Care Home: 1-5 New Street North

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What the care home does well The home continues to provide people who live in the home with a comfortable and safe environment. The programme of refurbishment and re-decoration is progressing and has involved individuals in the choosing colour schemes and soft furnishings. There has been continued success in maintaining a stable staff team, who are provided with good training opportunities to enable them to develop the skills they require in meeting the needs of people in their care. There are good systems for monitoring and reviewing care plans. What has improved since the last inspection? Improvements made by the home in its communication systems have created a closer working relationship with relatives and health & social care agencies. Care plans have been revised and systems put in place to ensure follow-up appointments are not overlooked. Good progress has been made in developing individual activity programmes that include in-house activities and a wider range of community-based activities. Medication procedures and practices have been reviewed to ensure the well being of people living in the home is more fully protected. What the care home could do better: An application for the registration of a suitably qualified manager should be made to who will ensure staff receive good supervision and appropriate support to meet the needs of the people living in the home. Systems for assessing and managing risks should be reviewed. Detailed records of agreements should be kept of any decisions to be made on an individual`s behalf or to limit the choices available to them. An internal quality assessment system should be implemented by the home to monitor and evaluate its own practice, report its findings and produce a plan for the development of the service. CARE HOME ADULTS 18-65 1 - 5 New Street North West Bromwich West Midlands B71 4AQ Lead Inspector Linda Elsaleh Key Unannounced Inspection 7th & 8th July 2008 2:30 1 - 5 New Street North DS0000004798.V366804.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 1 - 5 New Street North DS0000004798.V366804.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. 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1 - 5 New Street North Address West Bromwich West Midlands B71 4AQ 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) 0121 553 1755 0121 553 4254 enquiries@lonsdale-midlands-limited.co.uk Lonsdale (Midlands) Limited Manager post vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st January 2008 Brief Description of the Service: 1-5 New Street is a care home for 8 younger adults who are learning disabled and require additional support due to presenting behaviour that may challenge. The home comprises of 8 single rooms, a domestic style kitchen, 2 bathrooms, laundry, 2 lounges, an activity area, sensory room and a dining area. A lift services the first floor. Entrance to the home is via a coded door lock at the front, leading to the porch area. The home is situated on a slip road just off the main road adjacent to Dartmouth Park in West Bromwich. West Bromwich town centre is within walking distance and parking space is available at the front of the home. There is a lawn area to the front of the building and a small patio area located to the rear. The service has its own transport and regularly accesses local facilities. The home should be contacted for information about the current fees for this service. 1 - 5 New Street North DS0000004798.V366804.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 2 star. This means that the people who use this service experience good quality outcomes. This unannounced inspection was carried out on 7th & 8th July 2008. The purpose was to assess the home’s performance against the key standards in the National Minimum Standards for Care Homes and report on the progress made to address requirements made at previous inspection. Our findings are based on the information we received from the home since our last visit, comments received from other agencies, examination of records and documents kept at the home, discussions with the home’s managers and staff, comments received from relatives and our observations made during the visit. This is our second visit to the home since the last key inspection in January. It is pleasing to report the home has addressed the requirements made at previous visits. Since our last visit the number of people being care for has reduced from eight to six. Comments received from professionals who visit the home and relatives told us this has had a positive affect on the care being provided and improved the lives for the people who continue to live in the home. The registered provider is advised to consideration to these comments, the comments made by staff and the outcome of this report to formally reducing the number of people accommodated to ensure people living at the home will continue to receive a good standard of care. What the service does well: The home continues to provide people who live in the home with a comfortable and safe environment. The programme of refurbishment and re-decoration is progressing and has involved individuals in the choosing colour schemes and soft furnishings. There has been continued success in maintaining a stable staff team, who are provided with good training opportunities to enable them to develop the skills they require in meeting the needs of people in their care. There are good systems for monitoring and reviewing care plans. 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 7 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 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 8 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 & 3 Quality in this outcome area is good. People who live at the home are provided with information about the service. Care plans are regularly reviewed to ensure the service can continue to meet the individual’s needs. The assessment process for prospective users should be reviewed to ensure it includes the need to consider the needs of people who already live in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since 2004 there have been no new admissions to the home. A recent reassessment has been carried out on the needs of each person living at the home. This has led to the service working closely with other agencies to identify placements that are more suited to meet the needs of two people. This has reduced the current number of people being cared for to six. The managers and staff report this has improved the quality of life and care provided for the people still living in the home. The records we looked at show there has been a decrease in the number of incidents that affect the well being of people living in the home. 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 9 The admission policy is dated 2006 and should be reviewed to ensure due consideration is given to the needs and compatibility of any future residents with those of people living in the home. We looked in detail at the files for two people who live at the home. These contained an updated copy of the service’s Statement of Purpose/Service User Guide. These are produced in written and pictorial formats. There is good information about the service (including a photograph of the individual’s key worker) and the fee charged. A representative for one person has signed the document on her/his behalf; the other has yet to be signed. Relatives who responded to our survey stated the home “usually” provides them with information about the service. 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 10 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, 8, 9 & 10 Quality in this outcome area is good. Individual care plans are available for all people living at the home. These are reviewed regularly to ensure changing needs will be met appropriately. Staff support people to make decisions by talking to them or observing their responses to ensure the care provided meets their needs and their personal preferences. Individual risk assessments are carried out to protect people living at the home. However, all documents associated with risks should be kept up to date to ensure the safety and well being of individual’s are fully protected. People who live at the home know their information is stored securely to ensure their right to confidentiality is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 11 As previously stated the home the needs of people living in the home have been re-assessed. Where applicable, referrals have been made to other agencies, such as behavioural support and speech & language specialists. Care plans are more detailed about the individual’s care needs and how these are to be met. For example, one file we looked at identified methods of communication for supporting a person to make decisions about how her/his care is to be provided and their preferred lifestyle. Staff reported the use of verbal and pictorial prompts and report the person’s communication has “come on in leaps and bounds”. A care plan for another person focussed on irregular sleep patterns, leading to accidents such as bumping into furniture. The home is liaising closely with other professionals to identify effective ways of managing this. The records show staff continually monitor the care plans and regular reviews are arranged with the relevant agencies, relatives and/or representatives to ensure the plans continue to meet the individual’s needs. The allocated key worker regularly spends time with the individual to assess her/his satisfaction with care being provided. The individual’s comments and observations made by staff are discussed in meetings with the manager. This demonstrates individuals are provided with opportunities in plans for their care and the day-to-day running of the home. We saw a care plan for “Accessing the Community”, which was reviewed ain April 2008, and contained detailed information about assessing new places, using a wheelchair, the individual’s preferences and need for support to be provided by two staff. However, two community-based risk assessments contained different information. The first risk assessment we looked was also reviewed in April 2008, it stated support is to be provided by one worker. The second, dated June 2008, does not make any reference to staff support. Staff we spoke with told us the individual continues to need support when spending time outside the home and, depending on the situation, the support is provided by two staff. Care plans and risk assessments need to contain clear information to ensure risks are appropriately managed. Pass locks are fitted to the front door, kitchen and bathrooms. There are insufficient details to explain why such restrictions are required. For example, the care plans for two people state they are supported at all times by a member of staff, one of whom is support with their personal care needs by two staff. Hence, reducing the risk of accidents occurring in ‘high risk’ areas. We discussed this with the acting manager and area manager the need to restrict people’s access to some areas of the home. They have agreed to review this practice. 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 12 The home has produced an “Immediate Changes” folder. It alerts staff to the most recent changes to an individual’s care and any significant events. This is brought to the attention of staff during change of shifts. The details are recorded on the individual’s file. Both offices in the home are kept locked to ensure only people who are authorised to access information about individuals are able to do so. 1 - 5 New Street North DS0000004798.V366804.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): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. Daily routines are included in the individual’s care plan and the staff team provide the support needed to enable them to follow their preferred lifestyles. The home is providing opportunities for individuals to participate in a wider range of activities. People are supported to maintain positive relationships with family and friends. They are provided with access independent advocates to ensure their views and wishes are heard. The meals provided to meet dietary needs and personal preferences. Good arrangements are made for people to enjoy mealtimes. This judgement has been made using available evidence including a visit to this service. 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 14 EVIDENCE: People living at the home are provided with opportunities to develop their independent living and social skills. For example, each person has a weekly programme that includes support in keeping their rooms clean and going shopping. One person attends a day centre four days a week and two attend sessions at a local college. Staff told us one person has made very good progress in developing her/his practical and social skills. The home has been liaising closely with health & social care professionals to develop behaviour support plans. These and the guidance provided to staff are regularly monitored and reviewed. This has resulted in a reduction in the number of incidents that challenge the service. For example, the timely intervention of diversion strategies has enabled one person to participate in some small group activities. Comments we received from two relatives expressed concern about the reduced programme of activities and told us no holidays had been arranged for more than twelve months. Since then the home has replaced the individual monthly activity programmes with weekly programmes. The feedback from staff and details on individuals’ records show this has improved the provision of ‘favourite’ activities. A key worker told us how much one person enjoys going to the park. The worker is also looking into how the individual can be supported to experience a trip to the local swimming baths. The records show individuals enjoy spending time on art projects in the activity room, relaxing in the sensory room or spending time alone listening to music in their own rooms. Community-based activities usually involve shopping or trips to local parks. The home is in the process of developing more varied community-based activities. The manager told us arrangements for people to enjoy an annual holiday, or short breaks throughout the year, will be made now the home has a stable staff team and improved strategies for managing challenging behaviour. The home supports people to maintain regular contact with family and friends wherever possible. For example one person regularly visits family at weekends and another has an overnight stay each week. Individual discussions with relatives about issues of concern, identified at the random inspection in April this year, has resulted in closer working relationships and positive outcomes for people living in the home. An independent advocate supports people who do not have any family contact. The advocate regular visits them and attends meetings about her/his care. The comments we have received from the advocate have been positive about the improved standards of care provided by the home. 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 15 People’s individual routines and personal preferences are detailed in their care plans. For example one person likes to follow a strict routine when getting up and preparing to go bed and staff ensure these are observed. Another person has no identified routines for these times during the day and the staff team respond to her/his presenting behaviours to ensure their needs are being appropriately met. The home does not employ catering staff. The care staff team prepares all meals and snacks and are provided with training in basic food hygiene. They also support people to prepare their own drinks, snacks and meals at different times during the week. Menus are produced in pictorial formats and where alternative meals are requested additional pictures are available to enable people to identify their preferred choices. A record is kept of meals taken which enables concerns to be identified. Where applicable, concerns are discussed with the relevant health care profession. The home has sought advice from one person’s GP because of concerns about her/his weight. An officer from the Environmental Food Agency visited the home in April this year and recommended the home for a gold Good Hygiene Award. The home views mealtimes as social occasions. People are encouraged to take their meals in the dining room and supported to develop their social skills. 1 - 5 New Street North DS0000004798.V366804.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 good. Personal support is provided in accordance with the individual’s care plan and personal preferences. Arrangements are made for regular heath care checks and for need to be met. Details of any restrictions made to protect a person’s well being should be included in their care plan. People who live in the home are protected by the home’s policies and procedures. Medication is managed on their behalf by trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Five of the six people living in the home are identified has having limited communication skills and the Speech & Language specialists are involved in their care. Staff report working with these specialists has enabled them to improve their skills in communicating with individuals. For example staff photographs are used with one person to identify which member of staff, on duty, they would like to assist them with their personal care. 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 17 People are encouraged to choice which clothes they wish to wear. We were informed one person “loves clothes” and will put on as many layers as possible. S/he does not associate becoming too hot with wearing too many clothes. At present the person’s clothes are stored in the laundry, which is kept locked, and s/he is restricted in the number of items of clothing s/he can wear. This information is not included in the individual’s care plan. We discussed with the acting manager the need to ensure any limitations placed on a person to make their own choices should be discussed, recorded and regularly reviewed. Health care plans are produced in pictorial form and records are kept of any areas of concern and action taken. The home has introduced new systems to ensure information about people’s health care and appointments are accurately recorded on paper and computer records. The records show appointments are made for people to attend routine check-ups with the dentist, optician and other healthcare specialists. One person’s records show recent trips for routine dental and hearing checks have been unsuccessful and arrangements have been made for the person to be visited in the home. Detailed records are kept of the home’s monitoring of health issues such as epileptic seizures or PMT (premenstrual stress) and how these are to be managed. As previously stated, one person’s GP has been consulted over concern about her/his weight. The monitoring records show the individual refuses to be weighed. However, alternative strategies to indicate any weight changes, such as measuring the person or observing any changes in how her/his clothes fit, have not been identified. Good arrangements continue to be in place for the safe storage of medication. Staff trained in the safe handling and administering of medication manage medication on behalf of all people currently living at the home. They have signed the individual protocols produced for people who are prescribed “as required” medication to confirm they have read and understand these. Where specialised techniques are required written authorisation to do so is obtained from the person’s GP. Since our last visit in April this year the home has reviewed its medication policy and procedures. A procedure for formally handing over of the responsibility for medication and the keys from one trained member of staff to another has been introduced. Handwritten entries on the medication administration record (MAR) sheets for medication prescribed outside the normal delivery cycle, such as a course of antibiotics, are now witnessed and signed by a second member of staff to reduce the risk of errors occurring. The manager informed us she makes periodical monitoring of staff practice to ensure procedures are being followed appropriately. At present, people who spend time away from the home do not need to take any prescribed medication during these periods. 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 18 The files we looked at contained details of the medication. The medication administration record (MAR) sheets continue to be completed appropriately and the relevant codes are used, for example if medication has been refused. We were informed that one person had been refusing to take her/his evening medication. However, since the GP has changed the time the medication is administered the person is now taking this medication. 1 - 5 New Street North DS0000004798.V366804.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 & 23 Quality in this outcome area is good. People who live at the home are provided with a pictorial copy of the complaints procedure. Their relatives/representatives are familiar with this procedure and feel the home listens and acts upon any concerns they have. There are procedures to protect people from abuse, neglect and self-harm. Action taken to prevent an individual from harming themselves, or others, should be better recorded to demonstrate this is carried out safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the complaints procedure is kept in the reception area and pictorial copies are available for people who live in the home. Information provided by the home shows that during the last twelve months it has received one complaint and a record kept of the home’s investigation. The comments received from relatives confirm they are aware of the complaints procedure and told us the response from the home is usually good. We examined the records kept of personal allowances managed on behalf of people living at the home. There are suitable systems for recording incoming personal allowances and transactions made by staff on the individual’s behalf. The company’s policy on costs, not included in the fees, such as transport and meals taken outside the home, does not reflect current practice. The acting 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 20 manager is advised to request this policy is reviewed against the contracts, fees, and the current Statement of Purpose. The policy should be made available to people living at the home and/or their representative to avoid any misunderstanding occurring. The home reviewed its policy and procedures for safeguarding and preventing abuse and disclosure of abuse and bad practice (Whistle blowing) in 2006. These documents, and other associated documents such as the Department of Health (DOH) “No Secrets”, are kept in the office and staff are able to access this information at any time. Staff we spoke with told us they had recently attended training in protecting vulnerable adults. Two safeguarding adult referrals have been made to the local authority. The home has co-operated with the relevant agencies to ensure people living at the home are fully protected. There have been no safeguarding referrals made since out last inspection in April. Information provided by the home shows there have been thirteen incidents during the last twelve months when individuals have been prevented from causing harm to themselves or others. There has only been one incident reported to us since April. Some staff members have been trained in techniques for safely restraining people who are being physically aggressive. However, the guidance for recording such incidents has not been followed. For example, the records examined did not identify the type of restraint used or the length of time a person has been held. Staff reported improved strategies for identifying and managing potential challenging situations has resulted in a dramatic reduction in the number of incidents. 1 - 5 New Street North DS0000004798.V366804.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 & 30 Quality in this outcome area is good. Improvements continue to be made to provide a homely, comfortable and safe environment for people to live in. There are suitable infection control procedures to ensure people who live in the home are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Over the last year the home has been carrying out a programme of redecoration and refurbishment. The reception area was being re-decorated during our visit. The front garden and courtyard at the rear of the property is well kept. We were told the flowers had been planted by a member of staff and assisted by 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 22 some of the people who live in the home. Garden furniture is provided in the courtyard for people to sit outside and relax. Most of the communal areas have been re-decorated and the furniture arranged to better meet the needs of the people living in the home. The bathroom on the first floor has recently been re-decorated. However, the ground floor bathroom has yet to be re-decorated and the damage to the wall panelling repaired. The acting manager informed us this is included in the programme of work. The drawers to the cupboard in this bathroom have been allocated to individuals for storing their personal toiletries. We were told this was because individuals tended to spill/tip the contents over their bedroom floor. Staff consulted with each person about colour schemes and soft furnishings for bedrooms before re-decorating. The artwork produced by individuals is displayed on the walls in the activity room. Progress is being made in decorating and purchasing equipment for the sensory room. There is sufficient seating in the lounge to comfortably accommodate six people and staff on duty should they wish to watch a television programme or DVD together. However, due to the different needs of the individuals, large group activities are discouraged. The dining room is light an airy and suitably furnished. This is a pleasant environment for people to sit and enjoy their meals. The kitchen was refurbished earlier in the year and is well used by the people who live at the home, under the supervision of a staff member. We observed one person making their own lunch while the staff member prepared lunch for the other residents. The home does not employ domestic or laundry staff. The care staff team carries out these duties. Wherever possible they encourage people living in the home to participate. Cleaning schedules are in place to ensure a good standard of cleanliness is maintained. Protective aprons, gloves and equipment are provided for use when carrying out these tasks and are also available for use when providing personal care. There is a policy and procedures for infection control that has been assessed using the Department of Health guide “Essential Steps”. Written information is also provided on the Control of Substances Hazardous to Health (COSHH). Slight malodours were detected on the landing, ground floor bedroom and activity room. This was brought to the attention of the acting manager who informed us this should be fully eliminated in the near future when the carpets are replaced. 1 - 5 New Street North DS0000004798.V366804.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, 34, 35 & 36 Quality in this outcome area is good. The staff team is more stable and the acting manager and senior staff support them to carry out their duties. Training is provided to ensure they have the skills required to meet the needs of the people living in the home. The welfare and safety of people who live in the home are protected by the home’s policy, procedures and practice for the recruitment of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided by the home shows there are 18 permanently employed care staff. Eight hold the National Vocational Qualification (NVQ) Level 2 or above and five staff are current working towards achieving the level 2 qualification. The home has experienced difficulties in providing a stable staff team to meet the needs of the people living in the home. This is evident in the number of shifts covered by temporary or agency staff during the last twelve months. 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 24 However, in recent weeks there has been a reduction in the number of temporary/agency staff being used. Staff we spoke to told us the reassessments of needs, reduction in number of people living in the home and stability within the staff team has led to improved standards of care being provided. We looked at the recruitment records for three staff. Each contained an application form, details of employment history, training, two written references and satisfactory checks from the Criminal Record Bureau. This shows the home follows good recruitment procedures for staff to protect the well being of people living in the home. The most recently employed person told us that during their first two weeks they worked under the supervision of an experienced worker, was given opportunities to read care plans, policies and procedures and provided with a induction work book to complete. There was one supervision record available on the file of a worker who had been in post for nine weeks. It is advisable for new staff to receive more frequent supervision sessions to ensure they understand their role and responsibilities, the needs of the people they are caring for and identify training needs. Other staff we spoke to reported there was good training opportunities. One worker described the opportunities as “brilliant”. Adult protection and equality & diversity being two of the most recent training courses attended by the staff we spoke with. One worker said they were looking forward to more clientcentred training – particularly future training planned for understanding people with autism. A training matrix is displayed in the office and provides good information about the team’s training needs. However, the information kept on the individual staff files are not up date. It is advisable these are kept up to date to enable individual training needs to be more easily monitored. An annual appraisal should be carried out with each worker to assess overall practice and discuss future training needs in order for individual training & development plans to be produced for the following year. Staff we spoke to told us they receive regular planned supervision, at least once every eight or nine weeks. They told the sessions were useful for clarifying issues and helping them to improve their practice. Written records of these sessions are kept on the individual’s file and show care plans, practice issues and training needs are discussed. Staff meetings are held monthly and waking night staff are encouraged to attend, whenever possible. For staff unable to attend, minutes of meetings are available in the office. The records show the acting manager ensures suitable arrangements are made where issues need to be discussed with the waking night staff team. 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. The service does not have a registered manager. People living in the home have benefited from the changes introduced by the acting manager. The home does not have its own internal quality assurance system for monitoring its practice. For people to be confident that their views underpin all self-monitoring, review and development by the home a suitable system should be implemented. Arrangements are made to promote and protect the health, safety and welfare of people who live in the home. Certificates for the servicing of all appliances should be kept on the premises for monitoring purposes. This judgement has been made using available evidence including a visit to this service. 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 26 EVIDENCE: We have not yet received an application for the registration of manager for this service. The acting manager continues to manage the day-to-day running of the home with the support of the senior staff team. The area manager continues to provide additional support. The staff spoke positively about the support they receive from the acting manager and the changes being made to how care is provided. One worker told us “the acting manager is creating an homely atmosphere for service users”. Another said, “Action has been taken to address issues which were not addressed by previous managers”. We are informed quality audits of the service take place on a regular basis by the company’s quality & performance officer. The area manager also makes regular unannounced visits to assess the home’s day-to-day performance. The reports we saw show these visits take place once every two months. The area manager told us the formats for these visits were being reviewed and would take place each month in the future. The acting manager is advised to establish its own monitoring system for evaluating its own practices and producing an development plan for the future. Arrangements are made for staff to attend health & safety courses that include basic first aid, fire safety, manual handling and infection control. We looked at the records of checks made and service certificates for appliances and equipment. These show the servicing and checks are carried out as recommended by the manufacturer and relevant regulatory body, with the exception of the service certificates for the bath hoist and gas safety. We were told the estates department has not forwarded these certificates. The area manager said this would be addressed and a copy of each certificate sent to us. An officer from the West Midlands Fire Service inspected the home in April and reported fire safety arrangements were satisfactory. The home reports ten accidents have occurred during the last 12 months resulting in visits to the accident & emergency department. The records show the majority of injuries sustained have been due to individual behaviours and not resulted in the need for medical treatment. The home closely monitors the behaviour of individuals in an effort to avoid injury. Any serious concerns are reported to the relevant health care professionals to arrange for suitable strategies to be identified in an effort to reduce the risk of injuries occurring. 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 28 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 YA9 Regulation 12(1) Timescale for action Care plans, risk assessments and 11/09/08 any associated documents produced for managing risks must contain all up to date information to ensure the safety and well being of individuals are more fully protected. Appropriate records must be 11/09/08 kept of any incident where a person is restrained. This must include the technique used and the length of time the person was held. Requirement 2. YA23 13(8) 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 YA2 Good Practice Recommendations Relatives/representatives of people living at the home should be provided with up date information about any changes in the service. The assessment process should be reviewed to ensure due consideration is given to the compatibility of the needs of future residents with the needs of people already living at DS0000004798.V366804.R01.S.doc Version 5.2 Page 29 1 - 5 New Street North 3. 4. 5. 6. YA9 YA18 YA19 YA23 7. 8. YA35 YA35 9. 10. 11. 12. 13. YA36 YA37 YA39 YA39 YA42 the home. The use of pass locks fitted to doors should be reviewed to ensure unnecessary restrictions are not placed on people who live in the home. The restrictions placed on one person’s access to her/his clothes should be detailed in their care plan and reviewed on a regular basis. Alternative strategies should be explored to monitor the weight of the person who does not wish to be weighed. The finance policy for costs not included in the fees should be reviewed and made available to people living at the home and/or their relatives/representatives to avoid any misunderstandings. New employees should be more supported by the inclusion of more frequent supervision sessions as part of their induction progress. Individual training records for staff should be kept up to date and copies kept of their certificates. This will assist the appraisal process in identifying and producing individual training & development programme. A system for carrying out annual appraisals with staff should be produce to discuss their performance and training and development needs. An application for the registration of a suitable manager should be provided to the commission. A system for self-monitoring and evaluating the home’s practice should be established. Consideration should be given to formally reducing the number of people accommodated to ensure the quality of care currently being provided is maintained. Service certificates for gas appliances and hoist should be kept available on the premises. 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 1 - 5 New Street North DS0000004798.V366804.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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