Inspection on 04/07/07 for Willes Road

This inspection was carried out on 4th July 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Willes Road 18/07/08

Willes Road 19/11/07

Willes Road 11/07/06

Willes Road 29/11/05

Willes Road 19/05/05

Willes Road 26/10/04

Willes Road 14/05/04

Willes Road 03/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Willes Road 26 Willes Road Leamington Spa Warwickshire CV31 1BN Lead Inspector Martin Brown Key Unannounced Inspection 4th July 2007 09:30 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 Willes Road DS0000058002.V343788.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. Willes Road DS0000058002.V343788.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Willes Road Address 26 Willes Road Leamington Spa Warwickshire CV31 1BN 01926 336437 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) www.turning-point.co.uk Turning Point vacant post Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Willes Road DS0000058002.V343788.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered manager must successfully complete the Registered managers Award and NVQ level 4 by 1st November 2006. 14th February, 2007 Date of last inspection Brief Description of the Service: This house is home to five young people who have significant learning difficulties, impaired communication skills and complex behaviours. All are able bodied. The service offers 24-hour staffing and high levels of intensive support and personal care. 26 Willes Road is a Georgian detached house that has been divided into two separate, self-contained dwellings. The top two floors provide three bedrooms (one with en-suite), two lounges, one dining room, kitchen, laundry, one bathroom and separate toilet and staff office, all for three people with severe learning difficulties. The basement provides accommodation for two young men with learning disabilities. There is a rear entrance, two bedrooms, one bathroom, a small lounge and a small kitchen. There is a storage space that has been converted into an office come laundry. The fees currently range from £1,430 to £2,501. There are additional charges for transport; a £400 allowance is made towards an annual holiday. Willes Road DS0000058002.V343788.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over six hours during a weekday. During that time, staff were spoken with, residents were seen and their interactions with staff and each other observed. Service users have challenging behaviours and high communication needs, most communication being expressed in single words, or by gestures or behaviours, although one person is able, when he chooses, to communicate by his ‘light writer’ He chose not to during this inspection. Policies, and procedures and care records were examined, and the four of the five residents were ‘case tracked’, that is, their experience of the service provided by the home was looked at in detail. The home manager was not present during the inspection, but the service manager was available. The recently introduced Annual Quality Assurance assessment was filled in and returned by the management to further inform the inspection, as was accumulated evidence from regulation 37 notices concerning incidents affecting the well-being of the residents, copies of a complaint made by an ex-member of staff concerning practices at the home, as well as information from Regulation 26 visits from representatives of the registered provider. Two relatives who were able to be contacted by telephone gave views on the service. Typical comments included ‘my son is well looked after’ and ‘we have no worries’. Direct communication from service users was limited, as was verbal communication. Much of the time, service users were involved in their own personal activities, or interacting with staff, and either taking part in activities with them, or anticipating activities. What the service does well: What has improved since the last inspection? The bedroom of one service user is much improved, and the night time behaviour that led to problems in this room have finally been addressed. Willes Road DS0000058002.V343788.R01.S.doc Version 5.2 Page 6 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. Willes Road DS0000058002.V343788.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 Willes Road DS0000058002.V343788.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): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Any prospective service user may be confident that their aspirations and needs would be properly assessed. They may be less confident that the service, in its present configuration, could properly meet those needs on a practical and day-to-day basis. EVIDENCE: There have been no new admissions since the last inspection, and no further admissions are anticipated. Turning point has a referral assessment policy in place with comprehensive risk assessments, as detailed in the Annual Quality Assurance Assessment returned by the service. This notes that “We have a service user guide and statement of purpose that the service user would be given identifying his rights and expected behaviour of all who live at the service. We support the service users to lead their own lives through PersonCentred Care Palnning (PCP), making their own choices, creating opportunities to experience wishes and dreams as well as new opportunities, including choice of home. We support our staff by providing a comprehensive training and development package, regular supervision and appraisal in which is discussed PCA, Protection of Vu,nerable Adults (POVA) and reflective practice.” Observations detailed in later parts of the report show that the service is not readily addressing many elements of current needs and wishes. Willes Road DS0000058002.V343788.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): 6,7,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from individual support and thorough care guidelines, but their well-being is compromised if these guidelines are not followed and regularly updated. While staff are attentive to clearly understood choices, where service users communication is more unorthodox, or where they have difficulty in making wishes understood, care may not be consistent. Lack of care in storing personal information about service users can impact upon confidentiality, and, ultimately, service users’ dignity. EVIDENCE: Individual care plans are kept in individual bedrooms. Two care plans could not be located by staff when requested. The assumption was made that they were being reviewed. They were later found in the office. Care plans were found to be good at the previous inspection, containing reviews and health information, and user-friendly files, containing guidance on wishes, preferences and support needs, well-illustrated with photographs. Willes Road DS0000058002.V343788.R01.S.doc Version 5.2 Page 10 None showed any evidence of having been reviewed since then, which meant that all the guidelines were over a year old, some having been established and not reviewed since January 2006. We were later informed by the service manager that plans were in place to have the care plans reviewed by the outside professional responsible for setting them up, in the coming month. Most of the care plans looked at did not contain a review date. One had a ‘suggested’ review date. Being in individual bedrooms meant that care plans were in theory accessible to individual residents, but their location, in one instance ‘hidden’ behind a sofa, indicated this was not the case in practice. It also meant that care plans were not very accessible to staff, shown by the fact that staff were not clear where they were, and that guidelines in them were not always followed. One example was given by a staff member of a recent occurrence when a service user, who wears a protective helmet at night time only, was left with it on in the day by staff unfamiliar with his needs, and then went out, still wearing it, with another member of staff. Staff spoken with and observed on the day of the inspection showed a good awareness of the individual needs of the service and how to support them, with an acknowledgement in several instances that they still had more to learn about how individuals communicated their wishes. Individual daily records continue to kept, staff were seen to be completing these at the end pf the morning shift. The value of care plans and guidelines was shown when I was able to refer to one and name a pub liked and visited by one service user, and get a surprised smile of recognition- my only clear acknowledgement from this person- when I mentioned that I had been there. Service users were seen to be supported by staff in making choices in day-today activities. One-to-one staffing means that people are able to go out, or stay in, as they wished. One resident went out for a walk and something to eat. This was not communicated to another member of staff, who prepared her a dinner, which unsurprisingly, she did not wish to eat on her return. One resident chose to spend much of his time in his room, coming down for dinner when others had finished. Staff, and a relative, advised that he will eat with other residents on occasion. This has not been observed in at least four inspections. One service user has been supported by staff in a regular activity that had previously been valued. Recent reactions by that person to this activity suggested that this was no longer the case. This activity was cancelled, after the second time he reacted in a negative way, but there was no evidence that the first negative reaction to this activity had produced any response by the service, other than to record ‘incontinent of urine.’ Willes Road DS0000058002.V343788.R01.S.doc Version 5.2 Page 11 Amongst a number of various files in an open cupboard in the ‘snoozelum’ room, where personal records of one service user dating back several years. Willes Road DS0000058002.V343788.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): 12,13,15,16,17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from sufficient staffing to enable individual activities to take place on a day-to –day basis. There is a risk that service users may miss out on holidays because of staff changes, and that service users may continue activities they are no longer keen on if their wishes are not fully understood. EVIDENCE: The service is located favourably to facilitate ‘spontaneous’ activities, such as walks by the river, in the park, and to local shops and cafes. Good staffing ratios enable service users to go out regularly, escorted by staff. A staff member spoke of recent activities enjoyed by some service users, including a trip on a train, and recent holidays enjoyed by service users with staff support. One service user’s planned holiday is currently in jeopardy, because of staff departures. Most service users went out locally during the inspection. Staff said that most of the service users enjoyed going for a walk, especially when Willes Road DS0000058002.V343788.R01.S.doc Version 5.2 Page 13 combined with a visit to a café or similar. This appeared evident in the case of at least two service users who were enthusiastic about going out. Family contact continues to be supported, with regular visits and stays to families being supported. One relative spoken to was very positive about the service, saying they are always kept informed that they have no worries about the care and that there are plenty of activities, such as regular visits to a gym. One regular activity for one person, delivering newspapers with staff support, has been ongoing for over a year. Staff records indicated that this person enjoyed this activity, although recent reactions from the service user led to a questioning, and hasty cancellation, of this activity. There was no evidence of any recent evaluation by the service as to whether this activity was something that this person enjoyed, or merely ‘put up with’ until recently. A healthy lunch was prepared for the three residents in the main part of the building. However one person ate whilst she was out, and one person chose, as is often the case, to eat after everyone else had finished. The two residents in the basement had their snack in their kitchen. Staff were observed to be flexible, positive and accommodating in their support of service users with differing needs. Care plans detail different dietary preferences and needs. A recent regulation 26 visit reminded staff to continue to ensure that healthy eating was promoted and that dietary guidelines were adhered to. Willes Road DS0000058002.V343788.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although well-supported by staff numbers, the well-being of service users may be compromised if guidelines are not read, understood and followed, and if there is a shortage of experienced, trained and supported staff available. Service users will remain poorly served by medication administration for so long as there are insufficient numbers of staff properly trained to administer it. EVIDENCE: Service users were seen to be supported on an individual basis, although the absence of a manager meant that the shift leader was frequently taken away from immediate care duties to deal with phone calls and callers. One service user continues to prefer not to be with other service users, and to be unpredictable as to what he wishes to do. Staff were seen to manage his needs calmly and patiently. In some of the examples noted, such as managing a service user’s nighttime continence, there has been a long gap between the problem occurring, and it being identified and acted upon and resolved. It was not clear why this should Willes Road DS0000058002.V343788.R01.S.doc Version 5.2 Page 15 be so. Staff advised that the incontinence problem had not re-occurred since night staff had started regular toileting. There was no one on the morning shift to dispense medication. This meant it had had to be dispensed by the night shift worker at the end of the night shift, resulting in service users having their medication earlier than they may have expected or wished, possibly whilst they were still in bed. A notification had been received the previous month where medication had not been given because there was no person trained to do so competently. Staff were able to explain the procedure now in place whereby someone is contacted to ensure medication is given, and either an on-call person or someone from a nearby service visits the home. This is a short-term measure until more staff have received medication training. The service manager expressed frustration that this training had not already been progressed. Following the inspection, the service manager was able to inform me that medication training has been booked for staff to ensure there is always at least one person on duty at any one time to administer medication. Medication records were checked, and showed no discrepancies since that incident the previous month. One service user, who frequently asked ‘walk’, was most settled during a period when other service users were out and he sat in the lounge by himself. He appeared less settled when there were more people around. One service user, whose comments to me consisted of the word ‘man!’ was typically noisy, enjoying lots of contact, busyness, and going out. One service user was due a dental appointment the following day. Staff discussed the best way forward for this, in the light of perceived difficulties, and demonstrated a commitment to achieving the best result for this person. Staff interactions with service users during the inspection were seen to be good. Staff were seen to be aware of and to manage discretely the risk of one service user banging his head. Throughout, service users were spoken with and encouraged in a positive manner. An allegation still being investigated concerning poor practice, and examples given by staff concerning poor practice, indicate this may not always be the case. Indirect poor practice, such as sharp knives being left out, and unlocked cupboards containing hazardous substances, was noted. Willes Road DS0000058002.V343788.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ views are listened to and acted on; sometimes the service has difficulty interpreting these views when they are expressed in terms of behaviour. Service users can be confident that incidents of self-harm and allegations of abuse are investigated and addressed by the service, but may be concerned that these continue to occur. Service users are potentially at risk of financial abuse if procedures and practice for managing their personal monies is not improved. EVIDENCE: Service users have high communication needs and are dependent to a high degree on staff interpreting their views and wishes, using their knowledge, experience, and existing communication guides. Service users are able to make their views known with a mixture of gestures, one word responses, and in one instance, with a ‘light writer’ device – a light weight, portable, speaking typewriter. Staff were observed to respond to views and wishes where these were clearly understood. It is not clear that this is always the case, as evidenced in the initial lack of response to one service user’s incontinence whilst out with staff on a regular weekly activity. A sample of finances for two residents were looked at. One showed full and accurate receipts, although the running total of monies was inaccurate by a Willes Road DS0000058002.V343788.R01.S.doc Version 5.2 Page 17 small amount. The other record looked at was accurate in the running totals of monies, but there was a recent withdrawal that was not receipted. Staff spoken expressed confidence that this was a clothing purchase, but could not account for the lack of receipt. The service manager advised that this would be looked into and rectified. Receipts were not being regularly archived, with over a hundred being noted as still current in one person’s folder, and excessive monies were in individual boxes. Staff acknowledged that this made thorough and accurate checking an overly time–consuming task. There has been a history of Vulnerable Adult issues at the home over the past few years, and staff are very aware of whistle-blowing and issues of abuse, with a number of staff having either made allegations in the past, or been the subject of them. At present, an allegation concerning one member of staff is being investigated. The organisation’s investigations of allegations in the recent past have so far shown themselves to be thorough. One service user is particularly vulnerable in respect of self-harming, and has additional staffing to help prevent this. An incident of potential self-harm occurred recently with this person. Willes Road DS0000058002.V343788.R01.S.doc Version 5.2 Page 18 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): 24,25,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The three-storey property remains one which is difficult to maintain, and which is difficult for a service for five people with challenging behaviour to successfully operate in. Most service users benefit from spacious, well furnished, bedrooms. Communal areas are spacious, but access to the garden area, which should be a valuable asset, is limited. The sustainability of the basement flat, in the face of further flooding risks, is questionable. EVIDENCE: The service still benefits from improvements to the home noted at the previous inspection, with the dining room and lounge continuing to be fresher, brighter, and airier than previously. However, areas such as skirting boards and painted wooden surrounds still look grubby and marked, and add to what one staff called the ‘tired’ look of much of the place. The needs of the service users means that the home suffers a good deal of ‘wear and tear’, and this is not being made good. Rips in wall paper noted at the previous inspection are still evident, and the laminated flooring in communal areas now shows signs of damage/wear. A lock to a kitchen cupboard was broken; a member of staff Willes Road DS0000058002.V343788.R01.S.doc Version 5.2 Page 19 informed me that this had been reported, but that nothing had been done. The laundry room was cramped, and cluttered, with a number of items, such as two paint brushes, a length of cable, being in there, as well as toilet rolls and hand towels. There were no unpleasant odours in the home during the inspection. The home was generally clean; staff were seen to clean up spills and messes promptly. One staff commented that the whole home would benefit from a thorough clean by cleaning professionals. Individual bedrooms are spacious, with one exception, and are pleasantly and individually furnished. One relative commented that a different bedroom had been promised for over a year, but nothing had materialised concerning this. One bedroom has been refurbished, following concern expressed at the last inspection concerning unpleasant odours and general shabbiness. It is now a much more pleasant room. There was a notice on one bedroom door to the effect that this door must be locked when not in use, to safeguard that person’s belongings. The door was not locked. Staff later advised that this was no longer an issue, and that the room was now kept open for her to use whenever she wished. She agreed that the notice should now be removed. The basement, lived in by two residents, showed signs of continued improvement, with one bedroom being refurbished, and the kitchen area showing signs of improvement. However, the recent heavy rainfall had resulted in a risk of flooding inside, and actual flooding outside, with the result that the main exit to the garden is currently blocked by sandbags. The blocked door was the normal exit from the basement in the event of the stairs being unsafe to use. The staff consequently ensured that the alternative, the lounge door, was able to be used in the event of emergency. Access to the garden area was, at the time of inspection, not available, because of flooding owing to the recent heavy rainfall. I was advised by staff and management that the flooding was from drains, and that Seven Trent Water were to investigate, but the home had been told other areas were currently a higher priority. Staff advised that they maintain the gardens when they can, so that it is accessible to service users, and not overgrown. By the blocked exit, there were currently the remains of wardrobes that had been removed from a refurbished bedroom, which had not yet been disposed of. When the flood risk was at a peak, one service user had to sleep upstairs as a safety measure, whilst the other was at his parents’ house. Staff advised that the service user enjoyed sleeping upstairs, in the ‘snoozelum’ room. During the inspection, this person spent time upstairs, and appeared to be enjoying this, giving more frequent smiles and laughs than I had noted him giving downstairs. Willes Road DS0000058002.V343788.R01.S.doc Version 5.2 Page 20 The ‘snoozelum’ room has a few light features designed to be relaxing/stimulating for service users. Staff advised that individuals use it ‘occasionally’. This room continues to give the impression that it has no specific use. The room also has a staff notice board, an unlocked cupboard containing an assortment of files, and, on the day of the inspection, a mattress, on top of which was a sharp knife, unnoticed by staff, which was removed to a safer place. The service had experimented with running the basement as a separate unit, but shortages of experienced staff had resulted in the whole service having to be more integrated again. It was noted that a lot of staff time was spent going up and down stairs, and that having a service on three floors exacerbated staff communication problems, particularly between the basement and the rest of the building. There was no light bulb in one hall light socket; staff advised that the electrician had recently visited. The bathroom and toilet above the laundry is not lockable. Willes Road DS0000058002.V343788.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The quality of service offered to service users currently is weakened by the lack of experienced staff and the consequent reliance on a proportionately large number of relatively new staff and agency workers. A lack of training and supervision also impacts upon the quality and consistency of care. The staffing ratio remains good, and a number of those spoken to and observed showed commitment, enthusiasm, and initiative. Nevertheless, examples of poor practice, poor communication, and inconsistency, as highlighted in the report, were evident on the day and in recent months. EVIDENCE: Staffing ratios provide one to one staffing, with two to one staffing for one resident identified as requiring constant supervision. On the morning of the inspection there were two permanent staff on duty, one Turning Point staff from a nearby home, and three agency staff, all who had worked at Willes Road previously. A staff member advised that there had been several occasions on which all staff had been agency staff. In the absence of the manager, the ‘shift leader’ in the morning was a staff member who had been a permanent member of staff for less than six months. Willes Road DS0000058002.V343788.R01.S.doc Version 5.2 Page 22 Staff files were not able to be looked at on this inspection, in the absence of the homes manager. The Annual Quality Assurance Assessment returned by the service, states that it follows Turning Point recruitment policies, which have been seen to operate effectively in other nearby services run by the organisation, and are overseen by the organisation’s Human Resources department. There were no staff trained to administer medication on the morning shift. There was one staff on in the afternoon shift appropriately trained to administer medication. One staff believed that they could not be trained to administer medication until they had worked for the service for six months. One staff discussed training at length, and was concerned that some training needed updating, and expressed frustration at not having started National Vocational Qualification level 3, which, I was advised, had been a request for several years. Staff spoke of the difficulty of being released for training with so few permanent staff available at present. Staff spoken to confirmed that supervision was infrequent, with one supervision in six months being a typical view. Staff made clear their frustration at this, feeling this hindered their opportunity to discuss training opportunities and personal development. Willes Road DS0000058002.V343788.R01.S.doc Version 5.2 Page 23 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): 37,39,41,42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users are not currently benefiting from a well-run home. Whilst service users benefit from the maintenance of good staffing ratios, their well-being is compromised by a lack of appropriately trained and experienced staff, and an over–reliance on agency staff. Health and safety within the home is compromised both by poor practice and by identified shortcomings not being made good within reasonable timescales. EVIDENCE: The manager was absent on the day of the inspection. The service manager advised that the probationary period for the manager was not yet complete. The manager does not have the Registered Manager’s Award. The service has had a number of managers in recent years, and on several occasions, the service manager has had to take an active role in ensuring standards in the home are maintained or improved. Willes Road DS0000058002.V343788.R01.S.doc Version 5.2 Page 24 Several staff spoken with were unhappy that they had not accessed suitable training, or were not aware that they could. There were no staff on duty on the morning shift with the necessary training and competence to administer medication. Service user meetings are not taking place, and planned family forums had not taken place as planned, although staff advised that one was now to take place shortly. Both relatives spoken with felt they were kept informed on all relevant issues. Regulation 26 visits take place regularly. These have highlighted shortcomings in the service, and identified courses of actions to take. The Annual Quality Assurance Assessment returned by the service indicated that all appropriate safety checks were up to date. The device to safely hold the kitchen fire door open was missing, which meant it closed each time it was used. Staff were aware that it was not to be propped open. However, three doors in the basement were found to wedged open. These wedges were then removed. The staff advised that fire closures for these doors had been ordered. A Control Of Substances Hazardous to Health (COSHH) cupboard in the kitchen was locked, but a cupboard below the sink containing similar substances had a broken lock. Staff advised that this had been reported some time ago. Staff removed the potentially hazardous materials from this cupboard and into a safer, locked, place. COSHH documents were seen, but there was no evidence that these had been reviewed in over a year. Some hazardous materials were stored safely, but others, as noted previously, were not. As previously noted, a sharp knife had been left out. Willes Road DS0000058002.V343788.R01.S.doc Version 5.2 Page 25 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 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 3 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 2 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 x 2 x 3 x 2 1 x Willes Road DS0000058002.V343788.R01.S.doc Version 5.2 Page 26 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. Standard YA10 Regulation 12(4)(a) Requirement Personal information about service users must be stored appropriately, so that confidentiality and dignity is not compromised. A larger proportion of the staff team must be able to administer medication, to ensure service users can receive necessary medication in a safe and timely manner. (This is an outstanding requirement from the previous inspection.) All expenditure on behalf of service users must be properly accounted for, to ensure they are not being financially abused. Ripped wallpaper in the hallway must be made good, so that service users live in a more pleasant environment. (This is an outstanding requirement from the previous inspection.) There must be sufficient permanent staff to avoid excessive use of agency staff, so that service users are re-assured DS0000058002.V343788.R01.S.doc Timescale for action 30/07/07 2. YA20 YA35 YA32 13 18 30/07/07 3. YA23 13(6) 30/07/07 4. YA24 23 30/09/07 5. YA33 18(1) 30/08/07 Willes Road Version 5.2 Page 27 6. 7 YA35 YA36 18(1) 18(2) by a consistent staff team and a consistent approach. Staff must have appropriate training to be able to confidently meet the needs of service users. Staff must have adequate supervision to support good, consistent practice and help personal development. 30/08/07 30/08/07 8. YA41 17 9. YA42 23 10. YA42 23 The service must ensure that all 30/08/07 necessary records are up to date, stored appropriately, and are accessible, to support the well being of service users. Potentially dangerous items, 09/07/07 such as sharp knives, should not be left in communal areas, in case service users come to harm. Doors in the basement must only 09/07/07 be kept open by an alarm activated closure device, to help maintain safety from fire risks. All hazardous substances must be stored securely, to minimise the risk of harm to service users. 09/07/07 11. YA42 13(4) 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 is recommended that information in personal folders also include a specific review date, to ensure care plans are kept up to date to reflect and inform current needs of service users. Current cash and receipts for individual residents should be kept to a manageable minimum, to help ensure they are monitored regularly and accurately. DS0000058002.V343788.R01.S.doc Version 5.2 Page 28 2. YA23 Willes Road 3. YA24 A decision should be made as to whether the ‘sensory’ is to be used for that, or for some other, purpose, so that rooms are used for the maximum benefit of service users. The service should considers whether the basement is a suitable environment, and whether the service itself, in its present configuration, adequately meets the needs of some, or any, of the people who currently use it. Bathrooms and toilets should have suitable locks to ensure privacy and dignity for those using them. Better communication between staff will support a better service for service users at 26 Willes Road Addressing the rapid turnover of staff at this service may help a more consistent approach to the needs of the service users. 4. YA24 5. 6. 7. YA27 YA33 YA33 Willes Road DS0000058002.V343788.R01.S.doc Version 5.2 Page 29 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 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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