Care Home: West Street

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What the care home does well The home is very well presented both in general appearance and in the excellent sources of information included in the statement of purpose and service user guide. The home has a very good assessment procedure and care planning system in place and the service users family can be confident that personal needs are understood and can be met. The plans are devised to assist the service user to have a full and active life and the two to one staff provision supports this. The staff were seen to have excellent relationships with the service user. The home makes sure that the service user gets routine as well as specialist health care. The home is spacious, well decorated and pleasantly furnished and kept clean and fresh. Staff are recruited and selected in ways that ensure safe skilled individuals are employed and the home demonstrates a good commitment to staff training. What has improved since the last inspection? Refurbishments have been carried out including a new kitchen and flooring, some new equipment, redecoration and new furniture to the bedroom. The sole resident has been admitted, a manager has been appointed and registered and staff recruited to support and provide care. CARE HOME ADULTS 18-65 West Street 10 West Street Rowley Regis West Midlands B65 0DE Lead Inspector Richard Eaves Key Unannounced Inspection 16th January 2008 09:30 West Street DS0000047472.V352572.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 West Street DS0000047472.V352572.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. West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service West Street Address 10 West Street Rowley Regis West Midlands B65 0DE 0121 559 0636 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) info@Inshoresupportltd.com Inshore Support Limited Bhanisha Patel Care Home 1 Category(ies) of Learning disability (1) registration, with number of places West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th January 2007 Brief Description of the Service: West Street is an adapted terraced property that was refurbished for the purpose of providing long term care for two younger adults with a learning disability. The house is now empty pending on-going discussions with the Central Registration Unit with a proposal to accommodate one service user with a learning disability. The house is positioned in an established residential area within walking distance of the centre of Blackheath. Accommodation briefly comprises of two single bedrooms, bathroom, lounges and kitchen. The building has a private rear garden area. The home is managed by Inshore support, a company that has a number of small homes that have similar aims and objectives to West Street. The staffing in the home consists of a manager, senior support and support workers. The staffing ratio is under review dependent on discussions with the Central registration Unit. Fees for this service are currently £3532. The fee information given applied at the time of the inspection; persons may wish to obtain more up to date information from the Home. West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key unannounced inspection visit was undertaken by an Inspector from the Commission for Social Care Inspection using the following information: reports from the organisation relating to the conduct of the home, records maintained at the home, the annual quality assurance self assessment and meeting and speaking with the service user and staff on duty. The inspection involved a full tour of the property including all internal rooms and the garden. What the service does well: What has improved since the last inspection? What they could do better: West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 6 The home has settled quickly to provide a good service to the sole occupant and demonstrate good insight into the complexity of needs to be met. Arising from this inspection are a small number of requirements and recommendations. It was noted that the service user is inclined to food and mealtime obsessive behaviours, these are well documented/recorded but should be drawn together within a clear plan, similarly there are a number of as required medications, while one of these has a clear protocol the others should be treated the same. Staff involved with the management and administration of medication should undertake accredited training to supplement the in-house training. Environmentally, staff need to understand how the hot water system functions to ensure they can be sure of a safe supply. Hot water mixing valves must be set at 43°c and adjusted to remain at or close to that temperature and not be delivered outside the 41°c to 44°c range. 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. West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 – 5 Quality in this outcome area is good The homes statement of purpose and service user guide are good sources of information providing details of the service enabling the service users family to make informed decisions about admission to the home. Pre-admission assessments was undertaken by the most experienced staff and confirmation was given to the service users family that the assessed needs could be met by the home and further confirmed by contract at the time of admission. The service user undertook a trial period at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 9 The homes statement of purpose and service user guide revised during 2007 are good sources of information providing details of the service and a picture format was available, the weekly fee is included. The sole service user file showed very close collaboration between a multi disciplinary team who jointly assessed needs and prepared the home and staff to meet the assessed needs. Staff are well prepared to meeting the complex needs of this service user. The extensive assessments include the local authority ‘Individual Care Instruction’, the BILD life experience checklist and a detailed activities of daily living document which was in the process of being reviewed and rewritten. An extensive rang of risk assessments have been undertaken. West Street DS0000047472.V352572.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): Standards 6, 7 - 9. Quality in this outcome area is good. Care needs are comprehensively identified in Care Plans and the necessary directions of actions required to ensure that service users care needs are fully met and health is promoted. Care Plans are regularly reviewed and revised as necessary. The service user is encouraged to participate in daily activity at the home. Risk assessments have been undertaken to maximise the service users lifestyle This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service users case file was viewed and seen to contain detailed person centred care plans that related to a number of areas of need, as originally identified within the pre-admission assessments and reviews since this time. These care plans were seen to contain very clear and specific information as to the strategies and objectives for meeting the assessed needs. Good plans were seen for protocols for as required medication, an extensive list of likes and dislikes of foods but needs to address food obsessive behaviour. Strategies for dealing with challenging behaviours were clearly seen to be West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 11 drawn form the advice of the appropriate medical professionals. An appointment is planned with a senior medical professional for this week. A range of risk assessments were available for such as accessing the community, the garden, car travel and community toilet availability. Risks are minimised by two to one staff allocations. Guidance is provided on reducing running on the stairs, banging windows and limiting areas where crockery may be used and controls are in place for toiletries. All plans are subject to monthly reviews. The service users father is responsible for all financial dealings. Petty cash expenditure is appropriately managed with records and receipts and included within the responsible persons audit. Confidentiality of records and other aspects of personal information are maintained securely and included in staff training. West Street DS0000047472.V352572.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): Standards 12 – 17 Quality in this outcome area is good Staff support the service user to access opportunities for personal development. The involvement of family is encouraged in agreement with the service users wishes. The home provides a varied leisure, social and recreational activities that provide interest and pleasure for the service user. Meals at the home are wholesome and meet the nutritional needs of the service user while providing for choice and personal taste. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service user has an individual activity plan and an assessment of the type of activity that gives pleasure this information derived from the service user, through participation in the activity and from the family. The plan is applied flexibly to accommodate wishes of the moment. On the day of the inspection the service user had joined in putting away personal laundry and dusting the bedroom. The morning was spent watching tv and a walk to the shop, the afternoon plan is for drawing and colouring followed by a drive out and evening meal out. This largely follows the plan, slightly adjusted to accommodate West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 13 maintenance work during the morning. On meeting the service user he acknowledged the inspector and appeared acceptant of a visitor to the home while largely showing no interest across the rest of the visit. The service user was neatly dressed and of clean and tidy appearance, was relaxed and showed enthusiasm at going out to the shops. The records show that generally the service user is content and would appear happy on a day by day basis, this was confirmed by the parent who said they would know if he was unhappy. The programme of person appropriate leisure activities include; trampoleening, cinema, walks and shopping, drives out and pub meals. Planned trips have included the safari park and Black Country Museum and last summer included a holiday to France with family. The plan of activity identifies most weekends stay with father or other visits with siblings. Meals are prepared by care staff and choices are shown daily, and records kept of meals taken as many lunches are taken away from the home. The main meal is served during the evening. Breakfast is provided at a time to suit the individual. The service user can develop obsessions with and about food and elsewhere in this report it is recommended that the strategies employed for managing these be documented in the care plan. West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18 – 20 Quality in this outcome area is good. The service user receives support in a way acceptable to their understanding. Healthcare needs are well documented and are compiled with the input of the individual service user. The care plans give clear directions to ensure that the service users’ healthcare needs are assessed, recognised and addressed. Arrangements for the administration of medication are good and ensure service users medication needs will be safely met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 15 The service user has their physical, emotional and mental health needs met and the care plans evidence general practitioner and other health care professionals input, including consultant reviews. The GP is local as is the Dentist who undertook a treatment yesterday. An appointment with the consultant is due tomorrow at which time the protocol for lorazepam medication use is to be reviewed. Pictorial charts are available for health care to assist the service users’ understanding. The involvement of other allied medical professionals is clearly documented including speech and language and behavioural therapists. Appropriate monitoring charts, relating to known health risks, are included in the case file and were seen to be up to date. Food/mealtime obsessions are well documented and managed, this needs to be drawn together under a clear care plan. Arrangements for the management of medications are satisfactory but staff accredited training remains to be completed. Some local training is undertaken and the topic is included in NVQ studies. A protocol was available for an as required medication and this is to be reviewed by the consultant, another as required medication, senna, requires a protocol to be prepared. West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23. Quality in this outcome area is good. The home complaints and protection policies are robust providing a safe environment in which the service user can feel secure. Staff demonstrate good knowledge and understanding of adult protection issues which contributes to an environment that is safe from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A clear and concise Complaints Procedure is displayed in the main hallway, which includes reference to the Commission for Social Care Inspection as the regulatory body, together with contact details. The procedure is available in picture format in the service users bedroom. Homes’ survey indicates that the parent would know if the service user was unhappy. Policies relating to the protection from abuse were observed to be in place and readily accessible, these included, ‘Whistle Blowing’, ‘Abuse Awareness’ and ‘Adult Protection’. Staff training files indicated that Staff had received training in respect of these Policies. In addition to the above training staff have annual training in the management of actual or potential aggression and positive approaches (MAPA). All challenging behaviour episodes are fully documented from such as raising voice or banging feet on stairs and show responsiveness to redirection. Physical interventions records are detailed and cover interventions when destructive behaviour has occurred. All records are analysed monthly. West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 17 West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30 Quality in this outcome area is good. The physical design and layout of the home is suitable for a physically able service user and presents as safe, well-maintained and comfortable environment. There may be scope for some changes, this dependent on the needs of the proposed service user and any assessments of risk and need undertaken. The home is clean, hygienic and free from odours. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the previous inspection the home has been adapted for single service user occupation. The home is pleasantly decorated and well maintained, good quality furniture although the bedroom is somewhat minimalist to suit the service user. Staff could encourage acceptance of pictures other wise the home is well presented. The garden is secure and appropriate to season. The laundry has domestic washer and drier there being no continence problems. Maintenance and certifications are up to date. West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 19 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): Standards 31 – 36 Quality in this outcome area is good. The home has a stable, well-motivated and trained staff group offering consistency of care and enthusiasm to maximise the quality of life for the service user. The service user is further protected by good recruitment and selection practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The rotas confirm that staff numbers across the 24hour period are appropriate to the needs of the service user, being two at all times the second overnight being sleeping. The numbers are increased during the day by inclusion of the manager who share time between two registrations close by each other. A sample of four staff files including recently employed staff, show these to be completed to a good standard with appropriate recruitment and preemployment checks being undertaken. The induction programme is to skills for care standard. Staff are issued with the General Social Care Councils code of conduct. West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 20 Training of staff is of a very good standard with all mandatory training up to date, other topics such as management of aggression (MAPA)is undertaken annually. The 50 NVQ requirement is exceeded and 2 further staff are enrolled and are waiting to be signed of having completed the course. Supervision and appraisals were seen to be up to date and on target to meet the six sessions for the year. Staff spoken with said they were well supported and the supervisions relevant and useful. West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 21 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): Standards 37, 39 & 42 Quality in this outcome area is good. Leadership of this home is good and staff demonstrate an awareness of their roles and responsibilities. The managers approach is open and positive and develops positive relationships with the service user and with staff. The home regularly reviews its performance which includes seeking the views of the service user and their family. Environment management and staff training in respect of health and safety ensures service users safety and welfare are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been registered at the home since the last inspection and has completed the Registered Managers Award. The manager is well regarded by the staff this was apparent from speaking with the staff as well as observing West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 22 the interactions over the day. Discussion with the manager confirms that training is a priority with emphasis currently given to equality and diversity. The home has a quality assurance system that includes a regular audit system by the manager and audits by the responsible individual who also undertakes the Regulation 26 monitoring visits. Relatives and other stakeholders’ views are sought. Documentation was seen of a full range of servicing, maintenance and regular monitoring of services and equipment is undertaken, staff receive training in health and safety and first aid. Records of hot water monitoring show some outlets not meeting the national minimum standard and outside other HSE guidance. Staff were unable to say if water was being delivered from the boiler at a safe temperature. Fire safety including tests, staff training and equipment maintenance were seen to be up to date. Records of all accidents are recorded, using data protection compliant documentation and reported as necessary. Induction and foundation training is provided to Skills for Care standards. Overall the premises were observed to be well managed to meet safety requirements. West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 23 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 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 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 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 3 3 X X X 3 X X 3 X West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 YA20 Regulation 13(2) Requirement The registered person must ensure that all staff required to administer medications receive accredited training. The registered person must ensure that all hot water outlets deliver a safe supply. The staff should familiarise themselves with the hot water system. Timescale for action 30/06/08 2. YA42 23(2)(j) 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA20 Good Practice Recommendations The manager should prepare a plan of care for addressing food/mealtimes obsessive behaviours. The manager should prepare care plan/protocol for each medication that is prescribed as ‘as required’. West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 25 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. Extracts may not be used or reproduced without the express permission of CSCI West Street DS0000047472.V352572.R01.S.doc Version 5.2 Page 26 - 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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