Care Home: 27 Highfield Road

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• 10 Whitfield Avenue

What the care home does well The home provides an extremely comfortable environment for the accommodation of the service users that presents a domestic ambience whilst providing ample space for resident`s privacy. Staff spoken to showed an interest in their work and a commitment to the ethos of the home. There was seen to be a good level of training provision and steps are been taken to address any shortfalls in this area. There is a commitment to ensuring that resident`s health is monitored with assistance from community health care services. Support for newly recruited staff was seen to be in place and the home was using an appropriate induction and training tool for new staff. Based on the records seen and staff comments the provider is good in supporting staff with regular supervision that allows them to explore how they do their jobs, this so they can identify how they can improve outcomes for service users. What has improved since the last inspection? What the care home could do better: CARE HOME ADULTS 18-65 27 Highfield Road Colley Gate Halesowen West Midlands B63 2DH Lead Inspector Mr Jon Potts Key Unannounced Inspection 31st December 2007 09:00 27 Highfield Road DS0000025001.V353836.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 27 Highfield Road DS0000025001.V353836.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. 27 Highfield Road DS0000025001.V353836.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 27 Highfield Road Address Colley Gate Halesowen West Midlands B63 2DH 01384 410581 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) info@inshoresupportltd.com Inshore Support Limited Clair Louise Driver Care Home 3 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (3) of places 27 Highfield Road DS0000025001.V353836.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 3 MD and up to 3 LD Date of last inspection 8/1/2007 Brief Description of the Service: 27 Highfield Road is situated in a residential area of Colley Gate, Near Halesowen. The home is registered to provide care to a maximum of three service users who have been diagnosed as having a learning disability and/or mental disorder. The home is in a favourable position as it is located in a residential area yet is close to a main road with a bus route, a number of shops and other amenities. The home is a large, traditional, domestic type dwelling, comprising of two lounges, three single bedrooms, a kitchen come dining room, a first floor bathroom and a separate shower room. The garage has been converted into usable space, which has become the office. There is also a small and pleasant private patio area to the rear. As on previous inspections, the inspector was impressed with the home regarding its internal fixtures, fittings and furniture. The home is of a generous size, is well presented, well maintained, is clean, homely and has a warm welcoming atmosphere. The staff team consists of a registered manager who is supported by a number of seniors and support workers. The support staff also carry out domestic and catering tasks (supporting service users as appropriate). The manager is responsible to a responsible individual and other senior managers within a company that runs a number of homes of similar size and purpose. The charges for accommodation are not currently stated within the homes statement of purpose or service users guide and it was stated that these are calculated on a individual basis dependent on a pre admission assessment. 27 Highfield Road DS0000025001.V353836.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 the people that use this service experience good quality outcomes. This unannounced inspection was carried out on one day and involved the inspector assessing the homes performance primarily against the key national minimum standards for younger adults. Evidence was drawn from a number of sources and including case tracking the care for two residents (this involving looking at all the documentation in respect of their care and cross checking this with outcomes), observation of practice, discussion with the Registered Manager, staff and review of management records. There was some limited discussion with the residents. Information was also supplied pre inspection by the home. The residents and staff are to be thanked for their assistance with the inspection. What the service does well: What has improved since the last inspection? The home has addressed all the requirements raised at the time of the last inspection this meaning that: • Vocational NVQ training for staff has improved (this assisting the home to have a more skilled and knowledgeable staff team). • Records of medication administration had improved. • Stock control of medications was better this meaning that there was less chance of the home running out of prescribed medications. 27 Highfield Road DS0000025001.V353836.R01.S.doc Version 5.2 Page 6 • • The manager is now registered by the CSCI, this confirming her ‘fitness’ for this position. There has been improvement in some areas of record keeping, notably in respect of records of restraint, residents challenging behaviour and in ensuring residents monies are signed out when taken from the home. There has also been on going works carried out on the property to ensure that it provides a comfortable and appropriate environment for the residents. 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. 27 Highfield Road DS0000025001.V353836.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 27 Highfield Road DS0000025001.V353836.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): 1,2,5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective people looking to use the service, and their representatives have the information (in a standard written format) needed to choose a home, which will meet their needs. Prospective residents have their needs assessed and opportunity to test drive the service and meet others residents and staff. They also receive a contract, which clearly tells them about the service they will receive, this in written form. EVIDENCE: There have been no admissions to the home this fitting with the homes aims to provide longstanding accommodation to a small number of service users. Discussion about the process of admission with the manager showed that she understood the importance of having sufficient information available to the service user and their representatives, this to allow them to make a decision as to whether 27 Highfields was a home that would meet their needs and preferences. Whilst information was mostly available in written form the home does spend time in introducing the prospective service user to the home through staff spending time with them in their current environment and then allowing stays at the home for meals, overnight, and so on so that they can 27 Highfield Road DS0000025001.V353836.R01.S.doc Version 5.2 Page 9 sample the service and meet other residents and staff. The manager saw compatibility between the residents as an important issue. The homes statement of purpose is a specific document to the home based on a generic format used by the companies other homes (which all offer a similar service). It clearly sets out the objectives and philosophy of the home and includes a range of information about the service provided, the accommodation, staffing (experience and qualifications) how to make a complaint and so on. All residents have a copy of the statement of purpose/service user guide available to them in their case file although the use of a more pictorial based document would be better for the current resident group. Contracts (called lifestyle agreements) were also available and these set out the basic terms and conditions of the service but again would benefit from presentation in a format that would better suit resident communication needs, although it was stated by the manager that verbal explanation suitable to the service users needs would be given. The range of fees for the service for a prospective resident are not stated in the Statement of Purpose or Service User’s guide, the manager stating that these are calculated on an individual basis following assessment. It should however be possible to provide an illustration as to a fee range within which the cost of the service would fall. The admission process described by the manager was in accord with the homes admission procedure. Admissions are not made to the home until a full needs assessment has been undertaken this including the assessment by experienced staff with involvement of the social worker/care manager within this process. Admissions were stated by the manager to only take place following consultation with her by the company so that staff views could be shared. The views of and the compatibility with other residents would also be considered through the prospective residents visits to the home. 27 Highfield Road DS0000025001.V353836.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, & 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home encourages, and is developing ways in which individuals can have an increasing involvement in decisions about their lives, and play a more active role in planning the care and support they receive. EVIDENCE: The service is aware that individuals should be involved in the planning of care which affects their lifestyle and quality of life and the manager in the AQAA has identified that improving the way this is done is one of the priorities for the home. There was evidence that this is been implemented through resident’s involvement in reviews and signatures on care plans and related documents. Staff understand the importance of residents being supported to take control of their own lives and were heard to be offering choices to residents during the course of the inspection. 27 Highfield Road DS0000025001.V353836.R01.S.doc Version 5.2 Page 11 The care plans contain detail as to the preferred communication style of the individual, and any barriers that existing to effective communication. In discussion staff were aware of the detail in these plans and were also seen in cases to complement them in practice. The care plans are currently in written English, with some support to aid communication through life ways person centred plans although there was evidence that staff were developing a more pictorial base for the person centred plan for one individual. Another resident is also to commence a communication passport with an external professional as was seen to have been agreed in review minutes and documented in correspondence. The manager had plans to utilise the homes digital camera to assist the building of person centred planning and communication with residents, this however delayed due to a break in at the home. The manager stated that a new camera is to be purchased. The care plans are person centred and are where possible agreed with the individual. The way the plans are written is easy to understand and as such this would facilitate its transfer to a more pictorial presentation. The plans cover most areas of an individual’s life and there is reference to how needs are met that allows for a residents equality and diversity (for example the gender of the carers providing personal care, how to communicate with the individual etc). Staff in discussion showed a good understanding of person centred planning and stated that the provider was good in terms of providing training support. Whilst it was not always possible to involve the individual in all aspects of planning directly the staff use an individual’s expressed dislikes and likes as a basis for the care to be provided in respect of such as when they like to get up, their preferred foods, activities and so on. The manager stated that these do need review, and there was evidence of the staff having commenced this process with one resident. The care plans were seen to be supplemented by comprehensive risk assessments. These explore how the home provides a service that is safe without to much compromise to positive outcomes for the residents. Limitations were seen to be clearly documented and agreed with the individual service user. The home ensures that residents and their representatives are consulted regularly through the homes quality monitoring process to gather information about their satisfaction with the home. This information is gathered centrally and assists with the development and review of the service by management. 27 Highfield Road DS0000025001.V353836.R01.S.doc Version 5.2 Page 12 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 use services are encouraged to make choices about their life style, and supported to develop their life skills within agreed limitations. Social, educational, cultural and recreational activities are aimed at meeting individual’s expectations. EVIDENCE: The home encourages the service users to maintain relationships with families and friends this supported by the homes policies and procedures. Regular contact was reflected in various records maintained by staff. The way staff promote individual rights and choice is detailed within care plans and protection of individuals in supporting them to make these choices is underlined in risk assessments. 27 Highfield Road DS0000025001.V353836.R01.S.doc Version 5.2 Page 13 The service’s aims underline the need to respect the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. The homes policies and procedures support this aim and in discussion staff had a good understanding of how to promote such as resident’s privacy without compromising their safety. The staff team communicate with residents in accordance with communication strategies, both within the service and in the community, this to enable residents to participate in a way that limits risk for themselves and others they come into contact with, this usually in respect of the deployment of accompanying staff. Residents are involved in meaningful daytime activities of their own choice where possible although this may be limited due to one resident not always wanting involvement in such at the times activities are planned. This may cause some difficulties, as the staffing ratios required have not always been available to allow spontaneous activities at any point in the day. Involvement in community activities can also be limited following risk assessment prior to such in respect of the individual’s inclination to challenging behaviours at the time. Activity planners were available (although not yet in pictorial format, this however planned) and although records of the actual activities carried out did not always accord with the plan, there was evidence that staff have worked hard to provide stimulation to residents on a daily basis, despite staffing difficulties over the past twelve months. One more able resident has accessed education and occupational opportunities that were evidenced by sight of a college certificate for the same. There was evidence that the staff promote contact with external opportunities available in their local community, such as discos, the local shops, local leisure facilities and so on. There have been some difficulties in respect of relationships with neighbours due to levels of noise and the manager stated that they have worked hard to limit the impact of this on neighbours. Observation of routines on the day of the inspection evidenced that residents were fully involved in the domestic routines of the home. They were seen to be involved in washing up and simple food preparation and planning within case files showed that this extended to taking responsibility for their own room. Documented residents likes and dislikes showed residents preferences in respect of the foods they ate and with few exception this matched the details of the foods they actual ate as documented in menu records. It was evident from the records of food available on the day, and that provided as recorded on menu sheets that the staff offer a variety of dishes to residents, that do include healthy options. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals, and residents were seen to be enjoying their lunchtime meal. 27 Highfield Road DS0000025001.V353836.R01.S.doc Version 5.2 Page 14 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 This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs and the principles of respect, dignity and privacy are put into practice. EVIDENCE: Residents personal healthcare needs which included specialist health and dietary requirements are clearly recorded in each care plan, these giving a comprehensive overview of each resident’s health needs and serving as benchmark for any change in health requirements. The homes policies and procedures in conjunction with the statement of purpose detail how specialist treatment will be delivered by the home, or when the services of outside professionals maybe required. Staff are provided with training based on the individual requirements of the residents including such as training in the administration of stesolids. The residents individual plans detail how individual personal support is to be responsive to varied and individual needs and preferences, underlining how the delivery of personal care is individual and is flexible, consistent, reliable, and 27 Highfield Road DS0000025001.V353836.R01.S.doc Version 5.2 Page 15 based on the person’s needs. Observation of staff showed them to be aware of resident’s dignity in the way they conversed with them, encouraging and supporting what residents were doing and offering choices in terms of day-today living activities. The care plans outlined how resident’s privacy and dignity was to be promoted and staff in discussion showed a good awareness of these, and the reasoning behind them. It was clearly detailed as to the gender of carers that should undertake personal care tasks based on choice and needs, and the composition of the staff team allowed this to achieved. The staff are developing ways in which they can better listen and respond to individuals’ choices with the support of external professionals where needed. Individual plans underline where independence should be promoted and this was observed to follow through to practice from observation of the staff with residents. There was clear evidence that residents have access to healthcare and remedial services, this supported by clear records of visits to G.Ps, chiropodists and visits by psychiatrists and such like. Staff make sure that those who are fit and well enough are encouraged to be independent, have regular appointments and visit local health care services. There have been adaptations to the property to meet the specific needs of individual residents (for example guarded radiators, protected staircase). Staff have access to training in health care matters and are encouraged and given time to attend training on specialist areas of work although there was comment from some staff that access to an awareness session/training in working with people with autism would be beneficial. The aims and objectives of the home and the induction process for new staff reinforces the importance of treating individuals with respect and dignity. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow although it maybe beneficial to include the policy in the MARs folder for staff’s ease of access. Medication records are fully completed, contain required entries, and are signed by appropriate staff. Regular management checks, including those related to stock control, are recorded to monitor compliance. None of the residents currently self medicate this due to choice or where they lack capacity so care staff manage medication on their behalf and consent to the home doing so has been sought. Thought has been given to providing safe but sensitive facilities for keeping medication. All staff that give medication have completed and passed an appropriate accredited medication course and assessments are carried out to ensure each member of staff is competent to handle, record and administer medication properly. Where issues with medication handling have been identified the manager has responded appropriately and quickly in accordance with the homes policies. 27 Highfield Road DS0000025001.V353836.R01.S.doc Version 5.2 Page 16 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. People who use the service are able to express their concerns where possible and staff are aware of the need to monitor resident’s behaviour for signs of dissatisfaction. The home has a robust, effective complaints procedure. Residents are generally protected from abuse, and management are responsive when third parties raise concerns. EVIDENCE: The service has a complaints procedure that is up to date, very clearly written, and is easy to understand. It is available in written format, this supplemented by an easy read large print/pictorial version with the full procedure forwarded to resident’s representatives when annual questionnaires are sent out. Discussion with the manager and staff indicated that some of the residents had difficulty understanding the complaints process this meaning that it was critical for staff and management to be aware of any behaviour that indicated dissatisfaction with the service provided, this the case based on discussion with staff who showed a good awareness of how the residents express dissatisfaction. Residents have ready access to professionals independent of the service (community nurse, psychiatrists, social workers etc) on a regular basis and this has been known to provide a means by which concerns can be picked up and addressed. The homes procedure makes it very clear of what can be expected to happen if a complaint is made. Unless there are exceptional circumstances the service always responds within the agreed timescale. 27 Highfield Road DS0000025001.V353836.R01.S.doc Version 5.2 Page 17 The only complaints received at the home since the last inspection have related to levels of noise and the impact this sometimes has on neighbours. These have been addressed and there has been no recent reoccurrence of any issues. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff when asked know when incidents need external input and who to refer the incident to. Staff understand the procedures for safeguarding adults and will always attend meetings or provide information to external agencies when requested. There are a low number of referrals made as a result of lack of incidents, rather than a lack of understanding about when incidents should be reported. Whilst staff displayed a good awareness of safeguarding issues there is a need for training for some in this area. This has been identified by the company’s responsible individual and dates set for the training. Other training around dealing with physical and verbal aggression is also made available to staff as needed, and discussion with staff as well as records related to dealing with challenging behaviour showed that the homes procedures in respect of the management of potential or actual aggression are well understood. The staff understand what restraint is and alternatives to its use in any form are always looked for, with a measured response to challenges presented by residents well documented in behaviour plans that related to individual’s assessed needs. 27 Highfield Road DS0000025001.V353836.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 & 30 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The provider and manager have ensured that the physical environment of the home provides for the individual requirements of the residents who live there. The living environment is appropriate for the particular lifestyle and needs of the residents and is homely, clean, safe and comfortable. Residents are encouraged to see it as their own home. It is a very well maintained, attractive home, which is accessible to community facilities and services. There are some adaptations in place to meet individual residents needs such as the provision of radiator guards, appropriate and safe furniture etc. 27 Highfield Road DS0000025001.V353836.R01.S.doc Version 5.2 Page 19 The home is designed to provide small group living where residents can enjoy maximum independence in a discrete non- institutional environment that resembles a domestic dwelling. Residents are fully involved in decisions about the décor and any changes to the accommodation. They have had a choice of the room they live in and the home provides only single room accommodation. The rooms are very well planned and there is easy access to toilet and bathing facilities, no more than two sharing these upstairs and three downstairs. The fixtures and fittings are of a high quality, well maintained and adapted to meet the wishes of the present service users. Individuals personalise their rooms and bring in their own furniture if they wish. The management has a proactive infection control policy and staff understood how to promote infection control and maintain a safe and clean environment. Risk assessments and items necessary to support infection control were seen to be available (such as liquid soap and paper towels). It was however noted that the cupboard used by staff to store records needs attention as it was found to be difficult to open, and the homes safe was also broken and inaccessible. 27 Highfield Road DS0000025001.V353836.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): 31,32,33, 34 & 35 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and usually available in sufficient numbers to support the people who use the service in all aspects of their lifestyles, in line with their terms and conditions, and to support the smooth running of the service. EVIDENCE: There have been issues at the home over the last year in respect of maintaining optimum staffing levels, this a barrier at times to continued improvement as was identified within the AQAA. The home has used staff from other homes within the company to cover vacancies as well as allowing existing staff to work additional hours. These issues are however improving with less staff vacancies now and a more consistent staff group. Discussion with senior management has highlighted that there are now 28 staff hours on days and 25 on nights vacant , these covered by staff at the home reducing the necessity to use out posted staff. Senior management are also committed to recruiting additional suitable staff. The reduction in the behaviours of one resident in recent months is indicative of the fact that there is a more 27 Highfield Road DS0000025001.V353836.R01.S.doc Version 5.2 Page 21 consistency in respect of staffing. Based on assessments there is a need for a bare minimum of three staff (to ensure safety) although if there are planned external activities there would need to be up to five staff available. The staff spoken to were clear that the level of support in respect of training was very good and training opportunities were readily available. New staff work through common induction standards following a period during which they have time to familiarise themselves with the home, residents and policies/procedures. Staff stated that they were not able to have involvement in certain aspects of care until having received the appropriate training, for example the senior on duty did not administer medication as she was still completing her accredited training and no staff would have involvement in restraint until after completing of MAPA training (management of potential and actual aggression). Staff members undertake external qualifications beyond the basic requirements and the manager/provider was stated to encourage and enable this and recognise the benefits of a skilled, trained workforce. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. Where there were gaps in training provision there was evidence that this was usually identified either by the manager or responsible individual with follow up to arrange the necessary training for staff. The only training staff stated would be desirable in terms of improving their knowledge base was autism awareness (which would be appropriate for the service user group at the home). Despite there been evidence of training in staff files the homes training plan was not up to date at the time of the inspection, this a matter the manager stated she would address forthwith. It is of note that the level of vocational qualification within the staff team has improved despite staff turnover, this reflecting the commitment of the home to providing appropriate training for staff. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the home recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. The only deviation from this was one example where the full working history in respect of one member of staff was not fully documented. Where there are gaps in employment the manager was advised to ensure this was recorded. The management do need to explore ways in which there can be a greater involvement of the residents within the homes recruitment procedures. The regularity of staff meetings has not been as frequent of late due to recent staffing issues, although the manager was aware that these needed to be recommenced. Supervision sessions are regular and staff stated they find them helpful with a focus on improving outcomes for people using the service. Notes and action points are taken of these one to one meetings and sessions, and progress is regularly reviewed. 27 Highfield Road DS0000025001.V353836.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): 37,39,41 & 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect and is supported by an effective quality assurance systems developed by the provider. There has been some limited slippage in record keeping due to staffing issues this to date having little impact of resident’s well being and safety however. EVIDENCE: The manager of the home has successfully completed her registration since the time of the last inspection. The manager has experience from working within the provider’s homes for a number of years at a senior level and is currently working towards a recognised management qualification. The manager was aware of and worked to the basic processes set out in the NMS and showed a 27 Highfield Road DS0000025001.V353836.R01.S.doc Version 5.2 Page 23 clear commitment to improving outcomes for the residents of the home. Discussion with members of the senior team indicated that there was an enthusiasm and commitment to providing a good quality service that provided good outcomes for the residents. The AQAA returned to the CSCI contained relevant information that is supported by appropriate evidence and carried reference to some changes made and where there was scope for improvement. Improvement in the way the AQAA is completed is to be assisted with training that the responsible individual was setting up for the manager. The data section of the AQAA was as far as possible accurately completed however. The manager promotes equality and diversity, has good people skills (based on comments from staff and observation) and understands the importance of person centred care and effective outcomes for people who use the service. The manager’s practice, skills, and knowledge, is based on continuous development, gained through training and enthusiasm for the role. The company with support from the manager trains and develops staff that are generally competent and knowledgeable to care for younger adults. The service is planned to be user focused, and generally works in partnership with families of residents and professionals. The home has policies and procedures that set out the aims and objectives of the service. The home has systems in place that monitor practice and compliance with the homes plans, policies and procedures, this in conjunction with the services registered provider. The home has developed a health and safety policy that generally meets health and safety requirements and legislation. Checks show that records are generally up to date although some limited gaps/omissions were found in recording, including the need for some limited review of care plans, and ensuring management records (such as training plans) are up to date. The manager has systems in place to ensure that any residents monies taken off site (for such as activities) is now signed out but also needs to ensure that when signed out two staff sign, one as a witness to the amount taken. It was stated that staffing difficulties over the last year have on occasions impacted on the time the manager had available to devote to management records although the manager was positive this was an issue that would be resolved as staff vacancies were filled. It was not possible to check resident’s personal monies as the safe had broken (and was inoperable). This the manager stated was to be addressed but there had been a delay due to the Christmas/new year period. 27 Highfield Road DS0000025001.V353836.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 3 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 4 25 X 26 X 27 X 28 X 29 X 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 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X 2 3 X 27 Highfield Road DS0000025001.V353836.R01.S.doc Version 5.2 Page 25 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 YA1 Good Practice Recommendations The Registered Persons should develop all key policies and procedures (such as the service users guide) and care records (such as care plans, activity records) in pictorial or alternative formats that allow easier understanding by the residents. The Registered Provider should ensure that the range of fees that a prospective resident may pay are detailed within the home’ s service user guide or statement of purpose. The Registered Manager should ensure that all records related to individual residents care (care plans, risk assessments, activity plans, likes and dislikes) are kept up to date. The Registered Manager should ensure that the protocols in place for the administration of PRN medication are agreed by an appropriate medical professional (i.e. psychiatrist, G.P. etc) and that evidence of this is available. DS0000025001.V353836.R01.S.doc Version 5.2 Page 26 2. YA1 3. YA6 4. YA20 27 Highfield Road 5. 6. YA24 YA33 7. 8. YA34 YA35 The registered provider should ensure that an appropriate handle is fitted to the cupboard in the dining room (to assist access to records) and that the safe is repaired. The Registered Provider needs to ensure that staffing levels are kept under review through such as monitoring of the actual staffing rotas. The Registered Provider is to look at ways in which the residents can be actively supported to be involved in staff selection. The registered manager should ensure that the homes training and development plan is up to date and shows that staff training provision is appropriate for the needs of the residents. 27 Highfield Road DS0000025001.V353836.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Birmingham Local Office Commission for Social Care Inspection 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 27 Highfield Road DS0000025001.V353836.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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