Care Home: 18 Bushwood Road

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What the care home does well Staff treat each person as an individual and talk to people in a way that shows they respect them.Staff support people to make decisions about their day-to-day lives by spending time observing their gestures, facial expressions and their non-verbal communication. Care plans are kept up to date, and person centred so that staff have the information they need to meet people`s needs. People are encouraged and supported to maintain relationships with their families. Everyone who lives at the home has their own bedroom that is well maintained and contains their personal items. Staff support people to attend health check ups and monitor each person`s health so their health is promoted. Recruitment records show that the necessary checks have been done on staff to make sure they are suitable to work at the home. Staff have training to make sure they know how to support individuals in the right way and keep them safe. People have the equipment they need that make their lives easier and enable them to be as independent as possible. Staff have regular supervision and support so that they know how to meet the needs of the people living there. What has improved since the last inspection? This section is not applicable as the home has been reregistered. What the care home could do better: Individual risk assessments need to be completed regarding evacuating the home in an emergency to make sure people are moved as quickly and as safely as possible. The statement of purpose and service user guide need to be updated to make sure that people have all the information they need about the home. The people who live there should be supported to go out in the community more often as they enjoy doing this. Some rooms need to be redecorated so it is more homely and comfortable for the people living there.The garden area needs to be improved so it is more accessible and a pleasant place for people to use. More permanent staff should be recruited so that there are not so many agency staff and people are supported by staff they know well. The provider`s representative needs to visit the home more often to ensure it continues to be well run. CARE HOME ADULTS 18-65 18 Bushwood Road Weoley Castle Birmingham West Midlands B29 5AR Lead Inspector Kerry Coulter Key Unannounced Inspection 29th April 2008 09:45 18 Bushwood Road DS0000071284.V363800.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 18 Bushwood Road DS0000071284.V363800.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. 18 Bushwood Road DS0000071284.V363800.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 18 Bushwood Road Address Weoley Castle Birmingham West Midlands B29 5AR 0121 471 3871 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) enquiries@lonsdale-midlands-limited.co.uk Lonsdale (Midlands) Limited Miss Carlene Gillett Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places 18 Bushwood Road DS0000071284.V363800.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 (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 6 Physical Disability (PD) 6 The maximum number of service users to be accommodated is 6. 2. Date of last inspection Not applicable. Brief Description of the Service: The home provides nursing care to six adults who have learning and physical disabilities. Each person has their own bedroom. There is one bathroom with assisted bathing facilities, a separate shower room and a separate toilet. Ceiling track hoists are provided in the bathrooms and bedrooms of the home. There is an open plan kitchen and dining room, which leads to the lounge part in which there is a snoozelen (relaxing sensory) facility. A separate laundry is provided. Parking is available at the front and rear of the home. To the rear of the home there is a garden with grassed areas and a patio area. The service users guide recorded that the fees that are charged to live at the home are £1347.15 for the year 2007-08. Copies of CSCI inspection reports are kept in the home’s office. These are available on request. 18 Bushwood Road DS0000071284.V363800.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 two stars. This means the people who use this service experience good quality outcomes. The visit was carried out over one day; the home did not know we were going to visit. This was the homes key inspection for the inspection year 2008 to 2009. The focus of inspections we, the commission, undertake 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 the manager completed a questionnaire about the home – Annual Quality Assurance Assessment (AQAA). Survey forms were received from one relative and three health professionals. Some of their comments are included in the report. Three people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. The people who live at the home, the manager and staff on duty were spoken to. Due to the needs of the people living at the home they were unable to verbally communicate their views about the service. Therefore time was spent observing care practices, interactions and support from staff. A tour of the premises took place. Care, staff and health and safety records were looked at. 18 Bushwood Road is owned by Bromford Housing Association and managed by Lonsdale (West Midlands). Previously Bromford were the registered providers however the home was reregistered in December 2007 and Lonsdale are now the registered providers. What the service does well: Staff treat each person as an individual and talk to people in a way that shows they respect them. 18 Bushwood Road DS0000071284.V363800.R01.S.doc Version 5.2 Page 6 Staff support people to make decisions about their day-to-day lives by spending time observing their gestures, facial expressions and their non-verbal communication. Care plans are kept up to date, and person centred so that staff have the information they need to meet people’s needs. People are encouraged and supported to maintain relationships with their families. Everyone who lives at the home has their own bedroom that is well maintained and contains their personal items. Staff support people to attend health check ups and monitor each person’s health so their health is promoted. Recruitment records show that the necessary checks have been done on staff to make sure they are suitable to work at the home. Staff have training to make sure they know how to support individuals in the right way and keep them safe. People have the equipment they need that make their lives easier and enable them to be as independent as possible. Staff have regular supervision and support so that they know how to meet the needs of the people living there. What has improved since the last inspection? What they could do better: Individual risk assessments need to be completed regarding evacuating the home in an emergency to make sure people are moved as quickly and as safely as possible. The statement of purpose and service user guide need to be updated to make sure that people have all the information they need about the home. The people who live there should be supported to go out in the community more often as they enjoy doing this. Some rooms need to be redecorated so it is more homely and comfortable for the people living there. 18 Bushwood Road DS0000071284.V363800.R01.S.doc Version 5.2 Page 7 The garden area needs to be improved so it is more accessible and a pleasant place for people to use. More permanent staff should be recruited so that there are not so many agency staff and people are supported by staff they know well. The provider’s representative needs to visit the home more often to ensure it continues to be well run. 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. 18 Bushwood Road DS0000071284.V363800.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 18 Bushwood Road DS0000071284.V363800.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have most of the information they need so they can make a choice as to whether or not they want to live there. EVIDENCE: The statement of purpose for the home is on display in the hallway. This needs updating to reflect that Londsale are now the registered provider for the home and also to include the commission’s new contact details, so that people have up to date information. People were seen to have a copy of the service user guide in their bedroom. This included some information about the home to include staffing arrangements, the complaints procedure and a licence agreement detailing the fees to live at the home. Some of the information was in picture form so making it easier to understand. However the guide did not contain all the information needed and will need updating to make sure people have all of the information they need. The home does not have any vacancies. People have lived at the home for several years so it was not possible to assess the recent admission process and assessment as no one has moved in since 1999. The home has a satisfactory 18 Bushwood Road DS0000071284.V363800.R01.S.doc Version 5.2 Page 10 admission procedure in place. This states that an assessment of prospective service users would take place in advance of someone moving in. 18 Bushwood Road DS0000071284.V363800.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have most of the information they need so they know how to support the people living in the home and minimise the risks to their safety and well being. People are supported where possible to make decisions about their day-to-day lives. EVIDENCE: The care provided to two people was case tracked. These included an individual care plan that detailed how staff are to support the person to meet their needs. These include areas of supporting the person with their personal care, self-help skills, eating and drinking, mobility, behaviour, health needs, finances, emotional and psychological, contact with their family and friends, communication and leisure opportunities. Plans sampled were detailed. Separate person centred plans called ‘this is me’ were also available these focussed on peoples likes, dislikes, communication needs, personal preferences 18 Bushwood Road DS0000071284.V363800.R01.S.doc Version 5.2 Page 12 and goals. These are produced using pictures that would make the care plan easier for the person to understand. Choices and decision-making are often restricted to fairly mundane matters, (such as what to eat or what music to listen to) because of people’s learning disabilities and limited communication. Staff have to use their knowledge of individuals’ mannerisms, body language and gestures to interpret their wishes. Staff were observed to do this well, talking to people and asking them what they would like to eat and drink or if they would like a bath or shower. Records included individual risk assessments. These detailed how staff are to support the person to be as independent as possible whilst minimising any risks to their health, safety and welfare. Risks that had been assessed included travelling in the home’s vehicle, being moved in the hoist, use of bed rails, hydrotherapy, going on boats and risk of choking. Risk assessments had been completed regarding fire but there was no assessments specific to each person about the safest way of evacuating them in an emergency. These need to be completed to make sure people are moved as quickly and as safely as possible. Risk assessments seen had been regularly reviewed and updated where necessary. 18 Bushwood Road DS0000071284.V363800.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 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at the home experience a meaningful lifestyle but staffing arrangements sometimes affect the frequency that people can go out. People are offered a healthy diet that they enjoy. EVIDENCE: Discussions with staff and sampling of people’s activity records indicate that the majority of activities on offer take place within the home rather than in the community. Staff said that sometimes people cannot go out if there are agency staff on duty and that there is currently a shortage of staff who are able to drive the home’s vehicle. The manager said that interviews had just been held to recruit to a new role of driver / support worker and so it was hoped there would soon be a driver in post. Each person has their own activity plan. Activity records showed that in house activities included karaoke, massages, music, library tapes, sensory lights, 18 Bushwood Road DS0000071284.V363800.R01.S.doc Version 5.2 Page 14 having their nails painted and using the waterbed. Once a month the home is visited by ‘progressive mobility’. Staff spoken with said they try and offer new activities and for one person they have just introduced a ball pool activity that they said the person was enjoying. During the visit people some people relaxed in their rooms listening to music or story stapes. It is a good idea that staff write in a book what people have listened to. This means that where people are unable to choose for themselves what to listen to, staff are able to choose something they know has not been played recently. This means people do not get bored of listening to the same thing. Records and discussion with staff show when staffing permits the community activities on offer include swimming, cinema, out for lunch, hydrotherapy and shopping trips. One person loves going to the ballet and a trip was planned later in May. Records sampled and discussion with the Manager showed that staff support individuals to maintain contact with their family and friends through letters, phone calls and sending cards and presents for special occasions. The visitor policy on display shows that visiting times are unrestricted. The home has rotating menus in place. Meals on offer were observed to be nutritious and varied. Staff tried to get people to choose what they wanted for breakfast. At lunchtime people were observed to have different meals, this shows that people do not all have to eat the same things. Staff said they try and get people to choose what they want by their facial expression. They said that one person has a switch box they sometimes use but for others it can be trial and error- ‘if they do not want what is offered we try something else’. There were good levels of food stocks seen that included lots of fresh fruit and vegetables. 18 Bushwood Road DS0000071284.V363800.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive personal and health care support in the way they prefer and require so that their needs are well met. EVIDENCE: People who live at the home were dressed in good quality clothes appropriate to their age, gender and the weather. Each person had their own individual style of dress and hair. Records show that people are supported by staff to go to the hairdressers or barbers. Care records sampled included very detailed guidelines for staff to follow on how to support individuals with their personal care and daily routines. Staff were observed supporting people in a friendly and respectful manner, for example knocking on bathroom and bedroom doors before entering. Personal files provided evidence that people living in the house are supported to access primary health care and are referred to healthcare professionals for specialist support as required. One person whose care was case tracked had recently received input from a physiotherapist and a Speech and Language Therapist. One person has epilepsy and their care has been reviewed recently 18 Bushwood Road DS0000071284.V363800.R01.S.doc Version 5.2 Page 16 by the Epilepsy Nurse. Some changes to their medication and the way in which the home monitors the person at night have been suggested. One health professional commented ‘ they support the needs of people with epilepsy, monitoring seizures and requesting specialist input as required.’ Nurses at the home carry out regular health screening with people to include blood pressure and breast / testicular checks. Records sampled showed that people had been regularly weighed to ensure they were not gaining or losing a significant amount of weight, which could be an indicator of an underlying health need. When people are unwell records show that advice is sought from the GP or other health professionals as appropriate. Staff had completed health assessments and health care plans for people and the majority of these were satisfactory. For one person their health assessment was dated 2003, the manager said that this had been updated recently but was unable to find the updated version. For another person they had a risk assessment for pressure care (Waterlow assessment) this was undated so it was not possible to tell if it was a recent assessment. The manager needs to make sure that health assessments are all dated and up to date to make sure that staff have up to date information to meet peoples needs. Qualified nursing staff give the medication to people at the home. The medication cabinet was seen to be well organised. There was a photograph of the person at the front of their Medication Administration Record (MAR), so that unfamiliar staff would know who to give the medication to. Staff had signed all Medication Administration Records (MAR) appropriately. Staff complete a weekly medication audit to ensure that it is being given as prescribed. Where people are prescribed PRN (As required) medication a protocol is in place stating when, why and how this should be given. These had been recently reviewed and countersigned by a doctor. Copies of all prescriptions are kept so that it can be tracked what each person has been prescribed and staff ensure this cross-references with the medication supplied for the individual. The home has a separate fridge to store medication that needs to be kept cool. At the time of the visit the medication fridge was not being used and insulin was being stored in the home’s main fridge. The manager said that this was because the medication fridge was unreliable and was often too warm. The manager said that she had asked for a replacement fridge but was unsure when a new one would be purchased. 18 Bushwood Road DS0000071284.V363800.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that the people living at the home are protected from abuse, neglect and self-harm. EVIDENCE: The commission has not received any complaints or concerns about this home since it was reregistered in December 2007. The complaint log and discussion with the manager indicates that the home has not received any complaints directly. The home has a satisfactory complaints procedure and this was on clear display in the dining room. Surveys received from a relative and health professionals indicate they are aware of the complaints procedure and any concerns are appropriately responded to. Staff have completed training in adult protection and the prevention of abuse so they know how to protect the people living there from abuse, neglect and self-harm. Staff spoken with said they would always report any suspicions of abuse to the manager. The home has policies in place to protect people and also has a copy of the Birmingham multi agency adult protection guidelines. Systems are in place to safeguard the monies of people living at the home. Receipts for expenditure were available and numbered. Staff count and check the balance of monies held and checks of the money and records are also completed when a senior manager from Londsdale visits the home. 18 Bushwood Road DS0000071284.V363800.R01.S.doc Version 5.2 Page 18 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, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in an environment that is generally clean and comfortable and meets their individual needs. EVIDENCE: The home was maintained at a comfortable temperature. The home is homely in style with ornaments, pictures and photographs of the people who live there on display throughout the home. The décor in some communal areas of the home, particularly the kitchen and dining area are looking worn and dated in appearance. The manager said there were plans to redecorate the home but a firm date had not yet been set to do this. The dining area of the home looked quite cluttered. The appearance of the room was spoilt by having a large plastic tub for recycled rubbish stored there, lots of folders and books left on the dining table and items including books piled on top of the piano. More thought needs to be given to keeping this area tidy so that the appearance of the room is improved. The dining table needs 18 Bushwood Road DS0000071284.V363800.R01.S.doc Version 5.2 Page 19 some attention where the varnish has been scratched. The table should be sanded and re-varnished or replaced to reduce the risk of cross infection. Bedrooms were observed to be personalised according to individual needs, culture, gender and preferences. Décor, furniture and bedding was seen to be in good condition so that people had a nice room to spend time in. The patio area in the garden is quite small and for people to sit in the garden they would have to sit in a long row due to the design of the patio. The grass cannot be used as it is on a slope and is not suitable for wheelchair use. It is recommended that the garden area is improved to make it a more accessible and pleasant place for people to use. Suitable adaptations have been made inside the home to ensure it meets the needs of individuals with a physical disability, this includes ceiling hoists and special baths. The sinks in the bathroom and shower room are adjustable so that they can be set at the right height for people. Staff spoken with said that they had all the equipment needed to meet people’s needs. The home was clean and free from offensive odours throughout. Hand wash and hand towels were provided in all toilets and bathrooms to minimise the risk of cross-infection. 18 Bushwood Road DS0000071284.V363800.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are generally sufficient to ensure that an effective, competent and supervised staff team who can meet individual’s needs support them. The people living there are protected by the home’s recruitment practices. EVIDENCE: Support to people is given in a warm and friendly manner, and staff were seen to be polite, considerate and patient. Members of staff demonstrate that they have a good personal knowledge of the individuals in their care. One relative commented ‘they treat the residents as individuals and with loving care’. Discussion with the Manager and sampling of training records shows that over 50 of the care team are qualified to the appropriate NVQ level so ensuring that care staff have the skills and knowledge to meet the needs of the people living there. The home has several staff vacancies and has had difficulty in recruiting new staff. This means that the home often has to use agency staff to make sure there are enough staff on duty. Rotas and discussion with staff indicate that regular agency staff are used so that they are familiar with the people who live 18 Bushwood Road DS0000071284.V363800.R01.S.doc Version 5.2 Page 21 at the home. Agency staff were working at the home during the visit and were observed to have a good knowledge of peoples needs. Staff said that the agency staff were treated as part of the team and knew peoples needs well. However, as stated earlier in this report the use of agency staff has sometimes reduced the homes capacity to offer community activities to people. One relative commented that more permanent staff were needed. The manager said that several new staff had recently been recruited but were not able to start working in the home until all the necessary recruitment checks had been completed. Recruitment information for three members of staff were looked at. These provided evidence of an appropriate process, and necessary information was in place on files, as required to ensure people are protected from having unsuitable staff working with them. Records of training that staff have received are kept and were up to date. Staff surveys and staff spoken with indicate they are satisfied with the training they receive. Staff have received training in food hygiene, manual handling, adult protection, tissue viability, first aid and fire safety. Some staff have also done training in epilepsy, dysphagia and PEG (tube) feeds. There is a rolling programme of training and records showed that some staff had been booked to do refresher medication training, person centred approaches and the Mental Capacity Act. One health professional commented ‘Care staff appear to be well trained and knowledgeable’. Evidence shows that staff are appropriately supported through supervision sessions with the manager. In these sessions they had discussed the needs of the people who live at the home and how they were supporting them and identified any training and development needs that would help them in their role. One member of staff commented that they found supervision meetings to be very useful and that they had boosted their confidence. Records showed that the home had not had a recent formal staff meeting since January. However discussion with staff indicates that a detailed staff handover is held every day where people’s needs are discussed. Given that the staff team is quite small this system appears to generally ensure that staff get the information they need. However, once new staff are in post and the staff team is expanded more formal staff meetings should be arranged to ensure the staff team can discuss issues that are important to the home. 18 Bushwood Road DS0000071284.V363800.R01.S.doc Version 5.2 Page 22 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, 38, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that the people living in the home generally benefit from a well run home. EVIDENCE: The manager has worked at the home for a number of years and has many years experience of working with people who have a learning disability. The manager is a qualified Learning Disability Nurse and has completed the Registered Managers Award ensuring that she has the skills and knowledge to manage the home for the benefit of the people living there. The manager demonstrated a good knowledge of peoples needs throughout the visit. The annual assessment form (AQAA) was generally completed well by the manager and received on time. All staff spoken with said that the manager was very approachable and they would feel confident in raising any concerns with her. One health professional commented ‘excellent home, very good care’. 18 Bushwood Road DS0000071284.V363800.R01.S.doc Version 5.2 Page 23 An area manager for Londsdale visits the home and writes a report of their visits. These should happen monthly to ensure Lonsdale is monitoring the service that is being provided. There were three reports available for the last six months. The manger said that visits had been irregular due to changes of area managers. Monthly monitoring visits of the home should take place so that the provider ensures it is being well managed. The home has quality assurance systems in place but it is not clear how the views of people who live at the home or their relatives are included in this process. This is something that could be further developed so that peoples views underpin all development by the home. Staff at the home complete regular health and safety audits to make sure that people are safe. Staff test the fire equipment regularly to make sure it is working. An engineer regularly services the fire equipment to ensure it is well maintained and in good working order. A fire drill to ensure staff know how to respond in the event of a fire occurring was overdue, however this had recently been identified by the provider and arranging a drill was recorded in the home’s own action plan. The landlord’s gas safety certificate was in date to show that gas appliances are safe. Certificates were available to show that portable electrical appliances had been checked. The electrical hard wiring certificate showed that electrical installations were safe. Staff test the water temperatures weekly to make sure they are not too hot or cold and so people are not put at risk of being burnt. Staff test the fridge and freezer temperatures daily to make sure they are within the limits for safe food storage. 18 Bushwood Road DS0000071284.V363800.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 3 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 2 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 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 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 3 2 X X 3 X 18 Bushwood Road DS0000071284.V363800.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Not applicable as first inspection since home reregistered. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13(4) Requirement Individual risk assessments need to be completed regarding evacuating the home in an emergency to make sure people are moved as quickly and as safely as possible. Timescale for action 30/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA1 YA13 YA19 YA20 Good Practice Recommendations The statement of purpose and service user guide need to be updated to make sure that people have all the information they need about the home. The people living in the home should be supported to access the community more often to ensure they have a meaningful lifestyle. Health assessments need to be dated and up to date to make sure that staff have up to date information to meet peoples needs. A new medication fridge needs to be ordered so that medication that needs to be stored in a fridge is stored in a secure place. DS0000071284.V363800.R01.S.doc Version 5.2 Page 26 18 Bushwood Road 5. 6. 7. 8. 9. YA24 YA24 YA24 YA33 YA39 Redecoration should be done where needed to ensure that the home is comfortable and homely for the people who live there. Consideration should be given to improving the garden area, making it a more accessible and pleasant place for people to use. The dining table should be sanded and re-varnished or replaced to ensure that furniture is in good condition for people to use and the home looks nice. More permanent staff should be recruited so that there are not so many agency staff and people are supported by staff they know well. The registered provider’s representative should do monthly monitoring visits of the Home so that they can form an opinion about the standard of care provided to people and produce a report on the outcome. 18 Bushwood Road DS0000071284.V363800.R01.S.doc Version 5.2 Page 27 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. 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