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Inspection on 03/10/06 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 3rd October 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 18 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

Resident`s bedrooms are decorated in the way that reflects their individual tastes and interests. Resident`s often go out to places that they want to go to either on their own with staff or in small groups. A choice of food is offered to residents and they have a healthy diet. Residents take part in a range of activities that they enjoy doing. Residents are well dressed. Staff said that residents go out to buy their own clothes.

What has improved since the last inspection?

Care plans and risk assessments include all the needs of each resident so that staff know how to support them. Each resident has a Health Action Plan. This is a personal plan about what a person needs to stay healthy and what healthcare services they need to use. Some residents have had new carpets in their bedrooms, which have made their bedrooms more comfortable. More staff are now working at the home. This means that staff that know the residents well are working with them.Staff have had training so that they can meet the needs of individual residents better. The Acting Managers are still working at the home. Staff said that things had improved and it was good to have the same managers working there as they thought this improved things for the residents.

What the care home could do better:

There are some requirements that have not been met from previous inspections. These must be met to make sure that the people living in the home have a good quality of life. Staff must keep the necessary records for residents so that they can monitor their health and take them to the doctors if they are unwell. Residents must be able to withdraw money from their bank accounts so that they can do the things they want to do and buy what they want to. The Acting Manager is working hard to make sure this is done. Furniture no longer used must be removed so there is more space. One resident`s bedroom carpet must be replaced so their bedroom is more comfortable. The aids and adaptations needed by individuals to ensure that they are transferred safely from one position to another and can use the bath if they want to must be provided. All staff recruitment records must include evidence that the necessary checks have been done and that staff are suitable to work with the residents. Staff must have the training they need and regular supervision so that they can meet the individual needs of residents. The quality assurance system must be used so that residents and their representative`s views are listened to and make a difference to the running of the home. The health and safety checks must be done when needed so that the home is safe for the residents to live in.

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 3rd October 2006 09:30 Trittiford Road Nursing Home DS0000024900.V311001.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 Trittiford Road Nursing Home DS0000024900.V311001.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. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 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 Patrick McCooey (Acting Manager – 21) Patricia Glenholmes (Acting Manager – 23) Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 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 25th May 2006 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. The CSCI inspection report is available in the home for visitors to read if they wish to. The fees as stated in the statement of purpose are £135.53 per week paid to Accord Housing and the care element is funded directly by Social Care & Health. This does not include hairdressing or spending money when going out. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 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. One inspector carried out the unannounced fieldwork visit over eight hours. This was the homes second key inspection for the inspection year 2006 to 2007. The Acting Manager in bungalow 21 and the staff on duty were spoken to. Conversations with some residents were limited due to their complex needs and limited verbal communication. The inspector met with all the 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? Care plans and risk assessments include all the needs of each resident so that staff know how to support them. Each resident has a Health Action Plan. This is a personal plan about what a person needs to stay healthy and what healthcare services they need to use. Some residents have had new carpets in their bedrooms, which have made their bedrooms more comfortable. More staff are now working at the home. This means that staff that know the residents well are working with them. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 Page 6 Staff have had training so that they can meet the needs of individual residents better. The Acting Managers are still working at the home. Staff said that things had improved and it was good to have the same managers working there as they thought this improved things for the residents. 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.V311001.R01.S.doc Version 5.2 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.V311001.R01.S.doc Version 5.2 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, 2, 4 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents for bungalow 23 have the information they need to make a choice about whether or not they want to live at the home. All of the necessary information is not available in bungalow 21. Prospective residents individual needs are assessed and they have an opportunity to visit the home to see if they would like to live there. EVIDENCE: The service users guide has been produced using pictures so it is easier to understand. It included all the relevant and required information about the home. The statement of purpose of the home in bungalow 21 had not been updated to include all the required information. In bungalow 23 it had been updated so that prospective residents have the information they need about the home. Information on the fees charged was provided. There is a vacancy for one resident in bungalow 23. A prospective resident has visited and stayed overnight and at a weekend. It is hoped that they will be able to move in during November 2006. They have met with the other residents and staff. Staff said that they seemed to get on well with the other residents. A person – centred assessment of the individual’s needs and goals is being completed with the resident and their relatives. Care plans and risk assessments are being developed as staff are getting to know the individual’s needs and how they need to support the individual. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 Page 9 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 good. This judgement has been made using available evidence including a visit to this service. Staff have the information they need so that they know how to support individuals to meet their needs and achieve their goals. Staff support individuals to make decisions about their day-to-day lives and they are consulted on what goes on in the home. Residents are supported to take risks within a risk assessment framework. EVIDENCE: Three residents records were sampled. These included an individual care plan that stated how staff are to support the individual to meet their needs and achieve their goals. Care plans were reviewed monthly and updated to reflect any changes. In bungalow 23 care plans were written in a person centred way giving information about the person, what they like and dislike, where they want to spend their time and who are the people important to them. Care plans included how staff are to support individuals to make choices about their day-to-day lives. Staff were observed offering choices of food and drink to residents. Staff asked residents where they wanted to spend their time. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 Page 10 Due to their communication needs some residents were unable to make verbal indications of their choice. Staff were observed looking for non-verbal cues and gestures so that residents could make their own choice. In bungalow 21 minutes of residents meetings showed that these are generally held monthly. They are chaired by one of the night staff. They talk about activities, holidays, the staff that support them, the complaints procedure, the environment they live in and what can be done to improve it. In July 2006 residents said that they did not like unfamiliar staff supporting them. In bungalow 23 minutes of residents meetings showed that these are held monthly. Holidays, activities, menus and the new format of care plans using pictures were discussed. At the last inspection it was recommended that the health needs of individual residents are not discussed in meetings where all residents are present. In the minutes of the meeting in July 2006 the individual health needs of residents were discussed. Individual risk assessments were in place that stated what action staff are to take to minimise risks to the person. These included the risks of using the sling for the hoist, using bedsides, how the individual would be supported if there was a fire, moving and handling, having an epileptic seizure, going out in the community, sitting in the sun, choking, sitting in a chair with a lap strap on and falling. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 Page 11 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 good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place so that generally people living in the home experience a meaningful lifestyle. Residents are offered a healthy diet. EVIDENCE: Bungalow 21 One resident attends a day centre during the week, however they had not gone that day, as the day centre were short of staff. One of the residents went out to the cinema with a member of staff. Two of the residents went out for lunch with staff. One resident was unwell so they stayed in. Staff spent time with them painting their nails. Staff said that two of the residents had been on holiday this year to the Isle of Wight. One of the residents does not seem to like going on long journeys so they are going to go out on day trips to local places of interest. Staff went with one of the residents to the travel agents to book a holiday but the resident did not show any interest so they have been on day trips during the summer. A holiday was booked for the other resident to go to a caravan at Camber Sands. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 Page 12 However, this was cancelled due to the individual’s health needs and will be rebooked in the future. Two residents went with staff for the day to Weston the weekend before. The home has a vehicle that residents use to access the community. Five members of staff can drive the vehicle, which gives residents an opportunity to go out in the vehicle often. They also use other forms of transport such as taxis, buses and trains. Staff said that relatives visit regularly if they want to. Residents records sampled showed that residents are encouraged as much as possible to take part in household tasks to develop their independence skills. Bungalow 23 Residents records sampled showed that residents listen to music, spend time stretching out and relaxing on the mat, watching TV, DVD’s, having hand massages and going shopping. Most of these activities were identified on the individual’s care plan as activities they enjoyed. Shopping in crowded places was something they did not like and staff recorded this activity as not successful when tried. The resident’s activity planner for September 2006 stated several activities including bowling, parks, meals out and the Safari Park. Their daily records did not record that they had done these activities. Staff said that they were aware that the person had done some of these but they had not been recorded. Some residents had been out for a walk to the park and were spending time relaxing in the afternoon. Two residents returned from their holiday in Wales, they said that they had a good time and were keen to tell staff about it and show their souvenirs. Staff said that some residents had recently started going to a disco, which they really enjoy. Food records sampled showed that a variety of food is offered. On most days it was recorded that the person had the recommended five portions of fruit and vegetables. Adequate food stocks were available in both bungalows with lots of different foods so choice could be offered. Fresh fruit and vegetables were available. Staff said that they have received training from the Dietician on portion sizes to help residents to maintain their weight at a healthy level. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 Page 13 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 The quality in this outcome area is adequate. 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 the health needs of residents are not sufficient to ensure that individual’s health needs are always met. The arrangements for the management of the medication protect residents. EVIDENCE: Care plans stated how staff are to support individuals with their personal care. These included support that reflects the cultural background of individuals in regard to their hair and skin care. Residents were well dressed and it was obvious that attention had been given to their personal care. Residents dress was appropriate to their age, gender, the weather and the activities they were doing. In bungalow 23 when residents returned from their holiday staff made them a hot drink and talked to them about their holiday. One resident said that they were cold so staff got them a jumper and a blanket to warm them up after their journey. During the afternoon one resident was spending time in the conservatory relaxing, listening to music. The door was open into the lounge where the TV was on with nobody apparently watching it. This lessened the relaxing atmosphere, as there was a lot of noise. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 Page 14 Bungalow 21 One resident’s health records included a menstruation record. For 2006 this was blank. It was not clear whether the individual had not had a period this year or if it had not been recorded. Irregular or missed periods can be a sign of underlying health issues so records must be kept. Health professionals are involved in the care of residents. Staff follow the advice of professionals to ensure that the health needs of individuals are met. Residents were offered regular drinks during the morning. Residents records sampled showed that they regularly go for check ups with the dentist, chiropodist and optician. The Dietician recommended that one residents fibre intake be increased. They asked that staff record the resident’s bowel movement including the size and shape and some guidance was given on this. However, bowel records did not include this information. The resident had this year been admitted to hospital with impacted faeces so it is vital that for their well –being these records are kept. The other record sampled showed a gap of four days of not having a bowel movement. Staff said that the resident did have a bowel movement but they had not recorded it. A physiotherapist had recommended that one resident have a new wheelchair to meet their needs better and make them more comfortable. This had been purchased for the individual. Bungalow 23 Residents records sampled showed that where health needs are identified referrals are made to the relevant health professionals and advice sought. In both bungalows in records sampled there were three different weight charts at different places making it difficult to monitor whether residents had lost or gained weight. In both bungalows residents had an individual Health Action Plan. This is a personal plan about what a person needs to stay healthy and what healthcare services they need to use. The medication administration and storage systems were looked at in bungalow 21 but not in 23. All staff are doing the accredited ‘Safe Handling of Medicines’ course although at present only the qualified nurses administer the medication. The Acting Manager said that when care staff have completed the course they will give medication with the nurses to develop their understanding of medication and with two people giving the medication there is less chance of errors. He also said that it is important for staff to know what medication is being given and why and in their role they observe and can monitor any ill effects of the medication on individuals. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 Page 15 Boots supply the medication to the home suing the monitored dosage system in blister packs. Medication Administration Records (MAR) were signed appropriately. The blister packs cross-referenced with the MAR indicating that medication had been given as prescribed. The medication cabinet was organised and clean. Staff check the medication when it is delivered from the pharmacy to make sure the right amount has been delivered. During the month they then audit the MAR to make sure it is being given correctly. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 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 adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are in place so that residents or their representative’s views are listened to and acted on. Arrangements for protecting residents from abuse are not sufficient. EVIDENCE: The complaints procedure included all the relevant information so that people know how to make a complaint about the home and who to. It is produced using pictures so it is easier to understand. Residents had a copy of it in their bedrooms and it is discussed at residents meetings. There had been no complaints made to the home or the CSCI during the last 12 months. Staff had not received training in adult protection and the prevention of abuse but the Acting Manager said that this is being arranged. Staff do receive information about this during their induction so they are aware of the procedure to follow if an allegation of abuse is made. There have been problems with the resident’s money, which has been going on for some years. Each resident has their own bank account that their benefits are paid into. However, they are not able to withdraw their money because the bank will not accept a change of signatory. Since the Acting Manager in 23 has been in post they have worked hard by seeking legal advice and going to the Court of Protection to resolve this situation. A letter was received from the Public Guardianship Office for one resident stating that their money is to be released. Staff said that all other residents are going through the same process so it is likely that this will be resolved in the next few months. Because of this residents have rent arrears, which will need to be paid. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 Page 17 They have not been able to purchase personal items and have had to rely on money lent from the Trust to buy essential items such as toiletries and clothes. The CSCI would expect that clear records of how this money is repaid be kept so that residents are not disadvantaged through no fault of their own. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 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 not sufficient to ensure that residents live in a comfortable, and safe environment that meets their individual needs. EVIDENCE: Bungalow 21 The home was generally well decorated and maintained. The carpets in the lounge are steam cleaned regularly. There was a chair in the lounge that was very dirty and stained. The Acting Manager said that he did not think this was used anymore so it must be removed. Resident’s bedrooms were personalised and decorated according to individual’s tastes, age and cultural background. Some residents had recently had new beds and one resident had a new mattress. The carpet in one of the resident’s bedrooms was stained. The Acting Manager said that they have requested that a new carpet be provided as it had been recently cleaned but this was not effective. Following an assessment by an occupational therapist one resident requires a ceiling track hoist in their bedroom. This assessment was completed about eighteen months ago. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 Page 19 Staff currently move the resident from their bed to their wheelchair using a large manual hoist that the person finds distressing and staff find difficult to manoeuvre. The resident is unable to use the bath, as there is not a ceiling track hoist in the bathroom and not room to move the manual hoist. Other residents can also not use the bath for this reason so they have to have a shower whether they would prefer to have a bath or not. There has been some disagreement as to who is going to fund this hoist between Accord and the Trust. Copies of emails sent by staff and the Acting Manager advocating on the resident’s behalf were seen. The Commissioning Manager has now been asked to fund this. This must be resolved as it is unacceptable and putting the safety and welfare of the resident and staff at risk. To the rear of the home there is a large well maintained garden with a patio area. Around the patio there is seating, solar lights, flowerpots, windmills and mobiles making it an interesting place for residents to sit in. Bungalow 23 The home is generally well maintained and decorated. The carpet in the lounge is cleaned regularly and was free from stains or odour. Resident’s bedrooms were personalised and decorated according to individual tastes and interests. Some residents have recently had new carpets fitted in their bedrooms. One resident’s bedroom wall had been damaged behind their bed where it had been moved around. Resident’s wheelchairs had damaged several of the doorframes. Staff said that a contractor is coming to repair these and strengthen the frames to try to stop this happening. Staff said that there had recently been a new washing machine provided. Both this and the tumble dryer were in good working order. Both of the bungalows were clean and free from offensive odours. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 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 adequate. This judgement has been made using available evidence including a visit to this service. The arrangements are not sufficient to ensure that an effective, well supported and supervised staff team who can meet the individual needs of resident’s supports them. Residents are not sufficiently supported by the home’s recruitment practices. EVIDENCE: Bungalow 21 The Acting Manager said that all the permanent care staff have NVQ level 2 in Health and Social Care or above. Some care staff are currently doing NVQ level 3. Staff have completed the Learning Disability Award Framework (LDAF) training. This exceeds the standard that at least 50 of staff should have NVQ level 2 or above. An Acting Manager is in post and there are two other qualified nurses that work during the day and two qualified night staff. During the summer the Acting Manager was asked to manage another home for two weeks that is managed by South Birmingham PCT. During this time one of the other qualified nurses was on holiday. Staff said that they managed to have a nurse on duty at all times as two bank nurses were working in the home. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 Page 21 However, this does not offer consistency to the residents and these situations should be avoided if possible. The minimum staffing levels were met and a qualified nurse was on duty. Rotas showed that minimum staffing levels are met. There were no staff vacancies. Four staff records were sampled. Two of these records included the required recruitment records. One record did not include evidence that a satisfactory Criminal Records Bureau (CRB) check had been undertaken. The other member of staff had worked at the home about one month; their recruitment records were not yet available. The Acting Manager said that they would be getting these from the Personnel Department the following day. Staff have received training in moving and handling, first aid, ‘Safe Handling of Medicines,’ risk assessment, food hygiene and dementia. Staff had not received regular, formal, recorded supervision sessions with their manager. During these sessions staff should be supported in their job role and any training and development needs identified. Bungalow 23 Staff said that all staff except one had completed NVQ level 2 in Health and Social Care. This member of staff is soon to enrol to do this. Some staff are doing NVQ level 3. There is an Acting Manager and three qualified nurses who work during the day. There is one vacancy for a night staff and a regular bank member of staff is covering this. Staff said that they work 12- hour shifts. They said that sometimes they do not get sufficient breaks during this time and there is not anywhere for them to go for a break. The qualified nurse did not have a break during this day. To ensure that the home complies with the European Working Time Directive and residents are safe from harm staff must have regular breaks. Staff meeting minutes were available for one meeting in July 2006. There was an agenda on the office wall for staff to add items to for a meeting in October 2006. Staff said that there had not been any other staff meetings. There should be at least six staff meetings each year. Staff said that they had recently had training in adult protection and the prevention of abuse, dementia, health and safety and the ‘Safe Handling of Medicines.’ Staff said that they liked working at the home and felt well supported in their job role. Staff said that they have monthly, formal, recorded supervision sessions with their manager. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 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, 39, 41, 42 The quality in this outcome area is adequate. 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 underpin all selfmonitoring, review and development by the home. Resident’s best interests are not sufficiently safeguarded by the homes record keeping practices. The arrangements are not sufficient to ensure that the health, safety and welfare of residents are promoted and protected. EVIDENCE: There is an Acting Manager in each bungalow. Neither of them has yet made an application to the CSCI to be the Registered Manager although one Manager was completing the application forms. In the past there was one Registered Manager for both bungalows. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 Page 23 One of the Acting Managers said that there are plans for the bungalows to be registered separately with a Registered Manager in each. Since the Acting Managers had been in post there have been improvements to the running of the home. Staff said that it was more organised and they felt more supported in their role. A representative from Accord Housing visits the home monthly and writes a report of their visit as required under Regulation 26. The Social Care Manager from the Trust visits the home monthly to undertake an audit. The Social Care Manager visited during the inspection. A draft quality assurance system was seen that has been developed by the South Birmingham Primary Care Trust (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. This system now needs to be used as a tool to ensure that resident’s views underpin all self-monitoring, review and development. The recording systems of the home have improved and there are systems in place to record the required information. Staff do not always complete records and this is detailed earlier in this report under the ‘Lifestyle’ and ‘Personal and Healthcare Support’ sections. Fire records showed that staff regularly test the fire equipment to make sure it is working. Regular fire drills are held so that staff and residents know what to do if there is a fire. Staff had fire safety training in March 2006. They should have a refresher of this every six months. This could be as part of a staff meeting so that they are aware of how to prevent a fire starting and the action to take if there was a fire. Staff test the water temperatures weekly to make sure they are not too hot or cold. In bungalow 21 these were recorded as being between 34 – 43 degrees centigrade. The recommended temperature is 43 degrees centigrade. In bungalow 23 they were recorded as being between 41 – 43 degrees centigrade. An electrician completed the five-yearly electrical wiring test in September 2005 and stated that it was in an unsatisfactory condition. However, since then remedial works had been completed to bring it to a satisfactory condition. The portable electrical appliances were tested in May to make sure they were safe to use. The showerheads should be disinfected monthly to help prevent the risk of legionella. In bungalow 21 they had been disinfected monthly up until August but not since. In bungalow 23 they had been disinfected every month except in June and July. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 Page 24 Staff test the water temperatures daily to make sure they are within the safe limits for food storage to prevent the risk of food poisoning. These were recorded as being within the safe limits. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 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 Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 Page 26 CHOICE OF HOME Standard No Score 1 2 2 3 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 2 27 3 28 3 29 1 30 3 STAFFING Standard No Score 31 x 32 4 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 2 x 2 x 2 2 x Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4 (1)(c) Sch 1 Requirement Timescale for action 30/11/06 2. YA19 3. YA23 4. YA23 5. YA23 YA35 6. 7. 8. YA24 YA26 YA29 The statement of purpose in bungalow 21 must include all the information required in Schedule 1. 12 (1) (a) Staff must record resident’s bowel movements as recommended by health professionals. 20, 17(2) Residents must have access Sch4 to their bank accounts. Unmet from previous inspections. 17 (2) Sch 4 9 Clear records of how (a) residents pay their rent arrears and repay the money lent by the Trust must be kept. 13 (6), 18 (1) All staff must have training in (a) adult protection and the prevention of abuse. Unmet from previous inspections. 23 (2) (c, d) The chair in the lounge in 21 that is no longer used must be removed. 23 (2) (b, d) The carpet in one resident’s bedroom in 21 must be replaced. 23(2) (n) Where it has been assessed that a ceiling track hoist is DS0000024900.V311001.R01.S.doc 15/10/06 31/12/06 31/10/06 31/12/06 31/10/06 31/12/06 12/11/06 Trittiford Road Nursing Home Version 5.2 Page 28 9. YA33 YA42 13 (4) (a-c) 10. YA34 7,9,19 Sch 2 11. YA36 18(2) 12. 13. 14. 15. 16. YA37 YA39 YA41 YA42 YA42 9 24 (1) (2) (3) 17 (1) (a) (2) 13 (4) (a – c) 13 (4) (a – c) required this must be provided. Unmet from previous inspection. Staff must have regular breaks in accordance with the European Working Time Directive. 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. Unmet from previous inspections. All staff must have regular, recorded, formal supervision sessions with their line manager. Unmet from previous inspections. An application for a Registered Manager must be made to the CSCI. The draft quality assurance system must be used. Records of activities undertaken by individuals and of health issues must be kept. Water temperatures must be maintained at 43 degrees centigrade. The showerheads must be disinfected monthly and a record of this kept. 04/10/06 31/10/06 30/11/06 12/11/06 30/11/06 04/10/06 31/10/06 04/10/06 Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 Page 29 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. Refer to Standard YA8 YA19 YA33 YA42 Good Practice Recommendations Personal needs of residents should not be discussed during residents meetings. Residents should have one weight chart each so their weight can be monitored easily. There should be at least six staff meetings held each year. Staff should have a refresher in fire safety training at least every six months. Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Trittiford Road Nursing Home DS0000024900.V311001.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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