Inspection on 10/02/09 for The Dell

This inspection was carried out on 10th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Dell 05/08/08

The Dell 12/06/07

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOME ADULTS 18-65 The Dell 30 Monument Avenue Wollescote Stourbridge West Midlands DY9 8XS Lead Inspector Jean Edwards Key Unannounced Inspection 10th February 2009 08:30 The Dell DS0000069594.V374151.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 The Dell DS0000069594.V374151.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 Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Dell Address 30 Monument Avenue Wollescote Stourbridge West Midlands DY9 8XS 01384 826050 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Select Health Care (2006) Limited Mrs Mary Griffiths Care Home 7 Category(ies) of Learning disability (7) registration, with number of places The Dell DS0000069594.V374151.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 only to service users on the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning Disability (LD) 7 The maximum number of service users to be accommodated is 7 Date of last inspection 5th August 2008 Brief Description of the Service: The Dell is a large detached property, which provides accommodation for up to seven people with learning disabilities. It is a privately owned care Home, which is part of Select Healthcare Limited. The Home is situated in a quiet residential locality in the Wollescote area of Stourbridge and is within walking distance of the local village, which has shops, public houses, a park and other local amenities. The town centre of Stourbridge can be accessed by public transport. There is a small parking area at the front of the building and a patio and garden at the rear of the property. There is no lift access for residents. It 7 single bedrooms. There are lounge and dining room facilities on the ground floor together with a conservatory. The Home has bathing facilities on the first floor and a very small en suite in the ground floor bedroom. There are toilet facilities sited throughout the Home. There are limited car parking spaces at the front of the home. Access is via a steep drive, which has been improved with handrails, ramps and steps. There was no information relating to fees contained in the service user guide. For information about fees that the home charges you are advised to contact the Home Manager. Additional costs include hairdressing, toiletries and private chiropody, which can be provided within the home for an additional fee. The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We, the Commission for Social Care Inspection (CSCI), undertook a second unannounced key inspection visit for 2008-2009. This meant that the home had not been given prior notice of the inspection visit. A CSCI Pharmacist Inspector was present at this inspection. We monitored the compliance with all Key National Minimum Standards at this visit. The range of inspection methods to obtain evidence and make judgements included: discussions with the acting manager, assistant area manager and staff on duty during the visit. We also had discussions with people living at the home, and made observations of people without verbal communications. Other information was gathered before this inspection visit including notification of incidents, accidents and events submitted to the CSCI. The registered persons submitted the homes Annual Quality Assurance Assessment (AQAA) as requested prior to the key inspection in August 2008. We toured the premises, including the grounds, communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and peoples bedrooms, with their permission, where possible. For information about fees that the home charges people are advised to contact the Registered Manager. Additional costs include hairdressing and private chiropody, which can be provided within the home for an additional fee. The quality rating for this service is One Star. This means the people who use this service experience adequate quality outcomes. What the service does well: The home was clean, warm and homely with kind and caring staff. The people living at this home were able to choose when to be alone in their own bedrooms or when to join others in the communal areas. The staff showed respect for peoples privacy and allowed them to choose whether or not they wished to take part in any activities. Some people attended local day centres and college placements to develop their skills and knowledge. There were good relationships with other professionals, such as community nurses and workers from the Intensive Support Team. One person who had developed diabetes was being well supported to manage this condition. People with verbal communication skills told us they liked the food and those without those skills indicated their appreciation, demonstrated with cleared plates. One person told us, “The food here is good.” We saw staff made efforts The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 6 to ensure that food was freshly prepared and it looked appetising. There were dishes of fresh fruit available for people to help themselves as they wished. The complaints procedure was available in an alternative picture and symbol formats, informing people of their rights to raise concerns or how to complain. Each persons bedroom was attractively decorated and furnished to suit each person’s age and individual tastes and were homely with lots of personal belongings. What has improved since the last inspection? The organisation had recruited a new acting manager in August 2008, and allocated an assistant area manager who had made considerable improvements in a short time. There was now clear and accurate information in appropriate formats to prospective residents and representatives so that they can make realistic choices about where they wish to live. The acting manager had made improvements to written information to plan each persons support and care. This provided staff with comprehensive instructions how each person’s needs and preferences should be met. The home’s routines were now flexible and arranged around peoples choices and preferences, rather than around the number of staff available. There was improved quality of records of care and medication to offer confidence that the support and care needed was actually provided. The required improvements have generally been put place to assess and minimise risks, to support people to take risks which developed their quality of life and make sure that they are kept as safe as possible. There were improvements to the systems to manage the medication of people living at the home, giving better assurances that each person received their medication as prescribed by their doctor. There were some additional improvements required as a result of this inspection visit. There were also improvements in the provision of activities and access to the local community, though further improvements were needed for the stimulation for people to give them an enhanced quality of life. There were considerable improvements to the décor, furnishings and furniture throughout the home, creating a pleasant, home place for people living there. It was positive that people had been involved in making choices, especially for their own rooms. The acting manager had implemented a robust recruitment and selection process for new staff. This meant that people living in the home were better protected from risks of harm. The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 7 There was improved staff training in areas such as food handling, first aid, infection control, fire safety and moving and handling. A key worker system had been put in place and the acting manager had started a system to make sure all staff had regular formal supervision meetings to assist their development, review their practice and make sure they had the skills to give people the care and assistance they needed. There were a number of areas of health and safety, where improvement had been put in place and records were well organised and easy to audit. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Dell DS0000069594.V374151.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 Dell DS0000069594.V374151.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, 5, Quality in this outcome area is good. The home has an up to date statement of purpose and service user guide, which means that people have access to accurate information to help them make decisions about their choice of home. The home has comprehensive assessment documentation so that holistic assessments can take place. New and existing people living at the home could be assured their individual needs would be measured and met if it were used effectively. People living at the home are provided with contracts of residence, though these are not entirely accurate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw copies of the homes Statement of Purpose and Service User Guide prominently displayed in the hallway. These documents had been revised, updated and produced in an easy read style with symbols and pictures, suitable for people living in the home to understand. The ranges of fees charged for this service were added to the published service user guide during the inspection visit and individual fees were recorded as part of each person’s contract of residence. The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 10 We asked the acting manager about progress to meet the previous recommendations to revise and update the contracts of residence, especially relating to the list of additional services with a list of charges. She told us that the required details of additional charges in each persons contract had not been changed but no extra charges were ever levied. We looked at a sample of contracts, which were unchanged from the previous inspections. The acting manager and assistant area manager agreed to discuss the contracts at a home managers meeting. There had been no new admissions to the home since the last inspection visit, and the home had one vacancy. Good progress had been made to recruit and commence training programmes for new staff. We noted that there was a good rapport between the staff on duty and people at home during this inspection visit. The atmosphere was calm and generally much more relaxed than at the previous visit. There was evidence that referrals to appropriate health care professionals have been made since the last inspection. There was improved support for some residents with complex physical needs, such as diabetes and challenging behavioural needs, such as aggression or self-harming. During discussions staff could generally tell us about each persons preferences such as rising, retiring, and food likes and dislikes. The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are person centred care plans, which are still being developed to ensure that staff have the information needed to understand each person’s assessed and changing needs and personal goals. There are systems to support people and their supporters to participate with planning their care and identifying their wishes and aspirations. There is support for people living at the home with taking risks but this is not always consistently applied, meaning that in some instances people are not fully protected to reach their potential an independent lifestyle. The systems for safeguarding people’s finances are generally robust, which minimises risks of financial abuse. EVIDENCE: We looked at a sample of two peoples care files in depth, containing care plans, risk assessments and held discussions with people able to communicate The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 12 and staff about how each person was supported and given assistance to meet their daily needs. We noted that the person or their relatives and representatives, had signed the plans to indicate their agreement. The care plans we looked at were considerably improved and showed that they were being developed following person centred planning principles. Plans recorded each persons life experiences and showed how all their current needs and aspirations were to be met through the individualised support this home could offer. Examples were My Plan, which reviewed the care plan with allocated key worker and help from the Community Learning Disability Team (CLDT) worker and was in easy read words and pictures. One persons comments were that they liked living at the home and liked going to their day centre 3 days each week. They also liked visits from their family. There were further developments needed as part of this persons care planning, For example their communication passport needed to be completed with Makaton understandable to them. Makaton training also needed to be provided for all staff working at the home to make this meaningful. We also noted that a person had been prescribed pain relief to be administered only for stomach cramps, however the records documented that the medication was being administered three times a day on a regular basis. The Pharmacist highlighted this medicine as not being prescribed and administered appropriately. We noted that care plans generally did not contain specific and detailed information about peoples medication regimes. This issue is also referred to at the Personal and Healthcare section of this report. It was positive that work had been done to expand behaviour care plans with fuller information to guide staff to understand behaviour triggers for individual residents and how to manage behaviour that challenges, such as agitation, wandering etc. A previous recommendation had been made to review, update and expand written risk assessments to ensure that any unnecessary risks to the health and safety of residents were identified and so far as possible eliminated. We noted that some progress had been made however the risk assessment for someone who had previously had repeated falls had not been updated, though the number of falls had decreased to one since the last inspection in August 2008. There was a risk assessment for someone recently diagnosed with diabetes but this needed to be expanded to include risks of hypoglycaemia and control measures needed. There were also references to inappropriate behaviour towards children and women on one persons care file but no-one in the current organisation had detailed information about the accuracy of this information. We strongly recommended that the information be clarified and if accurate risk assessed and if found to be inaccurate removed from the persons records. The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 13 We saw that care planning also included a financial risk assessment and financial plan, identifying who would take responsibility for each person’s finances, if they were not able to manage their own money. The information did not contain details of any assessment of individual people’s capacity as defined by The Mental Capacity Act 2005. We noted improvements to the finance systems for managing peoples finances held in temporary safekeeping at the home. The acting manager had introduced an improved system for recording full details of all transactions made on behalf of people living at the home. We looked at a sample of financial transaction records and balances, which were satisfactory. It was positive that one person had their own bank account and they were assisted to access and manage their own money. Another person had a family solicitor who provided support and assistance with financial affairs. The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are increased opportunities for some people to lead meaningful lives with a wider range and more frequent stimulating community based outings and activities. People are supported to maintain important links with their families, wherever possible. People are offered nutritious choices for meals. EVIDENCE: At the previous key inspection on 5 August 2008, we looked for evidence claimed in the home’s AQAA in people’s activity planners and folders but found that activities had seriously declined. In addition some of the information in the AQAA about what the home claimed to do was inaccurate and misleading. At that inspection the staffing levels were not adequate to meet individual peoples needs for activities and socialisation. Individual activities had ceased and there were very few group activities or outings, resulting in an escalation of behaviours, which created tense atmospheres and abusive incidents between people living at the home. The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 15 It was positive to observe a transformation at this second key inspection. The atmosphere throughout this inspection was calmer and more relaxed. The level of incidents and reported accidental injuries had reduced considerably and there were none reported at this time. There was a new acting manager, supported by an assistant area manager and improved staffing levels. We were told that some people continued to attend community based day opportunities for younger people organised by the funding Local Authority, whilst those who chose to remain at home were encouraged to participate in their chosen leisure time pursuits. The acting manager told us that where it was appropriate people were involved in the domestic routines of the home. We were given examples that some people could take responsibility for their own room or help with tasks in the dining room and kitchen. We noted that one of the people at home during the visit particularly enjoyed helping around the home. One person who had previously accessed the community unaccompanied was now very reluctant to do so. It was positive that a referral had been made to the PCT Intensive Support Team and the allocated worker was offering support to this person. It was also positive that one persons care records clearly identified compulsive behaviour regarding the laundering their clothing and staff had good strategies to manage this. From the sample of records we saw that each persons preferences for activities were recorded and there was an activities planner for group events and individual planners for each person. We recommended that that the activities matrix be produced in pictorial formats for individual people, as appropriate. We noted that regular activities took place with opportunities for people to participate in including arts and craft, exercise, music and films. The acting manager and members of staff told us they organised and activities and outings so that people had access and opportunities to integrate into the local community. Examples of trips were visits to garden centres, shopping centres, and cinema. Generally the homes vehicle was used as transport for the people living in the home. People were now involving in food shopping and shopping for their personal toiletries, clothing and gifts. Everyone living at the home had enjoyed a holiday in the late summer last year and another holiday in Devon had been planned for this year. We were told the organisation paid for an annual holiday for each person, in addition to funding staff to accompany them. We were told that the majority of people at the home had the opportunity to develop and maintain important personal and family relationships. Some people had family visitors at the home. We noted that often decisions were being made on behalf of the person by their relatives. The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 16 The acting manager told us that action was being taken to look at peoples capacity in relation to The Mental Capacity Act 2005, and they were being assisted by the acting CLDT manager who would also facilitate the involvement of appropriate advocacy for decision making for any person lacking capacity. We also discussed the implications of recent legislation relating to Deprivation of Liberty (DOLs) and the acting manager gave us information about the training she was attempting to access via the Local Authority, which she was told would be available after 1 April 2009. People were complimentary about the food offered at the home and they especially liked going out for meals. Fresh fruit, hot and cold drinks were readily available in the open kitchen area. The acting manager and members of staff spoken to were aware of each persons needs and the importance of assisting at each persons pace, where assistance was required. The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health needs of people living at the home are generally met with evidence of multi disciplinary working taking place on a regular basis. The systems for the administration of medication are clear and comprehensive though arrangements do not entirely ensure each persons medication needs are met. EVIDENCE: During the inspection visit we saw that the members of staff and acting manager, who also sometimes acts as part of the care team, demonstrating awareness and understanding of principles of support for personal care and were generally responsive to the varied and individual requirements of the people living at the home. We saw evidence that unless people needed to get up to go out they could get up at a time of their choosing. One person stayed in their bedroom until after 10:00am and then was prompted and supported to make their breakfast and cup of coffee. Staff interviewed told us that they knew that personal care was very individual and needed to be flexible. We were given examples of how each person was given privacy and dignity when providing personal care, with only as much support and attention as needed without intruding on their enjoyment of The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 18 bathing. We noted that people were well groomed and complimented on their choice of clothing. We saw various staff, at various times, gently persuading one person who was able to undertake their own person hygiene, but was sometimes reluctant, to shave and attend to their hair. This person made themselves presentable at around teatime and staff praised their appearance. We saw very good evidence that people had good access to health care services that meet their assessed needs both within the home and in the local community. People had their own GP, and attended local dentists, opticians and other community services. There were positive comments in care reviews from health care professionals about the management of the health care needs of people living at the home. The home had introduced appropriate ways to educate residents and help them to understand the need to regularly check themselves for any abnormal or unusual changes in their bodies. We noted that people were offered access to health care screening processes, with agreements, outcomes or refusals recorded in each persons case file. There was continuing work with community nursing colleagues to implement Priority Screening for Health, health passports, for each resident covering all aspects of well being. We noted that advice from community nurse specialists and community dieticians had been sought for each person assessed to be nutritionally at risk. There were records of support and advice offered and there were food intake charts for each person. We noted that a person recently diagnosed with diabetes was supported to access specialist diabetic services in the community, which was positive. There were two people with weight loss; both people were being carefully monitored. We also saw evidence that all staff had received training relating to diabetes and staff spoken to were very knowledgeable, especially about healthy eating for people with this condition. We recommended that the acting manager should access advice and support from the Community Dieticians based at Amblecote, who would also assess the homes menus for nutritional content and offer staff awareness training. It was also recommended that a record be maintained of staff training in relation to nutrition. The pharmacist inspection lasted two and a half hours. Two residents medication was looked at together with the medicine charts and care plans. One care assistant was spoken with during the inspection. All feedback was given to the Acting Manager. The medicine management was good and it was clear that staff had worked hard to improve the safe handling of medicines. We saw medication stored safely and securely in a locked medicine trolley. We saw medication stored neatly and tidily, which ensured that residents’ medication could be easily located. However, there were some medicines stored incorrectly in the trolley. For example, an external preparation for use in the bath was stored next to a bottle of tablets, which means that there was The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 19 an increased risk of contamination. We saw records to ensure that medication was stored at the correct temperature. The temperature for medicine storage was recorded between 21-24°C, which is within the safe storage temperature for medication. Medication requiring refrigeration was not available, however a care assistant informed us that a locked container for use in the domestic kitchen refrigerator would be used. The medicine records seen were well documented either with a signature for administration or with a code to explain why the medication was not administered. We checked the medication records of one resident against the available medication. All of the medication checked was accurate. The amount of tablets removed from the blister pack matched the amount of signatures for administration on the medicine chart. This means that the records show that medication had been given as prescribed by a medical practitioner. The receipt and disposal of medication from the pharmacy was documented which meant that the service ensured that levels of medication were kept at a safe level. Hand written medicine charts recorded all the relevant information for trained staff to follow enabling staff to administer the correct medication. We looked at two residents’ care plan records and focussed particularly on their medication and healthcare details. One resident was prescribed a medicine on a when required basis for behaviour control. We saw a protocol available with the medicine records, which detailed a plan for staff to follow before administering the medicine. This ensured that staff knew exactly when the medicine should be administered and for what reason, therefore ensuring the health and well being of the resident. The medicine records documented that the medicine had been administered to the resident on 5 separate occasions over three-weeks. We checked the ‘Behaviour care plan’, which documented that the resident had been ‘agitated’ on the 5 dates, however the reason for administration of the medicine was only documented for three of these dates. Overall, these records show that the service is ensuring relevant information is available to staff and that when a resident becomes agitated medication is administered following a protocol, however the documentation did not always detail the reason why the medication was given. The second resident was prescribed a painkiller to be administered only for stomach cramps, however the records documented that the medication was being administered three times a day on a regular basis. A Boots pharmacist had undertaken a check on medication on 2/12/08 and had also noted that the medication was not being correctly administered. We spoke with a care assistant who informed us that an injection was now being administered. This information had not been documented or recorded in the residents care plan. The Acting manager recorded this information during the inspection visit. Concern was expressed that a painkiller was being administered on a regular basis with no information regarding the pain recorded or whether the medication was required any longer. This means that the health and welfare of the resident was not being met. The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 20 From the sample of care records we noted that each person had a record of their, or their familys final wishes and arrangements. The record for a person able to make their own decisions stated they wished to be buried with their mother at a local cemetery and would like a church service and flowers. The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home uses the organisation’s complaints procedure, produced in pictorial formats and generally people can have confidence their concerns or complaints will be listened to, investigated and receive an appropriate response. There were some procedures in place to provide safeguards and though training has been provided for staff they do not have up to date procedures for reference, which means that people are not entirely protected from risks of abuse or harm. EVIDENCE: The home had a copy of the organisation’s complaints procedure and there was a pictorial format of complaints procedure for the people who could not understand written information, which was positive. We were told that there had been no complaints made directly to the home or to other agencies. The people able to communicate with us at the home confirmed that they could tell the manager about any concerns and she would help them. The organisation had been issued with a requirement at a previous key inspection, for arrangements to be made to ensure that all staff have a clear understanding of adult protection and whistle blowing procedures and fully adhere to these. This was to ensure that people living at the home were not at risk of harm or abuse. At the random inspection in April 2008 the previous acting manager told us she was keen to promote and support staff training, The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 22 including safeguarding training. However at that time due to staff shortages, recruitment of new staff, and heavy dependence on agency staff who may not have received appropriate training to safeguard vulnerable adults, there was insufficient evidence and no confidence that all staff had received appropriate training and had sufficient understanding and awareness to adhere to policies and procedures. Following the evidence of serious concerns, accidents and incidents at the key inspection on 5 August 2008, the CSCI took further enforcement action. This was to ensure the organisation took prompt action to train staff and make referrals to the lead agency and notify the CSCI of any event adversely affecting people living at the home, which constituted allegations or suspicions of abuse. The acting manager and staff interviewed were aware of the multi agency procedures and reporting processes safeguard vulnerable people at the home. However the up to date Safeguard & Protect safeguarding procedure was no longer available at the home. The only version, which could be located was dated July 2004. The acting manager and assistant manager felt that the up to date version may have been taken away from the home. We recommended that an up to date version be obtained and all staff be given time to read and sign to demonstrate their awareness. The acting manager contacted Dudley DACHS Safeguarding manager to request up to date information, including leaflets, during the inspection visit. The manager and staff had undertaken training relating to the protection of vulnerable adults provided by an external training provider. We gave the acting manager the contact details of the Local Authority training, the lead agency for safeguarding matters, which would provide staff with additional knowledge of the multi-agency procedures. There were no concerns raised during discussions with people living at the home or with staff throughout the inspection visit. We also looked at accident records, ABC incident charts, monitored by staff from the Primary Care Intensive support Team, and daily records, which did not contain any information of concern. We felt the organisation had demonstrated compliance with previous requirements and enforcement action. The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good standard of the decor within this home with evidence of improvement through continuous maintenance. People living at this home are provided with a pleasant and comfortable environment. EVIDENCE: The Dell was a large traditional detached property adapted to provide accommodation for up to 7 adults with learning disabilities. It provided a bright and cheerful interior and the exterior of the premises was enhanced with containers of winter plants. The tour of the building identified that a considerable number of improvements have been made and the program of redecoration and refurbishment was continuing, with the majority of requirements for repairs and redecoration issued at the last inspection completed. Examples were all wardrobes were secured to the walls, all windows on the first floor were fitted with effective window restrictors and the compromised double glazed window unit in a residents bedroom had been replaced. New laminate flooring had been installed throughout the home and we saw evidence that people had been involved in making choices for their own bedrooms. The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 24 We were shown the bedrooms with each persons permission. One person wished to show us his bedroom, which was well decorated and furnished containing prized personal possessions, including a kettle and facilities to make drinks. Each person had a their bedroom, which they had personalised according to their individual taste. The communal areas, including the conservatory had been redecorated and new furniture had been provided, which was attractive and comfortable and suited to the needs of people living at the home. For example the dining room had new tables and chairs with sliders to assistant with movement without being damaged or becoming unstable. There were also large pictures of people enjoying themselves on trips to the safari park and Twycross Zoo. There were also framed photos of the people who live at the home. The conservatory had also been redecorated and a small dining area had been created, in addition to a small quiet seating area. There were magnificent views from this room. There were minor matters such as two light bulbs, which needed to be replaced. During discussion with people who could communication verbally they told us they liked the improvements and liked living at the home. The homes main kitchen was maintained in good order, and it was clean and tidy and well organised. We noted that appropriate food hygiene and safety measures in place, with well-kept records, monitored by the acting manager, the organisation and Environmental Services. During discussions staff were aware of food safety and used colour coded chopping boards for food preparation. We also noted there was a good, varied range of food and a mixed assortment of fresh fruit available. The laundry, on the first floor was small but was clean and tidy. There was a locked cupboard for substances hazardous to health. There was a supply of disposable gloves and aprons, dissolvo sacks for washing soiled or infected laundry and laundry bags for transporting dirty laundry through the premises. We noted that the home was very clean, warm, homely and comfortable. There were good infection controls in place. The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing levels have started to be more stable and people receive more consistent standards of care and there is higher staff morale. The staff recruitment processes are robust, which means that there are effective safeguards for people living at the home. The organisation and acting manager demonstrate a strong commitment to staff training and development. EVIDENCE: This home has had a very prolonged period of instability in the staff team. At this inspection visit we noted that there were 6 people accommodated, with a variety of dependency levels and diverse needs. The acting manager told us that she and the assistant area manager were reviewing staffing levels on a regular basis, taking account of the occupancy and dependency levels of the people accommodated, which demonstrated good practice. The assessment of staffing rotas and information from the inspection visit and staff personnel records demonstrated that the home was generally maintaining satisfactory staffing levels to met each persons needs. The home had a staff team of 15 people including 12 support workers and senior staff, who also undertake domestic, laundry and catering duties, the The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 26 acting manager and driver / maintenance. We were told that there was always 3 staff on duty during the wakeful day when people are at home, two people on duty at night and the acting manager had additional dedicated managerial hours. We looked at a random sample of staff personnel files, which were generally satisfactory. It was positive that the recommendation issued at previous inspections had been actioned and we noted that the acting manager was now involved in recruitment of all new staff and that processes have also been put in place to include the involvement of people living at the home. One person has helped to interview the new staff recruited since the last inspection. The acting manager demonstrated robust recruitment practices, with very well ordered staff files and documentation. We noted that a training needs assessment had been undertaken with a training plan and an up to date training programme implemented. Staff spoken to confirmed that there was good access to training. We noted that there were training dates in January, February and March 2009 for Diabetes awareness, epilepsy awareness, challenging behaviour, infection control, food hygiene, health and safety, safe movie and handling, dealing with complaints and allegations, protection of vulnerable adults, equality and diversity. The Dell DS0000069594.V374151.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, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The acting manager is effective in providing leadership and clear communication systems throughout the home. There is progress to regularly review aspects of the homes performance through a programme of self review and consultations, which include seeking the views of people living at the home, relatives, and other professionals. EVIDENCE: The home had not had a registered manager for a considerable period of time, with a resulting failure to maintain adequate standards for people living there. The previous registered manager for The Dell retired in June 2007, an acting manager was appointed in September 2007 and dismissed in August 2008. The new acting manager, Maxine Speadeanbury, appointed on 27 August 2008, was in day-to-day control of the home. She told us she would be The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 28 undertaking the Registered Managers Award (RMA). Theresa Owen, assistant area manager, who had experience as a registered manager, had supported her. As highlighted earlier in this report she had made significant improvements to this previously failing home, in a relatively short period of time. We stressed that an application for the acting managers registration must be submitted to the Commission as a priority. This is to give assurances to people living at the home they can expect to receive consistently good standards to maintain and promote their health and well being. It was positive that the organisation had recognised and actioned the need for dedicated managerial hours. We noted that the acting manager, supported by the assistant area manager, had been allocated managerial hours to plan, set goals, monitor, review and improve the quality of the service provided for people living at The Dell. We discussed the positive evidence of improvements and agreed with the acting manager and assistant area manager that we would share the findings of this key inspection visit with the commissioning manager of the local authority funding placements at the home. The acting manager told us the Responsible Individual visited the home periodically and the nominated person also undertook regular quality monitoring visits to the home and provided copies of Regulation 26 visit reports. The Responsible Individual also visited the home during this inspection to discuss the findings of this visit. We noted that the assistant area manager and acting manager were in the process of devising the homes annual development plan for the current year. The acting manager told us that she was starting the homes quality assurance system afresh. We saw very good evidence that she had started to use comprehensive self auditing systems. These included monthly audits of areas such as peoples care files, staff personnel files, staffing levels and accidents, incidents and falls, with remedial actions to minimise risks identified. The acting manager and staff team have made good efforts to develop more involvement of people living at the home, their relatives, representatives and other community stakeholders in the running of the home. An example was consultations about the redecoration, refurbishment and new floor coverings. We also noted that some staff meetings were taking place. The manager acknowledged that though staff supervision sessions and appraisals had commenced, this was an area where the home could improve. We looked at a sample of fire safety and maintenance documentation, which was satisfactory and much better organised than seen at previous inspections. There was evidence that all staff were in the process of undertaking mandatory The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 29 training commensurate with their roles, such as fire training, drills, and as identified at the Staffing section of this report. We had audited accident records at each of the random and key inspections undertaken over the last 12 months. There had been 1 recorded accident, involving people living at the home since 5 August 2008. The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 30 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 X 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 3 LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 3 2 X 2 X 2 3 X The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 31 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 YA7 Regulation 15(2) Requirement The registered persons must continue with the development of person centred care plans to ensure there is information and guidance for staff to met all identified needs and aspirations. Examples are communication methods, continence needs, pain management, and all aspects of diabetes. This is to maintain and promote peoples health and well being. 2. YA9 13(4) The registered persons must continue with the implementation and review of all aspects of risk for each person, with documented, up to date risk assessments and risk management strategies in place. This is to ensure that the health and welfare of people living in the service are safeguarded. 3. YA20 13(2) Ensure that service user’s individual health and care needs are set out in their care plan. DS0000069594.V374151.R01.S.doc Timescale for action 01/05/09 01/05/09 01/05/09 The Dell Version 5.2 Page 32 This is to maintain peoples health and well being. 4. YA20 13(2) Ensure that individual care plans set out in detail the action that needs to be taken by care staff to ensure that all identified health and care needs are met. This is to maintain peoples health and well being. 5. YA20 13(2) Ensure that a documented review of the care plan takes place when individual needs change so that staff have up to date information for maintaining service user’s health and well being at all times. This is to maintain peoples health and well being. 6. YA20 13(2) Ensure that service users receive their prescribed medication in accordance with the GP’s instructions. This is to maintain peoples health and well being. 7. YA20 13(2) Medication storage must ensure that medication to be used externally is not stored next to medication for internal use to protect the residents from harm. This is to maintain peoples health and well being. 8. YA37 9(1) The registered person must ensure that the acting manager submits an application to the CSCI for registration as a ‘fit DS0000069594.V374151.R01.S.doc 01/05/09 01/05/09 01/05/09 01/05/09 01/05/09 The Dell Version 5.2 Page 33 person to manage a Care Home without any further delay This is to assure people that they can expect consistently good standards of support and care. 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 YA5 Good Practice Recommendations It is recommended that each persons contract of residence be revised and updated with details of any additional charges for services are made more explicit or omitted. It is strongly recommended that the information about references to inappropriate behaviour towards children and women be clarified, and if accurate risk assessed, and if found to be inaccurate, removed from the persons records. It is recommended keeping the care plans simple and person centred, writing them in the first person wherever possible and using easy words and pictures. To ensure that staff more consistently and accurately complete activity records. Not assessed at Random Inspection 02/04/08 Not Met at this Key Inspection 5. YA16 To review ‘consent’ forms for residents’ rights, which have been signed on behalf of residents by their families. If residents are unable to give consent, then staff should consider making decisions based on their best interests as in compliance with the Mental Capacity Act 2005. Not Met at this Key Inspection 6. The Dell 2. YA9 3. YA6 4. YA12 YA17 We recommended that the acting manager should access DS0000069594.V374151.R01.S.doc Version 5.2 Page 34 advice and support from the Community Dieticians based at Amblecote, who would also assess the homes menus for nutritional content and offer staff awareness training. It was also recommended that a record be maintained of staff training in relation to nutrition. 7. YA23 It was strongly recommended that the up to date version of Dudley DACHS Safeguard & Protect be obtained and staff should be given time to read the safeguarding policies and staff signatures should be obtained when they have read these documents. To consider providing staff with specialist training in the Mental Capacity Act 2005 and person centred planning. Not Met at this Key Inspection 9. YA39 It is strongly recommended that the quality assurance system be fully implemented to demonstrate that the home is providing good quality lifestyle outcomes for each person. That the registered persons review the documented accident analysis to more clearly identify continued risks, trends and record remedial / control measures, which must also be reflected in each person’s care planning and risk management 8. YA32 10. YA42 The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Dell DS0000069594.V374151.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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