Inspection on 02/09/08 for Beech House

This is the latest available inspection report for this service, carried out on 2nd September 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Beech House 20/12/06

Beech House 20/02/06

Beech House 01/09/05

Beech House 01/03/05

Beech House 18/06/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 05/12/2008.

CARE HOME ADULTS 18-65 Beech House 21 Gravelly Hill North Erdington Birmingham West Midlands B23 6BT Lead Inspector Monica Heaselgrave Key Unannounced Inspection 2 September 2008 09:30 nd Beech House DS0000028592.V368174.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 Beech House DS0000028592.V368174.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. Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech House Address 21 Gravelly Hill North Erdington Birmingham West Midlands B23 6BT 0121 382 6163 0121 382 7290 beech_house@btconnect.com 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) Birmingham Focus on Blindness Manager post vacant Care Home 6 Category(ies) of Learning disability (6), Sensory impairment (6) registration, with number of places Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years Date of last inspection 22nd September 2007 Brief Description of the Service: Beech House is a large detached house situated in the Erdington area of Birmingham, and is within easy walking distance of the local shopping centre. Star city entertainment village with cinemas, shops, restaurants and bowling alleys is a five-minute drive away. The home offers accommodation to six people with sight loss and learning disabilities. Each person has his or her own personalised bedroom with en-suite bathroom. The Home is large and spacious enough to meet the needs of the people accommodated; it is well maintained and comfortably furnished. People have the specialist aids and equipment they need to support them. The home has a large car park to the front with attractive flower borders; the rear of the home can be accessed via a conservatory and is mostly laid to lawn with flower borders and attractive garden furniture. Information regarding the fee level for the Home can be obtained via contacting the Home directly. Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. Information was gathered from a range of places to inform the judgements made in this report. These included reports received from the home, a completed Annual Quality Assurance Assessment (AQAA) and previous inspection reports. The Inspector met with all of the people living at Beech House and spoke with the senior member of staff on duty and other members of the care team. Records including personal files, care plans, staff files and safety records were examined and a tour of the building completed. Two people who live at Beech House were identified for close examination this included reading their care plans, risk assessments daily records and other relevant information. This is part of a process known as “case tracking” where evidence is matched to outcomes for people who use the service. What the service does well: What has improved since the last inspection? The Manager and staff team have worked hard to achieve the things they were asked to do to make the service better. People’s strengths and needs are properly assessed before they move into Beech House, to make sure they get the care they need. Care plans and health care plans have greatly improved so that staff knows how to support people to keep them safe and healthy. The activities people enjoy have been explored further, and written into their care plan, to make sure they have opportunities to have a fulfilling lifestyle. Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 6 The daily reports have been improved to show how people make decisions, and what activities they choose, this means staff have the information they need to ensure the plans they make are suited to the person. Some rooms have been redecorated and new furniture purchased so that the house is made more homely and comfortable for the people who live there. Staff vacancies have been filled and the senior staff team have the experience, and skills to carry out their role effectively. This will help the service to develop better outcomes for the people living at the Home. All of the staff has had opportunities to do more training, to help them do their jobs even better. 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. Beech House DS0000028592.V368174.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 Beech House DS0000028592.V368174.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): 1 and 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People do have information about the Home they live in, but further work is needed to develop a more suitable format to meet the needs of blind and visually impaired people. This would make it is easier for people to access information and make decisions about whether or not this service could meet their needs. The support needs of people are assessed to make sure that they get the care that they require. The service has used assessment information well to ensure individuals have a home that will meet their needs and preferences. EVIDENCE: The manager told us that the Statement of Purpose and Service User Guide are being updated to provide information both in a pictorial easy read format and an audio format. These will be more suited to the needs of people in the home who are blind or visually impaired. Given that Beech House is a specialist service for people who are blind and who have a learning disability, it is disappointing that this work has not been completed as recommended at the last inspection in September 2007. Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 9 The manager told us in his Annual Quality Assurance Assessment, (AQAA), that the home would welcome any input from prospective clients, relatives and or friends when deciding upon the choice of home. Also the manager told us that people’s needs would be assessed to ensure that the home is able to meet these before they move into the home. This would result in people having the information they needed about the home, and that the home would be able to meet people’s needs before they moved in. We looked at the most recent referral information. It was pleasing to see that the assessment detailed individual needs. These were completed by a number of different professionals to include the manager, Day centre staff, physiotherapist and occupational therapist. This ensures that the individuals’ needs and aspirations can be planned for before they move into the Home, and met. This meets with the requirements made at the last inspection visit to the Home. Following on from this the manager has identified the aids and adaptations needed in the home to ensure the individuals needs can be met safely, this included hand rails on the stairs, a manual handling belt so that staff can guide the person, and a fixed toilet frame to support transferring. Staff will require training from the Physiotherapist or Occupational Therapist to support the person if the lift wasn’t working or in the case of a fire evacuation, the stairs had to be used, so that staff can do this safely. The assessment information was good and could be enhanced further by putting a profile of the individuals’ likes, interests, hobbies, or routines. It would be nice to see that the individual has contributed to this process ensuring the person is asked about his/her needs and it is recorded what he/she says. It was positive to see that the individual had the opportunity to spend time in the Home. Records seen indicate that efforts had been made to give information to the individual about what to expect from Beech House so that he has an informed choice. He was ‘walked through’ his bedroom to help him to gauge the size as he has no vision. This was a nice touch to help him appreciate what the environment and facilities offer. It is recommended that staff continue to make a record to demonstrate how they share information with new referrals in the absence of a brochure or audio information. The manager said that when the audio information is completed each person would have one in his or her bedroom. Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Significant progress in care planning has ensured that staff can support peoples’ individual needs and people get the support they want in ways that suit them. Risks are properly assessed, so that people has opportunities to experience different things, and make choices and decisions about their daily lives so that they learn and develop. EVIDENCE: The people who live at Beech House are blind or partially sighted; they have a range of complex needs to include a learning disability, Epilepsy, difficulties with mobility, behaviour that challenges and communication needs. Two people were identified for close examination. This included reading their care plans, risk assessments daily records and other relevant information. This is part of a process known as “case tracking” where evidence is matched to outcomes for the people who live in the Home. Changes within the organisation have meant the introduction of new paperwork for care planning and risk assessing. It is also clear that significant work has been done since the last inspection to improve the way that Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 11 information is recorded and presented. Care plans are detailed, include preferred daily routines for each person, and outline the things that are important for each individual giving staff detailed guidance about how they like to be supported. For instance there was an excellent profile of the character of the individual describing the personality as ‘bubbly, loud, and intelligent not to be overlooked’. A detailed account of how sight loss affects the individual, and how other related health concerns need to be managed, this included the risk of choking and life threatening epilepsy. A further section identified the aids and equipment needed to support the individual safely this included the use of the hoist for transferring the individual from wheelchair to bed or bath. Care plans are linked to individual risk assessments. For instance one showed what preventative steps had been taken to minimise the risk of choking, the numbers of staff needed to safely supervise the mealtime and a nice profile of nutritional needs and soft diet options to ensure the nutritional needs of the individual are met whilst managing the risk of choking and safe alternatives to eat. Risk assessments were in place for wearing protective helmets to avoid injury from falls, and manual handling risk assessments showed how people are to be supported safely, when being moved from one area to another. Significant progress has been made since the last inspection to improve the way that information regarding the aspirations people may have is recorded and monitored. It is important that people have opportunities to engage in activities they enjoy and choose or tasks such as self-help skills. Care plans now have measurable goals and this makes it easier to establish if the individual is having regular opportunities to engage in an activity, and for staff to measure any progress. The daily record format has also been improved and is linked to the care plan. It was really pleasing to see that a lot of work has been done in this area. The entries in the daily records are more detailed show what activity was offered and whether or not it was undertaken. The daily records also now reflect that people living at Beech House are actively making decisions. A month’s record were sampled for two individuals and showed that there had been a significant increase in the amount of activity the persons were engaging in, and where they had made decisions for themselves, such as declining an activity, or engaging in tasks around the house. It was overwhelming to see the amount of activity that now takes place at the Home on a daily basis. Some individuals took great pleasure in showing us (and other information was taken from the daily records) how they turn their own lights on, tidy their rooms, take their washing to the laundry room, set the table, help to construct fans, and so on. At the previous inspection none of this positive information was recorded, now it is easy to see that people are supported to undertake a lot of daily tasks, which they themselves are proud to announce. Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 12 The service has considered how the care plan is presented, the format, which is easy-read and pictorial, is more suited to the needs of partially sighted people who also have a learning disability. The care plans have been produced with the involvement of the individual and their family, this is important so that people who cannot see the plan do have another means of regularly going through the plan to ensure it meets with their agreement. Overall there has been a marked improvement in care planning which has addressed the shortfalls that were evident at the last inspection. This means people now have a person centred plan that is tailored to their individual needs and desires. Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There has been considerable improvement in supporting people to do a range of activities both in the community and at home, so that they are able to do things that they value. Staff helps the people living at Beech House to keep in touch with the people who are important to them. People have access to a varied and balanced diet so that they can enjoy their food and be supported to eat healthily. EVIDENCE: Five people currently live at Beech House all of whom attend a day service Monday to Friday. This is provided for people who are blind or partially sighted by the providers (Birmingham Focus on Blindness) and is a day care facility for up to 85 people. From the information available it is evident that continued improvements have been made since the last visit to the Home. There are lots of new community and indoor activities taking place. The daily Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 14 records format has changed now showing the choices individuals make, e.g. shopping, radio, disco; walk in garden, connect 4, listening to music, disco, clubs, meals out and take-away meals in. It was particularly pleasing to see that staff have improved the way in which they record daily events, now they are recording and monitoring the things that people can do for themselves such as, put away clothes, mop the floor, made cups of tea and coffee, helped in back garden, taken plate to kitchen, lay table for dinner, toilet cleaning, made bed, opened his curtains, took dishes to kitchen, and constructed a standing fan. In summary the records show that staff is recording each opportunity and whether or not it is taken up, this gives them some insight into what people are enjoying. The records show there has been a good improvement in recording information and there is now much more activity taking place as recommended at the previous inspection visit. There is a system for monitoring the frequency of activities to ensure these fit with the gaol plans. Activity planners ensure that people are consulted on the things they wish to do and these are monitored to ensure they do take part in the planned activity or a reason is given as to why not. The records gave good detail about how the decision was made and also how the person responds to the activity; recording this information helps with future planning for the person, and it was pleasing to see that the staff have taken this on board as recommended at the last visit. There has been a big improvement in checking that the daily routines and choices are in deed led by the people who live at Beech House, this promotes individual independence and the right to live in a flexible environment. It was positive to see therefore that the AQAA provided future plans for the Home to purchase a vehicle which will enable them to be more spontaneous in their ventures. Some of the people living at Beech House told us that they are supported to keep in touch with their families and loved ones. This includes receiving visits at home or going to see relatives at their own houses, and keeping in touch by telephone. People had photographs of family members in their rooms. Individuals’ specific eating habits and preferences set particular challenges in making sure that they get a healthy and balanced diet, but records provide evidence that this is generally well achieved. Observation of the evening meal showed that people have a choice of what they wish to eat as well as the quantity and where they prefer to eat their meal. Individuals made the following comments, “I love the food at Beech House, some of the staff are very good cooks.” “I like lots of different things and staff always asks me what I want.” Discussion with staff showed that they are also proactive in promoting healthy eating and nutrition and to this end have sought information regarding the Nutritional Tool which is an assessment of how nutritious a persons’ diet is and what additions can be added to promote a healthy eating plan. Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 15 Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are well cared for, and supported in ways they like and which help them to stay well and healthy. Proper arrangements are in place to make sure that they get their medicines at the right time and in the correct amounts. People are supported to access health care professionals, and the introduction of health care plans ensures health needs are monitored and appropriate action taken to ensure peoples’ safety. EVIDENCE: Dependency levels of the people who live at Beech House are high. All of the people have a learning disability; all have no sight, with the exception of one who has restricted tunnel vision. Some people have no speech, restricted mobility, and are incontinent. Some of the people have diagnosed epilepsy. One has potentially life-threatening seizures. Three people wear head protectors protecting against falls and self-harm. One person has challenging behaviour and there has been incidents resulting in self-inflicted head injuries. Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 17 At the Random inspection in February 2008 requirements made in relation to risk assessments to keep people safe had been met. Risk assessments for supporting people at mealtimes had also been put in place. At this inspection further improvements were noted to include the numbers of staff needed to supervise people during meals to avoid the risk of choking. Where people have specific needs in relation to their behaviour, strategies are now included in the care plan to show how staff can support them safely and minimise the risk of harm to themselves and others, meeting a previous requirement. The physical intervention plan seen states the goals, details of behaviour, known triggers, and identifies strategies such as structured activity plan, walks, coffee shops, reward a biscuit and drink whilst out, and to promote at least fifteen minutes contact time in every hour with staff. A record is kept to show this is happening. It is positive to see that there are actions to be taken to divert behaviour. The plan names those involved with devising the technique as the manager, parents, key worker and social worker. The risk assessments attached to the strategy are waiting on final approval from the board. Training has been arranged for the management of Epilepsy and training has been completed in MAPPA, (Safe restraint techniques). First Aid and Manual Handling training has been completed so that staff has the skills necessary to support them in the competent use of hoisting equipment and respond to accidents. It is pleasing to see that a lot of effort has been made to ensure all the requirements made by the Commission in relation to health care and safety, have been met. The manager said that they are waiting for training dates for the management of incontinence. Another development since the last inspection has been the introduction of Health Action Plans, (HAP). These are a personal plan about what a person needs to stay healthy and what healthcare services they need to access. The plan sampled identified critical information about breathing problems signs to look for, and the action staff should take so that every one knows what to do when and if a health concern arose. There were some pieces of information that could be improved on for instance, dates of last visit to health care professionals, an action plan to show what follow up is needed, and more measurable detail such as ‘how I keep fit” could be elaborated such as ‘walking, swimming, dancing- this will come as staff work through the process, but essentially the HAP does give the detail needed to guide staff in promoting good health care for the people at Beech House. People attend regular checkups with the GP, dentist, optician, practice nurse and so on. Staff has clearly worked hard in this area. Some difficulties were discussed with the manager with regards to weight monitoring. The people at Beech House are usually weighed at their Day Centre as they have the appropriate weighing equipment, but Beech House do Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 18 not have a record of these weights to help with weight monitoring. It was advised that staff should approach the G.P. surgery for access to weighing equipment. One person was identified as causing some concern with his nutritional intake. He refuses to eat breakfast and goes for long periods with out food. The manager was given the contact number for the clinic who can offer a nutritional assessment to identify risks and action needed. The manager said he would follow this up. Records showed that staff currently supports this individual by encouraging him to eat, offering smaller portions, ensuring a plentiful supply of foods he likes and taking opportunities to offer small snacks, it was positive to see that they encourage outings for meals with a reward. The general appearance of people indicated they receive a good standard of personal care. Conversations with the Manager and with staff on duty showed that they have a good understanding of individuals’ support needs, and this is very good as the majority of staff is relatively new to the Home and yet they have built up a good knowledge of individuals’ routines and preferences. Observations of interactions between staff and the people who live at Beech House showed that they are comfortable in each other’s company: support was given with warmth and friendliness and in an appropriately respectful manner. At the previous inspection not all staff who handled medication had been trained to do so. The practice observed at this inspection showed that has now been addressed, and the requirement made has been met. Medication is secured in a locked medical cupboard in the office. None of the people have been assessed as being able to take their own medication. The medication administration charts were well maintained, and the staff member dispensing medication on the day of the visit had completed accredited training. Staff’s training records were looked at and showed they had attended training in this area. This ensures staff competence in medicine management. Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 19 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 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has developed ways in which people can express their views and concerns in a safe and understanding environment. An audio complaints procedure would enhance access for people with communication support needs. The support people receive ensures that they are protected from harm. EVIDENCE: The people living at Beech House have complex support needs each individual has a learning disability, and sight impairment. Some people have communication support needs which mean all of the people living in this house would require a great deal of support or advocacy to ensure their rights are protected. Written documents would have little relevance for them individually. The AQAA tells us that the organisation has reviewed the procedure to ensure that it remains effective and achieves the expected outcomes. The method of communicating this procedure to people with communicational difficulties will be reviewed and suitable other methods implemented. The manager said that it is intended that an audio tape of ‘how to make a complaint’ and an easyread pictorial complaints procedure is being produced. In the absence of these it is positive to see that parents meetings and resident meetings are being used to reinforce the complaints procedure and highlight the process for raising any concerns on behalf of people living in the Home. Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 20 This is positive practice in seeking to develop ways in which people in the home can be supported to or have someone on their behalf, raise the things that concern them. The AQAA stated that there had been no complaints made to the Home in the last year. Minutes of a parents meeting indicated that a concern had been raised about the care of clothing this was resolved satisfactorily however, there was no written record to demonstrate this. The home should keep a full record of complaints and this includes details of the investigation and any actions taken. This will demonstrate their ability to improve service delivery in this area and inform their future practice. Discussion with staff demonstrated that they are familiar with people’s ways and able to pick up on changes in behaviour, demeanour, and body language as indicators that something may be amiss or that people are unhappy. They understand the importance of individual routines and rituals in helping them feel comfortable and secure. It was particularly positive that staff is supporting people to remain in weekly telephone contact with their family members. During the course of the inspection one person was supported to make a phone call and left to talk privately in his bedroom. This is another safeguard in which the people living at beech House can share their concerns if they have any with people who can act on their behalf. At the previous inspection there was a depleted senior staff team due to vacancies. At that time ‘acting seniors’ did not have the experience or training to effectively understand their role in protecting people. Beech House has successfully recruited to the vacant posts and these staff has the necessary training and experience to understand their role in protection matters. The training matrix and AQAA information shows that all staff has access to training in adult protection procedures so that they know when incidents need external input and who to refer the incident to. The training matrix and AQAA do not indicate if staff has undertaken training in the Mental Capacity Act. The Mental Capacity Act came into force in April 2007. This legislation requires an assessment of people’s capacity to be done if there is any doubt that the person does not have the capacity to make a decision about their health and welfare. If they are assessed as not having the capacity an Independent Mental Capacity Advocate (IMCA) can be appointed to help them with this. All staff should know about this legislation so they are aware of the implications of this for the people living there. This would be another step forward in ensuring staff are well equipped to support vulnerable people in this area. Care files showed that where some people display behaviour that can be challenging. Guidelines are in place to manage these behaviours and avoid Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 21 harm to the person displaying the behaviour and to the other people living there. The training matrix showed that staff had undertaken MAPPA training. This provides them with techniques of physical intervention to manage individuals’ behaviour. Further ‘refresher’ training in this area was also booked. Observation of the daily financial handover indicated that regular audits are undertaken by two staff to ensure the finances of people are kept safe. Beech House DS0000028592.V368174.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): 24,25,27,28 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Beech House provides a spacious, pleasant, safe place to live. There is a range of specialist aids and equipment to meet the needs of the people who use the service. Improvements to decoration and replacement of furniture have continued, ensuring the people who live at the Home have furnishings appropriate to their needs. EVIDENCE: The house is clean, safe and comfortable and all of the people who live there are familiar with the layout and able to access the areas they wish. There is a passenger lift to access the first floor which is utilised by those people who have mobility needs and cannot negotiate the stairs. There are six large bedrooms, two of which are on the ground floor which provides better access for those who have difficulty with the stairs. Bedrooms Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 23 are spacious well- equipped rooms with en-suite facilities, which provide a lot of privacy for the individuals personal care needs. Most bedrooms were seen to be personalised reflecting individuality. Of the six bedrooms seen, two require redecoration. The manager said these are planned to be done when the individuals are on holiday. The vacant bedroom may need a colour change if necessary so that it is in line with the preferences of any new person moving in. Some people require a range of equipment to support them; bedrooms accommodate the use of hoists and wheelchairs. Corridor areas are spacious giving access to the communal areas on the ground floor. This is important for people who require a wheelchair, and for people with visual impairments to move around safely free from obstacles. The AQAA tells us that some areas of the home have been improved meeting the recommendations of the last inspection visit. The improvements have had a great impact on the service as a whole, providing a fresher, more modern home. Previously seating in the dining area was not appropriate to some peoples needs. The chairs were not robust and were seen to be unstable when people were rocking. The AQAA tells us that new dining room furniture has now been ordered and this will be delivered shortly, meeting a previous requirement. Assisted bathing facilities are available this includes an electrically operated bath, which enables staff to support people who have high dependency needs. The laundry area needs redecorating, this is used by the people who live at Beech House but is not ideal in terms of them accessing it and having enough room to mobilise. The kitchen has been redecorated, it too is small and people cannot easily access this safely or independently. It was positive to see that the cleaning routines have now been resolved so that staff members do not do cleaning tasks during the time they care for the people who live there. There is an enclosed garden to the rear with seating. A conservatory provides an additional area for those who like to enjoy floor space. The AQAA tells us that there are plans to redecorate the hallway and landing and consider some renovations. Access to the house has been improved via improvements to the ramp and banisters making it safer for people to mobilise. New lights and a carpet in one bedroom have been added since the last visit. The roof is being improved and there are plans to purchase garden furniture. It is positive to see the continued improvements made to the environment and that the service is aware of the aids and equipment they may need to plan for as and when, the vacancy is filled. Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is staffed appropriately ensuring people have the support they need to undertake activities. Staff has the skills to ensure the needs of the people in the home are understood and met in a caring and skilled manner; further specialist training would enhance this further. The maintenance of recruitment records and arrangements for the support of staff has improved ensuring that the main focus is providing a quality service. EVIDENCE: The interaction between the people who live at Beech House and the staff clearly showed that there are friendly and respectful relationships. This is positive considering that a lot of the staff has only worked in the Home for less than a year. There was four staff on duty caring for the five people it was a relaxed atmosphere, with staff supporting people well with their personal care. Staff rotas were sampled and showed that there is usually four staff to support people with their care and activities. Discussion with the manager indicated Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 25 that staff levels are mainly maintained, although the last few weeks have been difficult due to maternity leave and sickness, shortfalls have been addressed by using overtime and one bank staff with no disruptions to the people who live at Beech House. This ensures that staffing ratios provide for peoples’ support needs. Staff responded well to the needs and requests of the people who live in the home. For example, one person wanted to be left alone to listen to his music, and later wanted to eat his tea separately from the other people in the dining room. Another person wanted to phone his Nan and was supported to do this. There was a good level of communication between staff and the people living there, people gravitated to staff clearly feeling comfortable in their presence. The AQAA shows 95 of staff has NVQ level 2 with some staff having or working towards NVQ level 3 and level 4. This exceeds the expectation and ensures the staff team is equipped to undertake their role in a skilled manner. The AQAA shows that All staff receive the following training as a minimum: First Aid, Safe Handling of Medication, Adult Protection, Sight loss awareness, Fire Awareness, Health & Safety, COSHH, Epilepsy Awareness, MAPPA, (Management of Actual or Potential Aggression) and NVQ and LDQ to the relevant level for their role. This ensures staff has the necessary specialist training and skills to care for people with complex needs. A staff-training matrix was available, meeting the requirements of the previous inspection. This verified that all staff has access to both mandatory and some specialist training. The training matrix indicates that the requirements made for training have been addressed except for Epilepsy and incontinence. The external training manager confirmed that requisitions had been put in to request this training. Refresher dates for 1st aid, Manual Handling, and MAPPA training were also booked. Structured staff training ensures staff has the skills and knowledge to meet the changing needs of the people living at Beech House. Sampling of staff meeting records showed that staff meetings are held regularly, four has taken place this year showing a big improvement in regularity, to remain on target the manager must ensure that a minimum of six meetings a year takes place. Minutes of these meetings show that the care of people at Beech House is regularly discussed and updated. There is lots of examples of individuals in the Home contributing to this for example one person shared with staff about his shower not working, another about a birthday party that went well, medical updates were also evident, as were tasks for staff being reviewed. There is a nice flavour to the minutes that demonstrate staff is keen to review and improve their practice for better outcomes for the people living at Beech House. Sampling of staff files provided evidence that the recruitment and selection procedures are appropriately robust. Required documents including completed Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 26 applications, written references and Criminal Records Bureau (CRB) checks were all in place, demonstrating that the service has carried out appropriate checks to ensure people employed by them are suitable to work with vulnerable adults. Three staff files sampled showed that staff had regular supervision sessions, to ensure their practice is monitored and improved. This meets a recommendation from the previous inspection. The AQAA advises that all staff has an annual appraisal, these were not looked at during this visit. Beech House DS0000028592.V368174.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 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home has improved following a successful recruitment of senior staff. There is a much better delegation of management tasks and there are positive signs that the service will continue to improve further, for the benefit of the people using it. There is a platform for peoples’ views to be heard and shape the way the service is delivered to them. Important checks are carried out around the home to ensure the safety of the people living and working there. EVIDENCE: The acting manager was on duty on the day of the visit to Beech House. He has a number of year’s experience of working with people who have a learning disability. He has experience of working with people who suffer the effects of Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 28 sensory loss, degenerative disease, autism, mental ill health and other complex needs. The acting manager has completed NVQ level 4 and the Registered Managers Award, RMA. He has the required management skills and knowledge to ensure the Home is run effectively. The manager has not yet been registered with the Commission an application for the registered manager post will need to be submitted. The findings of this inspection show that the manager has used the staffing resources available to ensure that the needs of the people living there are met. He and his team have worked to continuously improve the service. They have provided an increased quality of life for the people with a focus on equality and diversity, they have worked hard towards developing person centred planning so that the people who live at beech House can shape the service they get. At the previous inspection there were three senior posts and a deputy post vacant, this meant that existing staff at the home were ‘acting up’ in covering the three senior posts. They did not have the relevant experience to carry out this role effectively which led to some shortfalls. Many improvements have been noted now that the service has recruited to the vacant posts. This has meant that the manager can effectively delegate management tasks and the outcomes for the people living at Beech house have improved. As an example a completed AQAA (annual quality assurance assessment), which tells CSCI about how well the Home is performing and achieving outcomes for the people who live in the Home, was received by the Commission before we asked for it. It was completed to a good standard with examples of how the service has been improved and an overview of plans for future changes. Information from the AQAA tells us that the service has consulted with people who live in the Home, relatives and staff to obtain their views on what is important to them and what improvements they wish to see. Records in the Home demonstrated that ‘Friends meetings’ had taken place on a regular basis, with lots of positive plans shared with parents, such as the Health Action Plans, holidays, activities, and access to advocates. The minutes showed compliments from parents on personal progress made in the care of their son or daughter. Parents feel communication has vastly improved and this has been enhanced via the introduction of a weekly phone call from their son or daughter to update them on the things they have been doing during the week. It is positive to see that the things that are important to people are being taken on board ensuring better outcomes for the people who live at Beech House. There is a strong ethos of being open and transparent in all areas of running of the home. There has been a lot of hard work also in ensuring the requirements and recommendations of the Commission are carried out to improve outcomes and further more, this is being actively shared with the people who live at Beech House and their parents. Parents felt new staff fitted in well there is a much Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 29 improved atmosphere and one which is more welcoming. It was noted that the range and frequency of activities had improved and people have a more personal structure to their leisure. There are clearly positive and active communications between staff and parents who work well in moving the service forward. Records of residents meetings were dated 2007-no minutes were seen for 2008. Previous minutes indicated people who live at Beech House made choices about things they want to do, for example, to go shopping, buy flowers, or have a take- away meal. The manager said a meeting did take place the week previous and would forward a copy of the minutes. This was received by the Commission. An audio tape of the news letter was available and indicated that people have access to information in a format suited to their communication needs. The service is aware of the need for a quality assurance system, they are proposing to tape residents meetings, and already have a news-letter. There are plans to develop a news-letter from the people who live at Beech House. The provider has carried out monitoring visits to the Home. These visits are designed to ensure discussions take place with people living in the home and a tour of the premises is made to form an opinion about how the Home is being run. It was disappointing to see that these had not been regularly undertaken on a monthly basis. There needs to be evidence of consistent organisational monitoring by the owners. The manager said that there is a new head of care and that discussions have already taken place to ensure these visits are carried out on a regular basis. At the previous inspection it was recommended that the improvements to the format of this report be considered to ensure it provides for comments received from the people who live at the Home. It should include a detailed description of the findings so that the owner has a good oversight of the areas for development so they can influence change. There are no significant weaknesses in areas relating to health and safety, the management of health and safety has improved, and has been sustained as evident at both this inspection and the previous unannounced Random inspection in February 2008. The gas safety certificate confirmed that this is serviced and is safe to use. A fire drill takes place regularly and at least every six months to ensure that all staff working in the Home knows how to safely support people in the event of the alarm being activated. The weekly fire alarm test recordings were regularly done on a weekly basis, to show safety checks are being complied with. Records were available that demonstrated water temperatures are tested to avoiding the risk of scalding, regular tests of equipment such as the emergency call system, mattress assessment for pressure relief checked, and service of the shaft lift. The electrical test installation certificate was not available however confirmation that this work was completed was seen via the invoice for the Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 30 works carried out. The manager agreed to send to the Commission a duplicate of the certificate. The management of accident and incidents was found to be good concerns are logged on the required forms and notified to the Commission. Follow-up action had been recorded. The management of medication continues to improve, records show that the majority of staff had received training so that they can handle and dispense medication safely. Staff has also had first aid training to ensure they know how to support the people who live at Beech House who are vulnerable to falls and injury. The key standards in this area are generally met but there are some areas of improvement that should be made, in particular the registration of the manager, and the consistency of owner visits to monitor the practice and ensure continued good outcomes for the people living at Beech House. Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 31 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 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 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 2 X 2 X X 3 X Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 32 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard YA1 YA17 YA22 YA22 YA24 YA35 YA37 Good Practice Recommendations The Brochure should be made available in audio to aid those people who are blind and cannot access the written version. To further promote healthy eating and nutrition the manager should seek information regarding the Nutritional Assessment Tool. A complaints record should be maintained to reflect how the home manages complaints. The complaints procedure should be available in audio to aid people who cannot access the written version due to their visual disability. Some areas of the home would benefit from redecoration to improve the living areas for the people who live at Beech House. Staff should complete the arranged training in the management Incontinence and Epilepsy to ensure they have the necessary skills to meet specific needs. To ensure the Home is run effectively, an application DS0000028592.V368174.R01.S.doc Version 5.2 Page 33 Beech House 8. YA39 should be submitted to the Commission to register the manager. Monthly visits should be carried out by the Provider and a report should be available in the home so that staff knows what they need to do to improve the service. Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beech House DS0000028592.V368174.R01.S.doc Version 5.2 Page 35 - 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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