Care Home: 51 & 53 Brierley Lane

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What the care home does well The service meets people`s needs well. Personal care, health, dignity and skills are positively promoted. A health professional told us they have no concerns and that the service is `so far doing very well`. Service users are supported to access the community by staff who are safely recruited and supervised. Those that responded to our survey have indicated high levels of satisfaction. Relatives have referred to `high standards of care`, `excellent care`, feeling `welcomed`, `friendly,` `pleasant`, `kind staff`, and `I could not find any fault in anything they do`. A relative also said that staff are `familiar with the service user`s likes and dislikes which reflects in their approach`. Inspection confirmed this. Eight service users with the support of their key workers returned completed pictorial surveys to us. Five indicated maximum satisfaction with the service. The service is managed well on a day-to-day basis using a structured approach to care planning and provision. What has improved since the last inspection? Since the last inspection in August 2006 some steps have been taken to improve and maintain the environment through some redecoration, some recarpeting and the purchase of a new cooker. It also appears that since the last inspection staffing levels significantly deteriorated but that steps have been recently taken to redress this. Five staff have been appointed since Summer 2007 and an additional two staff have been recruited and are awaiting start dates. This has improved continuity of care for service users as the use of agency staff has reduced from for example 630 hours in August 2007 to 88 hours in November 2007. Two staff vacancies remain outstanding but the Manager is confident that Brierley Lane will be fully staffed by January / February 2008. What the care home could do better: Three requirements relating to the Management of the home were issued following the last inspection. These have not been met and remain outstanding. Brierley Lane has been taken over by a different care provider and although there remains some confusion as to the date responsibility transferred to them, they were registered with us shortly prior to this inspection. The Manager is now optimistic that concerns about management levels, the frequency of hersupervision and safety training for staff previously identified will start to be addressed. It is important that these are addressed without delay. Other areas must also receive the Providers priority attention: Whilst staffing levels are not considered currently to be unsafe, it is clear that for a variety of historical and contractual reasons the staffing complement exists now for the convenience of staff rather than the interests of the service or service users and this should be reviewed. Feedback to us from relatives, staff and service users consistently described reduced options for service users for example at evenings and weekends and personal care taking longer in the morning when staffing is reduced. Training opportunities were also strongly criticised by staff and their concerns are upheld by inspection. Training frequency is inadequate with staff having undertaken little training in the previous three years. Of particular concern is lack of training in health and safety and moving and handling when some service users are totally dependent on staff to move and handle them safely. Consideration of outcomes for service users is paramount however and to date from observation and feedback there are no known concerns about staff competence or service user safety and this has favourably balanced what would otherwise have been outcomes judged as poor. CARE HOME ADULTS 18-65 51 & 53 Brierley Lane Coseley Wolverhampton West Midlands WV14 8TU Lead Inspector Deborah Sharman Key Unannounced Inspection 7th December 2007 10:00 51 & 53 Brierley Lane DS0000071279.V356413.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 51 & 53 Brierley Lane DS0000071279.V356413.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. 51 & 53 Brierley Lane DS0000071279.V356413.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 51 & 53 Brierley Lane Address Coseley Wolverhampton West Midlands WV14 8TU 01902 402 103 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) enquiries@lonsdale-midlands-limited.co.uk Lonsdale (Midlands) Limited Miss Kulvinder Rai Care Home 12 Category(ies) of Learning disability (12) registration, with number of places 51 & 53 Brierley Lane DS0000071279.V356413.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service: Care Home only to service users of the following gender : either whose primary care needs on admission to the home are within the following categories: Learning Disabilities (LD) 12 The maximum number of service uses to be registered is 12. 2. Date of last inspection 22.8.06 Brief Description of the Service: The home is owned by Bromford Corinthia Housing Association Limited who lease the building to the care providers, Lonsdale Midlands Limited (Care Tech Community Services) The home comprises two detached purpose - built bungalows in a residential area close to all amenities and services. The accommodation is suitably designed for the needs of the Service Users with appropriate door widths and wash-hand basin heights. The bungalows provide accommodation for twelve service users. The accommodation in each of the bungalow consists of six single bedrooms, lounge, dining room, kitchen, one assisted bathroom with WC, one disabled WC, one assisted shower and WC, storeroom, a storage space for wheelchairs, office, shower room with WC, a laundry / utility room, garden at the rear and car park at the front of the premises. The staff sleeping-in room is situated at bungalow 53 and a quiet / resource room is located at bungalow 51. The weekly fee is not currently written in documentation available to the public. Further clarification should be sought from the provider. 51 & 53 Brierley Lane DS0000071279.V356413.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 unannounced key inspection between 10.00 am and 6.30pm. As the inspection was unannounced no one associated with the home received prior notification and they were therefore unable to prepare. As it was a key inspection the plan was to assess all National Minimum Standards defined by the Commission for Social Care Inspection (CSCI) as ‘key’. These are the National Standards, which significantly affect the experiences of care for people living at the home. The service is required to provide written information about the home in an annual return and this was requested prior to inspection. However the Manager did not receive the request so this information was not available to us in advance of the inspection but is due to be returned on 17th December 2007. Prior to inspection, the Commission for Social Care Inspection sought the views of service users currently living at Brierley Lane and other third parties associated with the home by sending out surveys. Responses were received from 1 health professional, 8 staff, 8 service users and 4 relatives. All this information along with information already known to us was analysed prior to inspection and helped to formulate a plan for the inspection and has helped in determining a judgement about the quality of care the home provides. During the course of the inspection the Inspector used a variety of methods to make a judgement about how service users are cared for. The Registered Manager was unavailable when the Inspector arrived as she was leading a team meeting. She rearranged the rest of her day however in order to be available to answer questions and generally support the process. We were able in addition to talk to five care staff and another Manager about their experiences. We used a new observational framework (SOFI) to observe care including staff interaction with four non-verbal service users in 5 minute time slots for an hour over the lunch period. We also had the opportunity to observe a staff member administering medication. We also spoke to a further service user about leisure activities and meals and he shared his life storybook with us. We then assessed in detail the care provided to two service users using care documentation and by discussing their needs and care with the manager. We also toured the premises and sampled a variety of other documentation related to the management of the care home such as maintenance of the premises, the management of service users finances, complaints and the recruitment of staff. 51 & 53 Brierley Lane DS0000071279.V356413.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Three requirements relating to the Management of the home were issued following the last inspection. These have not been met and remain outstanding. Brierley Lane has been taken over by a different care provider and although there remains some confusion as to the date responsibility transferred to them, they were registered with us shortly prior to this inspection. The Manager is now optimistic that concerns about management levels, the frequency of her 51 & 53 Brierley Lane DS0000071279.V356413.R01.S.doc Version 5.2 Page 7 supervision and safety training for staff previously identified will start to be addressed. It is important that these are addressed without delay. Other areas must also receive the Providers priority attention: Whilst staffing levels are not considered currently to be unsafe, it is clear that for a variety of historical and contractual reasons the staffing complement exists now for the convenience of staff rather than the interests of the service or service users and this should be reviewed. Feedback to us from relatives, staff and service users consistently described reduced options for service users for example at evenings and weekends and personal care taking longer in the morning when staffing is reduced. Training opportunities were also strongly criticised by staff and their concerns are upheld by inspection. Training frequency is inadequate with staff having undertaken little training in the previous three years. Of particular concern is lack of training in health and safety and moving and handling when some service users are totally dependent on staff to move and handle them safely. Consideration of outcomes for service users is paramount however and to date from observation and feedback there are no known concerns about staff competence or service user safety and this has favourably balanced what would otherwise have been outcomes judged as poor. 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. 51 & 53 Brierley Lane DS0000071279.V356413.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 51 & 53 Brierley Lane DS0000071279.V356413.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, 3. Quality in this outcome area is good. No new service users have been admitted to the home since the last inspection. There is no indication that performance has changed. The needs of existing service users continue to be met. The Statement of Purpose and Service User Guide require review but the Manager is aware of this and the matter is in hand. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s Statement of Purpose and Service User Guide have been recently reviewed but are in the process of being reviewed again. Steps are being taken to make the Service User Guide more accessible and the Manager is aware that the weekly fee needs to be included along with a fuller description of the range of needs the home is registered and equipped to meet. Inspection found some service users to be funding their own specialist equipment such as beds to meet their needs. As the Provider has a responsibility to provide equipment suitable to meet the needs of service users, it is important that service users financial liabilities are clear and agreed in advance with third party representatives where necessary. There has been no new service users admitted to the home since the last inspection some fifteen months ago. However, the Manager confirmed that 51 & 53 Brierley Lane DS0000071279.V356413.R01.S.doc Version 5.2 Page 10 she currently has no concerns about any service users and believes the home to be responding to their needs and changing needs appropriately. Social Services undertook a reassessment of all service users’ needs in Summer 2007, and the Manager confirmed that this process verified that Brierley Lane continues to meet the needs of everyone living there. As part of this inspection, we looked at care provided to two people in detail and identified no concerns about how their needs are being met. 51 & 53 Brierley Lane DS0000071279.V356413.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, 9. Quality in this outcome area is good. Individuals are involved in decisions about their lives and, where possible, play an active role in planning the care and support they receive. People are supported in a way that maximises their skills and independence with due regard to minimising risk where possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked in detail at the care provided to two people. Care plans are descriptive and provide sufficient information and detail to help staff provide individualised care that meets expectations, preferences and needs but also considers the service users ability to contribute to the tasks described. This serves to promote dignity, independence and maintain existing skills. It is particularly positive to see well-recorded ‘mini meetings’, which are held quarterly where staff reflect on the service users care and plan ahead for the forthcoming three months. They evidence a planned and systematic approach 51 & 53 Brierley Lane DS0000071279.V356413.R01.S.doc Version 5.2 Page 12 to the provision of care with good communication between the members of the care team. We observed the plan of care being adhered to. For example we saw a service user who uses incontinence pads being taken to the toilet helping to maintain continence, comfort and self esteem. We also observed this service user being helped when necessary to eat his lunch as opposed to being fed in accordance with the written plan. This shows that staff are aware of the care plan and by implementing it they are helping the service user to improve and maintain his skills and independence. Staff are aware of risk assessments and the need to adhere to them to minimise risks arising from identified hazards. A range of appropriate risk assessments is in place for the service users whose care was looked at in detail. It was positive to see a full range of risk assessments for a non-weight bearing service user. Risk assessments consider how to safely support this service user with a range of different transfers. We observed the service user, and others to be transferred safely using appropriate equipment. We also saw staff explaining to service users who are none vocal and sight limited what they were doing e.g. which medication or drink they were being offered and these tasks were managed at the service users pace. This effectively demonstrated that service users are respected and offered choices. Activities are evaluated. This also helps the service to consider the wishes and preferences of service users who are otherwise not able to verbally express a preference. 51 & 53 Brierley Lane DS0000071279.V356413.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, 17. Quality in this outcome area is excellent. People are able to make choices about their life style and are supported to develop their life skills. Social, educational, cultural and recreational activities meet individual’s expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We talked to one service user who was happy with his activities and it was clear that staff understand his particular interests and hobbies. He showed us photos of trips to Blackpool; his favourite resort, a meal out with his key worker and as a keen gardener with a greenhouse photos of hanging baskets and tomatoes that he has grown. It was particularly positive and valuing to hear him describe how tomatoes he has grown are used in cooking meals at the home. An excellent life storybook that he had completed with the help of his key worker was a very effective way for him to tell us his story. 51 & 53 Brierley Lane DS0000071279.V356413.R01.S.doc Version 5.2 Page 14 For other service users with less vocal ability we looked at financial expenditure as a way of assessing activity levels. For the service user chosen these records showed a full and active social life. We also observed service users coming and going throughout the day of inspection. Staff and relatives consistently expressed satisfaction with activity provision. One relative said ‘They lead a better life than we do.’ Another said ‘X experiences many services within the community i.e. church visits, barbers. I visit every Saturday and I am made to feel welcomed’ and ‘they encourage me to have a celebration of X’s birthday at Brierley Lane and to invite other family members’. Feedback told us that there is less satisfaction with activities available in evenings and weekends. Due to merging the day and residential services about 12 months ago day care staff hours are well provided Monday to Friday as most day staff have stayed on their original contracts. This reduces the number of staff available to support activities in evenings and at weekends. Food stocks were plentiful and it was pleasing to see good quantities of fresh fruit, vegetables and salads. We observed mealtime using SOFI methodology, a tool that helps us to assess care provision. Staff took time to support all service users to sit at the table including those who needed hoisting. Lunchtime was calm and was conducted at service users pace. Service users were supported appropriately by sufficient numbers of staff and their independence and existing skills were respected. We could see that each service user enjoyed their lunch. Staff ate lunch with service users and we witnessed a good level of interaction and engagement between staff and service users, who due to the nature of their disabilities depend upon staff for this stimulation. Each service user was then supported to leave the table, use the bathroom and get ready to go out for the afternoon. We observed staff supporting service users to have drinks in between meals. One service user who can vocalise said he enjoys his meals at Brierley Lane. 51 & 53 Brierley Lane DS0000071279.V356413.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. Quality in this outcome area is good. Service users are supported to maintain their personal care in accordance with their preferences and with attention to their privacy and dignity. Service users receive regular health screening and action is taken in response to identified changes in health. This helps service users to stay as healthy as possible and gives them the best opportunity to recover from any ill health. Some action is required to improve medication systems. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All service users present as well groomed with their own individual styles. Personal care is provided in private and moving and handling, where service users require this support is safe. Service users dignity is promoted by using continence pads where necessary but the need to use the toilet is not overlooked by the provision of these pads and people are supported to also use the toilet where this is planned. Bathrooms and toilets have locks and staff were seen to close the toilet door when supporting a service user but this option is not available with bedrooms as internal door lock mechanisms have 51 & 53 Brierley Lane DS0000071279.V356413.R01.S.doc Version 5.2 Page 16 never been provided. The Manager has committed to addressing this by asking each individual and or their representative about their personal preference; recording outcomes in care plans and taking action where necessary. We could see from records sampled that service users health is promoted by accessing a range of routine health appointments such as dentist, chiropody, optician, flu vaccinations, medication reviews and physiotherapy. Service users specific and individual health concerns are also addressed as staff support them to attend specialist appointments for X rays and consultations with medical Consultants. Records show that staff monitor and record any observed changes in a service users health and medical advice and treatment is obtained. There is evidence that issues are followed up with medics as records on the whole are well completed by staff with sufficient detail to evidence this. It was somewhat disappointing then to find for one service user that she had not been taken back to the GP after two days as advised following no improvement in her condition. The day of inspection represented the fourth day following medical consultation. The Manager was advised to ensure that the service user returns to the GP without delay. We observed a staff member administer medication to two service users. The staff member had a kind and encouraging approach informing the service users in advance of each medication she was giving them. She signed for each administration immediately afterwards which is good practice. We sampled medication administration records for three residents. For each, significant changes had been made to prescribed medical direction and medical authorisation for two of these could not be evidenced. The Manager said the changes had been made a while ago and records had been archived. In the meantime handwritten changes to pre printed Medication Administration records continue to be made, increasing the risk of human error. The Manager was advised to ensure that the GP reviews the prescribing directions. Other aspects of medication management were found to be good. 51 & 53 Brierley Lane DS0000071279.V356413.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, 23. Quality in this outcome area is good. There has been one complaint since the last inspection fifteen months ago and this was managed positively. There are omissions in adult protection training for staff, however outcomes to date for service users are good. There have been no incidents that have compromised their protection and they are considered to be safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One complaint has been received from a neighbour about furniture tipping near her property. Records show that the Manager who met with the neighbour could show that the tipped furniture had not come from the home and the matter was satisfactorily resolved within a day of receiving the complaint. There have not been any incidents that compromise service users protection. Most staff remain in need of adult protection training (seven out of twenty five have completed this) as it will develop their awareness of what abuse is and how they should respond. A staff member, who had attended training the day before inspection, had an excellent understanding. She was very clear about her role in a variety of given scenarios. The Manager who has undertaken appropriate training recently was advised to obtain a copy of Wolverhampton’s Multi Agency Safe Guarding procedures to enable the Manager to know how to 51 & 53 Brierley Lane DS0000071279.V356413.R01.S.doc Version 5.2 Page 18 respond according to locally agreed protocols in the event of an allegation or concern. Staff spoken to feel that very robust systems are in place to safeguard service users money and inspection confirmed this. Clear guidelines must however be in place to ensure that the limits and extent of service user expenditure is clear such as the purchase of specialist equipment to meet assessed need. The Manager said that service users have ‘always done this’ e.g. purchased expensive items such as for example a specialist bed, without being able to evidence the decision making process for this, the service users understanding of this, that independent representation was available or that responsibility for this is clear in contractual documentation. 51 & 53 Brierley Lane DS0000071279.V356413.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is good. The physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises including the small rear garden showed the bungalows to be well maintained, well equipped, clean, tidy and comfortable. Managers and staff are satisfied that they have sufficient equipment to meet service users current needs and where needs change staff and Managers know which agency to approach to reassess the suitability of equipment. Bedrooms have been personalised to reflect the tastes and interests of the service users who occupy them. Bathrooms are functional and meet service users needs if they are a little on the clinical side with a hospital rather than a homely feel. Steps have been taken since the last inspection to improve the premises. The kitchen and lounge have been decorated and a new cooker purchased. A new 51 & 53 Brierley Lane DS0000071279.V356413.R01.S.doc Version 5.2 Page 20 carpet has been provided in bungalow 51 and another ordered for the hallway in 53 which was reassuring as currently it is heavily taped following some exploratory work that was necessary underneath it. The kitchen and laundry are clean and cleanable, water temperatures are safe and personal protective equipment is available at all key locations for use by staff. Clinical waste is managed effectively reducing odour and risk of cross infection. 51 & 53 Brierley Lane DS0000071279.V356413.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is adequate. Staff are aware of service users needs and present as caring and competent. They are supervised well and are recruited satisfactorily. However training is inadequate and staffing configurations are inflexible serving the personal interests of staff rather than the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Speaking to staff at inspection it was very clear that there is general dissatisfaction with training opportunities available to them. Staff were very vocal about this describing it as ‘very lax’ and ‘crap’. It was clear too that previous requirements issued by CSCI to improve health and safety training generally, have not been met. For example some staff have not been provided with moving and handling training for three years or health and safety training at all. This is of concern as there are service users who do not weight bare and who are dependent upon staff to move and handle them safely. The Manager is aware of omissions in training. She feels positive 51 & 53 Brierley Lane DS0000071279.V356413.R01.S.doc Version 5.2 Page 22 that training is slowly beginning to be provided under the new management arrangements for the home and that it will take time to achieve. A training matrix for January to March 2008 where staff are booked to attend courses two at a time when in total there are 25 staff indicates progress will be slow. Steps should be taken to increase the rate of training provision. Training records are poor and there was a lot of uncertainty about courses staff have and haven’t attended. A telephone call to head office was made to obtain clarity. This showed that in two years 2006 and 2007 the staff member sampled had undertaken one training course (fire training in 2006). This with the exception of infection control training was true for a second staff member. This falls well short of the national minimum standard, which is a minimum of five training days per year per staff member. However written feedback to CSCI about the approach of staff is very positive. One a relative said: ‘‘Very supportive in all fields. They do an excellent job. When visiting I have found staff to be most courteous and always helpful. In all staff do a very good job’. Another relative said ‘every need is catered for. All the staff are very kind and are interested in every one at the home. I could not find any fault in anything they do’. A third relative described how staff: ‘Respond to X at all times with feeling and kindness’. Our use of a short observational framework for inspection (SOFI) where staff were observed in 5-minute time frames over the course of an hour, confirms positive outcomes for service users. We observed staff interacting and engaging with all service users positively and the quality of interaction and practice was good including moving and handling practice. Staff are supported by fortnightly team meetings and supervision which in terms of frequency meets the national minimum standard. The quality of supervision records however is inconsistent. The service has suffered from what the manager reported to be a previous block on recruitment. As a result in August 2007, 603 agency care hours were used. Since then the manager has been able to recruit and five appointments with an additional two pending have been made. Records for November 2008 showed 88 agency care hours to have been used. The Manager is confident that by January or February 2008 that they will be fully staffed. Two services, day and residential were merged a year ago with most day staff staying on their original contracts of employment. This provides sufficient staff to support activities Monday to Friday 10.00 am – 4.00 pm at the expense of staffing levels at other peak times such as early mornings, evenings and weekends. Some staff have reported dissatisfaction with this to us and the manager described it as a ‘nightmare’. Furthermore, two service user surveys indicate their evenings and weekends are dictated by staffing levels, as does one relative’s. All staff that replied indicated mild concern about staffing levels with mornings being a particular concern. Discussion with staff and the 51 & 53 Brierley Lane DS0000071279.V356413.R01.S.doc Version 5.2 Page 23 manager at inspection indicate that the provision of 3 rather than 4 staff in bungalow 53, where service users dependencies are higher is safe but that their personal care needs cannot be met in a timely way, with some care tasks still being outstanding when ‘day’ staff start shift at 10.00am. The Manager explained that when possible a member of staff is sent from bungalow 51 to bungalow 53 to help with the early shift but this is not accounted for on the rotas. Staff are recruited satisfactorily. Where Managers have chosen to start staff without a Criminal Record Bureau check, a POVA first check (a check against the national list of unsuitable people to work with vulnerable people) and all other checks have been obtained and designated persons are identified and recorded for each shift to supervise the new individual, ensuring they do not work alone. Induction training systems to national standard are available but could not be evidenced for current new staff as packs, the manager said, were in their possession and due for completion the following week. 51 & 53 Brierley Lane DS0000071279.V356413.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, 39, 42. Quality in this outcome area is good. Support available to the registered Manager has been insufficient and management roles are unclear. However the Registered Manager remains optimistic that this is changing and in spite of this the home is managed well on a day-to-day basis. The Manager is providing staff with clear direction and is promoting good practice in the absence of formal staff training. This is providing service users with a home that is safe to live in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Brierley Lane has been taken over by Lonsdale Care Tech, replacing Bromford Carinthia as the registered providers of care. Bromford continue to own the 51 & 53 Brierley Lane DS0000071279.V356413.R01.S.doc Version 5.2 Page 25 premises and lease them to Lonsdale (Care Tech Community Services). Following receipt of an application, CSCI has recently (November 2007) registered Care Tech as the provider of services at Brierley Lane. Discussion at inspection indicated that Care Tech had taken over the management of the home a significant time before registration and time frames remain unclear. Discussion also indicated that it would be useful for the new provider to outline the roles and responsibilities of the various parties to the Managers and staff as there is a degree of confusion. There is also confusion within the service as the current model of management has evolved with little evidence of purpose or rationale. A management presence within the bungalows has eroded over time. There is no assistant manager and the team coordinators are more practice than management based. The Manager who headed the now amalgamated day service remains a manager, is not contracted to work shifts and is not answerable to the Registered Manager. Lines of accountability are not clear. We made this a requirement for improvement at the last inspection. The Manager said that the new provider is aware of and are considering the various issues although it is disappointing that the requirement has not been met. The Manager is hoping that two part time care posts could be used to create an assistant manager post as without this function she feels it is difficult to move the service forward. The Manager herself has received little supervision but again is hopeful that this will improve with the new provider. She has a newly appointed Manager who since her appointment in August 2007 has provided the Manager with supervision on two occasions and has carried out a regulation 26 visit. Untoward incidents have been reported to CSCI, with records showing four reports to have been miner slips and trips with no injuries sustained. One accident has been reported under RIDDOR when a staff member scolded herself when cooking water splashed against her. Steps are being taken to help the service to assess its own performance. The Provider has recently appointed a Quality Assurance Manager who has developed a tool that the Manager has completed and is waiting to discuss. In April 2007 surveys for service users were devised at the home. Key workers largely completed these for those people who could not vocalise feedback. Whilst this is a step in the right direction, greater thought needs to be given to how the quality of service can be judged for none verbal service users. In its current form the exercise risks becoming an assessment of need rather than an assessment of service quality. The Manager said in the absence of an assistant manager, she had not been able to analyse or act upon the surveys findings. Fire systems are serviced and checked regularly, a fire risk assessment is available which is due now for review being 12 months old and fire training has 51 & 53 Brierley Lane DS0000071279.V356413.R01.S.doc Version 5.2 Page 26 been prioritised and recently provided for most staff with more planned. The kitchen is very clean and systems to minimise the risk of illness acquired from food storage are in place. All service and maintenance documentation requested was available and was up to date which can assure service users they are living in an environment that is well maintained and as safe as possible. The Manager undertook to verify the date that wheelchairs were last serviced as 2005 is indicated in available records although she felt that they had been serviced since this time. Risk assessments are in place to control risk within the environment including assessments for hazardous chemicals, which are stored safely. The provision of health and safety training to include moving and handling training must be prioritised now for all staff although no concerns about practice were highlighted at inspection. 51 & 53 Brierley Lane DS0000071279.V356413.R01.S.doc Version 5.2 Page 27 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 3 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 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 2 X 3 X 2 X X 3 X 51 & 53 Brierley Lane DS0000071279.V356413.R01.S.doc Version 5.2 Page 28 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 5(1)(b c) Requirement The Service User Guide must set out the arrangements in place for charging and paying for any services additional to standard services, the provision of accommodation, food and personal care. This will ensure that any responsibility for funding specialist equipment required by the service user to meet need is clearly known and agreed in advance. New requirement arising from this inspection December 2007. Timescale for action 31/03/08 2 YA20 13(2) Changes in medication prescribing direction must be accounted for. Current changes in prescribing direction must be reviewed with the GP. This will ensure that up to date directions are accurately included in MAR charts and that medication management is accountable to minimise the risk of error. This will enable the home to demonstrate that the 31/12/07 51 & 53 Brierley Lane DS0000071279.V356413.R01.S.doc Version 5.2 Page 29 service user is administered medication in accordance with medical direction to promote good health. New requirement arising from this inspection December 2007. 3 YA35 18(1)(c)(i) Steps must be taken to ensure 31/12/08 that persons employed to work at the care home receive training appropriate to the work they are to perform to sufficiently prepare them to meet service users needs appropriately and safely. This is a repeated requirement from August 2006. 4 YA37 18(2) The manager must receive regular formal professional supervision. Requirement not met from August 2006 31/12/08 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 YA23 Good Practice Recommendations A copy of Wolverhampton’s Multi Agency Safeguarding Policy should be available to managers and staff on the premises to ensure appropriate action is taken in the event of an allegation or concern. This will ensure that service users are protected to the fullest extent possible. New recommendation arising from this inspection December 2007. 2 YA33 Staffing arrangements should be reviewed to ensure that the numbers of staff on duty at peak times are sufficient to effectively and efficiently meet the individual and collective needs of service users in a timely way. New recommendation arising from this inspection December 2007. 3 YA42 Documentation to demonstrate regular services and DS0000071279.V356413.R01.S.doc Version 5.2 Page 30 51 & 53 Brierley Lane maintenance of wheelchairs must be retained. New recommendation arising from this inspection December 2007. 51 & 53 Brierley Lane DS0000071279.V356413.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Shrewsbury Local Office Commission for Social Care Inspection 1st Floor, Chapter House South Abbey Lawn Abbey Foregate Shrewsbury SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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