Care Home: Warstone Resource Centre

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What the care home does well The organisation continues to respond to requirements, which are made and is actively trying to improve the quality of care for residents living at the home. The home also has an experienced and competent registered manager and capable staff team. The atmosphere within the home is friendly, relaxed and informal. The home is fresh, clean and comfortable. All communal areas have comfortable furniture and are brightly lit. Staff make visitors feel welcome and people using the service are supported to maintain important links with their families and friends. The staff are caring, friendly and know about the individual people`s needs, using the name preferred by each person, treating them with respect. People using the service can move freely around the home and some people can make their own drinks and snacks with staff support and supervision where necessary.All people using the service provide by the home have a comprehensive assessment of their needs, which is undertaken both at their own home and during visits to the service. People enjoy a full and active life at the home. Staff help people using the service to maintain access to their usual educational and day centre facilities and take part in peer and culturally valued activities. Staff support people to have and maintain relationships inside and outside the home and have their rights are respected. Meals at the home are very good, varied and a choice is always available. People who use the service receive personal support in the way they prefer and healthcare that meets their needs. Care plans are comprehensive and involve people and relatives, where possible, in their development and review and are "person centred" rather focusing on tasks to be undertaken. There are good systems for managing people`s medication. The complaints procedure ensures that people using the service and relatives are listened to and their concerns receive an appropriate and timely response. The home has procedures and well trained staff to safeguard people using the service. This inspection was conducted with full co-operation of the registered manager, staff and people currently using the service. The atmosphere through out the inspection was relaxed and friendly. The Inspector would like to thank the manager, staff, and people using the service for their hospitality during this inspection visit. What has improved since the last inspection? What the care home could do better: Improvements must continue to the way resident`s care is planned to involve them more and to include more detailed information for residents with complex conditions such as behavioural difficulties and there must be fuller support for people with the capabilities to be as independent as possible. The registered persons need to make some additional improvements to the home`s staff training programme. Improvements are also needed to some areas of health and safety, such putting in place better systems to monitor hot water temperatures in bedrooms and showers and regular analysis of accident and incident records to highlight trends or risks. These actions will make the home a safer place for residents and staff. CARE HOME ADULTS 18-65 Warstone Resource Centre Salters Lane West Bromwich West Midlands B71 4BQ Lead Inspector Mrs Jean Edwards DRAFT Unannounced Inspection 20th & 21st November 2007 09:00 Warstone Resource Centre DS0000038653.V355053.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 Warstone Resource Centre DS0000038653.V355053.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. Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Warstone Resource Centre Address Salters Lane West Bromwich West Midlands B71 4BQ 0121 569 5382 0121 569 5387 Jacqueline-Postin@sandwell.gov.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Sandwell Metropolitan Borough Council Jacqueline Postin Care Home 15 Category(ies) of Learning disability (15), Physical disability (10) registration, with number of places Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 15 LD and up to 10 PD, not exceeding the maximum number registered for. Date of last inspection: 14 February 2007 Brief Description of the Service: Warstone Resource Centre is a respite care unit, including a small rehabilitation service for people with a Learning and Physical disability. The centre is situated near to Sandwell Valley Park Farm and about 15 minutes walk from West Bromwich town centre. The premises has limited parking to the front, and has external recreational space to the rear. The care home is on the ground floor and all of the bedrooms are single occupancy and provide en-suite toilet and shower facilities. (The first floor is not accessed by the care home and is utilised by other services, such as Community Support and the person centred planning forum team.) There are various lounges and a communal dining room, in addition to a games room and sensory stimulation area. Bathroom facilities offer equipment to care for service users with physical disabilities and various adaptations. The home offers a range of social and recreational activities, and has its own adapted transport. A statement of purpose and service user guide is available to inform people of their entitlements. The placements are block purchased by Sandwell Community Learning Disability Team. Information regarding the weekly fee of £1130 is available and each person makes an individual contribution towards the fee from their personal allowance. Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the key unannounced inspection visit for 2007 - 8, undertaken by an inspector from the Commission for Social Care Inspection (CSCI). The inspector has spent two weekdays at the home. All Key National Minimum Standards have been assessed at this visit. The range of inspection methods to obtain evidence and make judgements includes: discussions with the registered manager, and staff on duty during the visits, chats with people and their relatives using the service, observations of some people without verbal communications and examination of a number of records. Other information was gathered before this inspection visit from the homes Annual Quality Assurance Assessment (AQAA), notification of incidents, accidents and events submitted to the CSCI. The CSCI sent out 15 service user surveys, ten relatives surveys and staff and health care professional surveys. Comments from the one survey form from a service user and responses from 2 relatives and 1 health care professional are contained throughout this report. It is unfortunate that no staff surveys have been returned to the CSCI for analysis and input into this report. There are currently thirteen people staying at Warstone Resource Centre. Formal interviews are not always appropriate therefore other methods such as informal chats, observations of body language, eye contact, gestures, interactions between staff and residents have been used. What the service does well: The organisation continues to respond to requirements, which are made and is actively trying to improve the quality of care for residents living at the home. The home also has an experienced and competent registered manager and capable staff team. The atmosphere within the home is friendly, relaxed and informal. The home is fresh, clean and comfortable. All communal areas have comfortable furniture and are brightly lit. Staff make visitors feel welcome and people using the service are supported to maintain important links with their families and friends. The staff are caring, friendly and know about the individual peoples needs, using the name preferred by each person, treating them with respect. People using the service can move freely around the home and some people can make their own drinks and snacks with staff support and supervision where necessary. Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 6 All people using the service provide by the home have a comprehensive assessment of their needs, which is undertaken both at their own home and during visits to the service. People enjoy a full and active life at the home. Staff help people using the service to maintain access to their usual educational and day centre facilities and take part in peer and culturally valued activities. Staff support people to have and maintain relationships inside and outside the home and have their rights are respected. Meals at the home are very good, varied and a choice is always available. People who use the service receive personal support in the way they prefer and healthcare that meets their needs. Care plans are comprehensive and involve people and relatives, where possible, in their development and review and are “person centred” rather focusing on tasks to be undertaken. There are good systems for managing peoples medication. The complaints procedure ensures that people using the service and relatives are listened to and their concerns receive an appropriate and timely response. The home has procedures and well trained staff to safeguard people using the service. This inspection was conducted with full co-operation of the registered manager, staff and people currently using the service. The atmosphere through out the inspection was relaxed and friendly. The Inspector would like to thank the manager, staff, and people using the service for their hospitality during this inspection visit. What has improved since the last inspection? The way the home plans each persons care has improved with more detail and specific written information providing staff with better guidance about each persons needs and preferences. At this visit additional areas needing fuller detail have been discussed. The homes system for the management and administration of residents medication has been improved, though as a result of this visit there are some additional improvements needed, mainly relating to records and storage, so that residents are safeguarded as far as possible. The registered manager, as part of the monitoring systems in the home has started to put in place audits of all areas the premises. As a result improvements to the internal décor, fixtures and fittings and the exterior of the home continue to be made. Redecoration and new carpets of South wing are due to be completed by the end of November 2007 and new beds, bedrails and pressure relieving mattresses have been provided on the West wing for people with complex needs. Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 7 Staff have received refresher training so that they understand how to safeguard people using the service, and there is an improvement in the frequency and quality of staff supervision and development meetings. 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. Warstone Resource Centre DS0000038653.V355053.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 Warstone Resource Centre DS0000038653.V355053.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, 2,3,4,5 Quality in this outcome area is Good. The homes pre admission information, statement of purpose and service user guide is comprehensive and in appropriate formats suited to people and their supporters using the service, meaning that there is good access to useful information about the home. People have their needs assessed by competent persons prior to using the service and they are able to trial the home before staying there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes AQAA states the service does the following well, an initial assessment of needs and wishes is carried out by the care manager, Warstone management team upon receipt of this information will go and visit the individual to discuss their identified needs and determine how they can be met within the service, at this point the individual is given a pictorial guide to Warstone that includes general information and our statement of purpose. Upon satisfactory discussion the individual is then invited for a series of no less than 3 tea visits then one overnight stay, dependant on individual circumstances this may be extended until an individual is comfortable with us, the individual/care manager/carer/advocate are then invited to attend a review to determine if Warstone is appropriate for all parties concerned. If all Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 10 satisfied the individual is then invited to utilise Warstone as per individual requirements. A pictorial support plan is then developed with the identified coworker and relevant parties to ensure all areas of support required and risk management are covered. The inspection visit has established that the home has a comprehensive service user guide, available in an easy to understand pictorial format. Copies it is given to people who may use the service when the manager goes out to meet them in their own environment. From the sample of case files examined one person has had extensive short visits to the home and continues to use the service in the day time only and is not yet ready to use the service for longer stays, which is recognised and supported by the professionals involved. Two people have accessed the services as emergency admissions, the most recent person because of the bereavement of their main carer. The admissions have been handled with care and sensitivity, with staff at Warstone Resource Centre trying to obtain as much information as possible to support each persons care needs. One persons assessment information entered on the comprehensive corporate proforma has not been fully completed, dated or signed by the staff or the person or their relative. This home is currently accommodating 13 people with diverse needs, whose main residence is in the community. The home provides short stay / and intermediate care for approximately 107 people across Sandwell Borough. The homes AQAA states what the service could improve is, the up to date assessments for individuals who have accessed Warstone for a number of years The homes AQAA states the service has improved, Introduction of an admissions and discharge protocol, to capture up to date information from support workers relating to individuals. Introduction of pictorial support plans. The inspection visit has established that home is in the process of developing the pictorial support plans and these are not yet implemented for each person. It is positive that the registered manager is involved in developing a communication strategy for people with learning disabilities across Sandwell MBC. The homes AQAA states the service plans the following improvements over the next 12 months, Introduction of an admissions and discharge protocol, to capture up to date information from support workers relating to individuals. Introduction of pictorial support plans. At the previous inspection visit in February 2007 it was noted that terms and conditions of residency were not available within each persons case file. Assessment of the sample of case files shows that the recommendation that a copy of each individual persons terms and conditions of residency are retained within their care records remains outstanding. Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 11 Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 12 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 Good There is evidence that person centred care plans are being introduced in a way that means that staff have the information needed to know each persons assessed, and changing needs and personal goals. The home is improving systems to enable people and their supporters to participate in the planning of their care and to identify their wishes and aspirations. Support for people in taking risks is improving and generally there are good risk assessments meaning that people are safeguarded to lead an independent lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA submitted by the service states they do the following well, person centred approaches and support planning, inclusion in planning the activities of the unit, reviewing changing needs and wishes of individuals. Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 13 The AQAA submitted by the service states they have improved, introducing person centred approaches to care planning, using pictorial information, utilising risk management approaches to identify risk to individuals within the care planning process. The sample of 3 peoples care plans who are currently at the home show that two have comprehensive person centred care plans, which include each persons assessed needs, choices and strategies to ensure that they are able to make decisions. One person has only very recently been admitted as an emergency, with limited information as this person is not known to Social Services, never having received any service prior to the sudden death of the main carer. The manager and staff have shown great sensitivity to this persons situation, taking care to allow space and time for them to deal with things are their own pace. Records seen identify service users involvement in the planning and regular review of their care. One person, who is assessed as needing assistance with oral care, does not have a plan of how this is to be provided. On another persons plan there is detailed information about the use of an electric toothbrush and the need for verbal prompts to complete the task. The AQAA submitted by the service states they need to improve, Provide individuals with accessible information about policies and procedures in operation. At the inspection visit some procedures, such as complaints and fire are pictorial. The AQAA submitted by the service states they plan to improve in next 12 months, introducing person centred approaches to care planning, using pictorial information, utilising risk management approaches to identify risk to individuals within the care planning process. The sample of 3 case files show that there are risk assessments, which identify risks to each person including smoking, use of stairs, and potential for absconding. One person has a risk assessment relating to behaviours, which challenge the service, with behaviour management charts in place, however there are no details of incidents described in daily contact sheets. Although this person was at the home there are no daily records completed from 12 - 16 November 2007. This persons care plan has not been signed or dated to demonstrate their and / or their relatives involvement. Some daily records contain useful, detailed information, whilst others contain only very basic information and there are gaps where no code is entered to show what personal care has been provided. During the inspection visit staff have generally shown that they are aware of each persons needs, and there are improved records of each residents preferences such as rising, retiring, likes and dislikes, which reduces risks posed by reliance on verbal communication between staff. Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 14 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 The home promotes opportunities for people to lead meaningful lives with a wide range and stimulating activities (including community based outings) available. Staff support people using the service to maintain important links with their families, wherever possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is evidence that the daily routines at the home are flexible and promote independence, examples during the inspection visit are that people have been at various stages of rising, dressing and having breakfast, and going out to day time activities according to their preferences and activities for the day. The homes AQAA states the service does the following well, We support individuals to continue with outside interests and clubs, we welcome family and friends to visit and provide comfortable lounges to facilitate this. Warstone Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 15 operates a rehabilitation service where individuals are encouraged to maintain current skills and develop new ones. During the inspection visits evidence has been seen to demonstrate that the home encourages continuity of existing routines of daily life for people using the service, where they wish to do so. Staff are available to assist when needed to identify opportunities for occupation and benefits, or refer to other agencies as appropriate. Throughout the two day inspection visit a number of people have continued to access the educational and day facilities they would normally attend whilst at home. Whilst staying at Warstone Resource Centre people are encouraged and supported to pursue their own interests and hobbies. People using this service have opportunities to integrate with people who do not have a disability through the varied activities programme. There is evidence that the home encourages visitors and continuity of contact with relatives and friends, wherever it is possible and appropriate. However there is a good recognition that the purpose of a short stay at Warstone Resource Centre may be for a break from routine for people using the service and the people who are closely involved in their care in the community. The home has a visiting policy with no restrictions on visiting at reasonable times, and there are a variety of private and communal areas, which can be used. A number of relatives have visited the home over the two days of this inspection, they have been very complimentary about the service, one relative says, the staff are marvellous people, when son went home he wanted to go back to Warstone ...... its a home from home, excellent The homes AQAA states the service has improved, We have improved the range of activities offered to individuals, made them more consistent with individual choice and increased the frequency of activities both in house and out side. The home has its own vehicles, in addition to utilising public transport, and taxi’s. There are attractive photographic displays in the home showing people who use the service and staff enjoying a range of activities and outings. The home makes special efforts to celebrate the birthdays of people using the service, and these are extremely popular events, especially as the home has its own disco in the large dining room. The homes AQAA states what the service could improve by, Create opportunities for individuals to find and keep appropriate jobs and vocational courses. The home has every chance to achieve this goal with staff who are knowledgeable about the local area and facilities, and who have an awareness of peoples rights of access through the Disability Discrimination Act 1995. The manager states that Warstone Resource Centre has a good relationship with the local community, and strives to be part of the neighbouring community. The home has staff team, which reflects the racial and cultural diversity of people using the service and the wider community in Sandwell Borough. Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 16 The homes AQAA states the service plans the following improvements over the next 12 months, develop our policy on sexuality and relationships to encompass the needs and wishes of individuals whilst promoting adult protection issues and consent. The menus at Warstone Resource Centre offer a varied and well-balanced choice of meals, which accommodates individual preferences, cultural and specialist diets. There is an emphasis on healthy eating, with plenty of fresh vegetables, fruit and salad items available. The home has been awarded the Five for Life Award Level 3. People using the service can choose to be alone in private, if they wish either in their room or in one of the quieter lounges or conservatory. One person currently staying at Warstone prefers to eat in the conservatory rather than formally with other people in the dining room. Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 17 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 There is a good understanding of the concept of valuing people and as a result staff support each persons rights to dignity and privacy. Generally each persons health care needs are supported as part of their care. The home has made improvements to the procedures for administering medication, thereby reducing the risk to residents, but there are still some areas of practice, which can be improved to reduce potential risks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes AQAA states the service does the following well, We provide a service to meet the needs of individuals, taking a holistic approach to health care requirements. We promote a flexible approach to support required and provide this with respect, privacy and dignity as our driving force. The homes AQAA states the service has improved, Individuals have a health monitoring sheet on file where staff record interventions from health professionals and report further action required, daily contact recording against Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 18 needs met by staff which includes individuals choices, Comprehensive care plans which detail health requirements, personal support required etc. There is evidence from the sample of care records examined and from observations and discussions that each persons care needs are carefully considered and where possible they are encouraged to express how they would like their care to be carried out. Staff appear to understand that this has to be carried out sensitively whilst maximising each persons potential for independence. Preferred gender of staff to carry out personal care is recorded and respected as part of their person centred plan. However as previously highlighted there are some gaps in the daily contact records completed by staff to show what level of personal care has been provided. Each person has a health passport and health monitoring sheet on file recording contacts with health professionals. The homes AQAA states what the service could improve is, Create more opportunities for individuals to self medicate where appropriate. At this inspection visit we have noted that there are none of the thirteen people currently accommodated assessed to undertake any part of their own medication administration. It would be very positive to assist and support people wherever possible to have some responsibility for some part of their medication, on a risk assessed basis. The homes AQAA states the service plans the following improvements over the next 12 months, Health monitoring has always been difficult due to the nature of service we provide, and we have improved our records of involvement with health professionals. The home has copies of the corporate medication policy available at the home and staff show a good awareness of safe medication practices. All staff involved in medication administration have received medication training with continued assessment of their practice. The home generally uses an MDS (Monitored Dosage System), which offers the benefits of sharing with the primary carers in their own homes in the community, though some medication is still dispensed in original containers. The home has a safe system and good records for medication, which is administered outside the home and has implemented PRN (as required) protocols, which are linked to PRN care plans for any person requiring medication prescribed in this way. The home has a robust system of checking and auditing medication at each shift handover, where 2 seniors count and sign for all medication. There is now a system in place to monitor the temperature of the room where the medication is stored to ensure that medicines are stored at the required and safe temperature, as this room has the potential to exceed 25C despite the use of a fan. Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 19 Observations at this inspection have highlighted a small number of areas, which need to be improved. There are no photographs of 3 people currently using the service on their medication records. There are 2 MAR sheets with no carried forward balances and a small number without appropriate staff and witnesses signatures for handwritten entries. There are a number of instructions as directed, which is insufficient written guidance for safe administration. There is also am open container of Calogen, which is not stored according to manufacturers instructions in the refrigerator and has not been dated, which has the potential for it not to be used or returned within the specified 14 days. A copy of the homely remedies procedure and guidance devised by the CSCI Pharmacists has been given to the Manager to be used for any person wishing to use over the counter remedies such as the person currently taking Venos cough remedy. Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 20 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 The complaints process has improved and complaints made on behalf of people who use the service receive an appropriate response. Corporate safeguarding procedures are robust and offer suitable protection to people who use the service. Staff have good awareness following refresher safeguarding training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA submitted by the service states they do the following well, Promote the complaints procedure through individuals meetings and carers meetings, including service appraisals. Contact carers or advocacy services where required to support individuals. All staff trained in adult protection procedures, and raising awareness of potentially abusive situations. At the inspection visit there is evidence that the home uses the Sandwell Local Authority corporate compliments, complaints and suggestions procedure, which includes details of how to contact the Commission for Social Care Inspection, and has timescales and stages for action and completion of the process. Examination of the homes complaints log shows that there have been 3 complaints/ concerns highlighted in the last twelve months all of which were upheld and resolved to the complainants satisfaction. There are also records of Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 21 7 written compliments, which commend individual staff, the staff group for support to a visit to the theatre, support for someone to attend a family funeral, for support during tea visits and for previous stays, food and support to move into a new flat. There is evidence at the home of the local authority safeguarding policies and procedures. There is guidance, which incorporates a flow chart to give additional assistance to staff about actions required where abuse is suspected or an allegation is made. There has been one allegations of abuse since the last inspection, which has been appropriately referred and investigated in compliance with the multiagency safeguarding procedures. There was no evidence to support the alleged incident had taken place. All staff have now undertaken training provided by the Local authority to raise their awareness and knowledge to protect people using the service. The AQAA submitted by the service states they plan to improve, reassure staff to feel confident to report bad practice and make suggestions for improvement. The AQAA submitted by the service states they plan to improve in next 12 months, Introduction of comment cards for individuals to comment on their stay with us to evoke changes or address concern quicker, Finalise and implement the new physical intervention and restraint policy. Introduce feedback forms to meeting minutes so individuals opinions are listened to and acted upon. Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 22 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 adequate The premises are generally attractive, decorated and furnished to a good standard. Maintenance has generally improved but there are some further maintenance issues to be dealt with to avoid jeopardising residents’ safety and comfort. Mechanisms for infection control have generally been improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes AQAA states the service does the following well, We provide an accessible, comfortable, well maintained respite facility which has safe systems in place to maintain hygiene within the building. The individuals who access Warstone are consulted on colours and styles of furnishings to be purchased. Our rooms are single occupancy with en-suite facilities, we make use of our location and access Sandwell Valley Park on a regular basis for activities, we also use the local metro for outings. The homes AQAA states the service has improved, Introduction of environment audits to highlight areas of concern or re decoration required. Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 23 At the previous inspection visit in February 2007 it was reported that the décor was looking tired and shabby in places, with some carpets worn and a tripping hazard and an immediate requirement was made requiring that this be addressed to protect people at the home. Although the home has a refurbishment plan it was reported that the work had been delayed due to some structural repairs required, which should have been completed by the spring 2007. At this inspection visit there is evidence that the immediate tripping hazard has been remedied as an interim measure, however the redecoration and refurbishment has been further delayed due to structural deficiencies with drainage discovered by corporate structural engineers. The registered manager states that this is scheduled to be completed by the end of November 2007. She states that the colour schemes, carpets and furnishings have been chosen with the involvement of people using the service. Recent meeting have also discussed renaming the wings of the home, possibly Rosewood and Bluebell Walk and after different species of birds, though this has yet to be finally decided. She also states that there will appropriate signage for bedroom, bathroom and WCs to help people to orientate themselves around the home. There are 15 en suite bedrooms, which are personalised for each persons stay according to their preferences and on a risk assessed basis. The west wing has 4 bedrooms for people with complex needs and new profiling beds with bedrails, mattresses and protective bumpers have been provided since the inspection in February 2007. The home has three communal bathrooms, however the whirlpool bath in one remains out of order and requires replacement, this was outstanding at the previous inspection in February 2007, action needs to be taken as a priority. One bathroom containing the Parker bath and assisted shower has an overhead hoist. All bathrooms and toilets have suitable privacy locks. The home has a number of comfortable communal lounges to meet a range of different needs such as, a quiet lounge, a conservatory and activities room, with a pool table and activity equipment. The large separate dining room provides a pleasant environment, with tables set with attractive clothes, decorations, baskets of individual condiments / sauces and crockery. The tour of the home shows that it is maintained to be clean and odour free. There are laundry facilities, which are separate from accommodation used by the people staying at the home, though some people do take and collect their washing from laundry, on a risk assessed basis. The laundry area is well organised and has appropriate equipment. The manager is advised to display the laundry procedure and infection control guidelines to enhance good infection control measures. The home has a large well organised central kitchen, with a small area where Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 24 some people can make their own drinks. The home also has a rehabilitation wing, with a small kitchen, where some people, with support from staff can be involved in making drinks and snacks. It has been noted that a spare kitchen drawers have been deposited in the small lounge, posing a potential hazard. This has been removed during the inspection visit. The homes AQAA states what the service could improve is, Create a more homely environment, to include pictures and ornaments in bedrooms where appropriate to risk factors. The homes AQAA states the service plans the following improvements over the next 12 months, To redecorate and re carpet internal communal areas, to replace existing soft furnishings to compliment the environment. The areas noted during the tour of the home as needing improvement are: • • • • • • • Redecoration of reception area to be completed within agreed timescale Redecoration and refurbishment of the south unit, including replacement carpets to be completed within the prioritised timescale Redecoration of the east wing lounge (wallpaper peeling) within the timescale - by end of November 2007 Redesign of the exterior door and windows to garden area (in programme) by end of 2008 Renovate flooring in laundry where there corrosion and replace flooring as identified in the homes maintenance programme Exterior security lighting to be adjusted to activate as soon as it becomes dark Additional markings to the kerb and any stepped area at the entrances and exits to the home for people who have visual or mobility disabilities Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 25 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 Good There is generally good service continuity and quality due to a well qualified and experienced staff group who understand and can meet each persons needs. Recruitment and selection procedures provide safeguards to people staying at the home. There are comprehensive and structured inductions for new staff before they work with residents. Enhanced staff training is improving the quality of support offered to residents; this assisted by the manager ensuring formal staff supervision and development. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are currently 13 people accommodated, with a variety of dependency levels and diverse needs. From assessment of staffing rotas, observations and discussions indications are that the current staffing levels is generally adequate. The homes AQAA states the service does the following well, 93 staff trained to NVQ L1 and 2 as a minimum in their area of work. 35 staff hold NVQ L3 and above. Review the needs of individuals on a regular basis to set Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 26 staffing levels for the week to ensure maximum support is given where required. Provide staff supervision and personal performance development meetings on a regular basis to develop the team. The homes AQAA states the service has improved, Scheduled staff supervisions have been taking place more frequently The manager states she has a strong commitment to staff training and development, together with support measures such as structured supervision. From the sample of staff files examined there is evidence that all care staff have regular, structured and documented supervision sessions, signed by the supervisor and supervisee. There are also regular minuted staff meetings and recently the manager has encouraged staff to attend a staff meeting without management presence to have an opportunity to discuss issues they may have and give feedback relating to areas they wish to see addressed. Thee are no responses to the CSCI staff surveys sent to the home, which is disappointing and staff have lost a valuable opportunity to offer their views about the service they provide. The homes AQAA states what the service could improve is, Have clearly defined job descriptions that link to individual responsibilities and goals of the individuals who access Warstone. Provide staff training to cover specialist communication training. A sample of staff files and recruitment processes have been examined. The documentation and management of staff personnel files has improved and generally provides safeguards for people staying at the home. The homes AQAA states the service plans the following improvements over the next 12 months, To develop a training matrix that covers the specific training requirements of our staff to include mandatory and service specific training. To revise our current rota to create new posts to fulfil the needs and requirements of individuals during the evening and weekends. The manager is in the process of implementing the homes an annual training plan and individual staff training profiles. A comment from the CSCI relatives survey in response to what the service does well states, I cannot name just one thing as the whole centre and staff are excellent Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 27 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, 41, 42 Quality in this outcome area is Good The home has an experienced and capable manager who strives to provide effective leadership and improving communication. There is a quality assurance system, which includes views of the people and their relatives who use the service provided at this home. There are some areas of health and safety, which have improved; other areas have yet to be effectively managed and may compromise the safety and wellbeing of people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Jacqueline Postin is the registered manager at Warstone Resource Centre, she is capable and experienced to manage the home, she holds appropriate qualifications including the RMA (Registered Management Award) and Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 28 continues to update her professional development. Her many years of experience includes the specialist needs of the people who use the service. The homes AQAA states the service does the following well, Effective quality assurance system in place. Monthly management performance monitoring fully experienced and qualified management team The homes AQAA states the service has improved, We have continued to maintain the quality awards. Quality and frequency of staff supervision has improved. Clear accountability has been given to managers and clear direction to staff for their responsibilities. At the inspection it has been established that the home has an externally accredited, robust quality assurance system in place, which includes views of people who use the service and their relatives. The manager conducts regular audits and is currently implementing planned improvements for care planning, communication strategies, the environment, and team building. The home has an annual development plan and the RI (registered individual) representing the Local Authority as the registered providers makes the required Regulation 26 visits to the home and reports of monthly unannounced visits relating to the conduct of the home are made available to the home, senior managers and the CSCI. The homes AQAA states the service plans the following improvements over the next 12 months, For the management team to encourage openness and support effective communication. The homes AQAA states what the service could improve is, ensure consistent approach to staff being updated with relevant policy and procedures and ensure relevant policy and procedures are in accessible formats for individuals to understand. There is some evidence that policies and procedures are discussed in staff supervision meetings and some policies have already been developed in alternative formats, which are better suited to the understanding of people who use the service. Discussions have taken place relating to the new Regulation requiring the home to submit an annual AQAA on request by the CSCI and it is recommended that the registered manager proactively use this as an additional tool. In addition the evidence to support statements made in the AQAA need to be more detailed and accurate, as the evidence will be tested and verified during inspections. There is evidence that mandatory training is being provided for the staff commensurate with their roles in a rolling training programme. Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 29 The random assessment of a sample of health and safety and service maintenance records examined shows that they are generally satisfactory. However the records of the monthly checks on the hot water outlets do not currently show documented checks of the showering facilities, which the handy person states are thermostatically controlled. As with any mechanical or electrical devise they have the potential to develop faults and therefore must be regularly, maintained, checked with documentary evidence. The records of the hot water outlet checks show a small number of excessive temperatures, for example room 3 wash basin shows 48C on 9/8/07, 6/9/07 and 47C on 1/11/07, which poses a risk of scalding to any person entering and using this outlet unsupervised. The manager has agreed to put in place an immediate risk assessment and order remedial action as an urgent priority. The CSCI has received written conformation that remedial action has been completed. Accidents and incident forms are completed and filed, to be collated and analysed, with monthly statistics. However through examination of the records and discussions with the manager and staff there remains a lack of clarity about what is recorded as an incident and what is recorded as an accident. Since January 2007 there are 42 recorded incidents involving people using the service, some highlighting an injury, and there are 17 accident records. In addition there are 51 incident reports involving staff, a considerable number citing a resulting injury, without an accompanying accident record. The registered persons must obtain and work to clear definitions of accidents and incidents and expand the system for auditing, analysing and evaluating accidents, so that this highlights trends and situations of increased risk and shows effective control measures and management strategies to minimise known risks. Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 30 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 3 4 X 5 2 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 3 27 2 28 X 29 X 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X 2 2 X Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 31 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. 1. Standard YA34 Regulation 19 Requirement The manager must ensure that staff files include all requirements of the Care Home Regulations 2001 schedules 2 and 4. (Timescale of 31/03/07 Not Fully Met) It is the home’s responsibility to notify the CSCI when this requirement is met. 2. YA42 13(4) The registered person must ensure that hot water temperatures at all hot water outlets accessible to people using the service are maintained at all times between 38C and 43C (41C showers) and any excessive temperatures be reported and rectified as a priority Actioned immediately following the inspection visits It is the home’s responsibility to notify the CSCI when this requirement is met. 21/11/07 Timescale for action 01/02/08 Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA2 Good Practice Recommendations That the homes assessment document AP21d be dated and signed by the person completing the information and also where possible the person receiving the service and / or their representative That a copy of individual services users terms and conditions of residency be available within their care records. That care plans include details of how each persons oral care is to be assisted That daily notes be completed consistently and appropriate codes be consistently completed to demonstrate the daily care provided The registered manager needs to ensure that the files of people using the service contain all information specified in the Care Homes Regulations 2001, Reg 17 Schedules 3 and 4, which includes an up to date photograph That personal risk assessments be fully and accurately completed for every person using the service, with updated information as needs change That behaviour monitoring records needed for any person using the service are fully and accurately completed, with documented evaluation of risk management strategies That the weight of all persons using the service is regularly monitored and where a person refuses to be weighed this should be recorded in their notes and alternative options used, such as the MUST (Malnutrition Screening Tool) and / or assessment of the fit of clothing The following areas of medication administration need improvement: 2 YA5 3 4 YA6 YA6 5 YA6 6 YA9 7 YA9 8 YA19 9 YA20 Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 33 1) Ensure that there is a photograph of each person using the service on their medication records 2) Ensure that MAR sheets contain details of any allergies or record none known 3) Clarify any as directed dosages with the prescriber and / or pharmacist 4) Ensure all carried forward balances are recorded on MAR sheets and all handwritten entries are signed and witnessed by staff trained and competent to do so 5) Ensure all short life medicines are dated when opened and used / returned within specified period 6) Ensure Calogen is dated when opened, refrigerated and used with 14 days or returned to pharmacy 10 YA27 That the practice of using jugs in communal bathing facilities to wash / rinse hair ceases or a documented system to sterilise jugs be implemented That the laundry procedure, infection control guidelines and hand washing signs be displayed in the laundry That revised job descriptions within the staff team to clarify roles and responsibilities of care staff, and management team are issued and implemented. That strategies for management planning and practice are fully implemented, which encourage and reward innovation, creativity, development and change. That specialist training as required should be provided for staff, e.g., sign language, Makaton/finger spelling symbols, to ensure staff can communicate effectively with service users. That staff training files are updated to demonstrate that all staff have received all required training and refreshers commensurate with their roles That staff are provided with training relating to - Equality & Diversity - Mental Capacity Act That stakeholder surveys are implemented, with results DS0000038653.V355053.R01.S.doc Version 5.2 Page 34 11 12 YA27 YA34 13 YA35 14 YA35 15 YA35 16 YA35 17 YA39 Warstone Resource Centre collated, published and acted upon where necessary 18 YA39 That the homes Annual Quality Assurance Assessments (AQAA) submitted to the CSCI should contain accurate, verified information and fuller details of the supporting evidence of what the home does well and the improvements made That a definition of accidents and incidents is obtained and issued to staff to ensure that there is a clear distinction between incidents and accidents That the monthly checks of the shower hot water temperatures are recorded and maintained at 41C maximum That the registered manager undertakes a regular documented analysis of incidents and accidents, evaluating any trends and demonstrating that control measures are reviewed and revised where necessary to minimise risks 19 YA42 20 YA42 21 YA42 Warstone Resource Centre DS0000038653.V355053.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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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