CARE HOMES FOR OLDER PEOPLE
The Roundabout 96 The Roundabout Northfield Birmingham B31 2TX Lead Inspector
Monica Heaselgrave Unannounced 7 June 2005 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 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. The Roundabout E54 S33604 The Roundabout V231668 070605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Roundabout Address 96 The Roundabout Northfield Birmingham B31 2TX 0121 475 5509 0121 475 2705 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Birmingham City Council (S) Dorothy Ann Adams Care Home 42 Category(ies) of Older People, Dementia (E) registration, with number of places The Roundabout E54 S33604 The Roundabout V231668 070605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. That home is registered to accommodate 42 people over 65 years who are in need of care for reasons of old age or dementia. 2. Registration category will be 42 OP, DE (E) 3. 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. 4. That additional to above minimum staffing levels there must be two waking night care staff. 5. All toilets must be partitioned from floor to ceiling by 30th April 2005. 6. That the manager completes the Registered Managers Award or equivalent by April 2005. 7. 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 espite basis. 8. That if in the future the service users needs change and they need a permanent placement that the home informs the Commission without delay. Date of last inspection 16 February 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 quite nearby. The Roundabout was originally on three floors, but the lower ground floor is now a day centre run seperatly from the home. The bedrooms are located on both the ground and first floors, these are single. One double room is shared by a married couple, who also have access to a second room which has been furnished as their private lounge area. Bathroom and toilet areas have been recently 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 romo, 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 has recently been enclosed. Working with the Princes Trust, the home endevours to create a garden of interest for the people resident in the home.
The Roundabout E54 S33604 The Roundabout V231668 070605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Unannounced Inspection took place between 10am and 2:15pm, and was carried out by two inspectors. A tour of the building was carried out, and an inspection of the kitchen and food stocks undertaken. The inspectors spoke with ten service users, the manager, assistant manager and two care staff. Two staff from commercial services who manage the kitchen were also spoken with. A number of records were examined to indicate care plans, daily recordings, medication sheets, complaints log and staff rotas. The statement of purpose and a copy of the activities list were taken for reference. During the visit a fire alarm test was carried out and a visit by the dentist was underway. What the service does well: What has improved since the last inspection?
Toilets and bathing facilities have been redecorated, which adds to the comfort of service users. Some bedrooms have been redecorated and had new carpets. Service users stated they are happy with their private space. The Statement of
The Roundabout E54 S33604 The Roundabout V231668 070605 Stage 4.doc Version 1.30 Page 6 Purpose now advises new service users that some bedrooms may be too small to accommodate all their furniture. This will better inform people when making a choice as to live in the house or not. A new format has been developed to assist in its recruitment process. This will help to identify any gaps in employment, and lead to further safeguards in protecting vulnerable people. The staff team continue to receive training in relation to their role as carers. This includes Adult Protection training, which further protects service users from any potential harm or abuse. There has been a significant improvement with regard to the provision of meals, times of meals, storage of foodstuffs and dating and labelling of food. Commercial Services, who are responsible for this area of service provision, have acted upon requirements made at previous inspections. It is apparent that the service users are benefiting from these improvements, with improved variety, choice and flexibility around meals and mealtimes. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Roundabout E54 S33604 The Roundabout V231668 070605 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection The Roundabout E54 S33604 The Roundabout V231668 070605 Stage 4.doc Version 1.30 Page 8 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 standard(s) 1,3 4 Each service user has a Statement Of Purpose with improved and accurate information which enables informed choice. EVIDENCE: An updated statement of purpose, now meets with regulations, and better informs service users as to the facilities. Inspection reports were on display in the foyer, easily accessed by service users and families. Detailed assessment at the time of admission, involving service user and their families, is well used utilised in developing care plans. Changes in the assessed needs of service users were acted upon quickly as a result of positive and consistent monitoring. The Roundabout E54 S33604 The Roundabout V231668 070605 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7,8,10 Service users care needs are met by an observant and caring staff team. Service users care needs are set out in individual care plans which identify changing needs and action which should be taken. Service users are treated with respect and dignity. EVIDENCE: Individual service statements were up to date, and represented the choices of service users in relation to how they wished their personal care to be carried out. Given that some service users have severe dementia, it was positive to note good detail was recorded on their behalf, this included contributions from family. Records in the home indicated a good degree of consistency in the way care is delivered to individuals/ Personal traits and preferences were catered for, and staff are responsive to idiosyncrasies of character. Service users verified this, and those who were unable to verbally communicate this, have their preferences addressed. There was a wealth of good examples to include significant health care benefits, where health deterioration had been acted upon quickly, with positive results for the individual. The staff are careful to respect individual idiosyncrasies, this was observed in how they have accommodated known likes and preferences of those who cannot communicate them.
The Roundabout E54 S33604 The Roundabout V231668 070605 Stage 4.doc Version 1.30 Page 10 Staff members have a good personal knowledge of the service users, and utilise this well in their approach to care. It was positive to see that a married couple they have their own double bedroom and private lounge area with their own furniture. The Roundabout E54 S33604 The Roundabout V231668 070605 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12 15 Service users have access to interesting and stimulating recreational activities which are well organised. Service users have a well balanced and varied menu, and exercise choice over the time meals are provided. EVIDENCE: Activities are planned following consultation with service users at regular service user meetings. An activities list was on display in the foyer to advise service users of forthcoming trips. Several service users were spoken with, and all but one commented, “We enjoy the trips out.” Service users informed us that staff always ask them what they would like to do, or where they would like to go. Inspectors viewed the care plans, and found that individual preferences and pursuits are also recorded in these. It was positive to note that staff are mindful of the fact that some service users have dementia, and this is considered when deciding the venue, size of group and duration of the trip, or activity. It was interesting to note that the main difference of opinion in relation to opportunities to go out, came from a respite service user, who’s experience of the home, whilst good, commented upon the lack of opportunities to go out. The manager may well want to ensure that a persons stay in the home is as enjoyable as it can be, and that prospective respite service users are better informed as to what to expect during their stay. It was positive to observe good interaction between staff and service users, with a lovely level of ‘banter’;.
The Roundabout E54 S33604 The Roundabout V231668 070605 Stage 4.doc Version 1.30 Page 12 There have been positive improvements in relation to meals and mealtimes. Service users now have ‘soup’ on the menu, which they enjoy. This came about following a request from one individual, that has offered choice to others as well. Omelettes and boiled eggs for breakfast, are also firm favourites. Service users confirmed that their food preferences are considered when planning menus. Choices are identified the previous day, but staff are mindful that this can change, so alternatives are available. Service user meetings identified that the time of meals did not suit all, and they have now been brought forward. Fresh fruit is freely available in the afternoon tea trolley round, this is to prompt service users in a sensitive manner, and enables staff to monitor who may require additional support. Daily care records showed that staff are observant of weight loss, and monitor and act on this accordingly. The kitchen and storage of food were inspected. This area has greatly improved in terms of rotation of stock, appropriate storage, and labelling of food. The manager and commercial services staff, are committed to finding alternatives to the green plastic mugs currently used, and will discuss this with service users. The Roundabout E54 S33604 The Roundabout V231668 070605 Stage 4.doc Version 1.30 Page 13 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 standard(s) 18 Service users are protected from abuse. This protection will be further enhanced by the development of practice guidelines relating to challenging behaviour. EVIDENCE: One of the service users files indicated that there had been some incidents of challenging behaviour. Entries in the daily recording sheets, indicated that this person was causing “some concern to staff.” Another entry stated the person had been ‘nasty’. These entries were discussed with the manager, with the recommendation that staff describe in detail their observations of an incident. The terminology used must be appropriate. More detailed recordings will better inform the development of both a risk assessment and behavioural guidelines, to assist staff in the management of the behaviour. Staff have an understanding of these of service users needs and how to manage them, but could improve on their recordings and guidance. The manager continues to ensure that staff are trained in relation to adult protection. Training is scheduled for July 05. The home has continued to review its performance in relation to adult protection; the inspectors were pleased to view a ‘Gaps in Employment Form’ which has been implemented in order to identify and explain work history gaps. This is a positive feature since the last inspection. The Roundabout E54 S33604 The Roundabout V231668 070605 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19, 20, 21, 23, 24, 25 26 The Roundabout was clean, comfortable, well maintained and suited the needs of most service users. EVIDENCE: Since the last inspection, the redecoration and maintenance programme has continued. The toilet areas had been redecorated, and some bedrooms had new carpets and décor. Two service users informed us that they liked the improvements to the home, and the idea of “reporting repairs to the council.” There are three outstanding requirements from the last inspection, these were discussed with the manager, there is now a quote to replace the guttering. Inspectors were informed that this work will be done. Repairs to one of the homes boilers remains outstanding. The Inspectors were advised that Birmingham City Council are deciding how best to repair this, as well as improve the ventilation, with the least disruption to service users. The Commission will need to be updated on progress. At the previous inspection, the location of the toilets was required to be improved, as they are not close to service users bedrooms. The manager informed the Inspectors that this requirement remains, as yet, under
The Roundabout E54 S33604 The Roundabout V231668 070605 Stage 4.doc Version 1.30 Page 15 discussion with the Council. The Commission will need to be updated as to progress in this area. The home has a renewal and maintenance program for the year, and has identified works to be done; this included decorating the ground floor dining area. During the tour of the home, inspectors noted a light on the stairwell not working. We were advised that a ‘catch’ is to be replaced, and that there was additional emergency lighting in that vicinity. The home has lovely outdoor areas, in which service users state they like to sit. Work with the Princes Trust has lead to improvements in the grounds, with additional seating areas, fencing and patio, overall a pleasing and much enjoyed feature. During the course of the inspection, service users commented that the enjoyed the fact that there were several lounge and dining areas in which they could choose to sit and socialise, or be by themselves. The home has a designated smoke room. The revised Statement Of Purpose now clearly advises some service users that bedroom sizes do not meet the minimum furnishing standards. For some service users this means they may have less room for personal possessions. Bedrooms viewed by the inspectors were comfortable, clean and personalised, all are lockable. Some service users stated that they were happy with the space in their room. One couple have a double bedroom, and a private lounge which now accommodates their own furniture. This looked nice. The Roundabout E54 S33604 The Roundabout V231668 070605 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 Staffing levels are appropriate to the needs of service users. The homes recruitment procedures have improved and are robust in their protection of service users. EVIDENCE: This standard was met at last inspection. There has been no change to the staff team compliment. Some changes are however imminent due to two retirements. The manager is planning to advertise for an assistant managers position. Staff rotas were examined and showed the required staffing compliment for each shift. Changes to the proposed rota were clearly recorded on those rotas sampled, this allowed easy cross referencing. Several improvements in relation to, the provision of meals, choices, and flexibility around mealtimes, stock rotation, dating and storage of food is noted since the last inspection. Commercial Services, who are responsible for the provision of meals, and the kitchen, continue to have meetings with the home’s manager, to ensure that their service provision meets the requirements of the home. Inspectors were informed that six domestic vacancies have been highlighted, and that these will be recruited to by Commercial Services. This will further enhance the service provision. Comments from service users indicated that care staff are responsive to their needs, kind and patient. Several service users commented upon the improvements in relation to meals. At the previous inspection the manager was required to devise a means of exploring gaps in employment history for newly appointed staff. This would further protect vulnerable people.
The Roundabout E54 S33604 The Roundabout V231668 070605 Stage 4.doc Version 1.30 Page 17 A ‘Gaps in Employment’ form has been devised. This will be implemented as and when new staff are appointed. Other requirements regarding the recruitment policy and procedures were met at the previous inspection. This standard was not assessed further. The provider continues to ensure that all staff receive training in Adult Protection, the next date is set for July 05. There are Adult Protection procedures. The Roundabout E54 S33604 The Roundabout V231668 070605 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32 The home is managed well, with clear lines of accountability. Delegation of tasks is effective, and records indicate that concerns are followed up and acted upon. Service users are confident and secure in their interactions with the management team. EVIDENCE: The manager of the home is experienced, competent, and up to date with her training needs. She is qualified to NVG level 4. The manager has demonstrated her ability to act upon requirements made by CSCI. Throughout the inspection she has been receptive to suggestions and advice, and has agreed to take these to service users for fuller consultation. The manager has a stable management team. Inspectors observed good working relations, and clear lines of accountability and delegation of tasks. Records indicate that written communication is passed to managers and acted upon. This has led to very specific benefits for service users, particularly in relation to health care needs. Service users made positive comments about the staff team, and the approachability of the management team.
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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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 3 2 x 3 3 2 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 4 3 x x x x x x The Roundabout E54 S33604 The Roundabout V231668 070605 Stage 4.doc Version 1.30 Page 20 Yes 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 21 Regulation Requirement Timescale for action 7th June 2005 and ongoing 2. 25 3. 4. 25 27.7 Reg The Registered Person shall 12.(4)(a) ensure where service users 23(2)(j) private accomodation is without ensuite facilities that bathing and toilet facilities are available close to service users private accomodation in all areas of the home. This is a previous requirement, original timescale Dec 04 Reg 23 The Registered Person shall (2)(b) ensure the boiler is repaired. This is a previous requirement, original timescale 25.02.05 Reg 23 The Registered Person shall (2)(b) ensure the guttering is replaced. Reg 18(a) The Registered Person shall, through liason with Commerical Services, recruit to the domestic staff vacancies highlighted. 7th June 2005 and ongoing 7th June 2005 and ongoing 7th June 2005 and ongoing 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
E54 S33604 The Roundabout V231668 070605 Stage 4.doc Version 1.30 Page 21 The Roundabout 1. 12 2. 3. 15 18 A means of consulting with respite service users should be developed,to include information on their preferences and expectations in relation to activities. This will better inform prospective respite users as to what to expect during their stay. This is important, particularly given that respite service users are not always in situ for the usual consultations such as residents meetings. Review the use of green plastic cups, and consult with service users and external suppliers for advice specific to dementia and physical frailty. Detail of entries in the daily progress recordings should be ket under review. Risk assessments and behavioural guidelines should be developed from this information, where the behaviour of service users causes concern. The Roundabout E54 S33604 The Roundabout V231668 070605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Birmingham & Solihull Local 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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