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Inspection on 25/05/06 for Trittiford Road Nursing Home

Also see our care home review for Trittiford Road Nursing Home for more information

This inspection was carried out on 25th May 2006.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 24 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff spend time talking to the people who live there and asking them how they can support them. Resident`s bedrooms are decorated in the way that reflects their individual tastes and interests. The staff respect the dignity and privacy of the people that live in the home. When one person became upset staff took them to their bedroom to talk to them and then gave them some time on their own. The staff encourage residents to do as much as they can for themselves like helping to do their laundry and clean their bedrooms.

What has improved since the last inspection?

An Activity Co-ordinator has been appointed to work in each bungalow. It is hoped that this will improve the activities that residents do inside and outside the home. A variety of food is offered to residents and residents have a healthy diet. Residents have had health checks and Health Action Plans have started to be developed. This will ensure that staff know how to support each person to stay healthy and access the healthcare services they need. Some of the carpets have been replaced making the home a more comfortable place to live. Staff recruitment records were better and more of them included evidence that the necessary checks had been made to ensure that residents are protected from abuse. There is an Acting Manager in each bungalow. Staff said that the home and the records were more organised and they knew what was expected of them. Staff are doing all the health and safety checks to ensure that residents live in a home and use equipment that is safe. The security system has improved so that residents and staff can be better protected from harm. The staff are in contact with a Community Police Officer who has helped them feel safer when they support residents to go out in the local community.

What the care home could do better:

The homes statement of purpose must include all the updated information so that prospective residents have the right information about the home. Care plans and risk assessments must include all the needs of each resident. A range of activities for residents must be provided that includes things that individuals enjoy doing. Residents must be able to withdraw their money from their bank accounts so that they can do the things they want to do and buy what they want to. Some redecoration is required and carpets must be replaced in some of the bedrooms so that the home is comfortable and clean for the people who live there. The aids and adaptations needed by individuals to ensure that they are transferred safely from one position to another must be provided. Enough staff must be employed to work at the home that know the residents and can meet their needs. All staff recruitment records must include evidence that the necessary checks have been done. Staff must receive training and regular supervision so that they can meet the individual needs of residents.

CARE HOME ADULTS 18-65 Trittiford Road Nursing Home 21-23 Trittiford Road Yardley Wood Birmingham West Midlands B13 0ES Lead Inspector Sarah Bennett Unannounced Inspection 25th May 2006 09:30 Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 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 Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 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. Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Trittiford Road Nursing Home Address 21-23 Trittiford Road Yardley Wood Birmingham West Midlands B13 0ES 0121 441 5646 F/P 0121 441 5646 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) Accord Housing Association Vacant Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Care home with nursing, maximum 11 service users, under 65 years of age (11LD). Category is Learning disability. Three existing service users who are over 65 years of age may be accommodated for as long as the home is able to meet their needs. Date of last inspection 7th December 2005 Brief Description of the Service: The home comprises of two purpose built bungalows. They are home to eleven adults who have a learning disability and additional physical needs. The bungalows were purpose built in 2000, with the accommodated residents in mind. The homes aim to run independently from each other, although some sharing of staff and resources does occur. The providers have discussed separating the two bungalows into separate registrations. The homes have been well designed and adapted to meet the resident’s needs. Facilities include assisted baths, ceiling track hoists in some bedrooms and mobile hoists. All the bedrooms are single occupation. Both homes have a relaxing lounge area and small sun lounge. To the rear of both homes is a pleasant garden with some raised beds to enable wheelchair access. Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and reports from the provider. Two inspectors carried out the unannounced fieldwork visit over seven and a half hours. This was the homes key inspection for the inspection year 2006 to 2007. The Acting Managers and the staff on duty were spoken to. Conversations with some residents were limited due to their complex needs and limited verbal communication. The inspectors met with several residents and time was spent observing care practices, interactions and support from staff. A tour of the premises took place. Care, staff and health and safety records were looked at. What the service does well: What has improved since the last inspection? An Activity Co-ordinator has been appointed to work in each bungalow. It is hoped that this will improve the activities that residents do inside and outside the home. A variety of food is offered to residents and residents have a healthy diet. Residents have had health checks and Health Action Plans have started to be developed. This will ensure that staff know how to support each person to stay healthy and access the healthcare services they need. Some of the carpets have been replaced making the home a more comfortable place to live. Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 6 Staff recruitment records were better and more of them included evidence that the necessary checks had been made to ensure that residents are protected from abuse. There is an Acting Manager in each bungalow. Staff said that the home and the records were more organised and they knew what was expected of them. Staff are doing all the health and safety checks to ensure that residents live in a home and use equipment that is safe. The security system has improved so that residents and staff can be better protected from harm. The staff are in contact with a Community Police Officer who has helped them feel safer when they support residents to go out in the local community. 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. Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 7 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 Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 5 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents do not have all the information they need to make an informed choice about where to live. Residents have an individual licence agreement, which tells them what the terms and conditions of their stay are. EVIDENCE: A statement of purpose was dated April 2006. This includes the required information but not the Manager details. There is an Acting Manager in each bungalow, neither of them are the Registered Manager for the home. The statement of purpose also includes details of how to contact the CSCI. It does not include the fees charged but states that this information is available from the housing provider, Accord. A service user guide was available for bungalow 21. This included all the relevant information and was produced using pictures, making it easier to understand. The residents in both bungalows have lived there for a number of years. Sadly one resident in bungalow 23 died recently and there is now one vacancy. Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 9 All residents have a licence agreement with the housing association which states the terms and conditions of their stay at the home. These were not all signed by the resident or their representative. The Acting Manager said that they hope to produce these in a more user - friendly version for residents and their relatives. Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all the care plans include enough information to ensure that staff know how to support individuals to meet their needs, goals and aspirations. Residents are supported to make decisions about their day-to-day lives and are consulted on some aspects of life in the home. Residents are generally supported to take risks within a risk assessment framework. EVIDENCE: Two residents records were sampled in each bungalow. One residents care plan in bungalow 21 was being updated so this was not looked at in detail. Each individual had a care plan and risk assessments. Care plans detailed how staff are to support the individual to meet their communication, personal hygiene, health, dietary and social needs. One care plan did not include how staff are to support the individual to meet their social needs. Another care plan did not state what activities the person liked doing. The Acting Manager said that Activity Co-ordinators are to take the lead in looking at individuals’ response to activities that they do to see whether or not they enjoy them. Care Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 11 plans referred to how individual’s cultural needs would be met in terms of hair and skin care. These should be expanded to include any cultural dietary needs. The Acting Managers have devised a person centred plan using pictures. All staff are to have training in using this and will then be involved in developing them for each individual resident. Staff were observed offering a resident a choice of drink by bringing two bottles to them and encouraging them to choose one. Residents meeting minutes were available for two meetings in bungalow 21. These showed that holidays, staffing and nutrition were talked about. The residents have limited verbal communication skills due to their learning disability. Staff said that this could make it difficult to seek their views. Care plans for communication stated how the individual communicates using body language and gestures. Residents meeting minutes in bungalow 23 showed that some individual meetings take place. The minutes of March and April 2006 included discussions about the health needs of individual’s, it is not clear whether residents were present at these meetings. Individual needs should not be discussed at meetings where other residents are present. When a risk has been identified in the care plan these are cross-referenced to the risk assessment so staff know how to minimise the risk. Risk assessments were detailed and regularly reviewed. Where residents use bedsides to prevent them from falling out of bed a risk assessment was in place for one resident but not for another to ensure that they are kept safe from entrapment. Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are not sufficient to ensure that all residents experience a meaningful lifestyle. Residents are offered a healthy diet and enjoy their meals. EVIDENCE: Bungalow 21 One of the residents daily records sampled showed that in one week they relaxed in the lounge, watched TV, did colouring, listened to music, attended an appointment at the seating clinic, went out for a ride with staff and sat in the conservatory. The other residents records sampled showed that they went to the day centre on three days, attended an appointment at the seating clinic, listened to music and watched TV. One of the residents went out with staff to do the food shopping. Another resident went out to the park with staff to feed the ducks. An Activity Co-ordinator has been appointed to work in each bungalow. Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 13 The fridge was quite empty but staff said that they would be going food shopping in the afternoon. Staff said that residents always go food shopping. Residents were offered a choice of drinks with their lunch. Yogurts and fresh fruit were offered after they had eaten their first course. One resident chose to eat their lunch in the conservatory and staff respected this. At lunchtime staff were observed following individual’s eating and drinking guidelines developed by the Speech and Language Therapist. Menus are rotated every four weeks. They included fresh fruit and vegetables. Staff said they are reviewing them to reflect the change of season. Alternatives to the main meal offered were not always recorded. A record of the food provided to individual’s showed that a varied diet is offered. Fresh vegetables were recorded but not fruit. However, residents were offered fresh fruit drinks and staff said that they also make ‘smoothies’ that the residents like. The Acting Manager said that the dietician is going to do some training on PEG feeds for the staff to ensure they know how to support residents that receive their food in this way. Bungalow 23 Staff spent time sitting with residents and talking to them or looking at magazines or photos with them. Two residents went out for a walk to the park with staff. One resident went to the weight clinic with a member of staff. Residents records sampled showed that residents go to the pub for meals, the park, shopping, watch TV and DVD’s, do colouring, go to garden centres, listen to music, go out for a drive, have hand and foot massage and manicures. A music entertainer visits the home regularly to do a music session. Staff said and records sampled showed that where appropriate relatives visit and telephone regularly. Staff maintain contact on behalf of residents with their relatives by sending letters and photographs. Residents were observed to be supported by staff to take part in doing their laundry as much as each person was able to. Records sampled showed that residents take part in doing their laundry, help to clean their bedroom and cooking. Residents food records sampled showed that a variety of food is offered and the recommended five portions of fruit and vegetables each day are offered. A member of staff cooked a vegetable stir- fry for lunch using fresh vegetables. Staff sat with residents to eat and supported them appropriately. One resident refused their lunch so an alternative was given. Fresh fruit was available. The fridge, freezer and cupboards were well stocked with a choice of food. Last year none of the residents went on holiday, as they did not have access to their finances. This is discussed further under standard 23. Staff said that they hope that this year the financial situation will be resolved and are looking to find appropriate holiday destinations for individuals. Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive personal support in the way they prefer and require. The arrangements for meeting resident’s health needs and the management of the medication are generally adequate. The death of a resident was handled with respect and the needs of the other residents were considered. EVIDENCE: Resident’s records sampled included individual manual handling assessments. These were reviewed monthly and updated where necessary. They included which type of sling to use to ensure the safety of the individual when using the hoist. Staff were observed transferring a resident from a chair to their wheelchair. Staff applied the brakes on the wheelchair and talked to the person giving them verbal encouragement and appropriate support. Care plans stated how staff are to support individuals with their personal care. Residents were dressed appropriately according to their age, the weather and the activities they were doing. Staff supported some residents to go to the weight clinic. One resident went to an appointment at the wheelchair-seating clinic with staff. Where appropriate Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 15 referrals had been made to health professionals including the Physiotherapist, wheelchair-seating clinic, Dietician, Speech and Language Therapist and District Nurses. One resident’s records showed that their skin was sore in pressure areas however a pressure area assessment had not been completed. The Acting Manager said a Student Nurse was working on this. Health Action Plans have started to be developed for individuals in line with ‘Valuing People.’ Residents have regular health checks including visiting the dentist, optician and chiropodist. One resident’s bowel records showed that they had not had a bowel movement for fifteen days. After seven days their daily records stated that they were suffering from constipation and were prescribed suppositories to relieve this. Their bowel records only recorded when their bowels were opened. In order to ensure that bowel records are not overlooked it is good practice to record when the individual does not have their bowels opened so treatment for constipation can be given earlier if needed. Boots supply the medication using the monitored dosage system. Medication is stored in a locked cabinet in each bungalow for the people who live there. Copies of prescriptions are kept. The Acting Manager in bungalow 23 said that the protocols for PRN (as required) medication still need developing. The protocols in place for paracetamol did not indicate how the individual expresses that they are in pain. Medication administration records (MAR) had been signed appropriately. Creams and eye drops are dated when they are opened so they are not used after their expiry date. Staff test the temperature of the medication fridge daily to make sure that it is the correct temperature for storing the medication. All staff including staff that are not qualified nurses are starting the accredited training in the ‘Safe Handling of Medicines’ in September. This will give staff a better understanding of the medication that residents have and the reasons why it needs to be administered correctly. Sadly one resident in bungalow 23 died recently. Staff were talking to residents about the individual reminiscing about their life and things they had done. They also spent time looking at photos. One resident became upset so staff took them into their bedroom and spent time talking to them there. Staff said that they are going to support other residents to go to the Chapel of Rest and to attend the funeral. Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Adequate arrangements are in place to ensure that residents or their representative’s views are listened to. Arrangements are not adequate to protect residents from abuse, neglect and self-harm. EVIDENCE: Each resident has a copy of the complaints procedure. This is produced using pictures making it easier to understand. No complaints have been received by the home or the CSCI since the last inspection. Not all staff had received training in adult protection and the prevention of abuse. The Acting Manager said that this is booked but in the interim they would do some in-house training with one of the student nurses on placement. There have been some problems with the residents’ money, which has been going on for quite some time. Each resident has their own bank account and their bank statements showed that their benefits are being paid into these. However, they are not able to withdraw their money because the bank will not accept a change of signatory. The Trust has received advice from their legal department and is looking at how to resolve this. The Social Care Manager said at the last inspection that this is being sorted out as a priority. Having restrictions on their money has prevented some residents from having holidays. Staff said that petty cash or the money from City College work that residents participate in is used to supplement most of the resident’s personal Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 17 allowance. Staff said that it has restricted individuals in buying some personal items. Since one of the Acting Managers has been in post they have worked hard to try to resolve this. They said that they are applying to the Court of Protection and solicitors are involved in this. They have asked the housing provider, Accord to state what individuals rent arrears are to assist with this. Two of the residents personal allowance records in bungalow 23 were looked at. The individual purses/wallets contained the amount stated on their record. Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29, 30 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are generally adequate to ensure that residents live in a homely, comfortable and safe environment that meets their individual needs. EVIDENCE: Bungalow 21 Following an assessment by an occupational therapist and a manual handling assessment being carried out for one of the residents a quote for a ceiling track hoist has been sent to Accord. A large hoist is being used to transfer this person and this takes up a lot of space in their bedroom. A ceiling track hoist is provided in the shower room but not in the bathroom. Resident’s bedrooms were personalised and reflected their individual tastes, interest and cultural background. One resident said that they liked their bedroom. The lounge ceiling was stained with drink splashes and some stains were evident on the carpet. Bungalow 23 Since the last inspection the carpets in the hall and lounge have been replaced. Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 19 Some stains were evident on the lounge carpet. Staff said that they had bought a carpet cleaner to use. The home was generally clean and free from offensive odours. Resident’s bedrooms were personalised and reflected their individual tastes and interests. At the last inspection it was identified that the carpets needed replacing in some bedrooms, this remains outstanding. The WC nearest to the office needs redecorating. The lid on the bin in there was broken and needs replacing to minimise the risk of cross infection. Each bungalow has a garden. These have raised beds, footpaths and garden furniture. Staff said that they have planted sensory plants to make sitting in the garden a sensory experience for the residents. The gardens are accessible to the residents. Staff said that the security of the home has improved. At previous inspections it had been noted that vehicles had been broken into in the car park and staff did not always feel safe leaving the home after dark. There are cameras in place and staff are liaising with Community Police Officers, which has improved this. Staff said that they now feel safe when going to the local shops with residents, which they had not felt previously. Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 The quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Adequate arrangements are not in place to ensure an effective, well supported and supervised staff team who can meet the individual needs of resident’s supports them. EVIDENCE: The rotas in bungalow 21 show that there is five staff that have NVQ level 2 in care. In bungalow 23 two staff have NVQ level 2 and three members of staff are doing this. One member of staff is doing NVQ level 3. Therefore, this meets the standard of at least 50 of staff having NVQ level 2 or above. In bungalow 21 in addition to the permanent staff there was one agency staff used to cover the shift. However, the minimum staffing levels were not met at the beginning of the morning shift as another member of staff had phoned in sick. The Acting Manager said that there would be one staff vacancy when a new bank nurse starts on a three - month contract. They said there are still some occasions when there is only one qualified nurse between the two bungalows but these would be rare when the bank nurse starts. Since the Acting Manager in bungalow 21 has been in post there has been only one other qualified nurse Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 21 in post so bank staff or nurses from bungalow 23 working overtime have been used to cover the vacancies. In bungalow 23 in addition to the permanent staff there was one agency member of staff who had not worked there before and one member of bank staff. There is one vacancy for a night social care worker. In bungalow 21 there have been two staff meetings in 2006. The Acting Manager said that they plan to hold regular staff meetings in the future. In bungalow 23 there had been three staff meetings in the last twelve months. This does not meet the required standard of at least six meetings in twelve months. Staff recruitment records sampled in bungalow 21 included the required records with the exception of evidence that a Criminal Records Bureau (CRB) check had been completed for one member of staff. The Acting Manager said that this had been completed but the evidence was not available. Staff recruitment records sampled in bungalow 23 included all the required recruitment records with the exception of one that only had evidence that a CRB check had been undertaken. Staff training records in bungalow 21 showed that staff had not received the relevant training. The Acting Manager said that they will be producing a training matrix to be clear about what training is required and that training in manual handling, first aid and food hygiene would be a priority. Staff records showed that new members of staff had received an induction. In bungalow 23 a member of staff had recently been given responsibility for ensuring that staff receive the appropriate training. The training file showed that several staff had been booked in the next few months to attend the relevant training courses. Staff in both bungalows had recently completed training in health and safety and dementia care. Staff in both of the bungalows had not received regular formal, recorded supervision sessions with their line manager. The Acting Managers said that they plan to do a schedule to ensure that these are held regularly. Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Acting Managers have ensured that residents benefit from their leadership and management. The use of the draft quality assurance system will ensure that residents and their representatives are confident that their views will underpin all selfmonitoring, review and development by the home. Resident’s best interests are safeguarded by the home’s record keeping policies and procedures. Adequate arrangements are in place to ensure that the health, safety and welfare of residents are promoted and protected. EVIDENCE: There is an Acting Manager in each bungalow. The Acting Manager in bungalow 21 had been in post for two weeks. Staff said that things had improved since the Acting Manager had been in post. Staff said that they were better informed Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 23 as to what they should be doing and things were more organised. The Acting Managers were unsure whether they are to apply as Registered Managers. The Acting Managers had with all the staff developed an improvement plan for the home. This included developing activities for residents and developing person centred plans for each individual resident. Generally it did not include timescales and these should be added to ensure that the improvements could be audited. Staff had been delegated areas of responsibility. Staff said that they thought this was good and were keen to develop these roles. A representative from the provider, Accord visits regularly and writes a report of their visit as required under Regulation 26. A draft quality assurance system was seen that has been developed by the South Birmingham PCT. This included looking at medication, record keeping, fire safety and complaints. Audits will be carried out at weekends, nights and days. They will include looking at inspection reports and monthly monitoring visits by the Social Care Manager. A number of people who have a learning disability have been recruited and trained to assist in carrying out the audits and lay visitors will also be used. The Acting Manager in bungalow 21 had reorganised the files so it was easier for staff to access the information that they need. In both of the bungalows the fire records showed that staff test the alarm and emergency lighting regularly to make sure they are working. An engineer regularly services the fire equipment. Most of the staff had recently received training in fire safety. Regular fire drills are held to ensure that staff and residents know what to do if there is a fire. An engineer regularly services the hoists, bed rails and wheelchairs to make sure that they are safe to use. Staff test the fridge and freezer temperatures daily. In bungalow 21 these tested above 10 degrees centigrade for two days in May but had now reduced to within the safe limit of 0-5 degrees centigrade. Staff test the water temperatures weekly to make sure they are not too hot or cold. In bungalow 23 the bath tested at 37 degrees centigrade and one residents bedroom sink at 36 degrees centigrade. The recommended safe temperature is 43 degrees centigrade so this was a bit cold. Staff said that this had been reported to the Accord maintenance team. An electrician tests the portable electrical appliances annually to make sure they are safe to use. An electrician tested the wiring installation in September 2005 and stated that it was in an unsatisfactory condition. However, there was evidence to show that remedial work had been completed to ensure it was in a satisfactory condition. Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 24 A Corgi registered engineer had tested the gas equipment in March 2006 and stated that it was in a satisfactory condition. Risk assessments are in place and these had been reviewed recently and updated where necessary. Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 25 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 2 2 X 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 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 3 29 2 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 3 2 3 2 X 3 3 X Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 26 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 YA1 Regulation 4 (1)(c) Sch 1 Requirement Timescale for action 31/08/06 2. YA1 3. 4. 5. 6. YA6 YA9 YA14YA12 YA19 7. 8. YA19 YA20 9. YA23 The statement of purpose of the home must include all the information required in Schedule 1. 5(1)(2) Each resident must have a copy of the service users guide. It must include all the information required in Regulation 5. 15(1) Care plans must include details of how the individual’s social needs are to be met. 13(4)(a-c) A risk assessment must be in place for all residents that use bedsides. 16(2)(m,n) A range of activities must be offered to all residents. 13(2)(4)(c) A pressure area plan must be in place for all residents that are assessed as being at risk of developing a pressure sore. 12(1)(a) Each resident must have a (2)(3) Health Action Plan in line with ‘Valuing People’. 13(2) Protocols must be in place for all PRN (as required) medication stating when, why and in what dosage the medication should be given. 20 Residents must have access to 17(2) their bank accounts. DS0000024900.V289733.R01.S.doc 31/10/06 31/07/06 30/06/06 30/06/06 30/06/06 31/08/06 31/07/06 31/07/06 Trittiford Road Nursing Home Version 5.1 Page 27 Sch4 10. YA35YA23 13(6) 18(1)(a) 23(2)(d) 11. YA24YA30 12. YA26 16(2) 23(2)(b,d) 13. 14. 15. 16. YA27 YA29 YA30 YA33 23(2)(d) 23(2)(n) 16(2)(j) 12(1)(a) 18(1)(a) 7 9 19 Sch2 17. YA23YA34 18. YA35 18(1)(c) 19. YA36 18(2) Unmet from previous inspections. All staff must receive training in the prevention of abuse. Unmet from previous inspections. The lounge ceiling must be cleaned and repainted where necessary in bungalow 21. The lounge carpet must be cleaned regularly. The identified bedroom carpets in bungalow 23 must be cleansed to a satisfactory standard or replaced. Unmet from previous inspections. The WC must be redecorated in bungalow 23. Where it has been assessed that a ceiling track hoist is required this must be provided. The bin in the WC in bungalow 23 must be replaced. All staffing vacancies must be recruited to. Unmet from previous inspections. Evidence that a Criminal Records Bureau (CRB) check must be available in the home for all staff employed there. Staff records must include all the required records under Schedule 2. All staff must receive the appropriate training to meet the needs of residents. A record of this training must be available in the home. Unmet from previous inspections. All staff must have regular, recorded, formal supervision sessions with their line manager. Unmet from previous inspections. DS0000024900.V289733.R01.S.doc 31/10/06 30/06/06 31/08/06 31/08/06 31/08/06 30/06/06 31/07/06 30/06/06 31/10/06 31/08/06 Trittiford Road Nursing Home Version 5.1 Page 28 20. YA37 9 An application for a Registered Manager must be made to the CSCI. 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard YA5 YA8 YA14 YA17 YA19 YA33 YA39 Good Practice Recommendations The resident or their representative should sign the licence agreements. Personal needs of residents should not be discussed during residents meetings. Each resident should be offered the opportunity to go on holiday each year. Menus should include an alternative. Where the individual is not able to communicate verbally, bowel records should be completed daily. There should be at least six staff meetings held each year. The improvement plan should include timescales as to when improvements are to be made. Trittiford Road Nursing Home DS0000024900.V289733.R01.S.doc Version 5.1 Page 29 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. 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