Care Home: 29 Byron Street

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What the care home does well Lots of information in a pictorial format in order that it can be understood by people who cannot read. Residents have essential lifestyle plans (a form of person centred planning). These help them be involved in deciding how they want to be supported. Plans are regularly reviewed to ensure residents` needs are appropriately monitored by the home. Staff have excellent knowledge and understanding of involving people in decision-making processes. As one person explained, "we practice person centred care, this means all care is centred around the individual, what they want not what we think they want". Residents are able to make choices about their life style. One resident explained, "X takes me to the cricket in Harborne, I like watching. I still go to church, they are golden to me, pick me up, I go to church in Smethwick, religion is important to me, I go every week and if anything special is on, they have chairs for the disabled. We have been on holiday to north Wales the four of us, in caravans for 4 days". There is no set menu plan as residents choose meals on a daily basis that promotes choice and individuality. Residents are supported to raise concerns. As one person explained, "If I want to make a complaint I would tell staff, they sort anything for you, they are great". Staff treat residents with respect and courtesy. Meals that residents have are varied and well balanced. The health needs of residents are monitored by staff and access to appropriate treatment is sought when necessary. This means residents receive help when they need it. The building is decorated and furnished to a good standard. This means residents live in a comfortable and safe place. Staff that we spoke to all demonstrated good understanding of supporting residents and acting on their behalf if they are unhappy and protecting them from harm. Relationships between staff and residents appear good. One resident informed us, "We have had one or two new staff, all very nice. The manager is lovely, wouldn`t do without him. I love living here, they are very good to me". Management of the home is good. This means residents receive a good quality service. What has improved since the last inspection? The manager has obtained recruitment records for new staff that show residents are protected by the homes recruitment procedures. Since the last inspection the registered manager has reviewed the statement of conditions of residence with these now including details of fees charged for living at the home and any additional charges for items not covered by the fee. This ensures residents and their representatives are fully informed and their legal rights protected. Photograph albums have been compiled to evidence further activities that residents participate in. Since the last inspection the registered manager has arranged for one resident with support from an advocate to have their benefits managed by the local appointiship unit. This offers further safeguards to the individual. A written procedure for the sanitising of mops and their storage has been introduced, promoting good infection control measure.Staffing levels have increased to meet the needs of a new resident. Staff have received epilepsy training prior to a new resident moving into the home. This means staff have knowledge of this condition and can support the resident in the event of a seizure. All new staff have completed the Learning Disability Qualification (LDQ), with units of this currently being externally verified. This means new staff understand how to support people with a learning disability. What the care home could do better: No Requirements were made as a result of this inspection. We have made a number of recommendations. These include completing a comprehensive plan of care for epilepsy for a named resident to ensure the resident`s need is met safely and consistently by staff. Also that advice should be sought from a dietician for the named resident who on occasions chooses not to eat. This will help ensure the residents` needs are met safely. The home should contact the local Environmental Health Agency with regard to the laundry, seeking advice and implementing any recommendations made. This will help ensure good infection control measures are maintained. The practice of staff attending numerous training courses on the same day should be reviewed with a maximum of 2 courses undertaken to ensure staff can retain sufficient information in order to support residents safely. It is recommended that the home be enabled to access and use e-mail and web site facilities to assist with communication and researching current good practice and guidance. CARE HOME ADULTS 18-65 29 Byron Street West Bromwich West Midlands B71 1NP Lead Inspector Lesley Webb Key Unannounced Inspection 5th August 2008 09:00 29 Byron Street DS0000004826.V369125.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 29 Byron Street DS0000004826.V369125.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. 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 29 Byron Street Address West Bromwich West Midlands B71 1NP 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 2443 Pioneer Care Limited Mr Paul Jones Care Home 3 Category(ies) of Learning disability over 65 years of age (3), registration, with number Physical disability (1) of places 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include 3 service users whose ages may range between 60 and 65 years of age and above at any one time. 11th August 2007 Date of last inspection Brief Description of the Service: 29 Bryon Street is a semi-detached property, leased from the Local Authority, and operated as a Home by Pioneer Care Ltd. Set in a quiet residential area of West Bromwich, two miles from the Town centre, it is close to local facilities and well served by public transport. The Home provides care and accommodation for up to three adults who have a learning disability. Two of the Residents are over the age of 65 years. Accommodation comprises a dining area, lounge, kitchen, and toilet on the ground floor, with three bedrooms, ‘a sleeping-in room’, a bathroom and toilet on the first floor. There is a Wessex vertical lift leading from the lounge area directly into the bedroom of the Resident who has a physical disability. There is parking on the road in front of the property and there is a large, partly paved garden to the rear with access to both areas facilitated by ramps. The Home provides a range of in house and community based activities for Residents. A statement of purpose and service user guide are available to inform residents of their entitlements. Fees charged for people living at the home ranges from £592.30 to £601.60 per week. Fees charged do not cover items such as hairdressing, private chiropody, newspapers and magazines, personal toiletries and clothing. 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We carried out this inspection over one day, with the home being given no prior notice of the visit. Time was spent examining records, talking to residents, staff and observing care practices, before giving feed back on the findings of the inspection to the registered manager. Prior to the inspection the home supplied information to the Commission for Social Care Inspection (CSCI) in the form of its Annual Quality Assurance Assessment (AQAA). Also all 3 residents completed surveys that were returned to the CSCI. Information from both these sources was also used when forming judgements on the quality of service provided at the home. The inspector was shown full assistance during the visit and would like to thank everyone for making her welcome. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. What the service does well: Lots of information in a pictorial format in order that it can be understood by people who cannot read. Residents have essential lifestyle plans (a form of person centred planning). These help them be involved in deciding how they want to be supported. Plans are regularly reviewed to ensure residents’ needs are appropriately monitored by the home. Staff have excellent knowledge and understanding of involving people in decision-making processes. As one person explained, “we practice person centred care, this means all care is centred around the individual, what they want not what we think they want”. Residents are able to make choices about their life style. One resident explained, “X takes me to the cricket in Harborne, I like watching. I still go to church, they are golden to me, pick me up, I go to church in Smethwick, religion is important to me, I go every week and if anything special is on, they have chairs for the disabled. We have been on holiday to north Wales the four of us, in caravans for 4 days”. There is no set menu plan as residents choose meals on a daily basis that promotes choice and individuality. 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 6 Residents are supported to raise concerns. As one person explained, “If I want to make a complaint I would tell staff, they sort anything for you, they are great”. Staff treat residents with respect and courtesy. Meals that residents have are varied and well balanced. The health needs of residents are monitored by staff and access to appropriate treatment is sought when necessary. This means residents receive help when they need it. The building is decorated and furnished to a good standard. This means residents live in a comfortable and safe place. Staff that we spoke to all demonstrated good understanding of supporting residents and acting on their behalf if they are unhappy and protecting them from harm. Relationships between staff and residents appear good. One resident informed us, “We have had one or two new staff, all very nice. The manager is lovely, wouldn’t do without him. I love living here, they are very good to me”. Management of the home is good. This means residents receive a good quality service. What has improved since the last inspection? The manager has obtained recruitment records for new staff that show residents are protected by the homes recruitment procedures. Since the last inspection the registered manager has reviewed the statement of conditions of residence with these now including details of fees charged for living at the home and any additional charges for items not covered by the fee. This ensures residents and their representatives are fully informed and their legal rights protected. Photograph albums have been compiled to evidence further activities that residents participate in. Since the last inspection the registered manager has arranged for one resident with support from an advocate to have their benefits managed by the local appointiship unit. This offers further safeguards to the individual. A written procedure for the sanitising of mops and their storage has been introduced, promoting good infection control measure. 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 7 Staffing levels have increased to meet the needs of a new resident. Staff have received epilepsy training prior to a new resident moving into the home. This means staff have knowledge of this condition and can support the resident in the event of a seizure. All new staff have completed the Learning Disability Qualification (LDQ), with units of this currently being externally verified. This means new staff understand how to support people with a learning disability. 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. 29 Byron Street DS0000004826.V369125.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 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents considering this home have the information needed to decide on its suitability. They have their needs assessed and a contract that clearly tells them about the service they will receive. EVIDENCE: As in previous inspections there is a statement of purpose that covers all of the required subjects. There is also a home information pack that is maintained in each resident’s room that contains information such as house rules, complaints procedure, quality assurance questionnaires and the resident handbook. Many items of information have been produced in a pictorial format in order that information is accessible to residents. Information in the homes Annual Quality Assurance Assessment (AQAA) with regard to assessment processes states ‘we provide a holistic process so that potential new tenants can be assured their individual needs will be measured and met. All prospective new tenants will visit the home, on as many occasions as needed. They will be offered social visits and a number of overnight stays prior to potentially moving in to the home. Service users are provided with appropriate information regarding services available’. 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 10 One new person has moved into the home since our last inspection and by examining their care documentation and talking to staff we found the above information to be accurate. For example this persons records detail visits to the home and assessments of needs, both completed before they moved in. This ensures the home can be confident it knows a persons needs and can meet them. Records also evidence involvement from other parties including relatives, social worker and an occupational therapist, all who contributed to the assessment process on behalf of the individual. Since the last inspection the registered manager has reviewed the statement of conditions of residence with these now including details of fees charged for living at the home and any additional charges for items not covered by the fee. This ensures residents and their representatives are fully informed and their legal rights protected. 29 Byron Street DS0000004826.V369125.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. Residents are involved in decisions about their lives, and where possible play an active role in planning the care and support they receive. EVIDENCE: In the main care planning meets residents needs and encourages their involvement. Residents have essential lifestyle plans (a form of person centred planning) that give details of likes and dislikes, family contacts, medical issues, history, communication, personal details, hygiene and preferences. Plans are regularly reviewed to ensure residents’ needs are appropriately monitored by the home. Staff also complete daily records that give brief overviews of residents wellbeing, times of rising and retiring, activities, appointments and meals taken. When looking at the care planning documentation for the newest person to move into the home we noted that although there was a lot of information regarding their epilepsy this had not been correlated into a plan of care. We advised the registered manager that a 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 12 comprehensive plan of care for this identified need should be completed to ensure the resident’s need is met safely and consistently by staff. Residents are supported to make choices and involved in decision-making. Throughout the inspection members of staff were observed encouraging residents to make choices about day-to-day matters, such as what meals to have, and what they wanted to do on that day. People’s ability to exercise choice and to make informed decisions is variable, according to their degree of learning disability and communication needs. All staff that were interviewed demonstrated excellent knowledge and understanding of involving people in decision-making processes. As one person explained, “we practice person centred care, this means all care is centred around the individual, what they want not what we think they want”. As with care planning, generally risk assessments processes and documentation is good. Some improvements however should be undertaken to ensure risk assessments as completed for all identified needs. For example one person has epilepsy. A risk assessment is not in place for this. As the inspector explained this should be completed to ensure any risks associated with this condition are not only identified but also minimised where possible. 29 Byron Street DS0000004826.V369125.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. Residents are able to make choices about their life style. Social, educational, cultural and recreational activities meet individuals’ expectations. EVIDENCE: Information in the homes Annual Quality Assurance Assessment (AQAA) with regard to lifestyles states ‘we support services users to have opportunities for personal development. Encourage to participate in age peer and culturally appropriate activities and appropriate leisure activities. Encourage to feel inclusive of their local community. Support with their personal and family relationships. Ensure rights are respected and responsiblities recognised in their daily lives. Residents offered a healthy diet and enjoy meals. We listen effectively as a care team and escort on holidays each year’. We looked at records and talked to a resident and staff and found this information to be accurate. For example daily reports books record activities, meals taken and requests from residents. Also one resident confirmed his enjoyment of 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 14 activities he is supported to undertake. As he explained, “X takes me to the cricket in Harborne, I like watching. I still go to church, they are golden to me, pick me up, I go to church in Smethwick, religion is important to me, I go every week and if anything special is on, they have chairs for the disabled. We have been on holiday to north Wales the four of us, in caravans for 4 days”. The registered manager confirmed that all three residents have been on holiday this year to Wales. He informed us, “All had individual caravans, this was to promote individuality, privacy for each person, so holidays were tailored to individual needs”. Since the last inspection photograph albums have been compiled to evidence further activities that residents participate in (meeting a previous recommendation). As at previous inspections daily routines are flexible according to the individual preferences of residents. For example residents informed us that they can choose what time to rise or retire and we observed staff asking residents what they would like for lunch offering two choices. The home is good at ensuring the dietary needs of residents are met. Residents have the choice of eating at the dining table or in the lounge. As at previous inspections residents confirmed that they enjoyed the meals provided and stated their preferences that on examination of daily food records confirmed that they were offered their favourite foods. There is no set menu plan as residents choose meals on a daily basis that promotes choice and individuality. We noted that the records for the newest person to have moved into the home detail days when they have chosen not to eat. We discussed this with the registered manager suggesting that advice is sought from a dietician and a risk assessment completed until this is obtained. This will help ensure the residents’ needs are met safely. 29 Byron Street DS0000004826.V369125.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 excellent. This judgement has been made using available evidence including a visit to this service. The health and personal care that residents receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: As at previous inspections the staff and manager should be commended for the efforts made to ensure the personal and health care needs of residents are met. When we arrived at the home two of the three residents were sitting in lounge, watching television. Both appeared very smartly dressed and freshly shaved. Staff that we spoke to gave good explanations with regard to supporting residents with their personal care. For example one explained, “We take pride in helping them; they are aware of their appearance, like to be smart, it’s important for there self esteem, self-awareness”. Two of the three residents are of an older age but in excellent health with records evidencing staff ensure they receive regular support from various health care professionals. Each has a health action plan in place and regular weight check records as aids to health management. When looking at the 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 16 health records for the newest person to move into the home we advised the registered manager that further work should be undertaken to ensure this person’s health needs are met and monitored. This should include ensuring their health action plan is completed in full and that they attend a dentist appointment. We also advised that advice be sought regarding the completion of bowel monitoring charts to ensure the resident’s rights to privacy are not compromised. Further evidence of the homes excellent systems for managing health care is the fact that neither of the older residents is taking any medication. This is particularly good as one resident is over 70 years of age. The other resident was on regular medication when he first moved to the home but this has now ceased, again evidencing the homes excellent support in this area. However staff still receive training in the safe handling of medicines, which is an excellent initiative. The newest person to move into the home is prescribed medication. In the main we found records to be of good order. We instructed the home that a system must be introduced for recording medication given to next of kin when the resident is staying with them, as currently this is secondary dispensed with no records in place. We suggested that receipts are obtained, signed by the home and the next of kin for medication given and returned in order to identify responsibility for ensuring medication is administered as per the dispenser’s instructions. This will offer further safeguards to everyone. 29 Byron Street DS0000004826.V369125.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. Residents are able to express their concerns and have access to a robust, effective complaints procedure. Residents are protected from abuse. EVIDENCE: Information in the homes Annual Quality Assurance Assessment (AQAA) with regard to complaints and protection states ‘There is a comprehensive pictorial format in order that information is accessible to all. I ensure service users legal rights are protected by contacting appropriate departments social workers etc and advocates. One service user has accessed an advocacy group about financial arrangements’. We looked at records and talked to a resident and staff and found this information to be accurate. The resident we spoke to confirmed he is aware of his rights to complain, informing us, “If I want to make a complaint I would tell staff, they sort anything for you, they are great”. As at the previous inspection there have been no complaints received about the service during the last twelve months. The home uses a system called ‘Talk Time’ to ensure all residents are given the opportunity to raise issues or concerns. This is where the registered manager sits with each resident and talks to them, asking if they are happy or have any concerns. Since the last inspection a new person has moved into the home who has communication needs. We discussed this with the registered manager advising that 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 18 alternative ways of supporting them to raise concerns should be explored in order that they have the same opportunities as other residents. All staff have received training in vulnerable adult abuse and those spoken to demonstrated a good understanding of their responsiblities with regard to protecting residents from harm. As one person explained, “we always watch, look for potential dangers, support and guide, not here to tell them what to do but to support and help. We always work with 2 staff on duty, residents not left on their own. If thought abuse by staff would report straight away, it’s my job, the residents come first, regardless”. To support staff further we recommended to the registered manager that staff undertake refresher training in protection every 3 years and that they access the local authority protection training. Policies and procedures for the protection of vulnerable adults are in place along with a copy of the Local Authority vulnerable adult abuse guidelines. There are procedures in place with regard to residents’ financial affairs. Residents need varying levels of support to manage their finances. There are personal expenditure sheets to record all financial transactions with double signatures obtained from staff. Petty cash vouchers and receipts are obtained for larger cash purchases. Residents receive smaller sums of money to spend according to their wishes although they require support from staff. Since the last inspection the registered manager has arranged for one resident with support from an advocate to have their benefits managed by the local appointiship unit. This offers further safeguards to the individual. Systems for the management of another resident’s finances are also being investigated to ensure their rights are not compromised. 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents who live there to do so in a safe, well maintained and comfortable environment that encourages independence. EVIDENCE: A tour of the premises was undertaken including the viewing of residents’ bedrooms, all of which were freshly decorated and furnished to a good standard. Residents’ bedrooms are individualised with personal possessions, photographs, televisions and stereo equipment. We did observe that the floorboards outside one residents bedroom appear uneven and damaged. We advised the registered manager to take action to address this as they could pose a trip hazard to the resident. Until such time as the flooring is repaired a risk assessment should be completed, that identifies what actions can be taken to reduce risk of injury to the residents. The communal areas are bright and 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 20 airy with comfortable and homely furnishings. There is a large, secluded garden to the rear with an abundance of potted plants and outdoor seating. All parts of the home were seen to be clean and hygienic. The laundry is sited in an outbuilding. This was found to require attention, as the walls and flooring are not sealed, consisting of brick and concrete resulting in them being porous and not to infection control guidelines. This was the same at our last inspection and it was disappointing to find no action taken to improve this facility. We advised the registered manager to contact the local Environmental Health Agency with regard to this facility, seeking advice and implementing any recommendation made. Since the last inspection a written procedure for the sanitising of mops and their storage has been introduced, promoting good infection control measure. 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 21 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 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who live there. Recruitment practices ensure residents are safeguarded from harm. EVIDENCE: Information in the homes Annual Quality Assurance Assessment (AQAA) with regard to staffing states ‘Service users are provided with a staff team who are competent and qualified, are effective as team, are supported by recruitment procedures, committed to service users rights, ensure training is a priority. All staff have personal files with training certificates to confirm qualifications, the team can confirm themselves how effective they are, personal files to confirm recruitment and selection, supervision sessions are recorded, all training attended is certificated’. By looking at records and talking to staff we found this information to be accurate. As in previous inspections staff at Byron Street present as interested in their jobs, motivated and committed to the welfare of the people living there. Staffs spoken to were aware of residents’ individual needs and had a grasp of 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 22 knowledge of disabilities and conditions of individuals in general. For example one member of staff explained, “I have completed NVQ 2 also doing dementia awareness accredited with Walsall College, finished 4 units, 3 marked. Its very useful, helps understand why behaving certain way, helps ensure treated with respect and understanding. Helps to approach situations. We have had some new staff, the way they have joined us and fitted in is good, we are a good team, best interests of residents. Improvements enhance residents well being, to make life better for them”. Relationships between staff and residents appear good. Staff were observed talking to residents in friendly way and lots of laughter was heard. One resident informed us, “We have had one or two new staff, all very nice. The manager is lovely, wouldn’t do without him. I love living here, they are very good to me”. We viewed the staffing rotas and these indicate staffing levels meet residents’ needs. Since a new person has moved into the home staffing levels have increased with 2 staff on duty from 7am to 10pm apart from days when the resident is attending a centre. There are also 2 staff on duty during the night. The manager hours are not supernumerary however we could find no evidence of this having a detrimental effect on the quality of service residents receive. We examined the records of the 2 newest members of staff to assess if the homes recruitment practices protect residents. All contained an enhanced Criminal Records Bureau (CRB) disclosure, 2 references and other documentation that ensures residents are safeguarded. The only omission we found was that neither contained a copy of the staff members application form. We advised the registered manager to ensure a copy of the application form is obtained from the organisations head office to ensure robust recruitment processes are followed. As at previous inspections there is a training and development system in place that ensures staff receive appropriate training and induction in order that they have the skills and knowledge to support residents. It was positive to find that all staff received epilepsy training prior to a new resident moving into the home. This ensures staff have knowledge of this condition and can support the resident in the event of a seizure. We did note that many of the mandatory training courses that staff have undertaken took place on the same day. We suggested to the registered manager that this be reviewed with a maximum of 2 courses on the same day to ensure staff can retain sufficient information in order to support residents safely. Since the last inspection all new staff have completed the Learning Disability Qualification (LDQ), with units of this currently being externally verified. 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 23 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 and 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, with effective quality assurance systems that allow the home to measure if it is meeting its aims and objectives. EVIDENCE: As at previous inspections the registered manager demonstrated knowledge, competency and commitment to his role for which he should be congratulated. Feedback received from staff and residents was extremely positive regarding the management of the Home. Mr. Jones’s management approach is conducive to promoting an open and positive atmosphere for both residents and staff. 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 24 Good quality assurance systems are in place that allow the home to measure if it is meeting its aims and objectives. These include regular maintenance and health and safety audits, visits undertaken in line with Regulation 26 of the Care Home Regulations and residents satisfaction questionnaires. Copies of these were contained within the service user guide and examination confirmed that residents are happy with the support provided by staff at the home. Since the last inspection questionnaires have also been introduced for staff and stakeholders. These along with the residents questionnaires have been analysed and the findings incorporated into the development plan for the home. Prior to this inspection the home sent us its Annual Quality Assurance Assessment (AQAA) as we requested. The contents of this were brief in parts and give minimal information about the service provided to residents. We discussed this with the registered manager, advising that greater detail is included when next requested by the CSCI. This will evidence further quality services that residents receive. A random sampling of health and safety documents demonstrates systems ensure the safety of residents is maintained. For example there is weekly testing of the smoke alarm system and water temperatures are recorded for hand basins in residents bedrooms. Maintenance records for all areas of the building demonstrate that generally repairs are carried out within appropriate timescales and there is mandatory training for staff. Examination of the training records which was cross referenced with a sample of training certificates confirmed that staff have undertaken all of the required disciplines in statutory training which is an excellent achievement. 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 25 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 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 3 X 3 X X 3 X 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 26 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 2 Refer to Standard YA6 YA9 Good Practice Recommendations A comprehensive plan of care for epilepsy for a named resident should be completed to ensure the resident’s need is met safely and consistently by staff. A risk assessment for a named resident with regard to epilepsy should be completed to ensure any risks associated with this condition are not only identified but also minimised where possible. Advice should be sought from a dietician and a risk assessment completed until this is obtained for the named resident who on occasions chooses not to eat. This will help ensure the residents’ needs are met safely. The health action plan should be completed in full for the newest person to move into the home. They should attend a dentist appointment. Advice should be sought regarding the completion of bowel monitoring charts to ensure the resident’s rights to privacy 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 27 3 YA17 4 YA19 are not compromised. All of these actions will help ensure the health needs of the named resident are met. A system must be introduced for recording medication given to next of kin when a named resident is staying with them. This should include obtaining receipts, signed by the home and the next of kin for medication given and returned in order to identify responsibility for ensuring medication is administered as per the dispenser’s instructions. This will offer further safeguards to everyone. Alternative ways of supporting a named resident with communication needs to raise concerns should be explored in order that they have the same opportunities as other residents. To support staff further we recommend that staff undertake refresher training in protection every 3 years and that they access the local authority protection training. Contact should be made with the local Environmental Health Agency with regard to the laundry, seeking advice and implementing any recommendation made. A copy of staffs application form should be maintained with their other recruitment records in the home to ensure robust recruitment processes are followed. That the practice of staff attending numerous training courses on the same day be reviewed with a maximum of 2 courses undertaken to ensure staff can retain sufficient information in order to support residents safely. It is recommended that the home be enabled to access and use e-mail and web site facilities to assist with communication and researching current good practice and guidance. Greater detail should be included in the homes Annual Quality Assurance Assessment when next requested by the CSCI. This will evidence further quality services that residents receive. 5 YA20 6 YA22 7 8 9 10 YA23 YA30 YA34 YA35 11 YA37 12 YA39 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 28 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 29 Byron Street DS0000004826.V369125.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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