CARE HOMES FOR OLDER PEOPLE
Roundabout (The) 96 The Roundabout Northfield Birmingham B31 2TX Lead Inspector
Monica Heaselgrave Unannounced Inspection 12th December 2005 11:25 X10015.doc Version 1.40 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 Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 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 Older People. 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. Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Roundabout (The) Address 96 The Roundabout Northfield Birmingham B31 2TX 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) 0121 475 5509 0121 475 2705 Birmingham City Council (S) Dorothy Ann Adams Care Home 42 Category(ies) of Dementia - over 65 years of age (42), Old age, registration, with number not falling within any other category (42) of places Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. That home is registered to accommodate 42 people over 65 years who are in need of care for reasons of old age or dementia. Registration category will be 42 OP, DE (E) That minimum staffing levels are maintained at 5 care assistants throughout waking day of 14.5 hours enabling there to be minimum of 2 staff per floor with an additional member of staff to provide support and cover between the two floors. That additional to above minimum staffing levels there must be two waking night care staff. All toilets must be partitioned from floor to ceiling by 30th April 2005. That the manager completes the Registered Managers Award or equivalent by April 2005. That one named person who was under sixty-five years of age at the time of application can be accommodated and cared for in the home on a regular respite basis. That if in the future the service users needs change and they need a permanent placement that the home informs the Commission without delay. That the home can provide care and accommodation for service users with `working age` dementia. 7th June 2005 4. 5. 6. 7. 8. 9. Date of last inspection Brief Description of the Service The Roundabout is a purpose built Birmingham City Council home, first opened in 1968. It is situated in the South of the City, in a residential area of Northfield. The home is easily accessed via both local bus and train services, and local shops and amenities are close by. The home originally consisted of three floors, but the lower ground floor is now a day centre run separately from the care home. Facilities briefly include single bedrooms to the ground and first floor, which is accessed via a passenger lift.
Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 5 One double room is currently shared by a married couple who also have a second room, which has been furnished as a lounge for their private use. Bathroom and toilet facilities have been refurbished, to include portioning which provides improved privacy for service users. There is a large dining area, with a bar on the ground floor. Service users have the use of three lounge areas, one of which is a designated smoke zone. The main kitchen, office and storage room are on the ground floor. There are additional lounge and dining areas on the first floor, including a small kitchenette where service users can make drinks and snacks. There is a small patio area to the front and back of the property where service users can sit out and enjoy the well-maintained garden area, which continues to be improved to provide a garden of interest for people living in the home. Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on a Monday, between 11.25 am and 2.30 pm. The inspector met with the manager, and some of her staff team. A number of service users were spoken to individually. Observation of the daily routine was made, to include the preparation for lunch and the administration of the lunchtime medication. A number of records were inspected to include risk assessments, care plans, and staff training records and maintenance and inspection documents. This is the second of two inspection visits made this year. Both reports should be read in conjunction in order to have a fuller picture of the service provided. What the service does well: What has improved since the last inspection?
Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 7 Progress on the maintenance and redecoration of the home has continued. Service users have benefited from some of the bedrooms being decorated one service user was able to comment on how nice this was. Stairwells have also been painted, now presenting a much-improved environment for service users. New tables have been purchased for the dining room, which are more comfortable for service users one lady said how nice these were. A new floor has also been laid in the dining room. One of the lounge areas has been designated as a smoke lounge, service users using this were much happier with this arrangement as the room is a better size and more comfortable. The manager said an extractor fan is on order for this facility. The boiler has been repaired and is in full working order. External maintenance has been carried out, the guttering, fascias and lose tiles around the windows have all been repaired. Since the last inspection, three care staff have been recruited, there is now a full compliment of staff, which will further enhance the good standards of care already evident. A new cook is in post and six domestic staff vacancies have been filled. What they could do better:
This is the second unannounced inspection this year. On both inspections care standards were found to be good. Over the course of six months between the visits, the manager and her team continue to improve upon good care practice. The requirements made at this inspection relate to minor shortfalls in meeting the standard. A record of complaint investigation and outcome must be maintained this will ensure that these can be audited more readily. Whilst there is a quality assurance system in place, the outcome of the results and how these are published for existing and prospective service users, needs to be further developed. The Commission should be informed as to how the outstanding requirement regarding toilet location is to be addressed.
Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 8 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. Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Standards 1, 3 and 4 were inspected and met at the last inspection. The home does not provide intermediate care services, as described in standard 6. Standards 2 and 5 were not inspected at this inspection visit. Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Procedures for the receipt, recording, administration and storage of medication were good. Staff had been trained in this aspect of their work to ensure the well being of service users. EVIDENCE: Standards 7, 8 and 10 were inspected and met at the last inspection visit. During the inspection the lunchtime medication round was observed, and medication records and storage examined. Staff had a good understanding of the residents medication needs. Training records indicated that staff had received accredited training in medicine safety. Medication records were in good order, signed and included a photograph of each service user. Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 12 A record of medication ordered and received was maintained, which enabled staff to monitor that correct medication was received prior to administering it to service users. Medication was seen to be stored securely. Procedures for the storage and administration of controlled medicines were well maintained, with separate storage and double staff signatures. On two occasions the staff member, prior to administering to the service user, handled tablets. This practice contaminates tablets and must be avoided. This was followed up by the manager, following the inspection. The manager has given an undertaking to monitor this area of practice. No requirement is made. The Registered Manager must ensure that staff adhere to the procedures for the safe administration of medication. Service users care files showed that staff monitor the well being of service users on medication, and call the G.P. if concerns are evident. The review of medication was evident. Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14 An impressive level of consultation with the families of service users ensures contact arrangements are respected, encouraged and supported. There is positive consideration of service users who may have limited capacity to exercise choice in their lives, they benefit from the support offered by a caring staff team. EVIDENCE: A number of service users were spoken to and some were able to describe visits from their family members. Staff described the importance of assisting service users and their families to maintain contact, and a list of planned social events was on display to encourage this. It was especially commendable to note the efforts of the manager and her staff team in supporting individuals and their families, in maintaining some element of control over their lives, particularly where individual’s capacity to do this, may have been limited. Great care had been taken to explore the religious and cultural needs of an individual with dementia. The family had been consulted with, which had led to
Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 14 the service user being supported to attend a Polish club on a weekly basis, something, which he enjoyed previously. The service user had also been supported to attend the Memorial service, and attends church with staff support. It was a pleasure to observe the manager and the family exploring on the service users behalf, the type of choices he would wish to make, and the events and activities that had been important to him. It was evident that staff try very hard to ‘mirror’ previous lifestyle choices where they can. Care plans showed that cultural and religious needs are known and planned for. Staff showed the inspector a supply of Polish food enjoyed by a service user, this consisted of Salami, Rollmops and Sopocka, traditional Polish foods. It was lovely to see that staff respect the importance of individual’s identity and try to support them to maintain this. The inspector was informed that where possible, service users can and do manage their own financial affairs. The capacity to maintain financial affairs was seen to be explored and recorded in the care plan. Currently, one service user is supported to maintain some degree of autonomy in this area. Financial records were examined, and these confirmed one service user maintains some control of his bankcard and withdraws cash, which is then managed, on his behalf by the management team. Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 There are systems in place to respond to complaints, service users felt they would be listened to and acted upon. EVIDENCE: A complaints procedure is available which includes information for service users and their families for referring complaints to the Commission. Each service user has a copy of this procedure. The last complaint recorded was in 2003. Records relating to the details of complaint investigations are maintained on the service users care file. The manager should ensure that a complaint log is introduced which includes details of the investigation and any action taken. Service users spoken to felt that any complaints they had would be listened to. Standard 18 was inspected and met at the last inspection. A recommendation was made to improve upon the detail in recording behaviour. Since the last inspection, the manager has introduced new recording guidelines for staff, to assist them in improving the detail of their entries. This will ensure that staff have an understanding of managing behaviour that may challenge, ensuring improved consistency for service users.
Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users live in safe comfortable surroundings. EVIDENCE: At the last inspection all these standards except standard 22 were inspected. At this inspection these standards were not inspected. Progress on meeting two of the three previous requirements made is evident. A requirement made in relation to repairing the boiler has been met. A new tank is to be fitted in the loft as the water pressure is affected. The manager stated that this is down as a priority. The guttering, fascias and lose tiling around windows have all been repaired. This now provides safe and comfortable surroundings for service users to live. This standard is now met.
Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 17 A previously made requirement to provide toilet and bathing facilities closer to communal areas, was assessed This remains outstanding. Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 30 Service users benefit from Staff who are trained and competent in carrying out their role as carers, this ensures they can meet the needs of people accommodated. EVIDENCE: Staff training records show that 83 of the team are registered to undertake, or have done NVQ level 2/3. There is good awareness of the needs of Service Users, and Staff are competent in the roles they undertake, which ensures that Service Users are in safe hands. A training matrix is available, and training and induction follows the ‘Skills for Care’ targets. This will further ensure that staff have the skills and knowledge to meet the assessed needs of Services Users accommodated. Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 37, 38 There are good examples of how the manager and her team strive to respect and protect the interests of Service users. The health and safety of Service Users and staff is promoted. EVIDENCE: A Quality Assurance Monitoring System is in place. Meetings for families have been arranged; the inspector was told that most prefer to come directly to the manager. Meetings for service users have also taken place to seek their views on the service provided. Families and service users have also been provided with questionnaires in order to obtain their views.
Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 20 The assistant manager informed the inspector that there have not been many returns to the questionnaires, and one possible cause could be that there have been many new families and that this system may need to be re introduced. The inspector was informed that the local authority do utilise the information gathered, in order to improve the service. It was not clear how the results of the surveys or meetings are fed back to service users and their families. The arrangements for managing service users finances were found to be appropriate. Records sampled showed that all transactions are recorded and receipted. Totals of money balanced with those records viewed. The majority of service users are unable to manage their own finances, and the reasons for this are explored and recorded in their care plan. This ensures that the interests of the more vulnerable service user are protected. Statutory records were sampled and found to be up to date, organised, and well maintained. The management of safe working practices is good, there are systems in place for the monitoring and review of all practice areas, this ensures the well being of Service Users and staff. Staff training records showed training in manual handling, fire safety, first aid, infection control, and food hygiene had taken place. Records relating to the maintenance of gas, electric and safety equipment were in place. Hot water temperatures are tested and recorded to ensure service users are not exposed to the risk of scolding. Records relating to accidents and incidents are recorded and appropriately reported to the Commission. Risk assessments were seen in relation to service users at risk of falling, or choking or wandering, these provided safeguards for those more vulnerable to these events, and provided staff with good guidance as to how to minimise risks where possible. Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X X X 2 X X X 3 X STAFFING Standard No Score 27 X 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X 3 3 Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP16 Regulation 17(2) Sch4 11 Requirement A complaints log must be implemented, in which a record of all complaints made, the investigation and outcome is maintained. The Registered Person shall Ensure that toilet facilities are close to service users private Accommodation. This is an outstanding requirement. An action plan should be forwarded to the Commission. The Registered Person must ensure that the results of service users surveys are made known to service users and other interested parties. Timescale for action 12/01/06 2 OP21 12(4)(a) 23(2)(j) 12/03/06 3 OP33 24(3) 12/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 23 Roundabout (The) DS0000033604.V270600.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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