Care Home: 5 Shalnecote Grove

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What the care home does well Family contacts are promoted, so enabling residents to maintain contact with relatives and keep them updated with any events and changes. Residents are involved in making choices about the meals they want. They are involved in the shopping and preparation of the meals with support by the staff, so maintaining their independence as much as possible. Each resident has a health action plan that details specific needs and how these are to be met and appointment records show regular visits to chiropody, opticians and other health care professionals. Staff that we spoke to demonstrated good understanding of supporting residents to raise concerns. As with complaints staff spoken to demonstrated knowledge and understanding with regard to protecting residents from abuse.Flats are all self-contained and have doorbells and flashing alerts, so enabling residents to maintain their independence and alert them in case of a visitor of fire. Staff were observed to treat residents with respect and dignity. Staff spoken with had a good knowledge of individuals need. The atmosphere between residents and staff was relaxed and friendly, with good relationships observed. What has improved since the last inspection? The statement of purpose is now available in alternative formats including Braille, audio, large print and PDF format. This makes information more accessible to interested parties. There has been a major improvement in care planning documentation since the last inspection. Each resident now has a person centred plan that is detailed and informative, explaining specific needs and how these are to be met. Video diaries have been introduced. These are an excellent initiative as they demonstrate residents` involvement in life whilst also being a good tool for staff to ensure support given in consistent way. Risk assessments have been reviewed and completed for all resident activity where there is perceived risk` detailing the action required by staff to minimise the risk. There has been good improvement in the choice of activities that residents can participate in. This means residents are adequately stimulated and enjoy a fulfilling life. Staff hand washing facilities in the toilet area have been improved, meeting infection control standards, lighting in the communal hallways has been reviewed and improved, areas of the building have been decorated and minor repairs undertaken. This makes the environment a pleasant place for people to live. Ten of the staff employed at the home have received infection control training, promoting good hygiene standards. A new manager has been appointed. The manager was present for part of the inspection, during which he demonstrated understanding and commitment to providing a quality service to residents. Health and safety records in the main are in good order and up to date, promoting the safety of residents. CARE HOME ADULTS 18-65 Shalnecote Grove, 5 Kings Heath Birmingham West Midlands B14 6NG Lead Inspector Lesley Webb Key Unannounced Inspection 11th July 2008 13:00 Shalnecote Grove, 5 DS0000017148.V367834.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 Shalnecote Grove, 5 DS0000017148.V367834.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. Shalnecote Grove, 5 DS0000017148.V367834.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shalnecote Grove, 5 Address Kings Heath Birmingham West Midlands B14 6NG 0121 441 1640 0121 443 5723 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) www.sense.org.uk Sense, The National Deafblind and Rubella Association Vacant Care Home 6 Category(ies) of Learning disability (6), Sensory impairment (6) registration, with number of places Shalnecote Grove, 5 DS0000017148.V367834.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users must be aged 18-65 years. The service may provide personal care only for six persons (6) with a learning disability and sensory impairment July 2007. Date of last inspection Brief Description of the Service: Shalnecote Grove is a complex of flats owned by Moseley and District Housing Association. SENSE are the care providers and the registered owners. This inspection report relates to Shalnecote Grove, which consists of six flats registered as one service. Flat 1,2,3,4,5,are all on ground floor level. Flat 10 is located on the first floor and is accessed via a separate public hallway. All of the flats are self-contained and have a kitchen, bathroom, lounge, bedroom and store cupboard. However, the privacy of the residents in two of the flats is compromised as one of the rooms, the toilet and the kitchen is used by staff in flat 3 and one of the rooms in flat 10 is used as the managers office, as there is no staff accommodation. These shortfalls in physical standard matters are detailed in the homes statement of purpose. There is adequate parking available to the front of the property and a garden to the rear for use by residents when the weather permits. The home provides a service to six service users who are deaf blind or have sensory impairment and additional disabilities with complex needs. Shalnecote Grove, 5 DS0000017148.V367834.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this inspection over one day. The home was not informed that we would be visiting. Time was spent examining records, talking to staff and observing care practices, before giving feed back on the findings of the inspection to the 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). Information from this was also used when forming judgements on the quality of service provided at the home. The people who live at this home have a variety of needs. We took this into consideration when case tracking two individuals care provided at the home. For example the people chosen consisted of both male and female and have differing communication and care needs. The people who live at this home have communication needs that meant discussions with them could not take place. Because of this we spoke to staff on duty in order to find out about the support residents receive. The atmosphere within the home is inviting and warm and we would like to thank everyone for his or her assistance and co-operation. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. What the service does well: Family contacts are promoted, so enabling residents to maintain contact with relatives and keep them updated with any events and changes. Residents are involved in making choices about the meals they want. They are involved in the shopping and preparation of the meals with support by the staff, so maintaining their independence as much as possible. Each resident has a health action plan that details specific needs and how these are to be met and appointment records show regular visits to chiropody, opticians and other health care professionals. Staff that we spoke to demonstrated good understanding of supporting residents to raise concerns. As with complaints staff spoken to demonstrated knowledge and understanding with regard to protecting residents from abuse. Shalnecote Grove, 5 DS0000017148.V367834.R01.S.doc Version 5.2 Page 6 Flats are all self-contained and have doorbells and flashing alerts, so enabling residents to maintain their independence and alert them in case of a visitor of fire. Staff were observed to treat residents with respect and dignity. Staff spoken with had a good knowledge of individuals need. The atmosphere between residents and staff was relaxed and friendly, with good relationships observed. What has improved since the last inspection? The statement of purpose is now available in alternative formats including Braille, audio, large print and PDF format. This makes information more accessible to interested parties. There has been a major improvement in care planning documentation since the last inspection. Each resident now has a person centred plan that is detailed and informative, explaining specific needs and how these are to be met. Video diaries have been introduced. These are an excellent initiative as they demonstrate residents’ involvement in life whilst also being a good tool for staff to ensure support given in consistent way. Risk assessments have been reviewed and completed for all resident activity where there is perceived risk’ detailing the action required by staff to minimise the risk. There has been good improvement in the choice of activities that residents can participate in. This means residents are adequately stimulated and enjoy a fulfilling life. Staff hand washing facilities in the toilet area have been improved, meeting infection control standards, lighting in the communal hallways has been reviewed and improved, areas of the building have been decorated and minor repairs undertaken. This makes the environment a pleasant place for people to live. Ten of the staff employed at the home have received infection control training, promoting good hygiene standards. A new manager has been appointed. The manager was present for part of the inspection, during which he demonstrated understanding and commitment to providing a quality service to residents. Health and safety records in the main are in good order and up to date, promoting the safety of residents. Shalnecote Grove, 5 DS0000017148.V367834.R01.S.doc Version 5.2 Page 7 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. Shalnecote Grove, 5 DS0000017148.V367834.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 Shalnecote Grove, 5 DS0000017148.V367834.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 and 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering this service and their representatives have the information needed to decide if it will meet their needs. EVIDENCE: There is a static resident group in the home with all residents having lived in the home for a number of years. As at the previous inspection there is information available about the service in the form of a statement of purpose. In the main this contains sufficient information. We did note that although it includes information about what is included in the fee for living at the home, it does not include information about what is excluded. It is recommended this be put into place to ensure people are fully informed. The service user guide has been produced in a two-page typed document, which was in each residents file and was specific to them with individual photographs and some brief comments about the home. Further work is needed to ensure this document contains enough information to enable any new residents or their representatives to make an informed choice. We advised the practice supervisor to refer to the National Minimum Standards for Younger Adults standard 1.2. It was positive to find the statement of purpose is now available in alternative formats including Braille, Shalnecote Grove, 5 DS0000017148.V367834.R01.S.doc Version 5.2 Page 10 audio, large print and PDF format. This makes information more accessible to interested parties. We asked how interested parties would be made aware of the statement of purpose, service user guide and last inspection report. The manager informed us these are kept in the office with information given out when a vacancy occurs. We advised that the statement of purpose, service user guide and the latest report from the Commission should be made more accessible to anyone visiting the home, regardless of weather there was a vacancy or not. Shalnecote Grove, 5 DS0000017148.V367834.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. A person centred approach to care planning is undertaken. Individuals are involved in decisions about their lives but do not play an active role in planning the care and support they receive. EVIDENCE: All the residents in the home have complex needs as they are deaf and have a sensory impairment. Communication methods used with staff include body language, signing, the use of photographs, pictures and objects of reference. All residents have communication boards in their individual flats identifying staff and events in their lives. Interaction between staff and residents was observed to be good and residents were seen to be relaxed, smiling and using gestures to indicate they were happy when communicating. Information in the AQAA supplied to us prior to our inspection states ‘each person has a person centred care plan with clear goals and aspirations. Each person has an active weekly schedule which meet the needs, likes and choices Shalnecote Grove, 5 DS0000017148.V367834.R01.S.doc Version 5.2 Page 12 of the person. Each person has a total communication system. Each person has a person centred meeting with a multi disciplinary team; a review meeting then takes place 3 – 6 months after the meeting. Each person has regular core team meetings’. Through examining care plans, talking to staff and observing practices we found this information to be accurate. For example we found that there has been a major improvement in care planning documentation since the last inspection. Each resident now has a person centred plan that is detailed and informative, explaining specific needs and how these are to be met. Photographs have been used to aid communication, which are a good incentive and a ‘life story’ completed that gives a good insight to the person and things that are important to them. Each plan also has a communication section that again is detailed and informative, giving instructions on both expressive and receptive methods of communication. A requirement made at a previous inspection regarding care planning is now met (ensuring plans are reviewed). Staff confirmed that ‘core team meetings’ take place monthly where the needs of residents are discussed and actions agreed to address shortfalls. When talking to staff it was disappointing to find that residents have not been involved in these or in the compilation and reviewing of their care plans. No one could give an explanation as to why. This should be explored to promote residents rights to be involved in decision making processes and to promote person centred approaches to care and support. We were shown video diaries for one resident for activities including medication, dancing, morning routines, drying up and making lunch. These are an excellent initiative as they demonstrate residents’ involvement in life whilst also being a good tool for staff to ensure support given in consistent way. All plans that we viewed have a statement at the front ‘due to X sensory, communication and learning differences it is deemed that X lacks capacity (in line with the new Mental Capacity Act 2007). SENSE therefore adopts a multidisciplinary team approach to ensure that informed decisions are made in X best interests. It is important that any decision making process involves X himself, friends, family and support team’. We discussed this statement with the practice development worker advising that this statement is not in line with the Mental Capacity Act as everyone should be assumed to have capacity until assessed as otherwise. No assessments are in place to demonstrate this. We also advised that if after assessment a person is found to be lacking capacity in one area the assumption cannot be made they are lacking in all. The practice development worker informed us this statement was being explored by SENSE. We advised the home should consider removing this statement from the person centred plans and introducing a decision making protocol that is based on ‘best interest’. This would help evidence decision making and also consideration of the Mental Capacity Act. Shalnecote Grove, 5 DS0000017148.V367834.R01.S.doc Version 5.2 Page 13 Progress has been made to ensure risk assessments are reviewed and completed for all resident activity where there is perceived risk’ detailing the action required by staff to minimise the risk. We did find some omissions in risk management that should be addressed to offer further protection to individuals. For example one persons person centred plan states they can become anxious if they run out of cigarettes but no risk assessment has been completed and another persons plan identifies a medical condition, again with no risk assessment to support and minimise risk. Shalnecote Grove, 5 DS0000017148.V367834.R01.S.doc Version 5.2 Page 14 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): 12,13,14,15,16 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 and are supported to develop their life skills. Social, educational and recreational activities meet individuals’ expectations. EVIDENCE: There has been good improvement in the choice of activities that residents can participate in. This means residents are adequately stimulated and enjoy a fulfilling life. As part of the new person centred plans that have been introduced information regarding residents’ interests has been gained with plans now in place that ensure these are monitored. In addition to these each resident now has an activity schedule that details events during the day, evening and weekend. We did note that one persons plan identifies an action ‘X to source local cultural events/shops’. When exploring this we were informed that the staff member that this had been allocated to has left and the Shalnecote Grove, 5 DS0000017148.V367834.R01.S.doc Version 5.2 Page 15 action not passed to someone else. We advised this should be given priority to ensure the residents cultural needs are appropriately met. During our inspection we were only able to meet 2 of the 6 residents due to activities that they were participating in outside of the home. We view this as a positive, as our visit took place on a Friday afternoon and evening with the home being given no prior notice. This demonstrates the homes proactive approach to supporting residents to lead fulfilling lives. Records confirm residents participate in activities such as rock climbing, sensory stimulation, college courses, shopping, pub, meals, cinema, church and day trips. Since the last inspection the home has altered the transport is provides with 3 vehicles now available for residents to use. Everyone commented this has improved the choice of activities people can access whilst also promoting greater one to one events. As at previous inspections family contacts are promoted, so enabling residents to maintain contact with relatives and keep them updated with any events and changes. It was stated that staff send a newsletter to one resident’s family on a regular basis, so keeping them updated with their progress. SENSE has a family liaison officer who’s role it is to facilitate working with families. They have held a ‘family weekend’ at a local hotel, in the past and this provides an opportunity for relatives to keep up to date with SENSE plans, meet with staff and other relatives. We discussed with staff residents preferences with regard to personal relationships and were informed, “they are aware of each other but this is something we have not explored”. We advised that information regarding sexuality and relationships be obtained and training for staff be arranged. This should help support residents giving them the same opportunities as everyone else. We found evidence that residents are involved in making choices about the meals they want. They are involved in the shopping and preparation of the meals with support by the staff, so maintaining their independence as much as possible. Records of food intake are maintained and residents are weighed on a regular basis to monitor that they are taking a nutritious diet. Since the last inspection the majority of staff have undertaken healthy eating training to increase their knowledge and support residents further. We observed a staff member supporting one resident to prepare their evening meal. The member of staff explained to us, “I show various foods out of freezer, let them choose, encourage to be involved in preparation such as cutting vegetables, preparing salad, wash up afterwards, help them to do as much for selves as possible”. Shalnecote Grove, 5 DS0000017148.V367834.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: All residents live in their own flats in a housing complex and are visited by staff throughout the day or night as required, so providing the level of care they require. The circumstances ensure privacy for people and a degree of independence in their lives. Each residents person centred plan also includes information with regard to preferences for times of rising and retiring and personal care. This information promotes peoples wishes. Information about the support residents required in order to maintain personal hygiene is also included in their care plan. On discussion with staff it was stated that residents needed prompting or supervision and the records confirmed this. Care plans also included manual handling assessments and information on gender specific support. Residents were seen to be dressed appropriately for their age, culture, gender and weather. Shalnecote Grove, 5 DS0000017148.V367834.R01.S.doc Version 5.2 Page 17 Information supplied by the home in its AQAA with regard to health care states ‘Each person at Shalnecote has a very detailed and individual health action plan, this provides information to ensure staff support appropriately with health care needs. Each plan details how each person chooses to be supported in each area of health care, notes from all appointments are recorded and a log of all upcoming appointments is also recorded. SENSE has a hospital policy, which seeks to ensure staffing at all times during any hospital stays. We also provide specific training around individual need for diabetes, asthma and emergency medication administration. These health action plans support accurate and informed response to all health needs. Here at Shalnecote we receive specialist support from psychiatrists, occupational therapist and dietician to meet specific needs’. By examining records and talking to staff we found this information to be accurate. For example we found evidence that speedy referrals to health professionals have taken place, each resident has a health action plan that details specific needs and how these are to be met and appointment records show regular visits to chiropody, opticians and other health care professionals. The new person centred plans that have been introduced give good information regarding the specific health needs of residents. For example one persons needs have been identified for asthma and mobility while another’s are identified for secondary glaucoma and diplegic palsy. Health records also give good indicators to identify if a resident may be in pain, allergies and intolerances. One area needing further work is for a named resident with diabetes. This persons records give detailed information regarding eating and drinking and how this can affect being diabetic, being insulin managed and the taking of blood sugar level reading but do not include a risk assessment for identifying risks if these actions are not followed. As we explained to a staff member the completion of a risk assessment will ensure a holistic approach to health management in this area takes place. Medication is stored in each flat in locked cupboards and staff retain the keys to the cupboards. Within the locked cupboard is a further locked metal medication cabinet to house required medication. We were informed that residents are involved in the medication as far as possible. They go to the chemist to collect it and some sign the record indicating that they have taken the medication. We discussed why self-administration has not been explored further, possibly under supervision of staff. Staff agreed some might be capable of doing this especially if medication is supplied in blister packs. We suggested this be explored, to promote residents’ independence and control over their own lives. Shalnecote Grove, 5 DS0000017148.V367834.R01.S.doc Version 5.2 Page 18 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 supported to express their concerns. Staff have a good understanding of safeguarding residents from harm and abuse. EVIDENCE: Staff that we spoke to demonstrated good understanding of supporting residents to raise concerns. As one person explained, “Some get anxious with new staff, giving space to get to know you, familiarise yourself with them, you get to pick up vibe if good or bad mood, look for signs, in some ways acting out could be indication some thing is wrong, I would talk to staff and manager if not sure”. There is a written complaint procedure on display at the home. Staff could were unsure if this is available in a format that is more accessible to residents to enable understanding. Information provided by the home indicates that they have not received any complaints in the last twelve months and we have not received any complaints about the home. There has been one referral under the adult protection procedures that has been investigated and appropriate action taken. This record was not made available to the inspector and copies should be in the home at all times. We examined 3 residents financial records monies held on their behalf and found all to be in good order. Benefits go direct to SENSE finance department who then arrange for these to go to individual residents bank accounts. The manager is authorised to withdraw money and no resident currently signs for Shalnecote Grove, 5 DS0000017148.V367834.R01.S.doc Version 5.2 Page 19 his or her own monies at the bank (although the manager informed us he is looking into this). When looking at receipts we found that residents pay for meals outside of the home from their personal monies. The manager was unaware if contracts of residency give information about this practice, or if SENSE have a policy relating to this practice. We directed the manager to the statement of purpose which states meals are provided by the home. We instructed the manager that this situation must be investigated to ensure residents’ rights are upheld. We also advised the manager to find out how much the homes safe is insured to hold, as this information is currently not available. As with complaints staff spoken to demonstrated knowledge and understanding with regard to protecting residents from abuse. For example one person explained, “Look for changes in behaviour, mood, withdrawn, lose of interest in food, look for signs. Multi agency approach, inform CSCI, VA, line manager”. The majority of staff working at the home have received protection training. It is recommended that this be undertaken every 3 years to ensure staffs knowledge reflects changes in legislation and good practice. Shalnecote Grove, 5 DS0000017148.V367834.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 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 to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: There are six separate flats in this complex, which is owned by Moseley and District Housing Association. Five of the flats are located on the ground floor off a corridor area. The sixth flat is on the first floor and is accessed by a separate entrance. Flats are all self-contained and have doorbells and flashing alerts, so enabling residents to maintain their independence and alert them in case of a visitor of fire. All doors have locks so enabling privacy to be maintained. However, privacy is compromised in one of the flats as this is used for staff when undertaking a sleep-in shift, as there are no staff facilities. Staff also use the toilet and kitchen facilities in this persons flat. There is a very small office at the front of the building but this has insufficient space and poses health and safety risks to staff. We were informed that this is being Shalnecote Grove, 5 DS0000017148.V367834.R01.S.doc Version 5.2 Page 21 investigated with the possibility of the entrance of the home being moved so that the office can be made bigger. This should be given priority as staff were seen having to undertake a handover in the communal hallway, which impacts on confidentiality for residents. Since the last inspection staff hand washing facilities in the toilet area have been improved, meeting infection control standards, lighting in the communal hallways has been reviewed and improved, areas of the building have been decorated and minor repairs undertaken. Priority must now be given to addressing the issue of staff facilities and action taken to enhance the resident’s privacy possible. Four flats were seen and they were homely, decorated and personalised according to residents taste. They consisted of a lounge/dining area, kitchen, bedroom and bathroom. Five of the bathrooms had a toilet and bath and one had a shower facility, so meeting residents bathing needs. The flats were clean and adequately heated with good furnishings. Call bells were available in each flat to enable residents or staff to call for assistance when required. Ventilation in bathrooms must be explored as we were informed this is not adequate. Ten of the staff employed at the home have received infection control training, promoting good hygiene standards. Shalnecote Grove, 5 DS0000017148.V367834.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): 32,33,34,35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to meet the needs of residents. EVIDENCE: Examination of records and discussions with staff confirm there are usually 3 staff to 5 residents on shift during day downstairs and one to one upstairs. In addition to this the manger undertakes a variety of early and late shifts and is not included in the care numbers. We discussed staffing levels with the manager who explained that changes in shift patterns were being considered to meet residents’ needs. We advised that an assessment of dependency levels be undertaken as the home must be able to evidence the deployment of staff meets residents needs. Throughout the inspection staff were observed to treat residents with respect and dignity. Staff spoken with had a good knowledge of individuals need. The atmosphere between residents and staff was relaxed and friendly, with good relationships observed. When looking at staffing rotas we did note that these are not always being completed in full. We explained to the manager that all shifts must be Shalnecote Grove, 5 DS0000017148.V367834.R01.S.doc Version 5.2 Page 23 recorded, including sleep-ins and those covered by agency staff. This must take place to ensure records required by regulation are accurate and up to date. We examined a selection of recruitment files (including the newest staff to commence work at the home) and found them to contain an application from, health declaration, Criminal Record Bureau Check and two references, so ensuring a robust system that protects residents. We noted that one member of staff has a specific health need. We advised the manger to complete a risk assessment with regard to this to ensure this persons health and safety is not compromised. We also advised the manager to ensure a photograph and 2 forms of identification are on file for each person to promote residents safety further. We were informed that one resident is now being supported to be involved in the recruitment process for new staff. This is a positive move forward. The same opportunity should be given to all residents. Induction training for new staff is organised centrally by SENSE and includes areas such as protection, first aid, equality, values, diversity, working with deaf/blind people, communication manual handling, medication, challenging behaviour etc. Staff also complete modules over the six-month period that have a question and answer section and signed copies of these are retained on file. This ensures staff receive the training required to meet residents needs initially. Further training should be arranged in relation to the resident group such as diabetes, asthma, nutrition etc. to ensure staff are able to manage and care for residents medical needs. As at previous inspections staff were observed to be competent in communication with residents using British Sign Language or other communication methods used by residents, as they do not have speech. We were not able to communicate with residents directly, but staff showed good interpretive skills. Staff supervision both in group format and on a one to one basis is undertaken regularly to discuss progress, strengths/weaknesses, any concerns, and training needs. In addition to this the manager is in the process of implementing ‘development review’. This is a form of appraisal that identifies further development areas for staff. Shalnecote Grove, 5 DS0000017148.V367834.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 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. Further improvements to monitoring systems will offer assurances to residents that the home is meeting its aims and objectives. EVIDENCE: Since the last inspection a new manager has been appointed. He informed us that his main priority since taking up position in January 2008 was, “staff, to improve moral as this impacting on everything”. He informed us that moral is now excellent and this is reflected in the support residents receive. The manager holds a National Vocational Qualification (NVQ) level 4 and is due to start the Registered Managers Award shortly (aiming to complete by Christmas). In addition to this the manager has undertaken a range of courses including management of budgets, sickness monitoring, conduct, Shalnecote Grove, 5 DS0000017148.V367834.R01.S.doc Version 5.2 Page 25 recruitment and selection, risk assessment, finance, deaf blind and health and safety for managers. He has worked in care for 13 years, with SENSE for 5 of these, 2 years as a deputy manager and then 3 as a registered manager of another establishment. The manager was present for part of the inspection, during which he demonstrated understanding and commitment to providing a quality service to residents. All staff that were spoken to praised the management of the home. As one person explained, “100 better, feels like a team now. Theirs an air of professionalism, things get done, it’s a great place to work” and another “Good. Staff get on really well together and that’s good for the people we are supporting”. There are quality monitoring systems in place but further work should be undertaken to ensure these are based on the views of people. As mentioned earlier it is positive that a resident is now being supported in the recruitment of staff but this opportunity should be offered to everyone. There is a development plan for the home but we found this did not incorporate findings from surveys. The manager informed us that SENSE policy and quality team have sent questionnaires out and completed an audit. As yet a copy of this has not been supplied to the home. Monitoring visits in line with Regulation 26 of the Care Home Regulations take place with reports on file within the home. These evidence meeting residents, observations of activities, good practice, person centred plans, staff and premises. We examined a sample of health and safety records and found in the main these to be in good order and up to date, promoting the safety of residents. For example daily fridge and freezer temperatures are recorded, a Legionella assessment has been completed, gas appliances serviced and small electrical items safety tested. We could find no evidence of the home being inspected by the fire department and the manager had no knowledge of this ever occurring. We advised contact be made and a visit requested to ensure the homes fire safety systems protect residents in full. Records are in place of 3 monthly fire drills. These state as person receiving instruction ‘Shalnecote’. We recommend the specific names of individuals be recorded so that the home can monitor all staff regularly participate in these. The training matrix details 13 staff having undertaken moving and handling training, 10 food hygiene and 6 first aid. It also gives details of staff attending fire and health and safety training but many of these are out of date and refresher training is needed. Shalnecote Grove, 5 DS0000017148.V367834.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 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X X 2 X Shalnecote Grove, 5 DS0000017148.V367834.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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations Information about what is excluded from the fees charged for living at the home should be included in the statement of purpose to ensure people are fully informed. The service user guide should be reviewed and developed to provide prospective residents and their representatives with information about the services and facilities to enable them to make an informed choice about moving into the home. We advised the National Minimum Standards for Younger Adults standard 1.2 should be referred to. All visitors to the home should be made aware of the presence of the statement of purpose, service user guide and most recent inspection report. Residents should be involved in the compilation and reviewing of their care plans to promote residents rights to be involved in decision-making processes and to promote person centred approaches to care and support. DS0000017148.V367834.R01.S.doc Version 5.2 Page 28 2 YA6 Shalnecote Grove, 5 3 YA7 4 5 6 7 YA9 YA11 YA20 YA23 Residents should be involved in ‘core team meetings’ to promote residents rights to be involved in decision making processes. The home should consider removing the statement from the person centred plans regarding lacking capacity and introducing a decision making protocol that is based on ‘best interest’. This would help evidence decision-making and also consideration of the Mental Capacity Act. Risk assessments should be completed for all identified needs to minimise risk to residents. It is recommended that SENSE ensure all service users assessed needs and wishes re planned for and met. Self-administration should be explored further, possibly under supervision of staff, to promote residents’ independence and control over their own lives. Information about the amount the safe is insured to hold should be obtained to ensure residents money is safeguarded. Staff should undertake protection training every 3 years to ensure knowledge is maintained. Staff within the home should be made aware of the homes policies and practices with regard to expenditure of individuals monies on meals. A review of staff accommodation should be undertaken and action taken to ensure residents privacy is enhanced. The ventilation in the bathroom should be kept under review, and any action identified taken. Further training should be arranged in relation to the resident group such as diabetes, asthma, nutrition etc. to ensure staff are able to manage and care for residents medical needs. An assessment of dependency levels should be undertaken so that the home is able to evidence the deployment of staff meets residents’ needs. Staff rotas must be completed in full to ensure records required by regulation are accurate and up to date. When recruiting new staff it is recommended that residents be involved in the process. A risk assessment should be completed with regard to a named staff member to ensure this persons health and safety is not compromised. 8 YA24 9 YA32 10 YA33 11 YA34 Shalnecote Grove, 5 DS0000017148.V367834.R01.S.doc Version 5.2 Page 29 12 13 YA39 YA42 A photograph and 2 forms of identification should be on file for each person to promote residents safety further. A copy of audits undertaken and results of Quality Assurance should be available in the home, and the manager aware of content. A review of staff office accommodation should be undertaken to ensure the health and safety of staff is not compromised. Contact be made with the fire service and a visit requested to ensure the homes fire safety systems protect residents in full. Specific names of individuals are recorded when participating in fire drills so that the home can monitor all staff regularly participate in these. Greater numbers of staff should undertake fire and health and safety training to reduce the risks to residents. Shalnecote Grove, 5 DS0000017148.V367834.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands Office 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 Shalnecote Grove, 5 DS0000017148.V367834.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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