Inspection on 14/01/10 for 83 Beaconsfield Villas

This is the latest available inspection report for this service, carried out on 14th January 2010.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

83 Beaconsfield Villas 17/07/06

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Insight - Eastchurch

Southfields

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Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: 83 Beaconsfield Villas 83 Beaconsfield Villas Brighton East Sussex BN1 6HF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Niki Rayner     Date: 1 4 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: 83 Beaconsfield Villas 83 Beaconsfield Villas Brighton East Sussex BN1 6HF 01273295297 01273295782 fiona.baines@brighton-hove.gov.uk www.brighton-hove.gov.uk Brighton & Hove City Council Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Fiona Baines Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home The home was registered with the Commission in February 2006 to provide 24 hour residential care for up to 4 young adults with learning disabilities. The homes literature states that the service has been designed and modified to meet the needs of the current service users, all of whom have Autism, severe learning disabilities and challenging needs. The home was initially set up to provide accommodation for people leaving childrens services in Brighton and Hove. The Provider organisation is Brighton and Hove City Council. The building is a large detached four storey period building, Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 4 Brief description of the care home situated in a residential setting in Brighton. The building was converted from a day service to a residential setting in 2005 and now provides accommodation for one person in a self-contained flat and up to three others in the main house. All bedrooms are for single occupancy with appropriate communal areas. The home is domestic in scale and has a large garden that provides a safe and pleasant space for the people living there. The current fees range from approximately £3,000.00 to £3,700.00 per week. More detailed information about the services provided at 83 Beaconsfield Villas can be found in the homes Statement of Purpose and Service User Guide - copies of these documents can be obtained directly from the Provider. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This report reflects a key inspection based on the collation of information received since the last inspection, a review of the homes Annual Quality Assurance Assessment (AQAA) and an unannounced visit to the home, which took place over two days and lasted a total of ten and a half hours. The first day of inspection was unannounced on Thursday 14th January 2010 between 9.45am and 4.15pm. As the Registered Manager of the service was on leave on this day, a follow up visit was made on Tuesday 26th January 2010, which had been arranged in advance. This visit lasted a total of four hours between 10am and 2pm. Due to the complex needs of service users living at the home, it was not possible to spend any time with them or seek their views and feedback. However interactions between them and staff were observed. Care Homes for Adults (18-65 years) Page 6 of 34 The inspection process included a tour of the premises and the viewing of two service users care records. Other records and documentation seen included: the homes medication procedures, the provision of activities, quality assurance systems, systems for handling any complaints and safeguarding service users from harm. In addition, a number of records in respect of staffing were seen, including the homes recruitment and induction procedures, staffing levels and staff training. All communal areas and some individual rooms were seen. Throughout the inspection process the Inspector met and spoke with a number of care staff, the Service Improvement Manager and the Registered Manager of the home. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Funding was agreed in June 2009 for the basement of the home to be refurbished in order to support one of the service users in their own self-contained flat. However, the home has been slow to move this forward. This delay has meant that care staff are having to manage sometimes difficult care needs in order to keep people safe. Care records and risk assessments need to be reviewed and updated in line with person centred planning. This will help to ensure that all care needs are identified, reflect current practice and will help support staff in meeting the individual needs and choices of service users safely. Medication procedures and documentation need to be improved. The Manager needs to review the homes current induction and staff training needs. Improvements to the way in which the home is staffed must be prioritised. The home needs to improve its monitoring and reviewing systems to make sure that the home is being run in the best interests of service users and that any potential risks are identified and as far as possible reduced to keep people safe. Care Homes for Adults (18-65 years) Page 8 of 34 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The compatibility of service users living within the home will be improved once adjustments and refurbishment to the home have taken place. Evidence: The Manager confirmed that she is currently in the process of updating the homes Statement of Purpose and Service Specification Guide. A draft copy of this was seen during the inspection process, although it was not assessed in detail. It states that the service has been designed and modified to meet the needs of the current service users, all of whom have Autism, severe learning disabilities and challenging needs. Each of the service users have lived at the home since 2006. There have been no new admissions since this time. Through discussions with the Manager and care staff, observations made over the course of the inspection and the viewing of care records, it is evident that there are a number of compatibility issues between service users. The Manager explained that due to the abilities and challenging needs of the service users, the staff team are: Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: Managing the environment to make sure that those who do not get on with each other avoid each other. The basement of the home is due be refurbished during Spring 2010, which will accommodate one of the current service users in a self-contained flat. The Manager and care staff commented that this should help to resolve some of the current compatibility issues faced by service users. The Manager said that one other service user may also benefit from living in a smaller environment, which she intends to explore further with the person and their representatives at their next person centred meeting. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning records do not reflect the current needs of service users. Service users are being placed at risk of potential harm through the homes failure to identify and take the appropriate action to ensure their safety whilst out in the community. Evidence: All care records for two service users were looked at over the course of the inspection. Care staff explained that keyworkers are responsible for updating and maintaining these. These include: behaviour management guidelines, person centred plans, daily records, Health Action Plans, monthly summaries and risk assessments. The Manager confirmed that she is responsible for reviewing these with staff during supervision. Care staff confirmed that they have not received any training in the formulation of or reviewing of care records. A number of concerns were raised: The home currently uses a number of different recording methods and care files, Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: which therefore are not easy to read, follow and understand, whilst a number of care records and guidelines had been written using negative language and therefore not in line with person centred planning. For example, in one persons file the first thing that the reader learned about the person was in respect of their challenging needs and behaviours and how they can be difficult, therefore they focused primarily on the persons disability and not on individuals strengths. Similar concerns were raised throughout a number of care records seen. A number of guidelines and risk assessments had not been updated or reviewed to reflect individuals current personal care needs and choices. This was of particular concern following a high number of serious incidents that were reported to the Commission in 2009, which had serious implications for all people living at the home. Following the above mentioned incidents, the home put into practice a number of restrictive interventions in order to manage the situation as safely and effectively as possible. Whilst the correct procedures were followed and multidisciplinary support was sought, it was of concern to note that these practices and guidelines had not been reviewed since this time (June 2009) and through the viewing of records and discussions with staff it became questionable as to whether or not this practice was still necessary. Concerns were also raised in respect of how the home identifies and manages risks for certain individuals. Some risk assessments had not been reviewed or updated despite individuals changing needs and circumstances, whilst in other areas a risk assessment had not been undertaken. For example, the home purchased a new vehicle in August 2009, which does not have safety locks fitted for when the car is stationary, yet no risk assessment had been undertaken for this; the only risk assessment in place was dated September 2008 and was in respect of the previous car. These shortfalls had serious implications for one particular person, which placed both them and staff at risk. Guidelines were also found to be unclear and inconsistent with current practice in respect of supporting service users in the community. For example, the Inspector was told that one person is funded for 2-1 support when out in the community, when in practice it became evident that this is not always happening. This places both the person using the service and staff at risk. The Manager confirmed on the second day of the inspection that she and the Service Improvement Manager will be looking to review the current care planning procedures across all of their learning disability services in line with person centred planning. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: In light of the concerns detailed above, requirements have been made for the Manager to ensure that all care plans, behaviour management guidelines and risk assessments are up to date to reflect current needs. Care Homes for Adults (18-65 years) Page 15 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst service users benefit from the opportunities to access the local community and to participate in educational, social and meaningful activities, the service needs to ensure that this is managed safely in such a way as to promote and respect individual needs and choices. Evidence: Records, observations and discussions with staff showed that all service users are supported to access their local community, whilst some attend a variety of educational classes and activities. As well as daily educational classes in skills for life, service users also have access to their preferred activities such as swimming, trampolining, climbing, drives out and shopping, whilst one person is supported to attend church services. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: On both days of this inspection all four people were attending various different activities outside of the home at different times. Due to individuals challenging needs and as previously mentioned compatibility issues, none of the service users engage in activities together either inside or outside of the home. As already mentioned in the Individual Needs and Choices section of this report, not all activities particularly those outside of the home are managed safely. Another example of this was identified in respect of how the home supports individual lifestyle choices: One of the service users enjoys an activity that is discouraged by staff within the home in order to maintain the persons safety. Through discussions with the Manager and care staff it emerged that this particular activity was viewed by most as low risk due to the persons abilities and experience of this activity, yet their care records were heavily focused on discouraging this, albeit that the associated risks had not been assessed. Discussions with staff brought to light that some staff do support this activity in the community (although there were no guidelines in place for staff to follow in respect of this). All service users have regular contact with their families, who are actively involved in each persons care and welfare. Some spend time away from the home staying with their families overnight, whilst others have their family to visit. Albeit that service users verbal communication is limited, staff working in the home were observed to interpret individuals subtle level of communication and include them in the daily routines of the home wherever possible. Staff said that all weekly menus are arranged by care staff, based on their knowledge and understanding of individuals needs, likes and dislikes. Only one person at this time has a pictorial menu in place. Staff said that most food is prepared for service users by staff and explained that this is mostly due to individuals challenging needs. One member of staff spoken with commented that they would like to see individuals more involved in this process but at this time, due to the layout of the home and individual needs, this is not possible. Staff said that due to individuals needs and compatibility issues, it is not possible for any of them to eat together. Staff explained that they stagger mealtimes in order to manage this and keep any incidents or disruptions to a minimum. All service users however, do eat alongside staff. Care Homes for Adults (18-65 years) Page 17 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported with their personal care needs. Current medication practices potentially place service users at risk. Evidence: The Manager and care records confirmed that all service users are registered with a local GP and dentist and are supported to appointments as necessary, whilst specialist support from the local Community Learning Disability Team is requested on an individual basis. Records of all healthcare appointments are kept. The Manager said that each person has a Health Action Plan in place, although she said these have been slow to develop. This will be followed up at the next inspection. Albeit that concerns have been made in respect of the homes care planning procedures, staff were able to discuss individuals health and personal care needs and what they need to do to support service users. However, staff will be able to ensure a consistent appraoch to meeting personal care needs once all care plans and all guidelines have been reviewed and updated. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: Medication systems were assessed by way of a review of records, storage and discussions with staff. The medication policy was not inspected on this occasion. The home uses a pre-packed blister pack issued by the local pharmacy, which is easy to use and monitor. Only members of staff who have received training and been assessed as competent in the administration of medicines are able to carry out this task. Senior members of staff are responsible for the reordering and returning of medicines to the pharmacy. All staff confirmed that it is the homes policy to always have two members of staff checking, administering and signing for all prescribed dispensed medicines, yet the medication administration records (MARS) were not reflective of this. For example, there were a number of blank spaces on MARS where the second person should have signed. The Manager said that she is aware of this and that she is constantly reminding staff of their responsibilities for this. MARS showed that one persons medication had not been given one evening, despite advice from a doctor being sought. Staff spoken with were able to give a full explanation as to why this incident occurred, however this had not been recorded on the MARS or daily records and the areas for signatures and reason for nonadministration left blank. Some service users are prescribed PRN medication (for use as and when required) in order to help relieve their anxieties and/or challenging needs. One person is prescribed two such medicines depending on the level of their needs. The Manager explained that one is for heightened anxiety whilst the other is for dire emergencies, yet there were no clear guidelines in place for staff to follow to determine what differentiates between the two and what constitutes an emergency. It was also noted that on one occasion, PRN medication that had been given had not been recorded or signed for on the MARS. The home is required to ensure that safe procedures for the administration of medicines are adhered to at all times. Record keeping must be improved. Care Homes for Adults (18-65 years) Page 19 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager ensures that any concerns or complaints are dealt with promptly. Service users will be better safeguarded from potential harm, neglect and abuse once all staff have received the necessary training and risks to service users identified and minimised. Evidence: The homes Statement of Purpose states that the service is subject to the Brighton and Hove complaints procedure and that the Manager of the service will make copies of this available to service users, their family members or advocates on request. A service user friendly format is also available. The homes AQAA identifies that 3 complaints had been received by the home in the past year, all of which were resolved and responded to within 28 days, none of these were upheld. The details of these were not inspected on this occasion. New staff are only employed subject to the necessary recruitment checks being undertaken. It was identified however, that a number of care staff are in need of refresher Safeguarding Vulnerable Adults training; some have not received this in over two years. The AQAA identified that no safeguarding referrals have been made in the past 12 months. The Manager is required to ensure that all staff have up to date training in safeguarding matters. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: There are systems in place for checking service users personal monies kept at the home, which include monies being checked and signed for every day. In light of the concerns that have been raised in other sections of this report in respect of safety concerns for service users and how the home has failed to identify and adequately manage risks, the Commission considers the overall outcome area for this section to be adequate. Care Homes for Adults (18-65 years) Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further work and consideration is needed to upgrade the internal environment in order to provide a clean and homely property which fully meets the needs of all of the service users living there. Evidence: The home is an older style Victorian property laid out over four floors. All service users have their own bedrooms and own areas for their personal space. Certain areas have been specifically developed to meet certain peoples needs and staff have tried to individualise most bedrooms. Since the last inspection, the home has installed a trampoline pit in the rear garden, which some service users use. Most areas of the home were seen. Some areas of the home are in need of repainting and particular attention needs to be given to the kitchen area. The kitchen was noted to be dirty and a number of cupboard doors and drawer fronts replacing. Maintenance records showed that a request to the councils maintenance department was made in October 2009, however no action has yet been taken. The Manager said that it is anticipated that all kitchen units will be replaced, but no timescales have yet been set. At present, the Managers office and staff sleep-in room are in the basement of the Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: home. The basement was found to be very cold as radiators were not working and some radiator covers had been removed. In addition, a cupboard in the basement which had written on it Do not store any items in this cupboard due to fire regulations was found to have a number of items in it including a vacuum cleaner, kettle, cardboard boxes and plaster board. All items were removed by the Service Improvement Manager on the first day of inspection. As previously mentioned under the Choice of Home section of this report, the basement is due to be refurbished and made into a self-contained flat for one of the service users. The home notified the Commission of this in June 2009 following a difficult time for one of the service users, however this work has yet to be started. The Manager explained that there have been significant delays with this due to it very recently coming to light that the home will need to apply for planning permission as it is located in a conservation area. It raises the question as to why this matter has not been addressed before now. The Manager is required to have a robust refurbishment plan in place with clear action and timescales identified. This must include the proposed refurbishment of the basement. All areas of the home must be well-maintained and kept clean. Care Homes for Adults (18-65 years) Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are mostly supported by a dedicated team of staff who have been properly recruited and who are committed to working with them. Inadequate induction processes and lack of training for staff, fails to ensure that service users are well supported and their needs are met. Evidence: In addition to the Registered Manager, the home employs two senior care staff and 19 home care support workers. No domestic staff are employed. Staffing rotas confirmed that there are usually six staff on duty in the daytime and two waking night staff plus sleep-in person each night. Staff did comment that on rare occasions (usually due to staff sickness) the home can have only four staff on duty, which impacts on service users leisure activities. In addition to core staff, the home uses Brighton and Hoves Care Crew (temporary workers) to cover staff sickness and annual leave and in an emergency, agency staff are used. The Manager explained that they do try to use familiar care crew in order to maintain some consistency for service users, but due to the challenging needs of the service users this can be difficult. Despite 83 Beaconsfield Villas being a challenging place to work, it was pleasing to hear that all care staff (and care crew staff) were happy in their work and spoke Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: positively about the service users and their colleagues. The Manager and other staff spoken with said that a number of staff chose to leave at or around the same time in Autumn 2009, which has meant that care crew staff have been used more frequently whilst new staff are recruited and inducted. Recruitment records for new staff were seen on the second day of inspection, which confirmed that all the necessary checks are in place prior to any person starting work at the home. This is improved since the last inspection. Staff confirmed that Brighton and Hove Council run their own induction course for all new staff, which takes place over one week at premises owned by the Council. New staff are required to complete a standard induction pack, however none were available to view over the course of this inspection. When asked about the content of the induction, the Manager explained that it was more of an overview of the Councils learning disability services rather being specifically tailored to the individual needs of the service users living at the home. Some concerns were raised in respect of how the service inducts new staff: Given that 83 Beaconsfield Villas is a home specifically for people with autism and at times very challenging needs, it is crucial for both service users and staff that new staff do not work with certain individuals until they are suitably experienced, knowledgeable of individual needs and competent to provide care in line with individuals assessed needs. It was therefore of concern to note that some new staff (one person who had only begun working at the home the day before and was therefore supposed to be supernumerary) had been allocated to shadow another member of staff and support one of the service users in the community. This matter was of concern following another new member of staff who took a service user out alone which resulted in a serious incident occurring, despite this person being funded for 2-1 support. In addition, on the first day of the inspection only one member of staff and the Inspector were at the home with a service user who is funded for 2-1 staffing. This identifies that poor decisions are being made by the staff on duty when planning and leading shifts. The Manager said that shift leaders are usually identified on the rota as the person who is doing the sleep-in. Therefore shift leaders may not always be the most experienced and competent person on duty. A review of the training records identified that a number of mandatory training courses are overdue for a number of care staff. Similar concerns were raised at the last inspection in October 2007. The Manager is required to ensure that an audit of staff training is conducted to ensure that all staff undertake the necessary mandatory Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: and specialist training specific to their role. Care Homes for Adults (18-65 years) Page 26 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst service users are supported by staff who care for them, the homes failure to review and improve working practices, places both service users and staff at risk. Improved quality assurance and monitoring systems need to be developed to take the service forward. Evidence: Fiona Baines started working at 83 Beaconsfield Villas in February 2008. She was successful in her application to the Commission to become the Registered Manager of the service in July 2008. She has a vast range of working with people with learning disabilities over many years. She is qualified to NVQ Level 4 in Management and is currently working towards her Leadership and Management Award (LMA). She is supported in her role by two senior care workers, one of whom holds a Registered Managers Award (RMA). It was pleasing to note that all staff spoke positively about the way in which the home is managed a number commented that they find the Manager approachable and supportive. However, a number of concerns were raised during this inspection which Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: highlight that the home is not always being managed in the best interests of service users. Some examples of these include: The homes failure to identify and minimise a number of risks to service users, which led to an avoidable incident for one person. The homes care planning records, a number of which were out of date and failed to clearly identify how individuals health and personal care needs are to be met. Poor decisions being made in respect of staffing; including induction processes, numbers of staff on duty, staff working alone and training issues. Significant delays in the upkeep and general maintenance of the home (although it is recognised by the Commission that the Manager has reported these to the Council). Despite the home having a Performance and Management Development Team within the Council who undertake regular audits of the service, improved quality assurance and monitoring systems need to be in place to measure and ensure success in achieving the aims, objectives and Statement of Purpose of the home (as detailed within this report). Whilst specific health and safety records were not seen during this inspection, the homes AQAA stated that all necessary health and safety checks are regularly undertaken and all equipment is well-maintained. It was of concern however, to note that the health, safety and welfare of service users are not always being promoted and protected in respect of the areas of concern detailed throughout this report. Care Homes for Adults (18-65 years) Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 15(1)(2): That all service users have person centred care plans in place. These must be in a format that is easily accessible, reflect current health and personal care needs and be regularly reviewed. All guidelines must be clear and regularly reviewed. To ensure that all health and personal care needs are identified and met. 31/03/2010 2 7 12 12(1)(a)(b): That any restrictive practices within the home are regularly reviewed and monitored. To ensure the health and welfare of service users. 31/03/2010 3 9 13 13(4)(a)(b)(c): That risk assessments are up to date and cover all aspects of service users daily lives. 31/03/2010 Care Homes for Adults (18-65 years) Page 30 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that any unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. 4 20 13 13(2): That safe procedures for the administration of medicines are adhered to at all times. Clear records must be maintained. Clear guidelines must be in place for all medicines that that are prescribed on an as and when required basis (PRN). To ensure that service users health and welfare are maintained. 5 24 23 23(2)(a)(b): That a robust refurbishment plan is in place with clear action and timescales identified. This must include the proposed refurbishment of the basement. To ensure that the home is fit for purpose and to meet individuals needs. 31/03/2010 31/03/2010 Care Homes for Adults (18-65 years) Page 31 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 6 30 23 23(2)(d): That systems are in place to ensure that all parts of the home are kept clean and hygienic. To ensure the health and welfare of service users. 31/03/2010 7 32 18 18(c)(i): That all new staff 31/03/2010 receive a thorough induction to the home. They must have a clear understanding of service users individual needs prior to working directly with them. To ensure the health and welfare of service users and staff. 8 33 18 18(1)(a): That sufficient 31/03/2010 numbers of suitably experienced and competent staff are on duty to meet the assessed needs of service users. To ensure that service users and staff are safely supported at all times. 9 35 18 18(1)(a): That an audit of 31/03/2010 staff training is conducted to ensure that all staff undertake the necessary mandatory and specialist training specific to their role. Care Homes for Adults (18-65 years) Page 32 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that service users are supported by appropriately trained staff. 10 39 24 24(1)(2)(3): That improved quality assurance and monitoring systems are in place to secure improvements in the way the service is provided. To ensure that identified areas of improvements are acted upon to improve outcomes for service users. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 31/03/2010 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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