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

This inspection was carried out on 13th 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 9 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 13/02/07

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 Kerry Coulter Key Unannounced Inspection 13th July 2007 09:30 Wood Lane, 135 DS0000016881.V338998.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 Wood Lane, 135 DS0000016881.V338998.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. Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 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 Ltd Vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care (excluding nursing) and accommodation for service users whose primary care needs on admission to the home are within the following categories:learning disability, LD, 3. The maximum number of service users to be accommodated is 3. 2. Date of last inspection 13th February 2007 Brief Description of the Service: 135 Wood Lane is registered to provide accommodation, care and support for three people with learning disabilities. The house is a two-storey semidetached property and is located in a pleasant and well-established residential area in the Handsworth district of Birmingham. Accommodation is provided in three single bedrooms. One of the single rooms is on the ground floor. There are two bathrooms in the house, one on each floor. Downstairs there is also a lounge, separate dining room, kitchen and laundry. Upstairs, in addition to the bedrooms, there is a small office. 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. There are local shopping facilities within walking distance, and main bus routes also run close by. Information from the visit to the home indicates that the standard fee is £1155.72. Copies of reports from the CSCI are on display in the hallway of the home. Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit was carried out over seven hours, the home did not know we were coming. This was the homes first key inspection for the inspection year 2007 to 2008. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and a questionnaire about the home (AQAA). People who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. All people who live at the home were spoken to. Due to their communication needs some people who live at the home were not able to comment on their views. Discussions with staff, the Acting Manager and Operations Manager took place. CSCI survey forms were received from the relative of one person who lives at the home and two health professionals. Their comments are included in the report. What the service does well: Staff were observed to give support with warmth, friendliness and patience and treat people respectfully. People have the opportunity to go on holiday if they want to. Staff support people to keep in contact with their family and friends. Attention had been given to the presentation and appearance of the residents so that their own individual style and taste were reflected. Personal care is provided to residents in a gender sensitive manner that respects their dignity. Medication management is well managed so that residents receive their medication as prescribed. Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 Page 6 Robust recruitment practices are undertaken and staff employed are suitable to work with vulnerable people. What has improved since the last inspection? What they could do better: Some care plans need improvement so that staff have more information on how to support people’s health needs and manage behaviour so that people who live at the home get the care they need. Risk assessments need further development to ensure that risks to people are managed in a safe and responsible manner and staff have sufficient information to manage these risks. Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 Page 7 Some things that restrict people’s choices have not been agreed such as locking of bathrooms. This needs to be reviewed so that people’s lifestyles are not restricted unnecessarily. Staff must ensure people attend routine health monitoring appointments regularly to ensure they get the healthcare they need to stay healthy. One persons bedroom needs redecorating so that their bedroom will look nice and meet their needs. The unpleasant smell in the lounge needs to be removed so that this room is a nicer place to spend time in. Ensure staff have all the training and support they need to do their job and to support the people who live in the home. Better checking of the hot water temperatures is needed so that people who live at the home are not put at risk of scalding. A permanent registered manager is needed who is suitably qualified and experienced to make sure that the improvements that are needed get done. 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. Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have most of the information they need to ensure they can make a choice about whether or not they want to live at the home. EVIDENCE: 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. A laminated copy of the guide is available downstairs for people to look at if they wish but it should also be explored if anyone would like their own copy to be kept in their bedroom. The statement of purpose for the home was on display, this includes the homes admission criteria. At the last inspection it was identified that a new person had been admitted to the home without a full assessment of their needs and the homes suitability of the home to meet them. The individual has a number of behaviours that impact or place restrictions on others living at the home. The assessment for this person has now been completed. No new people have moved into the home but discussions with the Acting Manager and observation of the statement of purpose indicates full assessments will be completed prior to admission in the future. Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 Page 10 People 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 but was found to refer to the home they had previous lived in, managed by Milbury. A new agreement needs to be provided to accurately reflect current circumstances. Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans do not always contain sufficient information to guide staff to ensure that people’s needs are met consistently. Some risk assessments need further development to ensure that risks to people who live at the home are managed in a safe and responsible manner and staff have sufficient information to manage the risk. EVIDENCE: Previous inspections have identified that care plans should be developed so that they contain sufficient detail so staff know what support to offer people. Some of the plans still do not give staff enough information but lots of improvement has been made with most of the care plans having been rewritten. The care plans for two people were sampled, both were up to date. Care plans provided some information about how staff are to support people to meet their communication, social, cultural, spiritual, health, personal care, dietary and Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 Page 12 mobility needs but further detail was needed. As identified at the last visit one person has behaviours that challenge and 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. The Acting Manager said that a behaviour therapist was now involved and would be helping staff to develop behaviour management guidelines. Health care plans needed some improvement and this is detailed within the healthcare standards within this report. One person who lives at the home has some restrictions placed on them due to their behaviour. Agreement on some of these restrictions was not evident within their plan so it was not clear that they were in the person’s best interests. This is further detailed within the lifestyles section of this report. The Acting Manager has recently introduced a system of reviews with the people who live in their home with their key worker. It is a nice personal touch that the front sheet of the review has a photograph of the person and their key worker at their meeting. The format covers all areas of need and will be a good tool for reviewing peoples needs once staff have gained experience and confidence in using them as the initial ones completed lack details on the actual outcomes for people. The home completes risk assessments for activities people take part in to ensure that consideration is given to supporting them to take responsible risk and so promote independence. Requirements were made at the last inspection that further work be undertaken to show that risks have being accurately assessed and appropriate risk controls are in place. Risk assessments sampled at this visit had been rewritten. Improvement had taken place but some still required further work to demonstrate that staff have accurate information to manage risk in a responsible way. For example, people at the home wear their bedroom keys around their neck on a string. A basic assessment had been completed about the risk of strangulation but it would benefit from extra detail about the control measures in place such as staff ensuring people do not go to bed wearing it. An assessment had not been completed about the risk of injury to people by objects being thrown or broken by one of the people who lives at the home. Account needs to be taken of the environment to ensure it is safe. For example ornaments should not too heavy or easily breakable and pictures should not have glass fronted frames. There is evidence that people are supported to make some choices about their daily life. There is some opportunity for people 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. Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 Page 13 Personal information about individuals was not observed to be on display in the home and care plans were kept in a locked cupboard so that information about people is handled confidentially and their privacy respected. Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements for activities and meals ensure that people living in the home generally experience a meaningful lifestyle. Restrictions that have been placed on people without agreement does not respect people’s right and can impact on their lifestyle choices. EVIDENCE: Each person who lives at the home has an individual activity plan. The Acting Manager said a new plan is completed every Sunday. The plans were on display in the dining room. It would be good if the plans could be put in a picture format so that they are easier for people who live in the home to understand. Records sampled show that people regularly take part in activities to include shopping, attending college, shopping, pubs, gardening, library and meals out. It was good that where one person’s care plan recorded they liked the cinema their care records showed they went to the cinema regularly. During the visit Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 Page 15 everyone who lived at the home had the opportunity to go out on activities, one person went to the bank and two people went to see ‘Shrek’ at the cinema in the afternoon. As identified at the last inspection consideration still needs to be given to increasing the number of opportunities for evening activities in keeping with other people of a similar age, gender and culture. The activity records sampled recorded if people had enjoyed the activity or not. The Acting Manager said assessment of activities is being improved by introducing a new assessment form to evaluate new activities. She said staff would be told how to use the new form at the next staff meeting. Staff spoken with said that people who lived at the home had recently been on a short holiday to Welshpool that they had all enjoyed. One staff said that since the Acting Manager had been in post more activity equipment had been brought to include art equipment and musical instruments so that people had more choice of activities. People attend 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. It was pleasing that the lounge was well personalised with pictures of people who live at the home with their families. There were also pictures of people who used to live at the home. The home is good at supporting people to maintain contact with their families and they are supported to remember family birthdays and celebrations appropriate to their religion and culture, for example Easter and Christmas. As stated earlier in this report there are some restrictions that are placed on people that have not been agreed as part of the care plan. It was identified at the last visit that restrictions must be agreed. One restriction that has been agreed is the locking of one person’s wardrobes to prevent them from damaging their clothes. This person has previously thrown items out his window into the neighbour’s garden resulting in a complaint being made. A new restrictor was fitted to the window to prevent this happening but was broken off the next day. It was initially a concern that this person could be at risk of falling from the window due to having no restrictor fitted. It was later established that the windows had actually been nailed shut. The Acting Manager had not been aware of this. Whilst the person has access to some small top opening windows the nailing shut of the larger windows is not ideal as it restricts ventilation in the warmer weather. Consideration should be given to sourcing stronger restrictors before resulting to such drastic measures as permanently nailing the windows shut. One person at the home often puts items down the toilet causing it to become blocked. The Acting Manager said this had been happening every week and to stop it the bathroom was now being locked during the day when this person was at home. There was no agreement in the care plan about this practice and Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 Page 16 no written assessment about the impact this may have on other people who live at the home. Outcomes for people at the home regarding meals were poor at the last visit. Considerable improvement has now taken place in this area. Food records sampled showed that people are now having a healthy diet with lots of vegetables and fruit that meets recommended healthy eating guidelines. Daily records and discussions with staff show people have the opportunity to go food shopping and choose food they like. Staff said that they try and encourage people to help plan the menu by using pictures of food but that some of the people at the home will only choose by eating or refusing an actual meal that is placed in front of them. Menus are done on a four weekly basis and include healthy options. Stocks of food were satisfactory. Fresh fruit and vegetables were available. Meals provided reflect the cultural background of people at the home but it is good that opportunities are now provided to sample foods from other cultural backgrounds. One person has dysphasia (an eating difficulty that can put people at risk of choking), staff spoken with were aware of this persons needs and how to support them at mealtimes. Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and personal care records do not always clearly state how people’s needs are to be met and so their health needs may not always be consistently met so that their health is promoted. People who live at the home usually receive their medication safely and as prescribed by the GP. EVIDENCE: Care plans generally indicated the degree of assistance people required for personal care and some of personal their preferences such as what time people liked to get up in the morning. One person’s plan needed to clarify the type of supervision needed when bathing. Staff had paid attention to each person’s personal care, people were wearing clothes in good condition suitable to their age and gender. One person had her nails painted which she appeared to be very pleased with. Some serious areas of concern about people’s healthcare were identified at the last visit, most of these have now been addressed. New epilepsy guidelines have been developed so that staff know what to do if people have a seizure. Care plans contain more information about the risk of dysphasia and a new Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 Page 18 assessment has been completed by the Speech and Language Therapist so that staff have the information they need about what foods increase the risk of choking. At the last visit it was identified that the GP had asked that a blood test for high cholesterol needed to be repeated with no evidence that this had been done. A letter from the GP clarified that no further monitoring is required for this person. One health professional commented that staff generally seek and act on medical advice. It was identified at the last visit that one persons care plan said that they needed support to maintain their bowel movements but the care plan did not contain enough information about how staff should support him. Information available was still seen to be inadequate and may put people at risk of being constipated. Each person has a Health Action Plan. Health Action Plans are something that the Government paper, ‘Valuing People’ recommended that each person with a learning disability had by 2005. This is to ensure individuals receive all the care they need to stay healthy. Unfortunately the plan contained little information about how to prevent this person becoming constipated. One person last went to the Opticians in 2004 but it was unclear from their plan when they needed to go again. Records showed that people have regular medication reviews and their weight is monitored regularly. There was no evidence that people had been to the dentist regularly. One person last went in 2005 and another should have gone in March 2007 but had to be cancelled as it was the same day as a funeral the person was attending. Unfortunately staff had forgotten to re book the appointment. The Acting Manager said she would ensure staff telephoned for another appointment during the visit. The Acting Manager had put in place a new format the day before the visit for recording health appointments, this guides staff to include reason for the appointment and the outcome. 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. The home retains copies of prescriptions so that staff can check the correct medication has been received from the chemist. Medication administration records were sampled and found to be in good order. The Acting Manager said that staff had done medication training in June and were awaiting their certificates. Since the last visit information about what medication people have and how they like to take it has been updated so that staff have clear information about peoples medication needs. Sadly one person who lived at the home has died since the last visit. Staff spoken with said that they had attended the person’s funeral along with people who live at the home. It is nice that photographs of the person are in the lounge so that people who live at the home can still remember them. Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 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. 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. Staff generally have the knowledge and skills they require to protect people from the risk of harm in the event an allegation was made. Recruitment practices and the management of personal finances are adequate to ensure that people living in the home are safeguarded. EVIDENCE: The organisation has a complaints procedure and this was clearly on display in the entrance hall. The procedure is also available in an easy read format that includes some pictures. CSCI have not received any concerns, complaints or allegations since the last inspection about the home. The home had received one complaint since the last inspection. This was from a neighbour who was not happy about items being thrown into her garden. Records showed this had been dealt with to the neighbour’s satisfaction. One relative commented that they were not aware of the complaints procedure but had never had to make a complaint. It would be difficult for people who live at the home 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 yet in sufficient detail to give staff enough information about individual’s behaviours, how to manage them or what they mean so that they can respond in an appropriate manner and know how people indicate when they are unhappy. Staff had recently completed training in the protection of vulnerable adults. Two staff spoken with had adequate knowledge of the action to be taken in the Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 Page 20 event of an allegation of abuse being made. Staff have not yet had training in the Mental Capacity Act, this Act provides a statutory framework to empower and protect vulnerable people who may not be able to make their own decisions. However discussions with the Operations Manager indicates that the Department of Health information booklet on the subject is on order for the home and some training will be scheduled. As stated earlier in this report one person has behaviours of throwing or smashing items. Further risk assessment of these behaviours is needed to ensure that other people living at the home are protected from being hurt. An up to date inventory of people’s belongings is maintained so that staff can track if anything has gone missing and people’s property is looked after. The home holds people’s 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. Recruitment records sampled showed that a robust procedure is followed for the protection of people living in the home. Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People benefit from living in a home that is clean and tidy and reflects their interests. Some maintenance issues need attention to ensure that the home continues to provide a safe and homely environment. EVIDENCE: The front and rear garden of the home are very well maintained with lots of flowers, pots and baskets. The very pretty front garden gives a good first impression of the home. The home is a small domestic style property comprising of three single bedrooms. The first floor is accessed via a stairway and people have to be mobile to access rooms on the first floor. Since the last inspection the hallway has been redecorated and the kitchen repainted making these areas look nice. As previously required a new carpet and vanity unit has been fitted in one persons bedroom. The lounge is generally homely in style with ornaments, pictures and photographs of people who live or have lived at the home. Unfortunately this Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 Page 22 room had quite an unpleasant odour. One staff said they thought it was from the carpet and this had been cleaned recently but the odour came back. The source of the unpleasant odour needs to be identified and work undertaken to ensure the odour is removed so that this room is a pleasant area to spend time in. Bedrooms seen were generally well decorated according to individual’s tastes, interests, age and gender. Two bedrooms contained many personal possessions, for one person their room was quite sparse but this was reflected within their care plan. The décor of this room needed attention as the person has ripped large sections of wallpaper. The Acting Manager said it is hoped that the wallpaper will soon be stripped off and the room painted as this will be more suitable to the individual’s needs. The home was clean. Satisfactory hand washing facilities were observed in the bathroom, laundry and kitchen. Since the last inspection hand dryers have been fitted in the bathroom and shower room due the previous use of paper towels being unsuitable due to one person’s behaviours. In the laundry area the sink unit doors and drawer fronts were observed to need replacement due to the laminate being very chipped. Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are generally sufficient to ensure that there is enough staff to ensure people’s needs can always be met. People are supported and protected by the organisations recruitment processes. Staff do not yet have all the skills, knowledge, training or support needed to meet the individual and collective needs of people who live at the home. EVIDENCE: One health professional commented that there are ‘some pockets of good practice’ amongst the staff team but that some staff needed to be more motivated. During the visit staff were observed to give support with warmth, friendliness and patience and treat people respectfully. It was observed that staff team do not reflect the cultural background of people who live at the home 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. To ensure people are supported by a qualified staff team at least 50 of staff need to achieve an NVQ in care, presently only three staff have an NVQ. Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 Page 24 Generally there is two staff on duty throughout the day and one awake member of night staff, however there were three staff on duty on the day of the visit. Staffing levels appear satisfactory to meet people’s current needs. Sometimes staff work a double shift. Consideration should be given to ensuring staff do not do this too often as working long hours can make staff tired and mean that they may not be at their best in terms of their work performance. 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. Files sampled showed that robust procedures had been followed so that people are not put at risk by having unsuitable staff working with them. The last visit to the home identified some concerns regarding staff training, it was not possible to evidence that all staff had recent training to provide them with the skills to meet the individual and collective needs of people at the home. Since then staff have had lots of training to include manual handling, first aid, risk assessment, food hygiene, epilepsy and protection of vulnerable adults. Three staff had training on autism in March, the Operations Manager said that the behaviour specialist was organising some more training for the other staff. Staff have not yet had training in Makaton (a type of sign language) and Dysphasia (eating /swallowing problem). One health professional commented that staff generally have the right skills and experience but that staff needed more training. At the last inspection visit to the home in February 2007 it was identified that there had not been a staff meeting since August 2006. This meant about the changing needs of people, changes within the organisations philosophy or an opportunity to influence how care for people will be delivered in the future. One staff meeting has now been held, this was in May. The last visit also highlighted that staff did 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 and receive feedback on their performance. Whilst performance in this area is still poor as only three staff have since received one supervision a formal system for supervision has been developed. Dates have been scheduled for all staff to receive supervision and the Acting Manager was confident that the standard would be met soon. Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 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. 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. Management and health and safety arrangements at this service do not always ensure that people benefit from a service that is run in their best interest. EVIDENCE: At the last inspection visit the home was being managed by a senior support worker as the Registered Manager had left to take up a new post. It was disappointing that the senior had only been allocated one shift per week to do the management task. Since then an Acting Manager was transferred from another Milbury home, although it was difficult to establish the hours they worked in the home as they were not recorded on the staff rota. Two staff spoken with thought things had improved in the last two months since the home had an acting manager. This inspection has also found that many things have improved, but there are still improvements needed and a Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 Page 26 suitably qualified and experienced manager is needed to move the home forward. The Operations Director said that a new manager had now been recruited who was a qualified nurse and they were due to start on the 1st August. The Operations Manager visits the home and writes a report of their visit as required under Regulation 26. Reports available in the home showed these visits are generally done monthly. An annual service review was last done in 2006 by Milbury to see if people at the home were getting a good service, this covered areas such as food, daily living and the premises. The review gave a score for each area. Some areas did not score the top marks but there was no indication as to why. The report lacked any detail, and there was no development plan as a result of the review. The Operations Manager said that the next review was now due and questionnaires are in the process of being sent out to relatives. She said that there would be a development plan available following the review. A number of checks are undertaken regularly by the home to make sure that the health and safety of people living there is maintained. Systems are in place to monitor the temperature of the fridge, these records showed that food is stored at safe temperatures to reduce the risk of food poisoning. The West Midlands Fire Service visited the home in November 2006 and said that the fire precautions were satisfactory. Fire records showed that a risk assessment is in place so that the risks of there being a fire are minimised as much as possible. Staff had fire safety training in March. Staff regularly test the fire equipment to make sure it is working. An engineer regularly services the fire equipment to ensure it is well maintained. Staff could not find the record of fire drills during the inspection. However minutes of the staff meeting showed a drill had been done in May 2007 so that the home makes sure all staff know what to do in the event of a fire. The temperature of the water is usually monitored weekly to ensure it will not pose a risk of scalding to people. Unfortunately the last test had not been recorded and was last done two weeks before the inspection visit. This showed the bath water was too hot and there was no record of any action to reduce the temperature. The water was retested by the Acting Manager during the visit and was still found to be too hot. The Operations Manager arranged for a maintenance worker to attend the home during the inspection visit and reduce the water to a safe temperature so that people were not put at risk of scalding. Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 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 3 2 3 3 X 4 X 5 2 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 2 25 X 26 2 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 3 LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 1 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 3 2 X 2 X X 2 X Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 Page 28 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 YA9 Regulation 13(4) Requirement Risk assessments must be further developed to ensure that all areas of risk are assessed and the control measures are relevant and will effectively manage the risk. Outstanding from 2/3/2006. A review of the practice of locking the bathroom door is needed to ensure it does not place unnecessary restrictions on people who live at the home. Restrictions on people who live in the home must be agreed within their care plan and in their best interest. Outstanding from 15/3/07. Where people are at risk of constipation their care plan must guide staff clearly as to the care the individual needs to prevent constipation and what to do if constipation occurs. Ensure people are supported to attend regular health monitoring appointments such as the opticians and dentist so they receive the health care they need. Timescale for action 30/08/07 2 YA7 12(1) 30/08/07 3 YA16 12(1) 30/08/07 4 YA19 12(1) 30/08/07 5 YA19 13(1)(b) 30/08/07 Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 Page 29 6 YA23 13(6) Care plans must include specific guidance for staff on how to manage individual’s behaviours so that other people living at the home are protected from being hurt. Outstanding from March 2006 The first floor rear bedroom requires redecorating so that the room is in good decorative order and meets the needs of the person who uses that bedroom. All staff must receive training appropriate to the work they perform. Training for all staff is needed in: Makaton Dysphasia Autism (Training scheduled) Outstanding from 1/4/07 Water temperatures need to be effectively monitored and action taken when temperatures are too high (above 43°c so that people are not put at risk of scalding. 30/08/07 7 YA26 23(2)(d) 30/09/07 8 YA35 18(c) 30/09/07 9 YA42 13(4) 15/08/07 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 2 3 Refer to Standard YA5 YA6 YA12 Good Practice Recommendations People should 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. It would be good if the activity plans could be put in a picture format so that they are easier for people who live in the home to understand. DS0000016881.V338998.R01.S.doc Version 5.2 Page 30 Wood Lane, 135 4 5 YA12 YA22 6 7 8 9 YA22 YA30 YA24 YA36 10 YA36 11 12 YA37 YA39 Increase the number of opportunities for evening activities in keeping with other people of a similar age, gender and culture. Staff need enough information about individual’s behaviours, how to manage them or what they mean so that they can respond in an appropriate manner and know how people indicate when they are unhappy. Consider how relatives of people who live at the home can be made aware of the complaints procedure so that they know how to make a complaint if they need to. Consider how the unpleasant odour in the lounge can be removed so that this room is a pleasant place to spend time in. Replacement of the drawer and cupboard fronts to the sink unit in the laundry needs to be scheduled so that the fittings and fixtures in the home are kept in good order. Staff should have formal supervision at least every other month to so that they receive the support they need to carry out their job and receive feedback on their performance. Staff meetings should be held at least every other month so that staff get a formal opportunity to be updated regularly about the home and the needs of people who live there. The hours worked by the Acting Manager should be recorded on the staff rota so it is clear what management hours are worked. The system for the quality of care provided at the home needs improvement so that the review report is clear what has been looked at, how the assessment was made and the actions to be taken to improve quality for people who live at the home. Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 Page 31 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 Wood Lane, 135 DS0000016881.V338998.R01.S.doc Version 5.2 Page 32 - 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. 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