Inspection on 08/12/08 for The White House

This inspection was carried out on 8th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The White House 05/06/08

The White House 19/06/07

The White House 12/07/06

The White House 22/02/06

The White House 20/07/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 The White House 219 Green Lanes Wylde Green Sutton Coldfield West Midlands B73 5LX Lead Inspector Kulwant Ghuman Unannounced Inspection 8th December 2008 09:00 DS0000064612.V373301.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000064612.V373301.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000064612.V373301.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The White House Address 219 Green Lanes Wylde Green Sutton Coldfield West Midlands B73 5LX 0121 355 0908 F/P 0121 355 0908 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) Robinia Care West Midlands Limited Manager post vacant Care Home 7 Category(ies) of Learning disability (7) registration, with number of places DS0000064612.V373301.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65. Date of last inspection 5th June 2008 Brief Description of the Service: The Whitehouse is a large detached property in the Wylde Green area of Sutton Coldfield. There are communal areas on the ground floor, consisting of a dining room, lounge, bathroom, toilet, laundry and kitchen. There are seven single bedrooms, two of which are on the ground floor and five on the first floor. Two of the bedrooms on the first floor have en-suite bathrooms. The office/staff sleeping in room is also on the first floor. There is a pleasant garden to the rear of the property, which consists of a paved patio area and a lawn. There is some off road parking for a few cars to the front of the premises. The Whitehouse is located close to local amenities in Wylde Green and Sutton Coldfield. It is also close to bus routes for Sutton Coldfield and Birmingham. The service provides care and support services for up to seven adults with learning disabilities. The service user guide did not include information about the fees charged at the home. DS0000064612.V373301.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate outcomes. Following the last key inspection in June 2008 a random inspection was carried out in September 2008. The random inspection was carried out to check progress on the requirements made during the previous key inspection. The random inspection findings are referred to in the body of this report. Two inspectors carried out this inspection over one day in December 2008. As part of the inspection we had a look around the home, spoke to two of the people living in the home and observed the interactions with two of the other people living in the home. We looked at the care file of one of the people living in the home and the recruitment files of three of the staff. We spoke with the acting manager, team leader, a relative of someone living in the home and one member of the support team. We also looked at some of the health and safety documents to ensure that the home was safe. Before the inspection the Annual Quality Assurance Assessment (AQAA) was completed by the home and sent to us. This told us what the home had done since the last inspection and where improvements could be made. No complaints had been made to us regarding the home since the last inspection. One complaint had been made directly to the home and this had been resolved. At the time of the last key inspection one adult protection was ongoing. This had been resolved and the needs of the individual were being adequately met. Since the last key inspection allegations had been made by one of the people living in the home against two members of staff at the home. The acting manager had looked into these and management plans had been put in place. Since this key inspection we have been informed of an allegation made against one of the staff at the home speaking and behaving in a way that affected the emotional health of one of the people living in the home. This had been referred to the social work team to be investigated. What the service does well: The home fits in with the houses in the locality and does not stand out as a care home. It looks like a family home. The home was clean, odour free and is homely. DS0000064612.V373301.R01.S.doc Version 5.2 Page 6 There were some good interactions between the staff and the people who lived in the home. Bedrooms were homely, individualised and met the needs of the people living there. Some people were able to go into the kitchen and make drinks. People living in the home were able to get up and go to bed when they wanted. People dressed in a style that was individual to them. Relatives could visit the home at all reasonable times. What has improved since the last inspection? What they could do better: The service user guide could be made more appropriate for the people living in the home and amended to make sure the information included in it was accurate. It should include information about the range of fees charged at the home to help someone trying to decide if the home was suited to their needs make an informed decision. The terms and conditions of living in the home should make it clear what is provided by the home and what must be provided by the individual, for example, activities fund and the contribution made available by the organisation. Support plans should continue to be updated and improved ensuring that they are suited to the needs of the people living in the home. DS0000064612.V373301.R01.S.doc Version 5.2 Page 7 The home needed to be proactive in helping living in the home to plan holidays they wanted at times that were suited to them and that provided value for money. The acting manager needed to monitor the interactions between staff and the people living in the home to ensure that they were safeguarded. The acting manager needed to ensure that the people living in the home were safeguarded from being put at a financial disadvantage through the communal use of vehicles purchased by individuals and also through the use of transport such as taxis. The use of any restraint procedures must be recorded separately to show the restraint used, why and how long it lasted. This is so that the use of restraint can be monitored to ensure it is not being used inappropriately. It was important that all the staff undertake adult protection training especially as a number of incidents have arisen over the past year. All staff needed to undertake moving and handling training as soon as possible as some of the people living in the home had some handling requirements, however they were independently mobile. The organisation must ensure that all documents regarding the recruitment of staff are readily available for inspection. Induction records must show that the manager has assessed new recruits as being adequately trained and experienced to be left to provide support unsupervised. It was important for the people living in the home that there was some stability within the staff team so that they got to know them and felt safe in their care. It was also important for the staff to have a registered manager who could provide leadership and monitor the service to ensure that the people living in the home were safe in their care. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000064612.V373301.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000064612.V373301.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The admission process was not assessed because there had been no new admissions to the home. There was information available to people to help them decide whether the home would be suitable for them but some improvements needed to be made to both the content and format to make it more understandable and accurate. People living in the home were given a terms and conditions of residency but some improvements needed to be made to them to ensure that the people living in the home were aware of their rights and responsibilities. EVIDENCE: There had been no new admissions to the home since the last key inspection. The people who were living in the home had all lived there for several years therefore, the admission process was not assessed at this inspection. The file of one of the people living in the home was looked at and it contained a copy of the service user guide. It was pleasing to see that there were some pictures to make it easier for the people living in the home to understand. It was noted that the print size used was very small. A larger print should be used to make it easier for people to be able to read. The service user guide DS0000064612.V373301.R01.S.doc Version 5.2 Page 10 was also somewhat misleading, for example, there was a picture including a bed to show the number of beds in the home but the number with it was 3 rather than 7 as the home is registered for 7 people. It also stated that there was a car for people to use. In fact the vehicles at the home belonged to specific individuals and were not being provided by the organisation. The service user guide did not include any guidance on the range of fees payable. It was important that this information was available to people who were considering whether the home would be suitable for them. There was a copy of the terms and conditions available on the individual’s file. It stated that the individual would pay for their own holiday and made no reference to the contribution that was available from the organisation towards annual holidays or the activities fund available to the home. DS0000064612.V373301.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Support plans had been improved and were more person centred than at the last key inspection. Risk assessments were in place. Support plans and risk assessments needed to be updated as issues arose to ensure the people living in the home were safe. The people living in the home were enabled to make choices for example in food and activities. EVIDENCE: Following the last full inspection at the home in June 2008 a random inspection was carried out in September 2008 where only specific areas were looked at. At that inspection it was found that the two files that were looked at had care plans and some risk assessments in place but they needed further improvements. The Annual Quality Assurance Assessment (AQAA) told us that each person has a care plan containing support plans and risk assessments but that the service DS0000064612.V373301.R01.S.doc Version 5.2 Page 12 user plans needed further development to make them person centred and include more pictures. At this inspection we were told that all the files had been updated. The file of one of the people living in the home was looked at. It was pleasing to note that the files were more organised and more person centred. There was general information about what the individual liked to do, what made them happy, how they communicated and who was important to them. The support plans indicated whether they preferred a man or woman to provide help in undertaking personal care. There was some information about what assistance was needed and how the individual was to be prompted for some care tasks. There was information available regarding the health care needs. There were specific health action plans but these needed further development to ensure it was clear when appointments had been made, whether they had been attended and what the outcome was. The support plans also indicated the daily tasks that individuals liked to be involved in. It was evident that some goals had been identified for the individuals and we were told that the staff were taking photographs to make pictorial support plans for individuals to develop their skills in the kitchen. These had not yet been put in place but would be a helpful tool once completed. The support plans needed further development to ensure that the people receiving support could understand them and make meaningful comments about them. Support plans were reviewed on a monthly basis. There were risk assessments in place that covering identified risks. These were referred to in the support plans to ensure that staff knew what the associated risks of any tasks were. The daily records indicated that one individual had been going into the bedroom of another person who lived in the home and had broken some items. There were no details in the care plans as to what checks had been put in place to prevent this happening again. At the previous key and random inspections it was noted that the weekly meetings with the people living in the home to discuss the meals and activities for the following week were not being held regularly. Since the random inspection of September 2008 these meetings were being held regularly. This DS0000064612.V373301.R01.S.doc Version 5.2 Page 13 meant that the people living in the home were able to make choices about the food they ate and the activities that they wanted to be involved in. The menu was displayed with pictures of the meals chosen in the meeting for the next week. This meant that the people living in the home had a way of being reminded of the meals agreed for the following week. The acting manager was in the process of enabling the people living in the home to keep their files in their bedrooms in locked metal files. This needed to be considered in respect of whether this would really mean that individuals had access to their files as they would have to be able to look after the keys and the files needed to be in a format that they could understand for it be meaningful. DS0000064612.V373301.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were activities that were suited to the individual needs of the people living in the home. Some skills development was ongoing in the home for the people living in the home. There was regular contact with relatives and the local community and the people living in the home were provided with a healthy and nutritious diet. EVIDENCE: The people living in the home had weekly activity timetables. The person whose care was being tracked by us attended a day centre five days a week and during the evenings there were activities such as going to the pub, disco, Gateway club, board games and watching videos at home. The file looked at showed that the individual liked to do things such as playing with remote control cars and going out for a ride. DS0000064612.V373301.R01.S.doc Version 5.2 Page 15 Other people attended college, developed domestic skills such as cleaning their rooms, putting their laundry in the washing machine and making drinks. All the people living in the home generally attend the Gateway club and the disco together. They sometimes went out to the pub and cinema as well as using the local parks and shopping centres. This meant that they continued to be a part of the local community. During the inspection a person came into the home to undertake some activities in the home with the people there. The individual helped one person make some Christmas decorations, which she seemed to enjoy. The people living in the home had contact with the people who were important in their lives such as parents and siblings. This was sometimes by the relatives visiting them at The White House or by them visiting their relatives in their homes. The people living in the home had been on a day trip to Blackpool but there had not been any other holiday organised. The issue of the people living in the home not having an annual holiday had been raised with us previously and although they had had one during 2007 one had not been organised this year. The home needed to be proactive in helping the people living in the home to plan holidays they wanted at times that were suited to them and that provided value for money. On the day of the inspection we spoke to one relative who said that they were generally happy with the care and things had improved in the home. Improvements had been made in ensuring that the people living in the home were able to make choices about their meals and the introduction of a picture menu was a welcome tool as it enabled the people living in the home to know what was to be cooked during that week. The food records showed that the menus were being complied with ensuring that the people living in the home had food that had been agreed by them at the weekly meetings. The food records did not record what was being provided as part of the packed lunch that some people were taking out with them so that it was not possible to determine that their was variety in this meal. At the time of the last inspection there were some concerns about the nutrition of one of the people who was living in the home. This issue had been resolved and the individual was receiving a diet that had additional increased calories through the addition of cream and butter in the meals and supplements where needed. Fresh fruit was available in the dining room. DS0000064612.V373301.R01.S.doc Version 5.2 Page 16 Some staff had had training in the development of a healthy diet. One of the staff spoken with was aware of the importance of portion sizes and the need for meals to be balanced in terms of protein, carbohydrates and so on. DS0000064612.V373301.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living in the home were appropriately supported with personal care and the administration of medicines had improved. It could not be assured that the emotional needs of the people living in the home were being well met. EVIDENCE: People living in the home received support with personal care. The files recorded if there was a preference for a specific gender to assist the individuals. The people living in the home could do some care tasks but needed support with some aspects of personal care. The people living in the home appeared to be well cared for and their dress indicated that personal preferences were taken into account so that each person had their own personal style of dress. The people living in the home were assisted to attend medical appointments. At the time of the last inspection there had been some concerns raised because some of the people living in the home had been missing their appointments and adequate reasons for this had not been provided. DS0000064612.V373301.R01.S.doc Version 5.2 Page 18 At the random inspection of September 2008 this had improved but there was evidence that occasionally appointments were still being missed. In order to determine whether appointments had been attended the diary and the daily notes had to be cross-referenced. It is advised that the health action plans clearly show when appointments have been arranged, whether they were attended and what the outcomes were. Following the last key inspection we had been informed that there had been an error in the administration of medicines for one of the people living in the home. The person had not been given their medicines at two different times on the same day. The matter was looked into and the staff concerned were to be observed whilst administering medicines to assess their capabilities. On the 7th October 2008 the pharmacist inspector visited the home. The pharmacist inspector reported that the management of medicines had improved since the last inspection with regular audits being undertaken. Protocols were in place for medicines that were to be administered on an ‘as required’ basis. Staff had received information about administering medicines via an enteral tube. Following this inspection we were informed that one of the people living in the home had been spoken to in a way that was deemed unacceptable by other staff in the home. This had left the individual unhappy and distressed and emotionally upset. This issue has been referred to the social worker for further investigation. DS0000064612.V373301.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A number of allegations have arisen in the home and they have been appropriately handled and referred to the appropriate people by the home. There continued to be some concerns about how well the people living in the home were being protected. EVIDENCE: The home had received some complaints and these had been looked into and resolved. There had been no complaints made to us directly about the home since the last key inspection. At the time of the last key inspection in June 2008 some concerns had been raised by a health care professional involved in the care of one of the people living in the home in respect of records of nutrition, attendance at appointments, lack of written evidence and lack of knowledge of the staff attending medical appointments with the person. The home has been supported to improve these matters by the community medical services and at the time of this inspection it was felt that the issues had been resolved so that the adult protection meetings had been brought to an end. Following the last key inspection we were informed by the home that one of the people living in the home had made an allegation that one of the staff at the home had taken the individual to their home and asked them to wait in the home whilst the person had a sleep. An investigation was undertaken by the acting manager and the report stated that the person living in the home had DS0000064612.V373301.R01.S.doc Version 5.2 Page 20 been taken by the staff member to their home but that this was only to pick up an item of clothing as it was cold and they were going out. They had been told that this was not acceptable. At the time of the last inspection one of the people living in the home had made an allegation about a member of staff shouting at them. There had been a further altercation between these two people following the inspection. There was an obvious difficulty between these two people and the manager had looked into the matter. We were told that the person living in the home had some difficulties expressing their feelings about this particular member of staff at certain times and this sometimes caused problems. Plans had been put in place to ensure that there was always another member of staff in the vicinity when these two people were together. The AQAA we received stated that there had been one instance of restraint in the home. There was no specific record of this except in the behaviour charts in for the individuals. This had occurred following an incident between two of the people living in the home. The staff had to walk one of the individuals away. A separate record needed to be kept of any instances of restraint so that it was possible to monitor how often these were occurring and that they were proportionate. The home has kept us informed of incidents arising in the home and appropriately referring them to the social work teams. Two of the people living in the home had their own vehicles. One of the individuals was likely to be entitled to a reduced cost road licence. Examination of records showed that on occasions the motability vehicle belonging to one of the individuals living in the home was being used by the other people living in the home even when that person was not in the vehicle. Motability vehicles are supposed to be used only for the benefit of the individual they are for and can only be used by others with their agreement when they are in the vehicle. There was no record that the individual had agreed the use of the vehicle. There was no evidence either that the person had been reimbursed for the use of the vehicle for the period looked at. The acting manager needed to ensure that this was attended to. The other vehicle had been involved in an accident and had been written off by the insurance company. Since October the owner of the vehicle had been using a taxi and looking at the records it was evident that the person was paying a lot of money to use the taxi service to get out and about. It was also evident however that the person was paying for the member of staff to return to the home after escorting them to the day centre and so on. This was not appropriate and the acting manager should ensure that the person is paid back this money. On some occasions the taxi was shared by more than one person living in the home however the cost was not being shared by them. The acting DS0000064612.V373301.R01.S.doc Version 5.2 Page 21 manager must ensure that the costs are shared out between the individuals equally. Following this inspection the acting manager informed us that it had been alleged that a member of staff had spoken and behaved inappropriately with one of the people living in the home. The matter had been referred to the social work team and the appropriate actions were being taken in respect of the member of staff whilst the investigation was ongoing. DS0000064612.V373301.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The accommodation provided a comfortable and homely environment in which to live that iwas clean and hygienic. EVIDENCE: The home was found to be clean and odour free. It was homely and generally comfortable. No changes had been made to the building since the last inspection and continued to be suitable for it s purpose. The two bedrooms seen were singly occupied and appeared to be personalised to the individuals’ liking. There was sufficient communal space for the people living in the home. The kitchen was homely and suitable for the number of people living there. DS0000064612.V373301.R01.S.doc Version 5.2 Page 23 The office accommodation continued to be small and filing cabinets had to be stored outside some bedrooms as there was no room in the office. Fold up chairs had to be hung on the wall outside the office when not in use. At the time of this inspection there were decorators in the home who were sanding down the paintwork. This meant that some areas of the home were quite dusty. It was noted that the emergency call system in one of the bedrooms and the bathroom on the ground floor did not work. The team leader told us that they had been taken out of use. There did not appear to be any system by which a member of staff who was in distress could summon any support. It was important that a system was put in place that enabled help to be summoned in an emergency situation. The home was found to be generally clean however, there was one particular person who would pick up things off the floor and put them in their mouth. During a look in that person’s bedroom a fitting from the window was found on the floor. It was imperative that checks were put in place to ensure that no items were left lying around that could pose a risk to the individual. DS0000064612.V373301.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment process ensured that all the appropriate checks were undertaken before employment however documentation was not always readily available to support this as they were not kept at the home. The induction records were not fully completed so it could not be determined that staff had had sufficient information to be left alone to support the individuals in the home. EVIDENCE: Three staff files were sampled. One person had transferred from another home owned by the company therefore not all the documents were required. There was no evidence available for this person’s induction into the home. Not all the records were available at the home for the other two people. Some documents were faxed from the head office. One of the files did not have the CRB available although POVA clearance was available. References were available in all the files sampled. DS0000064612.V373301.R01.S.doc Version 5.2 Page 25 For one of the new starters it was not possible to determine when their induction into the home had been undertaken as the records were not signed or dated. There were no records available for the other person. The records showed that these individuals were due to have Skills for Care induction during January 2009, however, during the inspection some training had become available later that week. It was important that people new to the home had a recorded induction into the home that would ensure that they knew the basic operation of the home and what to do in the event of an emergency such as a fire. There was no evidence to show that the individuals had had any moving and handling training although it was evident that they would need to support people with handling both within the home and outside. The information provided to us before the inspection told us that during the past twelve months 7 of the complement of 14 staff had left meaning that there had been a significant turnover of staff. This can be upsetting for the people living in the home as they get used to seeing people. The information also told us that all the staff were working towards NVQ level 2 or 3 and of these, 5 had already achieved NVQ 2 and 4 were working towards it. Staff had had some training since the last key inspection in food hygiene, infection control, and medication administration. Five of the staff had undertaken adult protection training but the others had not. It was important that all the staff undertake adult protection training especially as a number of incidents have arisen over the past year. Some of the new staff had not had moving and handling training. DS0000064612.V373301.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home had improved however the manager needed to ensure the all the required health and safety checks were undertaken to ensure the safety of the people living and working in the home. EVIDENCE: The home had not had a registered manager in post since February 2007. Senior managers must ensure that an application for the registration of the acting manager is forwarded to us so that there is an accountable person in charge of the home on a day-to-day basis. The current acting manager has been in post for six months and has had some positive impact on the home. DS0000064612.V373301.R01.S.doc Version 5.2 Page 27 The management of paperwork in the home has improved and the care plans are becoming more person centred. Menus have been improved and staff have been provided with healthy eating training. The people living in the home appear to have a good relationship with the acting manager and she has built up a good knowledge of their needs. We were told that a member of the organisation visited the home on a monthly basis however, there was no evidence of this in the home. The last record of these visits was June 2008. We were told that the minutes of the meetings were with the person who carried out the visits. At the random inspection of September 2008 some of the requirements made at the previous key inspection were checked. Evidence of the service of the gas equipment to be forwarded to us had not happened however, it was noted equipment had been serviced. The service of the riser bath had not taken place. We were told that this was due to the fact that there was no contract for this and this was being set up. The bath was serviced in October 2008. There was evidence available at this inspection that the fire tests were being carried out on a regular basis and that the organisation had a health and safety department that visited the home to ensure that health and safety were managed satisfactorily in the home. The quality assurance system was not discussed with the acting manager at the time of this inspection as she had to leave to attend a meeting part way through the inspection. DS0000064612.V373301.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X X X X 2 X DS0000064612.V373301.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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 YA9 Regulation 13(7) Timescale for action A separate record of any form of 01/02/09 limitation put on people living in the home, including those to prevent harm, must be kept. This will ensure that the liberty of people living in the home is not restricted unnecessarily. 2. YA23 13(6) The registered person must ensure that the people living in the home with vehicles are not put at a financial disadvantage. People being escorted by staff in taxis should be reimbursed for the costs of staff returning to the home. 3. YA23 13(6) All staff in the home must undertake adult protection training and moving and handling training. This will ensure that the people living in the home are safeguarded. 01/04/09 01/02/09 Requirement DS0000064612.V373301.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The service user guide should include information about the fees charged in the home and be in a format suited to the needs to the people for whom the home is registered. This will ensure that people have the information on which to make informed decisions about the suitability of the home for them. 2. YA5 The terms and conditions of living in the home should make it clear what is provided by the home and what must be provided by the individual living there. This will ensure that the people living in the home are fully aware of their rights and responsibilities. 3. YA6 The support plans should be updated with changes as they occur and they should be in a format that can be understood and commented on by the people living in the home. This will ensure that the people living in the home know that their needs are known by the staff and how they want to be supported by them. 4. YA14 The home need to be proactive in helping living in the home to plan holidays they want at times that are suited to them and that provide value for money. The registered person must ensure that a record of what has been provided in the packed lunches is recorded. This will ensure that the variety of the lunches can be checked. Health action plans should clearly record the appointments made, reason and outcomes. This will ensure that the medical needs of the people living in the home can be monitored. The registered person must ensure that a system is put in DS0000064612.V373301.R01.S.doc Version 5.2 Page 31 5. YA17 6. YA19 7. YA29 place that enables staff to call for assistance in an emergency situation. This will ensure that the staff and people living in the home are not put at risk. The manager must ensure that new staff have a recorded induction into the home that enables them to safely care for the people living there before they are left unsupervised in the home. The registered person should ensure that there is a period of staff stability in the home. This will ensure that the people living in the home are comfortable with and know the people who are assisting them are aware of their needs. 10. YA34 All the recruitment records must be made readily available for inspection. This will enable the recruitment procedure to be assessed to ensure the safety of the people living in the home. Staff working at the home should have regular supervision. This will ensure that staff practices are monitored and they are supported to provide appropriate care. 12. YA43 The manager should have more appropriate office accommodation. This will enable private conversations and supervisions to be held. 13. YA43 An application for the registration of the manager should be forwarded to CSCI as soon as possible. This will ensure that there is an accountable person in dayto-day control of the home that can provide leadership to the staff. The reports of the monthly visits made by the provider’s representative should be available for inspection. This will ensure that the home is overseen by a responsible individual. 8. YA32 9. YA33 11. YA36 14. YA43 DS0000064612.V373301.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000064612.V373301.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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