Inspection on 12/06/07 for The Dell

This inspection was carried out on 12th June 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Dell 10/02/09

The Dell 05/08/08

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 The Dell 30 Monument Avenue Wollescote Stourbridge West Midlands DY9 8XS Lead Inspector Jayne Fisher Unannounced Inspection 12th June 2007 09:00 The Dell DS0000069594.V336097.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.V336097.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.V336097.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 8 Category(ies) of Learning disability (8) registration, with number of places The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Learning Disability (LD 8) The maximum number of service users to be accommodated is 8. 2. Date of last inspection 9 October 2007 Brief Description of the Service: The Dell is a large detached property, which provides accommodation for up to eight 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 service users. It has 1 double and 6 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 shared bedroom. There are toilet facilities sited throughout the Home. The home currently provides care for up to 7 service users, as there is only one occupant in the double bedroom. A statement of purpose and service user guide are available to inform residents of their entitlements. Information regarding the fee level was provided on by the manager in June 2007 which are between £765.02 and £808.38 week. There are additional charges for hairdressing, some toiletries and chiropody. The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place between 09.00 a.m. and 6.30 p.m. and was undertaken by one inspector with the home being given no prior notice. We met all of the seven residents who live at the home and chatted to those who wanted to speak with us. We also spoke with the area manager, registered manager and four members of staff. Questionnaires were received from two relatives. We looked around the home, examined records and observed care practice. We also looked at all of the information that we have received about this home since it was last inspected. What the service does well: Staff keep residents’ needs continually under review so that any changes are quickly identified and support can be altered. We saw that residents can choose when to be alone in their own bedrooms or when to join others in the communal areas. Staff respect residents’ privacy and allow them to choose whether or not they wish to participate in planned activities. One resident is enabled to maintain his independence and regularly goes out into the community on his own. The health care needs of residents are well met and they are enabled to access all routine health care appointments and specialist support. Residents have a varied and well balanced diet. Staff make the effort to ensure that food is freshly prepared and looks appetising. Residents’ bedrooms are decorated and furnished to suit their individual tastes and age. Bedrooms are homely in style with lots of their personal belongings. There is a qualified and enthusiastic staff group who receive support and guidance from a competent manager who is keen to raise standards. There are male and female staff available so that residents can have a choice of who they wish to support them. There are robust recruitment and selection procedures in order to offer protection to residents who are actively encouraged to help choose new staff. There are systems in place to promote residents’ health and safety. No negative comments were made by relatives regarding the support provided by staff to their family members. The manager and staff were very helpful and friendly through out our inspection visit. The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Staff have received training in risk management however this still requires improving, particularly with regard to written risk assessments and enabling all residents to take risks thereby developing their quality of life. Although there are better systems in place to monitor residents’ activities in order to ensure that these meet their preferences, staff need to ensure that these are more consistently completed. There are not always sufficient staff on duty to enable residents to have access into the community to undertake stimulating and individualised activities. There are procedures in place to safeguard residents from abuse, but staff have not always adhered to these and need to demonstrate a better understanding of how to protect residents. A programme of redecoration and refurbishment needs to be undertaken so that residents can live in a more pleasant environment. The Dell DS0000069594.V336097.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 Dell DS0000069594.V336097.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.V336097.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an holistic assessment process so that new and existing residents can be assured their individual needs will be measured and met. EVIDENCE: No new residents have been admitted to the home since we last visited. Existing residents have had their needs reassessed using a comprehensive assessment tool in order to ensure that their needs can continue to be met by staff. Residents’ files also contained a copy of the service user guide and contracts of residency. When we spoke to the manager she confirmed that residents do not pay for their own basic toiletries but do pay for ‘special toiletries’ which are considered to be over and above what is included in their basic contract fee. We recommend that these additional charges are made clear in the service user guide and contracts. The Dell DS0000069594.V336097.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): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally care plans provide staff with a range of guidelines regarding how to meet the needs of residents; there was only one area which needed further attention. Good attempts have been made at enabling residents to participate in identifying their needs and aspirations through person centred planning. Risk assessments need to be reviewed and further developed to ensure that they cover all potential hazards, and in order to demonstrate that residents are enabled to take risks as part of an independent lifestyle. EVIDENCE: We looked at care plans and found these to be well organised, clear and covering a wide range of topics. There was only one exception where further development is required. When we asked a key worker to show us a care plan regarding management of challenging behaviour for one resident, this could not be located. The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 11 Good progress has been made at introducing person centred plans. The manager told us that where possible, families had participated in this process as well as other professionals. There are goals and action plans identified, although it seems that some are not being progressed due to staffing shortages (see further comment in standard 13). Case files contained confirmation that advocacy services have been approached in order to ask for support in helping residents. Person centred plans also contained some brief details regarding how residents communicate. The manager told us that she thought staff would benefit from some training with regard to establishing communication passports for residents and that assistance from speech and language therapists, would be beneficial. It is recommended that this is pursued further. We looked at risk assessments and found that these were deficient in a number of areas. For example, there was no risk assessment in place for wheelchair use which covered all hazards as identified by the Medicines and Healthcare products Regulatory Agency (MHRA). We see that one resident had a risk assessment in place regarding challenging behaviour but that this did not describe all of the types of behaviours exhibited by the resident and therefore posing a risk to other residents and staff. The manager acknowledged this and told us that “it’s the risk assessments that I’ve left till last”. Reviews of risk assessments in order to allow for ‘therapeutic risk taking’ is also necessary. This enables residents to take risks thereby developing the quality of their lives. For example, we saw that one resident tried to enter the kitchen but was stopped by a member of staff and told to sit down and watch the television. Yet the same resident was allowed to enter the kitchen unheeded at other times. We discussed with the manager how some staff may try to be too over protective of residents. We saw that the kitchen was locked during one part of the afternoon. The manager told us that she did not want residents to scald themselves on the kettle if a drink had recently been made. Whilst this is a legitimate reason, it should be given further review and consideration as to whether it is still necessary, (or introducing other control methods for example such as removing the kettle). The Dell DS0000069594.V336097.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): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing shortages are impacting upon some of the opportunities for residents to engage in social and recreational activities. Residents are encouraged to maintain important links with their families. Very good progress has been in enabling residents to make choices with regard to their meals. EVIDENCE: Since we last visited efforts have been made to improve activity monitoring and recording. However although there are new recording systems staff are not always consisting completing these. For example, there were no records completed for one resident’s activities during a Sunday morning. Another resident had no activities recorded for one Thursday afternoon. There was nothing to demonstrate why the planned activities had not taken place. The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 13 Activities which are planned include a range of independent living skills, therapeutic sessions, attendance at day centres and access into the local community. Discussions with residents and staff demonstrated that some of these are taking place. We chatted to one resident who is enabled to access the community independently. He told us that he had been to Dudley town centre in the morning and had his hair cut, brought his own lunch and had gone shopping. He said “I go to church for tea and biscuits and I’ve been to Dudley”. The manager and staff told us that they felt that staffing shortages were impacting upon residents’ activities. We looked at one resident’s weekly activities and found that two outings had been cancelled because of lack of transport and another two planned outings had not taken place because ‘not enough staff’. Another resident’s records were left blank so it was not possible to determine whether the activity had taken place although one outing had been cancelled due to ‘not enough staff’. One resident’s person centred plan identified that she would like to go swimming and have a small pet. We spoke to the resident who confirmed this but said “no I haven’t been swimming but I’d like to”. There was nothing to identify why this had not taken place. We spoke to the manager who said that she had not been able to organise the swimming session as the key worker had gone on maternity leave and that there were insufficient staff available. Both relatives who completed questionnaires said that staff keep them up to date with important issues. One person said “good visiting times”. Daily routines respect residents’ privacy. We overheard staff knocking upon residents’ bedrooms doors before entering and asking them whether they would like a cup of tea. We asked one resident whether staff always knock on her bedroom door and she replied ‘yes’. When we asked the resident whether or not she had a key to her bedroom door she told us that she did not have one but added “yes I would like one”. We discussed this with the manager who told us that she felt that the resident would not be able to hold a key and would become distressed if she found she had locked herself out of her room. One resident is able to open his own mail. Other residents are not able and have had ‘consent’ forms completed by staff or relatives. We spoke to the manager about the new Mental Capacity Act 2005 and how this impacts upon relatives giving consent on behalf of residents. The manager demonstrated limited knowledge regarding the legislation and agreed that training would be beneficial. It is suggested that this training takes place and consent forms are reviewed. We observed two meal times which were relaxed and sociable events. The manager has made very good progress at ensuring that residents are able to The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 14 exercise choice about which meal option they would like to eat. Portions of both meals are cooked, and residents can choose either or both. Assistance if needed was given discreetly and residents had appropriate eating utensils. There is a pictorial menu booklet which is displayed in the dining room at the appropriate page showing residents what their choices are for the day. Residents’ individual food records demonstrated that they are having different options and that meals are balanced and varied. For instance breakfast can be either toast, cereal, eggs, bacon or kippers. Main meals include a range of meat, fish, vegetables, pasta and rice. The evening meal on the day of our visit consisted of cottage pie (freshly made by staff), vegetables or beef burgers and chips. There was a large bowl of fresh fruit available for residents in the kitchen. Residents can go food shopping although we did not see any residents assisting with preparing their meals. We spoke with one resident who told us that she liked to go to her day centre and undertook a cooking activity. When asked if she cooked at home she replied no, but added that she would like to. We discussed this with the manager who told us that she did occasionally cook at the home but often become disinterested. It is recommended that meal preparation and cooking are included as an option on residents’ activity menus. The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally residents receive personal support in a manner which meets their preferences. The health care needs of residents are well met thereby ensuring that any potential complications are quickly identified. Arrangements for management of medication are good which allows residents to receive their medication safely, only slight improvements are needed to enhance current practice. EVIDENCE: There are male and female staff employed so that residents have a choice about who to assist them. The cross gender care policy has been updated by the manager as we requested. We saw a consent form regarding cross gender care in place for one resident but this had not been signed or dated. Person centred plans include residents’ preferences about rising and retiring times. Not all staff were seen to have an understanding of the social model of disability. One staff member was overhead inappropriately addressing residents including on one occasion calling a resident a “good girl”. When we were speaking with the residents the staff member frequently interrupted and answered questions on their behalf thinking that she was being helpful. The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 16 We discussed this with the manager and also how to promote good practice regarding residents’ dignity. For example, a soiled tablecloth was left on the dining room table and chairs had not been wiped down after the lunch meal, which were stained. During the evening meal, tablecloths had been placed on dining tables which had holes in them and should have been removed. Table mats had been placed on tables but these were worn and scratched. We spoke to the manager about night time checks for residents. There is a task list for night staff which includes one check for some residents. However when we looked at residents’ individual daily records they were having in excess of these checks. The manager told us that the checks consisted of staff listening outside the bedroom door rather than entering the bedroom. These instructions may need to be made clearer particularly for any new staff carrying out these duties. We looked at residents’ health care records and found these to be up to date and well organised. They demonstrated that residents have access to a range of specialists and have regular health checks. We saw that residents had regular reviews of medication, annual health checks, eye tests, dental checks, hearing tests and chiropody. Residents are weighed regularly and there are screening checks for potential health complications such as breast and testicular cancer. There are completed health action plans in place. Comment cards completed by two relatives both felt that the home meets the needs of their family member. One person stated “The Dell is always clean and a lot of trouble is taken to ensure my brother has a normal life as possible”. We looked at medication and found that the improvements we had asked for had been made. There were clearer instructions on medication administration record (MAR) sheets and no overstocking of medication. The medication is stored in the kitchen but checks are taken to ensure safe temperatures are maintained. We did suggest that checks are made at varying times such as when staff are cooking the main meal in the evening. We discussed how a drugs trolley may be more appropriate than a filing cabinet and the manager agreed to consider this. The manager told us that some medication is administered with foods to ease ingestion rather than because residents’ refuse to take their tablets. The pharmacist advised that jam or honey are appropriate types of food to administer these tablets. However, the manager has resorted to using dairy products as these suit residents’ preferences. The manager acknowledges that she needs to discuss this with the pharmacist as some dairy products are unsuitable with certain types of medicines. Staff have received training and there is a signed handover sheet for the keys to the drugs cabinet. There were some areas where improvements are The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 17 needed. The date on which medicines are received and checked into the home is not recorded. There is no specimen signature sheet for staff. Some ‘as and when required’ (PRN) medications did not have guidelines for administration. It is recommended that the maximum dosage in 24 hours is identified in current PRN guidelines. It is also suggested that the maximum days treatment is given before medication advice is sought is also included. We found a tube of cream which did not identify the date of opening. There were two opened tubs of Sudocream, they were dispensed in 2002 and 2003 and the manager agreed that they needed to be removed. The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure so that people can feel confident their views will be listened to. Although there are procedures in place to safeguard and protect residents from abuse, these have not always been adhered to by staff which has the potential to place residents at risk. EVIDENCE: There is a new complaints procedure which has been introduced by the new owners. This is more comprehensive and clearer than the previous complaints procedure. The procedure states that a complaints leaflet is available and should be sent to a complainant, however the manager stated that she does not have such a leaflet and this needs to be obtained. There have been no complaints made about this service either to the manager or to the Commission for Social Care Inspection. We chatted to residents who were clear about whom to make their concerns known. One person said “I’d tell Mary” (the manager). Another resident said “I’d tell the nurse” (meaning support staff). Two relatives who completed comment cards stated that they know how to complain and that they always receive an appropriate response to any issues raised. One person stated “I have only had to make one complaint (several years ago). It was dealt with satisfactorily”. The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 19 There are adult protection procedures in place and there is a copy of the Local Authority Safeguard and Protect procedures available in the office. An allegation of vulnerable adult abuse was made in April 2007. This was investigated and not proven although other issues were identified and appropriate action was taken by management. However, the initial incident occurred on 27 March 2007; staff failed to follow the correct procedures which resulted in a delay in reporting this until 2 April 2007. The manager told us that she has reissued staff with the Whistle Blowing policy. We interviewed two staff and identified that although training has been carried out further training is necessary. One person told us “I can’t be positive but I think we did the training with X”. We asked one person to tell us who she would report a potential incident to if the manager was unavailable. She told us she would look in the policy folder, but then could not locate the correct policy when asked, and admitted “I wasn’t told which policy to look at”. She was generally unclear about adult protection procedures. Another member of staff pointed to a contact list displayed in the manager’s office regarding whom to report an incident to. However, she was also a little unclear about some areas of adult protection and could not give an unequivocal answer to what she should do if a resident asked them not to tell anyone that they were being abused. The manager disclosed that a letter had been received on 1 June 2007 making a number of serious allegations. This had not been reported to the Local Authority safeguarding adults manager in line with the multi-agency procedures, and neither had it been reported to the Commission. We spoke with the area manager who agreed to report it immediately so that the appropriate procedures could be implemented by the Local Authority. The majority of staff have received training in managing challenging behaviour although five staff undertook this training in 2003 and it is recommended that refresher training is considered. The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although residents live in a comfortable home suited to their life style and age, the standard of the décor, fixtures and fittings are deteriorating and require a programme of repair, refurbishment and redecoration. The premises are generally clean and hygienic although slight improvement is required. EVIDENCE: Since our visit the driveway has been repaired. We toured the premises and two residents showed us their bedrooms. There are some areas of the home that are looking tired and worn. For example, some furniture in residents’ bedrooms and communal areas was worn, damaged and eclectic in style. The manager told us that some of it had been donated to the home. The carpet in the lounge was stained; the manager told us that she hires equipment on a routine basis to clean carpets. There was a large crack around the walls to which the conservatory is attached with water damage to the wallpaper which is peeling. Plasterwork is missing from an area of ceiling where a previous curtain pelmet has been removed. In the dining room, one of the window frames is rotten and wall paper is torn. The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 21 In the communal toilet on the first floor a wardrobe has been installed as storage. This needs to be secured to the wall. The bath in the communal bathroom has scratched and the enamel is worn; grouting needs cleaning or replacing. Patio chairs have been placed in the bathroom and shower room in order for residents to sit on but more appropriate furniture would offer residents’ suitable dignity. The manager also agreed to remove a risk assessment regarding scalding and hot temperatures (a reminder for staff) from one resident’s ensuite shower. Residents’ bedrooms smelled fresh, and are decorated and furnished to suit their individual tastes and preferences. They contained residents’ personal belongings and were homely. One resident has his own kettle to make drinks. The manager told us that at present residents do not require the assistance of any aids or adaptations. The area manager told us that there are plans to carry out a programme of redecoration in the near future. The laundry is small but was clean and tidy. There is a locked cupboard for substances hazardous to health and appropriate information displayed. There are dissolver bags for washing infected laundry and laundry bags for transporting dirty laundry through the premises. There was a supply of liquid soap and paper towels. Mops were not drying inverted and are not washed on a daily basis at thermal temperatures. The manager states that they are soaked daily in bleach. It is recommended that they are either washed daily, or advice is sought from the infection control nurse. A thermostatic valve control still needs to be fitted to the wash hand basin. The cellar is kept locked for safety reasons. We asked the manager to remove some tins of gloss paint which are stored in this area as this is flammable liquid. There is a fridge in which fruit and vegetables are stored. The fridge door is very rusty and the interior was dirty. We met with the area manager who confirmed that a programme of redecoration and refurbishment was going to be undertaken in the near future. It is recommended that a written programme is forwarded to the Commission. The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported by a qualified and enthusiastic staff group. However staffing shortages are having an impact upon support provided to residents. Recruitment and selection practices offer protection to residents. Induction programmes need improvement in order to meet the specialized needs of residents. EVIDENCE: The manager told us that there are more than 50 of staff who are qualified to NVQ II or above which exceeds the national minimum standards. Staff have received some specialist training but would benefit from more. For example one staff member could not explain the ethos of person centred planning. We have already identified some issues with staff and residents’ access into the community. The manager told us that there are currently 75 vacant hours. Agency staff have covered two shifts during the last eight weeks. Staff told us “we’re definitely short staffed, if we had more staff the residents would get out more”. At the last inspection the home had a budget of 438 staff hours per week. We The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 23 looked at two duty rotas and found that during one week 380 hours were provided and 411 hours for the second week. We looked at recruitment and selection procedures for the latest member of staff to be employed and found that all pre-employment checks had been undertaken. It was pleasing to see that residents are involved in the recruitment process. Agency staff who had been employed recently also had appropriate checks in place although it was noted that one person’s criminal record bureau (CRB) disclosure check was not undertaken within the last twelve months. They had a range of mandatory training but there was no recorded experience or training in learning disabilities. A member of staff was working at the home who is normally employed at another care home. There were no employment checks or records. The new person employed has not undertaken specialist induction or foundation training such as the learning disability awards framework (LDAF). There was an induction record which demonstrated that this had taken place over one day. The manager said that she would have been given an more in depth induction programme to complete but this could not be located. Only three of the thirteen staff employed have undertaken training in equality and diversity. There are regular monthly staff meetings. We checked staff supervision records and found that staff are receiving frequent supervision sessions. There is also an annual appraisal system in place. The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well a home that is run by a competent manager. Progress has been made towards ensuring that peoples’ views are taken into account when developing the service. There are systems in place promote residents’ health and safety only slight improvements are needed. EVIDENCE: Through out our visit Mrs. Griffiths demonstrated that she is a caring and dedicated manager who has the best interests of residents as her priority. She is qualified and undertakes periodic training. The morale at the home is good and staff told us that they feel supported one person said “you can talk to Mary, she’s so understanding and you don’t feel threatened by her”. The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 25 Good progress has been made towards introducing a quality assurance system. The manager undertakes a number of quality audits every month including a food satisfaction survey and medication inspection. Questionnaires have been completed by residents, relatives and stakeholders. An annual development plan now needs to be established. The manager told us that the majority of maintenance and service checks are up to date and these were sampled and found to be in order. There are a couple of items which still need to be addressed. The gas fire needs to have an annual service by a qualified engineer and a larger hot water tank needs to be installed. We checked the accident book and found that this contained a small number of accidents which tallied with information we had been provided with. The fire safety officer visited in February 2007 and was satisfied with the fire safety precautions in place. There is a central training matrix and the manager told us that most of the mandatory training had been undertaken by external trainers and was accredited. These correlated with training certificates we sampled. It is however recommended that staff receive a six monthly update on their fire safety training. The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 26 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 2 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 2 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 x LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 x 3 X 2 X X X X The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 27 No 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 YA23 Regulation 13(6) Requirement Timescale for action 01/08/07 2. YA33 18(1)(a) Arrangements must be made to ensure that all staff have a clear understanding of adult protection and whistle blowing procedures and fully adhere to these. This is to ensure that residents are not at risk of harm or abuse. To ensure that there are 01/08/07 sufficient numbers of staff working on shift to meet all of the needs of residents particularly with regard to undertaking individual as well as group outings into the community. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations It is suggested that details of additional charges with regard to some items of toiletries are made more explicit in the service user guide and residents’ contracts. DS0000069594.V336097.R01.S.doc Version 5.2 Page 28 The Dell 2. 3. 4. YA6 YA7 YA9 5. 6. YA12 YA16 7. YA17 8. YA20 To ensure that care plans are in place for management of challenging behaviour. To consider pursuing referrals to speech and language therapists for assistance in developing communication passports. To review, update and expand written risk assessments to ensure that any unnecessary risks to the health and safety of residents are identified and so far as possible eliminated for example with regard to the use of wheelchairs. To ensure that staff more consistently and accurately complete activity records. 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. It is suggested that meal preparation and cooking are included as an activity on residents’ activity menus to see whether their interest or participation in this task can be encouraged. To seek advice from the pharmacist as to whether dairy products are suitable in which to disguise medication (or whether different forms of medication may be more appropriate). To introduce a staff specimen signature list. To ensure that there are guidelines for all PRN medication and to expand current guidelines to include maximum dosage within 24 hours and maximum amount of days treatment can be given before medical advice is sought. To ensure that all creams are labelled with the date of opening. To ensure that the date of receipt of medication into the home is recorded. To obtain a copy of the ‘complaints leaflet’ referred to in the complaints procedure and which is to be sent to any complainants. To progress with an audit of the premises from which a written programme of refurbishment and redecoration must be produced together with timescales for completion. A copy must be forwarded to the Commission for Social Care Inspection. To ensure that the wardrobe in the communal toilet is secured to the wall. 9. 10. YA22 YA24 The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 29 11. YA30 To remove gloss paint from the cellar. To ensure that the carpet in the communal lounge is cleaned and that a regular programme of cleaning is maintained. To ensure that mops are dried inverted and mop heads are washed daily at thermal temperatures (or to seek advice from the infection control nurse about current practice). To repair or replace rusted fridge and to keep clean at all times. To consider providing staff with specialist training in the Mental Capacity Act 2005 and person centred planning. To consider providing refresher training to staff in managing challenging behaviour. To ensure that agency staff have undertaken a CRB and POVA check within the last twelve months and have received training or experience in providing support to people with a learning disability. To ensure that all employment checks and records are held on the premises for temporary staff as required by the Care Homes Regulations 2001. To ensure that staff receive full and structured induction training suitable for the work they are to perform, and in order to meet the specialist needs of the residents. A written record must be maintained at the care home. To ensure that all staff receive equal opportunities including disability equality training. To provide induction and foundation training for staff by an accredited learning disability awards framework (LDAF) provider. To establish an annual development plan for the home. To install a larger water tank as required in the Legionella risk assessment. To ensure that there is an annual inspection and service of all gas appliances (including the gas fire), which is carried out by a CORGI registered gas engineer. To ensure that staff undertake a six monthly fire safety refresher training. 12. YA32 13. YA34 14. YA35 15. 16. YA39 YA42 The Dell DS0000069594.V336097.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection CSCI – Halesowen LO West Point Mucklow Office Park Mucklow Hill Halesowen B62 8DA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries.Halesowencsci.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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