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Inspection on 14/03/08 for 50 Yateley Avenue

Also see our care home review for 50 Yateley Avenue for more information

This inspection was carried out on 14th March 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff have very good knowledge of residents needs and were able to explain individuals preferences. For example one member of staff explained, "X goes to college Monday to Friday which he absolutely adores, he is more than capable with personal care and dressing, just needs help with washing his back and hair and drying it. When goes college chooses own outfits night before, likes to dress smart, likes practical jokes with people". No residents were seen to be excluded from conversations with staff and this appeared to be the norm. Residents were seen smiling and gesturing, indicating their pleasure. One resident attends college 5 days a week and indicated to us that he really enjoys this. A resident spent most of the inspection with us. Staff did not stop the resident being involved in the inspection process and encouraged him to join in conversations, demonstrating good understanding of this persons rights of inclusion. People are supported to keep in contact with their family and friends and the importance of these relationships is recognised by staff. One resident used sign to inform us that they use the telephone to talk to family members. There are no rigid rules or routines, the people who live in the home were observed to have a relaxed and flexible routine. All residents and staff sit together at the dining table to eat together, promoting a homely atmosphere. Staff prompt some individuals with their personal care to maintain their dignity and it is positive that residents have the choice of male staff to support them with their needs. Systems for the receipt, administration, safekeeping and disposal of medication are good, offering protection to residents. Some of the people who live at this home would not be able to access a complaints procedure or raise concerns without a great deal of support. It is a positive to find that residents meetings take place on a monthly basis where people are asked if they have any concerns. Views are indicated by gestures and signs and are recorded as such. We examined the finances and records for all residents. These appear appropriate and offer safeguards to residents.

What has improved since the last inspection?

Information is now included in the Service user guide regarding fees charged for living at the home, what fees cover and what is excluded. This ensures people are aware of their rights and responsiblities. All areas of the home were seen to be clean and free from dust. The laundry has recently been decorated and so have all residents` bedrooms. Previously there used to be a `sleep-in` person but this has changed to a `wake night` worker due to the increased needs of one resident.

What the care home could do better:

One resident has a degenerative condition. Efforts have been made to ensure documentation is in place to inform staff how to care for this individual but further work must be undertaken as a matter of priority to ensure care plans contain clear information. This will ensure staff work to a very high consistent standard and constantly monitor pain, distress and other symptoms to ensure the resident receives the care they need. A complaint made by a resident has still not been resolved to a satisfactory conclusion. This means the resident`s rights are being compromised. We were not able to look at staff training certificates, recruitment and supervision records as these are stored in a locked cabinet with only theRegistered Manager having access. We asked the senior if they have access to resident`s monies and records and they confirmed they do. We explained that this could been seen as an equality issue as the senior is trusted to look after residents documents but not staffs and indirectly this could give the view that residents records are not seen as important as staffs. The home must be able to evidence that agency workers have the required checks and qualifications as potentially they pose greater risks to residents due to being lone workers. Potential risks are also increased as all 3 residents have very limited verbal communication that would impact on them being able to say if they are being mistreated. The 3 people who live at the home have a range of needs, one requiring a great deal of care and support in order to keep them safe. It is therefore essential that the care plans say exactly what needs to be done to meet the individual`s need and reflect the extensive knowledge regular members of staff have of individuals. This will ensure people are kept safe and receive constant care. A number of recommendations are also sited at the back of this report that the home should take action to implement. These include improvements to activities, staff training and quality assurance systems.

CARE HOME ADULTS 18-65 Yateley Avenue, 50 Great Barr Birmingham West Midlands B42 1JN Lead Inspector Lesley Webb Key Unannounced Inspection 14th March 2008 15:30 Yateley Avenue, 50 DS0000016930.V356536.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 Yateley Avenue, 50 DS0000016930.V356536.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. Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Yateley Avenue, 50 Address Great Barr Birmingham West Midlands B42 1JN 0121 358 0462 F/P 0121 358 0462 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 Mrs Roseben Okeudo Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That the home can continue to accommodate two service users over the age of 65 years. Residents needs are kept under review. Date of last inspection 7th March 2007 Brief Description of the Service: 50 Yateley Avenue is currently registered to provide accommodation, support and personal care for up to four adults with learning disabilities. The Home is run by Milbury Care Services and staffed 24 hours a day. It accommodates three male residents at present, having recently converted a shared room to a single bedroom. The house is situated in a quiet residential street in the Great Barr area of Birmingham, about five miles from the city centre. The property is semidetached and on a domestic scale, in keeping with other houses in the neighbourhood. The Home is well served by public transport, and there is a range of local amenities including shops, pubs, libraries and parks within walking distance. There are three single bedrooms in the house and a bathroom with w/c on both floors. Downstairs there is a separate lounge and dining room, kitchen and laundry. One of the single bedrooms is also situated on the ground floor. Upstairs there are two single bedrooms, and the staff sleep-in room. There is limited off-road parking on the front drive. To the rear of the property is a pleasant enclosed and private garden. Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We, the commission undertook this visit over 1 day between the hours of 3.30pm and 10.30pm. The home was given no prior notice. During the visit time was spent talking to staff and residents, observing practices and examining records before giving feedback about the inspection to the senior member of staff on duty. The people who live at this home have a variety of needs. We took this into consideration when case tracking two individuals care provided at the home. For example the people chosen have differing communication and care needs. Prior to this inspection information was supplied to us by the home. This was also used when forming judgements on the quality of service provided at the home. Information regarding fees charged for living at the home is included in the Service User Guide. Interested parties are advised to contact the home direct if requiring this information. What the service does well: Staff have very good knowledge of residents needs and were able to explain individuals preferences. For example one member of staff explained, “X goes to college Monday to Friday which he absolutely adores, he is more than capable with personal care and dressing, just needs help with washing his back and hair and drying it. When goes college chooses own outfits night before, likes to dress smart, likes practical jokes with people”. No residents were seen to be excluded from conversations with staff and this appeared to be the norm. Residents were seen smiling and gesturing, indicating their pleasure. One resident attends college 5 days a week and indicated to us that he really enjoys this. A resident spent most of the inspection with us. Staff did not stop the resident being involved in the inspection process and encouraged him to join in conversations, demonstrating good understanding of this persons rights of inclusion. People are supported to keep in contact with their family and friends and the importance of these relationships is recognised by staff. One resident used sign to inform us that they use the telephone to talk to family members. Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 6 There are no rigid rules or routines, the people who live in the home were observed to have a relaxed and flexible routine. All residents and staff sit together at the dining table to eat together, promoting a homely atmosphere. Staff prompt some individuals with their personal care to maintain their dignity and it is positive that residents have the choice of male staff to support them with their needs. Systems for the receipt, administration, safekeeping and disposal of medication are good, offering protection to residents. Some of the people who live at this home would not be able to access a complaints procedure or raise concerns without a great deal of support. It is a positive to find that residents meetings take place on a monthly basis where people are asked if they have any concerns. Views are indicated by gestures and signs and are recorded as such. We examined the finances and records for all residents. These appear appropriate and offer safeguards to residents. What has improved since the last inspection? What they could do better: One resident has a degenerative condition. Efforts have been made to ensure documentation is in place to inform staff how to care for this individual but further work must be undertaken as a matter of priority to ensure care plans contain clear information. This will ensure staff work to a very high consistent standard and constantly monitor pain, distress and other symptoms to ensure the resident receives the care they need. A complaint made by a resident has still not been resolved to a satisfactory conclusion. This means the resident’s rights are being compromised. We were not able to look at staff training certificates, recruitment and supervision records as these are stored in a locked cabinet with only the Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 7 Registered Manager having access. We asked the senior if they have access to resident’s monies and records and they confirmed they do. We explained that this could been seen as an equality issue as the senior is trusted to look after residents documents but not staffs and indirectly this could give the view that residents records are not seen as important as staffs. The home must be able to evidence that agency workers have the required checks and qualifications as potentially they pose greater risks to residents due to being lone workers. Potential risks are also increased as all 3 residents have very limited verbal communication that would impact on them being able to say if they are being mistreated. The 3 people who live at the home have a range of needs, one requiring a great deal of care and support in order to keep them safe. It is therefore essential that the care plans say exactly what needs to be done to meet the individual’s need and reflect the extensive knowledge regular members of staff have of individuals. This will ensure people are kept safe and receive constant care. A number of recommendations are also sited at the back of this report that the home should take action to implement. These include improvements to activities, staff training and quality assurance systems. 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. Yateley Avenue, 50 DS0000016930.V356536.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 Yateley Avenue, 50 DS0000016930.V356536.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. Information is available to help people decide if this home can meet their needs. Not all information is up to date and may be misleading to prospective residents. Care needs are properly assessed so that residents can be confident the home understands the areas they require support in. Care plans have not been introduced for all identified needs, which could mean residents do not get the support they need in all areas. Residents are provided with a statement of terms and conditions that sets out in detail the role and responsiblities of the provider and the rights and obligations of the individual. These have not been agreed with individuals and information about money they have to pay towards transport is different to that in the Service User Guide. This could mean residents legal rights are not protected. EVIDENCE: The home has a Statement of purpose and Service User Guide that sets out the aims and objectives of the home so that prospective people considering the service have information on which to base their decisions. The Service Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 10 User Guide includes some simple pictures as an aid to communication for people. We found that these documents give information on the facilities and services, staffing, admissions procedures, fire precautions, diversity and complaints. We found that both these documents need reviewing as some information in no longer up to date. For example they contain the previous address and telephone number of the Commission for Social Care Inspection and state that the managers position at the home is currently vacant. We found that information is now included in the Service user guide regarding fees charged for living at the home, what fees cover and what is excluded. This ensures people are aware of their rights and responsiblities. There have been no new admissions to the home for several years and therefore we could not check in full if the homes assessment processes ensure people’s needs are identified prior to confirming if they can move in. We did find that all 3 residents have assessments in place that are score based for areas including communication, physical development, comprehension, personal hygiene and dressing. As we explained to staff on duty further work should be undertaken to ensure care plans are put into place for all identified needs generated from the assessment. This will offer further assurances to residents that they will receive the support they need. For example one persons assessment gave ratings of 5 and 6 (this indicating almost or fully independent) with care plans in place and other scores of 0 or 1 (indicating almost or fully dependant) but with no plans of care. We found that all 3 residents have been provided with a Contract of Residency that gives information on what people can expect to receive for the fee they pay. When examining these we found that all 3 residents have to contribute to the cost of the homes vehicle. This contradicts the homes Service user guide which states ‘no contribution is required for the use of the home vehicle’. As we explained to staff this must be investigated as both the Service User Guide and Contracts of Residency are legal documents and must work in conjunction with one another to ensure residents rights are protected. We also noted that none of the Contracts have been signed by residents or representatives of the home. Staff informed us that the contracts are “fairly new”. We discussed with staff residents understanding of the Contracts with staff informing us “none of the residents would understand contents of contracts, could sign but would be tokenistic. Some have families who could do this on their behalf but they limited involvement”. We discussed with staff the Mental Capacity Act and how this may impact on actions staff need to take if residents do not have capacity to understand and consent. Yateley Avenue, 50 DS0000016930.V356536.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. Care plans do not consistently reflect the care being delivered. Staff do not always have the information they need in individual’s care plans to support people in a person centred way, and maintain their safety and well-being. Attempts are made to involve residents in making decisions about their lives. Staff have a good understanding of the communication needs of people, supporting them to make choices about their life. The management of risk is positive in addressing safety issues while aiming for improved outcomes for people. EVIDENCE: We found that each of the 3 residents have care plans but the practice of involving residents in there development is variable. We also found that some information is out of date and that plans are not in place for all identified needs. For example one persons file contained a plan for maintaining a safe Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 12 environment which consisted of one sentence despite then going on to say they require one to one supervision at all times. The same persons file contained plans for road skills and awareness with aims and objectives, which is a positive. All plans were seen to have been reviewed on a monthly basis but we question the value of this as most recordings state ‘no change’ and no evidence of the resident being involved could be found. In addition to the monthly reviews we found a review document that states reviews take place bi-annually. Staff were confused about this, explaining that they thought these occurred annually. Records do not demonstrate either bi monthly or annual reviews taking place. One of the residents needs have altered greatly over the last 6 months due to a serious medical condition. We found evidence that staff have attempted to ensure care planning documentation is in place that will monitor and meet this persons changing needs but further work must be undertaken to ensure this person is not placed at risk. For example this persons ‘personal profile’ states food has to be cut up but staff informed us everything now has to be liquidised and the plan for mobility does not state that this person now only goes out into the community with the use of a wheelchair (as described by staff). Other plans for eating and drinking and personal hygiene were up to date, reflecting this person’s current needs. The home is now using regular agency staff during the night due to the increase in this persons needs. It is therefore crucial that accurate and up to date information is available for these staff in order that this persons needs are met. For all 3 residents staff confirmed that care plans are not in place for health care management. As we explained to staff priority must be given to reviewing all care planning documentation for the resident who is suffering ill health with the completion of a continuing care/end of life plan involving all relevant agencies. This will ensure the residents changing needs are closely monitored and actions taken to ensure needs are met in a timely way. Efforts have been made to make plans person centred. For example one plan contains photographs of the person using makaton signs as aids to communication and ‘personal profiles’ give very detailed information about how each individual prefers various aspects of their care to be delivered (however some of the information is not up to date as explained above). Work should continue in this area in order that documentation reflects practices observed during the visit. On a positive staff gave very good descriptions of residents needs. For example explaining, “ X can understand verbal communication that is given to him; very limited communication to give back so uses basic makaton, photographs and objects of reference. He has Cerebral palsy, autistic tendencies, has challenging behaviour usually demonstrated when can’t make himself understood. He goes to college Monday to Friday which he absolutely adores, been going for years, knows staff and built good relationships and with Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 13 other service users. More than capable with personal care and dressing, just needs help with washing back and hair and drying it. When goes college chooses own outfits night before, likes to dress smart, likes practical jokes with people, eating and drinking will eat anything expect salad. Food has to be cut into small bit size pieces, have to ask him to slow down as will rush, veg are usually blended and doesn’t like too much gravy” and with regard to another resident explained, “X is the elder of the house, can understand verbal communication but makes noises not words, usual response to basic yes or no answers is to ignore or smile. Cannot cope with any solid food, sometimes has to be fed, does cough a lot and regurgitates food or drinks. Seems like since he was diagnosed seems worse, weight loss, mobility. We have to give full assistance every hour half to use toilet, wears pad so have to change, full assistance with personal hygiene. Mobility is very slow and laboured, up to year ago could walk to local shops and back now lucky if could get to next door, out of breath, stairs we have to make sure one to one staff at all times”. The 3 people who live at the home have a range of needs, one requiring a great deal of care and support in order to keep them safe. It is therefore essential that the care plan say exactly what needs to be done to meet the individual’s need and reflect the extensive knowledge regular members of staff have of individuals. This will ensure people are kept safe and receive constant care. During the visit we observed staff encouraging people to make choices about day-to-day matters, such as what they wanted eat and drink, where they wanted to sit and what they wanted to watch on television. People’s ability to exercise choice and to make informed decisions is variable, according to their degree of learning disability. Staff were seen spending time with all residents and making efforts to involve them in conversations. No residents were seen to be excluded from conversations with staff and this appeared to be the norm. Residents were seen smiling and gesturing, indicating their pleasure. Care plans are supported by risk assessments and there are links to individual care plans. We found assessments in place areas including mobility, behaviour in transport, bathing and use of equipment. As with care planning some omissions in risk assessments were found, however we were informed by staff that a new care planning system is being introduced that will link assessments of need to care planning and risk management. This will offer a holistic care management approach to residents. Yateley Avenue, 50 DS0000016930.V356536.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, 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 make choices about their life style. In the main social, educational, cultural and recreational activities meet individuals’ expectations. Arrangements must be made so that residents can go on a holiday or day trips of their choosing each year, based on their individual needs and choices. Meals are balanced and nutritious and cater for the varying dietary needs of individuals. EVIDENCE: Information supplied by the home in its Annual Quality Assurance Assessment (AQAA) states ‘All service users are encouraged and supported to make decisions in all areas of their lives. Staff support service users to access Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 15 community facilities including Cinemas, Shopping, Meals out, Theatre visits, Pub visits and day trips. They are also supported to access local transport as well as using the homes vehicle. Service users are encouraged to be politically aware and to vote if they wish to do so. Open access policy regarding visitors, they choose where they wish to spend time with their families/ friends when they visit. Staff support service users to maintain accurate account of their finances. Service users access day services provided by North Birmingham College with support from staff. Menus planned with service users: They choose times of meals and where they would like to eat their meals’. We found that in the main this information is accurate. For example discussions with staff and examination of records demonstrate residents attend places of further education, residents are supported to maintain contact with relatives and are given choices of what to eat and when. We could find no evidence that residents visit the cinemas, theatre and have gone on day trips recently. However activities that residents participate in appear to reflect their individual interests, needs and capabilities. For example one resident who is younger than the other residents attends college 5 days a week and indicated to us that he really enjoys this. The other 2 residents are over retirement age and staff informed us they prefer in house activities such as watching television and listening to music. Activity records in the main detail attendance at colleges. We found some entries for shopping. Records include detail of what involvement resident has preparing for college such as ‘preparing bag got own coat on, prepared sandwich’ and also include staffs’ opinion if happy with the involvement. We could not find records of in house activities with staff explaining these used to be recorded but have now stopped. They were unable to say why. We advised that these should be reinstated again in order that the home can demonstrate residents lead full and active lives based on their individual needs and capabilities. None of the residents have been on holiday in the last 12 months. Staff informed us this was due to a variety of reasons. As we explained everyone should be offered an annual holiday or the equivalent in day drips based on their individual needs. If these do not take place the home must be able to demonstrate how this decision was arrived at. During the visit we observed 2 of the residents sitting in the lounge watching television. Both appeared relaxed. The third resident spent most of inspection with us in different rooms that we used during various stages of the visit. Staff did not stop the resident being involved in the inspection process and encouraged him to join in conversations, demonstrating good understanding of this persons rights of inclusion. Discussions with staff and examination of records confirm that residents are supported to maintain contact with their families. One resident used sign to inform us that they use the telephone to talk to family members. Staff explained that they help him phone every week. Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 16 There are no rigid rules or routines, the people who live in the home were observed to have a relaxed and flexible routine. We saw that residents are encouraged to choose what clothes they wish to wear and there are no set times when meals must be taken. We witnessed the evening meal being prepared and served by a member of staff. Fresh vegetables, potatoes with chicken Kiev were served. The meal looked and smelt appetising. All residents and staff sat together at the dining table to eat together, promoting a homely atmosphere. A liquidised meal was prepared for one resident. All residents appeared happy with the meal provided, smiling and appearing to enjoy the company of staff. Later in the evening we witnessed residents being offered choice of drinks including tea and drinking chocolate. They were also given a choice of cake and biscuits. One resident appeared especially pleased with the cake given, smiling and laughing. Yateley Avenue, 50 DS0000016930.V356536.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 good. This judgement has been made using available evidence including a visit to this service. The health and personal care that residents receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Information supplied by the home in its Annual Quality Assurance Assessment (AQAA) states ‘All service users’ individual plans identify their preferences regarding their personal care, health professionals are involved where necessary and all visits are recorded. Health care plans are developed including annual medical checks, Chiropodist, Dentist, Opticians visits are all recorded. Service users choose when to go to bed and when to get up the following morning. They are given the opportunity to choose their key workers, who to support them with their personal care and when to support them with their personal shopping and outings. Ageing illness and death of any service user is handled with full respect as the service users would wish’. Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 18 In the main we found this information to be accurate. For example staff were observed prompting some individuals with their personal care to maintain their dignity and it was positive to see that residents had the choice of male staff to support them with their needs. Records sampled showed that people are supported to have regular health related check-ups. Where appropriate individuals have been referred to health professionals who are involved in their care. There is a record of general health care information. The personal appearance of residents was good, their clothes were clean and appropriate for the weather, they were dressed appropriately for their age and gender. They were cleanly shaved and fingernails were clean and short, their physical needs had been addressed appropriately. We saw a notice displayed in the laundry instructing night staff to get all 3 residents up in the morning before 8am. We asked staff if all residents choose to get up before 8am. Staff said some do but not always if not attending centres. We explained this not person centred and could impinge on rights and should be reviewed. Systems for the receipt, administration, safekeeping and disposal of medication are good, offering protection to residents. For example the senior member of staff was seen to keep the keys to the medication cabinet on their person at all times, written guidelines are in place for the use of ‘as require’ medication, administration records viewed contained no unexplained gaps and both weekly and monthly medication audits are carried out. We did advise that any prescribed creams should include what part of the body they need to be applied to in order to reduce the risk of miss-administration, that the homely remedies list be reviewed by the GP as this last occurred in 1991 and that the home obtain a list of controlled drugs and drugs that are not controlled but should be treated as such in a residential home in order to offer further safeguards to residents. As mentioned earlier in this report one resident has a degenerative condition. Efforts have been made to ensure documentation is in place to inform staff how to care for this individual but further work must be undertaken as a matter of priority to ensure care plans contain clear information. This will ensure staff work to a very high consistent standard and constantly monitor pain, distress and other symptoms to ensure the resident receives the care they need. The current management plan in place gives some information but a continuing care/end of life plan must be implemented that brings together all elements of the resident’s current and future care needs. This must be reviewed on very regular basis and must be drawn up with involvement of professionals. Currently there are lots of different documents in place, some containing conflicting information. This could confuse staff and place the resident at risk of needs not being appropriately managed. Staff agreed action should be taken to address this as soon as possible. Yateley Avenue, 50 DS0000016930.V356536.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. Residents are supported to express their concerns and are protected from abuse. Further training for staff will offer greater protection to residents. EVIDENCE: Information supplied by the home in its Annual Quality Assurance Assessment (AQAA) regarding complaints and protection gives very little evidence of how people are supported to raise concerns or how they are protected from abuse. It states ‘All service users have written procedures in their files. This is called letting us know what you think/ I am worried, company concerns, complaints procedures. Staff supported a resident to make a complaint with the registered provider about the windows in this bedroom’ Staff on duty at the time of the inspection could not locate the complaints log and were not aware if one is in existence. They were able to produce letters regarding a complaint that a resident first raised in July 2006 regarding defective windows at the home. A written response from the provider was given to the resident May 2007 but this does not demonstrate the complaint has been resolved to a satisfactory conclusion. For example the letter from the provider states ‘Milbury have contacted the PCT who are currently the housing provider and notified them of the need to have works completed. It states the PCT estates department are currently under going a sale of this property and have to date not made a commitment to undertake this work prior to the sale and that the managing director of Milbury wrote to the PCT to establish whether they would consider reimbursing Milbury for the outstanding Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 20 works should they be in a position to action, however response not received’. At the time of this inspection the windows have still not been repaired and the resident expressed their dissatisfaction with this to us. This situation must be resolved. Fees are paid on behalf of the resident to live in a home that is maintained to a satisfactory level and as such the terms and conditions of residency are not being compiled with. This means the resident’s rights are being compromised. Some of the people who live at this home would not be able to access a complaints procedure or raise concerns without a great deal of support. It is a positive to find that residents meetings take place on a monthly basis where people are asked if they have any concerns. Views are indicated by gestures and signs and are recorded as such. The homes Statement of Purpose says that staff will be trained in behaviour intervention however we could find evidence of only one member of staff having done so. Staff were able to explain the needs of residents in this area but training would offer further safeguards to individuals. We examined the finances and records for all residents. These appear appropriate and offer safeguards to residents. Each person has separate financial sheets that detail both monies brought into the home and those spent. Receipts were seen to be in place and all monies accurately reflected recordings. We noted that the bank statements for one resident detail a very large amount of savings. We asked staff what actions are being considered to reduce these as they could impact on benefits that the individual receives. Staff were unable to provide any information. We recommended that advice be sought in the resident’s best interest. There are currently 7 members of staff permanently employed at the home (including the Registered Manager). Of these 4 completed protection training in 2007, 1 in 2004 and 2 have yet to undertake. In addition to this we could find no evidence that protection of residents is discussed with staff in venues such as staff meetings. Further work should be undertaken in this area to offer greater safeguards to residents. Yateley Avenue, 50 DS0000016930.V356536.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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have been made to the decoration of the home so that residents live in a comfortable environment. Repairs to some windows are needed so that residents’ comfort is enhanced further. The home is clean and smells fresh. Further training and guidance should be provided to staff to reduce the risk of infection. EVIDENCE: The house is situated in a quiet residential street in the Great Barr area of Birmingham, about five miles from the city centre. The property is semidetached and on a domestic scale, in keeping with other houses in the neighbourhood. The Home is well served by public transport, and there is a range of local amenities including shops, pubs, libraries and parks within walking distance. Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 22 There are three single bedrooms in the house and a bathroom with w/c on both floors. Downstairs there is a separate lounge and dining room, kitchen and laundry. One of the single bedrooms is also situated on the ground floor. Upstairs there are two single bedrooms, and room that was previously used by staff to sleep in. There is limited off-road parking on the front drive. To the rear of the property is a pleasant enclosed and private garden. We were asked by a resident to look at his bedroom. He went to the top small window, opened it but could not close it needing assistance from a member of staff. The window appears warped and the need for staff intervention takes away the residents independence. The resident has previously raised this as a complaint (see notes in complaints section of this report). The same residents room was seen to be tastefully decorated with matching accessories. The resident also took us to the light above the sink in his room, pulling the cord. The light did not come and should be replaced. There are lots of photographs around the resident’s room and personal affects. Two of the small windows in another resident’s room do not close fully. Staff explained they make “rattling” sound when windy. These should be repaired as soon as possible as the resident spends considerable time in their room due to poor health. As with the first resident’s room this is also tastefully decorated, spacious and clean. All areas of the home were seen to be clean and free from dust. The laundry has recently been decorated and appropriate personal protective equipment was seen to be in place, promoting good infection control. We advised that a system be introduced for washing and replacing bathmats as one was seen to be soiled and staff were unaware if or when these are replaced. Mops and buckets were seen to be stored in the back garden. A colour-coded system is in place. The mop heads are very soiled and worn and staff were unaware of any disinfection procedures being in place for these. We explained that infection control guidance for residential homes is available on the CSCI web site and that the home should obtain this and implement any recommendation to promote good infection control. Staff agreed with this. Of the 7 members of staff permanently employed at the home 4 completed infection control training in 2005 and 3 have yet to undertake this. It is recommended that all staff undertake training in this area to ensure their knowledge and practices reflect current good practice. Yateley Avenue, 50 DS0000016930.V356536.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 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Records were not accessible at the inspection. This means we could not be sure that all staff in the home are trained, recruited and supervised to meet the needs of residents. EVIDENCE: Information supplied by the home in its Annual Quality Assurance Assessment (AQAA) regarding staffing gives basic information and does not contain sufficient detail that we could use to inform judgments of quality. It states ‘All staff are supervised and appraised on a regular basis. They are paid to attend trainings. Recruitment process is appropriate and relevant checks are under taken. 75 of staff has NVQ qualifications. Staff meetings are held on a regular basis, job descriptions are clearly defined. Updated trainings in Pova. Manual handlings. Medications, infection control, first aid, food hygiene. One support worker gained NVQ3 award. Manager gained R.M.A Award’. We asked the senior on duty to show us staff training certificates, recruitment and supervision records. We were informed that these are stored in a locked cabinet with only the Registered Manager having access. Therefore as the Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 24 Registered Manager was not present at the inspection we were not able to assess if the homes practices safeguard residents. We asked the senior if they have access to resident’s monies and records and they confirmed they do. We explained that this could been seen as an equality issue as the senior is trusted to look after residents documents but not staff and indirectly this could give the view that residents records are not seen as important as staffs. Despite not having access to staff training certificates observations made during the inspection demonstrated those staff on duty have the skills and attitudes needed to meet the needs of residents. Respect and warmth was shown to all residents, with everyone being treated as equals. Staff should be congratulated for this. A training matrix was on display in the home. Of the 6 care staff permanently employed it states 2 staff hold a NVQ level 3 and one a NVQ level 2. We were informed another member of staff is in the process of completing a NVQ level 3. Staff were unsure if the remaining staff have been enrolled to undertake this qualification. The training matrix also details 4 of the 6 staff having received training in risk assessment, 1 person centred planning, 2 positive communication, 3 equal opportunities, 3 attitudes and values, 2 autism, 1 learning disability award framework accredited training and 2 epilepsy awareness. It is recommended that greater numbers of staff receive training in all these areas (apart from risk assessment) to ensure they have the skills and knowledge to meet the needs of residents. It is also recommended that staff receive training in continence management due to the changing needs of one resident. Rotas show that there are 2 staff on duty during the day and early evening and that one member of staff is on duty during the night. Previously there used to be a ‘sleep-in’ person but this was changed due to the increased needs of one resident. The home should be congratulated for taking action in this area. Rotas evidence that many of the Registered Managers hours have been undertaken in a care capacity. We were informed that this is due to change and that all of the manager’s hours will be supernumerary to care. Due to the change in staffing arrangements during the night the home has been using high numbers of agency workers. Attempts to minimise the disruption this may cause to residents have been made by where possible using a pool of regular agency staff. An agreement is in place with the Registered Provider and CSCI to retain recruitment documents at the organisations central office and that an information sheet for each person will be kept at the home with details of Criminal Records Bureau checks, references and other important information. Due to not having access to records in the home we could not assess if these are being completed. As we explained to staff, records required by regulation for the protection of residents must be accessible for inspection at all times. As already mentioned the waking night shifts are being covered by agency staff. Staff on duty at the time of inspection did not know if the home checks with the agency that workers it supplies have had the necessary checks Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 25 required by regulation to protection residents or if they hold up to date training certificates. We explained to staff that the home must be able to evidence that agency workers have the required checks and qualifications as potentially they pose greater risks to residents due to being lone workers. Potential risks are also increased as all 3 residents have very limited verbal communication that would impact on them being able to say if they are being mistreated. Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 26 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, 40, 41 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from living in a home that is generally well run. The quality assurance systems do not ensure that residents’ and other interested parties views are taken into account or help to shape the service provided. Residents’ health safety and welfare are generally well protected and promoted. EVIDENCE: As already mentioned in this report the Registered Manager was not present during this inspection. However evidence indicates that in the main the home is being adequately managed. Prior to the visit to the home the Registered Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 27 Manager completed the Annual Quality Assurance Assessment (AQAA) as instructed by CSCI. This in parts contains very little information and does not evidence how the home is meeting all the key National Minimum Standards. For example it gives no information regarding protection (standard 23) or quality assurance (standard 39). More supporting evidence would have been useful to illustrate what the home has done in the last year and how it is planning to improve. The data section of the AQAA was completed, although there are some omissions. For example the medication section. Systems are in place for monitoring quality within the home but these need to be developed further. Staff were unaware if the views of residents are sought and included in quality monitoring systems or those of staff and other interested parties. Policies and procedures are in place for most areas as listed in Appendix 3 of the National Minimum Standards for Younger Adults. Some need review to ensure they comply with changes in legislation and meet the needs of residents. For example the AQAA states there is no policy for continence promotion and a resident living at the home has specific needs in this area. Other policies including fire, first aid, Control Of Substances Hazardous to Health and infection control have not been reviewed since 2004. As detailed in the staffing section of this report some records required by regulation for the protection of residents were not accessible to us at this visit. Action should be taken to rectify this. The Registered Manager has completed risk assessments for the management of health and safety and regular monitoring of health and safety takes place, offering safeguards to both residents and staff. The training matrix states that of the 7 staff employed permanently at the home 3 have undertaken first aid training in 2007, 1 2006 and 1 does not specify a date, 3 staff completed health and safety training at the beginning of this year and one in 2005, 3 food hygiene at the beginning of this year and 2 in 2005, 4 manual handling in 2007 and 1 2005 and 4 fire safety 2008 and 1 2007. We were informed that one of the members of staff detailed on the training matrix is currently on long term sick and has been for a considerable time resulting in them being unable to renew any training. It is recommended that any staff that have not undertaken updates in first aid, health and safety, food hygiene, moving and handling and fire do so to ensure suitably qualified staff supports residents. Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 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 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 2 2 X 2 2 2 2 X Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement A detailed continuing care/end of life plan involving all relevant agencies must be completed for the named resident to ensure their needs are met. Very regular reviews of the life plan must take place to ensure the changing needs of the named resident are closely monitored and met. Action must be taken to resolve the complaint raised by a resident in July 2006 regarding defective windows at the home to ensure the residents’ rights are not compromised. The home must be able to evidence that agency workers have the required checks and qualifications as potentially they pose greater risks to residents due to being lone workers. Records required by regulation for the protection of residents must be open to inspection at all times in order that the home can demonstrate its practices safeguard residents. Timescale for action 15/04/08 2 YA22 22 15/04/08 3 YA34 19 15/04/08 4 YA41 17 15/04/08 Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 30 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 YA1 YA1 Good Practice Recommendations The Statement of Purpose and Service User Guide should be reviewed and updated so that people have access to accurate information. The practice of residents contributing to the homes vehicle costs should be investigated as this contradicts information in the Service User Guide. Changes to the Statement of Purpose and Service User Guide should only take place after residents and their representatives have been consulted, to ensure peoples rights are protected. Contracts of residency should be signed by residents and/or their representatives. Assessments of capacity must be undertaken in line with the Mental Capacity Act and appropriate action taken if a resident lacks capacity with regard to the signing of contracts. This will ensure people’s rights are protected. That care plans continue to be developed in order that residents’ needs and wishes are acknowledges and acted upon. Care plans set out in detail how all their current requirements and aspirations are to be met through positive individualised support. Care plans should be updated to accurately reflect areas of personal care. That the home evidences resident’s participation in the reviewing of their care needs, and reviewing their goals. Review and improve the range of opportunities for residents to participate in the local community as per their needs and wishes. Activity records should include any in-house activities that residents choose to undertake in order that the home can demonstrate residents lead full and active lives based on their individual needs and choices. 3 YA5 4 YA6 5 YA14 Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 31 6 7 YA18 YA20 All residents should be offered an annual holiday or the equivalent in day drips based on their individual needs. If these do not take place the home must be able to demonstrate how this decision was arrived at. The home should review the practice of getting all residents up by 8am to ensure resident’s rights are promoted. Prescribed creams should include what part of the body they need to be applied to in order to reduce the risk of miss-administration. The homely remedies list should be reviewed by the GP as this last occurred in 1991 and that the home obtain a list of controlled drugs and drugs that are not controlled but should be treated as such in a residential home in order to offer further safeguards to residents. Staff should be made aware of the location of the complaints log and given instruction on its use so that they are fully informed. Staff should be trained in behaviour intervention as per the homes Statement of Purpose and to offer further safeguards to individuals. Advice should be sought for the resident with large amounts of savings to ensure the home is acting in their best interests. All staff should receive adult protection training to offer greater safeguards to residents. The light over the sink in a resident’s bedroom should be repaired. The windows that do not close fully in a resident’s bedroom should be repaired or replaced. A system should be introduced for washing and replacing bathmats to promote good infection control. Disinfection procedures should be put in place for mop heads to promote good infection control. The home should obtain the infection control guidance available on the CSCI website and implement any recommendations to promote good infection control. All staff should undertake infection control training to ensure their knowledge and practices reflect current good practice. The home must be able to demonstrate all staff either hold DS0000016930.V356536.R01.S.doc Version 5.2 Page 32 8 9 YA22 YA23 10 YA24 11 YA30 12 YA32 Yateley Avenue, 50 13 YA35 14 15 16 YA39 YA40 YA42 a NVQ qualification or are working towards achieving this. It is recommended that greater numbers of staff receive training in person-centred approaches, autism, communication, epilepsy, equal opportunities and continence management to ensure they have the skills and knowledge to meet the needs of residents. Quality monitoring systems should be developed to include the views of residents, staff and other interested parties. Policies and procedures should be reviewed to ensure they comply with changes in legislation and meet the needs of residents. Any staff that have not undertaken updates in first aid, health and safety, food hygiene, moving and handling and fire do so to ensure suitably qualified staff supports residents. Yateley Avenue, 50 DS0000016930.V356536.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands Office 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. 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