CARE HOME ADULTS 18-65
Tarragon Gardens, 11 Frankley Birmingham West Midlands B31 5HU Lead Inspector
Gerard Hammond Unannounced Inspection 16th March 2006 09:45 Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 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 Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 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. Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Tarragon Gardens, 11 Address Frankley Birmingham West Midlands B31 5HU 0121 411 2133 0121 411 2133 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) RNID Miss Clare Booth Care Home 4 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (4), Sensory impairment (4) of places Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Residents must be aged under 65 years The primary care needs of all service users will be that of Sensory Impairment. 28th September 2005 Date of last inspection Brief Description of the Service: 11 Tarragon Gardens is registered to provide accommodation, care and support for four people with sensory impairment. The service is run by the Royal National Institute for the Deaf and the premises owned by Nehemiah Housing Association. The house is in a modern terrace, with the main accommodation on the ground floor. Above this are two flats, accessed independently via separate front doors either side of the main entrance to number 11. One flat is occupied by a person using the service, and the other is used for staff sleep-in accommodation and by residents for activities and meetings. In the main house there are three single bedrooms with en-suite shower facilities, an open plan living / dining area, a separate kitchen and also a separate shower room / w.c. The resident’s flat has a bedroom, living room, kitchen (with washer / drier) and bathroom. At the rear of the property is a secure private garden. There is car parking space at the front of the house. The Home is situated in the Frankley area of Birmingham, close to Northfield shopping area. Local amenities such as cinema, bowling alley, gym and restaurants can also be easily accessed at nearby Rubery Great Park. The area is well served by public transport. Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second inspection visit of the current year and was unannounced. This report should be read in conjunction with the one written following the inspection carried out on 28 September 2005. Direct observation and sampling of records (including personal files, care plans, previous inspection reports and safety records) were used for the purposes of compiling this report. The Registered Manager was formally interviewed and two other staff members interviewed informally. This inspection focussed mainly on requirements made at the last inspection and assessing outstanding Key Standards. A tour of the premises was also completed. What the service does well: What has improved since the last inspection?
Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 Page 6 Clear efforts have been made to meet requirements made at the time of the last inspection. The Statement of Purpose has been reviewed and the conditions of registration amended to reflect the current nature of the service on offer. Work has begun on reviewing and updating residents’ care plans, so as to improve detail and to include agreed goals. Specific requirements relating to helping one man keep in touch with family and friends, and another to maintain his room in an acceptable condition have been met. The kitchen and residents’ shower rooms have been redecorated. A new washing machine has now also been installed. Additional members of the care team are shortly to commence on a course of specialised training for supporting people with mental health care needs and hearing impairment. What they could do better:
Good work already done to develop care plans should now be built on. Plans need to be expanded to include more detail about precisely how support should be given, and to include agreed goals. Outcomes of goals should be measurable. It is recommended that the use of person-centred approaches be further developed, to support care planning and proposed training initiatives. It is further recommended that protocols for PRN (“as required”) medication be filed with the Medication Administration Record, for ease of reference. Proposals for relocating the service should be taken forward. In the meantime, work required to maintain the property should be carried out, for the benefit of the people living in the house. A staff training and development assessment and plan for each person working in the home is still required. Arrangements for formal supervision need to improve. Visits and reporting required by Regulation 26 (Care Homes Regulations 2001) must be carried out at least every month. Quality assurance and monitoring activity should demonstrate how the views of people using the service have been taken into account. The fire risk assessment is now due for review. The fire alarm must be tested every week, and a written record maintained. Action required by the Fire Officer’s report following his visit on 16 January 2006 must be completed as indicated.
Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 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. Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 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 Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 Appropriate information is available to support prospective residents make a choice about using this service. Prospective residents’ needs and aspirations are assessed appropriately, and they have opportunities to try out the service, prior to making any decision about placement. EVIDENCE: Key Standard 2 and Standards 1 and 3 were assessed at the last inspection and met in part. A requirement was made at that time that an application to vary the conditions of registration should be made to CSCI, so that these accurately reflected the nature of the service being provided. This has now been dealt with as required. The Statement of Purpose has now also been updated. There have been no new admissions since the last inspection, but changes are imminent. One resident, who currently lives in the upstairs flat, is scheduled to move out in the very near future. A prospective new resident is going through an introductory process, so that she can consider whether or not to move in, when the flat becomes vacant. Conversations with the Manager indicated that this process is an appropriate one, and includes the gathering of assessment information and the provision of opportunities to try out what the service has to offer, prior to any decisions being taken about placement.
Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 Page 10 This was supported by documentary evidence of the systems in place within the organisation to process new referrals. Evidence was also seen that existing assessments are being reviewed and updated, as previously required, and that this is a work in progress. Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 The good work already done to develop care plans should be continued and built upon. EVIDENCE: Key Standards 6, 7 and 9 were assessed at the last inspection. Standards 7 and 9 were fully met. A requirement was made at that time that care plans should be developed. It was reported that plans should contain more detail, so that they include clear guidance as to exactly how support should be given, in accordance with individuals’ preferences. Care plans should also include agreed goals, and it is important that the desired outcomes can be measured. Sampling of individual care records demonstrated that significant work has gone on to address these issues since the last inspection, and this should be acknowledged. Care plan development remains a work in progress, but efforts made to date should be commended. A number of specific requirements concerning individual plans have now been met. Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 Page 12 It was also recommended that person-centred approaches should be further developed. Conversations with staff indicated that specialist training being undertaken by members of the care team is heavily influenced by this way of working. It seems clear that developing the team’s understanding of these approaches will enable them to get the most out of training opportunities, and directly benefit the people living in the house as a result. Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15, 16 Members of staff support residents to maintain contact with their families and friends. Resident’s rights are respected, and staff try hard to support them to recognise and act upon the accompanying responsibilities. EVIDENCE: Key Standards 12, 13, 15, 16 and 17 were all assessed at the last inspection. Specific requirements were made with regard to the support available to one resident in maintaining contact with his family and other people in his area of origin. It was noted that this person’s care plan has now been amended to take this into account. Another requirement was also made in relation to the arrangements with one of the other residents for maintaining his room in an acceptable condition. Changes have been made to his care plan, and guidelines put in place clearly indicating action to be taken in the event that the agreed standard is not achieved.
Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Key Standards 18, 19 and 20 were all assessed at the last inspection. Direct observation of residents’ attire and personal grooming provided evidence that they enjoy a good standard of support in their basic personal care. As reported above, care plans are being developed to make guidance clearer and to express individual preferences in more detail. The Medication Administration Record was examined, and completed appropriately. It is recommended that protocols for PRN (“as required”) medication be filed with the MAR for ease of reference. A requirement that all members of staff are appropriately and specifically trained in order to meet residents’ mental health needs (given the specialist nature of this service) has been partially met (see Standard 35 below also). Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Key Standards 22 and 23 were assessed at the time of the last inspection, and met in full. Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 The staff team continues to work hard to make the house homely, comfortable and safe. The Home is generally kept clean and tidy, with a good standard of hygiene maintained. There are longstanding issues about the support needs of one resident, but staff work hard to deal with this appropriately. EVIDENCE: Key Standards 24 and 30, and Standard 27 were assessed at the last inspection. Staff and residents continue to work hard to keep the home clean, tidy and comfortable. The support that one resident needs to maintain his room to an acceptable standard continues to be problematic. As reported above, arrangements are in place to take action as required, and the staff team continue to do their best to deal with this appropriately. The last inspection report also made reference to issues relating to the provision of communal space in the home. It has to be acknowledged that there is limited scope for improving this in the current environment. However, plans are being taken forward to relocate this service to a purposebuilt property in the future. The Registered Provider is urged to progress these plans to make them a reality at the earliest possible time.
Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 Page 17 One or two areas of the building require attention, and these are detailed in the requirements section of this report. The Registered Provider should take these up with the Landlord or deal with them in accordance with existing agreements. It was noted that the kitchen and residents’ shower rooms have been redecorated since the last inspection visit, and a new washing machine installed. Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 A current training and development plan is still required to assess fully the qualifications, training and competence of the staff team. However, there is evidence that arrangements are in place to ensure that training needs are being addressed. General recruitment practice provides protection for people living in the house. Formal supervision of staff needs to improve in order to meet required standards. EVIDENCE: Concerns were expressed at the time of the last inspection with regard to training received by members of staff to enable them to support residents with mental health care needs. This is seen as especially significant, given the specialist nature of this service. Subsequent conversations with the Organisation’s Head of National Specialist Mental Health Services, and the Registered Manager indicate that significant progress is being made to address this issue. Three members of staff are scheduled to complete their studies towards gaining a Certificate in Community Mental Health from Birmingham University in June 2006. Three more are to commence working towards this in April 2006. The Inspector was advised that this course is being specifically developed by the University in partnership with RNID, to address the needs of people with mental health support needs who are also hearing impaired.
Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 Page 19 The Manager also advised that further developments are proposed to seek additional support for other staff members “in house” via the local Community Psychiatric Nurse service. All of these represent positive action to develop the service for the benefit of the people using it. A copy of the workforce development plan was provided on the day of the inspection visit. A current staff training and development plan for each member of staff is still required. As previously indicated, this should include (for each person working in the home) details of training completed and qualifications gained (where appropriate). Any gaps in training should be highlighted, including “refreshers”. The schedule should show when outstanding training is to be delivered, and by whom. The Manager indicated that ten members of staff have done Adult Protection training, but two have not. She also advised that all members of staff had qualified in British Sign Language level 1, three were qualified to level 2, and one to level 3. Members of staff made positive comments about the training opportunities available within the Organisation. Records relating to staff recruitment were sample checked and found to be generally satisfactory. The Manager acknowledged that formal supervision is not currently up to the required standard. However, it should be acknowledged that absence due to sickness on the part of senior staff members has been a contributory factor in the present situation. Staff group meetings have generally been at appropriate intervals. Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 The home is generally well run. People using the service are consulted, but reports of quality assurance and monitoring activity should demonstrate clearly how their views underpin review and development. General practice promotes residents’ health safety and welfare, but some aspects of recording continue to require attention. EVIDENCE: The Registered Manager is a qualified nurse (RNMH): she is currently working towards the Registered Manager’s Award, which she hopes to complete later this year. She is also due to commence working towards gaining the Certificate in Community Mental Health referred to earlier in this report, in April 2006. Direct observations support the view that the senior members of staff in the care team have a positive working relationship, and are supportive of each Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 Page 21 other in their efforts to develop the service for the benefit of the people living in the house. The Manager advised that there is a group established within the Organisation that has a specific brief with regard to Quality Assurance and Monitoring. She acts as representative for the group looking in particular at service user involvement, considering, for instance, ways in which they can play a direct role in staff selection and recruitment. This group reports to the Organisation’s senior management forum. A requirement was made in the last inspection report that visits and reports required under Regulation 26 (Care Homes Regulations 2001) should be completed at least every month. It was noted that reports were not available for March, July, August or October in the preceding twelve-month period. It was noted that residents’ meeting are being held on a regular basis. Reports of quality assurance and monitoring activity should demonstrate clearly how review and development of the service is underpinned by the views of the people who use it. Safety records were sample checked. It was noted that the fire risk assessment is now due for review. The record of tests on the fire alarm and emergency lighting systems had generally been completed appropriately, but there were still some gaps in recording. The fire alarm and fire-fighting equipment have been serviced. Fire evacuation drills have been carried out, but the record should show the names of all those taking part. A recent visit from the local Fire Officer has indicated a number of issues that require attention, and these must now be dealt with. The record of testing of water temperatures has been completed appropriately. It was noted that packages of food stored in the fridge had been labelled with the date of opening, in accordance with accepted good practice. Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X 3 X 2 X X 2 3 Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement Care plans should be developed as indicated in the main body of this report, so as to include the setting of goals with measurable targets. Targets should be evaluated at review and amended or reset as appropriate. (Partially met) (See requirement 1 above also) Develop care plans to ensure that individuals’ preferences, and specific guidance to staff about how support should be given, are clearly stated. (Partially met) Ensure that all members of staff are appropriately and specifically trained in meeting residents’ mental health care needs. (See requirement 5 below also) (Partially met) Repair plasterwork in bathroom (upstairs flat) and resident’s bedroom (LW). Repaint / stain the front door. Develop the garden so as to encourage and facilitate its use by residents.
DS0000017165.V287019.R01.S.doc Timescale for action 31/05/06 2. YA18 12(4a) 15(2b) 31/05/06 3. YA19 12 (1) 18 (1) 31/05/06 4. YA28 23 (2) 31/05/06 Tarragon Gardens, 11 Version 5.1 Page 24 5. YA35 18 (1c) 6. YA36 18 (2) 7. YA39 26 8. YA42 13 (4c) 9. YA42 13 (4c) Submit an up to date training and development plan for all members of the staff team, as indicated in the main body of this report. Ensure that members of staff are formally supervised at least six times in any twelve month period (pro rata for part-time staff) The Registered Provider must ensure that reports required under Regulation 26 (Care Homes Regulations 2001) are submitted to CSCI each month Ensure that fire evacuation drills are completed at least every six months. Records should show the names of all those taking part. Ensure that the fire alarm is tested weekly, and that the written record is appropriately maintained. Review the fire risk assessment and ensure that the requirements of the Fire Officer’s report are dealt with as indicated. 31/05/06 31/05/06 31/05/06 31/05/06 31/05/06 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 YA19 Good Practice Recommendations Place a prominent note on incident / accident records to remind staff completing reports of the need to meet the requirements of Regulation 37 (Care Homes Regulations 2001) (Not assessed) Place protocols for PRN (“as required”) medication on file with the Medication Administration Record (MAR) Provide training for staff to develop person-centred approaches. 2. 3. YA20 YA35 Tarragon Gardens, 11 DS0000017165.V287019.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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