Care Home: 66 Dudley Street

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What the care home does well Information and assessment processes meet residents` needs. All six residents completed surveys with assistance from staff at the home and returned them to the Commission for Social Care Inspection (CSCI) prior to the inspection. All state they were asked if they wanted to move to the home and that they received enough information about it to decide if it will meet their needs. Comprehensive care plans that include aims and goals for identified needs ensure residents can be confident of their needs being met and understood by staff. Risk assessments have been completed that work in conjunction with both the care plan and personal guidelines. Again these are detailed and appropriate. Staff demonstrated understanding of involving residents in making decisions despite potential communication barriers. For example one person explained, "I always look at facial expressions, ask those who able to show me, they will pull and take me to kitchen for drink. Everyone is different, you gradually get to learn, pick up on mood swings. Try what I can to make happy, offer choices, put things in front, use pictures". Evidence indicates residents lead full and active lives based on their individual needs and choices. Activity timetables detail events including personal shopping, living skills, leisure activities, college and free time. Privacy and dignity are respected at this home within a risk-managed framework. The majority of people who live here require as a minimum at least one to one staffing, however we observed that attempts are still made by staff to ensure privacy and dignity is respected. All of the six surveys completed by residents (with assistance from staff) state that they know who to speak to if unhappy and how to make a complaint. Additional comments made include `my mom will show her concerns for me` and `staff who know me well would know if I was not happy and would speak up for me and make a complaint for me`. Throughout the inspection we indirectly observed staff and residents interacting well and the atmosphere was relaxed and welcoming. What has improved since the last inspection? Although staff have not received formal person centred care training the manager has devised questionnaires relating to this and discussed this subject in staff meetings in order to be assured staff have the appropriate knowledge and understanding in this area. She has also completed guidelines with regards the completion of monthly summaries that are maintained with each resident`s records, again to ensure staff have sufficient knowledge. The home has introduced the Treatment and Education of Autistic and Related Communication (TEACHH) programme to help residents make choices. This programme uses visual aids to develop communication. Since the last inspection the home has obtained advice from the community nurse regarding self-examination of breasts for residents who may lack capacity to understand with written guidelines now in place. In addition to this the community nurse has also produced guidelines for testicular examination, promoting further a holistic approach to health care management. All requirements and good practice recommendations identified at the previous inspection relating to medication have now been met. For example the supplying pharmacist has formulated specific forms to be used when residents require medication administering away from the home, the General practitioner has agreed directions for the administration of PRN medication, homely remedies are now stored separately from prescribed medication and a record is maintained of the temperature within the medication cabinet. A requirement was made at the previous inspection to reimburse residents for the cost of meals that form part of the contract fee for living at the home. We were supplied evidence during the inspection that monies are being reimbursed this week. The registered manager has instigated a number of adult protection referrals since the last inspection. All documentation completed demonstrates the manager is fully aware of her responsibilities in regards to adult protection and works proactively with the local adult protection teams. There have been major improvements to the environment in the last twelve months offering more comfortable surroundings for residents. These include all the communal areas being painted, adding pictures done by residents to the communal areas, improving lighting and shelving in the office, carpets steam cleaned all over the home, new cleaning schedules incorporating internal, external doors, frames and skirting boards, fitting a self-closing devise to a bedroom door and purchasing a new shed for a resident to accommodate his personal belongings. The company that owns this home have introduced electronic E learning where staff can undertake a variety of courses including abuse, food hygiene, infection control and health and safety. This is a flexible approach to learning as it allows individuals to undertake training on an individual basis internally within the home but still achieving external verification. Since the last inspection the manager has completed her application for registration with the CSCI and is now registered for this purpose. Throughout the inspection the registered manager demonstrated understanding of her role and responsibilities. What the care home could do better: It was noted that one residents cultural care plan consisted of one sentence `is white British and his cultural needs are met`. This does not constitute a plan of care, as it does not identify what cultural needs the individual has, how they are going to be addressed and what monitoring would take place. We recommend that action be taken to ensure that all residents cultural care plans contain enough information to meet individuals` needs. When examining individual activity records of two residents we found that in some instances staff are recording `out for a drive` without recordings the destination. As all the people who live at this home have communication needs that have the potential to impact on them giving a view on activities undertaken we recommend greater detail be recorded to ensure effective monitoring can take place. It was also noted that the activities recorded asbeing undertaken by one person do not reflect those contained within their activity timetable. One individual has identified dietary needs with an aim to reduce weight. Records of meals taken by this person do not demonstrate that the home is attempting to support them in this area. Further work should be undertaken to support this individual for example seeking advice from a dietician and purchasing low calorie food items. When touring the building we found all areas to be clean apart from the kitchen. This in comparison to other areas needs attention, with particular action taken to ensure kitchen cupboards and drawers are kept clean and free from stains and food debris. We recommend that the home obtain this information for all potential employees to offer further safeguards to residents. We recommend greater care be taken with regards to storing some food items as several were seen in the fridge either not covered sufficiently or not dated when opened. Also action should be taken to repair the damaged panel in the communal bathroom and to repair the faulty lighting in the dining room and rear garden. Improvements in these areas will offer further safeguards to residents` health and wellbeing. CARE HOME ADULTS 18-65 66 Dudley Street West Bromwich West Midlands B70 9LU Lead Inspector Lesley Webb Key Unannounced Inspection 3rd December 2007 09:00 66 Dudley Street DS0000054828.V355765.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 66 Dudley Street DS0000054828.V355765.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. 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 66 Dudley Street Address West Bromwich West Midlands B70 9LU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0121 525 3900 londonroad@tiscali.co.uk Milbury Care Services Ltd Azra Bibi Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection January 2007. Brief Description of the Service: 66 Dudley Street is a detached property, which has been purpose built to accommodate up to 6 people with Learning Disabilities/Autism. The property provides single occupancy rooms, all of which have en-suite shower, toilet and hand basin and are generous in size. Service users rooms are available on both floors and communal areas include a lounge, dining area, quiet room, and activity room. A domestic size and equipped kitchen is available and an adequate size laundry area. A Jacuzzi/spa bath is provided in the communal bathroom, and there are a further two toilets. The property is situated on a busy main road near to West Bromwich town centre and is easily accessible by public transport. The location enables service users to access local amenities and facilities and also neighbouring towns. There is a small drive to the front of the property and there is parking available on the road. There is good size rear garden, which is well designed and level, and provides extra privacy and space for service users whilst making use of the area. The home offers intensive support to a group of individuals with a range of complex needs and strives to promote ordinary living principles and social inclusion. The service has its own transport. Specific information regarding fees charged for living at the home is not included in the homes Statement of Purpose. The Statement of Purpose states ‘the fees that are charged are set out in the service agreement, which is issued to each service user prior to admission. This will be fully discussed with the individual and their advocate if appropriate before moving in’. Interested parties should contact the home directly for further information regarding fees. 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that we carried out over one day. During the visit time was spent formally interviewing staff, examining records and observing care practices before giving feedback about the inspection to the Registered manager. The people who live at this home have a variety of needs. This was taken into consideration when case tracking two individuals care provided at the home. For example the people chosen have differing cultural backgrounds, with varying communication and care needs. The home is registered to provide long term care for people by the reason of learning disabilities and autism. Discussions with residents living at the home were not appropriate. Therefore observation of behaviours was undertaken in order to form judgements on care provision. Prior to the inspection the home supplied information to the Commission for Social Care Inspection (CSCI). Also all six residents completed surveys and returned them to the CSCI. Information from both these sources was also used when forming judgements on the quality of service provided at the home. A number of records and documents were also examined as well as case tracking. The inspector would like to thank everyone for his or her co-operation and assistance shown during the visit, where the atmosphere within the home was welcoming and friendly. What the service does well: Information and assessment processes meet residents’ needs. All six residents completed surveys with assistance from staff at the home and returned them to the Commission for Social Care Inspection (CSCI) prior to the inspection. All state they were asked if they wanted to move to the home and that they received enough information about it to decide if it will meet their needs. Comprehensive care plans that include aims and goals for identified needs ensure residents can be confident of their needs being met and understood by staff. Risk assessments have been completed that work in conjunction with both the care plan and personal guidelines. Again these are detailed and appropriate. Staff demonstrated understanding of involving residents in making decisions despite potential communication barriers. For example one person explained, 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 6 “I always look at facial expressions, ask those who able to show me, they will pull and take me to kitchen for drink. Everyone is different, you gradually get to learn, pick up on mood swings. Try what I can to make happy, offer choices, put things in front, use pictures”. Evidence indicates residents lead full and active lives based on their individual needs and choices. Activity timetables detail events including personal shopping, living skills, leisure activities, college and free time. Privacy and dignity are respected at this home within a risk-managed framework. The majority of people who live here require as a minimum at least one to one staffing, however we observed that attempts are still made by staff to ensure privacy and dignity is respected. All of the six surveys completed by residents (with assistance from staff) state that they know who to speak to if unhappy and how to make a complaint. Additional comments made include ‘my mom will show her concerns for me’ and ‘staff who know me well would know if I was not happy and would speak up for me and make a complaint for me’. Throughout the inspection we indirectly observed staff and residents interacting well and the atmosphere was relaxed and welcoming. What has improved since the last inspection? Although staff have not received formal person centred care training the manager has devised questionnaires relating to this and discussed this subject in staff meetings in order to be assured staff have the appropriate knowledge and understanding in this area. She has also completed guidelines with regards the completion of monthly summaries that are maintained with each resident’s records, again to ensure staff have sufficient knowledge. The home has introduced the Treatment and Education of Autistic and Related Communication (TEACHH) programme to help residents make choices. This programme uses visual aids to develop communication. Since the last inspection the home has obtained advice from the community nurse regarding self-examination of breasts for residents who may lack capacity to understand with written guidelines now in place. In addition to this the community nurse has also produced guidelines for testicular examination, promoting further a holistic approach to health care management. All requirements and good practice recommendations identified at the previous inspection relating to medication have now been met. For example the supplying pharmacist has formulated specific forms to be used when residents require medication administering away from the home, the General practitioner has agreed directions for the administration of PRN medication, homely 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 7 remedies are now stored separately from prescribed medication and a record is maintained of the temperature within the medication cabinet. A requirement was made at the previous inspection to reimburse residents for the cost of meals that form part of the contract fee for living at the home. We were supplied evidence during the inspection that monies are being reimbursed this week. The registered manager has instigated a number of adult protection referrals since the last inspection. All documentation completed demonstrates the manager is fully aware of her responsibilities in regards to adult protection and works proactively with the local adult protection teams. There have been major improvements to the environment in the last twelve months offering more comfortable surroundings for residents. These include all the communal areas being painted, adding pictures done by residents to the communal areas, improving lighting and shelving in the office, carpets steam cleaned all over the home, new cleaning schedules incorporating internal, external doors, frames and skirting boards, fitting a self-closing devise to a bedroom door and purchasing a new shed for a resident to accommodate his personal belongings. The company that owns this home have introduced electronic E learning where staff can undertake a variety of courses including abuse, food hygiene, infection control and health and safety. This is a flexible approach to learning as it allows individuals to undertake training on an individual basis internally within the home but still achieving external verification. Since the last inspection the manager has completed her application for registration with the CSCI and is now registered for this purpose. Throughout the inspection the registered manager demonstrated understanding of her role and responsibilities. What they could do better: It was noted that one residents cultural care plan consisted of one sentence ‘is white British and his cultural needs are met’. This does not constitute a plan of care, as it does not identify what cultural needs the individual has, how they are going to be addressed and what monitoring would take place. We recommend that action be taken to ensure that all residents cultural care plans contain enough information to meet individuals’ needs. When examining individual activity records of two residents we found that in some instances staff are recording ‘out for a drive’ without recordings the destination. As all the people who live at this home have communication needs that have the potential to impact on them giving a view on activities undertaken we recommend greater detail be recorded to ensure effective monitoring can take place. It was also noted that the activities recorded as 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 8 being undertaken by one person do not reflect those contained within their activity timetable. One individual has identified dietary needs with an aim to reduce weight. Records of meals taken by this person do not demonstrate that the home is attempting to support them in this area. Further work should be undertaken to support this individual for example seeking advice from a dietician and purchasing low calorie food items. When touring the building we found all areas to be clean apart from the kitchen. This in comparison to other areas needs attention, with particular action taken to ensure kitchen cupboards and drawers are kept clean and free from stains and food debris. We recommend that the home obtain this information for all potential employees to offer further safeguards to residents. We recommend greater care be taken with regards to storing some food items as several were seen in the fridge either not covered sufficiently or not dated when opened. Also action should be taken to repair the damaged panel in the communal bathroom and to repair the faulty lighting in the dining room and rear garden. Improvements in these areas will offer further safeguards to residents’ health and wellbeing. 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. 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 9 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 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 10 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): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have the information needed to decide if the home is suitable for them. Assessment processes ensure prospective residents needs will be met. EVIDENCE: The home is fully occupied and there have been no new admissions since 2003. We viewed the admissions policy finding it to be comprehensive and if adhered to, should ensure any prospective resident needs are appropriately assessed, resulting in the home being confident of meeting individual’s needs. All six residents completed surveys with assistance from staff at the home and returned them to the Commission for Social Care Inspection (CSCI) prior to the inspection. All state they were asked if they wanted to move to the home and that they received enough information about it, reinforcing that information and assessment processes meet residents’ needs. 66 Dudley Street DS0000054828.V355765.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. Individuals are supported to make decisions about their lives, and play an active role in planning the care and support they receive. EVIDENCE: We sampled two residents files with both containing comprehensive care plans that include aims and goals for identified needs including those for personal care, family contact, outings in the community, support with professionals such as occupational therapists, speech and language, life skills, intellectual needs, decision making, medical needs and social interaction. Both also had care plans for culture however it was noted that one residents plan consisted on one sentence ‘is white British and his cultural needs are met’. We discussed this with the registered manager when giving feedback on the inspection findings who agreed this did not constitute a plan of care as it did not identify what cultural needs the individual had, how they are going to be addressed and what monitoring would take place. We recommend that action be taken to 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 12 ensure that all residents cultural care plans contain enough information to meet individuals’ needs. It was also pleasing to find for each individual plan of care personal guidelines are in place to support and give additional information relating to the implementation of the care plan. Risk assessment have been completed that work in conjunction with both the care plan and personal guidelines. Again these are detailed and appropriate. Many of the people living at the home have behaviours that can challenge. Individual procedures for those likely to be aggressive or cause harm or self-harm are in place that describe any restrictions on freedom. Since the last inspection written agreement regarding their contents has been obtained by the relevant social work departments offering further protection to individuals. Although staff have not received formal person centred care training the manager has devised questionnaires relating to this and discussed this subject in staff meetings in order to be assured staff have the appropriate knowledge and understanding in this area. She has also completed guidelines with regards the completion of monthly summaries that are maintained with each resident’s records, again to ensure staff have sufficient knowledge. This was reinforced when talking to staff, most of who were able to explain the specific care needs of residents. All residents living at the home have differing communication needs. We explored this when interviewing staff, all of who demonstrated understanding of involving residents in making decisions despite potential communication barriers. For example one person explained, “I always look at facial expressions, ask those who able to show me, they will pull and take me to kitchen for drink. Everyone is different, you gradually get to learn, pick up on mood swings. Try what I can to make happy, offer choices, put things in front, use pictures”. In addition to this the homes uses the Treatment and Education of Autistic and Related Communication (TEACHH) programme to help residents make choices. This programme uses visual aids to develop communication. Other efforts to support residents to make decisions include many policies and procedures in large print picture format and care plans and other documents that include pictures and the use of colours. 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to make choices about their life style and to develop their life skills. Social, educational, cultural and recreational activities meet individuals’ expectations. EVIDENCE: As at the previous inspection evidence indicates residents lead full and active lives based on their individual needs and choices. Information supplied by the home prior to the inspection states ‘at Dudley Street we provide individual activities, individual timetables that have been devised with the service users and their advocates, however a flexible daily approach works well within the environment. This enable service users to experience a wide range of leisure activities according to their individual interests and capabilities and promotes choice to whether they want to engage in a specific activity or not. We encourage and support all external learning opportunities, the last three years we have had a OCP programme with collation from Handsworth college for all 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 14 six service users, use the local facilities i.e. hairdressers, shops, YMCA, gym, swimming baths, pubs and use local transport such as trams, trains and buses. All of our service users own a bus pass and cinema passes. This information was found to accurately reflect services received by residents. Records include detailed and comprehensive care plans and risk assessments relating community activities, further education and social contacts. Activity timetables detail events including personal shopping, living skills, leisure activities, college and free time. Actual activities that residents participate in are then recorded in the daily records. When examining individual activity records of two residents we found that in some instances staff are recording ‘out for a drive’ without recordings the destination. As all the people who live at this home have communication needs that have the potential to impact on them giving a view on activities undertaken we recommend greater detail be recorded to ensure effective monitoring can take place. It was also noted that the activities recorded as being undertaken by one person do not reflect those contained within their activity timetable. Information supplied by the home prior to the inspection relating to meals states ‘we continue to monitor nutritional needs and health needs through the appropriate tools, take action when required’. Records of meals indicate that residents receive a range of food items and work has been completed to ensure everyone’s nutritional needs are assessed. When case tracking two residents care needs we found that one individual has identified dietary needs with an aim to reduce weight. Records of meals taken by this person do not demonstrate that the home is attempting to support them in this area. In addition to this the persons weight chart details their weight fluctuating but not being reduced. We discussed this with the registered manager who was of the opinion that staff needed further guidance with regards to recording accurately what products the individual has eaten but also that further work should be undertaken to support this individual for example seeking advice from a dietician and purchasing low calorie food items. It is acknowledged that some work has been undertaken to support this person, for example staff accompany them to the gym and swimming but further work is recommended to ensure this persons needs are met in full. 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that residents receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: As at the previous inspection privacy and dignity are respected at this home within a risk-managed framework. The majority of people who live here require as a minimum at least one to one staffing, however we observed that attempts are still made by staff to ensure privacy and dignity is respected. For example staff only entered bedrooms upon approval of the resident and wishes in relation to times of rising, bathing and mealtimes were seen to be respected. The health needs of residents are well managed. We found that comprehensive records are maintained for each individual for medication, health appointments and medical conditions including epilepsy. All residents have health action plans in place for conditions including epilepsy, mental health, vision, chiropody, occupational therapy and psychology. Since the last 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 16 inspection the home has obtained advice from the community nurse regarding self-examination of breasts for residents who may lack capacity to understand with written guidelines produced by the community nurse now in place. In addition to this the community nurse has also produced guidelines for testicular examination, promoting further a holistic approach to health care management. All requirements and good practice recommendations identified at the previous inspection relating to medication have now been met. For example the supplying pharmacist has formulated specific forms to be used when residents require medication administering away from the home, the General practitioner has agreed directions for the administration of PRN medication, homely remedies are now stored separately from prescribed medication and a record is maintained of the temperature within the medication cabinet. The home uses the Boots medication dispensing system, with four senior staff employed at the home responsible for the administration of medication. All records relating to medication being booked into, administered and returned to the supplying pharmacy that we sampled appear appropriate. 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to express their concerns, and have access to a robust, effective complaints procedure, are protected from abuse and have their rights protected. EVIDENCE: All of the six surveys completed by residents (with assistance from staff) that were returned to the CSCI prior to the inspection state that they know who to speak to if unhappy and how to make a complaint. Additional comments made include ‘my mom will show her concerns for me’ and ‘staff who know me well would know if I was not happy and would speak up for me and make a complaint for me’. Detailed complaints policies are in place for both informal and formal complaints. The complaints procedure is also available in widget easy read format with a copy on each residents file as an additional aid to communication. Due to communication barriers we were unable to ascertain residents views on complaint processes and therefore spent additional time interviewing staff in order to assess their knowledge in this area. The majority demonstrated knowledge and understanding in this area, explaining their responsibilities to support residents. For example one person explained, “expressions they show, they will let you know by eye contact or the way they stand and look at you. If I notice anything I would try to find out what the problem is, try things bit by bit, it’s a process of elimination, communication is the key”. . 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 18 Two complaints have been made since the last inspection. Records evidence that full and comprehensive investigations have taken place ensuring people can be confident concerns are taken seriously. A selection of protection policies and procedures were examined with all appearing appropriate. Since the last inspection the home has reviewed the adult protection policy so that it makes reference to local authority adult protection guidelines and actions the manager must take in the event of an allegation. The registered manager has instigated a number of adult protection referrals since the last inspection. All relating to physical aggression between residents. All documentation completed demonstrates the manager is fully aware of her responsibilities in regards to adult protection and works proactively with the local adult protection teams. In addition to this the majority of staff spoken to demonstrated good understanding of protection. As one member of staff explained, “if I see anything I must report it. If I didn’t report it could continue, ignorance is not an excuse”. The majority of people living at this home have complex care packages to manage behaviours that can challenge, including physical and verbal aggression. There is a structured training programme in place ensuring staff are qualified to support residents in this area. Any staff that have not received the required training are not allowed to work with individuals who pose a risk of injury to either themselves or others. Financial practices were examined and found to be acceptable with records in place of all transactions and monies stored securely. We do however recommend that the home explores increasing the amount of money it is insured to hold on behalf of residents or seeks alternative storage facilities as on the day of inspection monies held on behalf of residents exceeded those that the home is insured for. Improvements in this area will offer greater protection to residents. A requirement was made at the previous inspection to reimburse residents for the cost of meals that form part of the contract fee for living at the home. We were supplied evidence during the inspection that monies are being reimbursed this week. 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment that encourages independence. EVIDENCE: Information supplied by the home prior to the inspection regarding the environment states ‘Dudley Street provides an accessible, homely, clean, hygienic, safe, well maintained and comfortable environment to meet individual service users needs, and meet current legislation. The home is well located to access local community facilities and transport networks. The home was purpose built for the needs of the service users; all bedrooms are of adequate size and have ensuite bath/shower facilities. We provide the service users with their own personal space in a self contained single room, with suitable furniture and fittings, we encourage and support service users to add personal belongings that reflect their personality and culture’ and ‘in the last twelve months we have had all the communal areas repainted, we have added 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 20 pictures done by service users at college to make the communal areas more personalised. The lighting wattage in the office is higher, new shelving in the office secured to the wall. We have an annual renewal programme for bed linen in place. Carpets have been steam cleaned all over the home. New cleaning schedules incorporating internal and external doors and frames and skirting boards. We have fitted a self-closing devise on bedroom one and purchased two new office chairs. The TEACHH workstation is up and running and have purchased a new shed for a service user to accommodate his personal belongings. We have straightened slabs in the garden which had subsided, built shelves in service users room to accommodate his personal belongings and installed a bell to a service users room who is profoundly deaf’. This information was found to be accurate when we undertook a tour of the premises. The home should be congratulated for the efforts made to the environment since the last inspection and for the plans for further improvements in the next twelve months that include replacing flooring and furniture and turfing the slabbed area of the rear garden to offer greater protection to residents with complex needs who are at risk of injury from falls. Infection control measures appear good at this home with no serious issues identified. There is a small domestic laundry that was seen to have all appropriate equipment, infection control policies are in place to promote good practice and many of the staff have received infection control training. When touring the building we found all areas to be clean apart from the kitchen. This in comparison to other areas needs attention, with particular action taken to ensure kitchen cupboards and drawers are kept clean and free from stains and food debris. 66 Dudley Street DS0000054828.V355765.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): 32,34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who live there. EVIDENCE: Relationships between staff and residents appear good. Throughout the inspection we indirectly observed staff and residents interacting well and the atmosphere was relaxed and welcoming. The positive relationships were further reinforced in all six residents surveys completed and returned to the CSCI. All state staff treat them well and listen and act on what they say. Information supplied by the home prior to the inspection in relation to recruitment, selection and training states ‘we employ a diverse staff team who receive a full Milbury induction and LDAF training to ensure they are capable and confident to complete their duties effectively when starting with the company. All potential candidates are CRB/POVA checked prior to employment commencing. Staff are aware of their role and responsibilities and are paid to attend all training course that are relevant to the home’. We sampled training and recruitment records and found this information to be 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 22 correct. For example the recruitment records of the three newest staff to commence employment at the home all contained the required records as detailed in the Care Home Regulations 2001 including evidence of suitable references, enhanced criminal record bureau discloses (CRB) and application forms. It was noted that in two instances the application forms did not detail full employment history. We recommend that the home obtain this information for all potential employees to offer further safeguards to residents. Since the last inspection the company that owns this home have introduced electronic E learning where they can undertake a variety of courses including abuse, food hygiene, infection control and health and safety. This is a flexible approach to learning as it allows individuals to undertake training on an individual basis internally within the home but still achieving external verification. In addition to this the registered manager has accessed external training with regards to the local authorities vulnerable adults procedures and the mental capacity act. All staff employed at the home (apart from four new members of staff who are currently undertaking LDAF) either hold a national vocational qualification level 2 or 3 or are working towards completing this. The home should be congratulated for its efforts with regards to improving training. 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, with effective quality assurance systems in place. EVIDENCE: Since the last inspection the manager has completed her application for registration with the CSCI and is now registered for this purpose. Throughout the inspection the registered manager demonstrated understanding of her role and responsibilities. There are various quality monitoring systems in place that allow the home to measure if it is achieving its aims and objectives. For example an annual quality assurance audit that includes obtaining the views of residents, staff and 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 24 stakeholders in the community has been completed, monthly unannounced visits are undertaken by the operations manager, with detailed and informative reports published, policies and procedures are regularly reviewed to reflect changes in legislation or good practice and regular staff meetings take place in order that staffs views are obtained. As at the previous inspection it was pleasing to find that the development plan completed by the registered manager is based on the National Minimum Standards for Younger Adults, allowing the home to measure its service against required legislation. The management of health and safety is good within this home, ensuring risks to residents are minimised. We randomly sampled a number of maintenance records and found all to be up to date and in good order. In addition to this no serious health and safety issues were identified when we toured the premises. We recommend greater care be taken with regards to storing some food items as several were seen in the fridge either not covered sufficiently or not dated when opened. Also action should be taken to repair the damaged panel in the communal bathroom and to repair the faulty lighting in the dining room and rear garden. Improvements in these areas will offer further safeguards to residents’ health and wellbeing. All requirements identified at the previous inspection are now met. These include ensuring all staff participate in an annual fire drill, ensuring fire drills take place at times when reduced staff numbers are in place and auditing of COSHH records. 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 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 3 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 3 33 X 34 3 35 3 36 X 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 3 X 3 X 3 X X 3 X 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 26 No. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA13 Good Practice Recommendations That action is taken to ensure that all residents cultural care plans contain enough information to meet individuals’ needs. That greater detail be recorded with regards to destinations of activities as apposed to ‘out for a drive’ to ensure effective monitoring can take place. Those activities undertaken by residents reflect those offered in activity timetables to ensure residents choices are not restricted. That further work be undertaken to support a named individual with regards to their dietary requirements, for example seeking advice from a dietician and purchasing low calorie food items to ensure this persons needs are met in full. That the home explores increasing the amount of money it is insured to hold on behalf of residents or seeks alternative storage facilities to offer greater protection to DS0000054828.V355765.R01.S.doc Version 5.2 Page 27 3 YA17 4 YA23 66 Dudley Street 5 YA24 6 7 YA34 YA42 residents. That the kitchen be cleaned, with particular action taken to ensure kitchen cupboards and drawers are kept clean and free from stains and food debris to promote good hygiene standards. That the home obtains a full employment history for all potential employees to offer further safeguards to residents. That greater care is taken with regards to storing some food items, ensuring those in the fridge are appropriately covered and dated when opened. Action should be taken to repair the damaged panel in the communal bathroom. The lighting in the dining room and rear garden should be repaired. Improvements in these areas will offer further safeguards to residents’ health and wellbeing. 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 66 Dudley Street DS0000054828.V355765.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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