Inspection on 25/04/08 for Ulysses House

This inspection was carried out on 25th April 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ulysses House 15/10/07

Ulysses House 19/04/07

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 28/09/2008.

CARE HOME ADULTS 18-65 Ulysses House 28 Fountain Road Edgbaston Birmingham West Midlands B17 8NR Lead Inspector Sarah Bennett Key Unannounced Inspection 25th April 2008 09:20 Ulysses House DS0000016734.V363975.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.V363975.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.V363975.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 Miss Margaret Irene Medlock Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Ulysses House DS0000016734.V363975.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th October 2007 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 person living there 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. There is a bathroom on the first floor, shower facilities on the first and second floors and a WC on all floors. 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 service users guide did not state the fees that are charged to live at the home. Ulysses House DS0000016734.V363975.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The visit was carried out over one day; the home did not know we were going to visit. This was the homes key inspection for the inspection year 2008 to 2009. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home. This included surveys completed by the people living there and their relatives and friends. Two people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. The people who live at the home, the manager and the staff were spoken to. Some people living there were unable to verbally communicate their views about the home due to their communication needs. 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: Each person has their own care plan so that staff know how to support them to meet their needs and do the things they want to do. People living there said, “The staff always treat me well. They always listen and act on what I say.” “I am happy.” The people living there have an individual health action plan. This is a personal plan about what a person needs to stay healthy. Staff know how to help each person to meet their health needs. Ulysses House DS0000016734.V363975.R01.S.doc Version 5.2 Page 6 When needed health professionals get involved to give advice and support so that individual’s health needs can be met. Friends of the people living there said, “ The people living there are extremely well cared for and are happy and content in their environment. We very much look forward to visiting.” Each person has their own bedroom with a number of personal belongings in them. This gives them their personal and private space. People have the freedom to go out on their own if they want to and are able to. Staff make sure it is as safe as possible for them to do this. The people who live there know who their key worker is and said they helped them to do the things they want to do. People who live there do the activities they enjoy doing and that help them to develop skills and meet their needs. Staff have training to make sure they know how to support individuals in the right way and keep them safe. What has improved since the last inspection? There is a new manager who knows how to run the home so it can benefit the people living there. Bedroom doors now have a lock that can be opened if there is an emergency so that staff can help people to be safe. Water temperatures are not too hot so that people are not at risk of being scalded. The people living there have been weighed when needed. This helps to make sure their health needs are met. Some further redecoration had been done to make the home more homely and comfortable to live in. Some things had been repaired so the home is safe for people to live in. Records show that the fire equipment is tested to make sure it is working. This will make sure that the people living there and staff are able to get out in an emergency. There is a quality assurance system that asks what the people living there think about the home so that their views make a difference to the service provided. Ulysses House DS0000016734.V363975.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ulysses House DS0000016734.V363975.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.V363975.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have most of the information they need so they can make a choice as to whether or not they want to live there. EVIDENCE: Records sampled included a service user guide. This was produced using pictures making it easier to understand. It included most of the relevant and required information so prospective service users would have the information they need to make a choice as to whether or not they want to live there. It did not state the fees charged. These should be included so that this information is available. The statement of purpose was reviewed in January 2008 and included the updated information about the changes in managers and staffing. Although the fees charged were not included it stated that the fees do not include toiletries, hairdressing, magazines and papers, public transport costs including taxi, clothing, entrance fees to activities, snacks over and above those provided and repair/renewals where damage is caused deliberately. People living there said, “My relatives received enough information about the home before I moved in.” Ulysses House DS0000016734.V363975.R01.S.doc Version 5.2 Page 10 There were six people living at the home so there were no vacancies. The people living there have lived at the home since before the last inspection. Therefore, the standard relating to assessment was not assessed at this visit. Ulysses House DS0000016734.V363975.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, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have the information they need in care plans and risk assessments so they know how to support individuals to meet their needs whilst ensuring their safety and well being. The people living there are supported to make choices and decisions about their day-to-day lives. EVIDENCE: Two records of the people living there were looked at. These included an individual care plan that detailed how staff are to support the person to meet their needs. Care plans cross-referenced to other documents where appropriate such as medication charts and behaviour management strategies so that it was clear to staff how to support the person in all areas of their life. Where people are able to they had signed their care plan to say that they agreed to it. Ulysses House DS0000016734.V363975.R01.S.doc Version 5.2 Page 12 Relatives said, “ We always feel that the home meets our relatives needs. Staff always give the support or care that we expected or agreed. The care staff have the right skills and experience to look after people properly and usually meet the different needs of people.” Records also included a person centred plan (PCP). These were dated 12/06 and had not been reviewed since. It was produced using pictures making it easier to understand and it was clear that the person had been involved in it. It stated the goals that the person wanted to achieve. These were short-term, within one year and within five years. There was no evidence in the person’s records that the person had been supported to meet their goal for one year or how they were being supported to achieve their goal in five years. The manager said that now there is a new staff team in place progress will be made on PCP’s involving the individual and their key worker. Key workers had met with the individual monthly to talk about their progress. One person said they were happy with the activities they were doing, they were happy with the menu and had been helping to make him a drink or sandwich and they were more independent with their personal care. Some of the people living there communicate using Makaton (a sign language). Staff were observed communicating well with individuals using Makaton. Two people attend a Makaton class at a local college. There were pictures of Makaton signs on the wall in the office to remind staff of these. Meetings had been held with the people living there. The minutes of these had been produced using pictures making them easier to understand. People had talked about health and safety i.e. not leaving things lying around, which could cause people to slip or fall, risk assessments, their health action plans, where they want to go on holiday, smoking, the plans for the garden and the decoration of their bedrooms. People said at one meeting that they liked the choices available on the menu. At one meeting staff talked to people about encouraging them to be more independent in doing household tasks and reminded staff not to do things for people. Records included individual risk assessments. These detailed how staff are to support the person to be as independent as possible whilst minimising any risks to their health, safety and welfare. Risk assessments had been regularly reviewed and updated if necessary. Staff had signed the risk assessments to say they had read them and agree to follow them so there is consistency of care. Ulysses House DS0000016734.V363975.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. The people living there experience a meaningful lifestyle. People do not have a healthy diet, which could impact on their health and well being. EVIDENCE: Some people attend college for computer, art and Makaton courses. One person attends a supported work placement four days a week. When they returned from this staff were observed talking to him about his day, which seemed to go well. One person said, “ I go out on buses on my own using my bus pass. Staff have talked to me about going on holiday but I am not sure where I want to go yet.” Ulysses House DS0000016734.V363975.R01.S.doc Version 5.2 Page 14 Relatives said, “The people living there are supported to live the life they choose. During the time our relative has been at Ulysses his quality of life has improved beyond expectations.” Throughout the day people were observed going out with staff to do individual activities or doing activities in the home. Daily records sampled showed that people go shopping, on bus rides to the places they want to go to, watch TV and DVD’s, spend time in the garden on the trampoline, have a massage, go for walks, go to parks, go to zoos and pet shops, to restaurants, colouring and drawing and going to pubs. Records sampled showed that the person went out most days if they wanted to. People who were able to had written their own activity plan for the week. Holidays were being planned for this year. One person wants to go to Spain and another to New York. Staff said they were looking at how they could ensure that people had an opportunity to go to the places they want to go to. The other four people said they wanted to go on holiday but did not know where they would like to go. Staff suggested that they might want to go to Center Parcs, Nottingham where they have enjoyed going to before. People said that they would like to do this. One person said they went to Blackpool last year and had a good holiday. One person was going to visit their relative for the weekend. Staff said the person usually goes once a month and his relative also visits them at the home. Staff go with the person on the bus to meet their relative at the bus station. Relatives said that staff help their relative to keep in touch with them by regular phone calls. Records showed and people said that they have regular contact with their family where this is appropriate. Where contact with their family is not possible the manager said that they are trying to get an advocate for the person. This will ensure that they have contact with a person independent from staff at the home who can speak on their behalf when necessary. Records sampled showed and it was observed that the people living there are supported to be as independent as possible. This included doing their laundry, cleaning their bedrooms, changing their bed, going shopping, emptying the bins and putting out the rubbish, going to the post office to withdraw their money and feeding their fish. The home has built up a relationship with the local police. One person invited them for lunch and helped to prepare this with staff. Staff said that it was a really positive day and that the people living there are more confident about how they would contact the police and their role in the community. There is a social work student on placement at the home, for which the home gets an allowance. Staff said they are using this to improve the garden and plant a vegetable garden at the bottom of garden, an area that has not been used before and will benefit the people living there. Ulysses House DS0000016734.V363975.R01.S.doc Version 5.2 Page 15 Food records sampled showed that people are not having a healthy diet that includes five portions of fruit and vegetables a day. One person’s records sampled showed that they had chips three times in five days. Another person who needs to lose weight to improve their health often had chips or potato wedges, both of which have a high fat content. Records showed that where people had refused breakfast staff had advised them to eat it and the benefits of this to their health. For one person who needs to gain weight there were records of them having nourishment drinks and milkshakes, which would help them to gain weight whilst getting the nutrients they need to improve their health. Menus and food records showed that people ate food that was reflected their cultural background and they had a choice of what they ate. Staff said that the menus are changing. They are going to be in picture format making them easier to understand. There are going to be fewer potatoes with chips only once a week. One a month they are having a ‘culture night’ with foods from different parts of the world offered to give people an opportunity to taste different things. Staff said they had spoken to the people living there about the menu changes and they were happy with it. The menu will also include alternatives. Staff said they are also going to cut down on portion sizes to ensure healthy diets. There were fresh vegetables and salads in the fridge. At lunch time people had cheese sandwiches and salad. There were two bowls of salad on the table for people to help them selves. There were condiments and sauces on the table. Staff sat and ate with people, making it a social occasion. There was a choice of cold drinks and people were offered a choice of hot drinks if they wanted after their meal. Ulysses House DS0000016734.V363975.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that the personal care and health needs of individuals are met so ensuring their health and well being. The people living there get their prescribed medication at the right time so their health needs are met. EVIDENCE: One person who was going to visit their relatives had been well supported with their personal care and clothing. They looked very smart and this was appropriate to their age. All the people living there were well dressed in individual styles that were reflective of their age, their cultural background, the weather and the activities they were doing. Staff were observed encouraging one person to take off his coat after going to the shops. The person said they could not do it and asked for staff to do it. Staff encouraged him to keep trying and he did it, so increasing his skills in independence and raising his self esteem. Ulysses House DS0000016734.V363975.R01.S.doc Version 5.2 Page 17 Records sampled included an individual health action plan. This is a personal plan about what support the individual needs to meet their health needs and what healthcare services they need to access. These had been produced using photos and pictures making it easier to understand. Records sampled showed that people had been regularly weighed to ensure they were not gaining or losing a significant amount of weight, which could be an indicator of an underlying health need. Records sampled showed that each person is registered with a local GP, who they are supported to visit if they are unwell. Where appropriate health professionals are involved in the care of individuals. The outcome of any health appointments are recorded and records showed that staff follow the advice given to ensure individual’s health and well being. Boots now supply the medication in monitored dosage blister packs, which makes it easier to ensure that the person receives the right dosage at the right time. The medication cabinet was locked so that people could not take out medication that may harm them. Only staff who have received medication give out the medication. Two members of staff give out the medication together to try to avoid errors. There was a photograph of the person at the front of their Medication Administration Records (MAR), so that unfamiliar staff would know who to give the medication to. Staff had signed the MAR appropriately indicating that medication had been given as prescribed. Some people are prescribed as required (PRN) medication. Clear records were kept of when PRN medication is given, which included the signature of the person having it if they are able to. This helps to ensure that the person agrees to have this medication and it is in their best interest to have it. Protocols were in place for people who are prescribed PRN medication that stated when, why and how much of the medication should be given to the person to ensure it is used appropriately. Relatives said, “Staff have helped with the support of his GP to reduce our relative’s unnecessary medication inherited from previous placements. We are always kept up to date with important issues him.” Copies of all prescriptions are kept so that it can be tracked what each person has been prescribed and staff ensure this cross-references with the medication supplied for the individual. All staff are doing the accredited training in the ‘Safe Handling of Medicines’ to ensure they have the knowledge so that people get their prescribed medication to meet their health needs. Ulysses House DS0000016734.V363975.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that the people living there feel their views are listened to and acted on. The people living there are protected from abuse, neglect and self-harm. EVIDENCE: The procedure for making complaints was available in the statement of purpose and the service users guide. It was produced using pictures making it easier to understand. The people living there said, “I know who to speak to if I am unhappy and how to make a complaint.” Relatives said, “ We know how to make a complaint and staff have always responded appropriately if we have raised concerns.” Since the last inspection we have not received any complaints about this home and the service provided. There was one complaint received by the home, which was one member of staff complaining about another. This is being dealt with internally by Senior Managers within the organisation. Records sampled included a list of the person’s belongings so if anything should go missing it would be easier to track when the person bought it and what it was like. One of these had last been updated in September 2007 and the other in October 2007. These should be updated more regularly as people buy things or dispose of their belongings for any reason. Ulysses House DS0000016734.V363975.R01.S.doc Version 5.2 Page 19 Sometimes the people living there display behaviour that can be ‘challenging.’ One person often went to grab staff or the other people living there. Every time they did this staff were observed calmly but firmly telling them said ‘No, don’t grab.’ The person stopped this immediately and the situation was deescalated without anyone getting hurt. The Deputy Manager is a trainer in Crisis Prevention Institute (CPI) method of physical intervention, which uses distraction and de-escalation techniques to manage individuals’ behaviours and only using physical intervention as a last resort. It also focuses on a positive approach to the person at all times not just when they are behaving in a way that can be ‘challenging’. The Deputy Manager was delivering this training to new staff and the Manager on the day of this visit. They said that other staff would soon be receiving refresher training in this as needed. There is always staff on duty that have received CPI training. The local police officers that have built up a relationship with the people living there also attended the training. They said, “We witnessed first hand the high level of skills of the staff and management.” From sampling records and talking to staff it was evident that staff spend time looking at the causes of individual’s behaviour to see if anything can be done to improve their well being. For example staff found that one person who was becoming increasingly agitated and aggressive was often drinking a high caffeine drink. The person’s consultant and staff are now working with him to reduce his intake of the drink as it was having a negative effect on his behaviour and well being. Individual’s money is held securely in the home. Finance records sampled cross-referenced with the money that individual’s had. Their records showed that regular money is being paid into their account so they are receiving the benefits they are entitled to. Individuals who are able to look after their money had received it and signed for it in accordance with their budget plan so that they have enough money to do the things they want to do. The manager, deputy manager and seniors have completed training in the Mental Capacity Act and how this affects the people living there. This Act came into force in April 2007 and states that each person’s capacity will be assessed as to whether or not they can make a decision about their life. If they are assessed as not having the capacity other people including an Independent Mental Capacity Advocate (IMCA) can make that decision for them in their ‘best interests.’ The managers said they are going to deliver awareness training on this to the rest of the staff team. All staff have completed training in adult protection and the prevention of abuse so they know how to protect the people living there from abuse, neglect and self-harm. Ulysses House DS0000016734.V363975.R01.S.doc Version 5.2 Page 20 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 parts of the home are not homely, comfortable and safe which could impact on the well being of the people living there. EVIDENCE: The kitchen cupboards were looking worn and should be replaced to ensure that the risk of cross-infection is minimised. Space in the kitchen is limited for people to be supported to make their own meals. There is a domestic size single oven with four hobs. Staff said that this could be difficult, as meals are cooked for about nine people to include staff sitting with people to support them at mealtimes. The dining room is functional but not homely. Staff said that they have asked for the table and chairs to be replaced, which would help to make the room Ulysses House DS0000016734.V363975.R01.S.doc Version 5.2 Page 21 more homely and comfortable. There was some chipped paintwork, which needs repainting to ensure it is clean. Games, art and craft equipment, a computer and TV are provided for the people living there. Since the last inspection the lounge had been redecorated, making it more homely and comfortable. The flooring had been replaced, a new radiator cover provided and the windowsill had been repaired making the room safer and more comfortable to spend time in. In two bedrooms and the dining room there were not covers on the radiators. A risk assessment should be completed to assess whether or not people are at risk of being scalded by the radiators. If there is a risk then radiator covers should be provided to minimise the harm to the people living there. Some bedrooms had been redecorated and new furniture and furnishings provided. This made them more personal to the individual and more comfortable. Staff and the people living there said they had been involved in choosing the decoration and the furnishings of their bedroom. People said they have the things they want in their bedroom. People who want to and are able to use a key have the key to their bedroom. Since the last inspection a master key system has been installed so that if needed staff could access people’s bedrooms in an emergency. Some bedrooms have an en suite facility and there are shower rooms and bathrooms on the first and second floor near to the other bedrooms. Since the last inspection the shower rail had been repaired in the second floor shower room so it was safe to use. In the first floor toilet the frame around the mirror was broken leaving sharp edges that a person could be at risk of cutting themselves on. The manager said this would be removed and replaced. In the garden there is a large trampoline with sides so it is safe for people to use. People who live there said they enjoyed using this. Staff said that they are going to use the bottom part of the garden that has not been used before to plant vegetables. This will give the people living there another interest as well as providing some home - grown vegetables to eat. Some people living there smoke and this is only allowed in the garden so that the house is smoke free. The home was clean and free from offensive odours throughout. It was evident that the people living there are involved in household tasks so increasing their skills in independence. Hand wash and hand towels were provided in all toilets and bathrooms to minimise the risk of cross-infection. Ulysses House DS0000016734.V363975.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing, their support and development are variable, which could affect the quality of life of the people living there. EVIDENCE: All staff have completed or are currently doing National Vocational Qualification’s (NVQ) level 2 or above in Care. This exceeds the standard that at least 50 of staff have this qualification so ensuring they have the skills and knowledge to work with the people living there. Throughout the day good interaction was observed between staff and between staff and the people living there giving the home a good atmosphere to live in. Staff said that they are working as a team and they now get the training they need so they know how to support the people living there. The manager said that two staff, one full time and one part time have left since the last inspection. These staff had been replaced and agency staff had not been used for about the last three months. This ensures that staff know the people living Ulysses House DS0000016734.V363975.R01.S.doc Version 5.2 Page 23 there and what they need. Friends of the people living there said, “ Staff provide an excellent, high level of care to the people who live there.” The manager said that the staffing hours are 465 per week including night staff. One person who lives there has 1:1 staffing during the waking hours. There are three staff on duty during the waking hours and one waking night and one sleep-in staff. The manager said it is difficult to accommodate staff training within the hours allocated as well as staff needing to take their holiday. Four of the people living there need 1:1 support in the community. Therefore, the staffing complement can limit the opportunities available to go out in weeks where staff training is also taking place. The staffing hours should be reviewed to ensure that staff can receive the training they need as well as ensuring that the people living there can go out and do the things they want to when they want to. Minutes were available of two staff meetings since the last inspection. Staff said there had been more meetings but the minutes were on the computer, which they did not have access to. These should be available so that all staff are informed of what is discussed and the progress of actions to be taken can be monitored so that improvements can be made. Rotas showed that the manager generally works 9-5 Monday to Friday but has worked some shifts so she can get to know all the staff and know what support people need at all times of the day and night. The deputy manager works shifts and this is important so that staff support can be monitored to ensure that staff practice reflects the needs of the people living there. Two records of the staff working there were looked at. These included the required recruitment records including evidence that a Criminal Records Bureau (CRB) check had been applied for to ensure that ‘suitable’ people are employed to work with the people living there. An analysis of what training staff need had been completed so that the manager can ensure that staff get the training they need so they know how to support the people living there. Staff have received training in food hygiene, Makaton, fire safety, medication, adult protection and CPI. Some staff have had autism awareness training. The deputy manager said they are going to deliver training in autism to all staff. The manager said they had recently purchased some training DVD’s, which they would ensure that all staff have an opportunity to watch. They also plan to do in-house training on individuals care plans and morning routines to develop consistency of care and support. Ulysses House DS0000016734.V363975.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42, 43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements ensure that the people living there benefit from a well run home and their views are considered. The health, safety and welfare of the people living there is promoted and protected so ensuring their safety and well being. EVIDENCE: Since the last inspection a new manager has been in post who has registered with the commission. The registered manager has many years experience in supporting adults who have a learning disability and challenging behaviour. She has achieved NVQ level 4 and the Registered Managers Award ensuring Ulysses House DS0000016734.V363975.R01.S.doc Version 5.2 Page 25 that she has the skills and knowledge to manage the home for the benefit of the people living there. Friends of the people living there said, “ Clearly the management has created a fantastic atmosphere at the home.” In the last two years there have been several changes of manager, which has resulted in the people living there and staff feeling unsettled. Staff said that the manager is good and they hope the home stays settled. Staff said that the manager and deputy manager listen to them and are approachable. They said that everybody is here for the benefit of the people living here. The manager said there is a new area manager who she is meeting the following week. Records showed that a representative of the owner visits monthly and a report of their visits is written to monitor the service provided. These reports showed that the views of the people living there are considered. The manager has developed a quality assurance system that includes seeking the views of the people living there and their representatives. Records showed that staff had tested the fridge and freezer temperatures daily. These were within the recommended limits to ensure that food is stored safely so the risk of food poisoning is reduced. The fire risk assessment had recently been reviewed. Staff had signed to say they had read this and agreed to follow the required actions to minimise the risk of there being a fire. Fire records showed that regular fire drills take place so that staff and the people living there know what to do if there is a fire. Each person has their own emergency evacuation plan so that staff know what to support individuals would need. Staff test the fire equipment regularly to make sure it is working. An engineer regularly services the fire equipment to ensure it is well maintained and in good working order. A Corgi registered engineer completed the annual test of the gas equipment in October 2007 and stated that it was safe to use. An electrician completed the five –yearly test of the electrical wiring in 2006 and stated that it was safe to use. The manager and staff said that the budget for the home is not enough. They receive £270 a week for food, cleaning and for staff to support people in activities. This should be reviewed to ensure it is in line with the current cost of living and ensures the people living there are receiving the service they pay for. Ulysses House DS0000016734.V363975.R01.S.doc Version 5.2 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 Standard No Score 1 3 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 2 2 Ulysses House DS0000016734.V363975.R01.S.doc Version 5.2 Page 27 No 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 YA24 Regulation 13 (4) (ac) Requirement A risk assessment must be completed to assess whether or not people are at risk of being scalded by the radiators. If there is a risk then action must be taken to minimise the harm to the people living there. The mirror in the first floor toilet should be replaced so that people are not at risk of cutting themselves. Timescale for action 30/06/08 2. YA42 13 (4) (ac) 30/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The service users guide should include the fees charged to live there. This will ensure that prospective service users have the information they need to make a choice as to whether or not they want to live there. Person centred plans should show how people are being supported to achieve their goals. This will ensure that people are getting the support they need to do the things they want to do. DS0000016734.V363975.R01.S.doc Version 5.2 Page 28 2. YA6 Ulysses House 3. YA17 Staff should continue to encourage the people living there to eat a healthy diet and inform them of how their diet affects their health. This will help to ensure that individual’s health needs are met. All staff should have an awareness of the Mental Capacity Act and how this legislation affects the people living there. Lists of individual’s belongings should be updated more regularly as people buy things or dispose of their belongings. This makes it be easier to track when the person bought it and what it was like if anything should go missing. The kitchen should be refurbished to ensure that the risk of cross-infection is minimised. Adequate cooking facilities should be provided so that meals can be cooked without difficulty for the number of people living there and staff supporting them at mealtimes. This will also help to ensure that people can be offered an alternative to the main menu. The dining room table and chairs should be replaced so it is more homely and comfortable. The chipped paintwork should be repainted to ensure it is clean. The staffing hours should be reviewed to ensure that staff can receive the training they need as well as ensuring that the people living there can go out and do the things they want to when they want to. Minutes of staff meetings should be available so that all staff are informed of what is discussed and the progress of actions to be taken can be monitored so that improvements can be made. All staff should receive training in autism so they know how this affects some of the people living there so they can support them appropriately. The home’s budget should be reviewed to ensure it is in line with the current cost of living and ensures the people living there are receiving the service they pay for. 4. 5. YA23 YA23 6. 7. YA24 YA24 8. 9. YA24 YA33 10. YA33 11. 12. YA35 YA43 Ulysses House DS0000016734.V363975.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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