Care Home: Sayer House

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What the care home does well This is a service that does many things well. The staff team provide a specialist service to people who have a learning disability and dementia and because of this are coming to the end of their life. Staff support people sensitively and show respect for them as an individual, which helps to make this stage of their life as good as it can be. Each person has a detailed care plan and risk assessments so that staff know how to help them to meet their needs and be as safe as possible.Staff make sure that when people are well enough they go out to places in the community that they would like to go to. Staff spend time sitting and talking to individuals and finding out what they need to make their life as comfortable as possible. Staff support the people living there to go on holiday so making sure that despite their illness they can still experience visiting other places. Bedrooms are well decorated and reflect the tastes and interests of the individual. The home is well decorated, homely and comfortable making it a pleasant place to live. People have their own comfortable specially adapted chairs so that they do not have to sit in their wheelchairs all the time. Staff have the training they need so they know how to meet the individual needs of the people living there. Other health professionals are involved in the care of individuals and staff follow the advice given by them so that the needs of the people living there are met. Each person has a Health Action Plan. This is a personal plan about what a person needs to be as healthy as possible and what healthcare services they need to use. The plan gives staff the information they need to support individuals to meet their health needs. Staff take care in making sure that the people living there are as relaxed as possible, which helps them to be comfortable and relieves their anxieties. There is a relaxed and calm atmosphere in the home, which helps this. What has improved since the last inspection? The kitchen units had been replaced so that the kitchen is clean and has the facilities so that staff can cook the food for the people living there. More decorating had been done to make the home a more comfortable place to live. There are more staff working there so that there are always enough staff on duty that know the people living there well. Staff records had all the information in them to show that `suitable` people are employed to work with the people living there so protecting them from abuse. What the care home could do better: A window should be installed in the shower room to increase ventilation and stop the flooring from rising so the room is safe to use. Consideration should be given as to how the dining room can accommodate the people living there and staff supporting them during mealtimes. This will make sure that people can eat their meals safely and that staff will be able to support them in the way they need to. A copy of the electrical wiring certificate should be forwarded to the Commission to evidence that it is safe. CARE HOME ADULTS 18-65 Sayer House 2 Newholmes Monyhull Hall Road Kings Norton Birmingham B30 3QF Lead Inspector Sarah Bennett Key Unannounced Inspection 19th December 2007 09:40 Sayer House DS0000062605.V351638.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 Sayer House DS0000062605.V351638.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. Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sayer House Address 2 Newholmes Monyhull Hall Road Kings Norton Birmingham B30 3QF 0121 443 2871 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) South Birmingham Primary Care Trust Ivy Winters Care Home 6 Category(ies) of Learning disability (6), Physical disability (6), registration, with number Sensory impairment (6) of places Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A qualified nurse must be working in the home at all times and must not have responsibility for any of the other Newholmes bungalows. 29th November 2006 Date of last inspection Brief Description of the Service: Sayer House was previously registered as part of the Newholmes registration of six bungalows. In May 2005 the homes were registered separately. Sayer House provides nursing care to six people who have a learning disability. The statement of purposes states, Sayer House aims to provide end of life care to service users with Down’s Syndrome and dementia. A category for dementia (DE) is to be imposed on the registration of the home. Sayer House is a six-bedroom bungalow that is fully accessible to the people living there. Communal areas consist of an open plan kitchen, dining room and lounge. There is an additional small room off the lounge. There is a bathroom, shower room and a separate WC. Ceiling track hoists are fitted in bedrooms and bathrooms. Adapted bathing and shower facilities are provided. To the side of the bungalow there is a garden with grassed areas, pots and hanging baskets. The garden has a fence around it making it private. The home is situated in the grounds of what was once Monyhull hospital. However, a new housing estate has been built around the bungalow which now makes it part of the local community. Family Housing Association owns the premises. The home is managed and staffed by South Birmingham Primary Care (NHS) Trust. The service users guide stated that each person pays £127.35 per week as their contribution to their fees. The people living there also pay £9 - £23 per week towards the minibus depending on the rate of Disability Living Allowance that the person receives. The information included in this report applied at the time of inspection and the reader may want to obtain more up to date information from the care service. The CSCI inspection report is available in the home for visitors to read if they wish to. Sayer House DS0000062605.V351638.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 3 star. This means the people who use this service experience excellent quality outcomes. The visit was carried out over one day; the home did not know the inspector was going to visit. This was the homes key inspection for the inspection year 2007 to 2008. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and the manager completed a questionnaire about the home – Annual Quality Assurance Assessment (AQAA). Two people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. The people who live at the home and the staff on duty were spoken to. Due to the needs of the people living there they were unable to verbally communicate their views about the home. Time was spent observing care practices, interactions and support from staff using the Short Observational Framework for Inspection (SOFI) tool. A tour of the premises took place. Care, staff and health and safety records were looked at. What the service does well: This is a service that does many things well. The staff team provide a specialist service to people who have a learning disability and dementia and because of this are coming to the end of their life. Staff support people sensitively and show respect for them as an individual, which helps to make this stage of their life as good as it can be. Each person has a detailed care plan and risk assessments so that staff know how to help them to meet their needs and be as safe as possible. Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 6 Staff make sure that when people are well enough they go out to places in the community that they would like to go to. Staff spend time sitting and talking to individuals and finding out what they need to make their life as comfortable as possible. Staff support the people living there to go on holiday so making sure that despite their illness they can still experience visiting other places. Bedrooms are well decorated and reflect the tastes and interests of the individual. The home is well decorated, homely and comfortable making it a pleasant place to live. People have their own comfortable specially adapted chairs so that they do not have to sit in their wheelchairs all the time. Staff have the training they need so they know how to meet the individual needs of the people living there. Other health professionals are involved in the care of individuals and staff follow the advice given by them so that the needs of the people living there are met. Each person has a Health Action Plan. This is a personal plan about what a person needs to be as healthy as possible and what healthcare services they need to use. The plan gives staff the information they need to support individuals to meet their health needs. Staff take care in making sure that the people living there are as relaxed as possible, which helps them to be comfortable and relieves their anxieties. There is a relaxed and calm atmosphere in the home, which helps this. What has improved since the last inspection? The kitchen units had been replaced so that the kitchen is clean and has the facilities so that staff can cook the food for the people living there. More decorating had been done to make the home a more comfortable place to live. There are more staff working there so that there are always enough staff on duty that know the people living there well. Staff records had all the information in them to show that ‘suitable’ people are employed to work with the people living there so protecting them from abuse. Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sayer House DS0000062605.V351638.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 Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about what the home provides is available so that people can make a choice as to whether or not they want to live there. Before a person moves into the home their needs are assessed to ensure they can be met at the home. EVIDENCE: The service users guide included all the relevant information so that the people living there know what is provided and what the terms and conditions of their stay are. Each person had a copy of the service users guide in their bedroom so that they and their visitors had access to it. It was produced using pictures making it easier to understand. The manager said that they are in the process of updating the home’s statement of purpose so that it includes the relevant information so that people can make a choice as to whether or not they want to live there. They said this would include photographs and pictures making it easier to understand. The manager said that the home does not have a mission statement but they plan to meet with the Psychiatrist and the Older Adults Nurse in February 2008 to develop this. The manager said that it is important Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 10 that these professionals are involved in developing it as they have been so involved in developing the service and working with the people living there. There have been no people admitted since the last inspection. However, there is one vacancy and the manager said that one person is currently being assessed to ensure that their needs can be met at the home. This has involved visiting the person at their home and the person and their family visiting the home. Sayer House DS0000062605.V351638.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, 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff have detailed information in individual’s care plans and risk assessments so they know how to support the people living there to meet their needs and ensure their safety and well being. The people living there are supported to make choices and decisions about their day-to-day lives. EVIDENCE: The records of two of the people who live there were looked at. These included an individual care plan. These detailed how staff are to support the individual to maintain contact with their family and friends, to minimise their pain and discomfort, to meet their health needs, the support the person needs during the night and the support they need for their social and leisure activities. Care plans were very detailed so that staff knew exactly how to support the individual. They had been regularly evaluated and updated where it was clear that the care plan was not effective in meeting the individual’s need. Daily Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 12 records sampled clearly described what care staff had given to the person and these were used to evaluate the care plan. The Disability Distress Assessment Tool had been used to assess how the individual expresses signs of pain or discomfort. These included behaviour, mannerisms, facial signs, body posture and speech. It was clearly stated in the person’s care plan how the person expressed pain and discomfort and what action staff needed to take to minimise this. Records sampled showed what action staff had taken to do this. Due to the needs of the people living there it is not always possible for them to make choices about their lives and this is often limited. However, staff had tried to offer people choice as much as possible. Each person had a record of the choices they had been offered and what their response was to this. Choices were generally limited to drinks, what clothes to wear, what position they wanted to lie in and whether they wanted to listen to music or watch a DVD. Often staff recorded that no positive response was given so they made the choice for the person. Staff then recorded if there was any response to the choice made from the person so that they had a record of the things they seemed to like or dislike. Some responses recorded were that the person smiled, chose one drink by looking at it, reached out for one dessert and became distressed when put in one position but was calm when moved to another position. Staff were observed throughout the day offering people choices. Records included individual risk assessments. These stated how staff are to support individuals to take risks in their day-to-day lives whilst minimising the risks to their health and welfare. These were detailed and had been regularly reviewed and updated where there had been changes to the individual’s needs. Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that the people living there experience a meaningful lifestyle. The people living there are offered a healthy diet that ensures their well being. EVIDENCE: Records sampled showed that the people living there go shopping, spend time using sensory equipment including lights and music, have massage therapy, go for walks, out for drives, to restaurants, cinema, parks, go to church, have hand and foot massages, watch DVD’s and listen to music. The manager said that from January 2008 a dog from the ‘Pet Therapy’ service would be visiting regularly. One of the people living there used to have a dog so think this may benefit them and possibly the other people living there. Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 14 The local church that used to be part of the Monyhull hospital site holds a service each Sunday that people can attend if they want to. On the morning of the visit there was a Christmas Communion Service at the church that the people living there went to with staff. In the afternoon there was a Christmas party held in the church hall for the people who live in the six bungalows that were built on the site when the hospital closed. Staff said that people had bought new clothes to wear at the party and staff spent time supporting individuals to get dressed up for the party. The manager said that all the people living there had been away on holiday this year. Two people went to Blackpool, two people went to Somerset and two people went to Wroxham. One person’s records stated that they went on a day trip to Ross on Wye with staff. Records showed that the people living there are supported to keep in contact with their family and friends. Some people had lived at other care homes before their health deteriorated but staff had supported them to maintain contact with the people they used to live with. Some relatives of people who lived at the home but have sadly now died still keep in contact with the home and some still visit. Because of the deteriorating health needs of the people living there it is difficult for them to be involved in household tasks. However, records showed and it was observed that people are encouraged to be as independent as possible. Food records sampled showed that people are offered regular meals that include fruit and vegetables to ensure they have a healthy diet. Where people had been prescribed nutrition drinks to ensure they receive the nutrition they need their food records showed that they are given these. Food records showed that a variety of food is offered that reflects the cultural background of the people living there. The people living there have swallowing difficulties. The Speech and Language Therapist has assessed each person to ensure they get the nutrition they need but the risk of them choking is minimised. They have made recommendations as to how each person’s food should be blended to ensure they can swallow it without choking. The lunchtime meal was observed and staff followed these recommendations. However, each part of the meal had been blended separately so that it looked presentable. The people living there need thickener in their drinks so they are not at risk of choking. Staff were observed adding this to individual’s drinks and whisking it to the required consistency so that the person could drink safely. Each bungalow had responsibility for providing food for the party. This home was responsible for providing food for people with swallowing difficulties. It was evident from listening to staff that they had put a lot of thought into this Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 15 ensuring it was interesting and enjoyable whilst not putting people at risk of choking. Sayer House DS0000062605.V351638.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, 20, 21 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that the people living there receive personal care and their health needs are met in they way they prefer and require to ensure their well being. People have their prescribed medication when they need it so their health needs are met. The illness and death of the people living there is handled with respect and as the person would wish. EVIDENCE: As part of this inspection the Short Observational Framework for Inspection (SOFI) tool was used. This involved spending one hour and forty minutes observing two of the people living there and the interaction and engagement they had from staff during that time. Analysis of this showed that for 84 of this period staff interacted with these two people. All of the interaction from staff was observed to be good. Staff were observed moving people from one place to another in their wheelchairs. They always told the person that they were going to move them Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 17 and where they were moving them to so that they were not startled by the movement or unsure of where they were going. The observation period included the mealtime. Staff sat with individuals as they gave them a drink and their meal and spent time talking to them about what they were eating, the church service they had been to in the morning and the party they were going to in the afternoon. Staff were observed talking to people and smiling at them, asking people if they wanted more of their dinner and stroking individual’s hands if they became upset to reassure them. At no time did staff put food or drink into a person’s mouth without first telling them that they were going to and what it was. Staff sat talking to people after their meal, the atmosphere was very relaxed and not rushed even though they were going to a party that afternoon. The people living there were dressed in good quality, comfortable clothes that were appropriate to their age, gender, cultural background and the activities they were doing. Staff said that people get their hair cut at local hairdressers. People had individual styles of hair and dress. The people living there need support from staff to move around. Each person had a moving and handling assessment that detailed how staff are to do this to ensure the safety of the individual and staff. They detailed what hoist and what sling the person used dependent on their needs and size. They were reviewed monthly and had been updated where the individual’s needs had changed. Records sampled included an individual Health Action Plan. This is a personal plan about what a person needs to be healthy and what healthcare services they need to access. Plans included pictures making them easier to understand. They had been recently been reviewed and updated where there had been changes to the individual’s needs. Plans clearly detailed how the person communicates so that staff know what the person does when they are unwell or in pain or discomfort. Where it was appropriate to the person staff had weighed them weekly. When a person loses or gains a significant amount of weight this can be an indicator of an underlying health need. Weight records showed that the person’s weight was stable. Records showed that other health professionals are involved in the care of individuals and staff work closely with the multi-disciplinary team to ensure that they meet individual’s health needs in the best way possible. Records showed that people have regular check ups with the dentist, chiropodist and optician to ensure their well being. Some of the people living there need bedrails to ensure that they do not fall out of bed. A risk assessment for this had been completed for the individual to ensure that the benefits of this outweighed the risks of them becoming trapped in them. Cushions and covers were used on the bedrails to reduce any risks of Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 18 people becoming trapped in the sides. Their assessment had been reviewed monthly to ensure that if their needs change they are still safe to use. Because of the poor mobility of the people living there their skin could be at risk of breaking down. Records sampled showed that each person has been assessed as to the risk of this happening. To minimise these risks pressure relieving equipment is used so that people do not spend too much time in one position, staff encourage people to move around as much as possible and ensure they have a good diet and regular fluid intake. Records of each person’s fluid intake are kept and this is monitored to ensure that the risk of their skin breaking down and of them becoming constipated or dehydrated is minimised. Medication is stored in a locked cabinet. At the front of each person Medication Administration Records (MARS) there is a photograph of the person so that if unfamiliar staff were giving medication they would know who to give it to. Only the qualified nurses give medication to the people living there. Unqualified staff still have training in medication so they know how this affects the person and can look for signs of any side effects. Some people are prescribed as required (PRN) medication. For each medication prescribed PRN a protocol was in place stating when, why and how much of the medication should be given to ensure it is given only when the person needs it. MARS had been signed appropriately and cross-referenced with the amount still stored indicating that medication had been given as prescribed. A weekly audit of the medication is completed to ensure that people are receiving their prescribed medication. People come to live at the home when their health is deteriorating due to dementia. Records showed that the person’s preferences on their deteriorating health and death had been discussed with them, other health professionals and their relatives where appropriate. These discussions were detailed in the individual’s records to ensure they could be met. Since the last inspection sadly one person had died at the home. Records sampled showed that staff had told the other people living there about this in a sensitive manner and supported them to attend the funeral if they wanted to go. One person had been supported by a health professional to complete a booklet called ‘When I die’ before their health deteriorated so they could have some input into it. Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that the views of the people living there are listened to and acted on. Arrangements are in place to ensure that the people living there are protected from abuse, neglect and self-harm. EVIDENCE: The complaints procedures for the South Birmingham Primary Care Trust and Family Housing Association were available in individuals service user guides so that if people are unhappy they know who to complain to. The AQAA stated that the complaints procedure had been explained to individuals when meeting with their key worker. The Commission had not received any complaints about this home in the last twelve months. One relative has made several complaints to the home. These were recorded in the complaints log and action has been taken to address the concerns raised. A representative from a carers group visited the home in September 2007 on behalf of the relative. They looked at the concerns raised and stated that they were satisfied that their relative is receiving a good service at the home. Records showed that staff are continuing to offer support to the relative when needed and listen to their concerns. The AQAA stated and the manager said that all staff have received training in adult protection and the prevention of abuse so they know how to protect the people living there. Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 20 The manager has attended training on the Mental Capacity Act. This legislation requires an assessment of an individual’s capacity to be made when making a decision about their health and welfare. If they are assessed as not having the ‘capacity’ to make the decision an Independent Mental Capacity Advocate (IMCA) can be appointed to make the decision in the person’s ‘best interests.’ There is a CD- rom and training pack in the home and the manager has discussed with staff the implications of this legislation for the people living there. The manager stated that the CD - rom and training pack would be used to ensure all staff are aware of this. The South Birmingham Primary Care Trust is the appointee for the people living there. Each person has their own bank account that their benefits are paid directly into. Finance records sampled cross-referenced with the amount in the individual’s purse or wallet indicating that their money had been spent appropriately. Receipts were kept of all purchases made. Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally arrangements ensure that people live in a homely, comfortable, clean and safe environment that meets their individual needs. EVIDENCE: Communal areas of the home were all well decorated making it a homely and comfortable place to live. Further redecoration had been completed since the last inspection and the office carpet that was very stained had been replaced. The kitchen units had been replaced so that the kitchen is clean and has the facilities so that staff can cook the food for the people living there. The front garden is very attractive with wind chimes, statues, plants and shrubs making the entrance to the home welcoming. Space in the dining room is limited, as staff need to support each person during mealtimes. Because of each person’s difficulty with mobility and posture Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 22 they sit at the dining room table in a chair that has been specially made for them and these are larger than the average dining room chair. The report of the last visit from a representative of Family Housing Association showed that they are looking at options as to how resolve this issue. In the shower room the flooring was rising. The manager said that the contractors have visited to look at it. They have suggested that a window be installed to aid ventilation in there, which could be the cause of the flooring rising. All the bedrooms were very well decorated, furnished and personalised. The manager said that staff had been involved in doing a lot of the painting of bedrooms to ensure they were completed and reflected the individual’s personality. There were photographs on bedroom walls of the person and their family. The home was clean and there were no offensive odours making it a pleasant place to live. Hand wash and hand towels were provided in all toilets so reducing the risk of cross infection. Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing, their support and development ensure that they have the skills and knowledge to meet the needs of the people living there. The recruitment practices ensure that the people living there are protected from abuse. EVIDENCE: The AQAA stated that seven of the nine care staff have National Vocational Qualification (NVQ) level 2 or above in Care and that the other two staff are working towards achieving this. This exceeds this standard that at least 50 of staff have this qualification ensuring that staff have the skills and knowledge to meet the needs of the people living there. The manager said that one full time member of staff had been recruited and would be starting in January 2008. This would leave on part-time vacancy which permanent staff would cover working extra hours so that staff that know the people living there work there. Sometimes bank staff are used to cover sickness or annual leave but agency staff are not used. There was a student nurse on placement who is extra to the staff and does not work as part of the Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 24 rota. Rotas showed that there are four members of staff on most shifts during the waking day so that there is sufficient staff to work with the people living there. Staff meeting minutes showed that these are held at least six times a year. These inform staff about how individuals needs are changing and give staff an opportunity to discuss how they meet the needs of the people living there, any changes within the organisation and to keep updated with ‘best practice’. Three records of staff that work there were looked at. These included the required recruitment records including evidence that a Criminal Records Bureau (CRB) check had been undertaken to ensure that ‘suitable’ people are employed to work with the people living there. Records for the qualified member of staff included evidence that are have current registration with the Nursing and Midwifery Council (NMC) showing that they are ‘fit’ to practice as a nurse. Records showed that when staff started working at the home they completed an induction so they knew how to meet the needs of the people living there. Training records sampled showed that staff have training in dementia, infection control, fire safety, food hygiene, equality and diversity, moving and handling, adult protection and the prevention of abuse, minimising confrontation, dysphagia (swallowing difficulties), epilepsy and Makaton (a sign language often used by people who have a learning disability). As detailed under the ‘Complaints and Protection’ section of this report staff are to receive training in the Mental Capacity Act. Records sampled showed that staff have regular, formal, recorded supervision sessions with their manager so they are supported in their role. Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements ensure that the people living there benefit from a well run home. The people living there can be confident that their views and that of their relatives underpin all self-monitoring, review and development by the home. Arrangements ensure that the health, safety and welfare of the people living there is promoted and protected so ensuring their well being. EVIDENCE: The registered manager is a Registered Learning Disability Nurse (RNLD). The manager said that she is just finishing her degree in Palliative Care and will be doing a Masters from September 2008. This gives her increased knowledge Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 26 and understanding in how to lead the staff to meet the needs of the people living there. The manager also has a NVQ in dementia as well as NVQ 4 Registered Managers Award and the NVQ Assessor’s Award so she can assess staff in their NVQ. It is clear from the outcomes experienced by the people living there and it was observed during the visit that the manager gives a clear sense of direction so ensuring that the home is well run. A representative from South Birmingham PCT and Family Housing Association visit the home monthly and complete an audit. A report of each of these visits is written and these show that the views of the people living there and their relatives are considered and included in the development of the home. An electrician had completed the five yearly test of the electrical wiring in November 2007. A copy of their report was forwarded to the Commission after the inspection, which confirmed that the wiring is safe. Fire records showed that the PCT fire officer had visited the day before to review the risk assessment to ensure that action is taken to minimise the risks of there being a fire. An engineer services the fire equipment regularly to ensure it is well maintained and works. Staff test the fire alarm weekly and the emergency lighting monthly to make sure they are working. Regular fire drills are held so that staff and the people living there would know what to do if there was a fire. A carbon monoxide detector is fitted so that staff would be alerted if there was an escape of poisonous gas. Staff test this weekly to make sure that it is working. The manager said there is an ongoing problem with the water temperatures and an engineer visited during the day. They said there could be a problem with the water pressure but that the temperatures were within the normal limits so they were not too hot or cold. The water temperatures are tested weekly and a new thermometer had been bought so that an accurate reading could be given. Records showed that recently temperatures had been recorded as being within the safe limits so that people were not at risk of being scalded. Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 4 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 4 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 3 4 X 3 X X 3 X Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA24 YA24 Good Practice Recommendations A window should be installed in the shower room to increase ventilation and stop the flooring from rising so the room is safe to use. Consideration should be given as to how the dining room can accommodate the people living there and staff supporting them during mealtimes. This will ensure that people can eat their meals safely and that staff will be able to support them appropriately. Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection 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 Sayer House DS0000062605.V351638.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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. 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