Care Home: Pia - 136 abc Manor Court Road

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What the care home does well Information about the home has recently been updated so that anyone new can get a clear picture about the home before they decide to move in. people have recently been issued new contracts so they know what they are required to pay for and what service they may expect. The staff at the home showed a good understanding of people`s needs and approached them in a friendly, respectful manner. The people at the home confirmed that they like the staff that support them and find them to be helpful. In a questionnaire returned by relatives, they also speak positively about the home, " My wife and I are very pleased with the way our son is cared for. The carers are very pleasant and helpful"Care plans are being reviewed regularly and overall they contain good levels of information to help staff to support people properly. Staff support people to get out and about to follow up their interests and to go on holidays. One person at the home enjoys going to church every Sunday, with friends, to meet her spiritual needs. Staff are trained to recognize and report any suspicions of abuse. The home takes any reports of abuse seriously and refers matters to Social Services to be properly investigated under the local Safeguarding Procedures, to ensure people are kept safe from harm. The home is kept clean and comfortable so that people have a nice place to live in. Downstairs bathrooms are suitably equipped to meet the needs of people with disabilities and a hoist is used for a person who needs help to move about safely. Staff are provided with regular training updates to enable them to support people in a safe manner. Staff have been provided with equality and diversity training to encourage them to see people as individuals with their own preferences that are to be respected. A senior manager visits the home regularly each month and writes a report. The manager follows up any shortfalls in the service. This shows that the senior managers take an interest in ensuring that the home runs well. What has improved since the last inspection? The staircase has been painted and the carpet replaced to make this area of the home look nicer for people. A new gas boiler has been installed as the old one was old and did not work very well. What the care home could do better: There is scope for improving the level of information concerning skin care needs. This is necessary to make sure that all staff are clear about the care they are too provide. The manager has also agreed to introduce a skin care risk assessment to keep track of people`s skin condition so any risks of sores developing will be picked up and dealt with promptly. The manager said that she would be arranging for staff to gain access to skin care and Parkinson`s disease training to increase their knowledge in these areas of practice, so that they are better equipped to support people effectively.The manager agreed to set up a record to keep a running total of medication that people take on an "as required" basis. This will make it easier for staff to keep track of tablets and to quickly account for any that are missing. Overall the house is clean and comfortable and provides a nice homely place for people to live. However plans should be made to paint the outside of the house as the paint is peeing off. The kitchen is old and should be upgraded so that people have a better equipped, modern kitchen to use. The fire alarms and other equipment are being routinely checked and tested as required. However the emergency lights are being tested every 3 months, instead of monthly, as recommended by the fire officer. The manager has agreed to address this to make sure the lights continue to work efficiently. CARE HOME ADULTS 18-65 Pia - Manor Court Road, 136 abc 136a Manor Court Road Nuneaton Warwickshire CV11 5HQ Lead Inspector Kevin Ward Key Unannounced Inspection 2nd June 2008 07:30 Pia - Manor Court Road, 136 abc DS0000004474.V365112.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 Pia - Manor Court Road, 136 abc DS0000004474.V365112.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. Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pia - Manor Court Road, 136 abc Address 136a Manor Court Road Nuneaton Warwickshire CV11 5HQ 02476 643776 02476 640146 arynn@people-in-action.co.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) People in Action Ms Angela Rynn Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st June 2006 Brief Description of the Service: 136 Manor Court Road is a registered care home for four people with learning disabilities. People in Action provide 24 hours care and support for the people living in the home. The home is situated on one of the main routes into the town of Nuneaton, which is easily accessed by the people living in the home. The ground floor accommodation consists of a kitchen and lounge, two service user bedrooms, each having an ensuite facility. On the first floor of the property there are two service user bedrooms, a lounge, bathroom with toilet and an office/sleeping room for staff. There is a large garden at the rear of the property, which provides lawned and patio areas. There is parking space for one car in the driveway to the house. The current fees in the service user guide range between £675.30 and £1403.83. The people at the home pay an assessed contribution towards their care and are responsible personal items, such as clothing, toiletries, recreation, hairdressing and none essential transport. Up to date information on fees should be obtained directly from the provider. Pia - Manor Court Road, 136 abc DS0000004474.V365112.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 that people who use the service experience good outcomes. This was a Key unannounced inspection which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for the people using the service. The inspection focused on assessing the main Key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. The manager completed and returned an annual quality assurance questionnaire, in time for the inspection, containing helpful information about the home. A questionnaire was also completed and returned by the relative’s of a person at the home, giving their views of the service. The inspection included meeting the four people at the home and case tracking two people. This involves looking at people’s care plans and health records and checking how needs are met in practice. Other people’s files were also looked at, in part, to check the healthcare support being provided at the home. The people using the service at the time of the site visit gave their views about the home spoke openly about the support they receive. Discussions were also held with two staff on duty and the manager and the assistant manager. A number of records, such as care plans, complaints records, staff training certificates and fire safety records were also sampled for information as part of this inspection. What the service does well: Information about the home has recently been updated so that anyone new can get a clear picture about the home before they decide to move in. people have recently been issued new contracts so they know what they are required to pay for and what service they may expect. The staff at the home showed a good understanding of people’s needs and approached them in a friendly, respectful manner. The people at the home confirmed that they like the staff that support them and find them to be helpful. In a questionnaire returned by relatives, they also speak positively about the home, ” My wife and I are very pleased with the way our son is cared for. The carers are very pleasant and helpful” Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 6 Care plans are being reviewed regularly and overall they contain good levels of information to help staff to support people properly. Staff support people to get out and about to follow up their interests and to go on holidays. One person at the home enjoys going to church every Sunday, with friends, to meet her spiritual needs. Staff are trained to recognize and report any suspicions of abuse. The home takes any reports of abuse seriously and refers matters to Social Services to be properly investigated under the local Safeguarding Procedures, to ensure people are kept safe from harm. The home is kept clean and comfortable so that people have a nice place to live in. Downstairs bathrooms are suitably equipped to meet the needs of people with disabilities and a hoist is used for a person who needs help to move about safely. Staff are provided with regular training updates to enable them to support people in a safe manner. Staff have been provided with equality and diversity training to encourage them to see people as individuals with their own preferences that are to be respected. A senior manager visits the home regularly each month and writes a report. The manager follows up any shortfalls in the service. This shows that the senior managers take an interest in ensuring that the home runs well. What has improved since the last inspection? What they could do better: There is scope for improving the level of information concerning skin care needs. This is necessary to make sure that all staff are clear about the care they are too provide. The manager has also agreed to introduce a skin care risk assessment to keep track of people’s skin condition so any risks of sores developing will be picked up and dealt with promptly. The manager said that she would be arranging for staff to gain access to skin care and Parkinson’s disease training to increase their knowledge in these areas of practice, so that they are better equipped to support people effectively. Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 7 The manager agreed to set up a record to keep a running total of medication that people take on an “as required” basis. This will make it easier for staff to keep track of tablets and to quickly account for any that are missing. Overall the house is clean and comfortable and provides a nice homely place for people to live. However plans should be made to paint the outside of the house as the paint is peeing off. The kitchen is old and should be upgraded so that people have a better equipped, modern kitchen to use. The fire alarms and other equipment are being routinely checked and tested as required. However the emergency lights are being tested every 3 months, instead of monthly, as recommended by the fire officer. The manager has agreed to address this to make sure the lights continue to work efficiently. 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. Pia - Manor Court Road, 136 abc DS0000004474.V365112.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 Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable admission procedures and information are in place to help people to make an informed decision to move to the home. EVIDENCE: No new service users have moved into the home during the last year, so it was not possible to re-assess the home’s current admission practices fully. This has been checked previously and past reports indicate that people’s needs had been assessed and relatives consulted before people moved into the home. Recent social work re-assessments were seen on people’s files, as evidence that information about people’s needs has been updated. The manager confirmed that new people considering a move to the home are able to visit on several occasions and meet with others at the home as part of the assessment procedure, before moving in. The Statement of Purpose has recently been updated and a new illustrated version of the service user guide was seen on file. The manager explained that this information would be passed to any new people planning a move to the home so that they know what the service has to offer. The manager also said that she would share the new guide at the next house meeting and put a copy on display so that everyone is able to see it. Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 10 Updated contracts, containing the current charges were seen on people’s files, explaining their rights and responsibilities whilst using the service. The contracts provide a satisfactory explanation of what service people may reasonably expect from the home. Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable arrangements are in place for planning and reviewing people’s needs and involving them in everyday decisions at the home so that their needs are met in the way they like. EVIDENCE: The people using the home all said they liked the staff and are happy with the support they give. Two care plans were checked. The care included good levels of information about people’s routines and the way in which they prefer their care support provided. This is a good way of helping people to have their decisions heard and exercise some degree of control over their care. This is particularly beneficial for a person with autism, as it is important that staff follow their routine quite strictly so they do not become upset by unnecessary changes in their pattern of care. Review records indicate that care plans have recently been reviewed to ensure that the information is kept up to date with changes in people’s needs. Local Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 12 Authority review records were also seen on file, providing evidence that social workers have reviewed people’s needs recently, to ensure that the home continues to meet needs appropriately. The manager said that she intended to increase the level of information in the care plan of a person who has recently required nursing input for pressure area care. This will help to ensure that the support to be provided is properly understood by any new staff joining the home. The staff on duty spoke in an informed manner about the care they provide in this regard and of the equipment available for a person with skin care needs. People at the home have a key worker to take responsibly for monitoring and co-ordinating their care. People at the home confirmed that they like their keyworkers and are happy with the support they provide. Risk assessments are in place for people covering a good range of everyday hazards that people may face in the home or out in the community, such as trips and falls, bed rails, house work, going out, eating safely, and kitchen safety. Recent amendments were seen to some risk assessments, as evidence they have recently been updated, in keeping with changing needs. A member of staff was seen to take time to sensitively consult with people over what they wanted for breakfast. People confirmed they go shopping to choose their clothes and toiletries as well as to choose the groceries. A staff member explained that people are encouraged to choose the clothes they want to wear each day and the people at the home confirmed this. Everyone is consulted about their gender care preferences and this is recorded on their care plan so that their choices can be respected. Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported to enjoy a satisfactory range of community activities and their preferences are taken into account, so that they enjoy themselves and are provided with meals they enjoy. EVIDENCE: Two people living at the home are supported to take part in day service activities part of the week. One person also attends a gardening project and the other works in café one day a week. The other two people are supported to on college courses and venturing out into the local community. A person at the home explained that they currently attend three courses a week, including craft, music and flower arranging. On the days that people are at home they are supported to take part in flexible social activities, such as shopping, bowling, parks and outings. Staff explained that people often go out to MENCAP activities at the weekends, including disco Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 14 and games sessions. Two people at the home confirmed that they enjoyed this. The week prior to the inspection several people went out to Coombe Abbey and had a meal out. One of the people at the home explained that they enjoy going to Salvation Army services regularly each weekend with friends. This is in keeping with their wishes expressed in the care plan. Meetings are held on a regular basis so that people can make plans and discuss the everyday issues in the home, such as staff changes, activities arrangements for celebrating birthdays and holidays. A party was being planned to celebrate a person’s birthday, to which their family had been invited. Another person at the home said that they were looking forward to going to Blackpool on holidays with staff and friends. People confirmed that they are encouraged to take part in light domestic tasks, such as cleaning and hoovering. This helps them to maintain a degree of independence and a sense of pride in their home. Keys have been provided for everyone to lock their bedroom doors if they wish to do so. The home encourages people to maintain contact with friends and relatives. One person explained that she they continues to enjoy going to town with her boy friend at weekends. People’s relatives are also invited to support them at their review meetings where they are able to do so. Some staff have previously been provided with sexuality and personal relationships training to help them to support people appropriately. A three week menu is in place at the home based on people’s likes and dislikes, providing a suitable variety of wholesome meals. The people at the home take part in shopping for groceries so that they can help to choose what they like. An older person at the home has previously received support from a dietician to take account of nutritional needs associated with increasing age. The assistant manager explained that full fat milk and ordinary yoghurts are purchased to combat decreasing bone density associated with older age. The manager said that everyone at the home is currently healthy and eating well. One person has previously been prescribed fortisips, to supplement their diet but the manager explained that their appetite is now much improved. The manager agreed to keep weight records for the person concerned so that any future changes in weight may be easily identified and responded to. Comments made by the people living at then home indicated that they enjoy the food provided at the home and are able to enjoy some snack foods between main meals. A person with high cholesterol was seen to have fruit on Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 15 their weetabix as part of a reduced fat diet. Comments by staff indicated a satisfactory awareness of people’s dietary needs and preferences. Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate support is provided to meet people’s personal care and health needs and suitable arrangements are in place for storing and administering medication so that it is given safely and accounted for properly. EVIDENCE: Staff were observed to respectful and friendly in their dealings with people at the home. A member of staff was observed to crouch down as he spoke to a wheelchair user to help aid communication with the person concerned. The people at the home confirmed that they like the staff that support them and are happy at the home. Everyone looked comfortable and relaxed as they went about their morning routines, indicating they are at ease in the home. One lady was supported to set her hair in rollers, in keeping with her care plan, indicating that people are encouraged to take a pride in their self-image. Everyone was dressed in age appropriate clothing, which they said they had chosen to wear. Staff demonstrated a good awareness of people’s needs, e.g. their food preferences and support required when eating. A member of staff demonstrated a good understanding of the needs of a person with autism and Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 17 physical disabilities. This included the need to follow the person’s preferred routines and how to make them comfortable (using the correct equipment) to avoid pressure sores developing. Similarly a staff member was aware of the preferred foods of an older person at the home and how to safely manage their mobility needs indoors and outside the home. Entries in people’s health records indicate that the home supports people to access appropriate healthcare support where required. One person’s records demonstrate that they have been supported to access an extensive range of consultants and health professionals and provided with specialist equipment to meet their changing health needs. Extra support has been sought from the nursing service to treat a small sore, which has now healed. The manager said that she is arranging skin care training and would introduce a skin care risk assessment (such as waterlow scale). This enables any increased risks of skin breakdown to be picked up early and dealt with. A sample examination of two people’s health records indicates that people are supported to access routine checks, such as GP appointments, dentist and optician check ups and chiropody. One person’s records demonstrate that they have been supported to attend consultant ophthalmologist appointments to monitor the condition of cataracts with a view to an operation at a future date. Comments made by a member of staff giving out medication demonstrated a satisfactory knowledge of the home’s medication procedures. A sample examination of recent medication sheets indicates that medication is appropriately signed for by staff at the home. Two staff also explained that medication training has been provided in the form of short courses and distance learning. This was verified in staff training records. Protocols are in place explaining the circumstances under which PRN (as required) medication should be given. Stock records are kept to account for medication received in to the home. The manager agreed to set up a record to keep a running total of PRN medication in the home. This makes it easier for staff to account for exact number of tablets in packs when they carry out the end of shift medication checks. Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are provided with access to suitable procedures and training to enable them to respond appropriately to any concerns they may hold, so that people are properly protected from harm. EVIDENCE: There have been no complaints to us about the home since the last inspection. The manager reports that there have been no complaints directly to the home during the same time period. The complaints log was checked. The log is being checked and signed by a senior manager each month, as evidence that complaints are monitored. A complaints procedure is available for staff and complaints information has been devised with symbols for the people living at the home, to make it more accessible to them. People at the home confirmed that they felt happy to raise any concerns they had with the staff or the manager. A Prevention of adult abuse policy is available in the home. Discussions with two staff demonstrated a good knowledge of the organisation’s adult abuse policy, including recognising signs of abuse and how to report any concerns. Comments by staff also confirmed that they are made aware of the adult abuse procedure as part of their induction and provided with training on this subject. Staff said that had attended training to protect people from abuse. One member of staff had recently attended whistleblowing training explaining how they should raise any concerns they may have about the home. One Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 19 incident of alleged abuse was referred to Social Services for proper investigation and appropriately dealt with under the local area adult abuse procedures. Two people’s money records were checked. The records show that two staff sign to verify any money spent by people. The manager also signs the record to demonstrate she has checked the money periodically. Financial audits are carried out by the financial manager to ensure that people’s money is properly accounted for at the home. Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall the home is clean and suitably equipped home so that people benefit from an environment that meets their needs. EVIDENCE: The home is based in an ordinary house on a busy street and fits in well with the other houses in the neighboured. The two lounges are well decorated homely and comfortably furnished. People’s bedrooms contain ample evidence of personal belongings, photographs and other items to confirm that people have been supported to personalise these areas to their own liking. A person at the home explained how they had chosen their own wallpaper, curtains and furniture to make their room look the way they like it. One of the bedrooms downstairs has an en-suite walk in shower room, suitably equipped for a person with mobility problems. The main shower room is also Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 21 suitable to meet the needs of a wheelchair user and has sufficient room for lifting equipment to be used. The current kitchen is quite small and not designed with wheelchair users in mind. The kitchen cupboards are old and the worktops are worn in places. This area would benefit from modernisation and improvement so that people have a better kitchen to use. The paintwork on the outside of the house is peeling off and needs to be improved so that the home looks nicer for people. The carpet on the stairs has been replaced since the last inspection to improve this area of the home for people. The home looked and clean and was free from any unpleasant odours. A cleaning schedule is in place that staff sign to confirm they have carried out cleaning tasks. Suitable protective clothing is available for managing personal care tasks. The manager explained that none of the people at the home requires the use of continence equipment or specialist laundry facilities. A suitable clinical waste bin is in place at the home for safe disposal of waste. Infection control training is provided to staff as part of the safe practitioner training they receive (confirmed by staff). Some staff have also attended further training on this subject to increase their knowledge of safe infection control and hygiene practices. Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable arrangements are in place for ensuring that staff are appropriately recruited and trained so that the people at the home benefit from suitable staff. EVIDENCE: An examination of recent staff rotas indicates that the home continues to provide at least two staff on duty during the day and evening. Comments made by staff indicate that this is currently manageable without placing undue pressures on the staff team. The manager explained that none of the staff are required to work a lot of extra hours that might them jaded for work. This was verified in recent staff rotas. Two people at the home confirmed that they find staff to be friendly and helpful and that they are available to help them to get out and about when they need to. During the morning, staff helped people to rise and get ready for the day in a relaxed and unhurried fashion and to take account of their preferred routines. Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 23 There have been a number of staff changes during the last year, though a core group of staff have remained at the home. The manager stated that consistency of care is supported by a keyworker system, whereby everyone has a named member of staff responsible for coordinating their care. The recruitment files of two new staff were checked. The files demonstrated that proper procedures are in place for recruiting staff, including taking up two references and a criminal record bureau check, to ensure that they are suitable to work at the home. The two staff on duty during the morning confirmed that they receive regular planned supervision. This was verified in staff supervision records. The supervision records indicate that the sessions are used purposefully to consider care practices and training issues. Annual appraisal records were also seen, verifying that the manager reviews staff performance. Two staff explained that they are provided with a good range of training opportunities, on an ongoing basis, including safe practice subjects, such as first aid, moving and handling, food hygiene, fire safety, safeguarding against abuse, risk assessment, Health and Safety and medication training. This was verified in training information provided by the manager. Some staff have also been provided with epilepsy, diabetes and whistleblowing training to support safe care practices. The manager explained that the proportion of staff currently holding National Vocational Qualifications (NVQ’s) has decreased during the last year due to a number of staff changes. Information provided by the manager indicates that 10 out of 22 staff have completed NVQ’s at level 2 or 3 and three more staff are completing these courses. These courses are necessary to equip staff to carry out their work role effectively. The manager stated a commitment to ensuring that all staff attend NVQ training courses this year where they have not already done so. Two staff also confirmed that they are provided with thorough induction training when they first start at the home, to prepare them for their work. A recently employed member of staff explained that she was completing the Learning Disability Qualification as part of her induction and would be applying to take NVQ level 2 in the coming months. Staff are provided with equality and diversity training. This helps them to see people as individuals with their own needs and preferences to be respected. The manager said that she would ensure that skin care training and Parkinson’s disease training is provided for staff to aid their work with the people at the home who have related needs. Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place for monitoring the work of the service so that people benefit from a well managed, safe home. EVIDENCE: The manager has 12 years experience of working with people with learning disabilities, including 8 years managerial experience. The manager holds the Registered Managers Award and the National Vocational Qualification in Care, level 4. These qualifications equip her for her management role at the home. Meetings are held regularly at the home so that people can be consulted about everyday matters, such as planning for holidays and activities and checking if anyone has any concerns. Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 25 The manager explained that questionnaires have been sent to the people at the home and to relatives to seek their views of the service, as part of the annual quality assurance process. Responses from two relatives indicated that they held a very positive view of the home and are happy with service provided. A senior manager is carrying out monitoring visits regularly each month at the home and reports are passed for the manager’s attention. The reports are followed up by an action plan, drawn up by the manager to address any shortfalls identified. Systems are in place for monitoring medication, care plans and the cleaning at the home. The shift handover process includes the nominated shift leader signing to confirm that the medication and the money balances correctly. Fire Safety records were examined. The records indicate that alarm tests are currently carried out regularly each week and that fire drills are carried out involving the people at the home and the staff. The lights are being tested every three monthly rather than 3 months as required. The manager said she would correct this and ensure that lights are tested every month in future. Hot water is being monitored to ensure that it stays at a safe temperature. Records show that showerheads in the home are being routinely flushed through with water to avoid the possibility of Legionella developing in the water system. A certificate was seen verifying that a suitably qualified gas fitter has recently fitted a new boiler. Records were in place to show that electrical equipment is routinely checked visually by staff, as well as being safety tested by an electrical contractor. Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 3 35 3 36 x 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 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 2 x Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 27 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations Increase the information in the care plan of the person receiving pressure area care, nursing input, to ensure that any new staff have clear information, to provide the correct support. A skin care risk assessment (such as waterlow scale) should be introduced to reduce the possibility of any pressure sores developing. Proceed with plans to arrange skin care training from the nursing services in order that staff are best equipped to manage pressure area care appropriately. Proceed with plans to set up a record, to keep a running total of people’s PRN (as required) medication. This makes it easier to balance the number of tablets in the home at the end of each shift, so that any errors can be easily identified and resolved. 2 3 4 YA20 YA35 YA20 Pia - Manor Court Road, 136 abc DS0000004474.V365112.R01.S.doc Version 5.2 Page 28 5 6 7 8 YA24 YA24 YA32 YA42 Action should be taken to make plans to modernise the kitchen units so that people benefit from a modern, well equipped kitchen, suitable for their usage. Action should be taken to paint the outside of the house to make it look a nicer place for people to live in. Proceed with plans to increase the number of staff trained in National Vocational Qualifications to better equip them to meet the needs of people at the home Emergency lights should be increased to every month to ensure that they continue to work. Pia - Manor Court Road, 136 abc DS0000004474.V365112.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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