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 6 Lots of improvements have been made since we last visited particularly since the home is now benefiting from a caring and experienced manager. Staff are happier, better trained, and are well supported which in turn means that residents are receiving a improved service. They are provided with stimulating lifestyles and have more access into the local community. The environment has also improved with bedrooms being redecorated in colour schemes which match residents’ personalities and suit their age and preferences. There is more sensory equipment in the home and garden area in order to provide residents with a more interesting environment. There are notice boards in the dining room which give visual cues to residents about what they are having to eat, how they are going to spend their day and which staff are on duty to support them. Other parts of the building has also benefited from redecoration and refurbishment. Care plans and risk assessments now provide staff with the guidelines they need to support residents. There is more emphasis on home cooked meals and on offering residents opportunities to try different types of food and drinks. Record keeping has also improved in a number of areas. There is a quality assurance system so that the service provided to residents is continuously monitored and reviewed. Health and safety procedures have also improved thereby offering more protection residents. What they could do better: Although staff clearly know residents’ likes and dislikes regarding food and drink these should be more clearly recorded in their care plans. Whilst some improvements have taken place with regard to management of medication, there are a couple of areas which still need attention in order to ensure that residents’ safety is fully promoted. Some of the carpets are still stained although we were told by the manager that they are due to be replaced in the near future. Good improvements have also taken place with regard to infection control measures with only a few areas that still need action. The manager needs to ensure that confirmation is received that agency staff have appropriate clearance checks and training before they commence duties in order to safeguard residents. Training certificates need to be obtained to demonstrate what training staff have undertaken. Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 7 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. Talbot Court DS0000004780.V349600.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 Talbot Court DS0000004780.V349600.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 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential residents have the information they need to make an informed choice about whether or not they want to live in the home. Prospective residents needs and goals are assessed before they move in to see whether it is a suitable place for them to live. EVIDENCE: The manager gave us a copy of the statement of purpose and service user guide for us to look at. These were detailed documents with lots of information to help residents make a choice about whether they wish to live at the home. The service user guide also contained detailed of fees and additional charges. There is only one slight amendment needed to the statement of purpose as this says that the home provides support to people between the ages of 18 – 65 years when in fact some of the people living at Talbot Court are over 65 years. We looked at the records of a resident who has recently been admitted and saw that there is an excellent assessment process to ensure that his needs can be fully met before he moved into the home. The resident visited a total of seven times to meet other residents and staff living at the home. There were very detailed reports completed by staff of the outcomes of these visits. Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 10 There was an assessment completed by the manager prior to the resident moving into the home and care plans and assessments from the placing officer. The manager had written to the resident confirming that Talbot Court could meet his assessed needs. We met the resident and his key worker. The resident chatted briefly to us saying that he liked living at the home. We saw good interaction between the resident and his key worker through out the day. During interviews it was clear that the key worker had built up a good knowledge of the resident’s likes and dislikes despite him only having lived at the home for a couple of months. Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans provide staff with the information they need to know in order to support residents to meet their needs, goals and aspirations. There is ongoing progress to introduce systems to enable residents to make decisions about their lifestyles through person centred planning (although these are not yet fully established). Residents are enabled to take risks as part of every day living and this is managed in a constructive and supportive manner. EVIDENCE: We looked at three residents’ care plans and saw that these had much improved. There is now an assessment tool so that residents needs can be reassessed periodically (although staff must ensure that they date these tools to demonstrate when they are completed). Care plans are divided into three sections and cover a wide selection of areas for example health, diabetes, oral hygiene, pressure area care, moving and Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 12 handling, diet, sleeping and bedtime. There are useful guidelines in place for staff in how to meet the needs identified in the care plans. There were detailed behavioural support guidelines in place for managing residents’ challenging behaviour. Care plans are reviewed on a regular basis. However as we discussed with the manager, there needs to be a system in place to demonstrate that residents, their relatives and significant professionals are invited to participate in reviews which are held on a six monthly basis. In addition, rather than staff just signing their name and writing ‘reviewed on 27/3/06’ staff should detail the actual outcome of the review. The manager showed us photographs that are being collected to help establish care plans in formats that residents can understand. She also discussed how these will form part of the person centred planning systems once they are fully introduced. It is suggested that staff receive training in person centred planning. The manager demonstrated a good understanding of the new Mental Capacity Act 2005 and the implications for making decisions in residents’ best interests as detailed in some care plans. It is recommended that staff receive training in the new legislation so that are aware of their responsibilities and duties under the new act. Residents have communication care plans in place and have access to speech and language therapists which was confirmed through feedback in surveys. One professional who completed a comment card said “staff recognise that different individuals’ have different communication skills and needs. Staff have been enthusiastic about communication dictionaries and have mentioned completing them for all individuals”. It was also stated that staff have referred residents for swallowing assessments and have implemented guidelines. Residents have access to advocacy and one resident is currently receiving the support of an advocate. As identified at previous inspections care plans should be developed regarding how residents are supported to manage their finances which is normally done on their behalf by staff and appointees. We looked at risk assessments and saw that these had also improved. Risk assessments cover bedrails (which are to be checked weekly), choking, scalding, moving and handing, fire safety and travel on the minibus. They provide staff with good control measures to minimize risks to residents. Although one resident had a risk assessment in place regarding his ‘agitation’ this mainly focused upon community presence. We recommend that as the resident has displayed challenging behaviour within the home, which has on at least one occasion affected another resident that a more detailed risk assessment is completed regarding his behaviours. We also discussed with the manager how one resident’s falls risk assessment should be reviewed as it Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 13 identifies a ‘medium’ risk when in fact according to the detailed falls chart the resident is high risk. Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place so that residents experience a meaningful lifestyle which includes participation in a range of activities within the home and local community. Contact with relatives is actively promoted. Residents are provided with a balanced and varied diet. Only slight improvement is needed in order to demonstrate how residents’ preferences are identified and met. EVIDENCE: We saw that progress had been made in recording activities undertaken by residents. Three residents attend college and the remaining seven residents have activities provided in-house. There is a detailed pictorial activities board in the dining room and a written activities programme in place. There are daily activity record sheets held in a very useful booklet which gives details of all aspects of the resident’s daily life. Records demonstrated that residents Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 15 participated in activities such as sessions in the sensory room, going out for walks, doing food shopping, visiting the pub and going bowling, visiting local parks, markets and towns plus undertaking independent living tasks. During our visit we saw residents going out on various trips to the shops and health care appointments. During the morning some residents were given massages by staff, they were doing jigsaws and having stories read to them. In the afternoon some residents visited a local park and others sat in the garden as it was a sunny day. We saw one resident being encouraged to help staff in the kitchen. All four relatives who completed comment cards stated that staff helped their family member to keep in touch. They all stated that there were ‘always’ or ‘usually’ kept up to date with important issues. One relative said “Talbot Court keeps me informed in every way”. All relatives and visiting professionals said that they feel the care home supports people to live the life they choose. One person said “they do everything possible and more to make their lives better, much more than I could do concerning my daughter”. It was stated by the same relative “it’s my daughter’s birthday and they have arranged a party for her, family are invited. They have done a lot more things to keep ‘X’ happy. I can’t thank all the staff at Talbot Court enough. It’s the nicest care home I’ve been in, and always felt welcome”. A visiting professional who completed a comment card said “I have attended several parties and am always impressed by the efforts made by the staff and the number of staff who attend, even when off-duty and how welcome they make residents’ family and friends”. All four health professionals who completed comment cards said that the care service respected individuals’ privacy and dignity. One person stated “staff will knock on individual’s doors before entering the bedroom and will draw the curtains if necessary”. During our visit we saw that staff kept bedroom and bathroom doors shut when assisting residents with personal care. However we did note that on occasions staff used various terms to address residents such as ‘sweetie, ‘sweetheart’ and ‘my dear’ rather than their Christian name which we discussed with the manager. We saw that improvements have taken place with regard to food and mealtimes. There is now a pictorial menu board in the dining room. We asked why there was no photograph for the lunch time meal and the cook explained that as it was the first time she had cooked homemade lasagne, that a photograph would be taken once the meal had been prepared. The manager later took a photograph so that this could be displayed. The breakfast gave a list of options but on discussion with the cook these were not available and were therefore taken off the board. Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 16 Through out our inspection staff were seen constantly asking residents what they would like to drink and giving them various options. Some residents are on specialist diets and these are also displayed on the menu board. We saw that there were a number of specialist food products in the kitchen to meet their dietary needs such as sugar free jam and gluten free products. We observed a lunch time meal being served to residents. Residents were given homemade lasagne, garlic bread and salad. One resident indicated that she did not like this and was given an alternative option. There were a large number of different hot and cold drinks available. A number of residents are very dependent and require assistance with eating. This was carried out by the majority of staff in a caring and patient manner which promoted the resident’s dignity. There was the exception of an agency worker who did not follow good practice. For example, the worker did not explain to the resident what he was having for his lunch, give verbal reassurance, use the correct eating utensils and did not sit facing the resident whilst helping him to eat. A permanent member of staff intervened and gave the agency worker guidance and instruction. We later discussed with the manager. Only a minority of residents are able to verbally communicate what they would like to eat. For the majority of residents, staff rely on their known likes and dislikes however these need to be recorded in their care plans. The cook explained that different meals are provided and are taken off the menu if residents are observed not to enjoy them. As we recommended, the manager has been introducing ‘taster’ sessions to establish if residents’ preferences have changed and introducing them to new foods. We saw that residents’ food intake records are much more consistently completed by staff. Although we could not locate a nutritional screening tool for the new resident, other residents had these in place. These have been reviewed as we previously requested and in addition the residents’ ideal body mass index has been calculated. One professional who completed a comment card said “the catering is the best of any home I have visited. The extent of the menu and the wide choices offered are exceptional”. Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally residents receive personal support in the way they prefer and require, and their health needs are well met. The systems for the administration of medication require only minor improvement to ensure residents’ medication needs are safely met. EVIDENCE: There were detailed care plans in place to demonstrate how residents’ receive support to meet their personal care needs. Sleeping and bedtime care plans gave details of pressure relieving equipment and the number of checks required during the night time. We suggested to the manager that residents’ preferences should be recorded as to whether they like male or female staff to support them with various aspects of their personal care such as administration of medication and bathing. All relatives and professionals said that they felt the care service can meet the different needs of people. One relative said “I can’t speak highly enough of the staff at Talbot Court”. Another relative said that staff do: “everything humanly possibly to make sure the people there get the very best attention”. One professional visitor stated that staff respect individuality and dignity. Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 18 All four health professionals stated that they felt individuals’ health care needs are met. They all said that staff seek advice and act upon it to manage and improve residents’ health care needs. There were detailed records kept of support from other health care professionals such as Macmillan nurses, occupational therapists, dentists and opticians. We saw that there was prompt action taken by staff when identifying a health care issue and residents were supported to receive hospital treatment where necessary. Tissue viability assessments are now regularly reviewed. Residents are weighed at the frequency identified in their nutritional screening tools. Residents have health action plans in place although the manager is awaiting support from the community learning disability nurse in order to review these and we discussed how this could be progressed by using the primary care team. There are pictorial statements and booklets regarding health care screening. We noted that there were no details regarding one resident in respect of routine mammograms and the manager agreed to look into this. There is blood glucose monitoring of diabetic residents although on one occasion staff had failed to identify what action they had taken when this was found to be slightly above normal, which we discussed with the manager. We looked at medication arrangements and saw that a number of improvements had taken place since our last visit. There were a couple of exceptions. For example, one tube of Fucidin had not been labelled with the date of opening. According to one person’s medication administration record (MAR) sheet there were three occasions where an antibiotic (Flucloxacillin) was not administered and was ‘refused and destroyed’. However, there were no records to demonstrate that the medication had been placed in the dedicated waste disposal container. Whilst staff are not always recording the date the or quantity of medication that is received into the home on the MAR sheet, nor medication which is carried over from the previous month (such as ‘PRN’, as and when required), there are separate daily audits sheets which contain this information. It may be easier to record this information on the MAR sheet to allow for easier monitoring. There were a couple of anomalies identified on the MAR charts. For example, there were a small number of gaps with no letter code or staff signature to confirm whether or not medication had been given. There was an occasion when staff had failed to identify the quantity of the variable dose administered to a resident. According to one resident’s MAR sheet they were to receive a third dosage of Procyclindine ‘as and when’ required however according to the nurse this was incorrect as the medication was to be given three times a day. The computerized instruction therefore needs to be altered. There were a couple of occasions where duplicate medicine labels had been stuck to the MAR chart which as we discussed with the manager is not advisable. As previously Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 19 It is recommended that an up to date medicine reference source is obtained as the home’s current edition was published in 2004. We discussed with staff the importance of ensuring that records are maintained when action has been taken to address any deficiencies identified in medication procedures. Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure which ensures that users’ views are listened to and acted upon. There are systems in place to safeguard and protect residents. EVIDENCE: There is a clear complaints procedure for residents and their relatives to access if necessary. There has been one complaint received by the manager during the last twelve months. There is a log book detailing the outcome of the complaint which was not upheld as according to the manager this related to another care establishment. However the action taken by the manager who initially thought the complaint was made about Talbot Court was swift and courteous to the complainant. During interviews staff gave examples as to how they would support people to make a complaint. The complaints procedure has been produced in a format suitable for service users. All four relatives said that the care service responded appropriately to any concerns they raised. One person said “they listen to the partner’s views and also, family and friends. It is a very friendly place”. Three professionals said that they had never had to make a complaint and a fourth stated that staff always responded appropriately if they raised any concerns. Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 21 According to information supplied by the manager there are 28 staff employed at the home. We looked at the training matrix which showed that 14 of these staff have completed training in safeguarding and protecting adults. It is recommended that all staff receive training. During interviews staff gave good responses as to how they would deal with any potential incidents of abuse. There was evidence to confirm that appropriate action had been taken earlier in the year when we asked the deputy manager to refer an incident of challenging behaviour to the safeguarding manager of the Local Authority. A strategy meeting was held which demonstrated that procedures were in place to protect residents. Since our last inspection the manager told us that residents have been reimbursed as we asked, for any items they were charged which are included in their basic contract fee, such as bed linen. Examination of residents’ current personal expenditure sheets confirmed that they are not paying for these types of items. We checked one resident’s monies and records. These balanced accurately. There are two staff signatures for all transactions made on behalf of residents and receipts for purchases are maintained. We saw staff checking monies and recording during the day as part of twice daily auditing systems. The manager told us that the organisation acts as appointee for some residents however their money is not held collectively and they have separate bank accounts as is good practice. Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made so that residents live in a more comfortable and relaxing home although there are some areas which still need to be addressed. Generally there are better systems in place to promote good infection control and prevent cross contamination. EVIDENCE: We looked around the home and saw the communal areas. One resident showed us his bedroom and another gave us her consent to visit her room. We saw that residents’ bedrooms had been redecorated and that they were personalised to reflect individual tastes and personalities. There was no damaged furniture in any of the rooms we viewed. Not all wardrobes have been secured to bedroom walls but the manager agreed to do this or to carry out written risk assessments. One relative who completed a comment card said “we are very happy ‘X’ has a place at Talbot Court. He has a lovely bedroom which has been tailor made Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 23 for his needs”. Bathrooms have also been redecorated and all residents can now access their ensuites. There is more sensory equipment in bathrooms and bedrooms. There were a couple of areas still needing attention. For example, the carpet in the communal corridor is stained and worn. The manager told us that this is due to replaced in the very near future. Some of the armchairs in the dining room are stained. The manager told us that these are cleaned by night staff and we saw the cleaning schedule which confirmed this (although the schedule has not always consistently been completed). One resident’s bedroom carpet was also slightly stained. It is suggested that deep cleaning of carpets and furniture is undertaken on a regular basis which is also included on the cleaning schedule. There were a couple of areas in the dining room were plaster work on the walls had become damaged and needs repair. The ceiling was also stained and needs repainting. One of the radiator covers had become loose and posed a safety risk however the manager ensured that this was made safe by a visiting handyperson. Infection controls procedures have improved with the laundry kept more tidy and torn flooring in bathrooms and toilets repaired. A clinical waste receptacle is now installed in the laundry room. There were some new items which need addressing for example: there was no liquid soap in the communal bathroom there was no supply of paper towels in the laundry extraneous items located on top of cupboards in the laundry need to be removed (such as a suitcase, paint trays and paper towel dispenser). a mop head was found drying on top of the draining board a member of staff had not removed their personal protective clothing when leaving a resident’s bedroom and entering the manager’s office. Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34. 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. On-going training is being provided to staff in order to ensure that they have the qualifications and skills to meet the specialist needs of residents. Residents are supported by a more stable staff team. There is a robust recruitment and selection procedure only slight improvements are needed in order to offer more safeguards to residents. There are formal systems in place to support staff although the frequency of supervision could be increased for some staff. EVIDENCE: The manager told us that almost all staff are completing their NVQ II and several are undertaking their NVQ III. Staff confirmed this during interviews. There is a training matrix displayed on the wall although we could not corroborate some of the recent training which was supposed to have been carried out as training certificates were still awaited. For example one person Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 25 had training certificates for stoma care, ‘deaf/blind’ awareness and autism. The training matrix indicated that he had also completed training in tissue viability, dementia, diabetes and epilepsy but there were no certificates to validate this. According to the training matrix a number of staff have yet to complete training in autism, equal opportunities and disability equality and person centred planning. Eighteen of the twenty eight staff employed have received training in non-violent physical crisis intervention (NVPCI). All relatives who completed comment cards said that they felt the staff team have the right skills and experience to look after people properly. One relative stated “there are regular staff for continuity which is an important aspect of care”. Visiting professionals also felt that staff have the right skills and experience to support people’s needs. There are currently increased staffing levels due to the needs of the new resident. At present there is one qualified nurse and seven support staff on duty per day time shift. The manager told us that she is actively recruiting new staff to meet the increased staffing ratio. There were two agency staff on duty but the manager and staff told us that agency are only used occasionally which we confirmed by looking at the duty rota. The manager needs to ensure that she records the hours she has worked on the duty rota. Staff confirmed that there are regular staff meetings which take place. We asked to see two new staff files to evaluate recruitment and selection procedures. Unfortunately, the manager was still awaiting the transfer of a personal file from head office for the latest member of staff to be appointed so we could not carry out a full assessment. There was a ‘personal file’ sheet which dated that a police clearance check had been received and two written references plus forms of identification. Good recruitment procedures had been followed for the second member of staff that we looked at apart from the fact that two written references had been received but both from the same employer. We suggested to the manager that a further referee should have been sought. We asked to see the clearance checks and training records of the two agency staff on duty. The manager was only able to provide us with details of one of the agency workers. The manager stated that the agency had stopped sending though the personal statement sheets containing this information. She was able to contact the agency during our visit and they faxed through the details of the second worker. We told the manager that this information must be received prior to agency staff commencing duties. There are continuing efforts to provide staff with induction and foundation training by an accredited learning disability awards framework (LDAF) provider. Although as yet not all staff have undertaken this training and new Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 26 staff are not completing it within the recommended timescales. The manager said training certificates were awaited. We looked at staff supervision records. One member of staff had received four supervision sessions in the last eight months but another had only received two sessions. The manager told us that now she has been in post for twelve months she will commence an annual appraisal process. Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit home that is run in their best interests by a competent and skilled manager. There is a quality assurance system so that people can participate in the development of the service which is regularly reviewed and monitored. Practice and procedures are in place to promote residents’ health, safety and welfare. EVIDENCE: Ms. Bailey is registered manager and has worked at the home for the last twelve months. She is a registered nurse and has completed her NVQ IV in management. There was lots of positive feedback from staff, relatives and other professionals regarding Ms. Bailey’s management style. One relative Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 28 stated “it is difficult to see how anything could be improved particularly since the manager Ruth has taken over much to our relief, on a permanent basis”. A visiting professional said “Since I have been working at Talbot Court there have been several managers; the staff have not been happy. However, since Ruth Bailey has been there, a marked change has taken place. The turnover of staff seems to have halted and the current staff seem much happier and are working in harmony. The residents seem calmer too and they are going out more for walks, swimming etc. which has to be good for their morale and well being”. Through out our visit Ms. Bailey demonstrated a good rapport with both residents and staff. She has kept herself up to date with changes in practice and legislation. We would still recommend however, that the home is enabled access to the internet so that management and staff can use professional websites to help with obtaining information and advice. There is a quality assurance system in place and the organisation has a dedicated senior manager who is responsible for monitoring and review. The manager showed us a report of a visit that had recently been undertaken together with actions for development. There are also daily checks undertaken by senior support workers which look at different aspects of the service and the manager told us of a recent open day that is being planned for families. The manager told us that there are questionnaires ready to be sent to stakeholders and we discussed how residents’ satisfaction can be measured perhaps by looking a observational tools. Since our last visit there have been improvements to health and safety. The laundry door is kept locked and substances hazardous to health are kept secured. We saw that there is more regular checking of the fire alarm system and that staff have participated in a recent fire evacuation drill as part of their fire safety training in July 2007. We looked at mandatory training and sampled three member of staff’s training certificates, although we could not carry out a full evaluation as a number of staff are awaiting training certificates. One staff member had up to date training in food hygiene, fire safety, moving and handling, first aid awareness and infection control. The other two staff members did not have the same number of training certificates in place. The manager explained that there a new training system and many staff have completed training but are still waiting for their certificates. Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 29 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 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 3 X 2 X X 2 X Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 30 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 YA24 Regulation 23(2)(d) Requirement To clean or replace all stained carpets through out the home and which include communal areas and individual service users’ bedrooms. This is a repeated requirement which was to have been met by 1/5/07. Timescale for action 01/11/07 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 YA6 Good Practice Recommendations To introduce a system to demonstrate that residents, relatives and significant professionals are invited to participate in six monthly reviews of care plans. To continue to pursue implementing a system of Person Centred Planning, or similar, such as Essential Lifestyle Planning. To produce care plans in different formats suitable for Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 31 2. 3. 4. 5. YA7 YA9 YA17 YA18 6. YA20 service users. To establish care plans regarding how residents are supported to manage their finances. To ensure that there are detailed risk assessments in place for residents’ challenging behaviour. To ensure that residents’ known likes and dislikes regarding food and drink are recorded in their care plans. It is recommended that residents’ preferences as to whether they would like male or female staff to support them in various aspects of their personal care is recorded in their care plans. The date of opening of all medicine containers should be recorded. All medication that is to be disposed of must be recorded and documented. To ensure that any incorrect computerized instructions entered onto MAR sheets are amended to reflect the accurate dosage prescribed. It is strongly recommended that the home obtains an up to date medicine reference source for example a new edition of the BNF. To provide all staff with training in safeguarding and protecting adults. To ensure that all wardrobes are secured to bedroom walls (or to carry out written risk assessments). To ensure that armchairs and carpets are regularly deep cleaned and to include this on the cleaning schedule. To carry out repair and redecoration of damaged walls and stained ceiling in the dining room. To ensure that there are adequate supplies of liquid soap and paper towels in communal bathrooms and laundry. To remove extraneous items from the laundry room such as suitcase, paint trays and disused paper towel dispenser. To ensure that staff follow good infection control measures and remove personal protective clothing when completing tasks and before entering other areas. To pursue specialist training for all staff and to obtain training certificates to demonstrate that this has been provided for example with regard to autism, NVPCI, diabetes, dementia, epilepsy, tissue viability, person centred planning and awareness of the Mental Capacity Act DS0000004780.V349600.R01.S.doc Version 5.2 Page 32 7. 8. YA23 YA24 9. YA30 10. YA32 Talbot Court 11. 12. 13. 14. YA33 YA34 YA35 YA36 2005. To ensure that the manager’s hours are recorded on the duty rota. To ensure that written confirmation of clearance checks and details of training are obtained for any agency staff before they commence duty. To ensure that staff are provided with training in equality and diversity. To ensure that staff receive formal structured supervision training on a bi-monthly basis. To implement an annual appraisal system. It is recommended that the home is enabled to access and use e-mail and web site facilities to assist with communication and researching current good practice and guidance. To continue to develop the quality assurance system by exploring different strategies for measuring residents’ satisfaction with the service provided. To continue to collate training certificates in order to be able to demonstrate that staff have received suitable mandatory training. 15. YA37 16. 17. YA39 YA42 Talbot Court DS0000004780.V349600.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Halesowen Office West Point Mucklow Office Park Mucklow Hill Halesowen B62 8DA 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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