Care Home: Mary Street

Similar services:

• Maple Lodge
• Heathlands
• Aston Court Nursing Home
• Breme
• Ravenhurst
• Bank House
• Inspirations
• Westmead

What the care home does well Mary Street provides a good level of comfort and homeliness for the people living there. Each person has their own self contained flat, with additional communal space where they can choose to socialise or not. People said they enjoyed the independence and privacy the accommodation offered, knowing they had the support from care staff when needed. The staff at the home has a good level of knowledge about peoples` needs and is able to continue to provide a good standard of care for the people living there. There were good interactions observed throughout the day between the staff and the people living in the home. The admission process to the home ensures that the needs of the people living in the home are known and met. Each person has a plan showing how they like to be supported and the things they need to stay happy, and healthy. The quality of food provided was good and able to meet the dietary needs of people living in the home. The home was proactive in providing a range of stimulating activities for people. People do the things that they enjoy, and try lots of new activities. The Manager and staff work really hard and have had training so that they know how to support people properly. People said `staff are really nice and listen to me and help me do the things I want to do`. The manager continues to be proactive and has positive plans for improving outcomes for people at Mary Street. They listen to the people and shape the service to fit their needs, this means people are well supported and continue to have new opportunities. What has improved since the last inspection? The range of activities continues to grow Mary Street is particularly good at arranging events which ensure people are kept aware of current issues. Mary Street have successfully organised a breast cancer awareness day, Black Awareness Month, Worlds biggest coffee morning, and a healthy eating day to look at and encourage healthy eating. The management of medication has improved and ensures people receive their medication in a timely and safe manner. Improved staffing levels has ensured that senior staff has more time to supervise and develop staff, which has helped to maintain good care standards and consistency for people living at Mary Street. Staff have had relevant training so they have the skills necessary to care for peoples` specialist needs. What the care home could do better: The manager was advised to audit all the radiators to identify any `hot spots` and make necessary arrangements to either turn radiators down or provide covers. This will ensure people are not at risk of burns from hot surfaces. There is a need for the cleaning schedule to be more consistently audited, to ensure cleaning tasks in the kitchen are carried out to a satisfactory standard. CARE HOMES FOR OLDER PEOPLE Mary Street 179 Mary Street Balsall Heath Birmingham West Midlands B12 9RN Lead Inspector Monica Heaselgrave Unannounced Inspection 9th December 2008 10:00 X10015.doc Version 1.40 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 DS0000017013.V370326.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 Older People. 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. DS0000017013.V370326.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mary Street Address 179 Mary Street Balsall Heath Birmingham West Midlands B12 9RN 0121 446 5719 F/P 0121 446 5719 valp@fch.org.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Friendship Care and Housing Association Mrs Valerie Paragon Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places DS0000017013.V370326.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Up to 21 service users requiring care by reason of old age (over 65). This number may include the one existing service user as at 2003, who requires care by reason of physical disability. That the home can accommodate one named service user over the age of 65 for reasons of Mental Disorder. 10th August 2006 Date of last inspection Brief Description of the Service: FCH Housing and Care own and manage 179 Mary St, which is registered to provide care and support to 20 older people and one younger adult with a physical disability. It currently offers this service to people from the AfricanCaribbean community. The home is situated in a residential area and is close to local shops, pubs, medical centre and places of worship. It is well served by public transport. Facilities briefly include 21 individual flats, each with its own lounge, bedroom, bathroom and kitchen. Each flat has a buzzer facility to summon staff for assistance. People have their own lockable front door, and can decorate and furnish their flats to individual taste. FCH Housing and Care are responsible for the maintenance and repair of the flats and the rest of the building, which consists of a communal lounge, dining room, office, staff rooms and laundry. FCH Housing and Care also maintain the grounds. The service user guide was not reviewed during this inspection and so information on fees payable was not seen. For information about fees that the home charges it is advised that the home manager is contacted. The inspection report is available in the home for visitors to read if they wish to. DS0000017013.V370326.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 2 stars. This means the people who use this service experience good quality outcomes. This report has been made using information that has been accumulated by the Commission for Social Care Inspection. The inspection visit was unannounced and the home did not know we were visiting. During the inspection, people living at the home were seen and spoken with. Staff on duty as well as the manager, were spoken with, and their interactions with people were observed. Surveys returned by people who live at Mary Street and relatives were also examined. The Annual Quality Assurance Assessment, completed and returned by the manager, also informed the inspection. This was well written, and gave clear examples of the home’s achievements, how it benefited people who live at Mary Street and how it could improve in the future. Five people were case tracked which means their care records were examined and their experience of the service provided by the home was looked at in detail. This was done by examining their care files, talking to staff involved in their care, talking to them or their relatives or friends, and observing interactions and care. What the service does well: Mary Street provides a good level of comfort and homeliness for the people living there. Each person has their own self contained flat, with additional communal space where they can choose to socialise or not. People said they enjoyed the independence and privacy the accommodation offered, knowing they had the support from care staff when needed. The staff at the home has a good level of knowledge about peoples’ needs and is able to continue to provide a good standard of care for the people living there. There were good interactions observed throughout the day between the staff and the people living in the home. The admission process to the home ensures that the needs of the people living in the home are known and met. Each person has a plan showing how they like to be supported and the things they need to stay happy, and healthy. DS0000017013.V370326.R01.S.doc Version 5.2 Page 6 The quality of food provided was good and able to meet the dietary needs of people living in the home. The home was proactive in providing a range of stimulating activities for people. People do the things that they enjoy, and try lots of new activities. The Manager and staff work really hard and have had training so that they know how to support people properly. People said ‘staff are really nice and listen to me and help me do the things I want to do’. The manager continues to be proactive and has positive plans for improving outcomes for people at Mary Street. They listen to the people and shape the service to fit their needs, this means people are well supported and continue to have new opportunities. What has improved since the last inspection? What they could do better: The manager was advised to audit all the radiators to identify any ‘hot spots’ and make necessary arrangements to either turn radiators down or provide covers. This will ensure people are not at risk of burns from hot surfaces. There is a need for the cleaning schedule to be more consistently audited, to ensure cleaning tasks in the kitchen are carried out to a satisfactory standard. DS0000017013.V370326.R01.S.doc Version 5.2 Page 7 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. DS0000017013.V370326.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000017013.V370326.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are given written information about the home and encouraged to visit before deciding whether the home is suited to their needs. Before people move in their needs are assessed so they know how the home will meet their needs. EVIDENCE: People who live at Mary Street have their own copy of the Statement of Purpose and Service User Guide. These documents include relevant information to inform people what to expect from the service. AQAA information shows that the service has continued to strive to make information more accessible to people and as such it was positive to see that supplementary information in the form of a leaflet that briefly tells people about the service provided, has been produced. A good range of assessments were seen on individual files. These showed that the manager visits the potential new resident in their own surroundings, and DS0000017013.V370326.R01.S.doc Version 5.2 Page 10 carries out an initial assessment to ensure the service is able to meet the persons’ needs. Introductory visits to Mary Street take place, and some people living at Mary Street confirmed they found this useful in helping them to make a decision. The information from the needs assessment combined with the assessment of the placing authority and consultation with the individual and their family, is used to create the initial care plan After the twenty eight day review, if every one is happy with the placement, then this is agreed. Information from the AQAA tells us that the service is looking to improve the outcomes for people moving into Mary Street by surveying those newly admitted to find out their experiences of both the referral and admission process. This is a positive initiative and once again demonstrates Mary Street as a service that constantly strives for best practice. DS0000017013.V370326.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home receive individualised care and identified risks are minimised. The management of medication has improved and ensures people receive their medication in a timely and safe manner. People are treated with respect and are clearly happy in the company of staff. EVIDENCE: Five care plans were looked at; these provided comprehensive details on how the needs of the individual are to be met. The care plans are written in large print making them easier to read for those with poorer sight. From reading the care plans staff would have a good insight into what they need to do to support individuals. The care plan covered all required areas including, personal care, medical needs, dietary requirements and social needs. It was nice to see a record of what people are able to do for themselves DS0000017013.V370326.R01.S.doc Version 5.2 Page 12 such as ‘can do own laundry but not carry the basket’, ‘can make own meals but requires assistance with shopping’, ‘can independently clean own flat’. Individual likes, dislikes and preferences were also included, such as ‘likes to listen to the radio, read the Bible, likes the theatre, seaside visits, and dances’. The care plan includes a wealth of information on all aspects of the persons’ needs, health, mobility, meals, sleep, continence, medication, memory, hobbies and interests, religion, culture, finances, and any specific equipment they may need to support their independence or assist with their personal care needs. Effective management of peoples care needs such as diabetes, weight monitoring, nutrition, and eye care, were recorded on the care plan, for instance the date of the last digital diabetes eye screening test, demonstrating that staff are aware of health care appointments and plan to follow these up. Care plans are reviewed monthly and updated to ensure they guide and reflect the care that is given and needed. The ‘key worker’ has an active role in this and speaking to individual staff demonstrated that they had up to date knowledge on how current care for their key client is managed. Risk assessments support the care plan and identify for each individual any event that may cause a difficulty to the person, such as, smoking, risk of scolding, manual handling, and evacuation in the event of a fire. These are important because they identify the every day risks or obstacles for people living in their own flat, and describe what type of support they might need to keep them safe whilst respecting their areas of independence. For instance some care plans contained a domestic chore plan which identified those tasks people needed assistanace with in and around their flat, such as doing their laundry, and the risk assessment identified which aspect of the task the staff may need to undertake, such as carrying the laundry basket. There were a range of risk assessments in place to show how people are supported to have a bath, cook their meals, go out shopping and to keep safe. Some risk assessments related to the need to supervise people at meal times who may be at risk of poor nutritional intake, or choking, some related to people who may wonder into other peoples’ flat. All the risk assessments seen gave sufficient detail to guide staff so that they could support the individual safely. A copy of the care plan and related risk assessments is in each persons flat, this ensures when staff go to assist them they have access to a current plan that will guide them in their care task. It also ensures that staff can record the support they have given and the individual can see for themselves what is recorded about them. The entries did contain relevant key facts of the persons day and routine. It was very positive to see that the staff meetings are used very constructively to go through care plans and discuss changing needs, this ensures all staff are kept informed of where changes are made or routines differ and supports more consistency for the people being cared for. DS0000017013.V370326.R01.S.doc Version 5.2 Page 13 Several people who live at Mary Street were spoken to, they were very positive in their responses about the care staff and the support they receive. ‘Staff are kind and always come when I need them.’ ‘They help me with my shopping, and my laundry and sometimes with my bathing if I’m not well, but it’s nice to do my own things as well’. ‘They check on me, ring my bell and ask if there’s anything I need, most times there’s not but it’s nice to have a chat and they are not too busy for that’. Care plans showed appropriate involvement of health professionals where required. Visits from health professionals took place privately, in peoples’ flats. Staff described individual arrangements in the support given to people around health care needs for example there are those who attend appointments independently and others who require staff support. This is recorded in their plan. Information from the AQAA tells us that Mary Street has actively embraced good practice when considering the last wishes of people they care for. They have joined the ‘PAN’ Birmingham Palliative Care Network to ensure dignity and respect is maintained up to and after the point of death. The medication round was observed and random samples of medication records were looked at. Where medications were not given or taken, the reason was clearly recorded. The majority of medications are dispensed from ‘blister packs’. An audit of five of these was carried out and showed that medications administered matched those recorded on medication records. The manager and senior staff had addressed previously noted shortcomings regarding the recording of medications not administered and maintaining a copy of the prescription to ensure staff could check the medication accurately. The medication round is a lengthy process, the staff member administering medication had received training, and called to each flat in turn. She was competent in checking the medications, administering them and signing appropriately. This time is also well utilised to check that people in their flat are well and happy. Staff was observed to be interacting with people in a respectful, friendly way throughout, and being attentive to needs. Whenever people were heard to ask staff for assistance, staff responded promptly. Peoples’ comments concerning the staff were all very positive, remarks such as ‘the staff is lovely’ and ‘they are always helpful’ being typical. Staff was seen to be responding to the call bell system effectively; this supported people who wished to remain in their flat whilst ensuring they had the support they needed. Call bells were not heard very often, some people spoken with were aware of them, but said they did not use them unless there were an emergency, no one had adverse comments concerning staff responses. Staff when spoken with said that if they did not hear from an individual they would make random checks to ensure people were safe whilst being careful not DS0000017013.V370326.R01.S.doc Version 5.2 Page 14 to invade their privacy. All of the flats have lockable doors and door bells enabling people to protect their own privacy. We surveyed people who live at Mary Street to find out their experiences of the care they receive. We had eleven completed surveys returned, people continue to be very satisfied with the quality of the care. Responses received included, The care home gives a lot of support and help” “Everything” “They look after us really well” “They look after the residents wellbeing and assistance is given whenever it’s needed” “Everyone is good to me”“It’s a nice place” “It’s a good place and I am happy with the service” It was positive to see that monthly audits include asking people if they are happy, or if there is anything they need. This has enabled staff to follow up on comments and ensure people are listened to. The home has a good track record for taking on board any feedback from people and using the information to improve and ensure standards are maintained. DS0000017013.V370326.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Mary Street have stimulating activities and are able to make choices in their daily lives. Visitors are welcomed and people enjoy the meals provided which are nutritious and varied. EVIDENCE: The communal lounge and dining area is where most people choose to congregate, the radio was playing the favoured radio channel and a lively atmosphere was evident with staff and people who live at Mary Street interacting well. The manager advised that activities are based on peoples’ wishes and are discussed regularly at house meetings. Minutes of the meetings showed that ideas for outings had been put forward and the manager was being pro active at meeting these wishes. Outings to the cinema, organising a salsa evening, a Toby carvery evening out, and inviting the Home library service into the home had taken place. It was particularly impressive to see that personal and individual requests had also been arranged, for one this involved attending a Baptismal in her own church. There has been a lot of work by staff to ensure people are kept aware of current issues and events that may affect them, Mary Street have successfully organised a breast cancer awareness day including a photo of DS0000017013.V370326.R01.S.doc Version 5.2 Page 16 staff wearing pink ribbons which was published in their own newsletter. They have held events such as Black Awareness Month, Worlds biggest coffee morning with proceeds to the cancer charity, they have had a healthy eating day to look at and encourage healthy eating particularly in light of diabetes and the need for people who buy a lot of their own food, to be aware of the choices they make. On a weekly basis a prayer meeting takes place and this was observed to be well attended. Activities include organised trips out, table top sales in the car park which involves the community. Daily events included walks, shopping trips, one person attends college, and people have enjoyed fetes. Care plans looked at included interests and preferred activities, and it was nice to see that staff tries to ensure people get to do the things they have asked for and are in their plan. Some people are very independent and enjoy a range of activities such as their own shopping, clubs and lunches out. Most people spoken with said they could choose what to do but enjoyed the fact that there was always something on offer. The garden has for some become a more regular pastime, relatives have got involved in gardening and this has encouraged people living at Mary Street to be involved, it is positive to see people developing new interests out of the options available to them. Activities were displayed in the communal areas so that people could see what was on offer. Apart from the activities previously discussed people are afforded the opportunity to make other choices in their daily lives. They have a choice of meals which was observed during the visit, and said that they could get up and go to bed when they wished. Having their own flat afforded them a degree of privacy and independence, some cook their meals and follow their own personal interests preferring their own company, whilst others enjoyed mixing socially later in the day it is a flexible environment which people say they enjoy. Meals were taken in the dining room. The majority of people have their main meal here; some choose to eat in their flat. Assistance was available when needed and was offered sensitively. People said that food was good and that there was always a choice. Choices were offered and portions were generous. Those requiring assistance were given it by staff that showed a good awareness of what help was likely to be required. Menus showed a variety of healthy food available, and meals offered included special diets. The minutes of house meetings clearly showed that food is discussed regularly to ensure that a range of cultural and religious preferences are available. DS0000017013.V370326.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at Mary Street say that they are happy with the service provided, and feel safe. The views and concerns of people have been listened to and improvements made. Staff has the skills necessary to protect people from abuse and know when incidents need to be reported. There are positive attitudes amongst the staff team and this ensures vulnerable people are protected. EVIDENCE: The Commission has not received any complaints about this service. People who live in the home were clear that they would speak to the manager if there were a problem. Surveys returned from relatives and people spoken with who live at Mary Street indicated that they were happy with the relationship they had with the manager and staff team and were confident that any concerns they had would be listened to and acted upon. People who live in the home are given a copy of the complaints procedure within their “Service User Guide” when they come to live at the home. The complaints procedure is also displayed in a leaflet in each flat, so that individuals or their family members can access it independently. Mary Street had a ‘Themed’ inspection in April 2008 during which the home DS0000017013.V370326.R01.S.doc Version 5.2 Page 18 was assessed to see how well it manages complaints and how it works in protecting people from abuse. The outcome of that inspection was positive, records looked at during this visit confirmed that staff had received training in the Protection of Vulnerable Adults and also have regular supervision when they discuss all types or abuse and actions that should be undertake if they suspected that abuse had occurred. Minutes of house meetings were looked at and indicated that people have the opportunity to raise any concerns they may have. These may be things they do not like, or where they think improvements can be made. There was a wealth of examples raised such as food menus and how they wish these to change for instance ‘some people dont like green bananas as they are too tough, and the plantain is too soft’. Repairs were raised such as trouble with the tap in one flat and loose tiles. It was also refreshing to see that any concerns or complaints are followed up in the monthly visit by the provider. This is a good means of quality assurance and another means of the service being able to obtain the views of people in order to make any improvements. The AQAA completed by the manager prior to the inspection visit stated that staff had received training in Adult Protection Procedures, and discussion with individual staff showed a good understanding of how to keep people safe. The training records showed that most staff had received training in how to recognise abusive situations and how to respond to them in order to safeguard people in their care. It was particularly pleasing to note that the manager updates her knowledge and skills in this area and recently attended a conference on ‘Keeping Older People Safe’, which means the service has a good understanding of how to protect and promote peoples’ rights. Relatives who returned surveys said that they had no complaints, and that if they did they would raise them with staff or the manager. People who live at Mary Street continue to be complimentary about the home, and especially about the staff, ‘Staff are very caring, they know when I need help and if ever I was worried I could talk to them or the manager’. DS0000017013.V370326.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There have been improvements that have addressed many of the issues raised at the last inspection. Mary Street provides a physical environment that is pleasant and well-maintained place to live. People have the specialist equipment they need. There is room for improvement in maintaining cleanliness in the kitchen and safe radiator surface temperatures could compromise an otherwise safe environment. EVIDENCE: At the last inspection the standards of cleanliness in one flat was poor, and the main kitchen required a deep clean, especially the extractor fans, cooker, and walls where there was evidence of spillages. All of the above could result in cross infection and place people at risk from sickness. DS0000017013.V370326.R01.S.doc Version 5.2 Page 20 There have been several improvements that have led to maintaining a pleasing environment for the people who live at Mary Street. For instance individual care plans now clearly show where people require support to manage their flat cleaning, and which aspects of cleaning and chores will be carried out by staff. This ensures that where people are unable to maintain standards, staff can ensure they continue to live in clean, comfortable and safe environment. It was positive to see that the shift planner specifies equipment cleaned, which helps to audit standards. Information provided in the AQAA matched that seen during the tour of communal areas. An enclosed garden has been improved with additional raised plant bedding space, and five of the flats have been redecorated to the individuals choice. Each flat is arranged to the individuals particular preference and all were seen to be comfortable with a range of personal possessions, people said they were ‘happy with their flat, and the privacy this offered them’. An orientation board was displayed in the dining area which informs people of the day, month, year and forthcoming activities, this is a nice way to keep people up to date. People have the equipment they need to support them such as a bath hoist, raised toilet seats, and grab rails along the corridors. One person with deteriorating sight recently had a black toilet seat provided so that it would contrast against the colour of the bathroom and help them to locate it more easily. Each individual flat and communal area is fitted with an emergency alarm system to summon help in an emergency. Items of cleaning materials were seen to be safely locked away. A walk around the communal areas and viewing of four of the flats showed standards of cleanliness to be good. Cleaning items were stored securely. One radiator in the lounge was extremely hot to touch and could pose a significant risk to people. Other radiators were randomly hand tested for surface temperature and posed no risk. The manager said that one flat had a radiator cover in place following a risk assessment. She is exploring quotes for other covers. She was advised to audit all the radiators to identify any ‘hot spots’ and make necessary arrangements to either turn radiators down or provide covers. There is a main kitchen and staff also support people in their own flat and so handle food on a daily basis. Staff had followed the ‘Better Busines safer Foods’ booklet and DVD to enhance their food safety knowledge. The AQAA tells us that Birmingham City Council Hygiene Award Scheme have awarded Mary Street 4Hs out of a possible 5Hs which indicates food hygiene is very good. The certificate is displayed at the front entrance. Fridge and freezer were checked foods were labeled dated and covered appropriately. Food temperature records showed that food temperatures are DS0000017013.V370326.R01.S.doc Version 5.2 Page 21 checked and recorded, gaps in these records were said to relate to when there is no cook available and meals are then pre ordered in. The oven, trolley and cooker had some grease residue and dust gathering. Staff must ensure equipement has a daily wipe down as food stuffs were evident on inside of oven doors, and the splash back. The pantry area was checked and food was seen to be labelled and stored appropriately. Dates and labels on foods in the fridge were evident although one tin of condensed milk which had been opened was removed. There is a need for the cleaning schedule to be more consistently audited, to ensure cleaning tasks in the kitchen are carried out to a satisfactory standard. Some rubbish was evident in the rear garden that needed removing. The garden areas are well maintained with raised flower beds where people have actively engaged in growing plants as well as vegetables. The area is level which means people can negotiate it safely. The large communal lounge and dining area was seen to be well utilised, activities were evident and the Gospel church singers visited in the evening, several people who live at Mary Street like to engage in the singing and it was nice to see they had a communal space that offered them pleasant and comfortable surroundings in which to do this. DS0000017013.V370326.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be confident of the attentions of a staff team they rate very highly, and who are properly recruited and deployed, and for whom training is enhancing the already high levels of care they are providing. Recruitment procedures provide robust safeguards for vulnerable people. EVIDENCE: At the previous visit in August 2006 it was noted that there were some gaps in the training programme, not all staff had the relevant skills and competency to ensure the needs of the people living at Mary Street were met. Training records sampled at that time demonstrated significant shortfalls in ensuring people were in safe hands at all times. It was positive to see that a lot of work has taken place in ensuring the gaps in training that were evident, are closed so that staff has the training they need to best understand and carry out their taskd more effectively. During this visit information taken from training records and the AQAA showed that over 71 of staff has NVQ level 2, four staff has completed infection control training, all staff have attended tissue viability, adult protection and dementia care training, and 100 of the catering staff has completed safe food handling. DS0000017013.V370326.R01.S.doc Version 5.2 Page 23 The manger said that during the last year staff had also completed training in first aid, manual handling, autism and challenging behaviour, adult protection, mental health, infection control, food safety, fire safety, medication, and diabetes. There clearly has been a lot of training activity which has been structured around the current needs of people living at Mary Street, that is focussed on delivering improved outcomes for them. The information available demonstrates that there is an ongoing structured training format where staff are nominated for the courses they need including a variety of statutory training with some specialist training as well. The manager said three staff had been nominated for safe handling of medicines, and three staff for tissue viability training. This should ensure that a competent and appropriately skilled staff team supports people. There is an Organisation Training Manager and the service is working towards delivering a consistent approach to induction. The service has recently introduced ‘Bite Size Management sessions’ to support staff in understanding procedures and policies and how these relate to their work. Two staff spoken with at this visit said they found these useful. There are good platforms for ‘testing out’ if these initiatives are indeed working for the benefit of the people living at Mary Street, as well as meeting the needs of the staff. For instance the minutes of five staff meetings in 2008 and ten monthly visits by the provider comment on how the training sessions are going, this is a really good example of how well Mary Street works in auditing their own practice and uses this information well in their planning to improve outcomes. Discussion with staff showed they have good understanding of their role and duties, feel supported by managers and in general have staffing levels needed to meet the needs of the people living there. The manager said that there has been improvements in staffing levels, training of staff, staff performance and links with other agencies. Staff said they have supervision regularly and this includes night staff and ancillary staff. Supervision targets are monitored via the providers’ visits to ensure staff has the one to one support and guidance they need to understand and carry out their tasks. Team meetings also take place and are used to discuss professional issues and procedures. Staff said they enjoy the in house training and recently had a presentation from manager on diabetes, which helped to inform their practice. Discussion with staff confirmed that they are aware of safeguarding procedures as these are discussed in their one to one supervisions and there are flow charts displayed to support them in this process. Staff spoken with was enthusiastic about their role and had a good knowledge of the individual care needs of people. The diversity in the staff team and its composition reflects the culture of the people using the service. DS0000017013.V370326.R01.S.doc Version 5.2 Page 24 The manager tries to keep use of external care agencies to a minimum by recruiting to the permanent and reserve staff team, in order to promote continuity of care for the people being cared for. Recruitment and selection procedures have remained consistently robust protecting the people who live there with all the required checks in place before the new employee commences work. DS0000017013.V370326.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People recieve a well-organised consisitently good level of care, and a process of canvassing their opinions is in place to make sure the service is run in their best interests. The manager actively promotes the health safety and welfare of people who live at Mary Street and has ensured staff has the training they need to best understand and carry out their tasks effectively. EVIDENCE: The people who live at Mary Street, staff and relatives were positive concerning the running of the home. The manager and her team has worked hard and successfully in addressing the shortcomings noted in the previous inspection. The manager is very experienced and uses her knowledge to ensure the needs of people are met. The canvassing of people’s views has led to many positive outcomes for them DS0000017013.V370326.R01.S.doc Version 5.2 Page 26 and these are published in the quarterly newsletter. This includes lots of updates on whos doing what, introduces people and provides a little profile on them. It informs people about events and activities that have taken place such as, gardeners corner, breast cancer awareness day, menus for Christmas, section on improvements they have made from listening to people such as Salsa evening, Toby evening, Home library service, and alerts people to new initiatives such as the first Customer Conference by friendship. There has been a continued effort to improve outcomes for people at Mary Street. The manager has attended a conference on Developing quality outcomes’, Dementia and Mental health, demonstrating her active involvement in updating best practice. The AQAA informs us that Friendship Care and Housing has given authorisation to over establish by 3 x 28hrs Support Worker posts, this is aimed at reducing the use of agency staff, and freeing up time for assistant managers to allow for monitoring and development of junior staff, a creative way of encouraging and developing a skilled, trained workforce. The responses in surveys sent to people showed that views of people living in the home and significant others are helping to inform the running of the home. Regular visits and comments by the area manager were also in evidence, and demonstrate that there is appropriate support to the manager in the running of the service. The home keeps small amounts of personal monies on behalf of people a sample of these was looked at and was seen to be kept safely. Staff said their supervision is completed on a regular basis, and is an effective system in monitoring their practice. Other platforms such as staff meetings also reflect that the manager has good communication with the team in communicating a clear sense of direction and supporting them in their role. The pre-inspection questionnaire detailed all necessary health and safety checks as being up-to-date. Certificates for the inspection and service of equipment confirmed this to be the case. With the exception of the kitchen which needed a clean to some surfaces, there were no health and safety breaches apparent during the inspection, items were stored appropriately and safely, and maintenance checks had been carried out to ensure all equipment was safe to use. The manager has highlighted areas where they need to make improvements such as maintaining safe surface temperatures of radiators, and has an action plan for undertaking this work. This has included risk assessments and arranging furniture to avoid direct contact with surfaces. The manager has also begun the process for auditing and budgeting for radiator covers. This will ensure people are protected from the risk of burns. DS0000017013.V370326.R01.S.doc Version 5.2 Page 27 DS0000017013.V370326.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 DS0000017013.V370326.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP25 Good Practice Recommendations Radiators are guarded or have guaranteed low surface temperatures. Audit all the radiators to identify any ‘hot spots’ and make necessary arrangements to turn radiators down and maintain low surface temperatures. To ensure the kitchen cleaning rota is followed, random checks should be made to maintain a satisfactory standard. 2 OP26 DS0000017013.V370326.R01.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 DS0000017013.V370326.R01.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!