Care Home: Unity Care

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What the care home does well People are well looked after by a group of familiar staff that have known them for quite some time. They are treated in a friendly way, and with respect. The service is sensitive to people`s cultural and spiritual needs, and people get the support they need to stay in touch with friends and loved ones. They are able to do things they value and go to places they like. They enjoy living in a house that is generally well maintained, comfortable and homely. Important checks are carried out to make sure that staff working in the home are fit for the job. Other checks are carried out regularly on equipment around the home, to protect the health and safety of the people living and working there. The Manager continues to try hard to run the service well for the benefit of the people who use it. What has improved since the last inspection? Work has been done to make people`s care plans better, so that some of the things they want to achieve are included. Improvements in the house include new floor coverings in the lounge and downstairs, and new equipment in the laundry room. Some work has been done to find out what people think about the support they get, and this is continuing. What the care home could do better: CARE HOME ADULTS 18-65 Unity Care 29 Freer Road Aston Birmingham West Midlands B6 6ND Lead Inspector Gerard Hammond Unannounced Inspection 30 May & 4th June 2008 09:30 th Unity Care DS0000016814.V366004.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 Unity Care DS0000016814.V366004.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. Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Unity Care Address 29 Freer Road Aston Birmingham West Midlands B6 6ND 0121 551 3079 0121 240 0941 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) Unity care.co.uk Mrs Sylvia Hamilton Mr Dillon George Hamilton Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD) 5 The maximum number of service users who can be accommodated is: 5 30th May 2008 Date of last inspection Brief Description of the Service: The home is a large terraced style property, with bedrooms on the ground and first floor for service users. Bathrooms are situated on both floors, and a small communal dining room leads onto the kitchen on the ground floor. To the front of the home is a lounge for use by service users. The home has a small front yard, on street parking is available although the road can be busy and parking can be some way from the home. To the rear of the home is a small garden. The home is registered to provide accommodation and personal care to five adults who have a learning disability. The home objectives stated that they intend that residents will receive care appropriate to their assessed needs. Unity Care DS0000016814.V366004.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 1 star. This means the people who use this service experience adequate quality outcomes. This is the home’s first key inspection in the current year 2008-9. Information to inform the judgements made in this report was drawn from a range of sources. The Manager sent us a completed Annual Quality Assurance Assessment (AQAA). Two visits were made to the home and time spent talking to the residents and to the Manager and staff. We looked at records including personal files, health records, care plans, safety records, other documents and previous inspection reports. A tour of the building was also completed. What the service does well: What has improved since the last inspection? What they could do better: People who may be thinking about moving to the home should get a chance to visit first. This will help them find out if the home can offer what they want. Residents’ care plans need to be more “person-centred” – to focus on them as individuals, so they get the support they need in ways that suit them best. Records of people’s activities need to be much better. They need to show how people have chosen the things they do and places they go. They need to show what people got from doing the activity. Doing this properly will help make sure that people get to do the things they want, and plan for the future. Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 6 Records about people’s health also need to improve. They need to be better organised and fully completed. This will help to make sure that appointments and important information are not missed. The home’s complaints procedure needs to be developed, so that people have all the information and support they need to help them make a complaint. The Manager needs to write an up to date plan for staff training, to make sure that people have the knowledge and skills they need to do their jobs well. He needs to make sure that he gives himself enough time to carry out his responsibilities. Doing this should mean that the home is managed more effectively. Some more work need to be done to find out what people think about the support the home gives. Listening to what they say will help to plan for the future and make the service 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. Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2&4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. It would be better if people had opportunities to visit and see what the service has to offer, before moving in. This would help to make sure that decisions are properly informed. Assessments of people’s needs should be detailed, so that their support can be planned more effectively. EVIDENCE: One person has moved in to the home since the last inspection, so that there are now four people living there. The new resident’s personal file was examined. It contained a copy of an assessment completed by her social worker prior to her admission. It was noted that this assessment only provided limited information about her support needs and personal preferences. The Manager said that his knowledge of these was now improving, now that they had had some time to get to know one another. The Manager was asked about the arrangements that had been made to support her make a decision about moving to the home. This included whether or not she had been given the opportunity to come and visit the home before she moved in. He said that the admission had been an emergency, when her previous placement broke down. In these circumstances, she was offered a place in the home without first being able to come and see what the home had to offer. However, she said that she was happy to have been given a place and had settled in quite well. Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 9 The Manager said that he was in the process of reviewing and updating her needs assessment. She has been resident for three months and staff are working with her to develop their understanding of her needs and wishes for the future. A written contract was in place, as required. Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans need developing so that staff have clear guidance about how people should be supported. Making their plans more “person-centred” will ensure that people get the support they need in ways that suit them best. EVIDENCE: The personal files of two residents were sampled. The “new” resident only had a care plan written by her social worker. This was very general in nature and did not include specific details of how support should be given. The guidance that was given was limited to “provide support as necessary”, “respect personal dignity”, “prompt personal hygiene”, “encourage meaningful day activities”, and so on. The Manager advised that he has developed the care plan format being used in the home. He said that the care plan for this resident is a work in progress, and was able to produce some evidence of this. The other file sampled had a current plan that had recently been updated. The new format in use provides evidence of considerable work done to develop Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 11 plans and address some of the issues highlighted at the time of the last inspection. Plans have a summary sheet to provide a “snapshot” of individuals’ support. Efforts have been made to set some goals and set times for them to be evaluated and reviewed. The Manager has produced a new system for keeping goals under review, but this has yet to be introduced to staff or implemented. Plans follow a set formula of identified areas of support need, and these “areas” correspond with the formula used for individual risk assessments. It was recommended that care plans be “flagged” to show if there is a corresponding risk assessment in place. It was noted that risk assessments were in place as appropriate, to support guidance given in individual plans. Care plans need further development to make them more “person-centred” and show clearly how residents have been directly involved in drawing them up and keeping them under review. The Manager advised that the home does not currently operate a “key worker” system. It is also recommended that personal files should be “weeded”, so that old material and superseded information is removed. This should then be destroyed or archived as appropriate. Doing this will help to keep records (and particularly care plans) as current, working documents. Supporting the residents to exercise as much control over their lives as possible presents particular challenges in this home. The levels of learning disability and personal capabilities of the four people currently living here are very varied. Two of the residents have significant communication support needs, so that seeking their views directly is not easy. Plans and recording need to be developed to show how people have been involved in the decisions that affect their lives. Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have some opportunities to do things they value, go to places they like and keep in touch with people who are important to them. However, recording about what they do and how decisions have been made needs to improve significantly. Doing this will help to make a fully informed judgement about their quality of life, and to plan for the future. EVIDENCE: At the time of the last inspection it was noted that records about what people are able to do from day to day were quite limited. This continues to be the case. The information provided in the Annual Quality Assurance Assessment (AQAA) is similarly limited. Two of the residents told us about things they enjoy doing. These include going to a local group for Asian women, attending church, going to the cinema, going out for meals, cooking at home and painting / drawing at home. They said that they were able to do the things they wanted, and got support from staff if they needed it. The Manager said that all of the residents had been on a holiday to Skegness last year, and also Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 13 stayed at an “adventure park” near Kidderminster on another occasion. The communication support needs of the other two residents meant that it was not possible to obtain their views directly about their activity opportunities. The personal file of one of them was sampled in detail. The format in use provides for staff to show activities offered, and whether or not these were provided, accepted or refused. In the recording sampled for a 7-day period, this information had not been completed. Other entries on the record were confined to “relaxing, listening to music, and slept after watching movies”, “relaxing in front room”, “day centre”, and so on. The entry for one of the days did show “went out for a drive, then out for a pub meal and later to disco”. Recording of people’s activity opportunities was discussed with the Manager. He expressed his disappointment about the quality of some of the records and said that this had been taken up with staff on previous occasions. Individual members of the staff team must accept their responsibilities in this regard, and make sure that they keep proper records. They need to understand why this is important. As previously reported, the activity opportunities that people are able to enjoy are prime indicators of their quality of life. These should be clearly linked directly to their individual care plans and personal goals. It is difficult to make a fully informed judgement about this in the absence of proper records. Evidence from the two residents who are able to tell us about what they do, and conversations with staff, suggest that people enjoy opportunities to do things they value and go to places they like. Information about this needs to improve, so that it is possible to see how decisions about what people do and where they go have been made. This is particularly relevant for the residents who are not able to speak for themselves. Making individual plans more “person-centred”, and clearly linking their activity opportunities to their personal goals, should go a long way towards addressing the problem. As previously reported, the home makes positive efforts to recognise and support individuals’ cultural and spiritual needs. It was noted that pictures, photographs and ornaments around the home reflect people’s cultural heritage. The newest resident is of the Muslim faith, so she is supported to buy and cook halal food. People are also supported to attend places of worship according to their wishes. They are also supported to keep in touch with families and friends where possible, through visits, regular telephone calls and staying over, where this is appropriate. Food stocks were examined: these were plentiful and included fresh produce. Records showed that people enjoy variety and choice, and that their diet is balanced and nutritious. Meals provided include a good range of AfroCaribbean and Asian recipes. Residents were directly observed taking their evening meal in the dining room. This was comfortable and relaxed: people said they enjoyed their food and could have what they wanted. Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are generally well supported and cared for. However, the way in which their healthcare is managed needs to improve. Records need to be completed accurately and fully, so that appointments do not get missed or important information overlooked. EVIDENCE: On both occasions during recent visits to the home, it was noted that residents were well dressed in clothing of good quality. Styles of dress were individual, age and gender appropriate and reflective of residents’ personalities and culture. It was also clear that people had been supported with their personal care according to their needs. Interactions between residents, the Manager and other members of the staff team were warm and friendly. All were clearly comfortable in each other’s company and treated each other with respect. As previously reported, the staff team remains stable, so that the service provides continuity of care from familiar workers. Residents said that they got on well with the Manager and the staff. Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 15 The newest resident is diagnosed as suffering from epilepsy, though this is well controlled by medication. The Manager said that she has not had a seizure since moving into the home, and that it is not known when she last had one. It was recommended that an epilepsy management plan be put in place, after obtaining advice from a suitably qualified professional. Another resident is also diagnosed with epilepsy, and this too is well controlled by medication. A management plan is in place, though this was not easy to find in her personal file. It is recommended that this person’s Health Action Plan should include a record for monitoring any seizures, as there is currently nowhere to record this. Sampled records provided evidence of the involvement of health professionals including GP, Community Nurse, Psychiatrist, Neurologist, Dentist and Optician. There were charts for monitoring individuals’ weights, but these had not been completed consistently in all cases. Work has been done on developing individual health action plans, and this needs to be continued. In the response to the Annual Quality Assurance Assessment, the Manager acknowledged that improvements were needed to recording of residents’ health appointments. To this end he has devised a new document specifically for the purpose. The record provides for a brief account of all appointments and the outcomes. It was noted that these had been introduced, but are not being completed appropriately as the dates of appointments were omitted. There were also gaps in recording of dental appointments. These issues were brought to the Manager’s attention. He advised that dental appointments had been made and kept, but acknowledged that the record did not show this. It was also noted on one person’s health action plan that he had a goal to eat healthily, by having 2 portions of fruit / vegetables daily. The recommended intake of fruit and vegetables to promote healthier eating is 5 portions each day. It should be acknowledged that the Manager has made some efforts to put systems in place to support the management of residents’ healthcare needs. Staff need to be aware of their responsibilities to use the tools they have at their disposal, and to complete records fully and accurately. The Manager needs to ensure that records are being completed, so that residents’ healthcare is managed systematically and effectively. Failure to do this means that appointments might get missed or important information overlooked, compromising the welfare of people using the service. None of the people currently using the service manages his or her medication independently. The home uses a monitored dosage system supplied by a local Pharmacist. The Medication Administration Record (MAR) was examined and had been completed appropriately. It was noted that protocols were in place for PRN (“as required”) medication. Medicines are stored in a locked cupboard in the kitchen. The store was secure, clean and tidy. Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure needs to be developed. This is to make sure that people have all the information and help they might need to help them make a complaint. People are generally protected from abuse, neglect and self-harm. Some staff may need training, to make sure their knowledge and skills about keeping people safe is properly up to date. EVIDENCE: We have not received any complaints in respect of this service. A copy of the current complaints policy and procedure was not available during the inspection fieldwork visits. The Manager sent this in subsequently. Attempts have been made to present this in a more accessible format through the use of pictures, in order to make it easier to understand. It was noted that this version is very limited. It does not give any information about making a written complaint, or about how to get in touch with senior managers in the organisation. The procedure does not give timescales for acknowledgement, response or actions to be taken in the event of a complaint being received. It does not provide information about getting support to make a complaint or details of local contacts to do this (e.g. independent advocates, local ombudsman, social services). Two of the current four residents could make a verbal complaint. The other two people rely on the vigilance of the staff team to note changes in behaviour or demeanour, as indicators that something may be amiss. The residents able to say so reported that they would be comfortable raising any concerns with Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 17 members of staff or the Manager. In the response to the Annual Quality Assurance Assessment, the Manager acknowledges that improvements could be made in ensuring that residents know how to complain, by checking with them on a regular basis. He also advised that the two residents who have limited verbal communication are able to let staff know when they are unhappy, through their behaviour or the use of familiar gestures. Staff confirmed that this was the case. During the tour of the premises, it was noted that the wardrobe mirror in one person’s bedroom had been broken. Not all of the glass had come away from the door, so there were sharp edges still exposed. This potential hazard was discussed with the Manager, who then removed the rest of the broken glass from the door. Staff on duty were able to show understanding of the different forms that abuse can take, and to say what they would do in the event of witnessing or suspecting it. They were also able to show that they understood that those who have limited verbal communication have ways of showing if they are distressed. They were able to identify things that they know they have to look out for, including unexplained marks or injuries and changes in behaviour or responses to particular individuals. Sampling of staff records showed that appropriate checks had been carried out with the Criminal Records Bureau (CRB) prior to employment. It was not possible to verify training in this area for the whole staff team in the absence of a current staff training and development plan. Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 18 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, 27, 28 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a house that is generally clean, comfortable and tidy. Some improvements to the décor should be made, to ensure that the house is a homely and welcoming place for the residents. EVIDENCE: A tour of the premises was completed in the company of the Manager. The home is a large terraced property, in keeping with the domestic scale houses in the street and surrounding area. There is a good range of local amenities reasonably close by, and the area is well served by public transport. People’s rooms are generally individual in style, with personal possessions and effects in evidence. One resident has a particular interest in painting and drawing. Her room has many of her pieces of artwork on display. Another resident’s room is fitted with a range of sensory equipment, fitted to provide stimulation to the senses and also for therapeutic relaxation. Consideration Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 19 should be given to supporting the newest resident to make her room more individual. The room is appropriately furnished and equipped but lacks the personal touch. This is partly due to the fact that she has not been resident for many months, and also the circumstances of her admission. As previously reported, ornaments, photographs and pictures on display reflect the cultural backgrounds of people living in the house, and the ethos of the service generally. It was noted that the décor in people’s bedrooms is now starting to show its age. There are sufficient toilets and bathrooms in the house to meet the residents’ needs. The Manager reported that the upstairs bathroom is scheduled for refurbishment shortly. There is a further bathroom with WC and separate WC on the ground floor also. New flooring has been fitted in the main lounge. In the Annual Quality Assurance Assessment (AQAA) the Manager stated that there are plans to replace the sofa in the lounge and to fit new carpets in the hall, stairs and landing. The laundry room has been updated, with new impermeable flooring and a new washing machine installed. There are rooms on the second floor of the house, but these are not used by the residents. These include the home’s office. On the day of the fieldwork visit to the house it was noted that this room was quite untidy and appeared generally disorganised. The staff team works hard to make sure that the house is kept in good order, so that it provides a homely and welcoming environment for the residents. The home was clean and tidy, with a good standard of hygiene maintained Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 20 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, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Proper checks are carried out on staff before they start work, to make sure they are fit for the job. There are enough staff to meet people’s assessed needs. It is difficult to assess fully whether or not staff have done the training they need. This is to make sure they have the knowledge and skills to do their jobs well. EVIDENCE: Information provided in the Annual Quality Assurance Assessment (AQAA) shows that there have been no changes to the staff team since the time of the last inspection. There are eleven permanent members of staff: the AQAA shows that ten of them hold qualifications at NVQ level 2 or above, and the other member of staff is working towards this. There are two staff on duty for the times when the residents are at home, usually in the mornings and evenings. Night cover is provided by a waking member of staff with an on-call manager on duty. This responsibility is shared with the Manager of the organisation’s other residential home. The staffing complement is deemed adequate to meet residents’ assessed needs and to keep them safe. Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 21 Three staff files were sample checked. All contained required documentation, including completed application forms, two written references, checks with the Criminal Records Bureau (CRB) and evidence of induction. There were written records of formal supervision and minutes of staff meetings. Sampled files also contained some evidence of staff training, but it was not possible to assess this fully in the absence of a staff training and development plan. This was requested and the Manager undertook to forward it: he subsequently sent in the format by e-mail, but this did not include the required information. As indicated in the last inspection report, the training and development plan for the staff team should show (for each member of staff) all qualifications gained or being worked towards. Staff records should include copies of qualification and training certificates so that these can be verified. The plan should also highlight any gaps in training and show when “refreshers” are due, and when this training is to be delivered. It is recommended that the plan be drawn up in spreadsheet or chart format. The purpose of doing this is to give the Manager a clear overview of the current state of staff training, and to provide the information he needs to plan future training. Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 22 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, 38, 39, 41, & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Manager continues to try hard to run the home in the best interests of the residents. Some improvements are needed to make sure that the home is managed more effectively. EVIDENCE: As reported at the time of the last inspection, the manager is appropriately qualified and has several years experience working with people with learning disabilities in a residential setting. He remains committed to supporting residents to achieve as much as they can, according to their individual abilities. He recognises that the people in his care have a wide range of abilities, and need support in different ways and at different levels. He is keen to support them to become as independent as possible. Staff say that he has a very open style of management, and that he is very approachable. Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 23 At the time of the last inspection, copies of reports required under Regulation 26 (Care Homes Regulations 2001) were not available for examination. It was noted that these had been completed each month since then, and copies were available for inspection on this occasion. In the response to the Annual Quality Assurance Assessment, the Manager reported that requests to complete quality assurance questionnaires were made regularly. The Manager was able to produce a copy of a questionnaire he has devised for the purposes of monitoring service quality. He advised that he has received one completed questionnaire back from one of the residents’ social workers. Comments about the atmosphere in the home, the interaction between staff and residents, and cleanliness / tidiness of the home were all positive. However, there was no other evidence of this available on the day of the inspection visit. In the response to the AQAA, the Manager acknowledged that sending out questionnaires to all parties involved in the care and support of service users was an area for improvement. Work on this now needs to be taken forward so that an appropriate range of information is gathered from residents and all interested parties. This should be analysed and reported on, so that it is possible to see how this has been used to develop the service in the interests of the people who use it. It was noted that the organisation currently holds the “Investors in People” award. The standard of record keeping in the home has been referred to in other places in this report, and is a cause for some concern. The Manager has a very “hands on” style of working and is actively involved in supporting residents on a day-to-day basis. It was suggested in the last report that some thought should be given to ensuring that he has sufficient time allocated to his management responsibilities, and consider what might be appropriately delegated to other members of the care team. The disorganised state of the office and continuing problems ensuring that records are maintained in good order, suggest that this now needs to be addressed as a matter of some priority. Tasks need to be delegated appropriately, and the Manager should monitor whether or not allocated duties have been carried out. Issues arising from this should be addressed in formal supervision meetings. It was noted that the home does not currently operate a key worker system. Care planning and management should assume priority, and measures put in place to ensure that the good work already done is built upon. Action in these areas needs to be more systematic, so that action is planned, carried through and evaluated appropriately. Good recording is an essential tool in making sure that this is done efficiently, and can provide clear evidence of effective management. Safety records were sample checked. The fire alarm and emergency lighting systems had been serviced, and regular tests had been carried out on these, as required. Fire drills had been completed at six-monthly intervals. The workplace risk assessment had been reviewed. Tests on the temperatures of water outlets and also the fridge and freezer had been completed, and a written record maintained. Certificates in respect of gas and electricity safety were both in date. Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 24 Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 25 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 X 2 3 3 X 4 2 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 2 2 X 2 3 X Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA35 Regulation 18 (1c) Requirement Ensure that staff have received all necessary training appropriate to the work they do, so that service users are supported according to their assessed needs. Produce a staff training and development plan (as indicated in this report) to support this, and forward a copy to CSCI. Previous timescale 31/08/07 not met Timescale for action 31/08/08 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. 3. Refer to Standard YA2 YA4 YA6 Good Practice Recommendations Develop needs assessment for new resident, to show clearly the agreed areas of support so as to inform care planning appropriately. Ensure that prospective new residents have the chance to visit the home, so that they have good information to help them make a decision about using the service. Develop care plans to make them more person-centred, so DS0000016814.V366004.R01.S.doc Version 5.2 Page 27 Unity Care 4. 5. 6. YA9 YA13 YA14 that people get the care they need in ways they like. Make clear links between care plans and risk assessments, so that important information is easy to find. Improve the way in which staff record activities undertaken by service users. Show how activities are chosen and link them to individuals’ personal goals. Record activities in sufficient detail so as to make clear judgements about the activity’s success, and to inform future planning. Develop individuals’ Health Action Plans to include clear goals, so that it is possible to tell what has been achieved when plans are reviewed. Ensure that health records are fully completed. This is to make sure that appointments are kept and important information about keeping people healthy and well is not lost. Develop the complaints procedure, so that people have all the information they need to help them make a complaint. Redecorate residents’ bedrooms and help new resident to make her room more personal, so that people can enjoy living in comfortable surroundings that reflect their individuality. Ensure that staff records include copies of their certificates of training and qualifications, so that these can be verified. Ensure that sufficient time is allocated to allow management tasks to be completed, so that the home can be managed more effectively. Develop systems to monitor service quality and report on this, so that it is clear how information gained has been used to develop the service for the benefit of people using it. Ensure that records are completed fully and accurately. Doing this will help to manage people’s care more effectively, and ensure that important information needed to achieve this is readily available. 7. YA19 8. 9. YA22 YA26 10. 11. 12. YA32 YA38 YA39 13. YA41 Unity Care DS0000016814.V366004.R01.S.doc Version 5.2 Page 28 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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