Care Home: Walmley Road

What the care home does well Each person has their own bedroom and they all contain things that are important to them. People are supported to go on holiday each year so they can have a break and experience new things. Different healthcare professionals support the people living there and staff make sure they follow the advice given so that people can be well. Staff said that they love their job and know the people living there well. The people living there were well dressed. Staff at all times treated people with respect and maintained their privacy and dignity so ensuring individual`s well being. Staff make sure that people get the medicines they need so they can help them to keep well. Staff have the training they need so they know how to support each person living there and meet their needs. New staff are started on an induction programme so they have the basic skills to meet individual`s needs. People are encouraged to do things for themselves so helping them to be more independent. Information about the home includes pictures so it is easier for people to understand. What has improved since the last inspection? The fire risk assessment had been looked at and updated to make sure that the risk of there being a fire is low which helps the people living there and staff to be safe. There have been more fire drills so that staff and people who live there would know what to do if there was a fire. Staff have had more training so they know how to support the people living there and keep them safe. There were more activities for people to do and each person does the things they enjoy. Care plans were better and people important to the person had been involved in writing these so staff know how to support individuals. Some rooms had been redecorated and new furniture had been bought. This has made the environment homely and comfortable to live in. Rubbish had been removed from the garden so that the people who live there are safe and can enjoy being in the garden. Staff have the information they need so that if they suspected abuse they would know who to contact to make sure people are safe. What the care home could do better: All staff should sign individual`s support plans to say they have read and understood them so they know how to support people to meet their needs. Plans should be updated when people`s needs change so that staff know how to support them. Menus should be in a format that the people living there can understand so they can be more involved in choosing what they eat. People should have enough fluids each day to make sure they keep well. CARE HOME ADULTS 18-65 Walmley Road 189d Walmley Road Walmley Sutton Coldfield West Midlands B76 1PY Lead Inspector Sarah Bennett Unannounced Inspection 1st December 2008 09:45 DS0000071272.V373407.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 DS0000071272.V373407.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. DS0000071272.V373407.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Walmley Road Address 189d Walmley Road Walmley Sutton Coldfield West Midlands B76 1PY 0121 313 0879 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) www.caretech-uk.com CareTech Community Services Ltd Barbara Lamsey Thompson Care Home 4 Category(ies) of Learning disability (4) registration, with number of places DS0000071272.V373407.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) 4 The maximum number of service users to be accommodated is 4. Date of last inspection 11th January 2008 Brief Description of the Service: 189d Walmley Road is a bungalow situated in the residential area of Walmley, Birmingham. A range of local shops are close to the home and public transport nearby gives access to Sutton Coldfield town centre. The accommodation comprises of four single bedrooms, a communal lounge and separate dining room, kitchen and laundry room. There are two bathrooms one of which has a walk-in shower facility. The home provides care and accommodation to four adults with learning disabilities who display behaviour that challenges service provision. During the day all four people living there are provided with one to one support. The service users guide stated that the fees charged for each person weekly are £1951.21. This applied at the time of the visit and readers are advised to contact the home for the current information regarding fees. A copy of the last inspection report is available in the office and on request. DS0000071272.V373407.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection was carried out over one day; the home did not know we were going to visit. This was the homes key inspection for the inspection year 2008 to 2009. The focus of inspections we, the commission, undertake 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. The manager completed the Annual Quality Assurance Assessment (AQAA) and sent it to us before the visit. This provides information about the home and how they think it meets the needs of the people living there. Two of the people living 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. A partial tour of the premises took place. A sample of care, staff and health and safety records were looked at. Due to the needs of the people living there it was not possible to ask for their views on the home so time was spent observing practices and interaction from staff. The manager, area manager and staff on duty were spoken with. What the service does well: Each person has their own bedroom and they all contain things that are important to them. People are supported to go on holiday each year so they can have a break and experience new things. Different healthcare professionals support the people living there and staff make sure they follow the advice given so that people can be well. Staff said that they love their job and know the people living there well. DS0000071272.V373407.R01.S.doc Version 5.2 Page 6 The people living there were well dressed. Staff at all times treated people with respect and maintained their privacy and dignity so ensuring individuals well being. Staff make sure that people get the medicines they need so they can help them to keep well. Staff have the training they need so they know how to support each person living there and meet their needs. New staff are started on an induction programme so they have the basic skills to meet individuals needs. People are encouraged to do things for themselves so helping them to be more independent. Information about the home includes pictures so it is easier for people to understand. What has improved since the last inspection? The fire risk assessment had been looked at and updated to make sure that the risk of there being a fire is low which helps the people living there and staff to be safe. There have been more fire drills so that staff and people who live there would know what to do if there was a fire. Staff have had more training so they know how to support the people living there and keep them safe. There were more activities for people to do and each person does the things they enjoy. Care plans were better and people important to the person had been involved in writing these so staff know how to support individuals. Some rooms had been redecorated and new furniture had been bought. This has made the environment homely and comfortable to live in. Rubbish had been removed from the garden so that the people who live there are safe and can enjoy being in the garden. Staff have the information they need so that if they suspected abuse they would know who to contact to make sure people are safe. DS0000071272.V373407.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. DS0000071272.V373407.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 DS0000071272.V373407.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need so they can make an informed choice as to whether or not they want to live there. EVIDENCE: The statement of purpose was reviewed recently so it includes the current information that people need to make a choice as to whether or not they want to live there. The service users guide included the relevant information about the home that people need including the fees charged to live there. It stated that these are based on an individual assessment of peoples needs. They do not include personal items, holidays, clothes, hairdressing and public transport. The service users guide was produced using pictures making it easier to understand. There was a copy of this in each persons bedroom so that they and their visitors have the information they need. The people living there have all lived there for a number of years and there are no vacancies. Therefore, the standard relating to assessment of peoples needs before they are admitted was not assessed. DS0000071272.V373407.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, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have the information they need so they can support individuals to meet their needs and ensure their safety and well being. EVIDENCE: The records of two of the people living there were looked at. These included an individual care plan that showed staff how to support the person to meet their needs and achieve their goals. The person where they were able to, their relatives and professionals working with them were also involved in writing the plan. The plans were detailed as to what support the person needed. They included encouraging the person to be as independent as possible and to make choices about the things they do, what they wear and what they eat and drink. Plans also included information about how the person does not want staff to treat them. For example for one persons continence care plan it stated that DS0000071272.V373407.R01.S.doc Version 5.2 Page 11 they did not want staff to leave them in the toilet or to shout if they are incontinent. This ensures that staff clearly know how to respect the person and what is and what is not acceptable when supporting them. One persons records included a letter from their doctor advising staff to reduce the amount of glucose testing that they do in line with a national diabetic review. The doctor requested that staff stop checking the persons blood sugars from the date the letter is received. This was two weeks before but had not yet been reflected in the persons plan. The manager was aware of this and said it would be updated. Plans included how staff are to support individuals to meet their religious and cultural needs so ensuring that all their needs are met and understanding that all their needs are important to their well being. Plans had been reviewed regularly and updated where needed to ensure they were still appropriate in meeting the persons needs. Some staff had signed to say they had read and understood the plans, staff that had been recruited in the last few months had not yet signed. All staff should sign to show they know how to support the people living there. A format for a person centred plan produced using pictures so involving the individual more was available. One persons key worker had started to gather information about the persons history so that staff know more about the person but these had not yet been completed. The people living there are not able to communicate verbally. Each person has a plan about how they communicate. This may be through facial expressions, gestures, body language and pointing to things. Staff use their knowledge of these and the individual to understand what they are communicating. Each person had a key worker and they spend time with the individual regularly talking to them about what they would like to do and how they are being supported. Talk time records are completed and from these an action plan is made. Records sampled showed that the actions stated had been completed showing that peoples views are listened to and acted on. One person had a communication passport that had been developed by the Speech and Language Therapist. The manager said that these are being developed for the other people living there. This clearly shows how the person communicates their needs and wants helping staff to understand these and ensuring that peoples needs and wishes can be met. Records included individual risk assessments. These detailed how staff are to support the individual to take risks whilst ensuring their safety and well being. They included people using public transport, going out in the community, eating, their health needs, their mobility and support they need at night. DS0000071272.V373407.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 good. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that people experience a meaningful lifestyle and have a healthy diet that ensures their well being. EVIDENCE: The manager said that some people had attended college courses doing cookery and pottery. They aim to support people to go back to college in January if there are courses that suit their individual needs and interests. During the day people were observed doing activities inside and outside the home. They did painting, watched TV, listened to music, played with percussion instruments, put away their laundry and played games. One person went to a sensory/relaxation room in the morning with two staff and in the afternoon one person went Christmas shopping with two staff. All the people living there were going to a disco in the evening with staff. DS0000071272.V373407.R01.S.doc Version 5.2 Page 13 Records sampled showed that people take part in a range of activities in the home and the community depending on their needs and interests. Three people need 2:1 staffing within the community and the other person needs 1:1 staffing. People generally go out on their own with staff unless they are going to a disco or event organised particularly for people who have a learning disability. These are often at safe venues where people would need less staff support. The home has a minibus, which staff drive to enable people to go out in the community. The people living there contribute financially to the minibus in addition to the fees they pay to live there. Where people are able to they are also supported to use public transport. The manager said she has applied for bus passes on behalf of the people living there so the cost of using these can be reduced. Staff said and photographs showed that three of the people living there had been on holiday with staff this year to various locations within England. Staff said that they are planning to take the other person away in the New Year. They said they have in the past taken people abroad and where they go varies depending on the individuals needs and where they would like to go. Records showed and staff said that people are supported to keep in touch with their family and friends so maintaining relationships that are important to them. This may be through visits to the home, visiting them at their homes, telephone calls and sending cards and presents for special occasions. Throughout the day staff were observed encouraging people to do things for themselves. Records sampled showed and it was observed that people are involved in household tasks so promoting their independence skills. Records showed that people go to bed and get up when they choose to although this may sometimes depend on whether they have planned activities that they need to get up for. Menus are developed around peoples likes and dislikes and to provide a balanced meal. At the last inspection it was recommended that these be made easier for the people living there to understand so they can have more input in them. Staff said that the Speech and Language Therapist is going to work with people to develop individual menus. They said that one person can point and say what they want but more help with pictures and photographs is needed so that all the people living there can make choices about what they eat and drink. Staff said they take it in turns to cook and there is a rota for this. Food records sampled showed and it was observed that people are offered a varied and nutritious diet that includes fruit and vegetables. Records showed that where people refused what they were offered an alternative was provided. Records showed that people have regular snacks as stated in their plan that DS0000071272.V373407.R01.S.doc Version 5.2 Page 14 they needed these to be well. Staff were observed sitting with people at mealtimes eating with them so making it a social occasion and supporting individuals as needed. DS0000071272.V373407.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal care and health needs of individuals are generally well met so ensuring their well being. EVIDENCE: The people living there looked clean and well dressed. People had individual styles of hair and dress that were appropriate to their age, gender, the weather and the activities they were doing. Staff were observed talking to people in a respectful way and records showed that staff respected peoples privacy and dignity. Records sampled showed that health professionals are involved in peoples care when needed to ensure their well being. Records showed that health professionals were satisfied with the care that people were receiving and that the advice they gave to staff was followed to ensure individuals health needs are met. When staff returned from accompanying a person to a health DS0000071272.V373407.R01.S.doc Version 5.2 Page 16 appointment they had recorded in detail the outcome of the appointment and advice given so that all staff could follow this. Records included a Health Action Plan. This is an individual plan about what the person needs to be well and what healthcare services they need to access. These were produced using pictures making them easier to understand. As people are unable to communicate verbally their plans detailed how they communicate to staff when they are in pain or are unwell. One persons plan had confusing information about whether or not they had a hearing problem. The manager confirmed that the person does have a hearing problem and would ensure that the information in their records was correct. Since the last inspection the dietician has been working with some people to ensure they receive the nutrition they need. People had been weighed regularly and had reached their target weight to ensure they are healthy. One persons records stated that for them to be well they needed over 2000mls of fluid each day. Staff had kept records of the persons fluid intake but these showed that most days the person had between 1500- 1750mls each day and only had over 2000mls on some days. The manager said she would remind staff of the importance of this for the individual. During the day staff were observed offering regular drinks to people. Each person had their own medication file that included their Medication Administration Record (MAR) and protocols for the as required (PRN) medication that the person is prescribed so staff know when and why to give it. Records showed that people have their medication regularly reviewed by their GP or psychiatrist to ensure that it is still effective in meeting their health needs. Medication plans stated the medication that the person was prescribed and should have stated what each medication was for but this was not all completed. Medication was stored in a locked cabinet in a locked room. Boots supply the medication in blister packs using the monitored dosage system. Each persons medication is pre packed by the pharmacist in the blister packs so to make it easier for staff to know what and when to give so reducing the risk of errors. MAR sampled showed that medication had been given as prescribed to the individual. The use of PRN medication to be given when people are agitated was minimal indicating that staff use appropriate ways to managing peoples behaviour without having to use medication. One persons records included agreement from their GP that as the person often refused their medication the GP had no objection to staff concealing their tablets in foods as they felt the persons quality of life when taking their medication was better than if not. DS0000071272.V373407.R01.S.doc Version 5.2 Page 17 The manager completes a monthly audit of the medication to ensure it is being given as prescribed. DS0000071272.V373407.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, 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 and they are safeguarded from abuse. EVIDENCE: The AQAA stated that there has been no complaints received by the home in the last 12 months and we have not received any complaints about this service. The manager said they had received two compliments about the support staff provide to the people living there but have not yet recorded these. They said that they would do as this can show improvements made to the service. One professional had stated in a letter found in one persons records, The home had a very pleasant and calm atmosphere, people looked very relaxed and generally happy. Positive change, warm, comfortable and friendly. The complaints procedure was in an easy read format so it was easier to understand. It had been laminated and was displayed in the hall so that visitors would know who to complain to if they were unhappy with service provided. Each person had a copy of the complaints procedure in their service users guide, which was kept in their bedroom. Records sampled included a finance support plan. These showed that each person has their own bank account that their benefits are paid into. The DS0000071272.V373407.R01.S.doc Version 5.2 Page 19 manager and a member of staff are the signatories for the persons bank account so that the amount of people who have access to peoples accounts is limited. Records included a finance risk assessment that detailed how the risks of the person being financially abused are minimised as much as possible. At the hand over of each shift staff count the money to ensure it is being used properly and held safely in the home. Individuals finance records are audited at the end of each month. The monies held in the home for two people were looked at. The money in their individual wallets cross-referenced with their record indicating that their money had not been misused. Their money had been spent on personal items and not on things that should be provided as part of the fees they pay. Receipts were kept of all purchases. Staff training records showed that staff had received training on safeguarding and how to protect the people living there from abuse. The organisations procedure on safeguarding and the local multi- agency guidelines on safeguarding were available so that staff would know what to do if they suspected that abuse had occurred. The manager attended a seminar the previous week organised by the City Council on the Mental Capacity Act and the Deprivation of Liberty. The Mental Capacity Act came into force in April 2007 and requires an assessment of the persons capacity if there is any doubt they may not have the capacity to make a decision about their welfare. An Independent Mental Capacity Advocate (IMCA) can be appointed to help with the decision if they are assessed as not having the capacity. Some staff are booked to attend training about the Mental Capacity Act and some staff have completed this training. The manager said that all staff would be attending this training so they know the implications of this legislation for the people living there. An easy read summary of the Act was displayed on the sleep in room notice board. All staff are expected to read this and sign to say they have so that they have an awareness of this. DS0000071272.V373407.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, 26, 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 homely, comfortable and clean environment that meets their individual needs. EVIDENCE: Since the last inspection several areas of the home had been redecorated and new furniture had been bought. This made the home look well decorated, homely and comfortable. The decoration and furnishings were contemporary and reflected the age of the people living there. Bedrooms were personalised according to individual needs, tastes and interests. Some people had sensory lighting equipment in their bedroom, which created a relaxing environment. Bedrooms included photographs of people important to the person and if appropriate to the individual religious DS0000071272.V373407.R01.S.doc Version 5.2 Page 21 pictures so ensuring their religious and cultural needs are considered. One persons bedroom carpet was in need of replacing as it was beginning to become worn. The manager said that this would be replaced in the new financial year. Since the last inspection the garden had been tidied and a bin store built to ensure that the rubbish was stored in a way that does not create a hazard to the people living there. The care staff do the cleaning as part of their role. Where possible they involve the people living there in this. The home was clean and free from offensive odours making it a pleasant place to live. DS0000071272.V373407.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, 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 the needs of the people living there are met so ensuring their well being. EVIDENCE: The AQAA stated that 58 of staff have achieved National Vocational Qualification (NVQ) level 2 or above in health and social care. This just exceeds the standard that at least 50 of staff have this qualification ensuring they have the skills and knowledge to support the people living there. The AQAA stated that new starters have completed the Learning Disability Qualification (LDQ) and are awaiting registration on the NVQ. The deputy manager had recently left to move to another home within the organisation. The manager said there were three staff vacancies including the deputy post. They had recently recruited one member of staff and further recruitment is planned. The manager said that permanent staff and staff from other homes within the organisation work overtime to cover the vacancies. Rotas sampled showed there are four staff on an early shift, sometimes three DS0000071272.V373407.R01.S.doc Version 5.2 Page 23 but generally four on a late shift and one staff sleeping -in and one waking staff at night. Agency staff are used to cover sickness if permanent staff are unable to cover. The manager said they try to use the same agency staff and have four agency staff they generally use who know the people living there. Rotas sampled confirmed that where agency staff were used these were the same staff. Staff meeting minutes showed that there had been six staff meetings in the last year. Minutes showed that staff discussed risk assessments, activities, working as a team and training. Some minutes showed that only four staff attended the meeting. The manager said she is monitoring who comes to meetings as staff get paid for going and are expected to attend at least four a year. Minutes are available and staff sign to say they have read so they can keep informed of what was discussed. The organisation has an agreement with us to keep their staff recruitment records at their Regional Office. Our Provider Relationship Manager (PRM) meets with the organisation and checks the recruitment records at their Office when needed. Three staff records were looked at during this visit at the home. These included evidence that a satisfactory Criminal Record Bureau (CRB) check had been completed to ensure that suitable people are employed to work with the people living there. The agency provides confirmation to the home that the member of staff has a CRB check and the training they have undertaken. Records of the agency staff used were seen. The AQAA stated and records sampled showed that staff complete an induction when they first start working there so they know how to meet individuals needs. The manager stated that the induction for agency staff had recently been updated to include more detail so agency staff would know how to meet individuals needs. Records sampled showed that staff have completed training in first aid, health and safety, abuse, fire safety, food hygiene, medicines, autism, epilepsy, diabetes and moving and handling. Training in person centred planning is planned for January 2009. The AQAA stated all staff have a 1:1 monthly supervision or informal supervision. Records sampled showed that supervisions were now more regular. The AQAA stated that in the next 12 months they plan to improve by implementing an annul appraisal process so that staff can identify personal development goals and it is hoped that this will assist the organisation in retaining staff. DS0000071272.V373407.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, 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 that is safe to live in. EVIDENCE: Since the last inspection the manager has been registered with us. The AQAA stated the manager has 15 years experience in the care profession and is working towards the Registered Managers Award. The manager said she generally works management hours during the day but does work as part of the shift if needed but this is not expected of her as part of her role. DS0000071272.V373407.R01.S.doc Version 5.2 Page 25 The organisation employs a quality and performance manager in the region. They visited the week before to do an audit. They spoke to us on the phone during the day and said that the report of their audit was not yet written. When it is they plan to revisit the home, meet with the manager and from a development plan is produced. They said improvements had been made, other professionals were involved in peoples care, recording had improved, care files were easier to follow, there were more activities within the community, induction of new staff was positive, there was a more person centred focus and the overall outcomes for the people living there were positive. They said they would forward a summary of their report to us when completed. The area manager visits the home at least monthly and every month completes an audit that looks at how the home is meeting the National Minimum Standards and complying with requirements and recommendations from our last report and their internal audit. The area manager visited during the day and said that managers now complete a self-assessment about the home. A master copy of this is kept in the home and is updated as things improve. Bromford own the premises and a representative visits the home every three months to look at the environment and discuss the improvements needed and what finances are available to make these. An Environmental Health Officer visited in February this year. They reported that the bins were overflowing. Since then a bin store has been built to reduce the hazards of this. They said the home was clean and no action was taken. Fire records showed that an engineer regularly services the fire equipment to ensure it is well maintained. Staff test the fire equipment regularly to make sure it is working. Since the last inspection there had been two fire drills so that staff and the people living there can practice what they would need to do if there was a fire to ensure their safety. Since the last inspection the fire risk assessment had been updated. This was detailed and stated how the risk of there being a fire is minimised in each room of the home including the loft. People had a risk assessment about fire that showed staff how to support them if there was a fire. Staff had signed to say they had read these. Staff have regular updated fire safety training to ensure they know how to minimise the risks of there being a fire. Records showed that a contractor tests water temperatures monthly and thermostatic valves are replaced as needed to reduce the risk of people being scalded. Showerheads are cleaned and disinfected regularly to reduce the risk of legionella. The annual test of the gas equipment was completed in May this year and records showed that it is safe to use. DS0000071272.V373407.R01.S.doc Version 5.2 Page 26 DS0000071272.V373407.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 X 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 3 25 X 26 3 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 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 X X 3 X DS0000071272.V373407.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. 3. 4. Refer to Standard YA6 YA6 YA17 YA19 Good Practice Recommendations All staff should sign individuals support plans to say they have read and understood them so they know how to support people to meet their needs. Care plans should be updated when peoples needs change so that all staff can support them in the appropriate way. The menu format should be reviewed so that they are more accessible to the people living there. People should have sufficient fluids to ensure their well being and where required by health professionals these should be accurately recorded. DS0000071272.V373407.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. Extracts may not be used or reproduced without the express permission of CSCI DS0000071272.V373407.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. 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