Care Home: 35 Hawthorn Road

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What the care home does well The Home`s Staff work hard to make sure that service user`s needs are put first. Care is provided to reflect principles of person centred care, lifestyle and specialist approaches which recognise and respect the individuality of every deaf/blind service user and treat each one as having their own unique needs and aspirations. Home Staff aim to provide care at a very personal and individual level on a daily basis by following them rather than the other way around. This approach is evident in the Care Plans, individualised Health Action Plans and in the wide range of activities scheduled to meet service users` needs and preferences. The same approach is also evident in the warm and relaxed atmosphere of the home, the commitment to promoting contact with service users family/friends/relatives and in observed staff/service user interactions and practice.The service also has a rigorous recruitment policy and a very positive approach to staff training. Staff come from a variety of social and cultural backgrounds. They have a wide range of skills and abilities. There is a very good structured induction programme covering a wide range of relevant knowledge/skill areas during the first six months. This is supplemented by ongoing supervision, staff development and training linked specifically to service user needs. What has improved since the last inspection? There has been a significant increase in the number of staff who has completed an NVQ in care. Old curtains have been replaced and these have added to general decorative improvements in the home environment. Fire training frequency has improved and 87% of staff are now trained in this area. A fire training DVD has been purchased to facilitate in house training. Service user risk assessments have been reviewed and updated appropriately. What the care home could do better: Start using the new person centred care plan format throughout the home and ensure staff are trained in how to use it effectively thereby increasing their confidence. The manager needs to ensure that the outcomes of health related appointments/treatments are recorded appropriately in order to safeguard service users` health. Work needs to be done to ensure that all staff are equally confident in all methods of non verbal communication in order to meet the individual needs of service users. The manager needs to ensure the cupboard containing harmful substances is locked at all times in order to keep service users safe. All staff should keep the office area tidy and the files/paperwork well organised to give ease of access when needed. Consider using the office for reviews instead of the dining room once it is tidied. Review the menu to make it more culturally relevant and healthy including adding more fresh fruit and vegetables and making explicit links between service users preferences/needs (as indicated in care plans) and what is provided.Review service users needs for access to educational and employment opportunities and work in partnership with local agencies to meet these appropriately. The Manager must ensure that all staff are trained to understand the principles underlying the Mental Capacity Act and enable them to ensure service users access the capacity/best interest`s assessment as required. CARE HOME ADULTS 18-65 Hawthorn Road, 35 Erdington Birmingham B44 8QS Lead Inspector Terri Whittaker Key Unannounced Inspection 15th January 2008 11:00 Hawthorn Road, 35 DS0000030424.V358738.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 Hawthorn Road, 35 DS0000030424.V358738.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. Hawthorn Road, 35 DS0000030424.V358738.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hawthorn Road, 35 Address Erdington Birmingham B44 8QS 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 384 2228 0121 386 4222 www.sense.org.uk Sense, The National Deafblind and Rubella Association Paul McDonald Care Home 5 Category(ies) of Learning disability (5), Sensory impairment (5) registration, with number of places Hawthorn Road, 35 DS0000030424.V358738.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Minimum of 3 suitably qualified staff on duty, as well as the care manager, from 7.30am - 10.00pm An additional member of care staff provided for six hours across the day All residents must be under 65 years of age That the registered manager undertakes a minimum of 21 hours dedicated management/administration time a week. 17th August 2006 Date of last inspection Brief Description of the Service: Hawthorn Road is a care home owned by Sense, who provides services to people who are deaf, blind and have associated disabilities. Hawthorn Road was first registered in December 2002, it is a traditional house, which was purpose designed to meet the needs of people with visual and hearing impairments and associated learning and communication difficulties. Hawthorn Road is currently home to five people with an age range from early thirties to early fifties. On the ground floor there is a communal lounge, a quiet sitting room and a dining room. There is a staff office, toilet and a laundry. One of the bedrooms is on the ground floor. On the first floor there is a further four bedrooms all with en suite facilities. The home does not have a lift, so only ground floor accommodation is accessible to someone with mobility needs. To the rear of the house there is a large garden with mainly grassed area and a patio. The garden also has a brick built sun house, which has the potential to be used as additional space for service users. The pre inspection questionnaire completed by the Manager states that the fee range for the home is £1695 to £3067.67 per week. Copies of the CSCI inspection reports are available in the office of the home on request. Hawthorn Road, 35 DS0000030424.V358738.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 stars. This means that the people who use this service experience good quality outcomes. Prior to the inspection visit a range of available evidence was gathered and looked at. This included, conditions of registration, previous inspection report, inspection record, notifications received from the home, self assessment quality assurance report from the provider, the results of a ‘have your say about’ survey and data from Skills for Care. The unannounced fieldwork visit was carried out over seven hours. This was the homes key inspection for the inspection year 2007-2008. The five service users in the home all have a wide range of complex and varied needs and were unable to communicate their views about the home. Time was spent observing care practices, interactions between staff and service users, and evaluating inputs from relatives and an advocate. The premises were inspected to include service user’s bedrooms, communal space, laundry facilities and office space. Staff views were asked for and given, policies and procedures were looked at, care plans were sampled, records relating to recruitment, training and supervision were examined. Internal quality assurance assessments and audits were read, a core review meeting for one service user was attended and the contents of the medication cupboard were checked. What the service does well: The Home’s Staff work hard to make sure that service user’s needs are put first. Care is provided to reflect principles of person centred care, lifestyle and specialist approaches which recognise and respect the individuality of every deaf/blind service user and treat each one as having their own unique needs and aspirations. Home Staff aim to provide care at a very personal and individual level on a daily basis by following them rather than the other way around. This approach is evident in the Care Plans, individualised Health Action Plans and in the wide range of activities scheduled to meet service users’ needs and preferences. The same approach is also evident in the warm and relaxed atmosphere of the home, the commitment to promoting contact with service users family/friends/relatives and in observed staff/service user interactions and practice. Hawthorn Road, 35 DS0000030424.V358738.R01.S.doc Version 5.2 Page 6 The service also has a rigorous recruitment policy and a very positive approach to staff training. Staff come from a variety of social and cultural backgrounds. They have a wide range of skills and abilities. There is a very good structured induction programme covering a wide range of relevant knowledge/skill areas during the first six months. This is supplemented by ongoing supervision, staff development and training linked specifically to service user needs. What has improved since the last inspection? What they could do better: Start using the new person centred care plan format throughout the home and ensure staff are trained in how to use it effectively thereby increasing their confidence. The manager needs to ensure that the outcomes of health related appointments/treatments are recorded appropriately in order to safeguard service users’ health. Work needs to be done to ensure that all staff are equally confident in all methods of non verbal communication in order to meet the individual needs of service users. The manager needs to ensure the cupboard containing harmful substances is locked at all times in order to keep service users safe. All staff should keep the office area tidy and the files/paperwork well organised to give ease of access when needed. Consider using the office for reviews instead of the dining room once it is tidied. Review the menu to make it more culturally relevant and healthy including adding more fresh fruit and vegetables and making explicit links between service users preferences/needs (as indicated in care plans) and what is provided. Hawthorn Road, 35 DS0000030424.V358738.R01.S.doc Version 5.2 Page 7 Review service users needs for access to educational and employment opportunities and work in partnership with local agencies to meet these appropriately. The Manager must ensure that all staff are trained to understand the principles underlying the Mental Capacity Act and enable them to ensure service users access the capacity/best interest’s assessment as required. 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. Hawthorn Road, 35 DS0000030424.V358738.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 Hawthorn Road, 35 DS0000030424.V358738.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 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service user guide indicate that prospective service users have the information they need to make an informed choice about where to live. The sampled care plans demonstrate that individual needs and aspirations are assessed prior to admission and incorporated into care plans. EVIDENCE: There have been no new service users admitted since the last inspection. Evidence drawn from case tracking two existing service users confirmed that their needs had been assessed prior to admission. These included vision, hearing and health assessments. One service user had visited the home prior to admission. Both service users had up to date care plans but these were not yet in the new person centred care plan format implemented by SENSE. However, both care plans reflected the individual needs and aspirations of service users. These included information for staff on how best to enable the service users to make choices, support them with personal care and communicate with them in line with their preferences and need to exercise control over their daily lives and Hawthorn Road, 35 DS0000030424.V358738.R01.S.doc Version 5.2 Page 10 activities. Relevant risk assessments were also included and cross referenced to areas of daily living. The Statement of Purpose and Service User guide included all relevant and required information including a summary of the admission process. This information was also available in widget (a pictorial communication method). We understand that this is due to be updated soon. It was not possible to talk to service users due to their lack of verbal communication. However, the results of a ‘Have your say about’ survey indicates that advocates and relatives feel that the service ‘always’ meets the needs and aspirations of their friends or family ‘and in a manner that is flexible to J’s changing moods and needs’. Hawthorn Road, 35 DS0000030424.V358738.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, 8 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is able to provide good quality care by responding to service users changing needs and meeting their personal goals. Service users participate in all aspects of the home and are supported to take appropriate risks. EVIDENCE: The care plans and risk assessments for two service users were sampled. These contained detailed assessment information including a personalised activity schedule and a section on their social life and preferences in terms of outings, holidays, current medication, health and personal care needs and a health action plan. Each section of the care plan was accompanied by associated aims and objectives and by guidelines relating to eating, drinking, nutrition, mobility, communication and behaviour. Both service users had their own individual communication preferences incorporated into the communication guidelines that staff used to interact with them. Hawthorn Road, 35 DS0000030424.V358738.R01.S.doc Version 5.2 Page 12 Both files contained up to date reviews recording changing needs and circumstances and also risk assessments relating to all of the above areas. They also contained information for staff on how best to minimise the risks identified. Each service user also had a daily diary indicating the nature of their involvement in daily life and the degree to which they were consulted about decisions affecting them. Each service user has a core team of staff who meet monthly to monitor their care plan, evaluate progress and action any outstanding issues/needs. Minutes of these core team meetings were included in the files sampled. Both files also contained up to date review processes that evidenced a multi-disciplinary approach involving family, advocates and health and social care professionals. A core review meeting relating to one of the sampled service users was observed during the inspection visit. Staff used written guidelines on how to run the meeting that listed all areas to be reviewed. They also used the service users daily diary and the accident book including any section 37 reports, to inform the meeting. We observed that staff had a good awareness of the service users needs and were very familiar with issues relating to his health, medication, mobility, communication and social preferences. The service user wanted to go to a local beer festival for his birthday in February and this was discussed at the meeting. We observed that Staff were aware of a potential risk of over consumption of alcohol but were able to balance this against the service users rights to exercise choice. The service users primary aspiration was to maintain links with his family and to go home for his brothers 50th birthday. We noted that staff and the family liaison officer were working hard to help him do this. Discussions with staff revealed that some staff were confused about the new person centred care plan format which SENSE had introduced. The care plans sampled revealed that this new format had not yet been fully implemented throughout the service although the home was making good progress towards this. Hawthorn Road, 35 DS0000030424.V358738.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. Staff encourage service users to pursue a wide range of social and leisure activities and to integrate fully within the local community. Generic and specialist Staff ensure that strong links with family and friends are developed and maintained. The dietary needs of service users are generally well met but there is some scope for improvement. EVIDENCE: The statement of purpose indicates that this service seeks to acknowledge and respect the individuality of every deaf/blind person and to develop a unique and individualised service that is based on three principles including a person centred approach, a lifestyle approach and a specialist approach. The service adopts a ‘total communication’ approach which uses consistent interaction to encourage deaf/blind people to develop skills in both expressive and receptive communication. Staff were observed using a variety of Hawthorn Road, 35 DS0000030424.V358738.R01.S.doc Version 5.2 Page 14 methods of communication with service users primarily symbols, sign language and hand under hand communication. Discussions with staff revealed that not all of them were confident in all methods of communication. However the organisation give staff the opportunity to attend college courses to gain a BSL level 1 qualification as well as support from specialists in communication. We observed service users exercising choice and control over activities and which part of the home they wanted to withdraw to by using a range of communication methods including symbols, signing and the hand over hand project. We also observed service users and Staff communicating non verbally when one service user put on her boots to indicate she wanted to go out. Sampled care plans including activity schedules indicate that staff are combining communication skills/knowledge with a person centred planning approach in order to maximise each service users opportunities for participation, integration and independence. Service users are encouraged to take part in a wide range of community based social and leisure activities including swimming, hairdressing, shopping, going to the pub and local café. Additionally, there was also a significant range of home based activities developed in line with individual service users lifestyle aspirations. These included spa baths, sensory boxes and hair and beauty routines. Observation of staff rotas indicated that staffing ratios are good and that there are sufficient experienced and stable staff on duty to ensure service users are able to access and enjoy these activities. We observed that the male service user reviewed at the core review meeting needed to spend more time with other male service users. This was seen as gender/peer appropriate and listed for action by the team. None of the service users appeared to be accessing educational or employment related opportunities. The service appears to be aware of these issues. The self assessment report I looked at indicated a need for further work in this area including the development of better links with local colleges and the development of appropriate courses/employment opportunities for blind/deaf service users. Three out of the five people living in the home are deaf and do not respond to spoken English but all 5 people living in the home were born within the UK and this is reflected in the menu. One of the people living at the home was overweight and on a diet. The care plans sampled did give relevant information relating to food preferences and dietary needs. There is a four week rolling programme for food. Hawthorn Road, 35 DS0000030424.V358738.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, 20 and 21. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users physical and emotional health needs are met and they receive personal and health care support appropriate to their needs and preferences. Arrangements for the monitoring and administration of medication are good and function to protect the health and well being of service users. EVIDENCE: Sampled care plans included sections on personal care/hygiene needs and provided guidelines to staff on service users communication preferences and the process and method of care being delivered. These had been reviewed during the last six months by the core team. Both contained information on the service user’s preferred toiletries and both evidenced that service users had accessed the barber/hairdresser as preferred/needed. On the day of the inspection visit all five service users were appropriately dressed and well presented and it was observed that their individual choices relating to dress style were respected. Hawthorn Road, 35 DS0000030424.V358738.R01.S.doc Version 5.2 Page 16 Both service users sampled, had individual Health Action Plans which recorded their visits to health professionals. However, it was difficult to find information relating to the outcomes of these visits in one case. Both service users had received regular check ups with GP’s, dentists, opticians and chiropodists but one had been waiting for a clinical hearing assessment for some time. Staff supported service users in preparing for, getting to and experiencing health related appointments. Both care plans provided guidance for staff relating to the specific requirements associated with particular types of appointments. For example, one service user disliked going to the dentists and staff had to support her in a specific way. Both service users also had medication appropriate to their medical assessments. The service has all medication dispensed using a system which comes in blister packs. Medication Administration Records (MAR) were signed appropriately and guidelines for staff were satisfactory. I looked at the medical file and at MAR sheets for all five residents including a PRN (As required) protocol written by a learning disability nurse for one of the sampled service users. Both were up to date and had been signed and reviewed regularly. The MAR cross referenced to the blister pack indicating that the medicine was given as prescribed. A personalised exercise plan prepared by a physiotherapist and dietary advice given by the dietician was included in one of the health actions plans sampled and this also included information for staff on the service users preferences for taking their medicine. Both care plans also contained information relating to the service user and their family and/or advocate requests in the event of their death. There is a policy and procedure for administering medication in place and all staff have to be assessed as competent and to read/sign it. There is also a procedure for ordering medicine, guidelines relating to medication usage and side effects and a contact list of doctors and pharmacies. Examination of the medicine cupboard revealed that all medication was labelled appropriately. We observed evening staff setting up the medication for residents and all required procedures were followed including the signing on the back of the MAR sheet stating when, why and what dosage the medicine had been given to the service user. Hawthorn Road, 35 DS0000030424.V358738.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. The systems in place for making and responding to complaints are satisfactory and function to ensure that service users views are listened to and acted upon and that they are protected from abuse, neglect and self harm. EVIDENCE: A number of concerns relating to the management and administration of the home have been raised following the receipt of regulation 26 reports including risk assessments and staff fire training being out of date and the control of substances hazardous to health (COSHH) being unsatisfactory. Sampled care plans and inspection of training records indicate that the problems with risk assessments and staff fire training have now been dealt with. However, inspection of the premises revealed that the cupboard containing potentially hazardous substances was again unlocked thereby placing service users health at risk. The service has a detailed complaints procedure available in a variety of formats. Service users in the home have multiple and complex needs, difficulties with communication and very high levels of dependency on staff. Consequently, they rely heavily on the accuracy of staff perceiving, interpreting and facilitating their desire to raise concerns or make complaints. We observed a core review meeting relating to one service user reported as becoming agitated and aggressive on two occasions since the last review meeting. The care plan contained behaviour guidelines and challenging behaviour/physical intervention monitoring forms relating to these incidents. I Hawthorn Road, 35 DS0000030424.V358738.R01.S.doc Version 5.2 Page 18 observed staff referring to these and to incident analysis records together with accident reports and regulation 37 records, to review the service users behaviour, make necessary changes and evaluate progress. There had been one occasion when staff had had to physically restrain the service user from harming himself. Discussions with staff and examination of regulation 37 records indicated that this was a last resort, that other approaches had been tried first and that it had to be done in order to protect the service user. Discussions with two members of Staff present at the review meeting, revealed their awareness of rights versus risks issues inherent in the situation. Both said they had attended a two day training course in non violent crisis intervention and that this was updated annually. The service has a detailed adult protection policy and the Birmingham MultiAgency guidelines also inform practice. Both members of staff said they had also received training in ensuring practice is not punitive and in the area of adult protection. Both said they felt ‘well trained and supported’ in reporting any concerns relating to adult protection. Staff training records for December, 2007 show that 80 of staff were trained in dealing with challenging behaviour and 100 in adult protection. Regulation 26 forms indicate regular observations of staff practice and these are supported by the work of the practice development worker, NVQ assessors and the Registered Care Manager (RCM). The permanent staff team is relatively stable and personnel files revealed that all are appropriately checked via the Criminal Record Bureau (CRB). Agency staff are sometimes used but records from the supplying agency show that they are also CRB checked and cleared. The service has a policy on deaf/blind persons finances which contains rules and guidelines for staff on deaf/blind persons spending. The financial records for one service user were sampled and were found to be up to date with relevant receipts for expenditure. SENSE carries out regular financial audits as part of a planned programme. An audit dated December 2006 was inspected and revealed that the process is rigorous, comprehensive and used to inform practice developments and improve financial systems in line with the best interests of service users. The Mental Capacity Act (MCA) applies to everyone who is involved in the care/treatment/support of persons over 16 years who lack the capacity to make informed decisions. The two care plans sampled indicates that no capacity assessments have been made. The latest regulation 26 report indicates that these issues are under discussion with managers and that a capacity and best interests form has been developed but is not yet fully implemented. Hawthorn Road, 35 DS0000030424.V358738.R01.S.doc Version 5.2 Page 19 Hawthorn Road, 35 DS0000030424.V358738.R01.S.doc Version 5.2 Page 20 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, 25, 26, 27 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable, homely and safe environment and have access to the space and equipment they require in order to maximise their independence and meet their individual needs. EVIDENCE: 35, Hawthorne Road is registered with the CSCI as a care home providing personal care for five adults of either sex, aged between 18 and 65 that are deaf/blind or have a sensory impairment and an additional learning disability and/or mental health difficulties. The home is situated in a residential area with various local shopping and recreational activities nearby. It is a short car/bus ride to the High Street, One Stop shopping centre and Sutton Park. It has excellent public transport links to all parts of Birmingham. Hawthorn Road, 35 DS0000030424.V358738.R01.S.doc Version 5.2 Page 21 The house is a traditional detached residence that has been adapted to meet the needs of service users. All five service users have their own en suite bedroom. Inspection of these revealed them to be spacious, well decorated, clean/tidy and adapted to meet individual needs. Doors are lockable if the service user desires. The house has recently been redecorated with contrasting paint colours on the walls, black edging to indicate doorways and other obstacles, hardwood flooring and suitable lighting. Some curtains have recently been replaced. The furniture is clean, attractive and functional. There is a large garden to the rear of the home with a patio, lawn and a covered pond. A brick sun house doubles as a room for relatives to meet with service users weather permitting. There is a gardener contracted to look after the garden and property and maintenance records indicate that the SENSE maintenance team respond promptly to requests for maintenance works. In the kitchen a fridge and separate freezer is available. The food in the fridge was adequately labelled and records show that water and fridge/freezer temperatures are recorded daily. Several burns in the worktop areas were noted as potential sites for harbouring germs and bacteria. The laundry room contains the cupboard used for storing potentially harmful substances. This was unlocked thereby putting service users at risk. The manager’s office was untidy and disorganised on the day of the inspection. It proved very difficult to access files/documents some of which were not yet filed. The conditions of registration include a requirement that the RCM undertakes 21hrs of dedicated management/administration time weekly and this needs to be adhered to. Hawthorn Road, 35 DS0000030424.V358738.R01.S.doc Version 5.2 Page 22 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 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff recruitment, training and supervision are satisfactory and ensure that an effective staff team supports and protects service users and meets their individual needs. EVIDENCE: On the day of the inspection visit there were four members of staff on duty. However, both the Registered Care Manager (RCM) and the deputy were absent. Staffing levels are a condition of registration and these require that a minimum of three members of suitably qualified staff are on duty between 730am and 10pm including the care manager. Shortly after my arrival the general manager arrived apparently having been called by a member of staff indicating that the two tier on call system works well. SENSE do not have senior care workers but use a ‘shift-co-ordinator’ system. I spoke to the nominated staff member for that day. She was clear about her role and responsibilities and told me she was required ‘to make sure the day goes according to plan, that service users schedules are followed, that medication is given properly and that their needs are met’. Hawthorn Road, 35 DS0000030424.V358738.R01.S.doc Version 5.2 Page 23 Observation of interaction between staff and service users demonstrated a high degree of trust and dependency from service users and also good levels of staff confidence in responding to their needs effectively. The atmosphere between staff and service users was relaxed and easy and there was no sign of any tension between them. Staff are recruited to the service using policy and procedures developed by the SENSE Human Resources team. There is a person specification linked to the needs of the service users. Discussion with staff and inspection of personnel, recruitment, supervision and training records confirmed that the service has a strong commitment to training and producing well qualified, competent staff. The two personnel files sampled, revealed that staff received a good structured induction programme during their first six months. They also had a clear route through agreed training and development to enable them to deliver an effective service and to progress their own career. Staff training is monitored by matrices maintained by the home and the training department. Staff also receive support in completing NVQ through NVQ clinics. Training records indicated that nine members of staff had achieved NVQ level 3. This is a significant improvement and the service now meets the standard of 50 of staff having an NVQ in care. These records also showed that 87 of staff had now received fire training which was a requirement from the last inspection. We observed that a fire training DVD for in house use had been purchased. Staff are supported and developed through a system of supervision, appraisal and professional development to enable them to meet service users needs effectively. Supervision files showed that staff receive monthly supervision and annual appraisals from the Registered Care Manager (RCM) and that both of these processes together with the work of the practice development worker are used to highlight training needs. The personnel files were better organised and more up to date for newer staff than for longer term workers. The older files were missing substantial amounts of information including references. Hawthorn Road, 35 DS0000030424.V358738.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40 and 42. The quality outcome in this area is good. This judgement has been made using available evidence including a visit to the service. Management arrangements ensure that service users benefit from a well run home and that their rights and best interests are promoted and safeguarded. EVIDENCE: The previous inspection report noted that the Registered Care Manager (RCM) has completed an NVQ4 in care and the Registered Manager’s award. We understand that he will soon be transferring to another post and that his deputy will replace him. The home has a quality assurance system in place which covers areas such as finance, staff rotas, audits, fire alarm testing, maintenance, staff training and health and safety. Inspection of an internal finance/controls audit and associated recommendations reflected a high degree of commitment to Hawthorn Road, 35 DS0000030424.V358738.R01.S.doc Version 5.2 Page 25 ensuring that users best interests were looked after. A recent health and safety and environmental health audit dated September and March 2007 was inspected and found to be satisfactory. Examination of the service’s internal self assessment reports for Feb 2007 and an associated review dated October 2007 provided feedback from families and health care professionals which was positive in terms of the conduct and management of the home. Property and maintenance files were also examined. All equipment had been tested and all requested maintenance had been undertaken. Fire procedures including fire drills and alarm testing were in place and the fire alarm and extinguisher had both been tested recently. Training records showed that 87 of staff had received Fire Safety training and 100 of staff had been trained in health and safety procedures. Regulation 26 visits are carried out monthly by a service manager who completes a report. The last two of these were examined and indicated that this process is rigorous and that any problems identified are addressed and resolved. Hawthorn Road, 35 DS0000030424.V358738.R01.S.doc Version 5.2 Page 26 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 3 26 3 27 3 28 x 29 x 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 x 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 x x 3 Hawthorn Road, 35 DS0000030424.V358738.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA24 Regulation 24.11 Requirement Ensure that systems for controlling substances potentially hazardous to the health and safety of service users are implemented at all times and that the cupboard containing these is kept locked. Timescale for action 01/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations Implement the new person centred care plan format throughout the home to ensure that all service users assessed and changing needs and personal goals are accessible in their individual plan. Ensure that staff know how to use these. Review the practice of sharing the service users dining room as staff meeting/review room to ensure service user privacy and enable other service users to use this part of the home if so desired. Tidy up and organise the office area to ensure records DS0000030424.V358738.R01.S.doc Version 5.2 Page 28 2 YA24 YA28 3 YA41 Hawthorn Road, 35 4 5 YA12 YA33 6 YA40 required for the protection of service users and for the effective and efficient running of the business are accessible, maintained, up to date and accurate. Help service users find out about and take up opportunities for further education, distance learning, vocational, literacy and numeracy training . Ensure there are staff on duty at all times who can communicate with service users in their first language including sign and that they have skills in other communication methods relevant to service users needs. Ensure staff have access to relevant training, policies, procedures and codes of practice relating to the Mental Capacity Act and that they are able to explain these to service users and/or their representatives Hawthorn Road, 35 DS0000030424.V358738.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Birmingham Office 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 Hawthorn Road, 35 DS0000030424.V358738.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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