Inspection on 13/02/07 for Wood Lane, 135

This inspection was carried out on 13th February 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 23 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wood Lane, 135 13/06/08

Wood Lane, 135 13/07/07

Wood Lane, 135 02/03/06

Wood Lane, 135 10/10/05

Wood Lane, 135 04/03/05

Wood Lane, 135 19/08/04

Wood Lane, 135 16/03/04

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 Wood Lane, 135 Handsworth Birmingham West Midlands B20 2AQ Lead Inspector Jane Rumble Key Unannounced Inspection 13th February 2007 09:00 Wood Lane, 135 DS0000016881.V293394.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 Wood Lane, 135 DS0000016881.V293394.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. Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Wood Lane, 135 Address Handsworth Birmingham West Midlands B20 2AQ 0121 523 5547 0121 523 5547 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) londonroad@tiscali.co.uk Milbury Care Services Limited Damien Crossan Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users must be aged under 65 years Service users must have a learning disability. Date of last inspection 2nd March 2006 Brief Description of the Service: 135 Wood Lane is registered to provide accommodation, care and support for four people with learning disabilities. The house is a two-storey semi-detached property and is located in a pleasant and well-established residential area in the Handsworth district of Birmingham. There are local shopping facilities within walking distance, and main bus routes also run close by. Accommodation is provided in two single and one shared bedroom over the two floors. No aids or adaptations are provided to assist people access the first floor, so residents need to have full mobility to access these rooms. One of the single bedrooms is on the ground floor. There is a bathroom with bath, wc and wash hand basin on the first floor and a shower room on the ground floor with separate wc Downstairs there is also a lounge, separate dining room, kitchen and laundry. A small office is available on the first floor. There is an attractive enclosed garden to the rear of the property, and this has a lawn, planted borders and a small patio area. At the front of the house is a paved area with limited off-road parking. Details of the range of fees charged and extra charges such as hairdressing was not available at the time of this visit. The home displays the most recent inspection reports on the notice board in the kitchen. Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place in one day over an eight hour period. Four residents were living at the home at the time of this visit. There was a small amount of information received by CSCI prior to this fieldwork visit that has being taken into consideration. Information was gathered from speaking to the acting manager and two care staff. The inspector met with all four residents but conversations with them were limited due to their complex needs and limited verbal communication skills. Time was spent observing the care practices, interactions and support residents received from staff. Care records, health and safety records and staff files were examined. The management of medication was reviewed and a tour of the premises was undertaken. One immediate requirement was made at the time of this visit relating to how staff were supporting a resident with their swallowing difficulties. What the service does well: What has improved since the last inspection? Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 6 Staff recruitment records are now kept in the home to demonstrate that robust recruitment practices are undertaken and staff employed are suitable to work with vulnerable people. Health Action Plans have been developed. These are a personal plan about what a person needs to stay healthy. However, they need further development to accurately reflect individual’s needs. What they could do better: Care plans must provide staff with clear guidance about how to meet all individual residents needs. Risk assessments need further development to ensure that risks to residents are managed in a safe and responsible manner and staff have sufficient information to manage these risk. The home needs to get better at meeting requirements made at inspection so that they comply with the law. The home must ensure that they employ robust pre admission checks so that residents can be confident that their needs will be met upon admission and that they will be compatible with the residents all ready living at the home. Information about residents must be stored appropriately so that they can be confident that confidentiality is maintained. Staff must have all the training and supervision they need to meet residents individual and collective needs. Residents must be offered a diet that meets healthy eating guidelines and individuals needs and preferences. Staff must know what to do in the event that an allegation of abuse is made so that residents can be safeguarded from harm. Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 7 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. Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2345 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to the service. Admission practices are not robust enough to ensure that prospective residents can be confident that needs and expectations will be met at the home EVIDENCE: The home has had a stable group of residents; three of the existing residents have lived at the home since it was opened in 1991. Since the last inspection one service user moved out and a new resident moved in on the same day from another home run by the same organisation that was closing. This meant that the new resident was unable to influence the décor of his room prior to moving in so that it reflected his taste and preferences. There was no evidence that a full and comprehensive assessment of this persons needs and the homes suitability of the home to meet them was undertaken prior to him moving into the home. A living skills assessment was completed after admission to the home. There was no evidence that an independent advocate was involved to ensure that this was the most suitable placement for this person. Records show that two introductory visits to the home were undertaken of short duration, and did not include an overnight stay. During these visits he was supported by a member of staff who was known to him. It is unclear how the success or not of these visits was measured. The individual has not had written confirmation from the home that they are able to meet his needs prior to him moving in as required by the Care Home Regulations 2001. Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 10 The individual has a number of behaviours that impact or place restrictions on others living at the home. It is not clear that this impact had being considered or discussed with existing service users and their representatives prior to his admission to the home to ensure that individuals interest are safeguarded. A copy of service user guide was available on the individuals file. It is pleasing that this document includes pictures and symbols to try and make the information more accessible to the people living at the home, in addition a laminated copy of the guide is available downstairs for residents to look at if they wish. The guide needs to be updated so that it provides accurate information about the service provided, to include details of the fees charged, and the cost of any extras such as hairdressing, chiropodist and leisure activities. Residents living at the home have a copy of the agreement of the terms and conditions of their stay. One of these was sampled at this visit. The document had not been dated or signed by a representative of the organisation or the service user and information needed to be updated to accurately reflect current circumstances. Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 7 9 10 Quality in this outcome area is poor. This judgment is made using available evidence including a visit to the service. Care plans do not contain sufficient information to guide staff to ensure that resident’s needs are met consistently. Risk assessments need further development to ensure that risks to residents are managed in a safe and responsible manner and staff have sufficient information to manage these risk. Residents cannot be confident that information about them is handled in a way that is respectful and maintains their confidentiality. EVIDENCE: Each resident has an individual care plan. This is an individualised plan about what a person is able to do independently and should state what help is needed from staff in order for the resident to have their needs met. At the last inspection requirements were made that care plans should be developed so that they contain sufficient detail so staff know what support to offer. It is of concern that care plans sampled still do not address individuals needs and do not provide staff with clear guidance about how to meet individual residents needs consistently. Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 12 It is not clear how what is included in the care plans is decided. The home completes a written assessment of individuals needs. It is disappointing that not all assessed needs are included in the plan of care and inconsistencies are recorded between assessment, risk assessment and care plans. This means that the home is not able to show that it meets all residents assessed needs. For example: • Where a person has behaviours that challenge not all of these behaviours are included in the care plan with guidelines available for staff to enable them to manage the behaviour safely, in a manner that respects the individual. • A care plan for one person’s attendance at college states support required, there is insufficient guidance for staff to support him safely. It is expected that the document should provide staff guidance on what support is needed to get to college there, what support if any is needed whilst at college. One person’s records states that they like to wear the same clothes every day and staff should offer daily alternatives. There is no guidance for staff how to achieve this or what to do if the resident chooses to wear the same clothes for several days. • The home completes risk assessments for activities residents take part in to ensure that consideration is given to supporting residents to take responsible risk and so promote independence. Requirements were made at the last inspection that further work to be undertaken to show that risk have being accurately assessed and appropriate risk controls are in place. Risk assessments sampled at this visit still require further work to demonstrate that staff have accurate information to manage risk in a responsible way. For example: • Shaving risk assessment for one person states he is heavy handed with wet razor, control measures are “all help is needed, he is touch sensitive and shaving is an ordeal”. There is no evidence that other safety measures have been considered such as an electric razor, safety razor, growing a beard or guidance about how often a shave is required. A travelling care plan and risk assessment do not contain adequate risk measures. They state “provide one to one support, accompany at a distance and remind of dangers”, but give no detail of what is a suitable distance to support from or detail of how the person should be reminded of the dangers and at what frequency. Staff need clear guidance to ensure they support people safely in a manner that meets their needs DS0000016881.V293394.R01.S.doc Version 5.1 Page 13 • Wood Lane, 135 There are a number of records made about how to meet the needs of people living at the home that have not being dated or signed by the person making them to enable their validity to be established. There is evidence that residents are supported to make some choices about their daily life. There is some opportunity for residents to select whether or not to take apart in an activity, where to spend time in the house and were observed to move around the home freely. However the behaviours of one person can impact significantly on the rights and choices of other people living at the home. For example sinks do not have any plugs, toilet tissue and paper towels are locked away, residents rooms are entered by one person without invitation and at times their personal belongings are moved without their knowledge or consent. Some entries located in communication book refer to confidential information about individuals. It is an outstanding requirement from the last inspection that confidential information about individuals is made in their personal files. In the kitchen there is information on the walls that relate to individual residents. This practice does not reflect that information about individuals is respected or their dignity promoted. Also in kitchen is laminated staff information sheets stuck to wall. This is not respectful to the fact it is individuals homes and this information should be moved to the staff office. Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 14 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): 12 13 14 15 16 17 Quality in this outcome area is adequate. This judgement is made using available evidence including a visit to the service. Residents have the opportunity to attend college courses and to practice their self-help skills to enable them maximise their independence. Residents would benefit from the range of activities available being developed so that they take part in activities at times similar to others of the same age, gender and culture. Residents do not receive a diet that meets their dietary needs so their health may be compromised. EVIDENCE: Records sampled show that residents regularly take part in community activities to include shopping, attending college, library and meals out. The range of activities offered does not show that residents have the opportunity to try new experiences very often. Activity recording sheets have being introduced that show the response of the resident to the activity offered. It is disappointing that staffs are not using these consistently and there is no Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 15 evidence that these are reviewed or evaluated to assist future activity planning. Records of activities do not show that residents are offered evening activities very often. The acting manager said once a week there is a opportunity to go out for a meal after college and typically people get home at about 7pm. Consideration should be given to provide more evening activities in keeping with others of a similar age, gender and culture. The home no longer has its own transport and resident use public transport and taxis to access the local community. All residents have enrolled at a local college on the adult support learning training for independence course. This means that residents take part in domestic and leisure activities to enable them develop their independence skills. They get paid a small amount to attend college. The home uses this money to fund leisure activities, meals out and some taxi fares. The home has some good photographic evidence of some of the activities individuals have participated in. Residents have an opportunity to have an annual holiday, photos around home indicate that these holidays are a successful and enjoyed by residents .It is pleasing that the Service agreement states that the organisation contribute £ 200 towards cost of each persons holiday. On the day of the visit one resident was at college. Three resident remained at home. Little engagement with these residents was observed during the visit. One person was taken for a walk by staff to local shop and come back with maltesers and was observed to eat them unsupervised. This is of concern as this person has swallowing difficulties and these are high-risk foods that may lead to him choking. The TV was on in lounge through out the inspection it was difficult to see how much residents were enjoying the programmes. One resident was looking at the same magazine through out the visit. Staff said that her mom brings a magazine in every week for her; it was disappointing that there was not a selection of magazines available for her or that staff did not spend some time discussing their content with her. It was pleasing that the lounge was well personalised with pictures of service users with their families. The home is good at supporting residents to maintain contact with their families and residents are supported to remember family birthdays and celebrations appropriate to their religion and culture, for example Easter and Christmas. Records of food provided were sampled. Staff the menu template is pre populated for all breakfast, lunches and Saturday evening meal develops a weekly menu. This means that residents are offered the same foods weekly so very little variety in diet provided. Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 16 On the day of the visit the lunch menu stated a choice of sandwiches or beans on toast. In practice on the day staff prepared a sausage sandwich for residents, residents were not given a choice of filling, or the option of sauce but did have a choice of cold drinks. Residents did not have the opportunity to assist in the preparation of the meal or setting the table. It is of serious concern that one person has dysphasia and the food offered was not suitable neither was it presented in accordance with the care plan. This places the resident at risk of choking. An immediate requirement was made at the time of the visit for staff to address this. The evening meal was pork steaks, potato and cabbage, again no alternative was provided. Tracking back over menus shows that residents receive a repetitive diet with the same or similar foods offered each week. Food records do not evidence that five portions fruit or vegetables are offered daily in accordance with healthy eating guidelines. There is no evidence that residents have the opportunity to try foods from other cultures. Menus do not show that desert is sometimes offered, yogurts were available in fridge but staff said that these are for college packed lunches. Food stocks in the home were adequate for the number of residents and fresh fruit and vegetables were available. It is pleasing that staff have the opportunity to eat meals with residents, as these are valuable opportunities for staff to model good practice and to enhance the social aspects of the mealtime Residents were well presented with attention given to appearance and were wearing clothing appropriate to age, gender and weather. Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 17 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 Quality in this outcome area is poor. This judgement is made using available evidence including a visit to the service. Residents receive their medication safely and as prescribed by the medical officer. Residents identified health care needs are not consistently met so that their health is promoted. EVIDENCE: The home operates a monitored dosage system of medication administration. Medication is stored securely within a locked cupboard in the kitchen. At the time of this visit medication administration was well managed. Residents are supported to access health care professionals and a record of these visits was maintained. Health action plans have being developed since the last inspection. These are an individual plan about what the person needs to do to stay healthy. However, they still require additional work so that they accurately reflect what the individual needs to do to stay healthy. Each person has a care plan. The care plans sampled at this visit need further work so that they contain enough information to inform staff about how to meet resident’s needs consistently. For example: Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 18 • One person’s health action plan stated that they had been seizure free for 10 years. Yet records made about that person’s health said that two seizures had taken place recently. The care plan did not say what staff should do in the event of a seizure. One person’s medical records showed that an assessment had taken place of their swallowing. This assessment found that the person was at risk of choking and made recommendations about how staff should support him. This guidance was not recorded in the care plan so that staff were clear about how to maintain his safety. At the time of the visit he was seen to be given high risk foods that may increase the chance of him choking. An immediate requirement was left asking staff to improve this area, since the visit CSCI have received confirmation that this has taken place. Blood test for one person showed that he had high cholesterol, dietary advice was given and a request made by the doctor that the test were repeated. There was no evidence that staff were following the guidance or that the blood test had being repeated. One persons care plan said that he needed support to maintain his bowel movements but the care plan did not contain enough information about how staff should support him. Records for one person stated that due to pain in his hip staff was to re introduce swimming as an activity. There was no evidence that swimming had been introduced. Risk assessments for oral hygiene were confusing as risk of cuts and lacerations to head and neck are identified as a potential hazard from this activity. Reviews of risk assessments do not occur as frequently as documents state they should to ensure that risk control measures identified are still relevant. There are no clear behavioural guidelines available for staff to support them to manage individual’s behaviours. Recordings made by staff of incidence are not adequate in that they do not record the antecedent, trigger, duration or consequence of behaviour. This means that staff cannot analyse what is happening or why to find better ways to support the person. Records sampled did not include detailed information about individual’s likes and dislikes to help staff support them in a way that would meet their preferences. • • • • • • • • Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 19 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): 22,23 Quality in this outcome area is poor. This judgement is made using available evidence including a visit to the service. Staff do not have all the knowledge and skills they require to protect residents from the risk of harm in the event an allegation was made. Recruitment practices and the management of resident personal finances are adequate to ensure that residents are safeguarded. EVIDENCE: The organisation has a complaints procedure but staff on duty could not locate it at this visit. The home have not received any complaints since the last inspection. CSCI have not had any concerns, complaints or allegations since last inspection about the home. Within the staff office were three cards from resident’s families complimenting the home for involving them in social events within the home. It would be difficult for residents to express their opinions or complain about the service received and are reliant on staff interpreting their wishes or behaviours for them. Records available were not in sufficient detail to give staff enough information about individual residents behaviours, how to manage them or what they mean so that they can respond in an appropriate manner. The staff training records do not evidence that staff have received any recent training in the protection of vulnerable adults. Two staff spoken to confirmed this. When talking to staff about what to do in the event of an allegation being Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 20 made, one person said they would report the matter to the manager appropriately the other person not demonstrate sufficient knowledge of the action to be taken in the event of an allegation of abuse and potentially placed service users at risk of harm. The home holds residents personal money on their behalf. Receipts are available to evidence any income or expenditure, one member of staff signs the record to confirm what the money was spent on. On the day of the visit the records of money held were accurate. However, the balance of money held on behalf of residents was high and should be reviewed. Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 21 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 25 27 30 Quality in this outcome area is adequate. This judgement is made using available evidence including a visit to the service. Resident’s benefit from living in a home a home that is clean and tidy and reflects their interest. EVIDENCE: The home is a small domestic style property comprising of two single bedrooms and one shared bedroom. Three of the existing residents have lived at the home since it was opened in 1991. The first floor is accessed via a stairway and residents have to be mobile to access rooms on the first floor. On the first floor is a domestic style bathroom and on the ground floor is a shower room with a WC adjoining. Two resident share a room and a privacy curtain is provided to assist them maintain their privacy and dignity. As raised at the previous inspection the carpet in this room is in need of replacement to enhance the environment. Some areas in the home required attention. For example: • The vanity unit in the shared room was chipped and in need of replacement Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 22 • • • • • • The waste stack in the bathroom was damaged and exposed and in need of repair There was no blinds or curtains provided in the bathroom to assist residents maintain their privacy and dignity Wall paper was torn in the bathroom COSHH cupboard in the laundry was unlocked meaning that residents could get access to cleaning products that could cause them harm. The under stairs cupboard also containing COSHH items were left unlocked with the keys in the door and this poses a risk to the people living at the home The ceiling in the kitchen was stained and in need of redecoration The acting manager advised that they were awaiting redecoration of the hall and stairs. Generally the home was clean and tidy and bedrooms contained resident’s personal possessions that reflected their gender, taste and interest. Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 23 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): 32 34 35 36 Quality in this outcome area is poor. This judgement is made using available evidence including a visit to the service. Staffs does not have the skills, knowledge, training or support needed to meet the individual and collective needs of residents. Residents are supported and protected from the organisations recruitment processes EVIDENCE: Generally there is two staff on duty throughout the day and one awake member of night staff. The organisations own bank staff is used to compliment the existing staff team to maintain these staffing levels and provide some continuity to residents. It was observed that staff team do not reflect the cultural background of residents however the gender care of individuals is well accommodated during the daytime with both a male and female member of staff on shift wherever possible to support individuals with their personal care needs. It was not possible to evidence that all staff have had recent training to provide them with the skills to meet the individual and collective needs Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 24 of residents. One persons care records refers to him having some Makaton sign language skills, but staff have not received training in this area to enable them communicate more effectively with him. Not all staff has received training in the specific needs of the people living at the home, including autism, epilepsy awareness or the management of behaviour that challenges. A new employee confirmed that she had received an induction into the home and the individual needs of the people living there. She had received an induction booklet with details of the things that she needed to know about to be able to do the job and she was also booked to go on some training in the near future. The organisations human resources department undertakes recruitment. They undertake a number of checks to make sure that staff are suitable to work with vulnerable people. Copies of recruitment records are forwarded to the home where they are kept on the individual member of staffs file. Staff files would benefit from being restructured so that the information within them is easily accessed. Staff do not receive regular, recorded supervision meetings at least six times a year so that they receive the support they need to carry out the job or receive feedback on their performance. Staff meetings have occurred infrequently with the last recorded meeting occurring in August 2006. This means that staff do not get a formal opportunity to be updated regularly about the changing needs of residents, changes within the organisations philosophy or an opportunity to influence how care for residents will be delivered in the future. Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 25 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 Quality in this outcome area is adequate. This judgement is made using available evidence including a visit to the service. Timely health and safety checks of equipment ensure that the resident’s welfare is promoted. Management arrangements at this service do not ensure that residents benefit from a service that is run in their best interest. EVIDENCE: Since the last inspection the registered manager has left to take up a new post and a senior support worker is acting up as manager. It is disappointing that he has only one shift per week allocated to do the management task. A number of checks are undertaken regularly by the home to make sure that the health and safety of residents is maintained. In addition the home has some general risk assessments available and these are evaluated regularly to make sure that risk control measures are still adequate. Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 26 It was disappointing that the fire evacuation risk assessment which had been completed for each individual was not personalised to show staff how to manage the individual behaviours or needs in the event of a fire, but referred to general measures to be taken. Records of fire drills attended by staff need to be clearer so it is possible to see which staff have attended and when so that the home can make sure all staff know what to do in the event of a fire. Staff on duty was unclear how the service they provide to residents was quality assured to measure its success in achieving the aims and objectives and ensure continuous development. Due to residents complex needs and limited communication it is difficult to establish resident’s views of the service they receive. The regulations require that the organisation visits the home monthly and does a report on the conduct of the home. These visits had not been undertaken monthly as required. Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 27 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 1 3 1 4 2 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 2 26 x 27 3 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 1 33 x 34 3 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 x 1 2 LIFESTYLES Standard No Score 11 x 12 1 13 2 14 2 15 3 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 3 x 2 x 1 x x 3 x Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 28 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 YA2 Regulation 14(1) Requirement The registered person shall not provide accommodation to a service user unless the needs of the person have been assessed by a suitably qualified and competent person prior to them being admitted The registered person must confirm in writing to the service user that having regard to the assessment the care home is suitable to meet their needs in respect of health and welfare Residents must have up to date details of their terms and conditions of residence including details of fees. Care plans must be developed further so that they include details of the individuals specific needs so that staff know how to meet specific needs consistently Care plans must clearly state resident’s likes, dislikes and daily routines. Care plans must include specific guidance for staff on how to manage individual’s behaviours. Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 29 Timescale for action 01/03/07 2. YA3 14(1) d 01/03/07 3. YA5 5 (3) 15/03/07 4. YA6 15 (1) (2) 01/03/07 5. YA19 13 (1b & 4c) Outstanding from March 2006 Ensure that appropriate guidelines are in place with regard to managing resident’s epileptic seizures. Outstanding from 2.3.2006 Risk assessments must be further developed to ensure that the control measures are relevant and will effectively manage the risk. Outstanding from 2.3.2006 Risk assessments must be regularly reviewed 01/03/07 6. YA9 13(4) 15/03/07 7. 8. YA10 YA12 12(4) a 16(2) m, n 9. YA13 YA 14 16(2) man Confidential information about 01/04/07 individual residents must be stored securely Residents must have 01/04/07 opportunities to take part in activities at time valued by others of a similar, age, gender and culture The range of activities available 01/04/07 to residents to participate in within the community is expanded and reflects individuals taste and interest. Restrictions on residents must be 15/03/07 agreed within their care plan and in their best interest. Toilet tissue, paper towels and items of personal clothing must be accessible Residents must be offered a 01/03/07 varied nutritious diet that meets healthy eating guidelines and individual needs. Residents must be given a choice of meals. The advice and guidance given 14/02/07 by health care professionals must be followed consistently so DS0000016881.V293394.R01.S.doc Version 5.1 Page 30 10. YA16 12 (4) a 11. YA17 16(2) I 12 YA19 13(1) b 12 (3) Wood Lane, 135 that health care needs are addressed. Dysphasia guidelines must be followed Advise to control cholesterol levels must be adhered to. Health care needs must be appropriately monitored A copy of the complaints 01/04/07 procedure must be available to residents or their representatives The registered person shall make 01/04/07 suitable arrangements by training of staff or other measures, to prevent service users being harmed or suffering abuse or placed at risk of harm or abuse. Provide a protocol detailing when all staff will receive training in the protection of vulnerable adults. The premises must be kept in a 01/05/07 good state of repair. • Repair soil stack in bathroom and redecorate • Replace vanity unit in shared room • Redecorate kitchen ceiling and hall Replace bedroom carpet in shared room. Outstanding from 2/3/06 Replace curtains in bathroom COSHH items must be stored securely at all times All staff must receive training appropriate to the work they perform. Training for all staff is needed in: First Aid Food hygiene Moving and handling Fire prevention DS0000016881.V293394.R01.S.doc 13. 14. YA22 YA23 22(5) 13 (6) 15. YA24 23(2) b 16. YA25 16(2) c 01/04/07 17. 18. YA24 YA35YA32 13 18(c) 14/02/07 01/04/07 Wood Lane, 135 Version 5.1 Page 31 Protection of vulnerable adults Mankato Epilepsy Dysphasia Autism Training plan to be developed to ensure all staff have received or arrangements are place for them to have received appropriate training by 1st April 2007 All staff working in the care home shall receive appropriate supervision. The registered person shall appoint a suitably qualified and competent person to manage the care home The registered person shall visit the home once a month, unannounced and inspect the premises, its record and prepare a written report on the conduct of the home. A copy of this report hall is provided to the Commission and the care manager. The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the home. 19. 20. YA36 YA37 18 (2) 8,18 15/03/07 01/04/07 21. YA39 26 01/03/07 22 YA39 24 01/05/07 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 YA4 Good Practice Recommendations That residents have meaningful opportunities to visit the service over different time periods to see if they like the service and it meets their needs. Records made of these visits should evaluate the success of the visit and gather DS0000016881.V293394.R01.S.doc Version 5.1 Page 32 Wood Lane, 135 further information gathered about the person 2. 3. 4. 5. YA7 YA17 YA18 YA18 Records of opportunities for residents to make decisions about their life should be maintained Consideration should be given to providing residents the opportunity to try foods from different cultures Consideration should be given to recruiting a staff team that reflects the ethnic, religious and cultural background of residents Taff files should be clearly organised so that information within them is easily retrieved. Wood Lane, 135 DS0000016881.V293394.R01.S.doc Version 5.1 Page 33 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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