Inspection on 12/12/06 for 19 Wheelwright Road

This inspection was carried out on 12th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

19 Wheelwright Road 30/01/08

19 Wheelwright Road 06/04/06

19 Wheelwright Road 04/10/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Wheelwright Road, 19 Erdington Birmingham West Midlands B24 8PA Lead Inspector Donna Ahern Key Unannounced Inspection 12th December 2006 10:30 Wheelwright Road, 19 DS0000065018.V323669.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 Wheelwright Road, 19 DS0000065018.V323669.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. Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wheelwright Road, 19 Address Erdington Birmingham West Midlands B24 8PA 0121 382 9746 0121 3829746 N/A www.caretech-uk.com Caretech Community Service Limited 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) *** Post Vacant *** Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: NONE Date of last inspection 6th April 2006 Brief Description of the Service: 19 Wheelwright Road is a terraced house located in the Erdington area of Birmingham. The home is registered to provide care and support to three adults under the age of 65 who have a Learning disability. At present the home has two female, and one male service user. All service users have some difficult to manage behaviour, and autism. The home is staffed across the waking day with three staff, and at night a waking night staff and sleep in staff provide support. The home has three single bedrooms. None have ensuite, but all are fitted with a wash hand basin. The home has a bathroom with over bath shower, a communal lounge room, a music room, wc, dining room and kitchen. Laundry facilities are housed in an outhouse at the rear of the property. Service users accommodated at this home all require full mobility as no adapted facilities, or mobility aids are available. The home has a rear garden. The home has no off road parking. The range of the fees for the home is £1666.45- £3758.57 per week. The CSCI inspection reports are available in the home in the staff office. Where possible the outcome of inspections is shared with service users. Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork visit was unannounced involved two inspectors and took place over one day lasting eight and a half hours. This was the homes second key inspection for the inspection year 2006-2007. During the fieldwork the inspector met all service users, observed the opportunities and support provided to service users, looked at the premises, and read records about care, staffing, and health and safety. Service users have complex needs and have limited verbal communication therefore their comments are not included in the report. Information about service users quality of life is based on observations and information gained from reading records. The home is required to report incidents, accidents and other events that occur in the home to CSCI. These are called regulation 37 notifications. All information reported via a regulation 37 notifications since the last inspection was analysed prior to the fieldwork visit. A pre inspection questionnaire was completed by the manager and returned to CSCI. Information from the questionnaire was used to help complete this report. What the service does well: What has improved since the last inspection? The previous inspection report made a number of requirements. It is positive that there was evidence of improvement in most areas looked at. There has continued to be progress made in supporting people to go out more in the local community and take part in doing activities that they enjoy. Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 6 Some good work has been undertaken, to help people that don’t use words to communicate, let staff know how they feel, and what they would like to do. This work has included taking photos, and using signs and symbols and providing communication boards. A lot of work has been done to the house to make it more comfortable, homely and safe. Service users showed the inspector their bedrooms with new floor covering, new beds and new bedroom furniture. They seemed really pleased with how their room looked and were involved in choosing the new items. A professional who works closely with the Home made positive comments about the stability of the service user they support and improved communication since the present manager has been in post. 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. Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 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 Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s):1 , 2 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users and their relatives have information to enable them to make an informed choice whether to live in the home. EVIDENCE: The Home has a stable service user group there have been no new admissions to the Home in the last twelve months. Social Care and Health assessments were seen in service user files. The Admission procedure states that a full assessment would be undertaken prior to admission and a three-month settling in period would take place to enable the service user to decide if the home meets their needs. The contracts that explain the terms and conditions to service user had been revised and were in the process of being signed by service users and their representatives. The contract had details of fees charged, details of additional charges and arrangements for terminating the contract. The statement of purpose and service user guide were looked at and describe the services and facilities provided. The provider should explore how information could be made available in different formats suitable for the people who live or may choose to live at Wheelwright Road. Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 9 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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made to communication systems within the Home enabling service users to have increased decision-making opportunities about their lives. Further development of care planning documentation is required so that there is clear, easy accessible guidance available for staff to follow to enable them meet service users needs consistently. EVIDENCE: The previous inspection report raised significant concern about service user individual care plans. They were assessed as not reflecting service user needs and did not provide staff with guidance on how they should meet service user needs. Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 10 Progress had been made on implementing a care plan format and two peoples care plans were looked at. Each person had two files one called a working file and another back up file. The individual support sheet detailing their care needs was not dated or signed which makes it difficult to keep information under review and the one persons was incomplete with information about medical, physical health and mental health incomplete. This has the potential to cause inconsistencies in care practice if people’s needs are not fully documented for staff to follow. However the individual support sheets on the working file were dated and had been reviewed. The working file had evidence of service user preferences recorded however, the section where it records that the information was discussed with the person and or their representative, had not been completed and should be to evidence that these discussions have taken place. The likes/ dislikes section was dated October 2005, it was not signed and there was no evidence this information had been kept under review. Recorded known behaviour was not included in the persons care plan and specific guidelines had not been developed. The other care plan looked at had good detail about the person’s cultural preferences although there could have been more information about how these should be met. The persons individual support requirements had been kept under review. The behaviour guidelines index provided staff with an overview of how to support the person and included pro-active guidance to prevent situations and reactive guidance to respond to situations. It gave information on how staff should follow up and record information so interventions are monitored. A detailed behaviour management plan was also in place and gave clear guidance on what staff must do to ensure that the persons receives the support they need and there was detailed information about their mental health needs. Information within the care plan was based on the managers and staff teams observations rather than a formal assessment tool this is of concern, as it does not provide a formal baseline. It was positive that monthly summaries are in place, which is a good system for keeping peoples needs under regular review and should provide a format for keeping the care plan up to date. When looking at incidents that had happened and cross referencing these to the monthly summaries there was no evidence that incidents were being appropriately monitored which makes this system ineffective. Daily records seen have a section on what has been important for the person however most of the recordings looked at lacked information about the persons response to the activity such as if they enjoyed it or if the activity was difficult for the person in any way. If this information is recorded it can help staff to plan future opportunities for people. Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 11 A number of risk assessments were in place on both files and there was some confusion about where information could be found. The manager stated that the most critical risk assessments were on the working file with more general risk assessments on the back up file. Inspectors were concerned that staff may not be familiar with all the required information to support people safely. It was advised that the filing system was revised and each file clearly marked with what they contain and where necessary directing staff to the required information. The risk assessments for two people were looked at the first included risk assessments on aggression towards others, supervision in the home, and accessing the community, and had all been kept under review. Risk assessments for the other person required further development as they had not fully detailed what the risks were and how these should be best managed. The manager said person centred plans will be introduced once staff have been trained on how to implement them. These are care plans that start with the person, not the service and take into account the individuals wishes about what they want to do and includes their requests on lots of things such as leisure, education and housing. They are produced in a format suitable for the individual such as easy read and picture format and would be a really good development for the service users at Wheelwright Road. Good progress had been made on developing assistance with people’s communication so that they can make decisions about their own lives. Staff interacted well with service user and makaton was used to assist communication. Following advice from speech and language therapy staff used techniques to promote and stimulate individual service user communication and self-expression skills. In the activity room a large board was in use detailing plans and activities for the day. Service users are encouraged to use the board to do picture illustrations if they wish to do so. Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s):12,13,14,15,16 and17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are supported to maintain contact with people important to them so they maintain personal relationships. The range of activities and how they are planned requires further development so that service users benefit from a range of opportunities that meet their individual needs. EVIDENCE: There has continued to be an increase in service users accessing community facilities, which is really positive. The manager said this has been linked to improvements with how staff are communicating and engaging with service users, which has resulted in a reduction in people’s behaviour that can present as challenging. Service users are supported to access community facilities including the cinema, bowling, local parks and shopping. One of the service Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 13 users is supported to attend a local college. Although progress has been made there is still much scope for further development of daytime activities. How leisure activities are planned and facilitated must be reviewed so that service user receive a range of valued and fulfilling activities that meet their assessed needs and is value for money. It is strongly advised that due to the specialist nature of this Home and the complexity of service users needs, specific resources such as dedicated staff should be available to resource and implement this. Service users opportunities to take part in activities impact on other service users due to staff availability. On the day of the fieldwork visit a service user had a medical appointment and required staff to support them; another service user was unable to go out until the staff returned. This is raised again under the staffing standards and must be reviewed. Records seen of service users response to activities lacked detail of what they had done and if they had enjoyed the activity. The three service users have limited verbal communication. It is important that this information is recorded so that it can be used for future planning and monitoring. The previous report raised some concern about the way activities are funded and this remains outstanding. Service users are funding themselves and the staff supporting them. This has been previously raised with the provider and Birmingham Contracts Department for further exploration. Concern was also expressed about how holidays for service users would be funded. Service users accommodated are all of different cultural heritage. It is positive that this is noted on the individuals care plan. Service users are supported to access community facilities that meet their cultural needs such as visiting specific food and clothing shops. In discussions the manager recognised that there is scope for further development for each service user so that their cultural and spiritual opportunities are explored further. Service users are well supported to maintain contact with relatives and friends where personal circumstances allow. It is really positive that a service user has an advocate. This is someone who will help to speak up for the person and make sure that things are done in their best interest and are independent of the staff in the home. During the visit staff interacted well with service users conversations were directed towards service users and staff engaged in one to one activities. Menus seen indicated that a range of nutritious and culturally appropriate food is provided. It was really positive that a service users relative visited the Home on the day of the fieldwork and worked alongside staff to prepare a culturally appropriate meal, which service users and staff shared at teatime. Progress had been made with helping service user to be more involved with menu Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 14 planning. Photographs and pictures of different food are available and service user was seen looking through the pictures and identifying different foods. Some further work to menu planning and auditing of the menus must be done so that they meet the target of five fruit and vegetables across each day ensuring all service user have a balanced and healthy diet. Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s):18,19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service user personal care needs are well met. Service users were well presented in a style that reflected their gender, culture and preferences. Health care recording and monitoring must be improved so that potential health problems can be identified and dealt with effectively. Medication is generally well managed ensuring that service users receive their medication as prescribed. EVIDENCE: Service user individual plans had details of people’s personal care routines and preferences. There was good detail about people’s cultural preferences and how these needs in terms of personal care should be met and respected. Service users were observed receiving good support with their personal care including skin and hair care. Service users were appropriately dressed in accordance to their age and culture. Concern was expressed about trousers Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 16 being to big on the waist for one person and it was asked that this be dealt with immediately. None of the current service users require assistance with moving and handling. The home is not suitable for a person with restricted mobility there are no adapted facilities and no mobility aids. Health care notes looked at indicate that service users are supported to attend routine G.P, dentist, chiropodist and optician appointments. Health Action plans have been implemented. This is a personal plan about what a person needs to stay healthy and what healthcare services they need to access. However health care recording and the tracking of outcomes of appointments was confusing. Information had been recorded in different places. The results of blood test had been recorded in the special notes section of the care plan and not with the other health information. Therefore it was difficult to track outcomes of appointments and it is of concern that important information could be missed. The “daily support folder” available in the office is practical guidance for staff on day-to-day practice, policy and procedures and gives very detailed guidance on the expectations of recording and how to record accurately. The manager agreed to address recording shortfalls and the implications of this with the staff team. The Home works closely with a multi disciplinary team to monitor the placement of a service user. The team meet every three months. As part of the post fieldwork contact was made with one of the professionals for comments on how the Home supports the person. Positive comments were made about the stability of the service user and improved communication with the Home since the present manager has been in post. The monitoring of peoples weight is important for the early detection of other health problems or complications. Service users weight monitoring recordings were infrequent. The manager said that service users now attended the weight clinic so that accurate monitoring could take place. There was a gap in recordings between August and October 2006. Concern was also expressed about the recorded weight loss of one service user and what action had been taken to follow up on this and to explore any underlying problem. The manager agreed to follow up on this immediately. The support service users require at night from waking night staff must be risk assessed and documented on their care plan so that any support given from night staff is in accordance with their assessed needs. Service user medication is stored in the main office on the first floor. All threeservice users require support from staff to take their medication. It was positive that service users medications had been reviewed with their G.P and where appropriate their consultant. The medication administration records Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 17 (MAR) cross-referenced with the blister packs indicating medication had been given as prescribed. Written protocols are in place to describe the circumstances which medicines given on an as required basis (PRN) should be given. One protocol seen required more information so that it gave guidance to staff about the service users particular health needs and how to look for possible signs of infection. Regulation 37 notifications have been received about medication errors. Examination of these and discussions with the manager indicate that appropriate action was taken following each incident to minimise the risk of errors. Following observations during the fieldwork visit it was advised that the manager reviews the procedure for the administration and storage arrangements of medication so that it minimizes the risk of errors being made. Refresher training in the safe administration of medication is scheduled for January 2007. The manager also undertakes medication competency audits to ensure that staff have the required knowledge and skills. Wheelwright Road, 19 DS0000065018.V323669.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 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Caretech has a robust complaint procedure ensuring concerns about the service can be raised and addressed. Some further development of behaviour management strategies is required so that service user are protected from abuse. EVIDENCE: The complaints policy was assessed at the previous inspection as robust and if followed would ensure concerns are dealt with thoroughly. There have been no complaints since the previous inspection and CSCI have received no complaints about the Home. It is advised that the complaints procedure is produced in a format more accessible for service users. The previous report raised concern about incidents of service user to service user abuse and how the Home had responded to take action to prevent reoccurrence. There has been a reduction in the recorded and reported incidents between service users. Progress has been made on the implementation of behaviour management strategies, which inform staff on how to support service users Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 19 consistently and recognise possible triggers although the strategies in place for one service user do require further development. When looking at incidents that had happened and cross referencing these to the monthly summaries there was no evidence that incidents were being appropriately monitored which makes this system ineffective. Incidents of challenging behaviour must be fully recorded, and reported. Review of these records must be undertaken to direct and inform care practice. It was advised that a log of regulation 37 incidents is kept in the home to assist with an audit trail of information and provide a more accurate system for auditing incidents. The organisations adult protection policy was not assessed at this visit. The manager had recently made an appropriate referral to Social Care and Health following an incident. The Home must have a copy of the Birmingham Multi – Agency Guidelines regarding the protection of vulnerable adults so that the guidelines can compliment their own policy and so the manager and staff team are familiar with what procedure to follow and who to inform should an incident occur. All service users require assistance to manage their finances. The home has a system for the recording and auditing of money received in and spent by individuals, so that service users finances are protected. Wheelwright Road, 19 DS0000065018.V323669.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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a safe and comfortable home that meets their needs. EVIDENCE: Improvements have been made to the physical standards since the last inspection. New carpets have been fitted throughout the home and new dining room furniture and tumble drier bought so the home is a more comfortable place for service users to live. Pictures had been purchased for the different communal areas and were reflective of the cultural heritage of the current service users. A piano is now provided in the activity room and new communication boards purchased to assist with the improvements made. Service user reacted positively during the fieldwork to these developments. The home was warm and clean and the environment was generally well maintained with no health and safety concerns noted. Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 21 Two of the service users showed the inspector their bedroom. New beds, bed linen, flooring and bedroom furniture had been provided so that the rooms were comfortable and safe for service users. Staff spoken with said service users were involved with the choosing of items for their rooms. Previous inspection reports have highlighted the need for the bathroom to be refurbished, as it is very worn and unattractive. It is really positive that work to improve the bathroom is scheduled for early January 2007. The garden was not looked at during this visit. The kitchen was clean and the arrangements for food storage and handling were adequate ensuring service users are not put at risk. The most recent environmental health report was completed in February 2006 and as stated in the previous CSCI inspection report, a mainly positive report was received. Wheelwright Road, 19 DS0000065018.V323669.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 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are not adequate to meet the social and recreational needs of the people living at the Home. Staff receive the training to enable them to meet service users assessed needs. EVIDENCE: Staffing levels are three staff across the day. At night there is one person doing a waking night shift and one person sleeping in on call. Additional funding provides 1:1 support for 24 hours a week for one service user. Both male and female staff are employed which is reflective of the service users gender. A risk assessment had been implemented for the occasions when only male staff are on duty at night. This must be kept under review so that service users safety and dignity is fully protected Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 23 The manager highlighted through the pre inspection questionnaire that there had been a high turn over of staff over the last six months. Staff had moved on for personal and development reasons. A core team of agency staff have been used to maintain staffing levels. Recruitment has taken place and the manager was in the process of inducting six staff members and expects to be fully staffed from January 2007. Opportunities for service users to engage in a full programme of activities across the week were looked at. Two of the service users have complex needs and require two staff to support them within the community to successfully and safely engage in suitable activities and all three require one to one staff support when at Home. Current staffing levels restrict opportunities for service users as raised under the core standards “Lifestyle” and must be formally reviewed. Service user were unable to tell the inspector their views but from observations during the fieldwork the inspector concluded that service user were very comfortable and relaxed with the staff on duty throughout the fieldwork visit. The recruitment records for three staff were sampled. Checks of the person’s suitability to work in the home had been made; including satisfactory Criminal Records Bureau checks, completed application form and proof of identification. A query was raised in respect of the one persons reference and the manager was asked to follow this up with the organisations Human Resource department. Training recently completed and scheduled for the next few months included both mandatory and those reflective of service users needs including Non Violent Crisis Intervention (November 2006), Health and Safety (December 2006) Fire safety (January 2007) Autism awareness, Diabetes, First aid and Makaton (March 2007). This should ensure that staff have the skills and knowledge to support service users. Some training certificates were on staff files. Staff training records must be developed so that training achieved and in need of updating is easy to monitor and should highlight any outstanding training needs. Wheelwright Road, 19 DS0000065018.V323669.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)37,39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The systems in place ensure that service users Health, safety and welfare is promoted and that they live in a safe Home. Quality assurance systems should be developed so that it seeks the views of service users and their representatives about how well the home is doing. EVIDENCE: The manager has been in post for nine months but has not yet made an application to be registered with CSCI. He is a qualified learning Disability Nurse and has a number of years experience with the client group. Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 25 Throughout the inspection the manager was open and welcoming to the inspection process. The relationships between the manager, service users and staff were good. Progress had been made on previous requirements. The manager does three shifts per week hands on and is allocated sixteen management hours per week. In light of the complexity of the needs of service users and the responsibilities required of a registered manager it is advised that this is reviewed and the amount of management hours increased. The service manager undertakes monthly regulation 26 visits to monitor that the home is being managed appropriately. Copies of the report are available in the home and sent to CSCI. The reports indicate that a thorough visit takes place. A quality audit system is in place and the Home had a full unannounced audit in June 2006 an action plan was drawn up of the recommendations and requirements. The organisation must explore how service users, their relatives and other stakeholder’s views are sought to measure the success of the Home in meetings its stated aims and objectives. A number of health and safety records were looked at. The manager had also completed the pre inspection questionnaire to confirm dates of health and safety checks. Fire safety records showed that the fire alarm system is tested and serviced as required so that it is kept in a safe working condition. Fire drills were being carried out every three months so that service users and staff have the opportunity to practice safe evacuation in the event of an emergency. It was advised that details of peoples names are recorded when the drills take place so that the manager can ensure all staff get this training. It is of particular importance that night staff take part in such drills, as they will be the lead person should an emergency occur at night. The Fire risk assessment was reviewed in September 2006. The Gas safety check was due in December 2006. Electrical wiring checks took place in October 2006. Certificates of the tests were available and indicate that the building is maintained for the protection of service users. A tour of the premises at the time of the fieldwork found no obvious health and safety hazards that would place service users at risk of harm. Wheelwright Road, 19 DS0000065018.V323669.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 2 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 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 3 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 2 X X 2 3 Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 17(1) Requirement A user-friendly format for maintaining service users records must be developed. Outstanding from previous inspection. Progress made further development required. Care documents must contain clear guidance on how care needs are to be met. Outstanding from previous inspection. Progress made further development required. Appropriate behaviour management plans that contain individual proactive strategies must be developed. Outstanding from previous inspection. Progress made further development required. Timescale for action 28/02/07 2. YA6 12(1)(a) 15 28/02/07 3 YA6 12(1) 31/01/07 Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 28 3. YA8 12(2)(3) Evidence of consultation with service users or their representatives must be available in the service users plans. Outstanding from previous inspection. Progress made further development required. Risk assessments must contain consistent information, and practice must be consistent with the assessment documents. Outstanding from previous inspection. Progress made further development required. The arrangements for funding of activities and holidays must be reviewed, and written evidence that this is compliant with the Birmingham City placement contract obtained. Outstanding from previous inspection. Progress made further development required. A choice of interesting and varied activities both in the home and community must be available for service users each day. Outstanding from previous inspection. Progress made further development required. 31/01/07 4. YA9 13(4)(a-c) 28/02/07 5 YA13 13(6) 01/08/07 6. YA14 16(2)(m-n) 28/02/07 Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 29 7. YA16 12(4)(a-b) 8 YA17 16 (2) (i) 9 YA18 12 (1) (a) (b) 10 YA19 12(1)(a) Service users must be offered opportunity to maintain and develop their spiritual and cultural beliefs. Outstanding from previous inspection. Progress made further development required. Menu planning must be monitored to ensure service users receive a balanced diet. The support people require during the night must be risk assessed and documented on their care plan. Arrangements must be made to ensure accurate weight measurement and recording is undertaken. Outstanding from previous inspection. Progress made further development required. The weight loss of a service user required further exploration. Health recording and tracking must be improved so that appropriate monitoring of service user health needs is established. One protocol seen required more information so that it gave guidance to staff about the service users particular health needs and how to look for possible signs of infection. 28/02/07 31/01/07 31/01/07 31/01/07 11 12 YA19 YA19 12 (1) (a) 12 (1) (b) 31/12/06 31/01/07 13 YA20 13 (2) Schedule 3 17 (1) a 31/01/07 Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 30 14 YA23 12(1)(a) 13(1)(b) Incidents of challenging behaviour must be fully recorded, and reported. Review of these records must be undertaken to direct and inform care practice. 31/01/07 15 16. YA23 YA33 13 (6) 18(1)(a) Outstanding from previous inspection. Progress made further development required. A copy of the multi agency 31/01/07 guidelines must be available in the home. Unmet from the previous 28/02/07 inspection. The number of staff on duty must be adequate to meet service users assessed needs and enable access into the community. Training records must be 28/02/07 developed so that there is evidence of training completed. The acting manager must 01/06/07 make an application for registration with the CSCI. The quality assurance 28/02/07 system should be developed to include the views of service users. 17 YA35 18 (1) c 18 19 YA37 YA39 8 (1) (a) (b) 9 (1) (2) 24 (3) Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 31 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 3 Refer to Standard YA1 YA6 YA12 Good Practice Recommendations It is recommended that the provider produces the service user guide in a format accessible to service users. It is recommended that Person Centred Planning be undertaken with service users to address peoples changing needs and aspirations. It is recommended that household activities be included in the service users support plans, so that progress made and the effectiveness of the strategy can be monitored and evaluated. It is recommended that information about service users be presented in an accessible format. It is recommended that the manager review the administration practice and storage arrangements for medication. It is advised that the complaints procedure is produced in a format suitable for service users. It is advised that details of staff involved in fire drills are kept so that manager can ensure all staff have this opportunity of implementing the fire safety procedure. 4 5 6 7 YA8 YA20 YA22 YA42 Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wheelwright Road, 19 DS0000065018.V323669.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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