Care Home: Mimosa

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What the care home does well People who use the service are encouraged to live as independently as possible and require support with this. Risk assessments have been carried out where a known risk has been identified.The assessed needs of the people who use the service are recorded and care plans are in place to ensure that these needs can be met. Health needs are also recorded and support is provided to attend GP and other health related appointments. The introduction of Health Action Plans is very positive. The standards for the safe management, storage and recording of medication are good. People who use the service know who their key worker is and say that they feel supported. People who use the service meet regularly with staff both in groups and for individual sessions to discuss their day-to-day lifestyles and care needs. The home is in keeping with other residential housing stock in the area and provides a domestic environment with sufficient private and communal space. All bedrooms are single and the people who use the service can have their own keys if they choose to. Staff training is provided and is up to date, staff receive 1:2:1 supervisions and also meet regularly as a team. Staff recruitment procedures are satisfactory and protect the people using the service. What has improved since the last inspection? The manager has confirmed that the main areas of concern identified at the last key inspection have been addressed. The service is in the process of introducing person centred approaches, and has involved people who use the service with health planning and the development of individual activity plans. Health action plans have been introduced. The organisation has introduced a service user forum for all of the homes in Stoke-on-Trent, a representative from each of the services attends these meetings. The complaints procedure has been changed to a user-friendly format. The shower room have been refurbished and redecorated. A new induction programme for new staff has been introduced. The manager is now registered with us. What the care home could do better: There is evidence of improvement in a number of areas since the last key visit, but some of the recommendations of the last report have not been fully implemented. The information provided for prospective and current service users in the Statement of Purpose and Service User Guide should be up to date. And people who use the service should know what the fees and costs of the service are. The introduction of the new person centred plans should be completed and staff should be provided with the training or the guidance they need to be confident they can support people who use the service with these. There are areas of the home that have deteriorated since the last key inspection visit. An immediate requirement was made during this visit to improve the first floor bathroom, the lounge and replace the two beds and other bedroom furniture. Other areas of concern have also been identified. Staffing levels should remain under review to ensure that they are sufficient to meet the needs of people who use the service, and all staff must receive mandatory training and have regular updates. An annual development plan should be produced based upon the outcomes of the quality audits of the service; the manager should complete the NVQ level 4. CARE HOME ADULTS 18-65 Mimosa 4 Shirley Road Hanley Stoke on Trent Staffordshire ST1 4DT Lead Inspector Wendy Jones Key Unannounced Inspection 18th August 2008 16:30 DS0000064017.V370231.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000064017.V370231.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000064017.V370231.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mimosa Address 4 Shirley Road Hanley Stoke on Trent Staffordshire ST1 4DT 01782 280838 01782 269187 stoke.enquiry@caretech-uk.com 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) Delam Care Ltd Mrs Pauline Adams Care Home 5 Category(ies) of Learning disability (5), Mental disorder, registration, with number excluding learning disability or dementia (5) of places DS0000064017.V370231.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th August 2007 Brief Description of the Service: Mimosa is a residential care home providing 24 hour care for five people with a learning disability and mental health concerns. The accommodation provides for one double and three single bedrooms. The home has a lounge and separate dining room and there is a small garden area at the rear of the property. The home has bathing and shower facilities - the bathroom being upstairs and the shower downstairs. There is no on site parking. The home shares the use of two people carriers with five other care homes in the vicinity owned by the same company. The home is located close to Hanley park and in the area there are some local shops. A short distance away there are other amenities such as medical services, a hairdresser and leisure facilities. People who use the service can attend a local college for a number of sessions a week and join with other from the neighbouring care home to go out on trips and on holiday. People who use the service are involved in day to day activities associated with running the home including ensuring their bedrooms are tidy and clean and with washing up, laying the table and shopping. The home has a staffing level of one care staff on at any time. The Care Manager has the responsibility for the care home next door. The Service User Guide for this service is currently under review, therefore if people who may use the service and their supporters want information about the range of fees and the costs of the service. They should contact the provider for this information. DS0000064017.V370231.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 star. This means the people who use this service experience good quality outcomes. This was a key inspection site visit of this service undertaken on 18 August 2008 between the hours of 16:30 and 20:20 and included formal feedback to the manager. The purpose of this visit was to assess the services performance and to establish if it provides positive outcomes for the people who live there. The visit included checking that any requirements and recommendations of the previous inspection visit of 29 August 2007 have been acted upon; looking at information the service provides for people who may use the service, their carers and any professionals; looking at information that the service provides to people who use the service to ensure that they understand the terms and conditions under which they have agreed to live at the home and the fees they should pay. Other information checked included assessments and care records, health and medication records; activity and records relating to the menu’s, finances, staff training and recruitment, complaints and compliments, fire safety and health and safety, and the environment. The manager, staff and people who use the service were spoken to during the site visit. Before the visit began, the service provided it’s own assessment of it’s performance, in the form of an Annual Quality Assurance Assessment (AQAA). Surveys have been sent out to people who may use the service, relatives, staff and any professional that has involvement in the service. We have not received any comments; this makes it difficult to comment on the views of others about the quality of the service provided. We made 4 requirements and 9 recommendations as a result of this visit. Since this inspection site visit we have completed an additional visit to the service to confirm that the service had complied with the immediate requirement notice we left at the home relating to environmental issues. This visit took place on 30 September 2008. We are satisfied the service has acted to address the areas of concern we identified within the required timescales. What the service does well: People who use the service are encouraged to live as independently as possible and require support with this. Risk assessments have been carried out where a known risk has been identified. DS0000064017.V370231.R01.S.doc Version 5.2 Page 6 The assessed needs of the people who use the service are recorded and care plans are in place to ensure that these needs can be met. Health needs are also recorded and support is provided to attend GP and other health related appointments. The introduction of Health Action Plans is very positive. The standards for the safe management, storage and recording of medication are good. People who use the service know who their key worker is and say that they feel supported. People who use the service meet regularly with staff both in groups and for individual sessions to discuss their day-to-day lifestyles and care needs. The home is in keeping with other residential housing stock in the area and provides a domestic environment with sufficient private and communal space. All bedrooms are single and the people who use the service can have their own keys if they choose to. Staff training is provided and is up to date, staff receive 1:2:1 supervisions and also meet regularly as a team. Staff recruitment procedures are satisfactory and protect the people using the service. What has improved since the last inspection? What they could do better: DS0000064017.V370231.R01.S.doc Version 5.2 Page 7 There is evidence of improvement in a number of areas since the last key visit, but some of the recommendations of the last report have not been fully implemented. The information provided for prospective and current service users in the Statement of Purpose and Service User Guide should be up to date. And people who use the service should know what the fees and costs of the service are. The introduction of the new person centred plans should be completed and staff should be provided with the training or the guidance they need to be confident they can support people who use the service with these. There are areas of the home that have deteriorated since the last key inspection visit. An immediate requirement was made during this visit to improve the first floor bathroom, the lounge and replace the two beds and other bedroom furniture. Other areas of concern have also been identified. Staffing levels should remain under review to ensure that they are sufficient to meet the needs of people who use the service, and all staff must receive mandatory training and have regular updates. An annual development plan should be produced based upon the outcomes of the quality audits of the service; the manager should complete the NVQ level 4. 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. DS0000064017.V370231.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000064017.V370231.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (good) This judgement has been made using available evidence including a visit to this service. People who may use and do use the service can be sure that their care needs will be assessed, but cannot be confident that they will receive up to date information about the service aims, facilities and costs in a format they can easily understand. This means that they cannot make an informed decision about moving in to the home. EVIDENCE: The service told us in the AQAA that, “Should a vacant room become available at Mimosa and a referral be made an assessment tool is in place to ensure that a full pre-admission assessment takes place. This assessment aims to determine suitability for the home and to ensure that the individuals needs can be met. The process involves a full and thorough assessment followed by visits to the home, where the prospective service user is allowed the opportunity to interact with both staff and residents. People at the home are aware of their rights and responsibilities in relation to the home through the provision of the home contract and statement of purpose.” We have been told that the Statement of Purpose and service user guide are under review, and will be produced in a user-friendly format. This was also the case at the last key inspection. The service should finalise the changes to both DS0000064017.V370231.R01.S.doc Version 5.2 Page 10 documents and ensure that they are made available to people who use the service and to prospective service users. No new service users have been admitted to the service since the last key visit. People who use the service have lived at the home for a number of years and have forged close relationships. Previous key inspection visits have found that pre admission assessments have been carried out satisfactorily. People who use the service said they are happy at the home. DS0000064017.V370231.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 can be confident that care plans are in place and they will be involved in discussions about them. But they should be certain that they are actively supported to make their own decisions about the care they wish to receive. EVIDENCE: The service told us in the AQAA that, “The support plans that we have in place are detailed and are split into sub-categories that are in line with the principles upon which our homes are based. These sub-categories include; General skills and qualities, Occupational needs, general health, personal care, domestic skills, community access, numeracy/literacy, memory/concentration/coordination, mental health/psychological needs, social behaviour and relationships. The support plans we have indicate an individuals capabilities and support requirements in the above areas.” DS0000064017.V370231.R01.S.doc Version 5.2 Page 12 We looked at care records for one person, a 24 hour support plan has been introduced, this provides a summary of the individuals preferred routine and the support they require. The manager said that they have yet to fully implement the new person centred model for care planning and staff have not yet received training in how it is to be used. When the person centred plans are implemented in full we would expect to see people who use the service leading in the decision making about their care and lifestyle. People we spoke to knew that care plans were in the office but we couldn’t be sure that they felt fully involved in their development. We have been told that the service has requested reassessments of people who use the service where care needs have changed and they require more support, but the funding authority is yet to respond to these requests. The service and organisation are committed to promoting the rights of people who use the service to receive a review from the local authority. Risk assessments are in place, and they are reviewed regularly in one sample a risk assessment has been completed because of the potential fire hazard presented by the behaviour of one person. The action taken is to lock the kitchen, this ensures that the risk is removed, but also restricts other people’s access to the kitchen. We discussed this at the last inspection and would continue to expect to see a regular review of any assessment. We have been told that the service arranges regular meetings for people who use the service, these include monthly 1:2:1’s, weekly menu and activity planning and monthly house meetings. We saw records that confirmed this and people we spoke to said, “we talk to staff about meals and the things we want to do each week.” The organisation has introduced a service user forum, where a representative from each of the local homes meet to discuss issues affecting them. The meetings are to be arranged 3-4 times per year. DS0000064017.V370231.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (adequate) This judgement has been made using available evidence including a visit to this service. People who use the service are supported to live as independently as possible and are involved in decision-making, but individual access to activities in the community can be restricted and person centeredness should be further promoted. EVIDENCE: The service told us in the AQAA that, “The home ensures that provisions are made should residents wish to partake in activities in accordance with the lifestyle that they choose to lead. Residents are also encouraged to maintain contact with family and friends where possible which some residents do take this opportunity.” We looked a sample of activity records for each of the people who use the service and note that it appears from the records that the activities people who use the service have been involved in, have been very similar and it is not always clear that person centred principles are being followed. There are new DS0000064017.V370231.R01.S.doc Version 5.2 Page 14 forms that have been introduced since the last visit that, not only are used to record the activity people are engaged in, but the date, duration of activity and gives an indication of whether the service user was actively engaged in it or enjoyed it. One person told us, “I’m going to college in September to do art and craft, I have completed an aromatherapy and a sewing course at college in the past.” “I represent the house at the service user forum, I enjoyed doing this and it was nice that everyone listened to what I had to say.” Another person said, “I like to come up to my room sometimes and watch the television, but it’s broken.” This was confirmed by staff, who spoke to the individual and agreed to make arrangements for a replacement to be purchased as soon as practicable. The service has it’s own transport; this is paid for by a monthly contribution by all the people living at the home. We have been told that everybody will be going on a holiday to a cottage in Welshpool shortly, and they have all agreed to this. The manager stated, that it can be difficult for some people to be assertive when discussing plans collectively and there is a tendency to passively agree to the plans put forward by others. It is hoped by adopting person centred approaches this will be resolved. People who use the service are generally dependent on staff to support them when out in the community; this can cause difficulties, as the staffing levels cannot always accommodate this. The manager said that her hours are supernumerary and help to provide sufficient support. As discussed at the last inspection this may be useful to provide staff for planned activity but restricts any spontaneous activity. It is recommended again that a review of staffing levels is undertaken. The manager has written to us with concerns that the funding authorities have not responded to requests for reviews of those people whose needs have changed and may need additional staffing hours. While this is an acknowledged difficulty the service has a responsibility to ensure that people’s needs are met. As discussed previously, weekly meetings are held to discuss menu and activity planning, the records available and people who use the service confirmed this. People who use the service said, “I like the food, we get to choose what we want to eat but I like most things.” DS0000064017.V370231.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 can be confident that their health needs are known and monitored. Systems for the safe administration and management of medication are robust which ensure that service users are not at risk. EVIDENCE: The service told us in the AQAA that, “All personal and healthcare support that we offer at Mimosa is provided in a way that maintains both independence and personal dignity. Service users are encouraged to tend to their personal care as far as they are able to and with the appropriate level of support. This approach we feel allows for greater flexibility and personal choice as the level of support that each resident requires does vary. The administration of medication in the home is also dependent upon the individuals requirements.” We looked a sample of health records and saw how Health needs are being met. Records show that people who use the service are supported to attend health related appointments. The service has introduced Health Action Plans (HAP) these outline the specific health needs of each individual and the support DS0000064017.V370231.R01.S.doc Version 5.2 Page 16 they require to remain healthy, they may also include a record of the known triggers that can result in ill health. Information shows that the staff team has received training in the administration of medication and the manager confirmed that the training provided met the recommended standards; the staff team has also had competency assessments. A member of staff confirmed he had received this training. The systems for the management, storage and administration of medication are satisfactory. Since the last key visit the service has changed its contract and is using BOOTS pharmacy. The manager gave a positive account of the change. One person self medicates, risk assessments relating to this are in place and suitable storage facilities are available. Protocols for the administration of, as required medication are in place. DS0000064017.V370231.R01.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): 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 can be sure that any concerns they have will be listened to and can be confident that the majority of the staff team know what to do to protect them from the risk of abuse. EVIDENCE: The service told us in the AQAA that, “The safety of our residents is paramount and is ensured at all times. Policy and protocol in relation to safety and security is followed closely and any concerns are carefully explained to residents through the medium of residents meetings and key working discussions. Any complaints that may be made are documented fully and are investigated as per policy and procedure. The complaints procedure is available to all service users, their families and staff and an easy-read version is displayed in the entrance corridor of the home. The complaints procedure is also included in the service user guide which each resident has their personal copy of.” The service has a complaints procedure; this has been developed into a userfriendly format and is displayed in the home. People who use the service know about it and what to do if they have any concerns. We have not received a complaint about Mimosa since the last key visit and the manager said they have not received a complaint in the last 12 months. DS0000064017.V370231.R01.S.doc Version 5.2 Page 18 People who use the service said, “ The staff help me if I need anything, and if I wanted to make a complaint I’d go to them.” “ I don’t have anything to worry about.” The manager said that updated safeguarding training has been provided for all staff and is included in the new induction. We are not aware of any safe guarding issues in this service. We looked at the financial records of three people and found that two are not accurate. There are minor inaccuracies in the amount of money recorded and the money actually kept on behalf of the two individuals. The manager is aware of this and will remedy the matter. We understand that checks of the amounts recorded against the actual money in the home are undertaken at every handover. Recruitment practice protects people who use the service. DS0000064017.V370231.R01.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): Quality in this outcome area is (adequate) This judgement has been made using available evidence including a visit to this service. The quality of life of people who use the service is being made worse by the standard of environment, people who use the service are having to make do with an environment that is in need of upgrading. EVIDENCE: The service told us in the AQAA that, “Mimosa provides a homely environment that is comfortable and friendly. The home is clean and work has been carried out to update areas that were in need of modernisation. All amenities are on hand for residents and the environment provides a safe area that meets resident’s needs.” We are also told that, “The shower room and kitchen have both had a complete upgrade and the kitchen has been repainted.” It was disappointing to see during this visit that a number of areas have deteriorated to unacceptable standard since the last inspection site visit. At the last visit we were told that the lounge was going to be decorated and people who use the service had been involved in discussion about the colours DS0000064017.V370231.R01.S.doc Version 5.2 Page 20 they would like. But this has not been done, and the evidence of this visit is that wallpaper and the wallpaper border is peeling off walls in a number of areas, the lounge suite remains stained. We saw the carpet in the first floor bathroom is badly stained and ingrained with dirt. The two bed bases in the shared bedroom have bowed in the middle and must be replaced for the benefit of people living there. The dividing curtain in the shared room must be cleaned or replaced; the current curtain is badly stained in places. The headboard of one person in the shared bedroom must be replaced and the bedroom redecorated, we saw a headboard that is stained black, as is the wall above the headboard. Staff said they try to keep it clean, but clearly this has not been successful. In the single bedroom of another person there is water damage and staining on the ceiling this should be repaired and redecorated and the mattress on the bed appears to be worn, this should be replaced. This room has two bedside lamps; none are near to a plug socket and therefore can’t be used by the occupant. The clock on the bedroom room wall was not working. In the bedroom of another person the carpet is dirty and the floorboards can be clearly made out beneath it. In the bedroom of another person there is an odour of incontinence, staff said they are aware of this and had tried to resolve it. We are told that this room is scheduled to be refurbished week commencing 26 August 2008; this will include replacing all of the furniture, the bed and the floor covering. Also in this room a roll of loose wire was seen by the door, staff said that it was probably from one of the call points in the room that is no longer connected. The person living in this room confirmed that they had chosen the new furniture for the room and had been told that it was to be redecorated while people who use the service are away on holiday. We saw that a number of internal doors are sticky to the touch, which makes them feel dirty, and in some examples there is some staining. Staff said that they are cleaned regularly, but there is clearly a problem this should be investigated and resolved. The situation on the first floor landing remains as at the last key inspection were the floorboards can be made out underneath the carpet and appear uneven, this could develop into a potential trip hazard and should be sorted out. The kitchen has had new cupboard doors fitted since the last key visit, staff said that they are intending to paint this room. But generally it appears clean tidy and suitable for the purpose. Records show that the fridge freezer DS0000064017.V370231.R01.S.doc Version 5.2 Page 21 temperatures are checked and recorded daily. It is noted though that all of the freezer drawers in the freezer are broken and should be replaced. The toilet to the far end of the kitchen has been fitted with new flooring that has been badly fitted, repairs should be made to improve this area. The ground floor shower room has been refurbished, but there is evidence that some further work is need to bring it up to a good standard, although there is a marked improvement on last year. On approaching the service the garden is overgrown and untidy at the front of the home and a light bulb is missing from the exterior light. Staff have worked with people who use the service and their neighbours to landscape the rear garden to make a pleasant area for them to sit. We have visited the service again since this key visit and have been satisfied that the organisation has acted to address the main areas of concern we identified and has developed a programme of works to ensure that the environment is bought up to a more acceptable standard. DS0000064017.V370231.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 can be confident that recruitment procedures are robust and staff are regularly supervised and receive the training they need to deliver a good standard of care. EVIDENCE: The service told us in the AQAA that, “Staff are subject to a full training programme and the training that is provided is to a high standard which will result in a good level of care and support being provided. The training department at Care Tech ensure that managers are issued with training schedules in advance so that nominations can be made and that all staff are in receipt of mandatory and medication training.” Staffing levels equate to 1 person throughout the waking day and 1 sleep in at night additional hours are provided by the manager when needed. Additional staff can be allocated if the need arises, to accommodate outings/ appointments. Staff rota’s confirmed this. We have asked the service to continue to keep staffing levels under review to ensure that they don’t limit spontaneous activities. The manager said that they are considering a mid DS0000064017.V370231.R01.S.doc Version 5.2 Page 23 shift, which means some one on duty each day in the late morning, early afternoon or evening to provide additional staff hours. We have been told that full time staff receive a monthly 1:2:1 supervision session, part time have bi-monthly supervision, in addition staff have an annual appraisal. Staff meetings are also held on a monthly basis. The records of staff training show that that 50 of the care staff have trained to NVQ level 2, have received mandatory training or are booked on updates. The records also show that some training was undertaken some time ago and may need updating; this applies to Safeguarding training. We have been told that the organisation is to introduce training for staff regarding equality and diversity. We did not check staff recruitment records as we have an agreement that means records are checked at the main head office of the organisation. We have confirmed from these checks that recruitment practice is good. DS0000064017.V370231.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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 can be confident that the manager of the service has the necessary experience to manage the service but they should be assured that the outcomes of quality audits are collated and an annual development plan produced to evidence continual improvement. EVIDENCE: The service told us in the AQAA that; “The Registered Home Manager has a number of years experience working in the field of care and in care management. Although newly appointed to the post of registered manager Pauline had previously been the home manager of both here and another service. The resident’s benefit from having a deputy home manager, in addition to the home manager who is mainly based at Mimosa. The management team ensure that residents rights are promoted and that support plans are followed appropriately in accordance with their aims.” DS0000064017.V370231.R01.S.doc Version 5.2 Page 25 The manager has been registered and approved by us, she has completed her RMA and we understand is enrolled on NVQ level 4 in care. People who use the service confirmed that the manager is supportive of them. We found that the AQAA provided good information about the service, but the service should ensure that the Statement of Purpose and Service user guide are up to date; that the environment is maintained to a good standard; that staffing levels are reviewed and that the financial records of people who use the service are accurately maintained. The manager said in the AQAA that all equipment in the home is serviced regularly, we checked and found that the current insurance certificate for the home is up to date and the certificate of registration with us is accurate. It has been reported to us that the organisation Care Tech has recruited a Quality Manager, to undertake audits of the local services on a regular basis. A report is produced with action points for the service to address within given time scales. This is in addition to the monthly visits that are carried out by the local operational manager. The service has yet to produce an annual development plan. But progress has been made in relation to listening to people who use the services’ views; the introduction of a service user forum is reported to be very positive. We asked to see recent copies of the monthly visits undertaken by a representative of the organisation. Staff said that these had been undertaken but the records of the most recent visits were not available. Fire safety officers have said they are satisfied with the standards of fire safety at the home, and risk assessments relating to fire safety have been completed. A person who uses the service confirmed that they were familiar with the procedures for fire evacuation and we have been told that staff have been involved in fire drills. General risk assessments have been completed and are subject to review. DS0000064017.V370231.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 2 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 X 12 2 13 2 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X DS0000064017.V370231.R01.S.doc Version 5.2 Page 27 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. 1. Standard YA24 Regulation 23(2) Requirement Timescale for action 20/08/08 2. YA25 23(2) 3. YA25 23(2) 4. YA24 23(2) The first floor bathroom carpet must be replace to ensure that service users have a hygienic environment. The broken two beds in the 29/08/08 shared room must be replaced to ensure that service users have suitable beds. The shared bedroom must be 29/08/08 cleaned and decorated to ensure that service users have a clean and well maintained environment. The lounge must be redecorated 29/08/08 to provide service users with a well maintained environment in which to live. 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 YA6 Good Practice Recommendations To continue to properly introduce the person centred DS0000064017.V370231.R01.S.doc Version 5.2 Page 28 2. 3. YA1 YA1 4. 5. 6. 7. 8. YA24 YA24 YA33 YA6 YA39 planning model. The manager must ensure that The Statement of purpose and Service Users Guide are up to date to ensure service users have accurate information. The manager should ensure that the fees and costs of the service are included in the service user guide. This will ensure that the people using the service have the correct information about what they may be expected to pay. Take whatever action is necessary to address the uneven floorboards on the landing. All of the environmental issues identified in this report should be addressed for the benefit of service users. The organisation should keep the current staffing levels under review to ensure that the individual needs of residents can be met. The manager should ensure person centred guidance should be offered to all staff. The manager should produce an annual development plan based upon the outcomes of quality audits, to demonstrate how the service intends to improve. DS0000064017.V370231.R01.S.doc Version 5.2 Page 29 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. 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