CARE HOME ADULTS 18-65
Warren Farm Road, 296-298 Kingstanding Birmingham B44 0AD Lead Inspector
Donna Ahern Unannounced Inspection 23rd February 2006 10.00 Warren Farm Road, 296-298 DS0000030417.V284836.R01.S.doc Version 5.1 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.V284836.R01.S.doc Version 5.1 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.V284836.R01.S.doc Version 5.1 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.V284836.R01.S.doc Version 5.1 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 12th October 2005 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 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.V284836.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day. The inspector met and spent time with all residents. Due to the needs of residents they were not able to verbally express their views. A partial inspection of the physical standards was undertaken. Residents care plans and risk assessments were inspected. Staff records were examined, and some Health and Safety records were inspected. The inspector had the opportunity to talk to the manager, deputy manager, general manager and three care staff. This report should be read in conjunction with the inspection report of 12th October 2005. What the service does well: What has improved since the last inspection?
The manager completed an action plan within agreed timescales to implement requirements identified in the previous inspection report. Good progress had been made on requirements. Thirteen had been actioned in full; evidence of progress had been made on the remaining six. Care plans had been reorganised and the index revised so that information was easier to find. There was ongoing work to update the care plan and streamline some of the information so that it is easier for staff to follow. It was positive that support staff are involved in this process. Warren Farm Road, 296-298 DS0000030417.V284836.R01.S.doc Version 5.1 Page 6 There was evidence of ongoing work to risk assessments and guidelines to support resident during the night. It was positive that the staff team were fully acknowledging resident’s needs and wishes. Progress had been made on reviewing resident’s manual handling needs so that residents and staff are protected by safe practice. Progress had been made on reviewing epilepsy protocols so that the practice is safe and clear for staff to follow. A lot of improvements had been made to the environment so that it is more comfortable for residents. A new carpet had been fitted in the lounge and new floor covering had been fitted in the dining room, which can be washed after meals so that it is more hygienic. The new sofas in the lounge were assessed prior to purchases so that they are suitable for residents to be transferred by the hoist. The rota has been reviewed so that staffing levels are fully compliant with the conditions of registration. The working hours have been increased by half an hour for one staff member each day so that there are four staff on duty throughout the working day. 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. Warren Farm Road, 296-298 DS0000030417.V284836.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Warren Farm Road, 296-298 DS0000030417.V284836.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Information about the home had been reviewed so that prospective residents have the information they need to make an informed choice about the home. EVIDENCE: There had been no new admissions since the previous inspection and the home had no vacancies. The organisation has an admission criteria and an admission procedure, which includes that prior to admission full assessments would be undertaken. Through discussion, the manager demonstrated a good understanding of these procedures. The previous report raised that due to the deterioration and increased care needs of one resident the manager was advised to write formally to the placing authority to have a reassessment of their needs to ensure that the home was the most suitable placement. The manager had written formally to the placing authority and followed up with telephone calls. The placing authority had verbally agreed that a reassessment would take place however this had still not taken place. The residents needs have continued to deteriorate. The provider has acted appropriately and additional staffing was in place. The manager agreed to pursue this again with the placing authority and agreed to keep CSCI informed of any developments. Warren Farm Road, 296-298 DS0000030417.V284836.R01.S.doc Version 5.1 Page 9 The Statement of Purpose contained the required information and had been kept under review. Warren Farm Road, 296-298 DS0000030417.V284836.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Care plans required further development so that information on how to meet residents needs is clear and accessible to staff. EVIDENCE: Care plans sampled included residents communication needs, their personal care routines, the range of activities that they are supported to engage in and how choices are to be offered. Information on the care plan is supported by a number of guidelines and advice sheets. Sampled care plans had been reorganised to improve access to information and the files had been culled. There was ongoing work to streamline the information and reword parts of the support plan. The manager explained that each care pan would be reviewed in turn in conjunction with the core team of staff who support each resident. The manager explained that there was ongoing work to the risk assessments and guidelines regarding the support required by residents during the waking night. Through discussion the manager demonstrated that thorough consideration had been given to the range of issues that impact on the guidelines including resident’s rights and dignity this is further complicated by
Warren Farm Road, 296-298 DS0000030417.V284836.R01.S.doc Version 5.1 Page 11 residents complex communication needs. The manager was liaising with other professionals to ensure that best practice is in place for each resident. Progress will be monitored at the next inspection. Warren Farm Road, 296-298 DS0000030417.V284836.R01.S.doc Version 5.1 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Not assessed at this inspection. The standards were assessed in full at the previous inspection on the 12th October 2005. Warren Farm Road, 296-298 DS0000030417.V284836.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Improvements must be made to medication administration and manual handling arrangements so that residents are not put at risk. EVIDENCE: Some of the residents have complex manual handling needs. The manager had instigated a review of manual handling practice to ensure that residents receive the support they require and that staff are adequately trained. Manual handling risk assessments and guidelines had been reviewed with input from the physiotherapist. Manual handling training took place in November 2005 and further training is required. Resident’s manual handling needs were discussed with staff who presented as committed to maintaining residents independence with their mobility. There remained some concern around the manual handling needs of one resident and the impact of their transferring needs on staff that are supporting the person. Further assessments of their needs are required and consideration must be given to the use of ceiling hoist, as the bedroom is not big enough to accommodate a mobile hoist. Speech and Language therapist was due to undertake a review of residents eating and drinking needs in March 2006. Warren Farm Road, 296-298 DS0000030417.V284836.R01.S.doc Version 5.1 Page 14 The previous inspection highlighted that the management of one resident’s epilepsy management required urgent review. The epilepsy protocol was still under review with the community nurse and consultant. CSCI must be informed when the protocol has been completed. Staff training on epilepsy management was in the process of being arranged and the manager agreed to inform CSCI when the training date has been confirmed. Risk assessments had been implemented for residents who have epilepsy it was advised that this information could be condensed. The previous inspection report highlighted an error in the administration of prescribed medication. The matter was fully investigated, a review of the homes booking in of medication was instigated and further training was provided for staff. All staff receive the organisations own medication training and training with Boots the chemists. The manager confirmed that all staff are registered to do the accredited medication training. In addition the manager completes assessments every six months on staff competence to administer medication. Examination of the procedures identified one error on the signing of the MAR (Medication Record sheets). The manager agreed to address this error with the person concerned. Warren Farm Road, 296-298 DS0000030417.V284836.R01.S.doc Version 5.1 Page 15 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): EVIDENCE: Not assessed at this inspection. Assessed in full at the previous inspection on the 12th October 2005. Warren Farm Road, 296-298 DS0000030417.V284836.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Residents live in a home that is, comfortable, safe, clean and well maintained. EVIDENCE: The home was purpose built for its registered category. The home was clean, warm and safe. A lot of work had taken place to improve the environment. A new carpet had been fitted in the lounge; new non-slip washable flooring had been fitted in the dining area. New furniture was provided in the lounge, which was in accordance with the assessed manual handling needs of residents so that the hoist could fit under the sofa to assist with transferring residents. New blinds had been fitted to the windows at the rear of the home and in one resident’s bedroom. The manager stated that the carpet in a resident’s bedroom, which was solied, was in the process of being replaced. Warren Farm Road, 296-298 DS0000030417.V284836.R01.S.doc Version 5.1 Page 17 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): 33, 35 Vacant posts must be appointed to so that there is an effective team in place to meet residents assessed needs. EVIDENCE: Residents have very complex needs and require a high level of staff support to carry out their care plan and to engage in appropriate leisure and recreational opportunities. Staffing levels are a condition of registration. The home is required to have four staff on duty throughout the working day (7.30-10.00). Examination of the rota indicated that there was five staff on duty; one of the residents has an additional staff member for six hours per day. Since the previous inspection staff hours on the afternoon/evening shift have been reviewed, one person shift now finishes at 22.00 hours instead of 21.30 so that there is four staff on duty until 22.00 hours. (Waking nights staff commence their shift at 21.15 hrs). There continues to be a high level of vacant posts requiring a number of agency and relief staff to cover. The manager stated that the 4.5 vacant post have all been recruited to subject to the outcome of CRB checks. Staff training records indicated that Fire Safety training took place on the 5th December 2006. The manager stated that six monthly interim training on Fire
Warren Farm Road, 296-298 DS0000030417.V284836.R01.S.doc Version 5.1 Page 18 Safety is arranged in-house. Manual Handling training took place in November 2005 and further training needs have been identified which the manager was addressing. One person must be trained in Advance First Aid. It was really positive that eight staff, which is over 75 , were enrolled on N.V.Q level two. Warren Farm Road, 296-298 DS0000030417.V284836.R01.S.doc Version 5.1 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): 37, 39, 42 There was an open and welcoming atmosphere, which benefits residents and staff. Health and Safety was well managed. EVIDENCE: The manager transferred from another Sense registered care home to be the acting manager in April 2005. In September 2005 she was successful in her fit person interview with CSCI and was approved as the registered manager. Throughout the inspection process the acting manager presented as open and positive. The manager completed an action plan within agreed timescales to implement requirements identified in the previous inspection report. Good progress had been made and the manager demonstrated a good understanding of the required action on outstanding requirements. There was evidence that the manager and staff liaise with resident’s relatives. Policies and procedures are kept under review. Quality monitoring systems were not assessed. Warren Farm Road, 296-298 DS0000030417.V284836.R01.S.doc Version 5.1 Page 20 The fire records were assessed and were in good order. The manager had instigated more frequent fire drills to improve practice following the response of staff during a drill in November 2005. The fire evacuation plan had been reviewed and forwarded to West Midland Fire Service for approval. Warren Farm Road, 296-298 DS0000030417.V284836.R01.S.doc Version 5.1 Page 21 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 3 3 2 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 3 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 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 2 2 X 3 X 3 X X 2 X Warren Farm Road, 296-298 DS0000030417.V284836.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes 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. 2. Standard YA3 YA6 Regulation 14(1,2) 12(1)(a,b) 15(1) (2) Requirement A reassessment of one resident’s needs was required. (Previous timescale 31/12/05). Care plans require some further development. (Progress made further work required). Resident’s risks assessments required further development. (Progress made further work required). 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. CSCI must be informed when the epilepsy protocol for one resident has been completed. The medication administration sheets must be signed when medication is administered. Training must be provided for all staff on epilepsy management and Manual Handling. One staff member must be trained in advance First Aid. Timescale for action 30/04/06 31/05/06 3. YA9 13(4)(a,b,c) 30/04/06 4 YA18 13 (5) 30/04/06 5 6. 7 YA19 YA20 YA35 12 (1)(a,b) 13(2) 17(1)(a)(3i) 18 (1)(c) 30/04/06 23/02/06 30/04/06 Warren Farm Road, 296-298 DS0000030417.V284836.R01.S.doc Version 5.1 Page 23 8. YA42 23(4)(c)(iii) The Fire evacuation plan was under review with West Midland Fire Service. CSCI must be informed when this had been approved. 30/04/06 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. Refer to Standard YA6 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. Progress made further work required. Warren Farm Road, 296-298 DS0000030417.V284836.R01.S.doc Version 5.1 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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