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Inspection on 07/12/05 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 7th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 48 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 well decorated and residents have many personal possessions. Staff encourage residents to help to do their laundry and clean their bedrooms. Relatives said, " The regular staff are wonderful." Residents said, " The good thing about living at the home is my bedroom, the staff and the food."

What has improved since the last inspection?

New sofas and curtains have been provided in the lounge in bungalow 21 and the carpet replaced. New kitchen units have been fitted in both bungalows. These have made the home more comfortable for the residents. The menus have been updated so that a variety of food is now offered to residents. The complaints procedure now includes all the information so that residents know that they can complain to the CSCI at any time. The hammock that was not being used, but was stored in the lounge in bungalow 23 has been removed. There is now more space in the lounge for residents to move around safely. Broken garden furniture has been removed so that the garden is safe to use.

What the care home could do better:

The home`s statement of purpose and service users guide must be found so that prospective residents have the right information about the home. Each resident must have a contract so that they know about the terms and conditions of their stay at the home. Care plans, risk assessments and manual handling guidelines must be reviewed regularly and updated so that staff know how to support each resident. Activities that residents enjoy doing inside and outside the home must be provided so that residents have a good quality of life. 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. Staff must follow the menus and make sure that enough fresh fruit and vegetables are provided. This will ensure that residents have a varied and nutritious diet. Residents must be supported to have health checks. Each resident must have a Health Action Plan so that they access the health services they need. Carpets must be cleaned or replaced in some rooms so that the home is comfortable for the residents. Enough staff must be employed to work at the home that know the residents and can meet their needs. Recruitment records must be available to show that checks have been made on staff to protect residents from abuse.Staff must receive training and regular supervision so that they can meet the individual needs of residents. A manager must be recruited to work at the home so that staff are supported to meet the residents needs and adequate systems are in place to protect the residents from harm. All fire equipment must be regularly tested to make sure it is working. The fire risk assessment must be reviewed to make sure that all risks of a fire starting are minimised. The security system must be good enough to protect the residents and staff from harm as much as possible.

CARE HOME ADULTS 18-65 Trittiford Road Nursing Home 21-23 Trittiford Road Yardley Wood Birmingham West Midlands B13 0ES Lead Inspector Sarah Bennett Announced Inspection 7th December 2005 09:30 Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 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.V264437.R01.S.doc Version 5.0 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.V264437.R01.S.doc Version 5.0 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 0121 444 2629 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 Karen Shanley Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 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. The manager Karen Shanley is to undertake and complete the Registered Managers award or equivalent by April 2005. 19/10/05 Date of last inspection 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 residents 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.V264437.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was conducted by, two Inspectors over seven hours. This was the second of the statutory inspections for this home for 2005/2006 and not all of the National Minimum Standards were assessed. To get a full picture of the home it is advised to read this report in conjunction with the report from June 2005. Due to concerns raised at previous inspections there were two follow-up inspections in October 2005. At this inspection time was spent observing care practices, interactions and support from staff. Some of the residents do not have verbal communication and their ability to communicate to the inspectors their views of the home was limited. A tour of the home was made. Residents care plans, risk assessments and a number of Health and Safety records were inspected. The Inspector had the opportunity to talk with members of staff, the Social Care Manager and the Acting Manager. Two completed CSCI comment cards were received from relatives and one was received from a resident. Stephen Ellis (expert by experience) and his supporter from ‘Sandwell People First’ were there for part of the inspection. As a service user Stephen has an expert opinion on what it is like to receive services for people who have a learning disability. As part of the Inspection Team, Stephen’s comments are included throughout this report. A letter of serious concern about staff training, support and recruitment practices was sent to the provider after this inspection. There will be further inspections to make sure that there is improvement. What the service does well: What has improved since the last inspection? New sofas and curtains have been provided in the lounge in bungalow 21 and the carpet replaced. New kitchen units have been fitted in both bungalows. These have made the home more comfortable for the residents. Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 Page 6 The menus have been updated so that a variety of food is now offered to residents. The complaints procedure now includes all the information so that residents know that they can complain to the CSCI at any time. The hammock that was not being used, but was stored in the lounge in bungalow 23 has been removed. There is now more space in the lounge for residents to move around safely. Broken garden furniture has been removed so that the garden is safe to use. What they could do better: The home’s statement of purpose and service users guide must be found so that prospective residents have the right information about the home. Each resident must have a contract so that they know about the terms and conditions of their stay at the home. Care plans, risk assessments and manual handling guidelines must be reviewed regularly and updated so that staff know how to support each resident. Activities that residents enjoy doing inside and outside the home must be provided so that residents have a good quality of life. 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. Staff must follow the menus and make sure that enough fresh fruit and vegetables are provided. This will ensure that residents have a varied and nutritious diet. Residents must be supported to have health checks. Each resident must have a Health Action Plan so that they access the health services they need. Carpets must be cleaned or replaced in some rooms so that the home is comfortable for the residents. Enough staff must be employed to work at the home that know the residents and can meet their needs. Recruitment records must be available to show that checks have been made on staff to protect residents from abuse. Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 Page 7 Staff must receive training and regular supervision so that they can meet the individual needs of residents. A manager must be recruited to work at the home so that staff are supported to meet the residents needs and adequate systems are in place to protect the residents from harm. All fire equipment must be regularly tested to make sure it is working. The fire risk assessment must be reviewed to make sure that all risks of a fire starting are minimised. The security system must be good enough to protect the residents and staff from harm as much as possible. 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.V264437.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 5 Prospective residents do not have the information they need to make an informed choice about where to live. Residents are not aware of the terms and conditions of their stay at the home. EVIDENCE: The statement of purpose of the home and service users guide could not be found. These must be available so that prospective residents are aware of the service that the home provides. Resident’s records did not include an individual contract. Each resident must have a contract that states rooms to be occupied, the terms and conditions of their stay at the home, what support, facilities and services are provided for them, the fees charged, their rights and responsibilities, details of their care plan and how this will be reviewed and updated and if any care is to be provided for them outside of the home. The resident or their representative and the registered manager should sign the contract. Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 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 Care plans are not regularly reviewed so that staff do not have the adequate information to support residents whose needs have changed. Adequate arrangements are not in place to ensure that residents are consulted on, and participate in, all aspects of life in the home. Arrangements are not adequate to ensure that residents are supported to take risks within a risk assessment framework. EVIDENCE: The Inspection Team found that all the residents had a care plan. Care plans included details of how to support residents to meet their needs. Some care plans were out of date, as the individual’s needs had changed. All care plans must be regularly reviewed and updated where appropriate. Care plans were generally about meeting residents health needs. There was little evidence of how staff are to support residents to achieve their goals and aspirations. Person centred plans should be developed to ensure that these are achieved. Some residents daily records had not been completed so it was not possible to see what care the resident had received, if they had any changes in their health or what activities they had participated in. Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 Page 11 Staff told the Inspection Team that there are no residents meetings because of resident’s lack of understanding and communication difficulties. Residents said that there are no meetings. One member of staff said that they used to have meetings together with residents and staff but the minutes of these had been moved to the office in bungalow 21 and were not available. Staff were observed asking residents to make choices about their day-to-day lives. Although a formal meeting may not be appropriate ways must be found to consult residents and where appropriate their representatives so that they can participate in the running of the home. Any decisions made or consultation must be documented. Individual risk assessments are in place. Some risk assessments were not regularly reviewed and some were not dated. Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 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 Adequate arrangements are not in place to ensure that people living in the home experience a meaningful lifestyle. Arrangements are not adequate to ensure that residents are offered a healthy diet and enjoy their meals. EVIDENCE: One resident goes to the daycentre during the week. At the last inspection the resident had not regularly gone to the day centre as staff were not available to drive them or the day centre did not have adequate staff. Records showed that they have been going more regularly and were able to go on the day of this inspection. A vehicle is provided to enable residents to access the community. Staff told the Inspection Team that resident’s are supported to use public transport. One resident’s records sampled in bungalow 23 stated that in five weeks they had been out of the home twice, once to a doctor’s appointment and once to a pantomime. Another residents records sated in four weeks they had been out of the home six times, twice for a walk, three times shopping and once for a doctors appointment. One residents records showed that in six weeks they went out of the home five times: shopping, Tamworth, out for lunch, church and to the park. In another Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 Page 13 eight weeks records sampled they had been out of the home four times: drive, park, pub lunch and to a pantomime. The ex by ex said, “ I don’t think that the residents do much at all. I feel that both bungalows need more activities to do when residents are in”. One resident spent most of the day in the kitchen colouring, which she said she enjoyed doing. One resident went out with a member of staff to do the weekly food shop. Staff in bungalow 21 told the Inspection Team that the residents sometimes go to the pictures, a meal or bowling. Staff told the Inspection Team that one of the residents enjoys gardening, which they do once a week. Staff told the Inspection Team that some of the residents were on a waiting list to go to college. Staff also said that residents are on a college programme where they get paid to learn basic skills. The Inspection Team observed one of the residents in bungalow 23 moving around the floor. Staff put a mat on the floor to make it safer and more comfortable but the resident kept hitting their back on a cabinet. One staff member did get up a couple of times to re-adjust the pillow that was supporting her back. The ex by ex said, “That was the only interaction I saw this resident receive from staff while I was there”. Staff said that three of the residents in bungalow 23 went on holiday this year. Staff said that a holiday was booked for the other residents but had to be cancelled because of difficulties with residents accessing their money from their bank accounts. Staff in bungalow 21 told the Inspection Team that two resident’s had been on holiday but because of the dispute over money other resident’s didn’t have a holiday. This is unacceptable and this situation must be resolved. Staff told the Inspection Team that residents are supported to maintain contact with their family and friends through visits, telephone calls and sending cards. Relatives said that staff make them welcome when they visit and they can see their relative in private. Relatives also said that they are kept informed of important matters affecting their relative. The Inspection Team saw a member of staff support a resident to do their laundry. One resident’s records showed that they were regularly supported to do this. Staff were supporting one of the residents to clean their bedroom. The kitchen in bungalow 21 was locked and staff said this was to keep the residents safe from harm. At the last inspection it was identified that it was not safe for some residents to be left in the kitchen unsupported by staff. It was also noted at previous inspections that residents benefit from and enjoy spending time in the kitchen. Staff must be available to support residents to spend time there. Where this is not possible a protocol must be in place stating the reasons for the restriction and what measures are to be put in place to ensure residents are supported to increase their independence skills. Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 Page 14 Staff told the Inspection Team that there is a set menu on a 4 weekly basis. Staff said that the menus had just been updated to include more fresh fruit and vegetables. Menus included a variety of food with fresh fruit each day. The menu in bungalow 21 stated beef broth for lunch however this was not available. For the evening meal it stated vegetable curry but there were not enough fresh vegetables to make it. For dessert it stated bananas and custard but no bananas were available. In bungalow 21, the Inspection Team observed the residents were having their lunch. One resident pushed their soup away. The Inspection Team thought that the resident clearly did not want the soup however the staff did not offer an alternative. The ex by ex said, “ This was terrible. The staff took it that the resident wasn’t hungry but they probably didn’t want the soup. It didn’t look very nice”. Staff in bungalow 23 showed awareness of the dietary needs of individual residents. In bungalow 23 residents food records sampled showed that fresh fruit and vegetables had been offered to residents. However, the recommended daily intake of five portions had not been offered on any of the days sampled. Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 Page 15 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 Arrangements are not adequate to ensure that residents always receive personal support in the way they prefer and require. Adequate arrangements are not in place to ensure that resident’s health needs are met. Arrangements for the management of the medication are generally sufficient to ensure that residents are protected from harm. EVIDENCE: Residents were well dressed and staff had obviously spent time supporting residents with their personal care. Residents had individual toiletries that were appropriate to their skin type. In bungalow 23 staff were observed using the hoist to move residents from one position to another. Staff talked to the person explaining where they were moving to and took time to ensure the person was safely transferred. Resident’s manual handling risk assessments and guidelines sampled were not all regularly reviewed and updated where necessary. These must be regularly reviewed so that staff are aware of how to move individual residents safely. The ex by ex observed one resident who made noises and sounded distressed. The staff came to her and understood that she needed help. One resident in bungalow 23 was sitting in a chair in the lounge having their food through a PEG tube. Their clothing was soiled and their mouth needed wiping. Staff came in and out of the lounge but did not wipe the residents Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 Page 16 mouth for at least 35 minutes. This resident looked uncomfortable in their chair with one of their legs hanging off the footrest. The speech and language therapist and dietician are involved in the care of some residents. The dietician had advised that one resident needed to be weighed weekly. However, their records showed that they had not been weighed for over seven weeks. Before that they had not been weighed weekly as advised. Other residents weight records showed that they had not been weighed as regularly as the dietician had advised. In bungalow 23 residents records sampled included a Waterlow assessment that had been regularly reviewed and updated. This cross-referenced to the residents care plan for their pressure area care. This was not evidenced in the residents records sampled in bungalow 21. Staff were observed ringing the GP on behalf of a resident to make an appointment after getting their blood test results. Two residents records did not include details of when the resident last had a check up at the dentist. Health Action Plans were not available for residents. The acting manager was observed making appointments with the GP so that each resident could have a health check, after which individual Health Action Plans would be developed. Medication is stored in a locked cabinet. Boots supply the medication to the home using the monitored dosage system. Medication administration records had been signed for and cross-referenced with the blister packs indicating that medication had been given as prescribed. One resident in bungalow 21 who has epilepsy had an epilepsy protocol as to when to administer ‘rescue’ medication. This was not detailed and said to administer after they have had a seizure for five minutes. It needs to include more detail on what types of seizure the resident has and for how long their seizures usually last. A referral must be made to the epilepsy nurse who must be involved in developing the protocol. In bungalow 23 one residents protocol for rectal diazepam medication for epilepsy was not signed by the doctor and this is required. A list of signatures of staff that administer medication is at the front of the medication folder so it is easy to establish when auditing the records which member of staff has given the medication. However, this was out of date as some staff have left and should be updated. Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 Page 17 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 Adequate arrangements are not in place to ensure that resident’s views are listened to and acted on. Arrangements are not adequate to protect residents from abuse, neglect and self-harm. EVIDENCE: Staff said that there have been no complaints since the last inspection. The Inspection Team found that there is not an easy to understand complaints procedure displayed around the home. The ex by ex said, “Although the residents have limited understanding there could still be procedures in easy words and pictures”. Since the last inspection the complaints procedure has been updated so that residents and their relatives are aware that they can complain to the CSCI at any time. Relatives said that they were not aware of the complaints procedure. Staff told the Inspection Team that 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 that this is being sorted out as a priority. Having restrictions on their money has prevented some residents from having holidays. The Trust has loaned residents money for activities and clothing but staff said that it has restricted individuals in buying some personal items. This situation must be resolved. Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 Page 18 One resident was observed shouting at staff when they were going to support them with personal care. Staff asked the resident to move to their bedroom, when the resident refused staff were observed to move the resident. Behaviour management guidelines for this resident were not adequate so that staff can support the resident using techniques, such as distraction, that do not involve physical intervention. Staff have not received training in adult protection and the prevention of abuse. None of the staff records sampled included any information as to how staff were recruited to work at the home or evidence that a Criminal Records Bureau check had been applied for. Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 Page 19 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, 28, 29, 30 There have been some improvements to the decoration and furnishings so that generally residents live in a homely, clean and comfortable environment that meets their needs. EVIDENCE: Bungalow 21 Some of the paintwork in the kitchen was damaged. New sofas and curtains have been provided in the lounge and the carpet replaced. The conservatory is being used to store an old table and the piano has been moved in there. The temperature in the conservatory felt cool. None of the residents were sitting in there at the time but all room temperatures must be maintained at 21 degrees centigrade to ensure it is warm enough for residents. In one residents bedroom there was damage to the paint/plaster work behind their bed. Bungalow 23 The Inspection Team saw that the lounge, hall and office carpets were soiled and in need of replacing. The radiator cover in the hall was broken. Some paintwork in the lounge was damaged and dirty and needed repainting. One resident’s bedroom is in need of redecorating and staff talked about new furniture and electrical items that the resident would be buying, which they Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 Page 20 said the resident would benefit from. Two of the resident’s bedroom carpets were soiled and in need of cleaning or replacing. In one residents bedroom the paintwork near to their bed was damaged. A chair was stored in the hall, staff were unsure of who the chair belonged to but said it had been stored there for a while. This must be removed to ensure that there is adequate space in the hall for residents to move around the home safely. Aids and adaptations are provided to meet individual residents needs. Ceiling track hoists are provided in the resident’s bedrooms and in the bathrooms. A weighing hoist is provided in the bathroom in bungalow 23.Adapted bathing facilities are provided so that residents can access these easily with staff support where necessary. The Inspection Team saw that both of the homes were clean and tidy. Resident’s bedrooms were generally well decorated according to individual tastes and interests. Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 Page 21 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 Adequate arrangements are not in place to ensure an effective staff team support residents and staff are not appropriately trained to meet residents’ individual needs. Residents are not protected by the home’s recruitment practices. EVIDENCE: The Social Care Manager said that there are five staff vacancies in each bungalow. In bungalow 23 the rotas for week commencing 5/12/05 showed that bank staff were used to cover eleven shifts. Relatives said, “there are often staff on duty who the residents do not know. The staff do not know the residents so cannot recognise individual behaviour patterns they display when they want their needs met. This I feel can often explain some of my relatives changes in behaviour as they cannot make themselves understood if there are staff who are not trained or familiar with the individual to recognise their needs which cause frustration ”. Relatives also said, “The regular staff are wonderful.” One member of staff who has recently started working at the home said they are doing NVQ level 2 in Care at a local college. Staff records sampled in bungalow 21 were inadequate and did not include the required information. None of the records included any information as to how staff were recruited to work at the home or evidence that a Criminal Records Bureau check had been applied for. Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 Page 22 Three qualified nurses records were sampled. None of these records showed that the nurses PIN had been checked to ensure they have the necessary qualifications and continue to be registered with the Nursing and Midwifery Council. Staff records sampled showed that four of the ten staff had not completed training in manual handling. In addition, two of the six staff that had received training in manual handling last received it over eighteen months ago. Several of the residents require assistance with their mobility and hoists are provided to assist residents to transfer from one place to another. Therefore, it is important that staff are appropriately trained to use the hoists and move people safely. Only four of the ten staff had received training in food hygiene although it is an implicit part of the staff role to prepare meals for residents. Only one of the ten staff had received training in first aid. There was little evidence that staff had received training in meeting the specific needs of residents. One member of staff had received training in communication skills; one in dysphagia and two staff had received training in autism. There was no evidence that staff have received regular, formal, recorded supervision sessions with their line manager. There were no records of supervision sessions for nine of the staff. The other member of staff had records of supervision in May and August 2003 only. Staff said that they have not received regular supervision. There must be established arrangements in place to ensure that all staff receive regular, recorded supervision meetings at least six times a year. This enables them to translate the homes philosophy into work with residents, monitoring of work with individual residents, support and professional guidance and identification of training and development needs. A letter of ‘serious concern’ was sent to the provider following the inspection about staffing, recruitment practices, staff training and supervision of staff. Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 Page 23 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, 42 Adequate arrangements are not in place to ensure that residents benefit from a well run home. Resident’s views do not underpin all self- monitoring, review and development by the home. Arrangements are not adequate to ensure that the health, safety and welfare of residents are always promoted and protected. EVIDENCE: The registered manager took a career break for one year from July 2005. An acting manager was in post but has since left. An acting manager started working at the home on the day of the inspection. The Social Care Manager said that the Trust are hoping to pursue registering the two bungalows as two separate registrations with a registered manager in each. They have advertised the manager’s position and a manager will be transferred from another home to fill the other post. It is hoped that both managers will start working at the home at the same time. Relatives said, “ The fact that they do not have a manager is a disgrace as they were aware that the previous manager was going in June.” They also Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 Page 24 said, “ without a manager there is nobody for the staff to be accountable to so ‘bad practice’ can set in.” There are several requirements arising from this inspection and some that have not been met from previous inspections indicating that the staff have not been adequately supported. Staff were unaware whether there was a formal quality assurance system in place. A manager from the Trust visits monthly to undertake an audit. There must be a formal system in place to ensure that all aspects of the service are regularly audited and improvement plans are put in place and regularly monitored. This should include the views of residents and their representatives where appropriate. Records of fridge/freezer temperatures showed that these have not been tested daily to make sure that these are at the correct temperature to store food safely. There was a record in bungalow 23 to show that the portable electrical appliances had been tested in April 2005. There was a record that an engineer had completed the five -year electrical wiring testing in September 2005. However, the certificate for this was not available and it was not clear whether they stated that the wiring was in a satisfactory condition. A Corgi registered engineer tested the gas equipment in June 2005 and stated that it was in a satisfactory condition. Cupboards containing hazardous materials were locked to keep residents safe from harm. In bungalow 23 there were records to show that an engineer regularly services the fire equipment. Staff regularly test the fire equipment to make sure it is working. A fire drill took place in June 2005. These need to be every six months to make sure that staff and residents are aware of the procedure to follow if there was a fire. In bungalow 21 staff had not tested the fire alarm regularly. Staff have not received training in fire safety every six months to make sure they are aware of what to do if there is a fire and of ways to prevent a fire starting. The fire risk assessments have not been reviewed in 2005 to ensure that the risks of a fire starting are minimised. Staff test the water temperatures weekly and alternate so that all water outlets are tested monthly. A record of these is kept, which indicated that these ranged from 40 – 42 degrees centigrade, which is below the recommended safe temperature of 43 degrees centigrade. The records in bungalow 21 did not clearly state which outlet had been tested. Records showed that the hoists are regularly serviced. Staff have not received training in fire safety, first aid, food hygiene and health and safety so that they are not aware of how to keep residents safe. Incidents of staff having their cars damaged and broken into in the car park outside the home have been reported to the CSCI. There is a CCTV system and a security camera outside the home but staff said that a contractor recently advised that the camera should be moved so that it is more effective. Staff said that there have been incidents of people standing by their cars when they Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 Page 25 go off duty. Staff were obviously concerned by this and this situation must be addressed so that the safety of staff and residents is protected as much as possible. Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 Page 26 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 1 x x x 1 Standard No 22 23 Score 2 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 1 2 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 2 3 2 3 3 LIFESTYLES Standard No Score 11 x 12 2 13 2 14 1 15 3 16 2 17 Standard No 31 32 33 34 35 36 Score x 2 1 1 1 1 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Trittiford Road Nursing Home Score 2 1 2 x Standard No 37 38 39 40 41 42 43 Score 1 x 1 x x 2 x DS0000024900.V264437.R01.S.doc Version 5.0 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 5(1)(2) Requirement The statement of purpose of the home must be available and include all the information required in Schedule 1. Each resident must have a copy of the service users guide. It must include all the information required in Regulation 5. Each resident must have an individual contract that states the terms and conditions of their residence. Residents care plans must be reviewed and updated when their needs change. Daily records of care must be completed and be available for inspection. Residents and their representatives must be consulted on all aspects of life in the home. Any decisions made must be documented.(Previous timescales not met). The provision of activities must be reviewed and increased, to ensure residents have a choice of activities from which to choose on a daily basis. Community presence for DS0000024900.V264437.R01.S.doc Timescale for action 28/02/06 2 YA1 28/02/06 3 YA5 5(1) 31/03/06 4 5 6 YA6 YA6 YA8 15(1)(2) Sch 3(3) (m) 12(2,3) 16(2)m,n 31/01/06 08/12/05 28/02/06 7 YA14YA12 16(2)(m, n) 31/01/06 Trittiford Road Nursing Home Version 5.0 Page 28 8 YA16 12, 13(6) 9 10 11 YA17 YA18 YA18 16(2)(i) 12(1)(a, b) 13(5) 12 YA19 12, 13(2) 13 YA19 13(2)(4)c 14 YA19 13(1)(b) 15 YA19 12(1)(a) 16 YA19 12(1)(a), 15 residents must be reviewed and work undertaken to ensure resources and staffing are available to support these. (Previous timescales of 31/01/05 & 31/07/05 not met) Written protocols must in place where restrictions are placed on residents i.e. locking the kitchen door in bungalow 21. A nutritious and varied diet must be offered to residents. (Previous timescale not met). Appropriate personal care must be offered to all residents. Manual handling risk assessments and guidelines must be reviewed and updated when residents needs change. Referrals must be made to the epilepsy nurse for all residents who have epilepsy and require ‘rescue’ medication. Epilepsy protocols must be detailed, fully completed and signed by the professionals involved. (Previous timescale of 31/07/05 not met). All residents must have regular health check –ups. A record of these appointments must be made. (Previous timescale of 31/07/05 not met). All residents must be weighed monthly and a record of this kept. Where the dietician has advised that residents must be weighed more often than monthly this advice must be followed. Pressure area assessments must be regularly reviewed and updated where necessary. These must cross-reference to a care plan on how staff are to support the resident to minimise the risk of them developing a pressure sore. DS0000024900.V264437.R01.S.doc 31/01/06 15/01/06 08/12/05 31/01/06 15/01/06 28/02/06 31/01/06 31/01/06 08/01/06 Trittiford Road Nursing Home Version 5.0 Page 29 17 YA19 12(1) (a)(2)(3) 13(2) 13(6) 18 19 YA20 YA23 20 21 22 23 24 25 26 27 YA23 YA35YA23 YA24 YA42YA24 YA24 YA28YA24 YA24 YA26 20, 17(2) Sch 4 13(6) 18(1)(a) 23(2)(d) 23(2)(p) 23(2)(b) 16(2)j 23(2)b,d 23(2)(b, d) 16(2) 23(2)b,d 28 29 30 YA28 YA33 YA23YA34 23(2)c 12(1)(a) 18(1)(a) 7,9,19, Sch 2 Each resident must have a Health Action Plan in line with ‘Valuing People’. (Previous timescale of 30/09/05 not met). A copy of all prescriptions must be kept in the home. Behaviour management guidelines must be available for all residents that display ‘challenging behaviour.’ All staff must follow these consistently. Physical intervention must only be used as a last resort and in accordance with the individual’s guidelines. Each resident must have access to their bank account. All staff must receive training in the prevention of abuse. A plan of redecoration work over the next 12 months must be submitted to the CSCI. All room temperatures must be maintained at 21 degrees centigrade. The radiator cover in the hall in bungalow 23 must be repaired. The lounge carpet in bungalow 23 must be replaced. (Previous timescale of 31/08/05 not met). The hall and office carpets in bungalow 23 must be replaced. The identified bedroom carpets in bungalow 23 must be cleansed to a satisfactory standard or replaced. (Previous timescale of 31/08/05 not met). The chair stored in the hall of bungalow 23 that is no longer used must be removed. All staffing vacancies must be recruited to. (Previous timescale of 31/08/05 not met). For each member of staff employed the required records under Schedule 2 must be available in the home. DS0000024900.V264437.R01.S.doc 31/03/06 08/01/06 31/01/06 12/02/06 31/03/06 31/01/06 08/12/05 15/01/06 28/02/06 30/04/06 28/02/06 08/01/06 28/02/06 28/02/06 Trittiford Road Nursing Home Version 5.0 Page 30 31 YA35 18(1)(c) 32 33 34 35 36 37 YA36 YA37 YA39 YA42 YA42 YA33YA42 18(2) 9 24(1)(2) (3) 13(4) 23(4)c (v) 23(4)(a) 38 39 YA42 YA42 23(4)(a) 13(4)(a – c) 13(4)(ac) 13(4)(ac) 40 41 YA9YA42 YA42 All staff must receive the appropriate training to meet the needs of residents. A record of this training must be available in the home. All staff must have regular, recorded, formal supervision sessions with their line manager. A manager must be recruited to work at the home. A formal quality assurance system must be in place. The fridge/freezer temperatures must be recorded daily. (Previous timescales not met). The fire alarm in bungalow 21 must be tested weekly and a record of this kept. All staff must receive regular training in fire safety. A record of this training must be available in the home. The fire risk assessments of both bungalows must be reviewed and updated as necessary. Evidence that an electrician has completed the five - year electrical wiring test must be available in the home. All risk assessments must be regularly reviewed and dated. An adequate security system must be provided. 31/03/06 31/01/06 28/02/06 30/04/06 08/12/05 08/12/05 31/01/06 08/01/06 15/01/06 31/01/06 31/01/06 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 Refer to Standard YA6 YA14 Good Practice Recommendations It is recommended that person centred plans be explored and undertaken with residents. Each resident should be offered the opportunity to go on holiday each year. DS0000024900.V264437.R01.S.doc Version 5.0 Page 31 Trittiford Road Nursing Home 3 4 5 YA20 YA22 YA42 The list of staff signatures at the front of the medication administration records should be updated. The complaints procedure should be in an accessible format for the residents. The water temperature testing records should clearly state which outlet was tested. Trittiford Road Nursing Home DS0000024900.V264437.R01.S.doc Version 5.0 Page 32 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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