Care Home: Loretta House

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What the care home does well Residents we spoke to told us about numerous opportunities they had to have involvement in activities, which they enjoyed, this including in cases jobs within the community. They also told us that they enjoyed life at the home and this included the meals that are available to them. Menus are well presented in appropriate formats, this to assist with regular meetings to discuss menus. We saw that staff provided good basic care to residents, and observed that the way they spoke to residents was appropriate and respectful. We have been told by the majority of people that they have confidence in the staff team and their ability to listen to and deal with any concerns raised. Those residents that require minimal staff assistance have flexibility in planning their time and are able to go out into the community when they wish, this assisted by easy to access transport (such as the bus). The atmosphere in the home was found to be relaxed and the environment homely and comfortable. What has improved since the last inspection? What the care home could do better: The following are some of the areas we identified where the home could improve: - There needs to be risk assessment of staffing arrangements to ensure that when there is one on duty this does not compromise residents safety. - Limitations for some residents that have limited mental capacity could be better identified; with more clarity as to what their level of decision-making is through risk assessment. - The home needs to ensure residents have regular access to their chosen means of worship, with consultation with residents and relatives as to when staff are needed as escorts so as to assist appropriate staff deployment. - All residents (as opposed to some) need ready access to dentists, should they wish it, or if they have there needs to be a clear record of their doing so. - There is scope for the improvement of some of the homes self-assessment systems that identify where there maybe risk to people living at the home. CARE HOME ADULTS 18-65 Loretta House 4 Hunton Hill Erdington Birmingham West Midlands B23 7NA Lead Inspector Jon Potts Unannounced Inspection 8/8/08, 3/9/08 & 20/11/08 09:00 Loretta House DS0000065681.V370043.R02.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 Loretta House DS0000065681.V370043.R02.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. Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Loretta House Address 4 Hunton Hill Erdington Birmingham West Midlands B23 7NA 0121 384 5123 F/P 0121 384 5123 lhome@btinternet.com None Kidderminster Care Ltd 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) Miss Fatima Chouhaib Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Loretta House DS0000065681.V370043.R02.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: Learning disability (LD) 10 The maximum number of service users who can be accommodated is: 10 25th July 2007 2. Date of last inspection Brief Description of the Service: Loretta House is a large, traditional style, detached and extended property, located at the junction of Hunton Hill and the Birmingham Road. The homes location, provides good access to bus and train services at the Gravely Hill train station, a few minutes walk away. Loretta House provides accommodation to ten service users, all who have a learning disability. The home briefly comprises of, two lounges located on the ground floor, a dining area. An open plan kitchen and laundry. Bathing and toilet facilities are located on all floors. The home does not have a lift, and the ground floor is on different levels. Service users must therefore be able to negotiate stairs. There is an adapted sit in bathing facility available in the home. There is a pleasant, wellmaintained private garden at the back of the house and off road parking for a number of cars to the front. The home has 24hr staffing with multiskilled carers (staff that carry out care and domestic routines) managed by seniors and Manager (registered just after this inspection was completed). The Registered manager is responsible to the director of the company. The current scale of charges for accommodation and services is now available in the homes statement of purpose this ranging between £312 - £850 per week. Loretta House DS0000065681.V370043.R02.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 2 stars. This means the people that use this service experience good quality outcomes. We carried out the visit to Loretta over two days with two inspectors involved in one of these visits. We also visited the home a third time following completion of the inspection to discuss the homes response to the outcomes identified. Our objective was to assess the homes performance against key national minimum standards and more importantly how this impacted on outcomes for service users. Evidence was drawn from a number of sources that including tracking the care for a number of residents, talking to residents, relatives, visiting professionals, staff and management, a tour of the premises and reading/checking numerous other records. Information was also provided by the home via an AQAA (annual quality assurance assessment) that outlined the home’s view of its own performance. All those involved with the inspection are to be thanked for their ready assistance with the inspection process especially residents. What the service does well: What has improved since the last inspection? We saw that there has been improvement this assisted by the use of a different filing system for care records. This has improved access to Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 6 information. Whilst these records are not always in a person centred format we found that they did draw on reviews with the individual (and their social worker) that had involved them, where they had opportunity to contribute. Whilst there is scope for further improvement in the way risks are assessed there is now clear identification of more generic risks to health such as skin condition, nutrition and falls that helps maintenance of an individuals health through regular review. We also saw that the staff are recording any incidents where residents may challenge staff so as to help identify the causes and ideally remove them. The one bathroom has been redecorated and refitted and is more comfortable as a result. The home now also has a sit in bath, that is available to those residents that may have difficultly sitting in a standard bath, this providing more choice. The management have also improved their vetting procedures for new staff they recruit – this to ensure that people at the home are better protected. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 5 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents and relatives who use the home usually have sufficient information presented to them to assist them with decision-making, and the homes procedures indicate that this would be the case for any prospective new admission to the service. The home reviews the needs of residents with input from social workers. EVIDENCE: The current residents at the home have lived there for a number of years meaning that there have been no recent admissions to test out the homes procedures and practice in this area. Time was therefore spent discussing how an admission to the home would be managed with the Manager of the home. This evidenced that the current procedures are generally satisfactory. The service has developed a Statement of Purpose, which sets out the aims and objectives of the home, and includes a service user guide, which provides information about the service and the specific type of care the home offers. The guide is made available to individuals in a large print format with some limited use of pictorial images at present although the Manager discussed her wish to produce a video based presentation as was the case at the previous Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 9 key inspection. We discussed with the Manager the need to ensure that any review of the Service users guide would be with the involvement of the current resident group. We were also told that there is an audio version of the guide available. The current Statement of Purpose has been subject to some review since the last inspection to reflect the provision of a service to residents that are becoming older and in some cases more frail. We received comments from relatives as to their views on receipt of information from the home 2 saying they usually did and 1 saying only sometimes. Comments included the following: ‘The staff are open and freely give any information when required’ ‘I would like more information, I only get it when I ask’ We saw that the procedures stated, and the Manager confirmed, that the home needs to consult assessments to see if they can meet the prospective individual’s needs, this before they make the decision to accept the application for admission and offer a placement. Due to no recent admissions there was limited evidence available although a new pre admission assessment format has been developed by the home (as was shown to us), this covering many areas of potential need and having space for an initial care plan. The Manager was also clear that she would obtain copies of assessments from social workers to assist with this process. We saw that the home has copies of the recent reviews carried out by social workers for those three residents whose care we tracked. These indicated that the home was meeting the needs of these individuals. Relatives told us that the home always or usually meets the residents needs one saying that ‘My (relative) is looked after very well and her needs are met’. Residents were seen to have been provided with a statement of terms and conditions/Contract, these reviewed since the last inspection to reflect changes in fees. The contract gives information on what people who live in the home can expect to receive for the fee they pay, and sets out terms and conditions of occupancy, although would benefit from presentation in more user friendly formats. It was noted that the three contracts seen were not signed. Two of the individuals concerned were stated not to be able to sign (as was indicated by assessments) although the third individual had signed their care plan, so therefore should be able to sign their contract. It was suggested to the Manager that the contract was explained to the individual and if they agreed they could sign, with the other two contracts to be signed by representatives (based on a clear indication in respect of individual’s mental capacity). Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has developed identification of individuals needs through a more structured care planning approach and where able individuals have involvement with care planning. Residents have a degree of involvement in making decisions about their lives, although limitations could be more comprehensively identified through risk assessment. EVIDENCE: We saw that the service has developed the resident’s individual plans with adoption of a new care record format (standex file system) that was found to be far easier to follow than records seen at the previous inspection. These were seen to be laid out so that access to the basic information about individuals informs care planning and risk assessments that cover basic area of risk such as falls, tissue viability, nutrition etc. The care plans we saw based on their content drew on some of the information detailed in recent social worker reviews and in most instances we saw evidence that care plans were followed Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 11 through, this by looking at other records, observing practice, talking to residents and staff. We noted that some of the care plans were signed by residents to indicate their agreement, or where there was indication that they lack capacity their relative. We spoke to two residents who told us that they were aware of their care plans and had been involved in drawing them together with their keyworkers. The plans we saw covered the individuals social, physical and emotional needs and there was reference to methods of communication with residents, identifying whether where there were limitations and what staff needed to be aware of, such as the limitations of an individuals communication, how they express themselves etc. These documents were mostly in written format however and consideration needs to be given to looking at formats they may assist with residents involvement when they are unable to read wherever this is possible, this possibly through person centred planning that uses more pictorial (possibly photographic) information. Care plans are reviewed and updated by the residents key workers usually every month with residents views stated to be reflected within this through key workers observation of their preferences and choices over the prior month. The plan is supported by risk assessments that focus on keeping the residents safe when involved with independent living skills including such as cooking, housework, sharp objects etc. There was some evidence of staff recording limitations placed on residents (for reasons of safety) within these although there was scope to consider use of risk assessment to build on identifying capacity issues in respect of specific areas of risk in terms of daily living. This approach should assist in identifying specifically what limitations on choice and independence are placed on the residents due to capacity, beyond those that the home has identified within case files. We saw some identification in respect of issues such as needing staff to accompany an individual in the community due to lack of understanding of risks. There are other areas where the home may take control in what is seen as the ‘best interests’ of individuals due to risk (for example not allowing residents access to the laundry, holding personal monies etc). Where this is the case this needs to be identified as a limitation and steps taken to ensure that where decisions are made for a resident they do not have the capacity to make this decision themselves in respect of specific areas of daily life. Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 12 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. Residents are supported to make choices about their life style, and develop their life skills in accordance with individual capability. Social, educational, and recreational activities generally meet most individual’s expectations. EVIDENCE: We saw that the service has commitment to individuals to develop their skills, through activities such as housework, food preparation, jobs and leisure. Many of the residents are involved with day placements at Adult training centres and some residents told us about the jobs they have. The home allows residents to participate in daytime activities that are of their own choice and according to their individual interests and capability, as identified through assessment. Where appropriate education and occupation opportunities are encouraged, these supported and promoted with access to Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 13 such as the aforementioned day centres. There are however some residents that due to age and frailty have a lesser involvement with activities limited by their ability and choice. Where residents are able they can usually access and enjoy the opportunities available in their local community, although this sometimes dependent on staff availability where residents may need staff support. Minutes of residents meetings showed that activities were frequently discussed and evidence of the activities residents told us about was seen displayed on the notice board, as well as in care records. Two families indicated that they would like to see their relatives go for more outings (such as swimming). Based on comments from more independent residents there would only seem to be restriction for more dependent residents presumably due to the need for staff to accompany them when going out which would dictate the need for targeted staffing provision. There was evidence that some residents attend church, although others may not, this stated by the Manager to be due to the fact that they have no interest. The documentation of this choice or discussion with representatives where they do not have capacity to make a decision should be considered. There was comment from relatives that attendance at church was limited to when they took them, and the home needs to ensure that individual’s opportunity to worship is clear and not limited by staffing considerations. The home encourages residents to maintain important personal and family relationships, some relatives responding to questionnaires confirming this was usually the case although there was one that felt contact could be better, with information brought to their attention as to the individuals general progress on a three monthly basis, not just when an incident occurred. The home is proactive in seeking the views of relatives through annual quality assurance questionnaires, the manager stating that questionnaires are due to be sent out. Staff have explored communication strategies with residents including PECS and sign although the use of the former is no longer pursued for one resident as the Manager told us there were difficulties getting the resident to instigate its use, despite speech therapy involvement. Residents are involved in the domestic routines of the home dependent on their individual capabilities and some residents told us that they cleaned their rooms. Residents have some involvement in meal preparation, and the home was seen to have a varied menu that includes alternatives for residents with specific dietary needs. The home has developed a pictorial book of all the meals available, these photographs of meals prepared at the home. This supplements a menu that is available in large print. Meals are balanced and nutritional and cater for varying choices and preferences, with individual care plans picking up on areas where there is specific dietary need. The manager told us that residents are involved in weekly meal planning, this confirmed by one of the residents. Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 14 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. The health and personal care that people receive is based on their individual needs. Residents tell us that they are satisfied with the way personal care is provided by staff although more diligence is required in monitoring access to community health care services. The homes policy/procedures and practice in respect of medication with some exceptions is satisfactory. EVIDENCE: We spoke to a number of residents and they stated that they were satisfied with the service and the way that care was provided by staff, this confirming comments from two relatives who stated that care and support was always or usually as expected. Only one relative stated that this was sometimes the case. One relative stated that the home was ‘strong on support and care for each resident’. The interaction we saw between staff and residents at the times of the visits to the home were appropriate, with the aims and objectives of the home reinforcing the importance of treating individuals with respect and dignity. Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 15 Personal healthcare needs including specialist health and dietary requirements are recorded in each resident’s plan giving a clear overview of what their health needs are; with detail as to how the home intends to address these. We saw that care plans documented how the home will meet specific health needs such as diabetes with detail as to how this will be monitored, and the actions that staff will take when issues arise. The home has introduced the use of tissue viability and nutritional assessments to identify any potential risks in these areas for all individuals, not just those becoming frailer due to age. We saw that resident’s access to healthcare and remedial services was usually seen to be clearly documented although there were gaps with no record of some of the more dependent residents having seen a dentist recently. In addition one resident’s last consultation with a chiropodist made reference to the need for a further consultation after six months and there was no record seen to evidence that this had occurred. The Manager told us that this was due to lack of recording and discussion with other residents evidenced that they had seen a dentist and had access to all health services, visiting these services when necessary. The home will request visits from local health care services when residents are not able to visit them. We noted that there was reference in the residents health action plans to such as breast screening although there has been no recording to show the response of the home to this. The Manager needs to clarify with the resident’s G.Ps as to what if any action they should be taking to pick up on any abnormalities, with recording in the resident’s files to reflect this advice/guidance. We saw that staff have access to training in health care matters and are supported to attend in house training given by appropriate health care specialists, such as epilepsy. The Manager was also able to evidence that staff using blood-monitoring machines to test on resident’ blood sugars have now received guidance from district nursing staff, this confirmed by letter. The home has an appropriate medication policy supported by procedures and practice guidance, signed by staff. These underline the importance of allowing residents to self medicate where possible and we saw that where residents are able to consent that there was records of their agreement to the home handling their medication. Medication records were seen to be fully completed, having required entries, with evidence that appropriate health professionals confirm changes but only in respect of prescribed tablets. There was no recording of the staff applying prescribed creams seen on the 2nd day of the inspection although this matter had been rectified at the time of our last visit. We saw that there is now a list of staff that administer medication in the MARs (medical administration records) with copies of their signatures, as they would appear on the MARs sheets, as should be the case so as to allow easy crossreferencing. Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 16 The contracted pharmacist has not carried out quarterly checks on the homes medication systems, this said by the Manager to be due to issues with said pharmacist. The Manager stated that she is trying to resolve this issue. The home does not currently hold controlled drugs although a controlled drugs book and policy is available should it be needed. We saw that staff that administer medications have received the appropriate accredited training, this evidenced through sight of certificates. We became aware of one incident where medication was given in error. The response to this incident showed that the staff knew the correct procedure and steps have been taken by the Manager to ensure that the possibility of any reoccurrence is minimised. We were not notified of this incident at the time however, although the Manager understood that we should have been and has since sent a copy of a report to us. Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, and are generally well protected from abuse. EVIDENCE: The service was seen to have a complaints procedure that was available in written and alternative formats, this on display in a prominent place in the home and accessible to all the residents and visitors. The Manager was however advised to add CSCI’s national contact number to this procedure. Residents confirmed that they were aware of how to make a complaint although stressed that they did not have any. Residents also stated that staff listened and responded to what they said. Two out of the three relatives that responded to questionnaires stated they were aware of the homes complaints procedure but they stated that the home always or usually responds to any concerns raised. One of the residents told us that if she had a complaint they told the staff and ‘they put right’ with a relative stating that ‘ The staff always listen to me and if it is in the interest and well being of my (relative) they will carry out what I ask, but they are also keen to let me know what is best for her’. We spoke to staff who told us they had not received any complaints of late although were aware of the correct action to take should any be brought to their attention. Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 18 The policies and procedures for safeguarding adults were available on request and were seen to be easily accessible to staff, as were those for the local social services department. We saw that all staff have received training in adult protection. The home has policies on physical intervention and restraint, these stating that the staff would not use restraint unless they are trained. From tracking resident’s care there was no evidence of any use of physical restraint and no behaviours from individuals requiring such intervention. The Manager was however advised to ensure subtler issues that may impose limitations on residents (such as not been able to complete daily living tasks, staff availability when they need to be accompanied in the community and such like) are fully explored in risk assessments in line with the mental capacity act. We saw that the home has improved its systems for the recording of residents behaviours, these seen to be documented clearly with identification of the reasons for the behaviour if known also identified. It would be helpful to build these triggers into care planning to avoid behaviours where possible, although we did judge that any challenges presented to staff were minimal and easily managed. The home has also introduced the use of body maps in case files for the recording of any marks on residents due to promoting independence, accidents, self-harm or pressure areas, so that the potential for any unexplained injuries is reduced. Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26 & 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents live in a homely, comfortable and for the majority a safe environment that does not compromise individuals independence. EVIDENCE: Based on residents needs the home provides a physical environment that allows the service to meet these. The home does not have any residents at present that have difficulty moving around the environment either independently or with some minimal staff assistance as is specified in care plans. Residents we spoke to said they liked their bedrooms and the home presents as comfortable. We saw that there has been ongoing works to improve the building with new baths fitted (one an adapted facility) and redecorating in some areas. We noted that toilet seats are now secure, this an issue at the time of a random inspection to the home in February 2008. Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 20 The last West Midlands Fire service inspection in June 2006 stated that ‘fire precautions are satisfactory’. We did however see that one resident had a mortise lock on their bedroom door with keys, meaning they could lock themselves in and prevent staff access. This would be a fire safety issue, although the resident did give the keys to the Manager at the time, this as they had a second lock on the door that staff could open. Whilst this is an issue that has now been addressed it is one that should have been identified by management within their risk assessment of the premises. We noted that there is an uneven area of floor in the kitchen, which may benefit from some form of highlighting so that people are aware of it. There have no been any trips that we are aware of as a result of this however, although discussion with environmental services as to best reduce any hazards that may present is advisable. We sampled routine servicing certificates for equipment within the property and found that these had been maintained in respect of such as gas safety, fire equipment and water temperatures. We saw a number of resident’s rooms, and these have been personalised. Residents showed and told us that they have access to keys to their bedrooms. Comment made in the last inspection report as to lighting in one resident’s room has resulted in improvement that the occupant told us was satisfactory and improved the light available. We saw that the home was clean and tidy, and there was no evidence of any unpleasant odours. We saw the homes cleaning schedules on display in the home. The home has infection control procedures that reference the need to contact the health protection agency when required. There have been no recent outbreaks of infection at the home. We saw that the laundry is sited well away from food preparation areas (meaning no soiled laundry has to be carried through food service areas) although we were concerned that the laundry was very hot and steamed up on the first day we visited. Discussion with the Manager on our second day of our visit indicated that there are plans to fit an external vent to the dryer so that the temperature in the laundry is bearable. We saw and staff confirmed that there is a good supply of protective equipment available to them (for example gloves, aprons) and there was liquid soap and paper towels available for hand washing in all toilets and bathrooms. Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff at the home are trained, skilled and usually in sufficient numbers to support the people who use the service. The homes recruitment procedures support the protection of the residents. EVIDENCE: The home has minimal staff turn over meaning the staff team is stable, with some staff having worked at the home, and with the residents for a number of years. Interactions observed between staff and residents during the course of the visit were positive, with residents supported with sensitivity and respect. Daytime staffing varied between three staff at busier times and one staff when the majority of residents were at day placements. On the first day we visited we saw that there was four residents at the home on our arrival but only one member of staff from 9am (after the night staff left). The staff member told us that there are usually less residents at the home at that time of day, with more stopping at home due to illness and holidays from day placements. Whilst the residents at the home did not require constant supervision, some seen to be Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 22 very independent, there was concern as to what may happen if there was an incident and the staff member needed assistance. The Manager told us that the staff member did have a number to call back up staff, although the staff member on duty was not clear about this when we asked. We have now seen a copy of the homes on call rota, this containing the names of individuals who are available on set days of the week if required at the home. The Manager has also told us that it has been reinforced with staff that this is to be used as and when circumstances dictate, although has agreed that a policy on when staff should be called out could be drawn up for staff reference. There is more staff available in the afternoons though which staff told us was ‘busier’ as ‘they have to prepare tea and do the baths’. Staff did however tell us that they felt staffing numbers are adequate and resident’s did not raise any concern as to these. There was comment from a relative about residents attending community activities such as church, where staff would need to be available to accompany them, this not always possible. The Manager told us that when given sufficient notice the staff would always try to accommodate such requests however. The Manager was advised to risk assess the staffing levels at the points where there was only one staff member available and identify any potential dangers, and then putting in safeguards to address these. Residents spoken to about staff were positive as to how they were treated. There was comment from staff as to other staff been ‘unreliable’ although there was no evidence of this impacting on resident’s positive perceptions of the staff or the practices of staff during the visits to the home. The service clearly recognises the importance of training, and tries to delivers a programme that meets any statutory requirements and the National Minimum Standards. All staff have received training in mandatory areas although would benefit from input in areas such as diversity and person centred planning. Induction training for staff was documented with use of the common induction standards for care homes although we did note that these had been completed over one day, and it was suggested to the Manager that she should encourage new staff to take more time exploring practice issues with use of such as on going supervision and written work to better evidence their understanding of good care practice. One staff member did however comment that they were well supported when they started work at the home and there was a clear record of staff supervision seen in staff files. Staff stated that team meetings could be better. Discussion with the Manager indicated that the last one that was arranged for July 2008 resulted in nonattendance by staff. This is an area that the Manager needs to discuss with the staff team to establish what their views are and why these differ. Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 23 The service has a recruitment procedure that meets the regulations and the National Minimum Standards and from sight of staff files we identified that safe recruitment practice protected residents. Loretta House DS0000065681.V370043.R02.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): 37,39,41 & 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are clear signs of the homes management and administration improving with better use of quality monitoring. There is however still scope to improve and continue developing monitoring systems for the home so that resident’s rights and best interests are safeguarded. EVIDENCE: The manager has completed the registration process with the CSCI shortly after we completed this inspection and was determined to be ‘fit’ to manage the home. The Manager has completed her nurse training and is currently undertaking her Registered Manager Award. Discussion with the Manager during the inspection evidenced that she is more confident and also clearer as to how the service needs to be developed. In addition the Manager is Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 25 supported by an experienced provider who has a wealth of experience in the care sector managing care homes. Comments received indicated that relatives felt that staff generally knew their jobs and carried these out satisfactorily. Comments we heard from residents as to staff performance are very positive. The Manager expressed a wish to run a service that is user focused, taking account of equality and diversity issues, and wanting to work in partnership with families of people who use the service, although we noted that there was mixed views of how successful communication with relatives is based on their comments, some very positive whilst one felt communication could be better. The homes policies and procedures in part support this approach and there has been some development of the homes quality monitoring system, this a checklist that the manager uses to assess the home against National Minimum Standards. We discussed this with the Manager and highlighted that the completion of this over a 12 month period would allow the assessors carrying out the assessments to complete it in greater depth; and in so doing provide a more critical and accurate analysis that the Manager would be able to use for improving outcomes for residents. We do however acknowledge that there has been some improvement in this area and the AQAA (Annual quality assurance questionnaire) that was returned to us identified a number of areas where there were plans to improve as well a reasonable picture of the current service that was evidenced by what we saw. Records we saw in respect of resident’s monies in safekeeping were found to be accurate although there was concern that transactions are not in every instance verified by a second member of staff or service user, this as there are occasions when there is only one member of staff on duty. In discussion the Manager has identified a strategy to overcome this issue however. It was pleasing to see that there are now inventories of resident’s property in place in resident’s files, although we found that some of these were not dated and one did not have a resident’s Walkman listed upon it. The Manager stated that this was a recent purchase but agreed that it should have been entered on the record. This matter was seen to have been addressed on the date of our last visit to the home. The Provider and Manager are aware of the need to promote safeguarding and have developed a health and safety policy that generally meets health and safety requirements and legislation. The home has an environmental audit which is now carried out more frequently than at the time of the last inspection. Comments as to ensuring all issues in respect of the homes safety as made earlier in this report should be noted as any audit should have highlighted the presence of issues with a bedroom door lock. Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 26 It was however pleasing to see that following the last Environmental Health food hygiene inspection (29/10/08) that the home has achieved a 4 star rating, this benchmarked as meaning there is very good food hygiene. Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 3 X 2 2 X Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 28 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 YA16 Good Practice Recommendations The Registered Manager should ensure that resident’s access to choices in regard to their daily living activities is risk assessed in line with the Mental Capacity act guidance. This should include reference to their choices in respect of worship, with appropriate assistance provided where needed. The Registered Manager should ensure that all residents have access to the full range of community health services, this to include dentists, and chiropodists. When residents have such access a record of this should be kept. The Registered Manager should consider how residents could be best screened for such as breast or testicular cancer following advice/consultation with the residents GP. The Registered Persons should discuss the impact of uneven flooring in the dining room with Environmental Services to identify how the impact of this potential hazard can be minimised, and risk to residents reduced. The Registered Persons should ensure that the laundry has DS0000065681.V370043.R02.S.doc Version 5.2 Page 29 2. YA19 3. 4. YA19 YA24 5. YA30 Loretta House 6. YA33 better ventilation to prevent it getting too hot, and preventing an uncomfortable working environment. The Registered Persons must risk assess the potential dangers presented by having only one member of staff on duty when residents are at home, and then identify strategies to respond to these. This is to ensure that any potential incidents that may occur will not endanger residents due to current staff deployment. The Registered Manager should continue to develop the home’s quality assurance systems so they enable increased proactively in management and as a result improved outcomes for service users. The Registered Manager should ensure that records of resident’s monies in safekeeping are countersigned by two persons, one preferably the individual to whose monies the records relate. 7. YA39 8. YA41 Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 30 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 Loretta House DS0000065681.V370043.R02.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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