Care Home: 88 Church Lane

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What the care home does well The people who live at Church Lane have hearing and sight loss which means they have different ways of communicating. The staff team are very skilled at supporting them with their communication, and use lots of different equipment to help people to be more independent with their everyday living skills. Each person has a care plan so that staff knows how best to care for people. 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. People have their own spacious bedroom, with room for their personal things. The house is clean and comfortable so it is a nice place to live.Staff checks the house daily so that people who cannot see, can move around safely. People do the things that they enjoy, they make decisions about things they want to do and places they want to go. This includes making sure they get away each year for a good holiday. The Manager and staff work really hard and do lots of training so that they know how to support people properly. There are good procedures to listen to people and keep them safe from possible harm. Church Lane is continually striving to improve outcomes for the people who live there and it is positive to see that they have many plans for the future. They listen to the people and shape the service to fit their needs, this means people are well supported and continue to have new opportunities. What has improved since the last inspection? The records of medicines has improved, it is easier to see why people may not have had their medicine. Staff records the things people enjoy doing at weekends and in the evening showing people has a good lifestyle. There has been lots of other improvements made which we did not ask them to do but which they have done to make things even nicer for the people living at Church Lane. For instance they have started to use lots of new activities for people to enjoy, some have attended music concerts, and one person has been able to have some work experience. New carpets and decorating has made it an even nicer place to live. They have more staff that can drive which means people can get to their activities more easily. What the care home could do better: Staff must make sure that where there is a change in some ones needs, there is a risk assessment so that they can all manage the individual`s risk in a consistent way. Where an individual has an allergy it would be helpful to have some written detail showing what signs to look for. This will alert staff should a situation arise. CARE HOME ADULTS 18-65 Church Lane, 88 Handsworth Wood Birmingham B20 2ES Lead Inspector Monica Heaselgrave Key Unannounced Inspection 12th September 2008 10:55 Church Lane, 88 DS0000030401.V370299.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 Church Lane, 88 DS0000030401.V370299.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. Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Church Lane, 88 Address Handsworth Wood Birmingham B20 2ES 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 554 7710/8858 0121 554 7710 churchlane@sense.org.uk www.sense.org.uk Sense, The National Deafblind and Rubella Association Mrs Christine Hannah-Smith Care Home 5 Category(ies) of Learning disability (5), Sensory impairment (5) registration, with number of places Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registration for 5 younger adults (under 65 years of age), categories learning disability and sensory impairment 13th September 2007 Date of last inspection Brief Description of the Service: 88 Church Lane is a large spacious house that has been adapted to meet the needs of people with visual and hearing impairment and associated learning disabilities. The home is located in the Handsworth Wood area of Birmingham. Sense is the homeowners and the care providers. The home is registered to provide care and accommodation for five adults. The accommodation comprises of a large communal lounge a separate dining room and large kitchen. There is an additional quiet lounge on the first floor and a sensory room, and gym. All five bedrooms have en-suite bathrooms. One bedroom is on the ground floor and four are on the first floor. An office and staff sleep in facilities is located on the second floor. There is off street parking at the front of the house. The home has a large rear garden with a decked terrace and steps leading to a lower grass area. Information is shared with people who live in the home by use of objects of reference and tactile markers to enable individuals to make choices and map out their location within the home. 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. Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. The visit was carried out over one day; the home did not know we were going to visit. 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). Two people were “case tracked” this involves discovering individual experiences of living at the home by meeting or observing them, discussing their care with staff, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. During the visit direct observations were made of the support given to people who live there. The communication support needs of the people living in the home meant that it was not possible to seek the views of each individual. Discussions took place with two managers and four care staff. 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 visiting general manager on the findings of the inspection. Thanks are due to the people who live at Church Lane and staff members for their help and co-operation throughout the inspection process. What the service does well: The people who live at Church Lane have hearing and sight loss which means they have different ways of communicating. The staff team are very skilled at supporting them with their communication, and use lots of different equipment to help people to be more independent with their everyday living skills. Each person has a care plan so that staff knows how best to care for people. 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. People have their own spacious bedroom, with room for their personal things. The house is clean and comfortable so it is a nice place to live. Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 6 Staff checks the house daily so that people who cannot see, can move around safely. People do the things that they enjoy, they make decisions about things they want to do and places they want to go. This includes making sure they get away each year for a good holiday. The Manager and staff work really hard and do lots of training so that they know how to support people properly. There are good procedures to listen to people and keep them safe from possible harm. Church Lane is continually striving to improve outcomes for the people who live there and it is positive to see that they have many plans for the future. They listen to the people and shape the service to fit their needs, this means people are well supported and continue to have new opportunities. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 7 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 Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, and 4. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Information is made available to people before they visit the home so that they can make an informed choice about whether to move in. People’s needs are properly assessed, to make sure that they can get the care and support they need. Arrangements are in place for people to come and visit so that they can make an informed decision about whether or not the service is right for them. EVIDENCE: Church Lane has a Statement Of Purpose and Service User Guide, which is made available to people who live there and their relatives. This has been updated since the last visit to the Home. Each person has a copy of this in their bedroom, the information in these includes an introduction from the people who live at Church Lane explaining the facilities and what to expect from the service. A CD Rom was attatched to these documents making it easier for those people who cannot access written information, the information was nicely presented, personal to Church Lane and would provide a good insight to people thinking of moving into the Home. No new people had been admitted to the Home since the last inspection and there were no vacancies. The standard relating to assessment of people new to the Home was not assessed. However records showed that detailed assessments of the ongoing and changing support needs of people are in Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 9 place, and these are kept under regular review. Information provided in the AQAA tells us the asessment of peoples needs includes specialist imput from Sense to identify the hearing and or sight needs of people. This ensures that the Home can continue to provide the specialist and appropriate support to individuals throughout their stay. Discussions with one of the people living at Church Lane confirmed that a comprehensive assessment was carried out recently to support the individual to move to alternative accommodation, the individual decided to stay at Church Lane this is a good example of how people are supported and ensures that their needs and desires are kept under review. Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 10 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 and independence of individuals. EVIDENCE: Two peoples care plans were looked at for the purpose of this inspection. Individual needs and choices are documented in the care plans. The Plans contain the persons goals, aspirations and preferred lifestyle within the following headings: health action plans, eating and drinking guidelines, vision and hearing details, communication needs, mobility and transport needs, personal support needs, educational/development needs, leisure and social needs, activities, likes and dislikes, personal details, cultural and religious needs, personal/relationship and sexual needs and any other information Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 11 relevant to the persons needs. It was positive to see that care plans were produced in a format suited to the needs of the individual. For instance sections of the plan are in diagrams and pictorial and show what the individual likes, such as food, own sofa, warm enviroment, alcohol, sunshine, walking, relaxing and holidays. It was positive to see that dislikes had been included such as art, salad, crowds, items out of order. This is important as people may have difficulty in communicating this information so it’s important staff know this and act on it to lesson any frustrations. The care plans represent individual interests and plans for the future. The two files looked at included a section on communication these say exactly how best to communicate with an individual, based on Speech and Language guidelines from the speech therapist. There is a profile of important things, such as ‘tactile cues’ and ‘markers’ these are items the person requires in order to establish where he is in the enviroment and aid him to move around the house independently, these may differ for each person so it is good to see that this important information is recorded so staff can maintain a consistent approach to the enviroment. Each care plan has a comprehensive list of likes and dislikes, and this could include the type of clothes they prefer to wear such as lose fitting, likes to stroke things, bright lights, and using the sensory room. Where the person does not have the capacity to make decisions or carry out actions for themselves, ‘best interest forms’ are completed and a multi disciplinary approach adopted so that any decisions made on behalf of the person are considered by the person themselves and their multi disciplinary team, assessment information, and historical information. This ensures that people are not limited in making their decisions but supported in a safe and managed way. This is further supported by the use of risk assessments, strategies to manage the risk are recorded, implemented and reviewed, to ensure that where possible risks can be minimised but choices not restricted unnecessarily. 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 may need specific equipment to support them or enhance their independence. It is evident staff have used their observations well in promoting the best practice for the individuals in their care. For instance they have looked at different equipment which will enable people to be more independent with their every day living skills. One individual recently visited the Sight Village open day (open day at RNIB) and was able to try various equipment to assess whether this would benefit him. Talking magnets have been purchased and Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 12 are in use in the kitchen so that individuals can identify what food is in each tin. To support the care plans ‘Impact Statements’ are used. These describe what a person has done independently e.g ‘got food independently by getting food symbol got up from sofa and went into dining room’. ‘Got from bedroom to laundry’. This is a particularly good means of recording specific information that allows staff to continue to support people in their independence. The home has a Practice Development Worker (PDW) who works to support the staff team with the development of peoples’ care plans and risk assessments. Sense has also employed an advisor to provide specialist practice and advice to the staff to encourage and promote best practice. This ensures that the people are supported by a skilled workforce who understands their specific needs. Church Lane also has the services of a Community Bridge Builder who actively seeks out the availability of Community based activities and social opportunities. This ensures people can explore and access opportunities they have shown an interest in. Care plans stated the individuals’ religion and culture and showed how these aspects of a persons’ identity are respected. Care plans had been reviewed and updated to ensure the changing needs of people are known and acted upon. Goals are measurable and personal to the individual, these are regularly reviewed and new goals set. People are supported to make choices about what and when they eat, when to go out, how to spend their time. Activities are planned and some are spontaneous, these are based on the things the person enjoys, and are monitored to show whether the activity had been carried out. This is an effective way to monitor the goals in the care plan to ensure they are suited to the needs of the individual. As part of their opportunity for self-help individuals were encouraged to take part in every day tasks such as tidying up, clearing the table, making drinks and helping with the shopping. During these observations people received good support from staff. People are supported to do the things they want to do and this was specified in their care plan. Church Lane, 88 DS0000030401.V370299.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): 11, 12, 13, 14, 15, 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 to take part in valued activities, so that they get to do the things that they like that are important to them. They are able to make use of local facilities, ensuring that they have a real presence in their local community. They get the support they need to make sure that they can stay in touch with people who mean a lot to them. They are able to make positive choices about the food they eat, so that they enjoy their meals and have a balanced diet. EVIDENCE: On arrival people were busy getting organised for their morning activities. One person was at the doctors, and one person was in his bedroom but came downstairs to introduce himself. The other three people were getting ready for their swimming activity which was on their planner. The people at Church Lane have weekly planners which reflect their likes and interests, these are linked to their personal care plan and show how staff will support people in their chosen lifestlye options to achieve their goals and Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 14 aspirations. Two care plans were looked at and showed that new goals are highlighted such as ‘personalise his bedroom’, and ‘to go on holiday’. There was a lovely section on how staff will support the goals such as by discussing with him his what type of holiday is prefered, whether new equipment is needed and so on. Daily records show whether an activity is carried out or not, reasons are recorded where an activity has not been carried out, for instance this morning the swimming activity was cancelled due to a mix up in the booking. This information is audited to ensure goals are measured and people are doing the things they want to do that are specified in their care plan. Since the last inspection visit records now describe what people had been doing at weekends and during the evenings, demonstrating that people continue to have access to a range of activities that meet their preferences as part of a meaningful lifestyle. One of the people said that he had been to Sight Village open day (open day at RNIB) where he had tried out various equipment to see whether this would benefit him or improve his independence, he was very excited about this and hopeful that some new equipment would mean he could rely less on staff and do more for himself. He said he had a web cam so that he could communicate with his family, and that in and around the house various pieces of equipment meant he could do things freely, like make a cup of tea with a specialist piece of equipment that minimised scolding from hot water. He said he was having some new computer equipment to help him do things independently, eg large print on the screen to aid his vision. Talking magnets have been purchased and are in use in the kitchen so that individuals can identify what food is in each tin. It was nice to see that where Individuals have expressed an interest in an activity they have been encouraged and supported to follow these through, for example an individual ‘bus spots’ collecting the numbers of buses. Line dancing is another individual interest that is attended regularly. One person said he goes to church regularly, and some part time work-experience is taking place which is being enjoyed by the individual. Staff said that they feel good efforts are always made to broaden the lifestyle opportunities for people, so that they can do the things they want to and enjoy, for example purchasing a dictaphone for one person so that he can record his shopping list so that when he is in the shop he can play back the list and ensure he purchases all items needed for his meal.These initiatives ensure people has the equipment they need to promote and encourage independence. Records show that people are able to access local facilities on a regular basis, such as shopping, going to the hairdresser, using local cafes pubs and restaurants, walks, attending a local disco. Sense has a resource centre that individuals are encouraged to access on a regular basis to do activities such as woodwork, pottery, arts & crafts and Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 15 massage. There is also an ICT suite where people can access IT and multimedia opportunities. The manager told us in the AQAA that Sense holds a Family weekend each year and all parents/advocates are invited. The weekends are used to discuss ideas, legislation and any topics that may have been highlighted. This ensures that people within the service are encouraged to have a voice and it helps to maintain contact with families. Individually people maintain contact with family and friends via regular telephone calls, emails, visits to the home or families visiting the home. The people send out presents and cards to their families for birthdays and other special occasions. Staff has been proactive in promoting healthy eating and nutrition. The Health Action Plans sampled showed (where relevant to the individual) an eating plan to ensure balanced meals. It was positive to see that professional advice is also sought from the Speech and Language Therapist to ensure that staff know how to support individuals with their eating. Records were seen showing individuals daily food intake which is important when monitoring their nutritional needs. Weight records were in place, and the AQAA advises that one individual has been successfully supported to maintain a healthy diet and weight. Staff said that menus are planned according to the likes of the people. Staff over the last 12 months have attended In Proportion training which has helped them to support a healthy diet. People commented that staff are ‘good cooks’ and that they ‘enjoy the food’. It was pleasing to see that this area of practice is audited on the provider monthly visits to the home, nice to see that ‘portion sizes’, ‘five a day options’, and balancing of menus is ongoing to ensure that the nutritional needs of people remain well met. Observation of the evening meal was that the food looked and smelled lovely, it was meat, curried potatoes and veg, at lunch time people had mixed vegetable pasta with salad which again was well presented and plentiful. Both lunch and the evening meal was relaxed, people had the support from staff and the utensils necessary for independent eating. Very posituive to see that the kitchen area is open access so that people can independently clear the table, and or get drinks or snacks for themselves. The kitchen is spacious with some adapted equipment to help people who are blind to make drinks independently, or locate food they want via talking magnets on food storage tins. Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are well cared for by a staff team who knows them well. They are assisted to get help from specialist and other health professionals to help keep them healthy and well. Arrangements are in place to make sure that they get their medicines at the right time and in the correct amounts. EVIDENCE: Health Action Plans were in place for each of the five people. The two looked at were up to date, and detailed all the significant health history. For instance how an individual expresses pain, how he or she takes medication, skin problems and how these are managed, footcare and who and how this is managed, sleep pattern and night time support needs, an eating plan to ensure a balanced diet and an exercise plan to promote good health which was also linked to a weight record to ensure problems with weight are monitored carefully and appropriate action taken before it becomes problematic. The health action plans contained good detail of appointments and treatments and the outcome of these. There is a system to ensure follow up appointments are recorded so that people get the treatment they need to stay healthy. Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 17 A list of health care professionals is included in the HAP and why they are involved, such as the G.P. physiotherapists, Consultant, Speech therapist, audiologist, dentist and chiropodist. The daily records were looked at to cross reference information in the HAP. These showed that for instance one individual saw the G.P and two days later saw the nurse to conclude their treatment. This information was then observed to be shared at the shift hand over and recorded into the HAP. This ensures a good audit trail, and ensures people do not have delays in accessing medical treatments to improve their health. The manager told us in her AQAA that Medical summary reviews are completed annually to reflect all medical appointments and the outcomes of these over the year. An assessment of health and mobility is carried out every 12 months and outcomes from these are recorded and where an individual needs support this will be sought. For example, through assessment it was noted that one individual required input from a mobility officer in relation to using his deaf/blind cane, therefore a referral was made. Each individual has a vision, hearing, communication, mobility and health assessment annually. The outcome of these assessments is reflected in the individuals care plan and HAP in the form of guidelines, advice sheets, or specific routines personal to the individual. To support this practice, monthly core team meetings take place to ensure that care plans and HAP continue to meet the changing needs of the individual. These systems ensure people receive consistency in their health care. During the course of the inspection it was observed that one individual was chewing a hand bandage. The Communication book seen had an entry alerting staff to the possibility of this being a choking hazard. The care file was looked at there was no written risk assessment in the file. Separate discussions with three of the care staff confirmed they were aware of the risk and the level of supervision needed to avoid this happening,and this was observed throughout the day. This was discussed with the visiting manager who drafted a risk assessment and put this on the file. The handover was observed and it was positive to see that this information was communicated to the staff. The lapse of the risk assessment had not compromised the safety of the individual as the level of supervision in place was appropriate, however written records must be maintained on the individuals file to ensure staff know what support they need. The staff handover included an update on peoples needs including the outcome of the person who had seen the doctor that morning. A good description of the outcome of that consultation was given and this was recorded in the daily records. The staff member then demonstrated to the team how the medication was to be administered into the ears, the medication was dated and put onto the medication administration records (MAR charts), meeting a previous requirement. Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 18 Health records showed significant information such as allergies, whilst in the one case the allergy was stated there was no detail as to the symptoms to look for to indicate an allergic reaction. This was discussed with the general manger and agreed that if information could be obtained the record was to be updated to show what symptoms to look for thus ensuring staff could act quickly if the need arose. An audit of medication was carried out and this was correct for the records seen. Medication was secure and signatures and codes used to indicate if medication had been given, were in place meeting a previous requirement. AQAA information informs that Sense employs its own Behaviour Support Team. As a team they support the care staff with guidelines and training to ensure that any incidents of behaviourcan be managed safely. The manager informed us in the AQAA that if they were aware that an individuals life was limited due to their condition or an illness they would put together an end of life plan to support the wishes of the person and their family. A parent or advocate completes a bereavement form for their son, or daughter or friend and this is kept on a confidential file. This provides details of personal preferences in this regard. This would ensure that the wishes of the people concerned, are respected. Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 19 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 excellent. This judgement has been made using available evidence including a visit to this service. Church Lane has continued to welcome views, complaints and suggestions about the service, and has used these positively in developing creative ways to support people who are vulnerable. This is further enhanced by the trained staff team and consistent checking that the way staff works actually meets the protection needs of the people in the Home. EVIDENCE: Appropriate complaints and adult protection policies are in place. The complaints procedure is produced in many formats such as CD, Braille, widget and pictures to ensure individuals have good access to these. One person spoken with knew how to make a complaint and felt that staff would support him to do so. The complex support and communication needs, of the people living in this house mean that the majority of people would have difficulty in accessing these procedures independently. It was positive to see therefore that steps have been taken to ensure the concerns of and safety needs of people living at Church Lane has been addressed via alternative means. For instance discussions with staff showed 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 are unhappy. They understand the importance of people’s routines and rituals in helping them feel comfortable Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 20 and secure. Secondly records in the Home demonstrate other platforms are used regularly to reinforce the complaints procedures and highlight the processes for raising any concerns on behalf of the people who live in the house. Core team meetings are held monthly, to discuss any complaints, concerns or protection matters, staff meetings take place monthly which also provide staff with the opportunity to raise any issues and concerns. Reports of the registered provider monthly visits demonstrated that the views of the people living in the house are sought. Discussion with staff indicated that their monthly supervisions includes discussions around complaints and protection matters so that they can be sure of their role and responsibilities. There have been no complaints made about the home since the last inspection. A log of complaints is maintained that records the nature of the complaint and the action taken in response. Information received before this visit on the Annual Quality Assurance Assessment stated that Sense has a Complaints free telephone line, which can be accessed by anyone, 24 hours a day. Training records showed staff has received training in the protection of vulnerable adults providing them with the skills necessary to keeping people safe. Since the last inspection staff questionnaires have been introduced in-between the formal training sessions, to ensure staff has maintained the skills and knowledge and are aware of how to raise and identify issues in relation to protection. This further enhances the protection of vulnerable people and ensures they are supported by a skilled workforce. Some people who live at the home may display behaviour that can be challenging. There were guidelines in place for staff to follow to manage these behaviours to avoid harm to the person displaying the behaviour and to the other people living there. Information provided by the manager in the AQAA tells us that Sense has employed an investigation officer to ensure complaints and concerns are monitored and managed within relevant timescales. This indicates that the service takes this aspect of their responsibility seriously and has looked at positive ways to support vulnerable people. A Regional Protection Forum meet on a regular basis to discuss protection training, changes in legislation and to review information to ensure people are protected by best practice. The AQAA informs us that a family liaison person is employed by Sense. This person liaises with families, friends, advocates and the staff, to provide advice and discuss any concerns or needs that they have. An annual family and or advocate weekend is arranged and from this a newsletter is produced, this is a creative way to consult with, explore needs and offer feedback to people on protection matters. Sense has robust recruitment procedures all staff is subject to CRB and POVA checks prior to taking up post to ensure they are suitable to work with Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 21 vulnerable people. There are systems in place to ensure the safekeeping of peoples personal finances. A daily financial handover is carried out. Detailed financial records of all transactions are maintained appropriately. Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The house is comfortable, clean and well maintained. Facilities meet the visual, hearing and mobility needs of the people so that they are able to enjoy living in a safe and homely environment. EVIDENCE: Church Lane is a spacious, detached house situated in the Handsworth Wood area of Birmingham. . Each person has his or her own bedroom, with en suite facilities. There is a very large lounge and dining room as well as having a meeting room upstairs which individuals can use when people visit them in addition to their bedroom. A tour of the premises indicated that a lot of consideration has gone into ensuring the enviroment has the specialist communication equipment available around the home to ensure people can independently move around. This was observed through the day. Using the various communication methods such as objects of reference, bleepers, contrasting colour schemes, pictures, tactile Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 23 objects, and other aids, people were supported in mapping their enviroment and finding their way around independent of staff. The front door has a key pad code entry system so that there are no risks for those people considered to be at risk if they went out without staff. The key codes are changed regularly to ensure the continued security of the house. It was positive to see that each person has an individual fire risk assessment which specifies what support is needed in the event of a fire. As the needs of the people demonstrate, specialist fire alarm equipment is required to alert them to a fire. The fire alarm produces flashing lights as well as a loud siren. The enviroment meets the visual, hearing and mobility needs of the people, and this was supported by the assessments in place. There is a variety of tactile markers, objects of reference, colour contrasts and textures. There is a staff photo board with pictures and symbols to indicate who is on duty. The house is spacious and now includes a sensory room equipped with sensory objects with various lights. All the people access this room and are able to relax and enjoy this space. All the individuals have had their bedrooms fitted with new blinds, which has made opening these easier. Four bedrooms have been decorated making it a nicer place to live, and people are being supported to purchase items to personalise their rooms. One individual was proud to show his bedroom, this was spacious, nicely personalised and included specialist equipment such as a CCTV monitor which enlarges writing. He said this enables him to access written information he is interested in. It was pleasing to see that a web cam has been purchased so that one of the people who live in the house can maintain regular contact with his family. Staff has plans to purchase a dictaphone so that the ingredients needed for purchasing food shopping can be recorded and played back to ensure he purchases all items needed for his meal. It is really positive to see that in promoting peoples’ independence staff are adapting the enviroment and seeking equipment to encourage and support independence. Church Lane provides a positive environment with the facilities people need and enjoy. It was found to be clean, comfortable and safe. All the indicators are that the house is kept clean, substances that could be harmful are locked away and certificates were evident to show equipment is serviced to ensure it is safe to use. Improvements have been ongoing to include new carpets fitted to the landing and hallway, and some rooms decorated. New furniture has been purchased for the garden. Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living at Church Lane are supported by a care team that is competent, qualified, trained, and supervised. Staff has 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: From discussions with individual staff members, sampling of records and observation of the care practice it is evident that people are supported by a well-trained and competent team of established staff that has a good understanding of their individual needs. Staff presented as caring and responsive in their interactions, and knowledgeable about the individual care needs of people. They were observed to be competent in supporting people with the daily tasks, and particularly skilled in communicating in the preferred style individuals understood, such as using objects of reference to support understanding. The observations made Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 25 on the day showed that the people living at Church Lane are safe, happy and motivated. There was four staff on duty caring for the five people it was a relaxed atmosphere, with staff supporting people well with their personal care. Staffing rotas were looked at and it was positive to see that the levels are maintained and appropriate to support the care needs and activities of the people. Staff said that rotas are planned around the activities of the people so that they can enjoy more personalised activities. It is positive to see that account is taken of whether a ‘driver’ is needed or a ‘swimmer’ to plan excursions. The manager told us in the AQAA that they have achieved a reduction in the use of agency staff as a result of employing a Bank Coordinator, this person oversees a pool of bank staff who are Sense trained and can be called on to support permanent staff without disruption to the people living at Church Lane, this will hopefully limit agency use. The home has recently recruited a deputy manager which is a new role at Church Lane; the general manager explained that a Deputy training programme has been introduced for deputy managers in post and also for those staff who are interested in developing within Sense. This is a positive initiative which will ensure consistency within the role and expectations of this position. The home operates a robust system of staff recruitment for the protection of the people who live there. Two staff files were sampled these contained the required documents including completed applications, written references and Criminal Records Bureau (CRB) checks. Sense strives to selective in their staff appointments and aim to match the skills of the new recruit to the needs and demands of different homes. This ensures the staff team have a good skills mix to meet the specialist needs of the people. The staff members’ performance, needs, productivity, confidence, training, and strengths are monitored and targets are set and dates for reviews to establish whether or not the target has been met. Each file contained a list of both mandatory and specialist training completed. Specialist training which is relevant to the individual needs of people living in the home, included Autism, BSL and deaf/blind training awareness, ensuring all staff has the skills to communicate effectively with the people who live in the house. Information supplied by Sense states that staff training statistics are currently at 100 for all mandatory and specialist training. This is a credit to the service and reflects positively on the dedicated training team Sense provides. Currently 90 of the staff team have or are working towards NVQ level 2. This exceeds the expectation and ensures the staff team is equipped to undertake their role in a skilled manner. The AQAA tells us that the service is aware of new developments and legislation such as the Mental Capacity Act and Equality & Diversity training and has included these in its training schedule. Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 26 Staff spoken with say training is very well structured, there is a booking system in place to continually review training targets, a comprehensive training matrix is available. The general manager said training is evaluated monthly to see what the team has done. All training is supported via the dedicated training department. AQAA information and discussion with the general manager demonstrated that Sense has continued to review and monitor all its practice areas to ensure positive outcomes for both the people who live and work at Church Lane. The manager has continued to look at what is needed within the home in relation to the team and looking at the changing needs of the individuals. Staff skills match with the needs of the people in the house, ensuring staff is able to offer the support needed. Discussions with staff confirm that staff meetings take place monthly and they are encouraged to participate and raise ideas, suggestions, and improvements. As mentioned earlier in this report staff handovers take place between each shift to ensure good communication. The handover observed included reference to the significant key pieces of information that arose during the day, evidencing that staff are competent communicators. All of the information available indicates that this is a service where continued hard work, planning and monitoring of their practice continues to benefit the people living at Church Lane. Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, & 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is well run for the benefit of the people who use it. Clear efforts are made to find out what people feel about the quality of the service they receive so as to meet their needs and wishes. Important safety checks are carried out regularly to make sure that people living and working in the home can stay safe. EVIDENCE: The registered manager was not present on the day of the visit. It is a testament to her however, that the staff team showed a high level of care, skill and understanding of their role, to include their responsibilities. Standards have been set high and staff work to these happily. They speak in positive Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 28 terms about the management style and find the manager approachable and supportive. The manager is trained and qualified for her role and previous reports show she has continued with her professional development to increase her understanding and skills to run the home. We asked the Provider to fill out an Annual Quality Assurance Assessment, (AQAA). The AQAA was detailed and contained relevant information that was supported by examples of good practice which corresponded with the records sampled in the home, discussions with staff, and observations of the practice. Church Lane has a quality assurance system. The system has all the elements for seeking views, analysis of findings and feeding this back to all concerned. The findings are linked to identifying improvements, and training needed to improve outcomes. Through listening to people the home now has a cat which the people are supported to feed and look after. One individual has began a work oppotunity in an admin role one moring a week, where he is being supported to learn and develop skills. A sensory room has been developed which the peoople appear to enjoy. A representative of the registered provider visits the home on a regular basis to report on the standard of care provided. These reports show that the views of the people who live and work at Church Lane are actively sought, for instance supporting the involvement of one individual in the interviews for the new deputy manager post, a nice example of people being actively involved in service provision. 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. Each person has a fire safety plan that describes how to assist them to evacuate the home safely in the event of an emergency. A report made by West Midlands Fire Service in August 2007 made one reference to an area of deficiency, which at this visit was noted to have been complied with. Staff has completed fire training to help them understand the importance of fire safety. Fire drills are carried out on a regular basis so that staff and people who live in the home know what to do in the event of an emergency; each drill had been recorded. The Landlord’s gas safety certificate and certificate for the electricity circuit are both in date. Portable appliance testing has been carried out on electrical equipment kept in the home. Regular testing and recording of water temperatures have been completed, and the home’s COSHH store was secure. Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 29 Staff has regular training in health and safety and infection control, and daily checks are made around the house to ensure it is free of potential hazards ensuring a safe environment for the people who live in the home. Accident and incident recording was appropriate and notifications had been sent to the Commission as is required by legislation. Ongoing improvements have ensured existing practices have been strengthened and new initiatives implimented to improve outcomes for the people living at Church Lane. A Deputy manager has been appointed, staff training percentages have improved, and a new staff appraisal system is in use. Church Lane has a consistent approach to delivering a high quality service and demonstrates that they recognise areas for improvement and manage them well. Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 30 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 OICE OF HOME Standard No Score 1 4 2 4 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 4 25 4 26 4 27 4 28 4 29 4 30 3 STAFFING Standard No Score 31 X 32 4 33 4 34 4 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 X 3 X LIFESTYLES Standard No Score 11 4 12 4 13 3 14 3 15 3 16 X 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 3 3 3 4 X X 3 X Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 31 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. Refer to Standard YA19 Good Practice Recommendations To support otherwise good practice staff must make sure that where there is a change in needs, a risk assessment showing how to manage the individual’s risk is in place. This will ensure the risk is managed in a consistent way. Where an individual has an allergy it would be helpful to have some written detail showing what signs to look for. This will alert staff should a situation arise. 2 YA19 Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 32 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 Church Lane, 88 DS0000030401.V370299.R01.S.doc Version 5.2 Page 33 - 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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