Inspection on 19/04/07 for Ulysses House

This inspection was carried out on 19th April 2007.

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 23 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ulysses House 25/04/08

Ulysses House 15/10/07

Ulysses House 10/10/06

Ulysses House 04/05/06

Ulysses House 12/10/05

Ulysses House 27/04/05

Ulysses House 13/01/05

Ulysses House 01/09/04

Ulysses House 07/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Ulysses House 28 Fountain Road Edgbaston Birmingham West Midlands B17 8NR Lead Inspector Sarah Bennett Key Unannounced Inspection 19th April 2007 09:25 Ulysses House DS0000016734.V334881.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 Ulysses House DS0000016734.V334881.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. Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ulysses House Address 28 Fountain Road Edgbaston Birmingham West Midlands B17 8NR 0121 429 9555 0121 429 9777 ulysses653@aol.com 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) Ulysses Care Limited Vacant – Acting Manager in post Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years. Date of last inspection 10th October 2006 Brief Description of the Service: Ulysses House offers accommodation for up to six young adults with learning disabilities who present with challenging behaviour. Ulysses House is a large, three storey, semi-detached Victorian house. The home is located in a residential area in Edgbaston and is well served by public transport. It is within walking distance of local shops, pubs and restaurants and the centre of Bearwood and is a short bus ride from the centre of Birmingham. Each resident has their own bedroom, two of which have en suite facilities. The home has a large dining room and kitchen, comfortable sitting room and utility room/laundry. The staff sleeping in room is also used as the office. The home offers a bathroom on the first floor and a WC on the ground and first floor. The premises can accommodate fully mobile adults, and does not offer disabled access or adaptations. There is a large enclosed garden to the rear of the house offering a large patio area and a lawned area. The CSCI inspection report is available in the home for visitors to read if they wish to. The Acting Manager said that the fees charged are from £1,000 - £1500 per week. The contract stated that these do not include clothing, leisure activities, meals out of the house, personal items, transport costs or holidays (over £130). Ulysses House DS0000016734.V334881.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. One inspector carried out the unannounced fieldwork visit over seven hours. This was the homes first key inspection for the inspection year 2007 to 2008. The staff on duty and the manager were spoken to. 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? Prospective residents have the up to date information about staffing and management in the service users guide so they know what is provided. Person centred plans had been developed with individuals so that staff know how to support people to meet their needs and do what they want to do. There are risk assessments that say how often staff need to check each person during the night so they are not disturbed unnecessarily. Where restrictions are put on people there are agreements so it is clear that all agree that the restriction is for the benefit of the individual. Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 6 Each resident has a Health Action Plan. This is a personal plan about what a person needs to stay healthy. The times of some staff meetings have changed so that staff that work at nights can also come to these and be involved and kept up to date with what is happening. Some redecoration and maintenance work had been done making the home a nicer place to live. What they could do better: All the people that live in the home must do activities that they enjoy doing and that will help them to develop skills and meet their needs. Health professionals must be involved when needed to ensure that individual’s health needs are met. Residents should have regular check –ups with the dentist so that their oral hygiene is promoted. Some further redecoration and maintenance is needed to make sure the home is a comfortable and safe place to live. One resident said that they would like to have a bigger wardrobe, as they do not have enough room to hang their clothes up. Enough plates, bowls and cups must be provided so that residents and staff can sit together to eat their meals. Residents said that they would like a lock on their bedroom door. Each bedroom must have a lock that can be opened from the outside if staff need to get in if the person needs help in an emergency. More staff must be employed to work there so that people can go out and do the things that they want to do. Information about staff must be provided so that it is clear that the right people are employed to work with the people who live in the home. Staff must receive the right training to make sure that they know how to support individual residents in the right way and keep them safe. There must be a quality assurance system in place that includes the views of the people who live in the home and their representatives so that their views make a difference to the service provided. Water temperatures must not be too hot or cold so that people can wash comfortably without being scalded or the water being too cool. Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 7 Fire equipment must be repaired when needed so that there is warning of there being a fire and if there is a fire it does not spread quickly. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have the information they need so that they can make an informed choice about whether or not they want to live at the home. Each person that lives in the home has an individual contract that states the terms and conditions of their stay. EVIDENCE: Two residents records were sampled. These included a copy of the service users guide. This was produced using pictures and some words making it easier to understand. It included all the relevant and required information about the home. The statement of purpose had been updated since the last key inspection. This was also produced using pictures and included the relevant and required information. Since the last key inspection where the assessment for a new resident was assessed and the standard met there have been no residents admitted to the home so this standard was not assessed. There are no vacancies for residents. Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 10 Resident’s records included an individual contract that stated the terms and conditions of their stay at the home including the fees charged and their rights and responsibilities. Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each person had a care plan so that staff know how to support them to meet their needs and achieve their goals. The people who live in the home are supported to make decisions and choices and are consulted on what goes on in the home. People are supported to take risks within a risk assessment framework to ensure they are safe from harm. EVIDENCE: Resident’s records sampled included individual care plans. These stated how staff are to support individuals with their behaviour, health needs, leisure and daily activities, accessing the community, eating and drinking, personal care and finances. Each resident had a personal planning book. This had been developed with the individual, their relatives where appropriate and their key worker. Goals had been set from this for individuals and these are discussed with their key worker at monthly key working sessions. Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 12 Regular meetings are held with the people who live in the home and minutes of these are kept. There were discussions about activities they wanted to do, menus, bedrooms and holidays. A meeting was planned for the next weekend and an agenda was put on the office door for people to add to if they wanted to. During the day residents were observed making decisions about what they wanted to do, where they wanted to go, what they wanted to eat and drink and how they wanted to spend their money. Resident’s records sampled included individual risk assessments. These included details of how staff are to support individuals to minimise the risks of financial abuse, the person’s inappropriate behaviour, going out on their own, health risks, injury from self injurious behaviour, accessing the community. Since the last key inspection individual risk assessment had been developed as to how staff are to support each person during the night. This ensures that staff do not disturb people’s sleep unnecessarily. One resident carried an ID card and said that this was to ensure their safety when they go out on their own. This included their name and address and who to contact in an emergency and was one of the actions stated in their risk assessment to reduce risks when going out on their own. Risk assessments cross-referenced to care plans where appropriate so it was easier for staff to see what support was needed and why. Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 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 people living in the home always experience a meaningful lifestyle. Residents are offered a healthy diet that meets their individual needs. EVIDENCE: Records and activity plans sampled showed that people go to college where they do cooking, art and pottery. One person had an interview at college in the afternoon for an Independent Living course. Staff supported them to go to this. In one person’s personal planning book their relative had added that they used to go to clubs and that he used to like bowling and maybe these were activities they could try again. The manager said that the person hopes to do these but at the moment this is difficult due to the staff vacancies. The minutes of the staff meeting held on 10th April stated that there are a lot of activities planned at the weekends but staff said there is not enough staff or money to carry out all the activities. The manager said he would look at the rotas and ensure that Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 14 there were enough staff. Rotas sampled did not show that extra staff are employed to work weekends. Records showed and residents and staff said that they go shopping, to cafés, parks, out for walks, to cinemas and football matches. An agency staff member said that they often go out with residents to the cinema, on bus rides, to parks and swimming. They said that people go out more often in the mornings when there is four staff on as there are three staff in the afternoons and one person needs 1:1 support. At the random inspection staff said that one resident enjoys going swimming but there is only member of staff that can take him. Staff also said that there should be more sensory activities for the person, as he would benefit from this. Staff had said this to the manager but activities had not been planned. At the key inspection records showed that these had not been planned and the member of staff who takes the person swimming was absent due to sickness. No contingency plan had been made so this resident could still take part in his preferred activities. Since the last key inspection all residents had been on holiday with staff to Center Parcs in Nottingham. One person said that they would like to go there again. Two people said that they want to go to Spain on holiday this year. The manager said that they are applying for individuals to have passports so that if they wish to go abroad this will be possible. Staff were observed talking to residents about budgeting their money so they would be able to save some money to go on holiday. Where appropriate people are supported to keep in contact with their family and friends. Two people had been to stay with relatives over the Easter holiday. Records showed that residents are supported to phone their family and buy presents for them on special occasions. Records showed and people were observed doing their laundry, going to buy their daily newspaper, loading the dishwasher, cleaning their bedroom, watering the garden and helping to prepare meals, enabling them to develop their independent living skills. An agency staff member said that the food served at the home is nice and there are fresh vegetables provided everyday. Food records sampled showed that a variety of food is provided that includes fresh fruit and vegetables. There was a bowl of fresh fruit in the hall for people to eat when they wanted to. The menus are developed with the people who live there and they reflected the cultural background of residents. At lunchtime a choice of vegetarian or meat pizza was available as was a variety of fresh salad that was well presented. Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 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 to ensure that the personal care needs of individuals are met. The health needs of individuals are not always met sufficiently, which could impact on their well-being. Arrangements are in place to ensure that the management of the medication protects residents so that they get their right medication at the right time. EVIDENCE: Residents said that they buy their own clothes with support from staff where needed. Residents were clean, well dressed in clothes appropriate to their age, gender and the activities they were doing. Residents had individual styles of hair and dress. For example, one person was wearing a football shirt of the team they support. Records sampled showed that where appropriate health professionals are involved in individual’s care. These included the physiotherapist, psychiatrist and community nurse. Each person had an individual health action plan. This is Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 16 a personal plan about what support the person needs to stay healthy and the healthcare services they need to access. Health records sampled for one person did not state when they last had a check up at the dentist or when their next appointment was due. The manager said this would be in the diary but when he looked at this there was no dental appointment for this person. There was a record in that the person had an eye test last year. Their weight record in January 2007 stated that they had lost 7lb and they had not been weighed since. Staff said this was because he was away in April. However, if a person has lost or gained a significant amount of weight their weight must be checked more often to ensure that they do not have any underlying health needs that could be shown by weight loss or gain. The other persons health records sampled showed that their weight was stable, they went to the dentist and optician in January and had their blood pressure checked regularly. At the random inspection staff were concerned about the sexual needs of one person and the affect this had on their behaviour particularly when going out in the local community. A requirement was made for them to be referred to the community learning disability nurse for advice. The manager said that this had not been done however they were setting up a meeting with the individual’s relative and key worker. Staff said that the behaviour is not happening so often in the community but does at home. They also said that the person is often incontinent of urine at home sometimes several times a day particularly when there are new staff on duty. A referral must be made to the community nurse so that advice on how to manage this behaviour can be given so as not to restrict their activities because of it and to maintain their privacy and dignity. Medication was stored in a locked cabinet that was clean and organised. A local pharmacist supplies the medication in blister packs using the monitored dosage system so that it is clear for staff what medication each person takes and when. Records sampled showed that individual’s have their medication reviewed regularly. Staff had signed Medication Administration Records (MARS) appropriately. The MARS cross-referenced with the blister pack indicating that medication had been given as prescribed. The manager said he is going to do a session on PRN (as required) medication at the next staff meeting as he had found that some of the staff do not know what PRN medication is and when and why individuals should have it. Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Arrangements are in place so that the people who live in the home feel that their views are listened to and acted on. Sufficient arrangements are not in place to ensure that the people who live in the home are protected from abuse, neglect and self-harm. EVIDENCE: Prior to the last inspection an anonymous complaint was made to the CSCI and this was investigated as part of the inspection. The complainant alleged that several staff had left and agency staff were being used which was detrimental to the residents wellbeing. Findings of the random inspection found that there were staffing vacancies and the use of agency staff was detrimental to some resident’s well-being. Requirements were made regarding this and are also made as a result of this key inspection. Information on how to make a complaint was produced using pictures making it easier to understand in the service users guide to the home. Some residents require staff to use physical intervention techniques to manage their behaviour. In the past staff were trained in using Crisis Prevention Institute (CPI) techniques however, none of the staff have updated training in this. Recently staff had received training in Breakaway techniques. Some staff had not received updated training in this and some staff had not received this training at all. All staff must receive this training and behaviour management Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 18 strategies must be updated to reflect the techniques that staff had been trained in using. Recently recruited staff had not had training in adult protection and the prevention of abuse. Since the random inspection residents inventory of belongings had been updated and signed by the individual where they are able to do so. Two individuals personal finance records were sampled. These showed that they spent their money on personal items and receipts were kept of all purchases. Where residents are able to manage their own money staff give them money as they request it to spend as they wish. One of the residents had stopped receiving their benefits, as the benefits agency had not been able to contact them due to a change of address. The manager had contacted the benefits agency and staff supported the individual to attend an appointment in the afternoon as required to get his benefits reinstated. Recruitment records including evidence that a Criminal Records Bureau (CRB) check had been undertaken were not available for two members of staff who had recently been recruited. This does not ensure that the people who live in the home are protected. Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some further improvement is needed to ensure that residents live in a homely, comfortable and safe environment that meets their individual needs. EVIDENCE: Since the random inspection a new wall bed had been installed in the office for sleep-in duties. This replaced a small sofa bed. Staff said this is much more comfortable. The desk in the office had been moved and the room was organised better. In the dining room as previously observed there was damage to the walls under the window from where the table had been pushed into it. There is panelling on a part of another wall in the dining room to stop the plaster being broken and this could be used in this area. As previously observed the TV did not have a clear picture. The owner needs to get better at meeting requirements so that the home is comfortable for the people who live there. A Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 20 pool table, table football game, games, paints and art materials are provided in the dining room for residents use. The door to the dining room from the kitchen does not shut to closing, so if there were a fire in the kitchen the smoke would easily spread to the dining room. Staff said this had been so since the flooring had been replaced in the dining room. An immediate requirement was made for this to be repaired. A follow up visit found that this door was repaired. However, it is important that repairs that could affect the health and safety of the people who live in the home are responded to promptly and not only when a requirement is made by the CSCI. Previously it was found that only a minimum amount of crockery was provided and this was not always enough for residents and staff to have a meal together. A requirement was made for new crockery to be provided but this had not been met. The back of the cupboard in the kitchen next to the cooker was broken and the shelves where the pans were stored were very scratched. These could be a risk to food hygiene, as could the dishwasher that was not working. Resident’s bedrooms were personalised and decorated according to individual tastes and interests. In the residents meeting in February 2007 one person stated that he would like a bigger wardrobe. The wardrobe in his bedroom was very small so there was little space for him to hang his clothes. Two chests of drawers had been provided however, one of the drawers of these was broken. One of the drawers was broken in another resident’s chest of drawers so that people did not have adequate storage for their things. In the residents meeting in March 2007 one person had requested a lock on their bedroom door. This had been fitted with a Yale lock although a spare key is available for staff to open if necessary to gain access. However, it needs to be a lock that can be opened from the outside in the event of an emergency. All bedroom doors must be fitted with these. The base of one residents bed was split and broken and their carpet was stained and in need of replacing. In their bathroom the paint on the wall above the toilet was blistering off and the ceiling wallpaper above it was peeling off. Since the random inspection new shelving had been provided in one residents bedroom so that they had more space to put their belongings. The back of their wardrobe had not been repaired and their radiator cover was broken in places. In one bedroom curtains had been provided since the random inspection to ensure the privacy of the individual. Residents said that they liked their bedroom. The hall carpet on the second floor was worn and in need of replacing. The shower in the shower room on the second floor was not being used as it was leaking. This was also the case at the last inspection in March. The shower rail was loose and coming out of the wall. Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 21 The bottom hinge of the door from the lounge to the garden was broken. The manager said that one resident kicks the door and this had been reported to the owner as needing repair. In the garden the grass had been cut and some small pots had been provided. The manager said that they are going to get a new grill for the barbecue so this can be used. Maintenance records showed that some repairs had been reported but there was not space on the record to write when the repair was completed and who it was reported to. The manager said that he often emails or phones to report maintenance issues and has copies of these in a folder on the computer. This did not make it clear to all staff when things have been reported, what needs chasing up and when jobs are completed. To ensure that the home is well maintained a clear record that all staff can access is needed so that it is easier to track whether or not jobs are completed. The home was clean throughout and free from offensive odours. There were hand towels, hand wash and toilet rolls in all of the toilets and bathrooms so that people can maintain their hygiene. Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff do not receive all the training they need to be able to meet people’s individual and collective needs consistently. The homes recruitment practices do not protect the people who live in the home. Permanent staff are well supported and supervised so that they know how to support the people who live in the home. EVIDENCE: At the random inspection records showed that one member of staff has NVQ level 2 in Health and Social Care and five staff had started this in the last few months. One staff had started NVQ level 3 and another had started NVQ level 4. When staff have completed their training the standard will be met that at least 50 of staff had completed NVQ level 2 or above. Records showed that regular staff meetings are held. The last staff meeting was held at 7pm so that night staff could attend. The manager said there are four full-time vacancies. One member of staff had started working at the home since the random inspection. One Team Leader Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 23 had been recruited but they are only available to work weekends. The manager said that an advert would be going out again for the Team Leader post. Rotas showed that there were two agency staff on duty and two permanent staff, one of whom had recently started working there. One agency staff said they had worked at the home regularly for about a month. Their records showed that they had an induction with the manager on their first shift. The other agency staff had done the sleep-in duty the night before and this was their first shift at the home. The manager said that they are using two agencies to supply staff. Permanent staff said that they often work with agency staff, if they are regular agency staff it does not affect activities but sometimes having agency staff who have not worked there before can affect activities. Staff were observed sitting and spending time talking to residents and listening to any concerns they had. People living in the home said that the staff are alright and help them out. Staff said it would be better to have more permanent staff and that residents would benefit from consistency of care. Staff said that they liked working at the home and that it is like a real home. Staff said that when they first started working there they had a chance to look at care plans and risk assessments so they got to know what support the residents needed. The member of staff who had recently started working there had an induction for three days when they first started. Their records did not include any of the required records pertaining to their recruitment. The manager said that the manager and the owner had interviewed the member of staff at the home but the owner had taken the records to Head Office. Records for the Team Leader that was recently recruited included proof of their identity but no application form, Criminal Records Bureau (CRB) check or references. The other two records sampled included the required records pertaining to their recruitment. The manager said that there had been no further training since the random inspection. He had a meeting planned with a training provider to discus the training that staff need. At the random inspection staff training records sampled showed that staff need refresher training in first aid, moving and handling, fire safety, health and safety and two staff need refresher training in adult protection and the prevention of abuse. New staff recruited had not received this training. In-house training in the new food hygiene regulations was booked for the end of March but there was no evidence that staff had received this training at this visit. None of the staff had received MAKATON training, however one of the residents communicates using this sign language. Staff said that sometimes they do not understand what he is trying to communicate. Most staff required training in epilepsy, autism, infection control and the needs of people who have Downs Syndrome. Some staff had not received training in using CPI techniques and physical intervention. Those that Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 24 had now required refresher training. Some staff had received training in Breakaway physical intervention techniques but this was not the techniques referred to in residents risk assessments and behaviour management guidelines. Staff had received training in the Safe Handling of Medication and Person Centred Planning. Staff said that they are now involved in developing care plans and risk assessments, which helps them to develop their skills. Staff records sampled showed that staff had received regular, formal recorded supervision sessions. Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not managed in a way that people who live there feel confident that their views underpin the review and development of the home. Arrangements are not sufficient to ensure that the health, safety and welfare of the people who live in the home is always promoted and protected. EVIDENCE: A formal quality assurance system was not in place to support the homes continuous development. A representative of the owner visits monthly as required under Regulation 26 and a copy of the report of this is sent to CSCI. Resident’s records sampled included surveys they had completed about their views of the home in August 2006. These were produced using pictures making them easier to understand. Both of the residents stated they were happy living at the home. Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 26 Fire records showed that an engineer visited a few days before and stated that the smoke detector in one of the bedrooms and the emergency light on the first floor landing were not working. The manager said that the engineer is coming back soon to fix it but did not have a date for this. Staff test the fire alarm weekly to make sure it is working. Records of the alarm testing stated since March 7th 2007 that the door from the kitchen to the dining room does not close properly and the emergency light on the first floor landing was not working. An Immediate Requirement was left for these and the smoke detector to be repaired by 25th April 2007. There is a fire drill every three months so that staff and residents know what to do if there is a fire. Staff test the water temperatures weekly. Records of these showed that one person’s sink and bath and the shower on the second floor were above the recommended safe temperature of 43 degrees centigrade. Records stated that the bath on the first floor was running cold or not working. The manager said he was not aware that there was a problem with the water or the bath on the first floor but he will get a new thermometer as he thinks this is not working properly. Some staff use their own cars to take residents out. They do not take one person in their car as assessments have shown that the risks involved in this are too high. One member of staffs insurance certificate was seen that included business insurance. There was no copy of their driving licence available. The manager was advised that if a MOT certificate is needed for the car then a copy of this should also be available. At the random inspection the fax machine was not working and a requirement was made for this to be repaired. This remains outstanding. The manager said that this could cause delay in getting information about residents to professionals. Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 X 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 1 35 1 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X X X 2 X X 1 X Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 28 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 YA12 Regulation 18 (1) (a, b) Requirement Sufficient staff must be available to ensure that residents can take part in varied and fulfilling activities. Timescale for action 30/04/07 2. 3. YA12 YA19 16 (2) (m, A range of appropriate activities 30/04/07 n) must be in place for all residents. 12 (1) (a) A referral to the community nurse must be made for one resident. (Outstanding from random inspection). All residents must have regular dental check – ups and a record of these must be kept. All staff must receive training in adult protection and the prevention of abuse. All staff must receive training in an accredited physical intervention technique suitable to the needs of the residents. The door from the kitchen to the dining room must close properly. The kitchen cupboard must be repaired. The dishwasher must be repaired. Sufficient crockery must be DS0000016734.V334881.R01.S.doc 07/05/07 4. 5. 6. YA19 YA23 YA23 12 (1) (a) 13 (6), 18 (1) (a, c) 13 (7) 18 (1) (a, c) 23 (2) (b) (4) (a, c) (i) 16 (2) (j) 23 (2) (b) 16 (2) (g) 07/05/07 31/07/07 31/08/07 7. 8. 9. YA24 YA24 YA24 25/04/07 07/05/07 30/04/07 Page 29 Ulysses House Version 5.2 provided. 10. 11. YA24 YA26 13 (4), 23 (2) (b) 16 (2) c The hall carpet on the second floor must be replaced. The bedroom carpet in the identified room on the second floor must be replaced. Resident’s bedroom furniture must be repaired. One resident’s bed must be replaced. Residents must have sufficient space to store their clothes and belongings. All bedroom doors must be fitted with a lock that can be opened in the event of an emergency. The shower on the 2nd floor must be repaired so that it does not leak. The shower rail must be repaired. At least 50 of staff must complete NVQ level 2 or above in Health and Social Care. Staffing vacancies must be recruited to. Staff must receive training in meeting the needs of individual residents including Makaton and autism. All staff must receive training in first aid, moving and handling, fire safety, health and safety and refresher training in adult protection and the prevention of abuse. There must be a quality assurance system in place. The emergency light on the first floor landing and the smoke detector in one of the resident’s bedroom must be repaired. Water temperatures must be maintained at 43 degrees centigrade. DS0000016734.V334881.R01.S.doc 31/07/07 30/04/07 12. 13. 14. 15. YA26 YA26 YA26 YA27 16 (2) 23 (2) c) 16 (2) 23 (2) (m) 13 (4) c) c, (b, c, (a- 31/05/07 31/05/07 30/06/07 07/05/07 23 (2) (b, c, j) 18 (1) (a, c) 18 (1) (a) 18 (1) (a, c) 16. 17. 18. YA32 YA33 YA35 31/12/07 30/04/07 31/07/07 19. YA35 18 (1) (a, c) 31/08/07 20. 21. YA39 YA42 24 (1) (2) (3) 13 (4) (ac), 23 (4) (a, c) 13 (4) (ac) 31/08/07 25/04/07 22. YA42 07/05/07 Ulysses House Version 5.2 Page 30 23. YA43 16 (2) (a) (ii) The fax machine must be repaired. (Outstanding from random inspection) 14/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA24 Good Practice Recommendations A maintenance record that clearly records what maintenance is required, who it has been reported to, when it is reported and when the job is completed should be in place. Consideration should be given to providing a computer for residents to use. It is recommended that the garden be further developed to increase the use of it by residents. Outstanding from previous inspections. 2. 3. YA24 YA28 Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ulysses House DS0000016734.V334881.R01.S.doc Version 5.2 Page 32 - 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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