CARE HOME ADULTS 18-65
Warren Farm Road, 296-298 Kingstanding Birmingham B44 0AD Lead Inspector
Alison Ridge Unannounced Inspection 5th June 2006 10:10 Warren Farm Road, 296-298 DS0000030417.V297979.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 Warren Farm Road, 296-298 DS0000030417.V297979.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. Warren Farm Road, 296-298 DS0000030417.V297979.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Warren Farm Road, 296-298 Address Kingstanding Birmingham B44 0AD 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) 0121 256 5005 Sense West Mrs Rosalind Ray Care Home 5 Category(ies) of Learning disability (5), Sensory impairment (5) registration, with number of places Warren Farm Road, 296-298 DS0000030417.V297979.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The home may provide care for five 18-65 year olds with a learning disability and sensory impairments In addition to care manager, a minimum of 4 suitably qualified and competent staff are on duty throughout the working day at all times, 7.30am - 10pm One suitably qualified and competent member of staff and a sleep-in member of staff throughout the night, 10pm - 7.30am 23rd February 2006 Date of last inspection Brief Description of the Service: 296 - 298 Warren Farm Road is registered to provide personal care and support to 5 adults with a learning disability, physical disability and sensory impairment, who have been assessed as requiring full assistance with daily living and other tasks. The home is staffed 24 hours a day including two waking night staff. Residents would be admitted to the home following a full assessment that would determine the level of support they require. The full range of medical services, leisure and social activities are provided for residents. A number of adaptations have taken place within the home in order to meet the assessed needs of residents. Residents are encouraged and supported to maintain links with their families and the local community. The care needs of residents are monitored and reviewed and action is taken to address any concerns. The home is situated in Kingstanding, a residential area of Birmingham and has good access to local amenities. Warren Farm Road, 296-298 DS0000030417.V297979.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was undertaken over half a day. This was an unannounced random visit, and the inspector only looked at care and medication. A full key inspection will be undertaken before the end of March 2007. The inspector was pleased to meet all five of the people who live at Warren Farm Road, staff on duty, the deputy, and registered manager. Information used in this report was obtained by observing the care and support people were offered, reading plans of care, and daily diaries, and looking at the way medicine is managed. The inspector spent time with the people accommodated at Warren Farm Road. The people accommodated at this home have communication difficulties and it was not possible to fully ascertain their views of the service they receive. What the service does well:
Each person has an individual plan of care. Staff have tried to capture on paper the specific wishes and preferences of each person, so all staff can work in the same way. The inspector was pleased to meet all five of the people who live at Warren Farm Road. They had all been supported to undertake personal care and dress to a high standard, in a way that reflected their culture, age and gender. The management of medication was good. Staff had numbered medicines that could not be blister packed, and it was very easy to establish if they had been given as required. Service users receive all the medicines they require. Staff are good at helping the people living at Warren Farm Road to see the necessary health professionals. This includes the dentist, optician, GP, and specialist staff who support with diet and nutrition. The records showed that the people living at Warren Farm Road are supported to stay in touch with their family and people important to them. This is in person, by letter and on the phone. Staff and one of the people living at Warren Farm Road went Grocery shopping. They bought lots of fresh products including fruit and vegetables. The food they brought home looked very tasty, and varied. This visit did not include a full tour of the premises. The areas of the home the inspector saw, were all very well presented, and clean and tidy. There were lots of things that the people living in the home like, such as different styles of music, and activities.
Warren Farm Road, 296-298 DS0000030417.V297979.R01.S.doc Version 5.2 Page 6 A representative of Sense undertakes an audit of this home each month. Records of these are passed to the CSCI. The records are in great detail, and show all the required areas are checked. This is another way to ensure the people living at Warren Farm Road are happy, and receiving the support and care they need. During the visit staff supported people in a very friendly and relaxed way. The inspector saw staff using communication aids to help people know what was happening. At this visit activities and opportunities were not tracked. However it was very positive to see that all the people were offered and supported to undertake an activity. This included in house crafts, foot massage, grocery shopping, and Information Technology. What has improved since the last inspection? What they could do better:
The people who live at Warren Farm Road have some very complex and specific needs. Staff had recorded that appointments with the wider healthcare team are taking place, but not all specific healthcare needs were well planned for. The inspector identified work was needed in the area of Epilepsy care, pressure care, PEG care, manual handling, continence and bowel care and night care. The medicine management was generally very good. Protocols for “As required” medicines (PRN) need to be available for all PRN medicines. Once written they need to be kept under review. The inspector observed staff support one person in a way different to that detailed in the care plan. Staff need to ensure they follow the plan of care, to provide consistency. It was positive to find that opportunities for people to be alone in their room were being provided. The staff need to ensure the monitoring of people during this time respects the persons privacy and dignity. This is the first visit this inspector has made to Warren Farm Road. She found many of the records to be duplicative, and sometimes confusing. It is
Warren Farm Road, 296-298 DS0000030417.V297979.R01.S.doc Version 5.2 Page 7 recommended that the manager look at ways to ensure the information developed is accessible and user friendly. 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. Warren Farm Road, 296-298 DS0000030417.V297979.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 Warren Farm Road, 296-298 DS0000030417.V297979.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X This was an unannounced random inspection. These standards were not assessed. EVIDENCE: Not assessed at this inspection. Warren Farm Road, 296-298 DS0000030417.V297979.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Each person has an individual plan of care and support, which includes information about how they would like their needs to be met. Staff need to show how they support service users towards goals and aspirations they have identified. EVIDENCE: In one of the files tracked, the inspector found a sheet of Personal Goals and aspirations. This sheet did not evidence how the goals had been decided upon, who was taking responsibility for supporting the service user with them, if any progress had been made towards them, or if there were any timescales in which the goals were to be achieved. The manager brought this to the manager’s attention, and identified these need to be linked with the monthly care review, and the activity planning, to ensure ideas raised are fully explored and actioned. The goals need to raised and set by the service user where possible, or clearly show how they were decided upon, to be in the persons best interest.
Warren Farm Road, 296-298 DS0000030417.V297979.R01.S.doc Version 5.2 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X This was an unannounced random inspection. These standards were not assessed. EVIDENCE: Not assessed at this inspection. Warren Farm Road, 296-298 DS0000030417.V297979.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Service users are supported to undertake personal care to a high standard. Personal care needs are planned for, reflecting the service users known needs and preferences. The service users are supported to access health care appointments. Specific healthcare and support needs are not all well planned for, or monitored by staff at the home, which could result in a need being unmet. Medication management is generally good, and service users get the right medication at the right time. EVIDENCE: The inspector was pleased to meet all five of the people living at Warren Farm Road. They had all been supported to undertake personal care to a good standard, and all the service users were very individual in appearance. Service users had been supported to style their hair, dress and undertake care in a way that reflected their culture, age and gender. The service users were also supported with personal care as required throughout the time of the visit. There were some skill development sheets among the personal care plans. Examples of these included programmes to support service users learn new skills such as putting on deodorant and shaving.
Warren Farm Road, 296-298 DS0000030417.V297979.R01.S.doc Version 5.2 Page 13 It wasn’t clear if these were still current, or if the service user had made progress towards being able to undertake these activities with greater independence. It was recommended these be cross-referenced with the morning routine, and that the plans be reviewed. The inspector considered it positive that service users needs regards expressing sexuality were planned for. It is required the monitoring of the person while having private time in their room is respectful of their dignity. Service users accommodated at Warren Farm Road have very complex and specific needs. It was positive to see that a wide range of health professionals are involved, and the records tracked showed service users had been supported to undertake routine health monitoring, as well as specialist appointments. The inspector was concerned to find a plan of care directing staff to dry one service users bottom and genitals with a hair-dryer if the skin was damaged or broken down. Staff reported this had been drawn up, under guidance from the community nurse. The inspector was concerned that the significant risks associated with this had not been assessed to ensure the service user is protected from a harm. Some plans were found to be duplicative, or confusing. An example of this included the night care plan. There was one plan for supporting the person to bed, and another for the support and monitoring they needed during the night. These were in separate parts of the file, and didn’t make reference to each other. The support one service user needs with difficult to manage behaviours was tracked. It was difficult to establish if the strategy was being effective as no monitoring of the behaviours planned for was being undertaken. The inspector observed one staff interaction, which was contrary to the strategy. The inspector did not find the strategy to give staff specific guidance. An example of this was, “If X becomes defensive, staff should begin to set boundaries that are clear, concise, realistic and enforceable.” There were no examples of how to do this, or how long to do this for, or what enforcement action would be appropriate. Guidelines were on file that had been written in 2000 regards hair pulling, scratching and pinching. These were not proactive in supporting staff to avoid such situations, or to note early signs or triggers, and no record of this behaviour had been made to establish if the plans were still required, or were being effective. One person was recorded to have some self-injurious behaviour. The record stated this often happened when the person was alone. No note of this was made in the night plan, which is the greatest period the person is alone.
Warren Farm Road, 296-298 DS0000030417.V297979.R01.S.doc Version 5.2 Page 14 Pressure care had been assessed. These were adequate for risks posed by wheelchair seating, but did not go on to assess other pressure risks, such as the body brace or PEG tube, or the risks to the service user when out of the wheelchair, or in bed. The plan of care to underpin the use of a Percutaneous Endoscopic Gastostromy (PEG) was tracked. There was clear guidance on the feeding regime, but no plan for the care of the PEG site or tube, or details of the PEGS life expectancy, or when replacement would be due. The needs of one female service user were assessed. It was not evident that menstruation was being tracked, or any monitoring being undertaken regards the specific risks associated with the medication taken. No plan of care regards menstruation was available. One person tracked has complex needs regards epilepsy. Three different protocols regards use of emergency medication were available. It was required these be rationalised. No basic plan of care that instructed staff re basic epilepsy care was available, or of the specific support needs of the person depending on their position in the home, wheelchair or community. Seizure monitoring was being undertaken. The inspector was concerned this was on separate sheets of paper spread through the daily diary. It was not possible to obtain an over view of the seizure pattern at a glance. It is recommended this be reviewed with the supporting healthcare staff. It was positive that a significant review of the persons needs had been scheduled. Manual Handling guidelines were available, but generally found to be confusing. The inspector recommends these be rationalised. Examples such as a plan that stated the service user is to be supported with a handling belt were identified. Actual guidance on the use of the handling belt was elsewhere in the file, and not cross-referenced to the document. One person tracked had specific bowel care needs. It was apparent they had been reviewed at the hospital, but no plan of care regards this, the use of laxatives, or the monitoring required was available. Medication management was generally very good. The storage of medication was organised, secure and clean. The record of administration (MAR) showed staff had checked medication upon receipt, and signed for it when administered. The medicines tracked were all in date, and with the exception of one cream available. It was of concern to find one cream had run out, and that staff had not taken action to ensure a replacement supply in good time. Warren Farm Road, 296-298 DS0000030417.V297979.R01.S.doc Version 5.2 Page 15 The manager must ensure protocols are available for all “As required” (PRN) products, and once written that the protocol remains under review. The inspector observed one controlled medicine in the home that was not listed on the MAR chart. It was listed in the controlled drug book, this must be recorded on the MAR if still prescribed, or returned for disposal. For one person, one dose of medication was missing. It was not evident if a dose had been spoilt, or if action to replace it had been undertaken. The inspector considered the system for managing non-blister packed medicines to be an area of good practice, and auditing of the medicines was made much simpler. Warren Farm Road, 296-298 DS0000030417.V297979.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X This was an unannounced, random inspection. These standards were not assessed. EVIDENCE: Not assessed at this inspection. Warren Farm Road, 296-298 DS0000030417.V297979.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X This was an unannounced random inspection. These standards were not assessed. EVIDENCE: Not assessed at this inspection. Warren Farm Road, 296-298 DS0000030417.V297979.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X This was an unannounced random inspection. These standards were not assessed. EVIDENCE: Not assessed at this inspection. Warren Farm Road, 296-298 DS0000030417.V297979.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X This was an unannounced random inspection. These standards were not assessed. EVIDENCE: Not assessed at this inspection. Warren Farm Road, 296-298 DS0000030417.V297979.R01.S.doc Version 5.2 Page 20 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 X 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 X 23 X ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 2 X X X X X X X X Warren Farm Road, 296-298 DS0000030417.V297979.R01.S.doc Version 5.2 Page 21 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. 2. Standard YA6 Regulation 15(1) (2) Requirement Timescale for action 01/09/06 3. YA6 12(1)(2) 4. YA9 13(4)(a, b, c) Significant progress towards this made, but outstanding from the previous inspection. (Previous timescale 31/05/06). Care plans require some further development. Goal setting for service users 01/08/06 must clearly show: who has set the goals, how they were agreed upon, who is responsible for meeting them, how it will be identified if they are met and when the goal was set. Significant progress towards 01/08/06 this made, but outstanding from the previous inspection. (Previous timescale 30/04/06). Resident’s risks assessments required further development. The plan of care regards sexuality must ensure service users are monitored in a way that is respectful of their dignity. 5. YA18 12(1)(a) 23/06/06 Warren Farm Road, 296-298 DS0000030417.V297979.R01.S.doc Version 5.2 Page 22 6. YA18 12(1)(a) 7. YA19 12(1)(a) 8. YA19 12(1)(a) and 13(6) 9. YA18 YA19 13 (5) 10. YA19 12 (1)(a, b) 11. YA20 13(2) A risk assessment for drying broken/damaged skin with a hairdryer must be developed. A plan of care that underpins service users needs regards epilepsy, bowel care, night care, pressure care, PEG care and gender specific needs must be developed as required. Difficult to manage behaviour must be underpinned with a robust strategy, containing both pro-active and re-active strategies. Monitoring of behaviour must be undertaken if required, to inform and direct care practice. Manual Handling Assessments completed, quotes being obtained for hoists. (Previous timescale 30/04/06). Further assessments of resident’s manual handling needs are required and consideration must be given to the use of a ceiling hoist in the resident’s bedroom. Significant progress towards this made, but outstanding from the previous inspection. (Previous timescale 30/04/06). CSCI must be informed when the epilepsy protocol for one resident has been completed. Protocols must be available for all as required medicines. When developed protocols must be kept under review. 23/06/06 01/07/06 01/07/06 01/08/06 01/08/06 01/09/06 Warren Farm Road, 296-298 DS0000030417.V297979.R01.S.doc Version 5.2 Page 23 12. 13. YA20 YA20 13(2) 13(2) 14. YA35 18 (1)(c) 15. YA42 23(4)(c)(iii) All prescribed medicines must be available for administration. All prescribed medication must be detailed on the medication administration record. Progress towards this made, but outstanding from the previous inspection. (Previous timescale 30/04/06). Training must be provided for all staff on epilepsy management. One staff member must be trained in advance First Aid. Progress towards this made, but outstanding from the previous inspection. (Previous timescale 30/04/06). The Fire evacuation plan was under review with West Midland Fire Service. CSCI must be informed when this had been approved. 23/06/06 23/06/06 01/09/06 01/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA18 Good Practice Recommendations It was recommended that resident’s files be culled and that the provider reviews the arrangements for presenting residents care plan information. It is recommended that skill development sheets be reviewed, and if required cross referenced to the morning routine. Warren Farm Road, 296-298 DS0000030417.V297979.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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