Inspection on 30/10/06 for The Roundabout

This inspection was carried out on 30th October 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Roundabout 12/12/05

The Roundabout 07/06/05

The Roundabout 16/02/05

The Roundabout 09/08/04

The Roundabout 20/01/04

The Roundabout 26/08/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Roundabout (The) 96 The Roundabout Northfield Birmingham B31 2TX Lead Inspector Monica Heaselgrave Unannounced Inspection 30th and 31st October 2006 11:20 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.V311047.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 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.V311047.R01.S.doc Version 5.2 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.V311047.R01.S.doc Version 5.2 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. 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 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 4. 5 6. 7. 8. Date of last inspection 12th December 2005 Brief Description of the Service: The roundabout is a purpose built Birmingham City Council Home. It was opened in 1968. It is situated in South Birmingham in the predominantly residential area of Northfield. The home is easily accessible by bus, and Longbridge railway station is nearby. The Roundabout was originally on three floors, but the lower ground floor is now a day centre run separately from the home. The Roundabout offers accommodation to forty-two people over the age of sixty-five years, who are in need of care for reasons of old age or dementia. One person under the age of sixty-five is accommodated on a regular respite basis. The Roundabout provides care for people who have working age Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 5 dementia. All bedrooms are single with a wash hand basin facility, and emergency call system. Bedrooms are located on the ground and first floor, with access via a passenger lift. One double room is shared by a married couple, which also have access to a second room, which has been furnished as their private lounge area. Bathroom and toilet areas have been refurbished to include partitioning, which provides improved privacy for service users. The home has a passenger lift to access the first floor. There is a large dining area, with bar, on the ground floor. Service users also have the use of three lounge areas. The main kitchen, laundry room, office and medication storage room, are also located on the ground floor. The first floor has additional lounge areas, two smaller dining rooms and a small kitchen. There is a small patio area to the front and back of the home where service users can sit out. The garden is enclosed, and working with the Princes Trust, the staff have provided a garden of interest for the people resident in the home. Copies of the previous reports written for the home are available from the manager upon request. Inside the home, the reception area has notice boards, which display information about forthcoming events and other articles that may be of interest. The current charge for living at the home is £64.65 per week low rate, £136.00 higher rate. Additional charges include chiropody, hairdressing, and newspapers. Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork of this unannounced inspection took place over 11 hours. Two visits were made over two days, enabling the morning, lunchtime and evening routines to be observed. Prior to the inspection the inspector received a pre inspection questionnaire completed by the home, and nine from service users, relatives, and visiting professionals. A number of service users were spoken with individually and the care delivered to service users was observed. Three service users were chosen to be case tracked to explore their needs and see how these are met. The inspector looked at their care file, daily records and spoke to service users staff and managers. Records relating to the recruitment, training, supervision, and work patterns of staff were examined. Medication records and stocks were sampled. A tour of the building was undertaken and bedrooms were sampled to ensure they met with service users needs. Examination of the procedures in place to protect the health and safety of service users was undertaken. What the service does well: What has improved since the last inspection? Continued physical improvements to the home have meant that service users live in a well maintained and comfortable home. The management team have worked hard to make sure that improvements are ‘visible’; this has included redecoration to several areas, new beds and equipment that have had direct benefits for service users. Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 7 Staff development has included a formal review of their practice and skill. This will help to tailor the training opportunities to fit with the needs of the service users. 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. Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 8 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.V311047.R01.S.doc Version 5.2 Page 9 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): 1,3,4,5, &6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is good written information available to help prospective service users make a choice about moving into the home. An established assessment and admission procedure means service users can generally be confident that the home will meet their needs and that they know what to expect from the home. EVIDENCE: The information available to service users has been updated and provides good information about what to expect from the service. The homes Statement Of Purpose and Service User Guide, is currently in a normal print format. The manager said that large print would need to be requested and this is available from the Social Services Department. Staff and service users spoken to confirmed that this information can be read independently or read to the individual to ensure they have clear information about rights and responsibilities. Some service users spoken with, confirmed that this experience has been very positive, and that they are happy with the information provided for them, which has enabled them to make an informed choice. However the majority of service users could not remember or articulate their opinions due to their Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 10 dementia. The inspector received completed questionnaires from service users who commented upon their experience in this area. One said ‘I came from hospital, they came to visit me there I didn’t know anything about the place till then but that was a help’. There is a really useful checklist on service users files which shows that staff go through a structured process at the point of admission, ensuring that the service user is provided with all the information they need. This showed that the information had either been given or read to them, that they had been offered a key to their room and that routines and procedures were explained. Given that the majority of service users have dementia it was good to see that where this was explained to their families, it was recorded. There is a well-established, pre- admission and assessment process. This includes the service user, their family, and any relevant professionals involved with the care of the service user. Visits to the prospective service user in their own home or hospital have been undertaken to support this process. Trial visits have also been a regular feature prior to moving in. Three service users were case tracked to explore how well their needs are known by the service. Two of these service users have significant health care needs and a level of risk relating to dementia, wandering, pressure care and diabetes. The three files examined showed that each had an assessment on file prior to moving to the home. This provided a good account of the individuals needs. It was positive to see that the cultural and religious needs of service users were explored and that their assessment included useful information mainly from their family, about aspects of their care important to them. For example one gentleman has specific food items supplied providing him with authentic foods he is known to favour. It was positive to see that there was significant information relating to risks, for instance, ‘lack of awareness poses significant risk’. ‘Has diabetes’. ‘ Prone to wandering’. ‘Suffers constipation and occasionally diarrhoea’. However this had not been utilised to develop a care plan for daily living. The plan of care lacked significant key points, which could prevent staff from knowing how to support individuals. The assessments are reviewed. This is good practice and ensures that as more information comes to light, this is added to the service users’ care plans. A formal review or assessment takes place six monthly which includes the service user, key worker, family and other professionals who are involved in the care of the individual. One file seen included several updates relating to the care needs of the service user. It was positive to see relative’s contributions are taken on board at the review. Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 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): 7,8,9, &10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A number of significant gaps in care planning could mean that service users health and social care needs are not consistently met, and may prevent service users receiving individualised care. Good practice in respect of medication administration ensures service users receive their medication in a timely and safe manner. Service users are treated with respect and are clearly happy in the company of staff. EVIDENCE: Care plans are developed for all service users these are called Individual Service Statements, (I.S.S.). The three files examined had a plan of care generated from the initial assessment. The care plan did not contain sufficient information in relation to service users needs. Significant aspects of their care needs, as identified in their initial assessment, were not in their care plan. This is needed to ensure that the areas in which a service user requires support, are identified and clear directions as to how those needs are to be managed, are in the care plan so that staff have the information they require in order to deliver the care in a safe an appropriate manner. Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 12 The inspector found several shortfalls in the planning; One service user identified as at risk of wandering, had no risk assessment or details in the care plan to show what steps were taken to minimise the risk and keep the person safe. The daily records were looked at and these showed there had been five occasions in the past month when this person was said to have left the building. This was most concerning as the initial assessment described this person as having a significant risk due to dementia and lack of awareness of their surroundings. At the time of writing this report these were the findings. Since the report went out to the manager, a response to the inspectors’ findings was received. The manager has provided the Commission with supporting information regarding these concerns. The inspector was satisfied that the real issue was one of inaccurate description by staff of what the service user was actually doing. For instance, staff recorded he had ‘left’ the building’. In fact it was found he had not and it was clarified that the level of risk was less than the recordings showed. As a result the outcome for the service user was good, and improved strategies for recording have been put in place. Health care needs such as diabetes, Parkinson’s disease, the management of continence, and the risk of pressure sores were areas of care identified as current needs for the service users case tracked. Their care plan did not contain any detail relating to these areas. This is was particularly disappointing because in discussions with staff and managers it was evident that these needs were known and that in practice, the service user was receiving the care required. However the gaps in planning mean that there is a risk service users’ will be exposed to unnecessary risks to their health or wellbeing. For instance the lack of risk assessment in relation to wandering behaviour could mean that the service user is not offered the support they need in order to stay safe. One service user requires pressure care. This means that the skin is prone to breaking down and so regular turning patterns need to be in place. When staff were asked about this they said they turned the person every time they went to them. This may be an appropriate intervention, but it must be agreed with the appropriate professional such as the district nurse and detailed in the care plan. In this case the outcome for the service user remains good. Five questionnaires were received from visiting professionals such as the G.P. and district nurses, and the comments in these demonstrated that staff works well in following clinical guidance. However staff must ensure that Tissue viability assessments are incorporated into the care plan. Staff must have clear care plans describing how to respond to this need. A service user who requires full care and is confined to bed had no plan for daily living that specified how his needs are met. When staff were asked about this persons’ needs they gave a good verbal account of what they do to assist and comfort him. However this was not recorded in his care plan. More Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 13 concerning was that the plan had recently been reviewed and the comments made were ‘no change.’ There were significant changes to this persons health, nutritional screening was in place but this was not in the care plan, there was a significant weight loss but it was not recorded in the plan what steps were being taken to rectify this. This person was no longer mobile there was no mention of the district nurse input or pressure care. Manual handling needs had increased significantly and a risk assessment was in place for this. The daily records were looked at and showed that this service user had fallen from bed whilst being assisted by staff. This raises concerns as to the quality of the care plan in instructing or guiding staff as to how they should assist someone safely. The files of those service users case tracked showed that there were a variety of health care needs identified. The plan of care lacked significant key points; and did not in all cases set out in detail the action that needed to be taken by care staff to ensure all aspects of the health, personal and social care needs of the service user are met. This could result in needs being overlooked, and poor direction to staff in responding to these needs. Records did show some service users and or their representatives contributed to the review process. This was good and shows that there is a good level of inclusion in this process, but this is not utilised effectively when key aspects are not then incorporated into care plans. The management team need to ensure that there is a system in place to review and monitor these areas of care, so that shortfalls can be picked up quickly and rectified. Service users’ feel they are treated in a respectful manner, and their right to privacy is respected. This was evident at the time of the visit, staff directed service users to their own rooms or toilet areas, and offered discreet support. Service users have access to a phone to make private calls and where they can they manage their own mail and private affairs. Staff were observed to be very caring and patient when interacting with service users who experienced dementia, they offered calm and reassuring guidance and made time to sit and talk to the service user. The medication administration records (MAR) were kept well. There were no gaps in signing for medication. There was a photograph of each service user to assist with identification. The storage of medication was secure making it safe for service users. The home had a copy of medication administration policies and procedures and showed that they were aware of what they contained. Audits are carried out to ensure that all medication is given out correctly and signed for this ensures that any errors made can be picked up quickly and rectified. Staff who administer medication have received appropriate training to do so. Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 14 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): 12,13,14, &15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The activities on offer meet the interests of some service users, but those people who suffer dementia do not have similar opportunities as their peers. There needs to be a structured activities programme and a means of monitoring it. Service users are supported to maintain contact with their families and friends. The dietary needs of service users are well met, they benefit from meals that are well presented, wholesome and varied. EVIDENCE: A programme of planned activities was on display in the foyer. This was varied and included regular bar nights, film nights, and a trip to Walsall lights, Harvest Festival, Fish and Chip supper, birthday parties, and Tea Dances. Service users said that entertainment celebrations and parties are a regular feature. Staff said that maybe the weekly planning of activities could improve. Those service users spoken with enjoyed what was on offer. The care plans and daily records were examined to explore what activities regularly take place, and whether these are in line with the type of activity or interests previously enjoyed by the service user. It was disappointing to see Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 15 that in one instance a service user had ‘enjoyed’ the visiting choir, but this was the only activity recorded in a month of the care notes. The inspector spoke with a key worker to a second service user who had lots of information about the interests of this person. The care plan was looked at and showed that lots of interests were evident to include; films, gardening, hockey, light orchestra, and opera, but there was no plan to show how or when these were offered, and the daily notes made no reference to what activity had taken place. A third service users’ review notes showed that the family had said ‘previously enjoyed competitive darts’. A staff member confirmed that a darts board had been purchased and that staff are looking to set this up as a planned activity within a risk assessment framework. This is positive, and ensures that service users have access to meaningful and stimulating activities to enjoy. However the majority of service users have dementia that can make motivation difficult. The home needs to demonstrate how the individuals social activity needs are met. There was no accurate means of monitoring whether service users were engaging in activities, and this was particularly sad as from other sources it was evident that some positive social activity is made available, but there needs to be a much greater structure to ensure that those people with dementia have similar opportunities to their peers. Staff must ensure that the I.S.S and daily records accurately demonstrate that service users, particularly those with dementia, have and engage in meaningful activity. Some service users described flexible routines in relation to getting up and retiring to bed, personal care, and routines personal to them. Service users appear to be able to rise and go to bed when they wish they did not raise any concerns in this area. Questionaires completed by some service users confirmed that they are supported in making decisions about aspects of their lives, or maintaining some degree of independence, one said, ‘staff put my clothes out for me because I like to dress myself and if they are left ready I can do this.’ Another person said in the questionnaire, ‘She always creams my legs for me which I like.’ Another service user said, ‘He says is there anything else you need before I go? I like that.’ Observation of service users in the presence of staff was positive. Personal hygiene needs were attended to; service users appeared well cared for, appropriately dressed and comfortable. Staff described areas in which service users exercised their own choices and made decisions, this included what they wore, decisions on menus, activities and attending church or other community amenities. The service user meetings confirmed their involvement in these areas. Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 16 Staff support service users in maintaining contact with their family and friends, and questionnaires completed by relatives said that staff had always been inclusive and welcoming towards them. Some service users maintain a degree of control over their lives, to include their religious observance, leisure time, personal relationships, and daily routines. The arrangements in place to support services users in managing their money were explored. It was positive to see that some part-manage, or fully manage this aspect of their life. Procedures for recording and receipting were sampled and found to be well maintained. Where family or staff manage this aspect, records were well maintained and showed the expenditure, receipts and running balance. This ensures that the financial arrangements in place protect the service users’ interests. Since the last visit there has been a new pilot scheme introduced concerning nutritional screening for all service users to identify those who are at risk from low body weight. Staff, have completed monitoring forms to identify those who are at risk in this area and this means that service users are identified quickly and plans made to monitor and improve their nutritional intake. There have been positive outcomes for all service users following this initiative; some have had a significant weight increase, and meals have been improved in variety, with an increase in fresh fruit, and fibre and protein content. The menus were well planned and included good choices for teatime and suppertime. Service users said that meals were a positive feature within the home. Service users were seen to have appropriate support to eat their meals. The meal on the day was nicely presented with service users saying the portions were to their liking. The questionnaires returned to the Commission included favourable comments from service users in relation to the meals provided. It was disappointing to see that those service users who had been identified as at risk in this area, and clearly are benefiting from the intervention, did not have this incorporated into their care plan. This needs to be included to demonstrate that where concerns are identified, staff can show the action being taken to remedy this, ensuring that the needs of the service user are not overlooked. Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 17 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&18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users and their relatives were confident that their concerns would be taken seriously, and they have access to the complaints procedure should they need to make a complaint. There are serious shortfalls in maintaining accurate records, which could place service users at risk of harm. EVIDENCE: The Commission has received no complaints about this service since the last visit. Service users were clear that they would speak to the manager or other staff member if there were a problem. They were happy with the relationship they had with the manager and staff team and were confident that any concerns they had would be listened to and acted upon. There is a complaints procedure and those service users case tracked had a copy of this. Formats suited to people with dementia or poor sight are not available unless requested, however records showed that staff have explained and read the procedures to service users at the point of admission to the home. The complaints records were viewed, these have improved considerably since the last visit and now show that a record of the investigation, action taken and outcome is maintained. However the outcome should be made known to the complainant, preferably in writing so that they have the opportunity to say whether they are satisfied or not with the action taken. Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 18 A compliments book is maintained which enables visitors to comment on the care delivered, the entries were positive. The monthly regulation 26 visits showed that compliments and complaints are audited, this is a good means of quality assurance and another means of the service being able to obtain the views of people in order to make any improvements. A recent adult protection incident highlighted serious shortfalls in how staff recognise and respond to incidents where service users may be at risk. At this visit this area of practice was examined closely and it was concerning to note that there are still some significant shortfalls in how staff follow procedures. The pre inspection questionnaire completed by the manager prior to the inspection visit stated that Adult Protection Procedures and Whistle Blowing procedures were available, but there was no date to show when these were last reviewed, to ensure they are in line with current good practice. These were not examined at this visit. It was positive to note that as a result of the adult protection incident staff training has been implemented in order to equip staff with the knowledge and skills necessary to keeping service users safe. Staff training records showed that staff had received training in manual handling and dementia care, helping staff to recognise potentially abusive situations or risks and how to respond to them in order to safeguard service users. Further training is planned in adult protection procedures, managing challenging behaviour, dementia care, recording techniques and first aid. In order to fully protect service users, staff must fully understand their responsibilities in this area and demonstrate that they are following procedures. It was very worrying to note that there were several examples where this was not happening and this means that service users who are vulnerable are placed at unnecessary risk. The social workers’ care plan for one service user case tracked stated that this person was ‘prone to wandering and has a lack of awareness posing a significant risk ‘. This describes a person who has a significant risk factor, and potentially very vulnerable. The daily records were sampled for a month and there were five entries stating this person had ‘left the building’ at night, there was no other detail about the time the person left, for how long, or what steps staff took to protect the service user. There was no risk assessment on file to show how this risk is managed to minimise the risk of harm to the service user, or what action staff should take in relation to ‘missing persons’ procedure’. There had been no regulation 37 reports to the Commission to inform of this concern. When this was discussed with the manager and assistant manager they were concerned that they were not made aware of this, they said that it was likely to be poor reporting in the way that staff were recording incidents, as apposed Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 19 to the service user actually leaving the building. Information sent to the Commission also stated that the social workers risk assessment related to the person living in their own home unsupervised, and that the risk was not evident whilst in the residential home. However as no risk assessment was available to show the risk had been explored it is not possible to establish that the service user was indeed safe. Staff must record in detail what actually occurs because this will inform any strategies that may need to be put in place to safeguard the person. It is more concerning to note that staff have not improved the detail in daily progress records to ensure accurate accounts are maintained. The lack of a risk assessment further hinders this process, because this should state whether there is or is not a risk, currently it is not possible to establish this because the absence of accurate records. . It was accepted that the issue of risk was related to poor recording of events, as apposed to real risk to the service user. The inspector was satisfied that the information available at the time of the visit, was poor and not reflective of their usual practice. A risk assessment is now in place. A second concern related to a service user who has had a significant deterioration in health. The care plan was viewed and showed this had been recently reviewed the comments added were ‘ No change.’ There was no care plan to show how this persons’ care is being delivered whilst being cared for in bed. A recent fall from bed was noted in the care records, this was cross referenced with the manual handling assessment which did provide detail as to which sling to use for hoisting and the number of staff required to assist, however whilst in the supervision of staff the fall occurred. Clearly there needs to be a detailed care plan which provides sufficient information and direction to staff, as to how to administer care in a manner that keeps the service user safe from harm. Two other service users had no risk assessment in place to show how the risk of falls was being minimised. The lack of specific moving and handling assessments and poor recording means that vulnerable service users are at risk of harm. The management team must ensure that there is a system in place that ensures care practices are monitored and the management of risks posed to service users, is improved. The financial records of three service users were seen. The records showed that a record is maintained of incoming money, and expenditures. Receipts are maintained and a running total kept. No discrepancies were found. The service user had signed to say they had received some of their money. Some service users said they manage their own money and are happy with this arrangement. Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 20 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): 19,20,21,22,23,24 &26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Continued investment has led to improvements in the appearance and facilities of this home creating a comfortable and safe environment for service users. EVIDENCE: The Roundabout is located at the top of the road in a corner position overlooking nice well-kept grounds. It’s an old building built approximately thirty five years ago, and as such does not meet some of the current standards in relation to room sizes, or en-suite facilities. Requirements to improve the environmental standards for the comfort of service users have been made and the manager has ensured many of these improvements have taken place. Significant improvements have been noted at this visit; redecoration has taken place in a number of bedrooms to the service users satisfaction, new beds and bed sets and carpets have been purchased and new commodes provided. The stairway and corridors have been painted making it nice and fresh, a smoke room is provided for smokers and this has been fitted with new carpets and an extractor fan, providing a nice alternative to the previous room. Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 21 The kitchen roof has been replaced and the kitchen refurbished with stainless steel fitments improving food safety, and a new hot trolley provided to ensure meals are provided at appropriate temperatures for service users to enjoy. New light fittings, and an improved nurse call system make it a safer and more homely environment for service users. Old worn chairs have been removed for recovering so that service users have appropriate and nice furnishings around them. The car park has been resurfaced, and external block paving levelled making it safer for service users and their visitors. New fascias and guttering have improved the appearance and safety of the home. Service users have the benefit of new garden furniture. A tour of the building showed it to be a well-maintained comfortable and pleasant environment, which meets with the needs of the service users. Bedrooms were very pleasant and had a lot of personal touches and possessions, it was evident that staff, support service users in this area to ensure they are comfortable and have nice surroundings. Those service users spoken with were very happy with their bedrooms and said they met with their needs. It was a pleasure to walk around the premises; everywhere was clean, fresh, and comfortable. There are domestic staff who are responsible for the general cleaning, and all areas viewed were hygienic. The arrangements in place for infection control were good staff were observed using protective clothing, and lidded waste bins were in toilet areas. A contract for the collection of clinical waste was in place. Systems were in place to deal with soiled linen, lessening the risk of cross infection. The toilet are not located near to service users bedrooms, this is a previously unmet requirement, but provide good accessibility and space for those who require assistance or the use of aids. The décor of these is old and worn these require some redecoration. In contrast the bathing facilities were modern, nicely tiled and provided for the current needs of service users to include assisted bathing facilities, specialist baths and hoist equipment. This means service users can be assisted in a safe and comfortable manner. The office area is very much a ‘hub’ of activity, service users clearly enjoy the open door policy and regularly sit in the office area having a chat or cup of tea. This is also a work area for staff and it would be nice to see that their working environment is a pleasant one. The office would benefit from some redecoration and de-clutter. This is often the first point of contact for visitors and it’s a shame that it looks old and drab, which takes away from the professional status of the home. Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 22 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): 27,28,29&30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There is a stable permanent staff team and this ensures service users receive continuity of care. Service users safety is compromised by the lack of risk management strategies and poor recording. Some gaps in staff training further compromise the safety of service users such as continence care, pressure care and risk assessments. Recruitment records showed that all the checks necessary for the safety of service users were undertaken, ensuring they are not placed at risk. EVIDENCE: Staff rotas were sampled and showed that the required levels are maintained throughout the working day. There has been no staff turnover since the last fieldwork visit to the home, and sickness levels remain low. The staff team are an established one, know the service users well and observations show that service users are happy in the presence of staff. Comments from service users indicated that staff is responsive to their needs, kind and patient. Questionaires completed by some service users also highlighted positive relations between service users and staff, ‘The staff always listen to me, and will do what I ask or what they can for me.’ ‘Sometimes you have to wait till they have finished with others, but I’m very fond of them, I can sit and chat with staff and say all kinds of things, they are good to me.’ ‘The office is always open to see the managers, the staff are lovely they help me a lot and helped me make friends.’ Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 23 Over 79 of the 21 care staff had attained NVQ Level 2 or 3 and this was to be commended. Three senior care staff has NVQ level 3, and three staff hold a current first aid certificate. The staff ratios and training they have undertaken should ensure service users are in safe hands at all times, but this is compromised with the lack of risk management and poor record keeping which could mean service users are exposed to unnecessary risk. It is also of concern that despite staff being provided with Adult Protection training, staff practice during a recent event, was not consistent with this training. The recruitment files of two staff were sampled. These showed that good recruitment procedures are followed. This means that all the checks necessary for the safety of service users are undertaken. The service follows the TOPPS training format, implemented in line with TOPPS requirements. These developments will ensure that staff have, the opportunity to develop their skill in meeting the needs of the people accommodated. There was a training record that indicated that staff had undertaken training in Dementia Awareness, Infection control, Fire Awareness, manual handling and nutritional screening. Adult Protection, recording skills, challenging behaviour, first aid, and refresher on adult protection was planned for the coming months, aspects of this training are specific to the deficits noted in the recent adult protection incident that occurred, and this training should mean that staff are better equipped to meet the specific needs of the service users in their care. Neither the completed training or planned training included continence management, pressure care, or risk assessment and care planning, all of which are relevant to the current service users being cared for, and this will need to be undertaken to ensure the assessed needs of the service users are met in a safe and appropriate manner. Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 24 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): 31,32,33,35,36,and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall this is a well managed home with a nice inclusive atmosphere that enables service users and their families to feel involved and valued. The exception to this is the assessment of risk was not always consistent and this means that problems with the service may not be identified and acted upon quickly enough to prevent potential harm to service users. EVIDENCE: The manager is experienced in the conditions that affect older service users. She holds the NVQ level 4 in management and care and the Registered Managers Award. She has several years of experience in caring for older persons, and managing a staff team. She holds a diploma in managing care services and has undertaken periodic training to update her skills in the management role of running a home for older service users. The manager has ensured that previous requirements made have been addressed in a timely Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 25 manner and she continues to work towards providing a good quality service with a stable and committed staff group. Service users speak positively about their inclusion in events within the home. The inspector received nine completed questionnaires from service users, relatives and visiting professionals. These showed they were satisfied with the care standards this service provides. Relatives felt that their concerns are listened to and that they are made welcome and kept involved. Service users and staff spoke positively of the ethos of the home. There are some platforms in which service users felt they could contribute to the way the home is run, this included service user meetings, and questionnaires to relatives and visitors to obtain their views. A newsletter is also provided. The majority of families come directly to the manager and her team to share their views, as yet there is no formal system for feeding back to service users or representatives the outcome of the audit. Staff meetings are well established and provide a good sense of direction for staff in undertaking their role and responsibilities. Formal supervision has been consistent to provide staff with a platform in which their practice can be appraised as well as providing a sense of direction in their work. Performance and development reviews have been undertaken with all staff and the outcome of these will inform a structured future training plan, which should ensure that good care standards are maintained. Records of service users’ finances held at the home meet the standard. All the records seen balanced with the amount of money held. The home kept individual receipts for all spending of money. Regular financial audits are carried out in order to safeguard service users’ money. There are appropriate arrangements to ensure the health and safety of both service users and staff. Appropriate maintenance and inspection certificates for all appliances were seen. Visits are taking place by the Registered provider on a monthly basis copies of these reports were available at the home. The arrangements for ensuring safe working practices require closer monitoring and improvement. Staff have received appropriate training in these areas but this is compromised by the lack of including the outcome of risk assessments in care plans. Clear direction is needed in the care plans to ensure staff know how to respond to service users who have specific needs such as; manual handling, diabetes, pressure care, and the risk of wandering. This must be incorporated into service users care plan to ensure service users are not at risk of having their needs overlooked. During the visit an immediate requirement report was left with the manager about the things that she needed to take action on, in order to safeguard service users. Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 26 The staff and management team are able to demonstrate a good understanding of service users needs, characters and level of vulnerability, but this knowledge is not utilised effectively when structuring care. Senior staff must ensure that there is a system to regularly review and monitor the standard of care plans, risk assessments and daily recordings. This will ensure that any shortfalls are highlighted quickly and rectified so that service users are not exposed to unnecessary risks. It is particularly sad to see these shortfalls because there are many aspects of care that are good, and some good initiatives have been implemented such as the nutritional screening programme, but this is not reflected in the care plan either, to demonstrate the good work being done for the wellbeing of service users. Specific roles and responsibilities need to be formalised so that areas of practice that have some shortfalls, will be more quickly picked up and acted upon to ensure the wellbeing of service users. Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 27 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 3 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 2 3 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 X 3 3 X 2 Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15. (1) & 15. (2)(b) Requirement Timescale for action 20/12/06 2 OP8 13(4c) & 13(5) 3 OP8 15(2c) 4 OP12 16(2m) & (n) The registered person must ensure that each person has an up to date care plan which sets out in detail, the action to be taken to ensure all aspects of health and social care needs are to be met. This includes the care needs of those who have diabetes, Parkinson’ disease, and incontinence. The care plan must be reviewed and updated at least six monthly or as changes indicate. The registered person must 02/11/06 ensure that risk assessments are carried out for those service users at risk in the following areas; falls, wandering, and Tissue viability. This is an immediate requirement. The outcome of risk assessments 10/12/06 must be incorporated into the care plan to include detail as to the intervention used and the action to be taken to minimise the risk. Service users must be offered a 10/01/07 choice of activities. These must DS0000033604.V311047.R01.S.doc Version 5.2 Roundabout (The) Page 29 5 6 OP18 OP18 13(5)& 13(6) 13(6) 7. OP21 12(4)(a) 23(2)(j) be explored on behalf of those who have dementia to ensure they have planned activity time, and opportunities similar to their peers. This must be recorded in their care plan and kept under review. Suitable moving and handling arrangements must be detailed in the care plan. The registered person must ensure that service users are protected from harm or abuse by training staff in the procedures to be followed such as ‘missing persons’, and ensuring accurate recording of events 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. 10/12/06 01/01/07 01/01/07 8 OP21 23(2)(d) 9 OP30 18(10(a) 10. OP33 24(3) The toilet areas require 01/01/07 redecoration. A proposed plan of action should be submitted to the Commission. The registered person must 01/01/07 ensure that staff undertakes training in relation to continence management, pressure care, risk assessments, care planning and recording. A training programme should be submitted to the Commission. The Registered Person must 20/12/06 ensure that they can demonstrate that the results of service users surveys are made known to service users and other interested parties. Senior staff must ensure that there is a system to regularly DS0000033604.V311047.R01.S.doc 11 OP38 24(1)(a) (b) 20/12/06 Page 30 Roundabout (The) Version 5.2 review and monitor the standard of care plans, risk assessments and daily recordings. This will ensure that any shortfalls are highlighted quickly and rectified so that service users are not exposed to unnecessary risks. 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 OP15 Good Practice Recommendations The outcome of the nutritional screening programme should be incorporated into the care plan to demonstrate the intervention being taken to assist service users in this area of their care. It’s recommended that the outcome of complaint investigations be put in writing to the complainant. This will ensure they have the opportunity to state whether they are satisfied with the action taken. It would be positive to see that the office area is included in any redecoration programme to provide staff with a conducive working environment, and a more appealing and inviting one to service users and visitors. 2 OP16 3 OP19 Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 31 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 © 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 Roundabout (The) DS0000033604.V311047.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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