Care Home: Chesterberry

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What the care home does well Staff can communicate well with people who live at Chesterberry in their preferred language which is British Sign Language, BSL. The staff team have lots of experience in supporting people with their needs. Each person has a plan showing how they like to be supported and the things they need to stay happy, and healthy. The house is big and people have lots of room for their own things. Staff is very good at checking the equipment used by people every day so that the things they use are safe.People do the things that they enjoy, and try lots of new activities. The Manager and staff work really hard and do lots of training so that they know how to support people properly. People said `staff are really nice and listen to me and help me do the things I want to do`. Staff is good at making things better 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? Staff had worked hard to make sure the care plans have lots of information about the person, what they need and what they want. The care plan is looked at regularly and any changes needed are made, this means people have a plan that best suits their changing needs. There has been lots of improvements in how staff support people with their cultural needs so that they have the food, hair care, and skin care items they need. People have had the chance to try new hobbies and interests such as football, golf and fishing. Smaller holidays were planned so that people could have the holiday they wanted which they really enjoyed. Lots of work and training has taken place so that staff know what to do to keep people safe from harm, this has included harm from other people, harm from fire or accidents. The house has the equipement it needs to keep people safe from germs and infections. Staff have one to one meetings more often so that they know what to do when supporting people. Staff are more involved with writing care plans and risk assessments because they have support from someone who can help them with this. What the care home could do better: The manager said she would like to produce the information about the home in British Sign Language so that people who are deaf, can read it.Staff needs to look at how they can find out the views of the people who live at Chesterberry, their friends and families so that they can be sure that the things they are doing are exactly what people need and want. The monthly visits should also include the views of the people living at Chesterberry. There should be at least six staff meetings every year so that staff can share information. CARE HOME ADULTS 18-65 Chesterberry 766 Chester Road Erdington Birmingham West Midlands B24 0EA Lead Inspector Monica Heaselgrave Key Unannounced Inspection 3rd November 2008 10:30 DS0000016724.V370322.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 DS0000016724.V370322.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. DS0000016724.V370322.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chesterberry Address 766 Chester Road Erdington Birmingham West Midlands B24 0EA 0121 386 2290 0121 386 2290 heather.andrews@bid.org.uk 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) Birmingham Institute for the Deaf Heather Louise Andrews Care Home 7 Category(ies) of Learning disability (7), Sensory impairment (7) registration, with number of places DS0000016724.V370322.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 (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Sensory impairment (SI) 7 Learning disability (LD) 7 The maximum number of service users who can be accommodated is: 7 26th September 2007 2. Date of last inspection Brief Description of the Service: Chester Berry is registered to provide accommodation, care and support for seven people who are profoundly Deaf and have additional needs. The service is owned, managed and staffed by Birmingham Institute for the Deaf. The property has recently been refurbished and is a large, detached periodstyle house situated on the main Chester Road in the Erdington area of Birmingham. There are seven bedrooms (five of which have en suite facilities), one lounge, one sitting/activity room, kitchen, laundry room, one bathroom (which can be shared by up to two people), one WC, one staff/visitor WC, conservatory and staff facilities (one sleep in room and office). The home is equipped with specialist equipment for Deaf People including flashing door bell/phone alerts, fire alarm systems and Mincom/fax, and provides access to interpreting support and further equipment when required. All equipment systems are linked to pagers for staff. To the rear of the property is a very large private garden, with patio area and garden furniture and lawned areas with shrubs and flowerbeds. At the front of the house there is limited off-road parking. The Home has its own vehicle, but the area is also well served by public DS0000016724.V370322.R01.S.doc Version 5.2 Page 5 transport. The shopping areas of Wylde Green and Erdington are both close by and include a wide range of local amenities. The statement of purpose states the fees charged are variable to include 24 hour staffing, food and drink, laundry, support to access medical appointments, heating, lighting and water, social and community support and communication support. Dry cleaning, hairdressing, private phone installation and calls and network connection and charges are not included in the fees. The inspection report is available in the home for visitors to read if they wish to. DS0000016724.V370322.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. 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. A British Sign Language (BSL) interpreter was there for part of the visit to assist in communicating with the people who live there and staff who are Deaf. It was not possible to seek the views of each individual. Discussions took place with the manager and four care staff. Records including personal files care plans, staff files and safety records were examined and a partial tour of the building completed. Thanks are due to the people who live at Chesterberry, and staff members for their help and co-operation throughout the inspection process. What the service does well: Staff can communicate well with people who live at Chesterberry in their preferred language which is British Sign Language, BSL. The staff team have lots of experience in supporting people with their needs. Each person has a plan showing how they like to be supported and the things they need to stay happy, and healthy. The house is big and people have lots of room for their own things. Staff is very good at checking the equipment used by people every day so that the things they use are safe. DS0000016724.V370322.R01.S.doc Version 5.2 Page 7 People do the things that they enjoy, and try lots of new activities. The Manager and staff work really hard and do lots of training so that they know how to support people properly. People said ‘staff are really nice and listen to me and help me do the things I want to do’. Staff is good at making things better 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: The manager said she would like to produce the information about the home in British Sign Language so that people who are deaf, can read it. DS0000016724.V370322.R01.S.doc Version 5.2 Page 8 Staff needs to look at how they can find out the views of the people who live at Chesterberry, their friends and families so that they can be sure that the things they are doing are exactly what people need and want. The monthly visits should also include the views of the people living at Chesterberry. There should be at least six staff meetings every year so that staff can share information. 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. DS0000016724.V370322.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 DS0000016724.V370322.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, 3 and 4. Quality in this outcome area is good. 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: The Statement of Purpose and Service User Guide is made available to people who live at Chesterberry and their relatives. This had been updated at the last visit to the Home to reflect the refurbished accommodation. Previously the seven people lived in two separate houses, and had two separate staff teams, now the seven people are supported by one staff team. From the Statement Of Purpose and Service User Guide any person thinking of moving into Chesterberry would know what to expect from the service. Discussion with the manager identified no new people had been admitted since the last inspection visit. The manager stated in her AQAA that these documents could be improved by having the information translated into BSL (British Sign Language) making it easier for people to access information in their first language. However there are good arrangements in place to ensure DS0000016724.V370322.R01.S.doc Version 5.2 Page 11 that any prospective new people have access to staff who can share this information with them in their first language. All staff is required to already possess or work towards British Sign Language Level II so that they are able to communicate with the people living there. Records sampled showed that an assessment of needs is carried out prior to admission. A meeting is arranged to share information. This is a home for Deaf people, whose first language is British Sign Language, staff who have BSL meets the prospective new person and or their family and communicates in British Sign Language and or adapts the communication to the persons preferred method of communication. The team have varied knowledge and experience of working with Deaf adults with additional disabilities, and this ensures people thinking of living in the Home can be supported by people who can communicate with them and understand their specialist needs. During the assessment introductory visits and overnight stays at the home take place to build up knowledge of needs especially the type of communication prefered. Information provided in the AQAA tells us the asessment of peoples needs includes the hearing and or communication needs of people. This ensures that the Home can be confident they can provide the specialist and appropriate support to individuals before offerring them accommodation. DS0000016724.V370322.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, 8, 9 and 10. 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 support people to have a good quality of life and independence. 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: needs relating to communication, personal care, support during the night, health, dietary, the management of money, making choices, leisure, social and emotional needs. Plans indicate whether the person needs eating and drinking guidelines, which aids or equipment they require to support their communication, personal DS0000016724.V370322.R01.S.doc Version 5.2 Page 13 support needs, educational, leisure and social needs, activities, likes and dislikes, and cultural and religious needs. Discussion with two of the key workers showed that staff is up to date with the individual needs and interests of each person, and this included the type of support needed to help them do the things they wished to do, safely. The plans looked at reflected the activity planners, showing that staff structure the week so that people get the opportunities they have identified in their plan. For instance Golf has been introduced for some people who have identified this as an interest, and some people have now purchased their own golf clubs and go regularly as evidenced in their planner. One person went to see Manchester United play, and others had a holiday. Staff have worked hard to ensure they can ‘show’ people their achievements and have managed this by recording events on DVD. A second care plan looked at described the person as ‘active’ who loves travelling, he was supported to have a holiday. People are also supported to follow their religious and or cultural interests, some people worship regularly at the deaf church with deaf people. Staff were good at supporting people to make decisions, throughout the day people came to staff to cross out an activity on their planner and staff took the time to explain the options and or alternatives to them. Plans showed a good description of specific needs and how this may affect the individuals choices, activity and support needs. For istance Autism and how this impacts on an individuals behaviour, e.g ‘may prefer set routines, enjoys solitary rather than group activities, reflects signing back to staff so limited signing ability may impact on understanding.’ Where individuals have behaviour that can challenge care plans showed that risk assessments were in place and up to date management plans, with good guidelines for staff as to what to do if an incident occurs. Staff said that they had done training to help them support people with their behaviour and in discussion, staff were able to describe clearly the steps and techniques they would use. The management of risk is positive. It is important that people are supported to take risks when doing an activity. The benefits to the individual often outweigh the risks involved. The risk assessments stated how staff are to support the person to minimise the risks whilst ensuring that people can be independent and take risks in their daily lives. One of the people living at Chesterberry gave several examples of her interests and how staff had supported her with these. She enjoyed the theatre and was going on a theatre visit that night. She enjoys cooking and is supported to make authentic cultural dishes she enjoys. She has been encouraged to buy embroidery kits and has numerous completed ones DS0000016724.V370322.R01.S.doc Version 5.2 Page 14 showing she has a new skill and interest. The care plans represent individual interests and plans for the future. 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 specialist equipment which will enable people to be more independent with their every day living skills, such as flashing beacon to be alerted of someone at bedroom door, flashing beacon to be alerted of fire alarms. The home has access to ATW (access to work) team who works to support the staff team with the development of peoples’ care plans and risk assessments, by translating them into BSL so that staff fully understand in their own first language how to support the needs of the people. 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. There was good information to show that issues of confidentiality are promoted. DS0000016724.V370322.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): 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 make use of local facilities, ensuring that they have a real presence in both their local and deaf community. They get the support they need to stay in touch with people who mean a lot to them. They make choices about the food they eat and planned new menus will help ensure that they enjoy their meals and have a balanced diet. EVIDENCE: On arrival people were busy getting organised for their morning activities. Introductions were made with the support of the care staff and the BSL interpreter; some individuals had difficulty in understanding the signing being used and mimicked this back. The people at Chesterberry have weekly planners which reflect their likes and interests, these are linked to their personal care plan and show how staff will DS0000016724.V370322.R01.S.doc Version 5.2 Page 16 support people in their chosen lifestlye options to achieve their goals and aspirations. The two planners looked at showed a variety of activities to include, football match, golf, threatre visit, shopping, dentist visit, and a visit to B&Q. Every one had something planned for the day and the evening, even though this changed throughout the day as people exercised their choices. Staff recorded whether an activity is carried out or not, for instance this morning some individuals changed their mind about college or line dancing and independently communicated this to staff who then recorded this on their planner, this shows people have the opportunity to make decisions and that staff are flexible in their arrangements. 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 with the golf, football and embroidery. 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. 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. Visits to the theatre and cinema are arranged for when these productions have BSL signers, and this takes some forward planning on behalf of the staff. It was positive to see that they make themselves aware of events in the deaf community so that people can continue to enjoy and participate in activities with their peers. Individually people maintain contact with family and friends via fax or using the Mincom. Observation of the lunch time meal was that the food looked good, plentiful and well presented. Lunch was relaxed, people had support from staff and a choice of where they ate their meal. The kitchen area is open access so that people can independently clear the table, and or get drinks or snacks for themselves. One person informed us that she enjoys the food, and is supported to cook cultural authentic dishes of her choice. Staff stated that some ‘basic’ food brands are purchased which are considered not to be so tasty. This was discussed with the manager who said that this had been the case and that staff have been advised to be flexible with the shopping. It was pleasing to see that the manager has highlighted in the AQAA that menu planning is to be reviewed to ensure people are eating nutritional meals. DS0000016724.V370322.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, 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 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. DS0000016724.V370322.R01.S.doc Version 5.2 Page 18 Improvements had been made to maintaining monitoring records for health. A bowel record was maintained but this should also be linked to the care plan. For instance the care plan should say that there is a history of constipation, and the health action plan should say how this is being managed so that the persons’ health needs are met. In a second care plan and daily reports looked at these showed that blood pressure monitoring is in place. Discussion with staff identifies they do not know what normal rate should be for the individuals’ blood pressure readings. The records show readings as fluctuating. The care coordinator who devises the written plans said they bought the person his own blood pressure monitor, this was not requested by the G.P they thought it was good practice as he had difficulties in the past. This was then discussed with the manager and recommended that they need to determine with the G.P. if this monitoring is necessary, and if so what the expected readings should be so that the staff can monitor this effectively. The management of Epilepsy is good, records show what the medication is used for with a good write up of Epilepsy and action to be taken. A record of Epileptic siezures is also evident indicating further good monitoring of health care needs. The care files were well organised up to date and tidy, with enough detail to direct staff in the support needed by individuals to meet their health care needs. 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 had an appointment with the dentist that day, 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. Observation of medicines being administered showed that medication was secure and signatures and codes used to indicate if medication had been given, were in place. As a team staff support individuals with their behaviour, guidelines are in place so that staff know what type of support is needed and staff has recieved training to ensure that any incidents of behaviourcan be managed safely. DS0000016724.V370322.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 good. This judgement has been made using available evidence including a visit to this service. Chesterberry 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 training staff has had since the last inspection, staff has good knowledge of what to do if concerns are evident. EVIDENCE: Appropriate complaints and adult protection policies are in place. The complaints procedure is produced in BSL to ensure individuals have good access to these, although the manager is hoping to update these documents. One person spoken with knew how to make a complaint and felt that staff would support her 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 Chesterberry 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 and secure. DS0000016724.V370322.R01.S.doc Version 5.2 Page 20 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. For instance, daily reporting of any injuries or bruising which may alert staff to incidents. Staff supervisions are used to reinforce and clarify the role of staff in protecting people who live in the Home, and how to report concerns they have. Discussion with three staff indicated that they have a good knowledge of protection matters so that they can be sure of their role and responsibilities. Staff meetings also provide staff with the opportunity to raise any issues and concerns, and discuss their understanding of what to do and who to report concerns to. 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. Training records showed staff had received training in the protection of vulnerable adults providing them with the skills necessary to keeping people safe. The AQAA informs us that Chesterberry has a robust recruitment procedure, all staff is subject to CRB and POVA checks prior to taking up post to ensure they are suitable to work with vulnerable people. There are systems in place to ensure the safekeeping of peoples personal finances. A daily financial handover is carried out, and this was observed at the time of the visit. Detailed financial records of all transactions are maintained appropriately. DS0000016724.V370322.R01.S.doc Version 5.2 Page 21 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 good. 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: Chesterberry is a spacious, detached house situated in Erdington. 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 equipment available around the home to ensure people are safe such as vibrating fire alarms. The front door has a visual alarm to show when someone is there or when the door is opened, DS0000016724.V370322.R01.S.doc Version 5.2 Page 22 this alerts people to visitors, or staff to concerns about vulnerable people leaving the house. There is a 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 assisted bathrooms ensuite with hand grab rails, rooms are spacious and minicom systems in place for telephone calls, door bells and fire alarms. One of the bedrooms was viewed this was well decorated, had its’ own en-suite for privacy and was spacious, there were lots of personal possessions and items clearly indicated the occupant is supported to have their own personal ‘space’. Chesterberry 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; the laundry which now has a wash hand basin installed which reduces the risk of cross infection. An extractor duct has been fitted to the tumble dryer so that it can be used to dry people’s clothes. Infection control procedures were evident and the laundry door was locked, these arrangements ensure that the risks of cross-infection and risks to the people are minimised as much as possible. People can choose to lock their bedrooms for increased privacy. Staff has an overriding key to gain access to their bedroom in an emergency. The people living at Chesterberry had been involved in choosing their bedroom furniture, and the colours to decorate their rooms. Chesterberry is a comfortable and spacious house with room for people to socialise or not, nice furnishings, warm and bright, with no visible hazards noted. It was good to see staff do a check of equipment to ensure the safety of deaf people. DS0000016724.V370322.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Chesterberry are supported by a care team that is competent, trained, and supervised. Staff has specialist training which means they can communicate with the people living there in the language of their choice. The needs of people 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 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 British Sign Language, BSL to support understanding. The observations DS0000016724.V370322.R01.S.doc Version 5.2 Page 24 made on the day showed that the people living at Chesterberry are safe, happy and motivated. There was four staff on duty and rotas showed that there is appropriate levels of staff each day to support people with their care needs and activity choices. The manager told us in the AQAA that they have achieved a reduction in the use of agency staff, and ensure that where agency staff is used they have been trained in BSL so that they can communicate with the people living at Chesterberry. Currently twelve of the sixteen staff 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. Three staff records were sampled. These included the required recruitment records including evidence that a Criminal Records Bureau (CRB) check had been undertaken to ensure that ‘suitable’ people are employed to work with the people living there. There is a training matrix which showed both mandatory and specialist training completed. Specialist training which is relevant to the individual needs of people living in the home, included Autism, BSL adult protection and challenging behaviour ensuring all staff has the skills to communicate effectively with the people who live in the house. Discussions with staff confirm that staff meetings do take place although they still struggle to have a minimum of six a year. The minutes of these meetings showed 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. The staff members’ spoken with were very positive about their own support. They described formal supervision sessions as ‘great’, feeling that their performance, needs, confidence, and training, are monitored. They have access to work (ATW support) to ensure written information is translated into BSL their first language so that they understand the procedures in the home and what is expected from them. The information available indicates that this is a service where continued efforts are made to ensure the care practice continues to benefit the people living at Chesterberry. The previous inspection in April 2008 was a themed inspection. The thematic inspection looked at how well this service makes sure people are protected DS0000016724.V370322.R01.S.doc Version 5.2 Page 25 from abuse. We looked at whether this service has good procedures and training for safeguarding; how it works with other organisations to make sure people are safe; how they recognise abuse and respond to allegations to protect the people who use their service. We call this ‘safeguarding systems’. Information taken from the themed inspection identified that recruitment practices are good. Staff files contained an enhanced criminal records check, 2 references and a completed application form. All of these records had been obtained before staff started working at the home. This means the way staff is recruited protects people living at Chesterberry from harm or abuse. 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. The manager stated that the CSCI inspection report which is written in English is not accessible to the majority of staff, this would have to be read then translated into BSL for staff to understand and that this often is a big pull on her resources. The manager said a more appropriate format would be a DVD or the report produced in British sign Language. Following the inspection alternative formats were explored, the outcome was that feedback should be given to the staff team with the provision of a BSL signer supporting the inspector. A feedback date for this is to be arranged. This is a unique unit, all information that is written is translated for staff to access, they have ATW support from signers and office days where they can go through written material and have it translated into a form they understand. There is a mini com system and fax so information for non hearing staff is available. However there is always the need to translate some information and this can be time consuming. Care plans and risk assessments are written by the care coordinator who is employed in this new role, and who supports staff in accessing the written plans. Daily records are written by staff. The manager and care coordinator ensure staff has the support they need. Since the last inspection staff involvement with developing care plans and risk assessments has increased, by them working with the care coordinator, this ensures that the outcome for the individual is more effective because staff know what the care plan goals are. DS0000016724.V370322.R01.S.doc Version 5.2 Page 26 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. There needs to be an improvement in the efforts 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 staff team showed a good 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 terms about the management style and find the manager approachable and supportive. DS0000016724.V370322.R01.S.doc Version 5.2 Page 27 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. Chesterberry has a quality assurance system, but it does not fully include seeking the views of people using the service or an analysis of findings and feeding these back to people. There are examples of how improvements have been made through listening to people such as introducing golf, football, and small group holidays. A representative of the registered provider visits the home on a regular basis to report on the standard of care provided. These reports do not show that the views of the people who live and work at Chesterberry are actively sought. This was raised at the previous visit and remains outstanding. 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 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 was out of date. The manager said she had been trying to obtain a new service contract. The gas boiler had recently been serviced. A few days after the visit, the manager confirmed that the gas supply had been serviced and a certificate issued to ensure its’ safety. Regular testing of water temperatures had been completed, ensuring people avoided the risk of scolding, and the home’s COSHH store was secure so that dangerous substances were not in reach of vulnerable people. Staff has had training in health and safety and infection control. The manager stated in the AQAA that they hope to improve, on the regularity of health & safety training for all staff. In practice it is positive to see that safety checks are carried out daily to ensure the equipment people use is safe and potential hazards identified ensuring a safe environment for the people who live in the home. For example a wire had snapped on a vibrating fire alarm under one persons’ pillow. This was picked up by staff carrying out their daily visual check, this was reported for repair and a working alarm replaced. DS0000016724.V370322.R01.S.doc Version 5.2 Page 28 Accident and incident recording was appropriate and notifications had been sent to the Commission as is required by legislation. 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 Chesterberry. DS0000016724.V370322.R01.S.doc Version 5.2 Page 29 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 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 2 X X 3 X DS0000016724.V370322.R01.S.doc Version 5.2 Page 30 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 YA17 Good Practice Recommendations To review menus to ensure people are eating nutritional meals, and show that people are being offered a healthy diet to ensure their health and well being. 2. 3. YA19 YA19 4. 5. YA33 YA39 Explore whether blood pressure monitoring is required so that the health care needs of people can be met effectively. The health action plan should be linked to the care plan. The care plan should state any health history such as bowel health problems, and the health care plan should state how these are being managed so that the person’s health needs are met. Although progress has been made, the manager should continue to work towards at least six staff meetings per year so that there is a regular exchange of information. Monthly visits should include asking the views of the people living there and their friends and family to ensure DS0000016724.V370322.R01.S.doc Version 5.2 Page 31 that their views underpin the development of the service. DS0000016724.V370322.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 DS0000016724.V370322.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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