Inspection on 04/09/08 for Yorkminster Drive

This inspection was carried out on 4th September 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Yorkminster Drive 06/06/09

Yorkminster Drive 19/03/08

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 14/11/2008.

CARE HOME ADULTS 18-65 Yorkminster Drive 1-5 Yorkminster Drive Chelmsley Wood Birmingham West Midlands B37 7UG Lead Inspector Julie Preston Key Unannounced Inspection 4th September 2008 10:30 DS0000070424.V371477.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 DS0000070424.V371477.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. DS0000070424.V371477.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Yorkminster Drive Address 1-5 Yorkminster Drive Chelmsley Wood Birmingham West Midlands B37 7UG 0121 788 2763 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.caretech-uk.com CareTech Community Services Ltd Vacant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places DS0000070424.V371477.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only To service users of the following gender: Either Whose primary care needs on admission the home are within the following categories: 2. Learning Disability (LD) 12 The maximum number of service users to be accommodated is 12. Date of last inspection 19th March 2008 Brief Description of the Service: Yorkminster drive is situated in Solihull within easy reaching distance of shopping facilities, the town centre of Chelmsley Wood, places of worship and public transport. The home provides care and accommodation to up to twelve people with a learning disability, some of whom have a physical disability. There are three bungalows in the complex housing four people in each bungalow. Facilities available include washing facilities, individual bedrooms, and lounge and kitchen space and laundry facilities. Equipment is provided for people who have difficulties with moving around, including ramps, hoists and adapted bathing facilities. Each bungalow has its own front door and back door entrance and staff are designated to work in each bungalow. The fees charged each week are £1196 of which people pay a contribution according to their individual welfare benefit. The inspection report from the CSCI is made available in the home for people and/or their representatives to look at. DS0000070424.V371477.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. 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 to include notifications received from the home and a questionnaire about the home. The questionnaire is called the Annual Quality Assurance Assessment (AQAA). The visit took place over one day and staff and people who live at the home did not know that we were coming. The new manager and representatives of the registered provider were present during this visit and answered questions about the management and running of the home. Three service users were “case tracked” and this involves discovering individual experiences of living at the home by meeting or observing them, discussing their care with staff, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. We spent time speaking to five people about what it is like to live in the home. Their comments are included in this report. Before this visit took place we were told that there had been concerns about the amount of food available in each bungalow for people to eat and that on one occasion people had not been given their medication as prescribed. We looked at food supplies, the records of food people had eaten and menus to make sure that a nutritious and balanced diet was being offered to people who live at Yorkminster Drive. A pharmacy inspector from the CSCI visited the home on 13th August 2008 to look at the way medicines are managed for people’s continuing health and well being. The pharmacy inspector’s comments are included in this report. Staff files and health and safety records were reviewed. We looked around the building to make sure that it was warm, clean and comfortable. DS0000070424.V371477.R01.S.doc Version 5.2 Page 6 There were no immediate requirements after this visit. This means that there was nothing urgent that needed to be done to make sure people stayed safe and well. What the service does well: What has improved since the last inspection? Information is available to people and their relatives in a way that can be easily understood so that they can be sure that their needs would be met in the home. Records that explain how people like and need to be cared for are better written and get reviewed more often to make sure that people get the care they need. People have food they like and need to help them stay healthy and well. People’s health is being monitored so that they do not risk becoming unwell. There are more staff on duty to help people do the things they enjoy and to help them stay safe and well. Complaints have been acted on quickly so that people are not left waiting for answers about their worries. DS0000070424.V371477.R01.S.doc Version 5.2 Page 7 Staff have had training to help them understand how to meet people’s needs and help them stay safe. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000070424.V371477.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 DS0000070424.V371477.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available to prospective service users and their relatives in a way that can be easily understood so that they can be confident that their needs would be met on admission. EVIDENCE: There have been no new people admitted to the home since the last inspection in March 2008. All of the people who live at Yorkminster Drive have lived there for a considerable period of time. The home has a service user guide and statement of purpose, which were looked at during this visit. Both documents had been reviewed to give information about the current care provider, CareTech and the services and facilities offered in the home. The service user guide was written in plain language and had pictures to describe the layout of the home, the house “rules” and how people could raise concerns and complaints if they wished to. One person said, “The pictures make it easier to understand”. DS0000070424.V371477.R01.S.doc Version 5.2 Page 10 Staff that we spoke to said that the service user guide would be given to people who were considering moving to Yorkminster Drive to help them decide whether they wished to visit before “trying out” the home. The statement of purpose provides information about the procedure for assessing people’s needs before they move to the home to make sure that it is suitable to meet their needs. We saw from reading the statement of purpose and from talking to the manager that trial visits are offered to give people an opportunity to try out the home before moving in. DS0000070424.V371477.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have the information they need and a good understanding of how to offer care and support to each person, which should ensure that their needs are met in a way they prefer. EVIDENCE: We looked at three care plans, for one person in each of the three bungalows. Care plans explain what each person’s needs are and the care and support they require to make sure these needs are met. From looking at the sampled care plans and from talking to two members of staff and the manager, it was evident that the plans had been recently reviewed to ensure that they were relevant to people’s current needs. DS0000070424.V371477.R01.S.doc Version 5.2 Page 12 The files we looked at gave detailed information about how staff should support the person in order to meet their individual needs in relation to health, personal care, communication, culture and social and leisure preferences. Care plans had been linked to a risk assessment so that the person could take responsible risks according to their individual needs. Some risk assessments had not been completed. For example, one plan stated that an assessment should be made of each community based activity that a person took part in so that their safety could be maintained. This had not happened. We spoke to the member of staff who had written the care plan who told us that she was due to complete the risk assessments but as all records were being reviewed, she had not had time to finish this piece of work but had planned time to do so. We spoke to members of staff who work with each of the people whose records we looked at. The staff demonstrated knowledge of people’s individual needs which was consistent with the information on file. This indicates that staff know how to provide care and support to people so that their needs are understood and met. The manager told us that people who live in the home have been referred to Speech and Language Therapists (SALT) for communication assessments. Some files showed that assessments and communication guidelines were in place to help staff understand how people use body language and gestures as a means of expressing themselves. We observed staff working with a person during a meal and saw that they were responding to the person according to the guidance written by the SALT. Two people who live in the home spoke to us about the opportunities they have to make choices and decisions about their lifestyles. They said, “ I go to the social club every week. I really like going”. “I make my own drinks and sometimes help with the tea”. “I have a lie in when I’m not going to the centre. Staff bring me a cup of tea in my bedroom”. “We have chosen our dinner”. DS0000070424.V371477.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, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home experience a meaningful lifestyle that promotes their independence and is reflective of their individual needs. EVIDENCE: Before this visit took place we were told about some concerns relating to the amount of food available in each bungalow and that on one occasion people had gone out to their day centre without having eaten any breakfast. This is currently being investigated by the registered provider, CareTech who will advise the commission of their findings once the investigation is complete. At this visit we looked at the amount of food in each bungalow, the records of food that people had eaten and the menus available for this week and the DS0000070424.V371477.R01.S.doc Version 5.2 Page 14 following week to make sure that meals were being planned according to peoples’ needs and personal tastes. In each bungalow we saw a wide range of fresh, frozen, tinned and dried foods. The food supplies that we saw matched the planned menus for each bungalow. There were stocks of food for people who follow a specific diet for health care reasons. We spoke to a member of staff about the arrangements to cater for people who have a soft diet to make sure they maintain good health. The staff member showed us the SALT guidelines for planning a person’s meals as well as the supply of food supplements that the person needed to stay healthy and well. The records that we looked at for this person showed that each meal had been written down and that they were eating well. Three people told us that they had enjoyed their breakfast and had eaten toast and honey, cereal and eggs as well as tea and coffee. One person said that they were looking forward to their evening meal of roast chicken. We observed the preparation of this meal, which consisted of a large roasted chicken, potatoes, fresh carrots, broccoli, cauliflower, cabbage and gravy. The menus that we looked at showed that choices are made available at each meal and that a range of foods are offered such as traditional roast lunches and other English dishes, in accordance with people’s cultural needs. We looked at care plans and daily records to establish that people are leading meaningful lifestyles and taking part in activities that they enjoy. We also spoke to one person from each bungalow about their day to day lives and activities. The majority of people who live at the home go to a local day centre either on a full or part time basis. People have been doing this for many years and told us that they enjoy it. One person said, “I have lots of friends there. I love going”. The care plans that we looked at described what people like to do during their leisure time. We looked at daily records for one week to see if people have opportunities to do these things. The records showed that people had been to their day centre, out to evening social clubs and day trips, visiting relatives, shopping for food and personal items and to the airport to watch the planes. People told us, “I’m going to the airport today”. This person did go out to the airport as planned. “I’ve been on lots of trips out”. This person’s daily records showed that they had been on a number of day trips to places of interest during the summer. DS0000070424.V371477.R01.S.doc Version 5.2 Page 15 The care plans and daily records that we looked at showed that people take part in the day to day routines of the home according to their skills and needs. For example, some people took responsibility for tidying their bedrooms and making hot drinks and doing their laundry. There were risk assessments in place to make sure that people completed these activities safely. One person said, “I like cleaning my room. The staff help me”. The home is good at supporting people to keep in touch with their friends and relatives. The records that we looked at specified the type of assistance people need to maintain this contact. One person told us, “ I ring X (my relative) every week”. DS0000070424.V371477.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are effective systems in place to meet peoples’ personal and health care needs. The medicine management was poor in each of the bungalows, which puts people’s health at risk of harm. EVIDENCE: We looked at three personal and health care plans during our visit to the home. Each had been reviewed to make sure that they reflected people’s current needs. There was written evidence that a range of health care professionals had been included in devising health care plans for people, such as SALT’s, psychologists, community nurses and dieticians. Each personal care plan that we looked at described the individual’s daily routines. The information specified the times that the person liked to get up and go to bed and the level of support needed to complete their preferred DS0000070424.V371477.R01.S.doc Version 5.2 Page 17 routines. This should ensure that people receive care in a way that they need and like. People told us, “I get a cup of tea in bed every day”. “X (staff) helps me paint my nails”. We met all of the people who live in the home. Everyone was well dressed and had clearly been offered personal care regularly throughout the day. At lunchtime staff were quick to help a person get changed after they spilled some food on their clothing. We asked three members of staff questions about the care they offer people with regard to helping them maintain good health. The staff members were able to show us the systems used to monitor people’s needs such as weight charts and assessments to reduce the risk of choking. There was evidence in the files we looked at to show that people have regular appointments with health care professionals and that the outcome of each contact is written down so that staff have up to date information about people’s needs. We spoke to a visiting health care professional who confirmed that she was in the process of assisting staff to review care plans for people who have epilepsy to ensure that they were up to date and accurately described how to support people with this area of their healthcare. The manager has implemented a shift leader plan so that personal and health care issues are handed over at the end of each shift to the next shift leader. We spoke to a shift leader, who said that the new planning system has helped focus on handing over up to date information and to make sure nothing gets missed. For example, a person had complained about feeling unwell, this was handed over to a shift leader for observation and a GP appointment made later that day. The commission’s pharmacy inspector visited the home on August 13th 2008 as we had been notified of several errors in giving out medicines since the last inspection. The pharmacy inspector made the following report. “The pharmacist inspection lasted two and a half hours. It took place on a different date before the key inspection. In total five residents medicines and medicine charts were looked at to assess whether the medicines had been administered as prescribed and records reflected practice. One care assistant was spoken with during the inspection and all feedback was given to the manager in charge of the home at that time. DS0000070424.V371477.R01.S.doc Version 5.2 Page 18 There was no system to check the prescription prior to dispensing or to check the dispensed medicines and medicine charts received into the home. This had resulted in medicines hand written on the medicine chart with doses that could not be confirmed. Some errors had been identified after the medicines had been dispensed instead of before. This had resulted in a delay in obtaining the correctly written medicine chart from the community pharmacy. The home had no quality assurance system to confirm staff competence in the handling of medication. Errors found during the inspection had not been identified earlier or corrected. Audits indicated that medicines had been administered but not recorded as such and not administered but recorded they had been. Gaps were seen and it could not be demonstrated exactly what had occurred in all instances. Some medicines were unaccounted for. Other medication was not available for administration, as the home had failed to order enough medicines in time to ensure a continuous supply. This is of serious concern as one resident could not be administered his prescribed medication. Many residents are absent from the home for some of the medication doses. This had been recorded as “social leave”, but it could not be demonstrated that the resident’s medication was given to the carer to administer outside the home. Staff did not always follow the written directions by the doctor. For example one medicine prescribed to be administered twice a day when required was offered to the resident to take four times a day. This may have resulted in the resident receiving twice the prescribed dose. Many medicines had a protocol for staff to follow if the doctor had prescribed these for occasional use for example to control behaviour. In some instances these medicines were not available to administer and the protocol had not been removed. It was unclear whether the doctor had decided not to prescribe these medicines or the home had run out of them. One care assistant who administered medicines had a very poor knowledge of the medicines she handled. She didn’t know basic reasons why a medicine had been prescribed. This is cause for concern especially as she didn’t know what one medicine prescribed to control behaviour was for even though a protocol was accessible for staff to read to administer them as the doctor intended. The care assistant would not be able to fully support the clinical needs of the residents living in the home and may inappropriately administer medicines or fail to identify any side effects of the medication. The storage of medication had improved and all medicines were locked away at the time of the inspection.” DS0000070424.V371477.R01.S.doc Version 5.2 Page 19 We were told that since the pharmacist’s report a number of measures had been put in place to manage medicines more safely• • • A full medicines audit by a CareTech pharmacist. A medicines competent staff member available to lead each shift. A review of staff training in medicines management. The manager showed us an action plan written by a representative of CareTech, which specified when these actions would be taken. Since the date of the visit by the commission’s pharmacist one medication error had been reported to us, which is currently being investigated by CareTech. DS0000070424.V371477.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are effective systems in place to listen to and respond to complaints made about the service and to safeguard vulnerable people from harm. EVIDENCE: There have been four complaints about the home since the last inspection in March 2008, three of which were made directly to the commission. The records that we looked at showed that CareTech managers had investigated each complaint and the outcome reported to the complainant. The complaints procedure is included in the home’s statement of purpose and service user guide, which we were told, is made available to people who live in the home and their relatives. We spoke to people in each bungalow who told us that they would speak to staff if they were not happy about something in the home. Two safeguarding alerts have been raised in relation to the care of people who live in the home since the last inspection in March 2008. On both occasions Solihull Care Trust (who are the lead agency for safeguarding vulnerable adults) met with representatives from CareTech to decide how best to address each allegation. The commission were kept informed of the action taken to maintain people’s safety and the home notified us that these events had taken place. DS0000070424.V371477.R01.S.doc Version 5.2 Page 21 As a result of the most recent safeguarding alert (in August 2008) CareTech have instigated spot checks to the home to make sure that risks to people who live there are reduced. During this visit two senior managers were present reviewing rotas so that there were enough staff on duty to meet people’s needs. We spoke to staff and looked at training records to determine that training in safeguarding vulnerable adults had been provided. Staff told us (and the training records showed) that sessions had been completed in April 2008. Some people who live in the home demonstrate behaviour that determines staff must work with them in a particular way to help them stay safe and well. We were shown guidelines, which had been recently reviewed by psychology services to explain how staff should support people with these needs. We observed staff following the guidelines several times during this visit, which indicated that the team had read and understood the importance of their role in helping people to stay safe and well. The home implements a robust system of recruitment so that people are protected from having unsuitable staff working with them. We looked at the recruitment records for two members of staff. There was an individual proforma that included a photograph of the person and clear records of documents to demonstrate who they are. CareTech has a Performance Relationship Manager (PRM), employed by us, who checks recruitment records every 6 months. This has been agreed with the commission. We were shown evidence that an audit had taken place on 1st September 2008 and that the records were satisfactory. DS0000070424.V371477.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a clean and comfortable home, which is fitted with equipment that meets their needs and helps them maintain their independence. EVIDENCE: Yorkminster Drive consists of three bungalows that have separate entrances and rear doors, linked by the gardens at the back of each property. The home is located near to Chelmsley Wood shopping centre, places of worship and public transport routes. The day centre that the majority of people attend is about a mile away. This is important to the people who live in the home as they make regular use of these facilities. We looked at each bungalow and at the bedrooms of the people we had “case tracked”. The bungalows were clean, warm and well furnished. There were no unpleasant odours, which would indicate poor cleaning routines. DS0000070424.V371477.R01.S.doc Version 5.2 Page 23 The kitchen in bungalow number 1 had been refitted and there are plans to do the same in the other two bungalows. There are separate laundry rooms, which were clean and tidy. There was no evidence of a build up of laundry, which indicates that washing is done promptly. We saw that substances, such as cleaning products that could cause harm to people had been locked safely away. In each bungalow there is a lounge, which leads onto the kitchen/dining room. There is enough space for people to sit and eat together if they wish to. We were told, “I like sitting in the kitchen, I can watch the staff cook”. The bedrooms that we looked at were all very different. People had personalised their bedrooms with ornaments, photographs and pictures, which made the rooms look homely. One person said, “I love my room”. Another said, “It’s good because I have space for all my CD’s”. One bungalow has a ceiling hoist and adapted bathing facilities to meet the needs of people who live there. We were shown certificates that evidenced that the equipment had been serviced regularly to make sure it was safe to use. Each bungalow has individual garden space, which is maintained and has ramps going from kitchen door to assist those with limited mobility to go into the gardens. DS0000070424.V371477.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home operates a robust system of recruitment for the protection of the people who live there. People are supported by a well trained team of staff who understand their individual needs. EVIDENCE: People who live in the home made comments about the staff that work with them:“They are very kind”. “They help me”. “I missed X (staff) when she was away”. Some people were not able to tell us what they thought of the staff team, so we watched how they related to those on duty at various times during the day. DS0000070424.V371477.R01.S.doc Version 5.2 Page 25 People sought out staff and sat next to them, people smiled when staff members spoke to them. One person made it clear that they wished to be alone and the staff member gave them the space to do so. It was evident that the staff on duty had made good relationships with the people who live there. The home’s rotas had been reviewed so that those people who need one or two members of staff with them have access to that level of support. The rotas that we looked at showed that night staffing had been increased in one bungalow to meet the needs of the people who live there and that a qualified nurse had been employed to work at night. The manager and senior manager present at this visit confirmed that some agency staff are being used to cover staff vacancies. We were shown an induction format for agency staff, which described what they needed to have read and looked at before starting work with people. An agency member of staff confirmed that she had completed this process and found it useful in getting to know people via reading their care plans and daily records. The rotas showed that agency staff work only in the company of established staff so that people are not placed at risk of having staff working with them who do not know them well. At this visit the manager changed the allocation of staff so that a person did not have to go on a trip out with someone he did not know well. House leaders have been appointed in bungalows three and five and a deputy manager working from bungalow one. We spoke to one of the house leaders who talked with confidence about her role in leading shifts so that staff knew what they would be doing each day. The manager and senior manager told us that two members of staff were due to start work soon in bungalow number one. Both staff members are male, which is consistent with the gender of the people living in this bungalow. This report has identified that the staff on duty that we spoke to demonstrated good understanding of people’s individual needs. We were told that all staff recruitment records have been checked by head office and the main information is held centrally, each staff member has an individual proforma, which states what is available in their records. The Performance Relationship Manager who is employed by us, checks these records every six months to ensure that the process of employment remains good. The most recent audit took place on 1st September 2008 and was found to be satisfactory. Staff training records were looked at to check that they are having sufficient input to assist them to meet the needs of people living in the home. CareTech had produced a staff training matrix that we looked at during the visit. The records showed that a range of opportunities had been undertaken and DS0000070424.V371477.R01.S.doc Version 5.2 Page 26 included sessions in health and safety, food hygiene, mental capacity, fire safety, moving and handling and infection control training. A visiting healthcare professional confirmed that she had provided training in epilepsy awareness to help staff meet the specific needs of people who live in the home. The manager told us that staff had not received regular supervision with senior staff and was aware that this needed to improve so that staff have opportunities to reflect on their practice and consider their individual training needs. DS0000070424.V371477.R01.S.doc Version 5.2 Page 27 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, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The appointment of a full time manager has had a positive impact on the day to day running of the home so that this is in the best interests of the people who live there. EVIDENCE: The home has a new manager who was present at this visit. The manager works full time and is in the process of enrolling to undertake National Vocational Qualifications in care and management. This person has yet to make an application for registration as the home’s manager with the commission. DS0000070424.V371477.R01.S.doc Version 5.2 Page 28 The manager was able to demonstrate that she had reviewed a number of systems since her appointment leading to better outcomes for people such as care plan and risk assessment reviews, the implementation of shift leader plans and referring people to healthcare professionals where this had not previously been identified as necessary. We spoke to the manager and a senior manager from CareTech about the recent concerns about the home and were assured that the organisation took these very seriously and were committed to making improvements. We were told that senior managers are taking a lead role in supporting the new manager and deputy manager to raise standards in the home and are available every day. It was evident that some action had been taken to make improvements; we saw revised rotas that provided additional staffing to people who need it, a reduction in the number of medication errors reported to us and better menu planning so that people had meals that did not disregard their individual health care needs. In response to some of the concerns CareTech have enlisted the support of their Quality and Performance Manager, who visits the home each week to audit health and safety records, medication management, menu planning and rotas. This manager’s reports have been sent to Solihull Care Trust who have currently suspended placements at the home in light of the safeguarding alert raised in August 2008. Other systems of quality assurance are being developed. We were shown a “What do you think?” questionnaire which are due to be filled in by people who live in the home and/or their representatives. The manager explained that responses would be collated to make improvements to the way the service is delivered and to measure people’s satisfaction with the service. A representative from CareTech visits the home each month to report on the standard of care provided. Copies of these reports were available in the home. We looked at records to check that people’s health and safety is being promoted. The fire alarm system had been tested and serviced on a regular basis to make sure it was in good working order. A fire drill took place in June 2008 to enable people to practice evacuating their home safely. One person told us that he knew what to do when the alarm sounded and another told us they knew they had to wait for staff to help them. The staff records that we looked at showed that training had been provided in health and safety, infection control, moving and handling and first aid. This should contribute towards the promotion of a safe environment for people to live in. DS0000070424.V371477.R01.S.doc Version 5.2 Page 29 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 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 3 X X 3 X DS0000070424.V371477.R01.S.doc Version 5.2 Page 30 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9 Regulation 13(4)(b) Requirement Risk assessments must be reviewed on a regular basis to make sure they remain relevant to the person’s needs and continue to promote their safety. People living in the home must receive their medication as prescribed so that their health is maintained. The medicine chart must record the current drug regime as prescribed by the clinician. It must be referred to before the preparation of people’s medicines and be signed directly after the transaction and accurately record what has occurred. The right medicine must be administered to the right person at the right time and at the right dose as prescribed and records must reflect practice. 3 YA20 18(1)(a)(c) Staff who have responsibility for administering medicines must have training to make sure that DS0000070424.V371477.R01.S.doc Timescale for action 01/10/08 2 YA20 13(2) 13/09/08 01/10/08 Version 5.2 Page 31 they are competent to do so to avoid unnecessary risks to people’s health and well being. All staff must be trained to know the indications and side effects of the medicines they handle. 4 YA20 13(2) All dose regimes must be clearly written on the medicine chart, checked by a second member of staff for accuracy to ensure that the staff have clear directions to follow. 13/09/08 5 YA20 13(2) The quantity of all medicines received and any balances carried over from previous cycles must be recorded to enable audits to take place to demonstrate the medicines are administered as prescribed. 13/09/08 All prescribed medicines must be available for administration and must be administered to the person they are prescribed to only. A quality assurance system must be installed to assess staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribe and records do not reflect practice, to ensure that all medicines are administered as prescribed and this can be demonstrated. Members of staff must have regular supervision with senior staff so that they have opportunities to review their performance and practice for the benefit of people living in the home. DS0000070424.V371477.R01.S.doc 6 YA20 13(2) 13/09/08 7 YA36 18(2) 01/10/08 Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA20 Good Practice Recommendations The system of auditing medicines should be reviewed so that errors are identified promptly to enable people to maintain good health. The new manager should make an application for registration with the CSCI. 2 YA37 DS0000070424.V371477.R01.S.doc Version 5.2 Page 33 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 DS0000070424.V371477.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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