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Inspection on 11/05/07 for The Bungalow

Also see our care home review for The Bungalow for more information

This inspection was carried out on 11th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Inspectors first visit to the home. Observations were that staff at the home had an understanding of the needs of service users and were very good at promoting the diverse needs of individuals. Staff explained how they continue to support people to take part in domestic duties to promote their independence and also support them to develop their numeric and literature skills by participating in tabletop games. The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 As at previous visit people who live at the home also access a wide variety of community venues including local pubs, horse riding facilities, swimming pools and local parks such as Cannock Chase. In addition to this all service users use the local shops to purchase personal items such as clothes and toiletries. The inspector was told that staff help to arrange home visits for individuals and write letters on a weekly basis (assisted where possible by service users) to families to keep them informed of events and the welfare of their relative. Observations today were that staff on duty had a very good understanding of service users rights to make choices. As at previous inspection it was explained that, "when getting someone dressed I always hold 2 items. If a service user points or tries`s to hold one of them I take this as them telling me which one they prefer.

What has improved since the last inspection?

Requirements of the previous inspection have been complied with. These include updating care plans to include aims and goals for service users, individual risk assessments, Inspector was told all staff have now received risk assessment training, Activity monitoring sheets are in place, pictorial choice of food daily, Nutritional assessments are carried out, adult protection training completed, infection control training completed, kitchen/domestic staff employed, fire training.

CARE HOME ADULTS 18-65 The Bungalow 1 Short Street Brownhills Walsall West Midlands WS8 6AD Lead Inspector Mrs Kathryn Marks Key Unannounced Inspection 11 & 14th May 2007 09:00 th 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 The Bungalow DS0000041185.V338110.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. The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Bungalow Address 1 Short Street Brownhills Walsall West Midlands WS8 6AD 01543 372333 01543 372308 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) Chase Community Homes Vacant post (Proposed Care Manager In Place) Care Home 7 Category(ies) of Learning disability (7) registration, with number of places The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 2005 Brief Description of the Service: The Bungalow is a seven-bedded Care Home that aims to provide specialised care, support and teaching for people with autism and allied conditions. Facilities within the home include a living room/dining area, seven single bedrooms (all with ensuite facilities), kitchen, laundry and office. There is parking for up to four cars at the front of the building and an enclosed garden to the rear. Emphasis has been placed on a small group living together, enabling a high staff to resident ratio, giving opportunities for residents to develop the ability to transfer skills and knowledge from one area of their lives to another. The home opened in 2003, is domestic in nature and located at the centre of Brownhills very close to shops, markets, and post office, public houses and bus routes. There are several sport centres within a short distance from the home, providing a variety of leisure activities. There is a local provision for riding for the disabled and Cannock Chase is close by for walks etc. The Bungalow is one of a number of homes that forms Chase Community Homes, a private company that is owned by two teachers, both of whom have over twelve years experience of teaching in residential schools for complex and delayed developmental disorders including autism. The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key Unannounced Inspection was carried out on 11/05/07 and 14/05/07 and covered all of the core standards. The inspection took place over two visits totalling 9 hours by one inspector who used the National Minimum Standards for Younger Adults as the basis for the inspection. A tour of the home took place with staff and the younger people living here who were present in the home. Prior to the inspection visit, survey information has been requested from individuals and their relatives. Positive responses were received via feedback cards “Staff are always friendly but very professional competent and caring” “The Bungalow is a happy home from home” The inspection included an examination of records, indirect observation, with the young people living here although understanding and conversation is limited. The Proposed Care Manager was unavailable at the first visit however throughout the inspection other staffs were spoken with whilst working with individuals. The Care Manager from the company’s adjacent home who used to be Care Manager at The Bungalow assisted throughout this inspection. Case tracking of two-service users care plans took place. Three staff records were examined and observations were made of interaction with young people during daily events. Information gained from the Care Manager who assisted with the inspection and written information via a pre inspection questionnaire identified that the current fees charged are £995 to £1300 per week. What the service does well: Inspectors first visit to the home. Observations were that staff at the home had an understanding of the needs of service users and were very good at promoting the diverse needs of individuals. Staff explained how they continue to support people to take part in domestic duties to promote their independence and also support them to develop their numeric and literature skills by participating in tabletop games. The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 6 As at previous visit people who live at the home also access a wide variety of community venues including local pubs, horse riding facilities, swimming pools and local parks such as Cannock Chase. In addition to this all service users use the local shops to purchase personal items such as clothes and toiletries. The inspector was told that staff help to arrange home visits for individuals and write letters on a weekly basis (assisted where possible by service users) to families to keep them informed of events and the welfare of their relative. Observations today were that staff on duty had a very good understanding of service users rights to make choices. As at previous inspection it was explained that, “when getting someone dressed I always hold 2 items. If a service user points or tries’s to hold one of them I take this as them telling me which one they prefer. What has improved since the last inspection? What they could do better: Employ a Registered care Manager. Ensure that keys to office remain on site enabling access to records at all times. The Bungalow DS0000041185.V338110.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. The Bungalow DS0000041185.V338110.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 The Bungalow DS0000041185.V338110.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): Standard 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has in place a Statement of Purpose and Service User Guide providing residents and prospective residents/carers/relatives with details of the services the home provides enabling an informed decision about admission to be made. Pre Admission Assessments are carried out for all new service users. EVIDENCE: Detailed assessments are carried out prior to a service user being admitted to The Bungalows to ensure staff can meet the individual needs highlighted. On going care reviews are on care plans two of which were fully reviewed and found to be informative. Care Plans also contain full details of assessments and how needs highlighted are to be addressed. Limited understanding and lack of conversation made it difficult to ascertain from individuals if they felt that their needs were being addressed, observations of service users at the time of inspection indicated they were. The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 10 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): Standards 6,7,9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of care planning was good providing staff with clear guidance and information to meet individual needs. Service users were supported to make day-to-day decisions and risk assessments were in place. EVIDENCE: Individual’s needs were assessed and reviewed on a regular basis. Written evidence of this was seen in care plans and care review documentation in service user files. Personal communication plans are in place various forms are used and displayed around the home including pictorial, and makaton. Picture exchange, body language, eye contact are all forms of communication used and the care plan identifies the specific choice for a particular individual enabling staff to communicate with them. The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 11 Management guidelines are in place for challenging behaviours to assist staff in the management of this behaviour. Families are involved in compiling care plans service user is present but not always able to express their wishes and make a constructive input. Advocates or parents speak on the individual’s behalf and on behalf of service users offered the following comments: “ Have a peer group” “lots of staff” “like living here” “like the food” Staff explained that daily choices are available and individuals are offered two of everything physically i.e. two items of clothing, makaton board, whatever communication is appropriate is used. Evidence was seen on service users individual care files of risk assessments having been carried out and risk management strategies being in place. The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,15,16,17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service, the examination of service user plans and general observations during the process of the inspection. Contact is maintained with families and individuals regularly access the local community enabling them to have a variety of experiences. EVIDENCE: Service users at The Bungalow all have limited communication and understanding making outside employment unlikely. One service user 18years old will continue to attend school until they are 19years old. The remaining service users within their planned curriculum will be attending Chase Community Homes new day service which is due to open shortly. All take part in the homes planned activities/weekly programme of events that includes: Personal Skill Training The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 13 Domestic Skills Independent skills Personal shopping Skills Music Therapy Cooking Leisure skills Relaxation Links with the local community are good service users access local public houses, general practitioners, dentist, Local Park, shops, hairdressers, shire oak local club, swimming, library, local church. Three young people went out shopping and for lunch today. Relationships are maintained with parents staffs help individuals send home a weekly letter and photograph and families visit on a regular basis this is identified in individual care records. Special dates are celebrated with families attending. Staff said that individuals would be able to indicate if they don’t want contact with family when they visit. Mealtimes are flexible to meet the needs of individuals with fresh fruit and vegetables always available. The home now employs a cook there is a choice of menu and cakes are home made. Menu was seen and offers a varied diet. Individual food records are kept. No special diets were being catered for at the time of this visit. The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19,20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Observations of staff on duty indicated that they had a very good understanding of the service users personal, emotional and physical support needs. The medication at this home was well managed via secure storage and good recording systems. EVIDENCE: Staffs on duty were observed to provide sensitive personal support to service users promoting the individual’s privacy and dignity throughout this visit. All service users have their own key workers who assist them on a daily basis. Significant dates and special events are all celebrated. Staff said that individuals generally enjoy the relaxation of bathing. Intimate care, is provided by a person of the same gender on a one to one basis. This was confirmed by staff on duty and enables individuals to have undivided attention from staff. Observations were made of individuals making choices about how they were to spend their time today. The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 15 Specialist support is available as required this is evidenced via individual care plans that were seen and is accessed through a General Practitioner referral. If needed behavioural team and community learning disability nurse are also available. There are two General Practitioners practices involved with the home and all service users attend well man and well woman clinics. Annual Health checks take place. Generally all service users are assisted to manage health care conditions but where able are encouraged to use own creams. Arrangements are in hand for all service users to receive hearing tests through an outside agency visiting the home. All service users have risk assessments on file for the administration of medication and no one is currently self-medicating. Medication Administration Records were looked at and found to be up to date. All staff administering medication is trained to do so. Medications are stored in a locked metal cupboard secured to the wall. The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22,23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has in place a complaints procedure that is in written and pictorial form to ensure it is accessible to service users. EVIDENCE: The home has received no complaints since the last inspection. There is a complaints book in place to record complaints and any action taken to deal with complaints. The homes complaints procedure is given to relatives and explained to them on admission of service user. Service users may have limited understanding of the process. Feedback questionnaires from families of service users confirmed that they were aware of the complaints procedure and how to use it. Staff received Adult Protection training and staff on duty confirmed this. Policies and procedures were in place and staffs were familiar with and able to discuss these. The home does not deal with service users monies this is dealt with by families and advocates. The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 17 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): Standards 24,27,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was suitable to meet the needs of residents, with adequate communal space, sufficient bathing and shower facilities and single occupancy bedrooms. EVIDENCE: The home is suitable for its stated purpose, safe and well maintained. All service users have single bedrooms with en/suite facility and all bedrooms are personalised as individuals wish, as far as they are able to express. The home was generally clean and odour free with individuals moving freely around. There is a ramp to the garden with a handrail that has lighting all along it. There is a small laundry with policies and procedures in place for the management of linen and laundry. The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 18 The washing machine has medical/disinfection programme and alginate bags are used. Staffs have completed a twelve weeks Infection control course via Wolverhampton College. The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 19 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): Standards 34, 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Observations at the time of this inspection were that staffing levels were adequately maintained to ensure that service user needs were appropriately addressed. EVIDENCE: The Inspector was told that robust recruitment policies and practices were in place at the home. The office at the home was locked so staff records could not be accessed to review them. The Care Manager who assisted with the Inspection from the company’s adjacent home said that a staff training and development plan was in place with a training matrix but this again was in the office. A subsequent visit to the home was made when staff files were reviewed along with training records. Robust recruitment policies and procedures are in place, Criminal Records Bureau checks, Pova checks, and two references are taken up prior to the The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 20 appointment of staff. The records of two staff employed were sampled and found to be satisfactory. Observations of the inspector where that staff on duty were knowledgeable about the needs of service users in their care and were meeting those needs in a sensitive caring way. A discussion took place with the proposed care manager/key holder regarding access to the homes office and records in her absence. Interim arrangements are that the key will be left with designated person and proposed care manager will discuss digital lock on office door with providers. The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 21 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): Standards 37,39,42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffs demonstrate an awareness of their roles and responsibilities, ensuring that the health, safety, and welfare of residents are observed. EVIDENCE: There is currently no Registered Care Manager at The Bungalow. The proposed Care Manager has worked at the home for four years and has been deputy here for 18 months. She has completed NVQ Level 3 and is waiting to start NVQ Level 4 and her registered managers award. The proposed Care Manager attends staff training along with other staff to update her knowledge. The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 22 Formal effective professional quality assurance system is in place to monitor and review systems and standards in the home. This is carried out on a six monthly basis. The management also carries out internal annual review/audit of systems and procedures in the home. All records relating to the home that were reviewed Staff rota, staff training, Food hygiene, Medication records fire records and risk assessments were found to be detailed and up to date. Policies and procedures were in place to inform staff of practice. The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 23 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 X 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 X 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X 3 X X The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 YA34 Regulation 17(3) (b) Requirement The registered person shall ensure that the records referred to in paragraphs (1) and (2) are at all times available for inspection in the care home by any person authorised by the Commission to enter and inspect the care home. The registered person shall ensure that the records referred to in paragraphs (1) and (2) are at all times available for inspection in the care home by any person authorised by the Commission to enter and inspect the care home. The registered provider shall appoint an individual to manage the care home whereThere is no Registered Manager in respect of the care home. Timescale for action 28/05/07 2 YA35 17(3) (b) 28/05/07 3 YA37 8 (1) (a) 13/06/07 The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 25 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. YA35 Refer to Standard Good Practice Recommendations Staff receive Training update on Mental Capacity Act The Bungalow DS0000041185.V338110.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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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