Care Home: 74 Church Hill

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What the care home does well Staff treats each person as an individual and talk to people in a way that shows they respect them. Staff supports people to make decisions about their day-to-day lives by spending time observing their gestures, facial expressions and their non-verbal communication. Each person has a care plan so that staff knows how best to care for people, meeting their needs and their wishes. They are supported to keep appointments and do things to help them stay healthy and well. This includes having a balanced diet, eating healthily and enjoying their food. The food is nice and people have a healthy diet with fruit and vegetables. People are involved in choosing their meals with the use of photographs so they can make informed choices of what they wish to eat.The people living there were well dressed and had been supported with their personal care helping to raise their self-esteem and well being. People living there have their own bedroom. These are spacious with room for their personal things. The home is spacious, clean and comfortable with nice fixtures and fittings so it is a nice place to live. Staff has a good understanding of people`s needs, and this ensures continuity of care for people. There are regular maintenance checks and servicing of the equipment used at the Home and this ensures that they are safe to use. What has improved since the last inspection? The most noticeable improvement has been the move to new premises. This provides the people who live at Church Hill with a living environment that meets their needs. They can now move around the house more easily because it is a bungalow and there are no steps or obstacles in their way. There are different areas they can spend time in such as the lounge, the conservatory or their own bedroom which they can get to without having to climb stairs. The improvements the Commission asked for at the last visit concerning the property that the men used to live in, no longer apply. Staffing levels have increased during the day, this means people have increased activity because they have the staff to support them. The care manager has obtained a professional qualification, which ensures she has the skills needed to run the home smoothly. What the care home could do better: Some minor improvement to the daily records would help staff to record a more detailed picture of daily events. Where staff may have to physically stop someone from hurting themselves or others, they need training to do this safely. Staff needs to have very clear written guidance to help them do this safely. The move to 74 Church Hill has provided the people who live there, with a home that is more appropriate to their needs. It is a very pleasant, spacious bungalow. With some further improvements in terms of aids and adaptations, the lives of the people living there, will be enhanced further. It would be nice to see some improvements to the front of the house to make it more pleasant and inviting, and make it `their own`. Access to the house could be improved with hand grab rails or a ramp to help the people living there, get in and out without difficulty. There are plans to improve the garden so that the people can access it safely.There are plans to improve the kitchen. The kitchen is open plan and includes a dining area, appropriate access to the kitchen part to keep people safe needs to be considered. People should be supported to have the items of furniture they need in their bedrooms such as chest of drawers, bedside lamps, and mirrors. Some bedrooms need redecoration, and pictures, so that people have a nice `space` to call their own. The bathing, toilet and shower areas could be improved to make sure the people living in the home have the aids or equipment to support them safely. It was positive to see that the home is aware of the things that need to be done to improve the environment so that the people living there can benefit. CARE HOME ADULTS 18-65 74 Church Hill 74 Church Hill Wednesbury WS10 9DJ Lead Inspector Monica Heaselgrave Key Unannounced Inspection 30th March 2008 12:30 74 Church Hill DS0000070487.V360937.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 74 Church Hill DS0000070487.V360937.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. 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 74 Church Hill Address 74 Church Hill Wednesbury WS10 9DJ 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) The Sandwell Community Caring Trust Mrs Debbie Louise Cleaver Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: 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: 2. Learning Disability (LD) 3 The maximum number of service users to be accommodated is 3. Date of last inspection This is the first Key inspection for 2008. Brief Description of the Service: 74 Church Hill is a four-bedded bungalow and provides good one level accommodation for people who have physical disabilities. Access to the bungalow is via a step and so people who live there currently need to be able to negotiate this step until improved access is provided. The home was registered in October 2008, and is managed by Sandwell Community Caring Trust. The home is registered for three people who have a learning disability, currently all residents are male. The three men moved into the property from previous premises, which no longer suited their needs. The home promotes normal lifestyle principles, where people who live there have good opportunities and experiences with support. All three people have a double bedroom; one of these has an en-suite shower facility. The premises are a bungalow design and therefore appropriate to people who have difficulties with their mobility. There is a comfortably furnished, lounge and an open-plan kitchen/diner. A conservatory to the rear of the property provides further space in which people can relax and take part in activities. To the rear of the home there is a garden accessed by a ‘decked’ area, the garden is on more than one level and not therefore fully utilised by people who 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 5 live in the home. There are plans to improve this area and make it more accessible. The frontage to the property has parking for the homes own vehicle and other cars. The CSCI inspection report is available in the home for visitors to read if they wish to. Readers of this report are advised to check the service users guide for fees charged to live at this home. 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The visit was carried out over one day; the home did not know we were going to visit. This was the homes first key inspection for the inspection year 2008 to 2009. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home, previous reports and the manager completed a questionnaire about the home – Annual Quality Assurance Assessment (AQAA). A visit was made to the home and direct observations made of the support given to people using the service. The levels of learning disability and communication support needs of the people living in the home meant that it was not possible to seek their views directly. The Inspector met with the two people living there and observed the care practices, interactions and support from staff. Discussions took place with the senior member of staff on duty and another member of the care team. Records including personal files care plans, staff files and safety records were examined and a tour of the building completed. Following the inspection visit, verbal feedback was given to the senior staff member on the findings of the inspection. Thanks are due to the people who live at Church Hill, and staff members for their help and co-operation throughout the inspection process. What the service does well: Staff treats each person as an individual and talk to people in a way that shows they respect them. Staff supports people to make decisions about their day-to-day lives by spending time observing their gestures, facial expressions and their non-verbal communication. Each person has a care plan so that staff knows how best to care for people, meeting their needs and their wishes. They are supported to keep appointments and do things to help them stay healthy and well. This includes having a balanced diet, eating healthily and enjoying their food. The food is nice and people have a healthy diet with fruit and vegetables. People are involved in choosing their meals with the use of photographs so they can make informed choices of what they wish to eat. 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 7 The people living there were well dressed and had been supported with their personal care helping to raise their self-esteem and well being. People living there have their own bedroom. These are spacious with room for their personal things. The home is spacious, clean and comfortable with nice fixtures and fittings so it is a nice place to live. Staff has a good understanding of people’s needs, and this ensures continuity of care for people. There are regular maintenance checks and servicing of the equipment used at the Home and this ensures that they are safe to use. What has improved since the last inspection? What they could do better: Some minor improvement to the daily records would help staff to record a more detailed picture of daily events. Where staff may have to physically stop someone from hurting themselves or others, they need training to do this safely. Staff needs to have very clear written guidance to help them do this safely. The move to 74 Church Hill has provided the people who live there, with a home that is more appropriate to their needs. It is a very pleasant, spacious bungalow. With some further improvements in terms of aids and adaptations, the lives of the people living there, will be enhanced further. It would be nice to see some improvements to the front of the house to make it more pleasant and inviting, and make it ‘their own’. Access to the house could be improved with hand grab rails or a ramp to help the people living there, get in and out without difficulty. There are plans to improve the garden so that the people can access it safely. 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 8 There are plans to improve the kitchen. The kitchen is open plan and includes a dining area, appropriate access to the kitchen part to keep people safe needs to be considered. People should be supported to have the items of furniture they need in their bedrooms such as chest of drawers, bedside lamps, and mirrors. Some bedrooms need redecoration, and pictures, so that people have a nice ‘space’ to call their own. The bathing, toilet and shower areas could be improved to make sure the people living in the home have the aids or equipment to support them safely. It was positive to see that the home is aware of the things that need to be done to improve the environment so that the people living there can benefit. 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. 74 Church Hill DS0000070487.V360937.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 74 Church Hill DS0000070487.V360937.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): 1, 2, and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The support needs of people are assessed to make sure that they get the care that they require. The service has used assessment information well to ensure individuals have a home that will meet their needs, and preferences. Easy read information is available about what the service provides, and this ensures people know what to expect. EVIDENCE: Three people live at Church Hill they have a learning disability and additional needs. The three men moved into the bungalow at Church Hill in October 2007, their previous premises being unsuitable to meet their needs. The Statement of Purpose and Service User Guide were looked at and describe the services and facilities provided in the home. Information has been produced in an easy read and pictorial format, making it more accessible for the people who live at the home, although all would require support to fully understand this information due to the level of their learning disability. This is important to ensure people living in the home know what to expect. 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 11 The three men have lived together for a number of years, having come from long term hospital placements in 1999. Therefore, standard 2 relating to assessment could not be fully assessed. Sampling of two peoples’ personal files showed that assessments of their current support needs are in place, and these were compiled prior to the men moving to the bungalow, these are kept under regular review. The AQAA provides further information demonstrating that good efforts are made to ensure suitable assessment of need is ongoing. This was evident in assessing peoples’ needs and choosing a bungalow premises to meet these needs more fully, hence the move to Church Hill. There are also plans to adapt and maintain the property to ensure it remains a good home environment that is suited to the specific needs of the people who live there. Records seen also contained current license agreements and statements of terms and conditions of residence, including the fees payable. This sets out for people, what they should expect from the service and as such protects their rights. 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 12 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. People are supported to make choices and decisions about their daily lives. There is written information to guide staff in supporting peoples individual needs. The management of risk is positive, whilst keeping safety in mind, staff is mindful of improving the quality of life of individuals. EVIDENCE: Two peoples care plans were looked at for the purpose of this inspection. Care plans were up to date and generally set out in detail the care required to be carried out by staff and included information on the persons likes and dislikes, health needs, personal care, culture and preferences. There was information on files showing that staff had consulted with a range of professionals to promote best practice for the individual. Since the last key inspection the care planning system has improved, these now represent individual interests and plans for the future. The two files looked at included a ‘communication sheet’ these say exactly how best to 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 13 communicate with an individual, what behaviour to expect and how to manage that behaviour and interpret it. For instance where someone is flicking water in the shower, turning it off, the plan advises staff that this is ‘play’ and communication. Staff is advised to prompt to complete the task. This is a positive way to record the preferred communication style of the individual, and promote choice. Words and phrases regularly used by the individual are clearly recorded to aid staff understanding. Care plans showed a nice profile of the individuals routine, how they like things done and in what order, for instance, ‘ breakfast and medication before their shower, likes to wear slippers and not shoes, likes joggers and not trousers’. The plan also showed a list of abilities to include, ‘ tidying up, switching off the lights, taking clothes to the laundry, putting paste on the toothbrush, using flannel on face’. It was positive to see that the care plan identifies what people can do for themselves, and looks at all areas of the individual’s life. This detail ensures the diverse needs of an individual are identified in a person-centred way. This is particularly important where people cannot easily communicate their needs verbally, and it is evident staff have used their observations well in promoting the best practice for the individuals in their care. Plans stated the individuals’ religion and culture. Food records, and personal possessions such as music, and religious pictures showed that these aspects of a persons’ identity were respected. Care plans had been reviewed and updated to ensure the changing needs of people are known and acted upon. Behaviour management strategies were on sampled files had been kept under review and gave information on how best to support people. During the course of the day the staff were observed supporting one individual in this area and used their knowledge and skill well in diverting behaviour. People are supported to make choices about what and when they eat, when to go out, how to spend their time. On the day of the inspection one of the men had requested a trip out and it was positive to see that staff responded to this, demonstrating that people have choices and the service is responsive to this. Discussions with the two staff on duty indicated that risk-taking is promoted and staff support people to be safe and to promote their independence. A number of risk assessments were sampled and indicated that they are kept under review and updated due to changes in needs or circumstances. The people who live at the home have a range of complex needs, to include a learning disability, Epilepsy, impaired vision, difficulties with mobility, behaviour that challenges and communication needs. They require a great deal of care and support in order to keep them safe. It is therefore essential that the care plan say exactly what needs to be done to meet the individual’s need. Care plans were supported with risk assessments which identified specific health care and safety risks such as choking, risk of 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 14 falls, behaviour strategies for dealing with aggression and the approach to use to diffuse anxiety. It was positive to see that there had been improvement in developing the range of activities for people to engage in. This was supported by additional staff during the day so that people could engage in activities with the level of support they needed. An ‘activity sheet’ was seen which identified the things the person enjoys, and an ‘activity planner’ was seen which showed whether the activity had been carried out. This was reviewed on a weekly basis, which is an effective way to monitor the goals in the care plan to ensure they are suited to the needs of the individual. It was recommended that the daily records be extended as there is not a lot of room for staff to comment, for instance whether goals were achieved, the opportunities that had taken place, and the persons’ response to this, i.e. whether or not they enjoyed it. As part of their opportunity for self-help individuals were encouraged to take part in every day tasks such as tidying up, sorting clothes for the laundry and putting clothes in the wardrobe. These observations showed people received good support from staff. Information provided in the AQAA supported the person-centred care planning approach that has improved since the last inspection. 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported in making lifestyle choices and taking part in meaningful daytime activities, according to their individual interests, age and capabilities. People can access and enjoy the opportunities available in their local community, which is enhanced by having appropriate transport provided. Meals are varied, nutritious, and include a review of risk factors associated with food, which ensures nutritional needs are met. EVIDENCE: There are three people living at Church Hill, on the day of the visit two were present. From the records sampled and discussion with staff the two men spend their time doing activities with staff at home and in the local community. Records sampled showed and staff said that people go to parks, watch TV, go out for lunch, play skittles, have massages, and aromatherapy. One persons records showed that they had been out six times in the week, this consisted of lunch out, pub visits, rides in the mini bus, visit to Portland for music, and a day out at Bewdley. Extra staffing hours in the middle of the day have made 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 16 an improvement to the levels of activity and community presence and this is very positive. Access to the homes own tail lift vehicle ensures that transport is not a barrier to going out. During the visit the two men went out with staff, as this had already been prearranged. Later one person sat and listened to his Ipod; the other person spent some time in the conservatory where there is a variety of sensory equipment and a large fish tank. In one of the bedrooms one person showed his music centre and enjoyed listening to this. Both of the men seemed to really enjoy listening to music, interacting with staff and one in particular enjoyed moving around the house to different areas, something he can do safely in the bungalow as there are no stairs. This is positive because people can move freely and independently between different areas of the bungalow. Records showed that contact with relatives and family, is supported and encouraged. Food records showed that people were offered a varied menu. Fresh fruit and vegetables were observed in the kitchen, as was a good supply of snacks, biscuits and cakes. A record of what individuals eat was on file and nutritional assessments to support people who require particular diets were in place. Advice from the physiotherapist and speech therapist has been sought regarding the risk of choking on food and advising on appropriate seating when eating meals. People are supported to choose their meals by using a selection of photographs of food, and this enables them to have more choice and control over what they like to eat. 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 17 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. People who use this service have good personal support in the way they prefer. Health care is well planned; ensuring peoples’ needs are consistently met. Medication is well managed, which ensures people get the right medication at the right time, and the auditing system provides further safeguards for people who are dependent on staff. EVIDENCE: Church Hill accommodates people who have a range of personal care needs, some relating to age and mobility. Within this one person has specific and complex health care needs, which have recently led to a full assessment and review of his needs. Routines are flexible and seen to meet the needs of the people accommodated, each has a plan showing their particular routine and level of support needed, this ensures that those who require it have the structure they need and that 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 18 personal care is met in a manner that is appropriate to their individual preferences, particularly where an individual cannot easily communicate this. Healthcare plans had been reviewed and updated providing a good record of the changing needs of the person. Records were well organised making it easy to track appointments and treatment. A variety of health care professionals had been utilised to include the occupational therapist, speech therapist, dentist, G.P. psychologist, chiropodist and optician. All the relevant health professionals had been involved and their advice followed. A ‘compliments log’ was seen which contained positive comments from the hospital regarding the personal care offered to people, from a chief executive for improving the quality of life of people in the home, and from the local chemist for having an ‘excellent’ medication audit. Church Hill provides transport for people who live in the home, which ensures that those who require it have transport to appointments. This means that the difficulties experienced by some, do not hinder their access to healthcare facilities in the community. One persons’ health had deteriorated, a range of relevant specialist support was being utilised, to ensure he has the continuity of care that is needed to maintain good health. Another person has a tendency to fall over a falls risk assessment was in place advising staff how to support the person. The management and reporting of accidents is good. The accident record specifies the cause of the accident. Steps had also been taken to involve the physiotherapist and occupational therapist in assessing the type of aids people needed to keep them safe and well, this included wheel chairs, tail lift for the mini bus, and a waist strap and foot rests for the wheelchair. One person has a rather low bed, which may not be appropriate to his needs. He is currently in hospital having recently fallen whilst trying to climb over the bed rails. It was recommended that the occupational therapist assess the appropriate bed for this person who requires some assistance to get from his chair to the bed and also suffers from Epilepsy. Medication management was good. A record of medication received, administered and returned had been maintained. The security of medication was safe. The manager carries out in-house audits of medication to ensure procedures are followed and mistakes rectified, this is good practice and ensures the safe administration of medicines to people who live in the home. It is evident that the changing health care needs of people are kept under review and that the right support is utilised to ensure the wellbeing of the people in the home. 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 19 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 20 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. Arrangements are in place to ensure that the people living at Church Hill are protected from abuse, neglect and self-harm. Staff understands their role in safeguarding adults, and the service is looking to enhance this further by recruiting advocates. EVIDENCE: Previous inspection reports show that appropriate complaints and adult protection policies are in place as required. It is positive to see that an easy read complaint format was available in individual files. The complex support needs, levels of learning disability and communication support needs of the people living in this house, indicate that these documents would have little relevance for them individually. The AQAA informs that the organisation recognise this need and are hoping to recruit advocates to act on behalf of people who have no family to advocate for them. The training matrix and AQAA do not indicate if staff has undertaken training in the Mental Capacity Act. The Mental Capacity Act came into force in April 2007. This legislation requires an assessment of people’s capacity to be done if there is any doubt that the person does not have the capacity to make a decision about their health and welfare. If they are assessed as not having the capacity an Independent Mental Capacity Advocate (IMCA) can be appointed to help them with this. All staff should know about this legislation so they are aware of the implications of this 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 21 for the people living there. This would be another step forward in ensuring staff are well equipped to support vulnerable people in this area. Staff spoken to demonstrate that they are familiar with people’s ways and able to pick up on changes in behaviour, demeanour, and “body language” and so on as indicators that something may be amiss or that people is unhappy. They understand the importance of people’s routines and rituals in helping them feel comfortable and secure. Staff spoken with had a good understanding of protection procedures they were able to identify where they would be able to access further information and guidance should this be needed. There is a system in place for the logging and recording of regulation 37 incidents, which are reportable to CSCI. This ensures the regulatory body is informed of significant events involving people living in the home and action taken by the home to ensure peoples welfare and safety is protected. The home has a complaint log and no complaints are recorded for the last twelve months. The Commission have received no complaints about the home. The AQAA advises that multi agency procedures advising staff what to do and who to contact are available these were not looked at during the visit. The AQAA and training matrix reflected that staff had training in safeguarding adults, this showed four staff had training in 2004, one staff in 2005 and 2 staff in 2006. Staff needs to have regular updates on these procedures to ensure they know what to do in the event of an incident occurring. Risk assessments are in place regarding ‘grabbing’ behaviour. Staff gave a good description of how they manage this behaviour. The staff-training matrix showed that seven of the eight staff has done training in challenging behaviour. At a previous inspection a requirement was made for staff to undertake training in Accredited Physical Intervention. The training matrix does not indicate that this has been done. It is important that where staff may have to restrain someone for their own safety, that this is done safely to protect both the people in the home and the staff undertaking the restraint. At the last inspection the Commission required that the Physical Intervention policy be reviewed in line with Department of Health guidelines. This was not looked at on this visit, although the AQAA states that policies and procedures had been reviewed to ensure they are in line with current best practice. 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 22 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 23 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, 27,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a much-improved physical environment that is more appropriate to the specific needs of the people who live there. It is a very pleasant, safe place to live. Further improvements in terms of aids and adaptations will enhance this home further and fully meet the needs of the people living there. EVIDENCE: The three men moved into Church Hill in October 2007 from a property that was no longer suited to their needs. Church Hill is a four-bed bungalow, which is spacious and has everything on one level, so is more suited to the needs of the men who now live there. The house is spacious, nicely furnished, and comfortable. The shared spaces in the house include a comfortable lounge and a separate dining room. There is also a conservatory to the rear of the property. This has sensory equipment, music system and a large fish tank, the men were seen to be enjoying this space. On the day of the visit it was quite warm, the 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 24 conservatory would perhaps benefit from a fan to ensure people do not get too hot. The house is located on a residential street near to shops, bus routes and the local town. There is a wide frontage to the property allowing off road parking. It would be nice to see some improvements to the front of the house to make it more pleasant and inviting. Access to the house could be improved there is a step into a small porch and another step into the hall. It was observed that the two men had some difficulty negotiating this, in the absence of hand grab rails or a ramp to help them mobilise more independently. There is an enclosed private garden at the rear of the house. The garden is under utilised presently. There are different levels to the garden making it difficult for the men to use it safely. There are plans to change the garden area. Access to the garden is via a decked area; this when wet, is a slip hazard and not ideal for people who have difficulties with mobility. A risk assessment was in place for this to ensure no one goes out on the decking and gets hurt. The garden is potentially a nice space for people to enjoy when the weather permits, but a lot of work is needed to ensure it is suited to the needs of the people living there. The kitchen is functional and spacious, but requires new units. The dining room is open plan onto the kitchen. Presently a stair gate is used to prevent people going into the kitchen area. Some consideration is needed therefore of the layout of the kitchen/dining room so that it can remain open plan but with a more appropriate access to the kitchen part. There is a large bathroom area to include bath, shower, sink, toilet and bidet. However the bathtub is fitted to the wall and is boxed in. This inhibits staff from using hoist equipment or offering assistance to people who require it during a bath. The toilet is very low and there are no grab rails to support people. The bathroom therefore needs to be re-fitted so that it provides for the use of aids and or wheel chair access to support the men safely. The bedroom areas are spacious. One bedroom has an en-suite. The shower facility is a ‘walk in’ type suited to the needs of the person who occupies the room. There are no hand grab rails by the toilet or in the shower. The provision of such aids must follow an assessment of individual needs and meet the recommendations of an Occupational Therapist. Whilst the bedrooms are individual in style, some further work is needed to ensure they reflect the preferences of the occupant. One room had lots of pictures that were suited to the age, culture and religion, of the occupant, lots of personal possessions, and plenty of storage space. 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 25 Some items of furniture such as chest of drawers, bedside lamps, mirrors were lacking in individual rooms. Wallpaper was peeling in two of the rooms, and one room had no pictures on the walls whilst another had pictures more appropriate to a female. Whilst the move to Church Hill is a positive one in terms of providing a physical environment that is appropriate to the specific needs of the people who live there, there is a need to explore and provide specialist aids, adaptations and equipment to meet their needs. The men who live in this property have specialist needs, some relating to mobility and one person registered blind. Future planning to meet these needs should ensure that the aids and adaptations enable people need to live an independent life as possible. The AQAA provided some indication that there are plans for ongoing improvements. The home is a pleasant, safe place to live. The house is kept clean, hygienic and tidy and provides a homely and welcoming environment to live in. Observations indicated that the men could move freely around the house without being inhibited by steps or other obstacles. 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 26 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, 35, and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is staffed appropriately with more staff being available at peak times of activity ensuring people have the support they need to undertake activities. Staff had specialist training which means the needs of people in the home are understood and met in a caring and skilled manner. The arrangements for the recruitment, development, and support of staff are good and indicate that the main focus is providing a quality service. EVIDENCE: Staff interaction with people who live in the home clearly showed that they have formed friendly and respectful relationships with them. There were two care staff on duty caring for two people; the third occupant has been in hospital for some time. The day of the visit was a Sunday and people had just finished lunch. It was a relaxed atmosphere, with staff supporting people well with their personal care in preparation for a trip out. Staff used their methods of communication to guide and prompt people providing good cues as to what was happening next. 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 27 Staff rotas were sampled and showed that there are usually two staff with a third member during the day to support people in their activities, this ensures that staffing ratios provide for peoples’ support needs in following their interests. Staff responded well to prompts by people who live in the home. For example, a person who clearly indicated that they wished to go out was supported to do so. Staff also supported one person with their behaviour who found the presence of the inspector in the home distracting. The home has a rolling programme for both mandatory training and specialist training which is relevant to the individual needs of people living in the home. Two staff files were sampled and showed that training in the management of Epilepsy, Autism, and Dementia care, had been undertaken. Observation of staff training records and discussion with some staff members identified that training opportunities continue to be offered on a regular basis. The training matrix showed that staff had undertaken a variety of training, although the dates indicate that some staff now needs refresher training. A qualified staff team supports people living at Church Hill, at least 50 of staff should achieve an NVQ in care. Information received in the Annual Quality Assurance Assessment stated that 80 of the current staff team have either achieved or are working towards this qualification. This exceeds the expectation and ensures the staff team is equipped to undertake their role in a skilled manner. Information taken from previous inspection reports indicates that the recruitment procedures are robust. There are no personnel files kept in the home so these records were not sampled. The senior member of staff said that this information is kept at the Personnel department. The AQAA advises that appropriate checks had been made to make sure that staff were suitably experienced and qualified to work with vulnerable adults. Criminal Records Bureau checks had been made and written references received before the employee began work so that people were protected from the risk of having unsuitable staff work in the home with them. Recruitment information provided in the AQAA matched the records sampled in the home and discussion with staff on duty. These showed there is a full and structured induction programme. Staff felt their induction was positive, and was supported by 1-1 sessions with their manager in which they reviewed their training and development needs. Files sampled showed that one staff had seven supervisions in 2007, another file showed regular supervision in 2007, but a gap of four months between October 2007 and March 2008. Clearly, the past few months have been busy, with the move to the new premises, it may be that some issues have had to be allocated first priority. The indications are that any identified shortfalls will be sorted out appropriately. Yearly appraisals 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 28 were evident which provide a performance and development review for each member of staff. 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 29 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 manager and management team ensured the smooth running of the home in a competent manner. Systems are in place for monitoring the quality of the service offered with a view to continuous improvement. The health and safety of the people living in the home and staff was being well managed. EVIDENCE: The manager was not present during the inspection. The AQAA shows she has recently obtained the Registered Managers Award. We asked the Provider to fill out an Annual Quality Assurance Assessment, (AQAA). The AQAA contained 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 30 relevant information that was supported by the records sampled in the home, discussions with staff, and observations of the practice. It is a credit that those staff that was on duty were professional, competent and well informed as to all aspects of the running of the home. They spoke positively of the ethos of the home and demonstrated a commitment to improving the lives of the men who live there. Their practice was open and transparent, regular random checks take place to closely monitor the care practice. A system for monitoring and assuring the quality of the service provided is in place. Records seen reflected regular monitoring by the organisation, these visits take place monthly, and all aspects of the care practice are looked at and commented on, with areas identified for improvement or further development. This ensures better outcomes for the people who live in the home. A review of the service takes place annually to include questionnaires being sent out to seek the views of families and others. An annual development plan is available identifying the things the service wants to do to improve outcomes for the people who live in the home. The manager has ensured risk assessments are in place to protect people from harm during every day activity. Care plans have been produced and identify peoples needs and the level of support they need, in a person centred way. A number of checks are made by staff to make sure that peoples’ health and safety is maintained. Records showed that the fire alarm system had been regularly tested and serviced to make sure that it was working properly. Staff had completed fire drills to help them understand the importance of fire safety, and fire training was booked for April 2008. Staff had undertaken health and safety, safe food handling and infection control training. This ensures a safer environment for the people who live in the home, and safe food handling practices prevent people getting ill from unhygienic food handling. Accident and incident recording was appropriate and notifications had been sent to the Commission as is required by legislation. 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 3 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 3 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 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 3 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 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 YA7 2 YA18 3 YA23 Refer to Standard Good Practice Recommendations Daily records could be extended further to show how the person responds to activities. This will enable staff to expand on their recordings, and provide a more detailed picture of daily events. The moving and handling needs when supporting one person to bed should be reviewed. This will ensure that appropriate bedroom furniture and equipment can be provided and the person and staff are not at risk of injury. Accredited Physical Intervention training should be undertaken by all staff that may be involved in the restraint of a person living in the home. This is to ensure the safety and protection of staff and people living in the home. A Physical Intervention policy that is in line with Department of Health guidelines and The British Institute of Learning Disabilities Code of Practice, should be DS0000070487.V360937.R01.S.doc Version 5.2 Page 33 4 YA23 74 Church Hill available to staff. This will guide them in safe practice. 5 YA24 To ensure people live in a comfortable well-maintained environment the following improvements are needed. *The conservatory would perhaps benefit from a fan to ensure people do not get too hot. *It would be nice to see some improvements to the front of the house to make it more pleasant and inviting. * The garden is potentially a nice space for people to enjoy, it is under utilised presently. There are different levels to the garden making it difficult for the men to use it safely. The plans to change the garden area should be continued. *The kitchen requires new units. The dining room is open plan onto the kitchen. Some consideration of the layout off the kitchen/dining room is needed to include appropriate access to the kitchen part. *The fixtures and fittings in individual bedrooms must reflect the preferences, age, gender and culture of the occupant. *Some items of furniture such as chest of drawers, bedside lamps, and mirrors are needed in individual rooms, to ensure people have the items necessary to their comfort. *Peeling wallpaper in some bedrooms needs to be made good or redecorated to ensure people live in nice wellmaintained surroundings. 6 YA29 Future planning should ensure people have the specialist aids and equipment they need to maximise their independence and enhance their safety. The following areas are identified for improvement: *Access to the house could be improved with hand grab rails or a ramp to help the men mobilise more independently. *The bathtub is low, fitted to the wall and boxed in. This inhibits staff from using hoist equipment or offering assistance to people who require it during a bath. 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 34 *The toilet is very low and there are no grab rails to support people. The bathroom therefore needs to be refitted so that it provides for the use of aids or equipment to support the men safely. *The en-suite shower facility has no hand grab rails by the toilet or in the shower. The provision of such aids must follow an assessment of individual needs and meet the recommendations of an Occupational Therapist. 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 74 Church Hill DS0000070487.V360937.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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