Inspection on 13/06/08 for Wood Lane, 135

This inspection was carried out on 13th June 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wood Lane, 135 13/07/07

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 28/09/2008.

CARE HOME ADULTS 18-65 Wood Lane, 135 Handsworth Birmingham West Midlands B20 2AQ Lead Inspector Lesley Webb Unannounced Inspection 13th June 2008 11:00 Wood Lane, 135 DS0000016881.V366327.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.V366327.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.V366327.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) Voyage.com Milbury Care Services Ltd Marie Stephens Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Wood Lane, 135 DS0000016881.V366327.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 July 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. Copies of reports from the CSCI are on display in the hallway of the home. Wood Lane, 135 DS0000016881.V366327.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. 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 provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered including 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 and the Registered Manager also took place. CSCI survey forms were received from the relative of one person who lives at the home. No residents’ surveys were received. We were told this was due to the capabilities. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. What the service does well: The service user guide includes pictures and symbols to try and make the information more accessible to the people living at the home. People regularly take part in activities to include shopping, attending college, shopping, pubs, gardening, library and meals out. Residents take part in domestic and leisure activities to enable them develop their independence skills. The home is good at supporting people to maintain contact with their families. Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 6 People are having a healthy diet with lots of vegetables and fruit that meets recommended healthy eating guidelines. Staff pay attention to each person’s personal care, people were wearing clothes in good condition suitable to their age and gender As at the previous inspection the front and rear garden of the home are very well maintained with lots of flowers, pots and baskets. The rear garden is very private, with a green house and vegetable plot Staff were observed to give support with warmth, friendliness and patience and treat people respectfully. What has improved since the last inspection? What they could do better: Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 7 Written consent must be obtained from the general practitioner to ensure crushing of medication does not have any adverse side affects that could harm the resident. GP consent for the use of ‘as required’ medication must be obtained to ensure residents are not at risk due to medication practices. The practice of residents funding meals outside of the home without any contribution must cease until clarification is sought with regard to the amount that the home should be contributing. An audit of residents’ financial records must take place and reimbursement made. Staffing levels must be maintained to meet the needs of residents, with agency staff brought in if permanent staff are not available. Staff on induction must not be included in the staffing ratios, as they will not have sufficient knowledge of the residents. Staff information forms must contain all the required information so that people are not put at risk by having unsuitable staff working with them. A list of recommendations is located at the back of this report. 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.V366327.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.V366327.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 and 2. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their representatives have the information needed to decide if this home will meet their needs. EVIDENCE: As at the previous inspection a copy of the service user guide was available on each of the residents files we viewed. 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. The statement of purpose for the home was on display; this includes the homes admission criteria. We were informed one new person has moved into the home since the last inspection. We looked at this persons file and found that the registered manager has completed assessments of needs for all areas including physical, social, medical and psychological. From these care plans have been devised in order that staff have the information needed to meet the person’s needs. In addition to this the registered manager has completed a document titled ‘Personal Plan’. We found this to read as a general assessment wrote in the 3rd person and includes some use of widget symbols and large print. These aid communication for the resident. This document gives a good overview of the person and identifies health needs such as a low fat diet due to cholesterol, Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 10 physical needs such as support with shaving and personal care and communication needs. None of the assessments contained evidence that the resident or their representatives have been involved in their compilation. As we explained to the registered manager, this should take place so that the views of the resident are considered when planning care and support. If residents are not able to be involved in planning their care and have no family or representatives, advocates should be obtained. Both residents’ files that we looked at contained a copy of the service user guide and contracts of residency. These now include specific information about fees charged for living at the home, meeting a previous requirement. When looking at these we found the service user guide states meals outside of the home above the agreed allowance are excluded from the fee. Neither document contained this information and the registered manger was not aware of it either. We also noted that none of the residents’ contracts have been signed by the residents or their representatives. As we explained to the registered manger this should take place as these are legally binding documents. This will ensure residents’ rights are protected. Wood Lane, 135 DS0000016881.V366327.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 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been a major improvement in care planning however there is still little evidence of residents being supported in decision-making processes. EVIDENCE: Previous inspections have identified that care plans should be developed so that they contain sufficient detail in order that staff know what support to offer people. It was pleasing to find residents now have comprehensive care plans in place that give staff enough information about the support residents need. All files that we looked at were very well organised with documents in a system that was easy to follow. All plans include long and short-term goals, how to attain these and dates when to be reviewed. Plans are in place for areas including daily routines, communication, opening mail, and choices. Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 12 As identified at the last visit one person has behaviours that challenge. All of these behaviours are now 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. We noted that a separate file is used to store each resident’s daily records and monitoring forms. We discussed this with the registered manager suggesting these be correlated with care plans and risk assessments so information is at hand when being reviewed. The registered manger agreed this is a good idea. Each resident has a care plan titled ‘Supporting to make a choice’. These state that key worker meetings will be held every four weeks. We found that key worker meetings have not been taking place and no systems are currently in place for obtaining residents views on the contents of their care plans. It is acknowledged that residents have communication needs that have the potential to impact on them being involved in decision making processes. However efforts must be made to overcome these to promote person centred approaches to care and support. 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. As with care planning, risk assessments have been reviewed and now work in conjunction with care plans. The format for assessing risk includes giving a score rating. The form used by the home includes a section at the bottom for identifying if the risk rating is low, medium or high. None of the risk assessments we viewed had this part of the form completed. We discussed this with the registered manager explaining this should take place in order to be able to determine how often the assessment should be reviewed. Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to live fulfilling lives based on their individual needs and capabilities. EVIDENCE: As at the previous inspection we found each person who lives at the home has an individual activity plan. We were informed that new plans are completed every Sunday with residents who are able. 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. Since the last inspection care plans have been implemented to help residents develop life skills such as making snacks and undertaking domestic activities. It was pleasing to find an abundance of photographs on file evidencing residents’ participation in activities. Records sampled show that people regularly take part in activities to include shopping, attending college, shopping, pubs, gardening, library and meals out. Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 14 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. On arrival to the home we were informed one resident was relaxing in their bedroom, another was using the computer with a member of staff and the third out shopping (again with a member of staff). The registered manager informed us that this week while new flooring had been fitted in the home all residents have visited west midlands safari park and on another day one had been on a coach trip to Liverpool, while the other two residents had been to the cinema and had lunch out. The one area that should be improved is activities of a weekend. There are two staff allocated on each shift of a weekend and as some residents require one to one staff when out in the community this means activities cannot take place outside of the home of a weekend. 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. 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. Since the last inspection restrictions for one resident have been included in a care plan. As already mentioned if agreement cannot be gained from the resident due to their capability this must be sought from their representative. This will ensure their legal rights are protected. Food records sampled showed that people are having a healthy diet with lots of vegetables and fruit that meets recommended healthy eating guidelines. As at the previous inspection daily records and discussions with staff show people have the opportunity to go food shopping and choose food they like. During the inspection we observed the evening meal being prepared. This appeared appetizing. One resident stood in the kitchen while the staff member was cooking the meal. It was pleasing to see this person was not restricted from this area and that the member of staff talked to the resident in a friendly and relaxed way. Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The principles of dignity and respect are upheld. The health needs of residents are met. EVIDENCE: As already mentioned in this report there has been a good improvement with care planning documentation. This also includes plans for the management of residents health needs. Plans now include personal preferences such as times of rising, routines with personal care and assistance with bathing. This means personal and health care is given in a person centred way. We observed that 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. 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 assessment has been completed by the Speech and Language Therapist so that staff have the information they need about what Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 16 foods increase the risk of choking. At the last inspection it was identified 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 them. It was pleasing to find this person’s care planning documentation has been completely reviewed and now contains all information needed to reduce risk to the individual. Records show that people have regular medication reviews and their weight is monitored regularly. We found good health records detailing reasons for visits to various specialists and outcomes as a result. One area that should be improved is that of dental and hearing tests. No records could be found for any resident attending these specialists. Since the last inspection one resident’s health has deteriorated. Evidence indicates this has been managed appropriately by the home. For example the home has ensured involvement of the falls assessment team, occupational therapist, physiotherapist and community nurse. The home operates a monitored dosage system of medication administration. Medication is stored securely within a locked cupboard in the kitchen. As at the previous inspection 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. We found information for one resident that states ‘difficulty swallowing, consultant, GP and pharmacist permission for tablets to be crushed’. We could find no evidence of permission for this practice. As we explained to the registered manger written consent must be obtained from the prescriber to ensure crushing of medication does not have any adverse side affects that could harm the resident. We also found protocols in place for the use of ‘as required’ medication. We were informed that the GP is refusing to sign agreement of these. We were concerned to hear this as it indicates the GP does not agree with the contents. This situation must be clarified to ensure residents are not at risk due to medication practices. Another resident has a written protocol for ‘as required’ medication for behaviour. This states ‘staff on duty must seek permission from homes manager or senior on call before administering’. We instructed the registered manager to review this protocol as it indicate a person who is not present when behaviour is being displayed will make the decision as to whether medication should be administered. This is not appropriate and has the potential to place the individual at risk. All records for medication entering, being administered and leaving the home were found to be in good order. Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 17 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. Complaint procedures ensure concerns are acted upon. In the main people are protected from abuse and harm. The management of resident’s personal monies is not in line with their terms and conditions of residency. This means their rights are not being upheld. 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. No complaints have been received at the home in twelve months. 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. Since the last inspection care plans have been completed to support people to complain. These were developed in May 2008 and as yet no staff have signed to say they have read these. This should happen to offer assurances to residents that staff will act on their behalf with regard to complaints. Of the eleven staff employed at the home nine have completed training in the protection of vulnerable adults. Since the last inspection eight of the staff have had training in the Mental Capacity Act, this Act provides a statutory Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 18 framework to empower and protect vulnerable people who may not be able to make their own decisions. As mentioned earlier in this report one person has complex behaviours. It was pleasing to find that comprehensive care plans, behaviour management guidelines with proactive and reactive strategies and risk assessments have now been completed. These were dated 14th April 2008. No staff have signed to say they have read these. Staff must read these documents and implement the guidelines to ensure that other people living at the home are protected from being hurt. Another resident was found to have a care plan for behaviour that states ‘to implement behaviour management guidelines’. The registered manager confirmed these are still not in place. We explained that a risk assessment should be completed to reduce the risk to residents. Eight of the twelve staff working at the home have been training in challenging behaviour. This helps reduce risk of harm to residents. 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. However we found that records and receipts indicate residents’ personal monies are being spent on meals outside of the home without any contribution by the home. We informed the registered manager that the service user guide clearly states a contribution is to be made by the home and that this practice must cease until clarification is sought with regard to the amount that the home should be contributing. The registered manager stated she was not aware of this and would seek advice. Recruitment records sampled showed that a robust procedure is not being followed for the protection of people living in the home (detailed further in the staffing section of this report). Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: As at the previous inspection the front and rear garden of the home are very well maintained with lots of flowers, pots and baskets. The rear garden is very private, with a green house and vegetable plot. We were informed that residents like to get involved in growing food items and plants. We were also informed that a request has been made for a ramp access to the garden for one resident due to deterioration in mobility. 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. The lounge is generally homely in style with ornaments, pictures and photographs of people who live or have lived at the home. Since the last Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 20 inspection new light fittings and carpet have been provided and we were informed decorators will be visiting shortly to paint the lounge and a new television and seating have been ordered. There is a separate dining room. This has recently been painted and also has been fitted with new flooring. The dining table and chairs are looking worn and this room would benefit from new furniture. 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 home was generally clean. Satisfactory hand washing facilities were observed in the bathroom, laundry and kitchen. 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. We did observe that the ground floor toilet and separate shower room appear worn and do not appear to be as well maintained as other areas of the home. It is recommended that these be included on the maintenance plan for the home and that timescales for action also be included to ensure the home is maintained to a satisfactory level throughout. Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36. 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 skills and knowledge to support residents. Staffing levels must be maintained to ensure residents needs are met. Gaps in recruitment records mean residents cannot be assured they are supported by staff who have had the required checks to ensure they are safe. Supervision of staff is not consistent. This means they may not have the support needed to do their job. EVIDENCE: 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 all staff must either hold a National Vocational Qualification or be enrolled to undertake this. Currently there are only two staff who have achieved this and one in the process. Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 22 We viewed the staffing rotas for May and June 2008 and found levels vary on a morning and afternoon. These range from two staff to four. At night there is one wake person on duty. We asked the registered manager why staffing levels appear to vary so much and were informed that some days not all residents were at the home and that staff shortages due to sickness have also had an impact. Rotas evidence two staff is the norm planned for weekends. We instructed the registered manager that staffing levels must be maintained to meet the needs of residents, with agency staff brought in if permanent staff are not available. If staffing levels are not maintained this means residents choices can be affected. We were particularly concerned to find a new member of staff who should have been on induction on duty with one other staff member, bringing the total staff to two. We informed the registered manager this is not acceptable as the mix of low staffing levels and a person who does not know the needs of the residents or have all the required training places residents at risk. 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. A form is kept at the home that has been agreed with the CSCI. This details important recruitment information about each staff member. None of the 4 staff files we looked at contained either a staff information form that had been completed in full or recruitment records. This means we cannot be sure robust procedures are being followed so that people are not put at risk by having unsuitable staff working with them. Since the last inspection five staff have had training in Makaton (a type of sign language) with three others booked to undertake this and four staff Dysphasia (eating /swallowing problem). Three staff have undertaken Learning Disability Award Framework training (now known as LDQ) and ten staff autism awareness. This means staff have more information in order to support people living at the home. Efforts should now be made to ensure all staff have person centred planning and equal opportunities training, this would increase staffs knowledge further. Supervision of staff continues to be inconsistent. This means staff may not be informed about the changing needs of people, changes within the organisations philosophy or have an opportunity to influence how care for people will be delivered in the future. Of the four staff files we sampled all contained minutes of one supervision meeting they have received. A supervision agreement was seen to be in place that states supervisions should take place every 6 to 8 weeks. On a more positive note records indicate three staff meeting have occurred in 2008 where subjects including care plans, training and health and safety were discussed. Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 23 Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management of the home has improved in most areas. The outstanding areas must be addressed to ensure residents can have a say in the care delivered to them. Management of health and safety meets resident’s needs. EVIDENCE: Since the last inspection Ms Marie Stephens has become the registered manager. She is suitably qualified and competent for the role. Before we visited the home we received notification from the organisation that the registered manager is resigning and that another person has been recruited. When we arrived at the home we found it to be the registered managers last day working there. We were informed the new manager is due to commence working at the home in the next two weeks and that a senior support worker Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 25 will be managing the home with support from the responsible individual until that time. During this inspection we found that many things have improved, but there are still improvements needed. It is hoped the new manager will continue with these. We were pleased to hear that the new manager has visited the home twice in order to meet residents and to look at management systems already in place. Quality monitoring systems include an annual service review (completed 2007) to see if people at the home were getting a good service, this covered areas such as food, daily living and the premises. A development plan is available following the review. Prior to this inspection the home sent us its Annual Quality Assurance Assessment (AQAA) as we requested. The contents of this were brief in parts and give minimal information about the service provided to residents. We discussed this with the registered manager, acknowledging this was the first time this document has been completed but advising greater detail is included when next requested by the CSCI. 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. 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, a risk assessment is in place so that the risks of there being a fire are minimised as much as possible. An engineer regularly services the fire equipment to ensure it is well maintained. Acceptable numbers of staff have received training in first aid, health and safety, food hygiene and fire awareness. Greater numbers of staff should receive moving and handling training, as the mobility of one resident has deteriorated resulting in greater assistance needed. Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 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 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 2 X Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 27 No 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 YA20 Regulation 13(2) Requirement Written consent must be obtained from the prescriber to ensure crushing of medication does not have any advise side affects that could harm the resident. GP consent for the use of ‘as required’ medication must be obtained to ensure residents are not at risk due to medication practices. The practice of residents funding meals outside of the home without any contribution must cease until clarification is sought with regard to the amount that the home should be contributing. An audit of residents’ financial records must take place and reimbursement made. Staffing levels must be maintained to meet the needs of residents, with agency staff brought in if permanent staff are not available. Staff on induction must not be included in the staffing ratios, as they will not have sufficient Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 28 Timescale for action 01/08/08 2 YA20 13(2) 01/08/08 3 YA23 13(4)(6) 01/07/08 4 YA33 18(1)(a) 14/06/08 knowledge of the residents. 5 YA34 19 Staff information forms must contain all the required information so that people are not put at risk by having unsuitable staff working with them. 20/06/08 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 Refer to Standard YA5 YA6 Good Practice Recommendations Residents or their representatives should sign the terms and conditions of residency. This will ensure residents’ rights are protected. Residents or their representatives should be involved in the compilation and reviewing of care plans so that their views are considered when planning care and support. If residents are not able to be involved in planning their care and have no family or representatives, advocates should be obtained. Daily records should be correlated with care plans and risk assessments so information is at hand when care plans are reviewed. Key worker meetings should take place on a regular basis to promote person centred approaches to care and support. Score rating should be translated into a risk level (low, medium or high in order to be able to determine how often risk assessments should be reviewed. 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. Residents should be supported to attend dental and hearing appointments. This will ensure a holistic approach to health care. The ‘as required’ protocol that states permission for administration must be gained from the manager should be reviewed as it indicates a person not present will make the decision as to whether medication should be DS0000016881.V366327.R01.S.doc Version 5.2 Page 29 3 4 5 6 7 YA7 YA9 YA12 YA19 YA20 Wood Lane, 135 8 YA22 9 YA23 administered. Staff should read and sign residents care plans for supporting them to complain to offer assurances to residents that they will act on their behalf with regard to complaints. Staff should read and sign residents care plans for behaviour to ensure that other people living at the home are protected from being hurt. A risk assessment should be implemented for the resident who is waiting for behaviour management guidelines to be implemented in order to reduce the risk of harm. The dining table and chairs are looking worn and should be replaced. Refurbishment of the toilet and bathing facilities should be included in the maintenance plan for the home and timescales for action included to ensure the home is maintained to a satisfactory level throughout. To ensure people are supported by a qualified staff team all staff must either hold a National Vocational Qualification or be enrolled to undertake this. Efforts should now be made to ensure all staff have person centred planning and equal opportunities training, this would increase staffs knowledge further. 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. Greater numbers of staff should receive moving and handling training, as the mobility of one resident has deteriorated resulting in greater assistance needed. 10 YA24 11 12 13 YA32 YA35 YA36 14 YA42 Wood Lane, 135 DS0000016881.V366327.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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.V366327.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!