Care Home: Dove House

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What the care home does well Each person has a care plan that shows staff how to help them to meet their needs and reach their goals. Staff ask the people living there what they want to do, what they want to eat and drink and where they want to spend their time. A relative said, " I`m more than happy with the service provided." The people living there go out often and do the things they enjoy doing. People have a choice of what food they eat. They are encouraged to eat a healthy diet to ensure they keep well. Staff have supported some people to go on holiday abroad if they wanted to. Staff help the people living there to go to health appointments when they need to. They follow the advice of health professionals so that the person`s health needs are met. One relative said, " Dove House appears to me to be a clean, smell free, comfortable place to live." Each person has their own bedroom. These are well decorated in the way that the person wanted it to be. There were many personal belongings in people`s bedrooms so they had things around them that they like. The home is clean. The staff help the people who live there to clean their bedrooms. One relative said, " Staff have impressed me with their care and consideration for the people they look after." What has improved since the last inspection? The service user guide now includes up to date information so that anyone who wants to move into the home would know what is provided there. Risk assessments are in place for all risks that the people living there face in their day-to-day lives so staff know how to help them to be as safe as possible. Each person has a Health Action Plan. This helps staff know what the person needs to stay healthy and what healthcare services they need to use. Furniture and carpets had been replaced. The kitchen had been refurbished and several rooms had been decorated. This makes it a more comfortable and homely place to live in. Old records had been moved from the quiet room and this is now being used as a relaxing sensory room for the people living there to spend time in. Staff have had more training so they know how to meet the needs of the people living there and keep them safe from harm. What the care home could do better: All staff must have training in minimising confrontation. This will make sure that staff know how to meet the changing needs of the people living there and keep them safe from harm.Some improvements should be made to make sure that the risk of food poisoning is reduced and food is stored and prepared safely. There should be a bigger extractor fan in the shower room so it is comfortable when staff are supporting people to have a shower. The bathroom should be redecorated to make it a more comfortable and clean room. There should more staff meetings and staff should have more supervision sessions. This would make sure that all staff know about the changing needs of the people living there, `best practice` and any changes happening within the organisation. All staff need to have an induction when they start working there so they know how to help the people living there to meet their needs. Staff should test the emergency lighting monthly to make sure it is working. CARE HOME ADULTS 18-65 Dove House 3 Monyhull Hall Road Kings Norton Birmingham West Midlands B30 3QF Lead Inspector Sarah Bennett Key Unannounced Inspection 21st November 2007 10:10 Dove House DS0000024871.V340216.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 Dove House DS0000024871.V340216.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. Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dove House Address 3 Monyhull Hall Road Kings Norton Birmingham West Midlands B30 3QF 0121 443 3460 0121 443 2034 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) Family Housing Association South Birmingham Primary Care Trust Mr Malcolm Piper Care Home 6 Category(ies) of Learning disability (6), Physical disability (6), registration, with number Sensory impairment (6) of places Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home accommodates six people with a learning disability under 65 years. The home can accommodate three named service users over 65 years. Date of last inspection 17th May 2006 Brief Description of the Service: Dove House is a purpose built care home, on the site of the former Monyhull Hospital, in a new development of houses. The home accommodates six people who have a Learning Disability, and additional needs relating to impaired mobility or poor physical health. The accommodation is on the ground floor and comprises of six single bedrooms, an adapted bathroom, shower room, WC, lounge, dining room, kitchen, laundry, quiet room and office. The home is on a bus route to Kings Heath, Kings Norton and Birmingham City Centre. The home has transport, to which the people living there financially contribute. During the day there are a minimum of four staff on duty and at night there are two waking night staff. The service users guide stated that each person pays £127.35 per week as a contribution to their fees. The information included in this report applied at the time of inspection and the reader may want to obtain more up to date information from the care service. The last inspection report is available in the home for visitors who wish to read it. Dove House DS0000024871.V340216.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 two star. 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 the inspector was going to visit. This was the homes key inspection for the inspection year 2007 to 2008. The inspector visited to do a random inspection in March this year and reference is made to this in this report. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and a questionnaire about the home – Annual Quality Assurance Assessment (AQAA). Two people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. The people who live at the home and the staff on duty were spoken to. Due to the learning disability and communication needs of the people living there it was not possible to ask for their views about the home so time was spent observing the support given by staff. Three relatives of people who live there completed the Commissions ‘Have your say’ survey that asks for their views on the home. What the service does well: Each person has a care plan that shows staff how to help them to meet their needs and reach their goals. Staff ask the people living there what they want to do, what they want to eat and drink and where they want to spend their time. A relative said, “ I’m more than happy with the service provided.” The people living there go out often and do the things they enjoy doing. Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 6 People have a choice of what food they eat. They are encouraged to eat a healthy diet to ensure they keep well. Staff have supported some people to go on holiday abroad if they wanted to. Staff help the people living there to go to health appointments when they need to. They follow the advice of health professionals so that the person’s health needs are met. One relative said, “ Dove House appears to me to be a clean, smell free, comfortable place to live.” Each person has their own bedroom. These are well decorated in the way that the person wanted it to be. There were many personal belongings in people’s bedrooms so they had things around them that they like. The home is clean. The staff help the people who live there to clean their bedrooms. One relative said, “ Staff have impressed me with their care and consideration for the people they look after.” What has improved since the last inspection? What they could do better: All staff must have training in minimising confrontation. This will make sure that staff know how to meet the changing needs of the people living there and keep them safe from harm. Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 7 Some improvements should be made to make sure that the risk of food poisoning is reduced and food is stored and prepared safely. There should be a bigger extractor fan in the shower room so it is comfortable when staff are supporting people to have a shower. The bathroom should be redecorated to make it a more comfortable and clean room. There should more staff meetings and staff should have more supervision sessions. This would make sure that all staff know about the changing needs of the people living there, ‘best practice’ and any changes happening within the organisation. All staff need to have an induction when they start working there so they know how to help the people living there to meet their needs. Staff should test the emergency lighting monthly to make sure it is working. 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. Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that prospective service users have the information they need to make a choice as to whether or not they want to live there. Before a person moves in their needs are assessed so to ensure that they can be met there. EVIDENCE: The statement of purpose had been updated in August this year to include changes to staffing and management arrangements. One part about the number of people who live there had not been updated and the manager said they would do this. It was produced using pictures and photographs making it easier to understand and included the required information. The service users guide included pictures and photographs making it easier to understand. It included all the relevant and required information about the home that people who are looking to move in would need to make a choice as to whether or not they want to live there. Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 10 One person had moved in since the last key inspection. Their records showed that an assessment of their needs was completed before they moved in to ensure they could be met at the home. The manager and staff visited the person before they moved in. They visited the home so having an opportunity to view the premises and meet the other people living there. The manager said that they would not take a person in an emergency without undertaking an assessment and meeting the person. Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have the information they need in care plans and risk assessments so that they know how to meet the needs of the people living there and keep them safe from harm. The people living there are supported to make choices and decisions about their lives and what happens in the home. EVIDENCE: The records of two of the people living there were looked at. These included an individual care plan. These were detailed and centred on the person. They included the information that staff would need so they know how to support the person and what things the person likes and dislikes so their preferences can be met. Some parts of the care plan included pictures making it easier to understand. Where appropriate the care plan was cross-referenced to relevant risk assessments, the person’s medication administration records, reports from other health professionals and policies so the reader would have all the information they need about the person to support them. Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 12 Care plans stated what makes the person happy, sad and angry. They stated the person’s hopes and dreams and the goals that they want to achieve. As the person had reached their goals this was stated and if anything needed to be done to continue to support the person this was stated. Care plans are regularly reviewed and updated with any changes. Care plans included how staff are to support the individual to make choices and decisions about their lives. This included regular meetings with the other people living there and making day-to-day decisions about what to wear, eat and drink, where the person wants to go and how they want their hair styled. Minutes of meetings held with the people living there showed that they talked about how they wanted their bedrooms decorated, what they wanted to do at Christmas, the quiet room and how it was to be redecorated, holidays, activities, day trips and the garden. At one meeting people talked about the menus. Staff supported people to make choices by looking at the food in the cupboard and pictures. Staff said they are going to take more photos of different meals so that people can have a wider choice. The manager said that at the next staff meeting they are going to introduce 1:1 sessions with individuals and their key workers so encouraging people to have more choice about their lives. Records showed that people are involved in developing and reviewing their care plan. Records included individual risk assessments. These stated how staff are to support the person to minimise the risks involved with moving around the home and the community, having a bath or shower, falling, during the night, having support with their personal care, using the minibus, using their wheelchair, choking, their health needs, using the kitchen and their behaviour. Risk assessments are reviewed regularly to make sure they are still effective in minimising risks and updated as needed. Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that the people living there experience a meaningful lifestyle. The people living there are offered a varied and healthy diet so helping to ensure their health needs are met. EVIDENCE: Each person has an individual activity sheet. Staff said that they are developing seasonal activity sheets so that people can have a range of activities that is appropriate to the time of year and the weather. During the day the people living there took part in a range of activities inside the home. These included art, watching DVD’s and TV, listening to music, making cakes with staff, spending time in the quiet room with the sensory lighting and music on and spending time with staff while they were preparing meals. In the afternoon two people went with staff to Solihull to pick up a new TV for one of the people. Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 14 Records sampled showed that people watch DVD’s and TV, go shopping, go to the park, go to church, bake cakes, go to parties at other homes, go to the bank, the hairdressers, go out for meals, play games, go to concerts, the theatre and go to the pub. Some people have booked tickets to a pantomime in the city centre over Christmas. All the people living there have planned to go out Christmas shopping and have a meal out. Staff said and records showed that two people had been on holiday with staff to Turkey for a week. Some of the people living there have not been able to go on holiday this year due to their changing health needs and one person had showed in the past that they do not enjoy going on holidays. Records showed that they have been out on day trips during the summer months that they had enjoyed. Records sampled showed and staff said that people are supported to keep in touch with their family and friends where appropriate. This may be through telephone calls, visits to the home and visiting them and inviting them to attend their reviews, if they want to. One relative said, “ I can visit at any time. The staff do not know I’m visiting.” Another relative said, “ The staff are always welcoming when I visit. I attend case conferences about my relative and voice any concerns I have at the meeting. ” Records showed and it was observed that the people living there are encouraged to be as independent as possible and take part in tasks within the home. This included cleaning their bedrooms, putting their laundry away, helping to make drinks and helping to prepare meals. Food records sampled showed that the people living there are offered a variety of food that includes fruit and vegetables. Staff have improved in the recording of fruit and vegetables offered to show that people do have a healthy diet. On most days sampled it was recorded that people had the recommended five portions of fruit and vegetables for a healthy diet. A smoothie maker had been purchased to encourage people who may have difficulty in swallowing or may not like fruit to have it more often. There was a large bowl of fresh fruit in the kitchen and fresh vegetables were provided. The food provided is appropriate to the cultural background of the people living there. Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that the personal care and health needs of individual’s are met so ensuring their well being. The systems for the management of the medication ensure that people get the right medication at the right time so ensuring their health needs are met. EVIDENCE: The people living there were well supported with their personal care and were well dressed appropriately to their age, gender, the weather and the activities they were doing. Staff supported people to change their clothes if they were soiled or stained so they were comfortable. Each person had their individual style of hair and dress. Staff were observed supporting people to sit comfortably in the lounge or their bedroom wherever they chose to be. One relative said, “ My relative has always been clean and well cared for.” Records sampled included how staff are to support individuals with their personal care and health needs. Records showed that staff had supported Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 16 people to have regular health checks and where appropriate referrals had been made to health professionals to ensure people’s health needs are met. Records sampled included an individual Health Action Plan that was produced using pictures making it easier to understand. This is a personal plan about what a person needs to be healthy and what healthcare services they need support to access. Staff monitor individual’s weight and work with the Dietician to ensure that individual’s are well nourished and healthy. District nurses visit one person living there each day. When they visited they interacted well with the person and the staff, which showed that the staff work with the nurses for the benefit of the individual. Some people living there have dysphagia (difficulty in swallowing). They had been referred to the Speech and Language Therapist who had developed individual guidelines for staff to follow so they receive the nutrition they need but are not at risk of choking. These guidelines were displayed in the kitchen so as staff are preparing and serving food they know how to do this for individuals to ensure they are safe. Medication is stored safely in a locked cabinet. Records sampled included details of what medication the person was taking, the dose, any side effects and what it had been prescribed for. Some medication prescribed for one of the people living there are classed as Controlled Drugs (CD’s). These are stored as required in a separate cabinet and are checked by staff at the handover of each shift and recorded to ensure they are not used inappropriately. These were checked at the visit and the records cross-referenced with the amount stored in the cabinet indicating that the medication was being given as prescribed. Some people are prescribed PRN (as required) medication. For each medication prescribed PRN there was a protocol in place that stated when, why and how much of the medication should be given to ensure they only receive it when they need it. Medication Administration Records (MARS) sampled cross-referenced with the amount of medication in the cabinet indicating that medication had been given as prescribed. At the front of each person’s MARS there was a photograph of the individual so that unfamiliar staff would know who to give the medication to. Since the last inspection more staff had received training in administering medication and had been assessed as competent to do so. This means that there are always staff on duty that are competent to give the medication to the people living there. Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 17 The pharmacist from the PCT had visited twice in the last year. Records showed that the recommendations made by the pharmacist had been met so ensuring that the medication management systems were improved. Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that the views of the people living there are listened to and acted on. The people living there are protected from abuse, neglect and self-harm. EVIDENCE: In the last year there had been one complaint received by the home about an overhanging tree from their garden. This had been resolved by a tree surgeon visiting to cut the tree. There had been no complaints about the home received by the Commission. A copy of the home’s complaints procedure is available in the service users guide which is in each person’s bedroom. It is produced using pictures making it easier to understand. Records sampled included an inventory of the person’s belongings so that staff can keep a track of what the person has and if anything should go missing it would be easier to track this. These had been updated regularly as the person had bought new things. Records showed and the manager said that all staff have now received training in adult protection and the prevention of abuse. This had been outstanding from previous inspections and now ensures that staff know how to help people to be safe from harm. Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 19 Staff have not yet had training in the Mental Capacity Act but information is available in the home for staff to look at so they are aware of it and the implications for the people living there. This legislation requires an assessment of people’s capacity to be done if there is any doubt that the person does not have the capacity to make a decision about their health and welfare. If they are assessed as not having the capacity an Independent Mental Capacity Advocate (IMCA) can be appointed to help them with this. The manager said that when training is available he will book some staff to attend it and ask them to feedback to the staff team so all staff have an understanding. All the people living there have their own bank account. The Primary Care Trust (PCT) are the appointee for most of the people living there except one whose relative is their appointee. Benefits are paid straight into individual’s bank accounts. Finance records sampled cross – referenced with amount in their individual purse indicating that their money was being handled appropriately. Records showed that individual’s money had been spent on personal items and receipts were available of all expenditure. The manager said that if staff want to withdraw money on behalf of an individual agreement is needed from a senior manager and staff need to give an outline of what it is needed for to help ensure that people’s money is spent appropriately. The senior care staff audit the finances regularly to ensure that the systems in place protect the people living there. Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 20 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, 26, 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that people live in a homely, comfortable, clean and safe environment. EVIDENCE: The home was well decorated and the decoration and furniture were of a contemporary style. Since the last inspection a new table and chairs had been provided in the dining room. This gives enough room for staff to sit with the people living there to support them at mealtimes. Some of the chairs are fitted with arms to give people more support and prevent them from falling. The hall had been redecorated and the carpet had been replaced. The kitchen had recently been refurbished, redecorated and re-tiled to a high standard. Some of the electrical appliances, crockery and glasses had been replaced. There were no handles on the fridge/freezer. This made it difficult to open and ensure it was closed properly so that food is stored at the correct Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 21 temperature. Therefore, it is recommended that this be replaced. The chopping boards were very scratched and should be replaced to ensure that food hygiene standards are met so that people are not at risk of food poisoning. A new fly screen had been fitted to the window and back door. This was clean and helps to ensure that the risks of food poisoning are reduced. Bedrooms were well decorated to individual tastes and interests, very personalised, comfortable and included many personal possessions. Some people had recently purchased new furniture for their bedroom that they had been involved in choosing. Each bedroom door had a picture of something the person likes on it so to help them to identify their bedroom. In the shower room the flooring and tiling had been replaced. Staff said that the extractor fan is not big enough and it gets very hot in the room when supporting people to have a shower, which makes it uncomfortable to spend time in. In the bathroom a new bath chair had been provided so that the people living there can get in and out of the bath safely. One person has her own shower chair that ensures they are safe when being supported with their personal care. There were dolphin transfers on the bathroom walls making it less clinical, however the decoration was worn and should be repainted to make it a more comfortable room. The toilet had been decorated since the last inspection. The quiet room had been cleared of old records. Since the random inspection more furniture and sensory equipment had been provided. Staff said that this room is now used often by the people living there as a relaxing sensory room. They plan to get a waterbed for this room so that people can be more comfortable and have more opportunity to relax. At the random inspection it was found that the garden was not always used because some people had difficulty in accessing it. Since then a new extra wide gate had been fitted so that the people living there can access it more easily. There was a raised flower box that staff said they plan to turn into a herb garden in the spring to make the garden more pleasant to sit in. The laundry room had been decorated. The washing machine and tumble dryer were working so that people’s washing could be done as needed. The home was clean and there were no offensive odours making it a pleasant place to live. Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements for staffing, their support and development needs some improvement This would ensure that the people living there are always supported by an effective staff team who are supported, supervised and have the knowledge to meet individual’s changing needs. EVIDENCE: Rotas showed that all but one member of staff had completed National Vocational Qualification (NVQ) level 2 or 3 in Care. The member of staff who had not completed NVQ as well as other staff had completed the Learning Disability Award Framework (LDAF) training. The number of staff achieving NVQ exceeds the standard that at least 50 of staff have this and ensures that staff have the skills and knowledge to meet the needs of the people living there. In addition to this the LDAF provides staff with the skills and knowledge to work with people who have a learning disability. The manager said that there was a vacancy of thirty- two care staff hours during the day and one night a week. However, the night is to be filled by another night staff increasing their hours. One member of staff was absent due Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 23 to sickness and three members of staff had to take annual leave as an emergency that week due to personal issues. There was one member of staff short for the morning shift as a member of bank staff booked was also sick. The bank staffing section were sending another bank staff. When they arrived there were two bank staff and two permanent staff on duty. Both bank staff had worked there before and knew the people living there. They both said that they had an induction when they started working at the home. The manager helped staff until the other bank staff arrived to ensure that individual’s needs were met. The manager said and rotas showed that permanent staff were working extra shifts to help cover and give consistency of care to the people living there. Minutes of staff meetings showed that there had only been four meetings in the last year. The standard states that there should be at least six staff meetings in a year to ensure all staff are kept updated with the changing needs of the people living there, ‘best practice’ and any changes happening within the organisation. Three records of staff employed at the home were looked at. These included the required recruitment records including evidence that a Criminal Records Bureau (CRB) check had been undertaken. This helps to ensure that ‘suitable’ people are employed to work with the people living there. The manager said that all training requirements from the last inspection apart from training in minimising confrontation had been met. There are no dates available for this at present but he said that he would ensure staff attend this when dates are available. Records showed that staff had received training in moving and handling, medication, adult protection and the prevention of abuse, diversity in the workplace, first aid, food hygiene and three members of staff had completed training in dementia. A relative said, “ I do not know what training the staff have but I have always been more than happy with the care they show.” Records sampled showed that staff had not completed an induction when they first started working at the home although one member of staff had not yet completed their induction period. The manager said that he thought the others had completed an induction but their records were not available. All staff should complete an induction so they know how to support the people living there to meet their needs. Staff supervision records sampled showed that staff discussed their role as a key worker, the needs of the people living there and identified training and development needs. Supervision records showed that staff had not received at least six sessions in the last year as is recommended. The manager said that this would be improved as the PCT now expects all staff to have supervision monthly. Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements ensure that the people living there benefit from a well run home. The people living there can be confident that their views underpin the self-monitoring, review and development of the home. Arrangements are generally sufficient to ensure that the health, safety and welfare of the people living there is promoted and protected. EVIDENCE: The manager has several years experience of working with people who have a learning disability in a supervisory role and is a Registered Learning Disability Nurse (RNLD). Since the last key inspection he has been registered with the Commission. Staff said that the manager is very approachable, supportive and helps out where needed. Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 25 A manager from the PCT visits the home every month and completes an audit. A report of this visit is made and forwarded to the Commission. The senior manager was visiting when the inspector arrived. They said that they are developing an action plan that will go with the monthly audit so that it is clear when improvements are being made. The audit includes seeking the views of the people living there and staff. A representative from Family Housing visits the home monthly. As with the PCT audit they complete a report of their visit that includes seeking the views of the people living there and staff as to what needs to be improved to make the home better for the people living there. A relative said, “If they can maintain the standard of care for the people living at Dove House, that I have seen during this past year, that would be a great and much appreciated achievement.” Fire records showed that staff test the alarm regularly to make sure it is working. Staff had not always tested the emergency lighting monthly to make sure it is working and this was discussed with the manager. Staff have regular training in fire safety. There had not been a fire drill since January this year. These should be at least every six months so that the people living there and staff know what to do if there is a fire. A record of a fire drill being completed on 27th November 2007 was forwarded to the Commission following the inspection. An engineer regularly services the fire equipment to ensure it is well maintained and works well. Records showed that staff had not tested the water temperatures weekly to make sure they are not too hot or cold. A member of staff tested these during the inspection. They were all within safe limits to ensure that the people living there are not at risk of being scalded. Staff test the fridge and freezer temperatures twice daily. Records of these showed that they were within safe limits to ensure that food is stored appropriately so helping to reduce the risk of food poisoning. An electrician completed the annual test of the portable electrical appliances in October this year and stated that they were safe to use. A Corgi registered engineer completed the annual test of the gas equipment in March this year and stated that it was safe to use. An engineer regularly services the hoists, the slings and the adapted bathing facility to make sure they are well maintained and safe to move the people living there. Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 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 2 25 X 26 4 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 27 Yes, one. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA35 Regulation 13 (4) (ac), 18 (1) (a, c) Requirement All staff must receive training in minimising confrontation. This will ensure that staff know how to meet the changing needs of the people living there and keep them safe from harm. Outstanding from last inspection. Timescale for action 31/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA24 Good Practice Recommendations The handles on the fridge/freezer should be repaired or it should be replaced. This will ensure that food is stored at the correct temperature to reduce the risk of food poisoning. The chopping boards should be replaced to ensure that food hygiene standards are met so that people are not at risk of food poisoning. The extractor fan in the shower room should be replaced with a larger one so it is comfortable when staff are supporting people to have a shower. The bathroom should be redecorated to make it a more comfortable and clean room. DS0000024871.V340216.R01.S.doc Version 5.2 Page 28 2. 3. 4. YA24 YA27 YA27 Dove House 5. YA33 6. 7. YA35 YA36 8. YA42 There should be at least six staff meetings in a year to ensure all staff are kept updated with the changing needs of the people living there, ‘best practice’ and any changes happening within the organisation. Records should be available to show that all staff have completed an induction so they know how to support the people living there to meet their needs. Each member of staff should have six supervision sessions a year to ensure they know how to support the people living there and have identified their training and development needs. Staff should test the emergency lighting monthly to make sure it is working. Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Dove House DS0000024871.V340216.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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