Inspection on 27/05/08 for 1 Beech Close

This inspection was carried out on 27th May 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1 Beech Close 13/11/08

Similar services:

Kings Lane (32)

Pemdale

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 1 Beech Close 1 Beech Close Dunstable Bedfordshire LU6 3SD Lead Inspector Nicky Hone Unannounced Inspection 27th May 2008 10:20 1 Beech Close DS0000071733.V365378.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 1 Beech Close DS0000071733.V365378.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. 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1 Beech Close Address 1 Beech Close Dunstable Bedfordshire LU6 3SD 01582 708999 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) TACT UK Ltd Mrs Yvonne Matore Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning Disability - Code LD The maximum number of service users who can be accommodated is: 6 This is the first inspection of 1 Beech Close since it transferred to TACT UK Ltd. The last key inspection was on 06/08/07. 2. Date of last inspection Brief Description of the Service: 1 Beech Close is a home for up to six adults with learning disabilities. On 01/03/08 TACT UK Ltd took over as provider of the service from the Bedfordshire and Luton Mental Health and Social Care Partnership Trust (BLPT). The bungalow is owned by the MacIntyre Housing Association (MHA), which is responsible for the maintenance and upkeep of the building. The bungalow is situated approximately one mile from Dunstable Town Centre. It shares a site with three other registered care homes and a resource centre. The bungalow has six single bedrooms, two lounges, a dining room, kitchen, laundry and bathing facilities. There is a fair-sized, enclosed garden to the rear of the property, with adequate parking to the front and side of the building. The home provides its own transport. Full information regarding the fees, including any additional charges, was not known at the time of writing. From the documents we looked at, it would seem that the people who live here know what rent they pay to the Housing Association, but do not know the full cost of their care. 1 Beech Close DS0000071733.V365378.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 0 star. This means the people who use this service experience poor quality outcomes. TACT UK Ltd. took over as provider of the service at 1 Beech Close from the Bedfordshire and Luton Partnership Trust (BLPT) on 1st March 2008. The building is owned and maintained by MacIntyre Housing Association. At the time of this inspection there were six people living at 1 Beech Close. Following our inspection in August 2007, we (the Commission for Social Care Inspection) rated1 Beech Close as a ‘poor’ (0 star) service. For this inspection we looked at all the information that we have received, or asked for, since the last key inspection of 1 Beech Close. This included: • The AQAA (Annual Quality Assurance Assessment) that the manager completed and sent to us in May 2008. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living at the home. It gives the manager the opportunity to say what the home is doing to meet the standards and regulations, and how the home can improve to make life even better for the people who live there. The AQAA also gives us some numerical information about the service; What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement; Any safeguarding issues that have arisen; and Information we asked the home to send us following our visit, including a response to our ‘serious concern’ letter, which we received on 12/06/08. • • • We sent surveys to the home but the manager said she did not receive them, so we did not have any completed surveys to look at. This inspection of 1 Beech Close included an unannounced visit to the home on 27/05/08. We met five of the people who live at the home, and observed the way staff were supporting them. Most of the people who live here do not use words to communicate, so they were unable to tell us about their home. We spent time with the manager, and spoke with some of the staff. TACT’s operations manager had arrived at the same time as we did to do her own 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 6 review of the service, so she was present when we told the manager about what we had found during the inspection. We also looked at some of the paperwork the home has to keep. This included care plans, risk assessments, medication charts, and records such as staff personnel files, staff rotas, menus and fire alarm test records. What the service does well: What has improved since the last inspection? What they could do better: The number of requirements made following this inspection (17), and the number of requirements from the last inspection that have not been met (12), means that the management of this home is not effective. The evidence from the inspection (detailed throughout this report) shows that the outcomes for the people who live at 1 Beech Close are not good enough. Things this home must do to make life better for the people who live here include: • • • • Making sure all incidents are reported to the safeguarding team Making sure the needs of the people who live here can be met Meeting people’s healthcare needs so that they keep well Giving people more opportunities for personal development, education and leisure activities DS0000071733.V365378.R01.S.doc Version 5.2 Page 7 1 Beech Close • • • • • • • Provide training for the staff in all topics relating to health and safety and in topics related to the specific needs of the people who live here Produce care/support plans which give staff clear guidance on how to support each person Assess all the risks that affect each person and plan to minimise and manage the risks Offer staff regular supervision Keep a record of the benefits each person is entitled to, and how much they pay for their care and rent Keep the home well maintained, clean and pleasantly decorated so that people have a comfortable place to live in Put a quality assurance system in place so that people know their views will be taken into account 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. 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 People who use this service experience poor quality outcomes in this area. 1 Beech Close does not meet the needs of any of the people who live here. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has produced a Statement of Purpose and Service User Guide to give people information about the home. The Service User Guide included some pictures and symbols, but still contained unnecessary information (as it did when we last inspected) and could be much more user-friendly. We looked at all the paperwork the home keeps for two of the people who live here. We found detailed assessments of each person’s needs. The assessments had been done in June 2007 by care managers (social workers) from Beds County Council, and in January 2008 by TACT and the home manager. In our last report we wrote, “One of the people who live here has recently been re-assessed by his social worker. The assessment indicates that his needs are not being appropriately met at 1 Beech Close. The evidence we gained during 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 10 the inspection (see other sections of this report) also indicates that this person’s needs are detrimental to the lives of the other people who live here.” We made a requirement that the home must be able to meet the needs of all the people who live there. In early March 2008 we attended a strategy meeting, held under Adult Safeguarding procedures, about this person. At this meeting we informed TACT’s representative that we were concerned this person was still living at the home as his needs were clearly still not being met. At the time of this inspection the situation had not changed. The person was still living at the home, and his behaviour was still having a serious and detrimental impact on the lives of the other people who live here. The assessment from June 2007 said “[name] would benefit from having his own home……..which wouldn’t impact on other residents”, and the assessment from January 2008 clearly stated this service is not right for him. Staff we spoke with, including the manager, said they felt this person would “come on leaps and bounds” in his own flat. Following the inspection we wrote a ‘serious concern’ letter to TACT in which we said “We are extremely concerned that the needs of one of the people who lives at 1 Beech Close are not being met, and that his behaviour seriously impinges on the lives of the other people who live here. We expressed our concerns about this issue following our visit in August 2007 (see our report). We also discussed this with Eddie Morgan at the beginning of March 2008 when Mr Morgan told us that it was clear [this person’s] needs could not be met and that the issue would be dealt with as a priority. Yet at the end of May we find he is still living here, and there are no firm plans for him to move elsewhere. Every person we spoke to told us that the person’s needs are not being met, and how he adversely affects the lives of the other people. We observed this several times during our visit.” We have made a further requirement: if the timescale is not met, CSCI will take legal advice and will consider taking further enforcement action. In the AQAA the manager stated that “each person has a contract to live in the house, which is drawn up by their landlord and a Support Service Agreement”. We did not see these on the files we looked at. We did not see any thing that would give people clear information about the total amount they have to pay for the care they receive, and how this is covered by benefits (this was a requirement in August 2007). 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 People who use this service experience adequate quality outcomes in this area. Care plans and risk assessments do not contain enough information for staff to fully meet the needs of the people who live at 1 Beech Close. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Each person had a great deal of paperwork about the support they need. We found that some of it was out of date, and some gave conflicting information. Each person had a Personal Service User Care Plan which gave staff some information about the support needed by the person. Each person also had a ‘Communication Passport’ which gave staff guidelines on ways the person prefers to communicate. 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 12 We found a “summary of instructions to staff to manage [name’s] behaviour” in the shift planning file for both the people whose records we looked at. One of these summaries had been written in October 2007 by the manager and deputy manager: at the bottom of the document it was written ‘awaiting expert and professional guidance’. We saw a letter from a psychologist dated March 2008, giving advice about supporting this person to manage his behaviour, but the instructions to staff had not been updated. The “summary of instructions” for the other person was not dated. One Service User Plan we looked at had been signed by the manager and deputy manager: there was no evidence that the person themselves, their relatives or an advocate had been involved in drawing up the plan. In one plan, objectives had been identified for the person, for example going to college, but the way this was to be achieved was not clear. Some needs had been identified, for example sexual needs, but there was no advice or guidance to staff on how to support the person to meet those needs. There were risk assessments on both people’s files which related to general issues rather than being specific to the person. For example, the risk of being involved in a road traffic accident. Risk assessments for one person had been reviewed in January 2008. The risk assessments for the other person stated they had been reviewed in March 2007: from the content of the assessment, we suspect this should read 2008. Risk assessments on needs specific to each person, for example one person has diabetes, were missing. 1 Beech Close DS0000071733.V365378.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): 11, 12, 13, 14, 15, 16, 17 People who use this service experience adequate quality outcomes in this area. People are not offered enough opportunities to lead full, satisfying and interesting lives. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Staff we spoke with, and the manager, said they are trying to improve opportunities for the people who live at 1 Beech Close to do more. They are using pictures to offer people activities such as swimming, walking, bowling and so on, as well as using their knowledge of what the person enjoys doing. The manager told us she recognised that there was a need for more organised activities for everyone who lives here. Staff said they would like people to 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 14 have more independence to do things like go shopping, make their own breakfast, or have a part-time job. One of the people who lives at 1 Beech Close joined us for the start of the inspection. He indicated he was happy when staff told us that he supports Manchester United football team, went to the stadium a couple of weeks before the inspection, and is hoping to get a season ticket. This person also goes to church every Sunday with staff support. Records for one of the people we looked at showed that he has little stimulating activity. Notes showed that he gets up by about 10a.m., has a bath and breakfast, lunch at 12 and goes back to bed for a rest. He has dinner between 6 and 7p.m., then back to bed by 7.30. In the week before our inspection this person had been out 3 times for a drive, stopping one day for a pub lunch, and on one day he had been to a party and his mother had visited. On one day, we saw that the only activity recorded was that he had helped staff with his washing. One of the people whose records we looked at has one-to-one support to make sure he does not leave 1 Beech Close unaccompanied. Information about this person shows clearly that he loves to go out, and that his behaviour is much less of a problem when he’s out. Staff said this person’s activity plan remains the same each week as the psychologist has recommended greater structure to the plan, and includes two walks a day. The staff said the walks do not happen if it is raining, and are substituted with something else. However, the records do not support this. Over the previous seven days, he had been out ten times. However, some of these were only very short outings (for example, ‘walked to local shop to buy milk’; ‘local shop to spend money’) indicating that he spent long periods of time in the bungalow. One day, no activity was recorded. One day staff had taken this person on a walk to the local pub. When they got there they said there was no time to go in, so turned round to head back home. The person was understandably upset. On the day we visited, we saw the staff following this person around the bungalow, and out into the garden, but we did not see them attempt to interact with him or involve him in any activity, other than when he went out after lunch. Staff are supporting this person to pay for things using his own money when he goes shopping, which is a good move towards greater independence. Staff told us about a holiday they had arranged for two people who have chosen to go to Blackpool. Four staff will go with them. Good records are kept of the food people have chosen to eat. The records we looked at for one person, who is diabetic and overweight, showed that he is not supported to choose food which will make sure he remains as healthy as possible. For example, over a short period of time his diet included sausage 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 15 rolls, pork chops, pizza, fish fingers, fish in batter, crisps, custard pudding and so on. When we looked round the kitchen we were surprised at how little food was in the cupboards. The manager said the shopping was due to be done that day. She explained that a menu-planning meeting is held each week with the people who live here, so that they can choose what they want to eat the following week. 1 Beech Close DS0000071733.V365378.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 People who use this service experience poor quality outcomes in this area. People’s healthcare needs are not being met well enough to be sure that people are supported to be as healthy as possible. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: One of the people whose records we looked at is diabetic. We found some recommendations from a dietician, but these were not reflected in the person’s care plan, and were certainly not reflected in the food this person had eaten (see Lifestyle section of this report). This person’s weight was recorded in February 2008, but had not been recorded since then. Staff told us they were concerned that this person’s diabetes was not being taken seriously enough. Staff and the manager also told us that they were concerned about a deterioration in this person’s behaviour and that he had been referred to his psychologist. It had not occurred to the manager that possibly this could be linked to the poor management of the person’s diabetes. 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 17 This person’s healthcare needs were not being met, so we wrote a ‘serious concern’ letter to TACT immediately following the inspection. We wrote “The home is not addressing the healthcare needs of one of the people who lives at 1 Beech Close sufficiently well for his health to be maintained or improved. [Name] is diabetic and clearly overweight: this could have serious implications for his future health. The manager said the doctor has told her that [name] need not follow a special diet or do anything other than take the medication he has been prescribed. She said she is trying to get the doctor to put this in writing. However, regardless of this, staff should be encouraging people to lead a healthy lifestyle: the record of food [name] eats shows that this is not the case. There was little evidence that [name] gets enough exercise. He is not being weighed, so there is no evidence of whether his weight is increasing or decreasing. Staff said [name] has been showing some “aggression” recently: they have not thought to investigate whether his mood might be linked to his diabetes. He does not have his blood sugar levels monitored. One member of staff told us s/he has tried to talk to the manager about this, but has been ignored. As a diabetic, s/he is worried that [name’s] diabetes is not being managed as it should be.” In his response to our letter, TACT’s Chief Executive accepted our concerns and told us of a number of actions that have now been taken to support this person in the management of his diabetes and improvement of his overall health. None of the people who live at 1 Beech Close manage their own medication completely. One person is able to administer some of his own medication with support from staff. The home uses a ‘nomad’ system to administer medication, which is dispensed weekly by a local pharmacy. Each person has a separate folder for all documents linked to medication. We looked at the Medication Administration Record (MAR) charts and found these had been completed correctly by staff. Staff said they have been trained to give medicines properly, and two staff always sign to confirm that medications have been administered. We noted that there had been no reviews of one person’s medication by a doctor since 2006. Each person has a form in their file, giving consent for their medicines to be administered by staff. These letters were all signed by the doctor. On one person’s file we found “Medication Administration Guidelines”. These guidelines had been revised in April 2008, yet we found that they gave different doses of one of the medications to what was written on the MAR chart. There was no evidence of why there was this difference, or whether staff had questioned it. Each file also had a copy of TACT’s medication policy. Staff had all signed to say they had read it and would follow it. Yet this policy had clearly been written for a different situation (possibly supported living, or domiciliary care) and was not suitable for a care home. We were concerned that staff, including 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 18 the manager, had not questioned the relevance of the policy, but had signed that they would follow it (which they could not do). The policy contained no reference to the way prn (when required) medication should be administered, and there were no guidelines for this on individual files. The files also contained charts recording the temperature of the medication fridge. 1 Beech Close DS0000071733.V365378.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, 23 People who use this service experience poor quality outcomes in this area. People who live here, and their relatives, have been given information about how to complain, but they cannot be sure that incidents will be reported so that people are safeguarded from harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home had made the information for people about how to make a complaint much clearer than when we last inspected. This information was on the notice board in the quiet room, and the manager said she had sent the revised procedure to all the relatives in 2007. The manager told us that all the staff had received Safeguarding (SOVA/POVA) training from Beds County Council during 2007, before the home transferred to TACT. Training records we saw, and staff we spoke with confirmed they had done this training. We looked at records of incidents and accidents and were concerned that at least one incident had not been reported as required. Staff had found that one of the people who lives at the home had some unexplained bruises. The home had not reported this to the Safeguarding (SOVA/POVA) team, nor to CSCI. It was identified at a strategy meeting in March 2008 that “input is required to staff teams on appropriate process for reporting SOVA.” 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 28, 30 People who use this service experience adequate quality outcomes in this area. 1 Beech Close is not decorated, furnished, maintained or cleaned well enough to offer people a comfortable, homely, hygienic and pleasant place to live. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We looked round the bungalow. Communal areas such as lounges, bathrooms, and people’s bedrooms were generally clean and smelled fresh. Last year we commented that staff had started to add pictures and photographs round the home: nothing further had been done to make bedrooms or communal areas more homely. 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 21 In our report following our inspection in August 2007 we wrote “We noticed that there were no plugs in any of the bedroom washbasins, and no toiletries or other items on display. The manager said everything has to be locked in a cupboard under each of the washbasins because one of the residents goes into other peoples’ rooms and takes things away”. This situation has not changed (see Choice of Home section of this report). The kitchen was not as clean as it should be (we commented on this, and made a requirement following our visit in August 2007). There was food debris and dirt on the floor, especially in the corners and down the sides of the appliances. In the fridge we found unwrapped cheese which was not dated, and there were ants in one of the cupboards which contained open packets of dry foods such as rice and breakfast cereals. We advised the manager to make sure foods were stored in sealed containers. Some of the chairs in the lounge were still damaged, the carpets still stained, and paintwork still scuffed even though we made requirements in August 2007 that these faults should be rectified. The manager told us the carpets are cleaned regularly, both by the staff with a domestic machine, and by a commercial cleaning company, but the stains will not come out. The manager said the Housing Association have put a hold on doing any refurbishment until they are clearer about the future of the home. This is not satisfactory for the people who are living here. 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 People who use this service experience poor quality outcomes in this area. Staff have not received enough training, and are not supervised well enough to be sure that the people who live at 1 Beech Close have their needs met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Rotas showed that there are usually five staff on each shift during the day. This reduces to four at weekends when one person goes home. Staff we spoke with said the number of staff sometimes limits the activities people can do, because two people need the support of two staff each when they go out into the community. The manager and operations manager said staff know the number on duty can be varied to suit any planned activities. This does limit however the amount of spontaneous activity that can take place, and only four staff means only one person can go out at a time. We looked at the personnel file for one member of staff: all required documents were on the file. We could not look at any more as we were told 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 23 they had all been taken to head office for copying. The operations manager offered to get the files for us but we decided we will inspect these more thoroughly at the next inspection. The manager told us that the home “is behind with mandatory training” but that all staff have received training in Safeguarding/Protection of Vulnerable Adults (SOVA/POVA). Staff we spoke with, and records we saw, confirmed this. The majority of staff need an ‘update’ in all training areas now, or before the end of 2008. The manager said that more than 50 of the staff have been awarded a National Vocational Qualification (NVQ) in care, either level 2 or level 3. Staff said they feel reasonably well supported by the manager and by TACT. In the AQAA the manager said that staff receive regular supervision which is recorded. However, during the inspection she admitted that formal one-to-one supervision sessions have ‘slipped’ a bit this year. Records, and discussion with staff, confirmed this. 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 People who use this service experience poor quality outcomes in this area. The management of 1 Beech Close is not effective enough to make sure that the people who live here have a good quality of life and are kept safe. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Staff we spoke with said that on the whole they were happy with the management of the home, and found the manager very approachable. One person said that communication could improve. 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 25 The operations manager told us that as an organisation TACT has a quality assurance process in place. This includes people who use the services visiting other services in different areas to assess the quality of the service being offered. It also includes formal questionnaires being sent out. As TACT had only taken over management responsibility for the home in March, the process had not been implemented yet, but we were assured it would be. Within the home, the manager told us meetings with the people who live there have continued on a weekly basis and people have continued to make decisions about things that affect their lives, like the menus, activities, holidays and so on. We looked at records of tests of the fire alarms and emergency lighting. The fire authority wrote to the home in January 2008 to tell them their fire risk assessment is satisfactory. Emergency lights had been tested regularly as required (although a mistake had been made in the date recorded). Fire alarms had been tested weekly, with one test missed at the end of April, and one test missed the week before our inspection. 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 26 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 1 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 X 28 2 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 2 X 1 X 2 X X 2 X 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 5 Requirement The Service User Guide must be further developed. It must be suitable for the people who it is for, so that they know what they can expect from the home. This requirement is carried forward again - it was partly met. 2 YA3 14 The home must be able to demonstrate that it can meet the needs of the people who live there. The management of each person’s needs must not have a detrimental effect on the other people whose home this is. This requirement is carried forward from August 2007 it was not met. 3 YA5 5 Information regarding the fees charged to service users, what they cover, and the cost of all facilities and services not covered by fees, must be made clear for each service user. This information must be recorded in the service user contract, and be DS0000071733.V365378.R01.S.doc Timescale for action 31/07/08 31/07/08 31/07/08 1 Beech Close Version 5.2 Page 28 agreed with each service user (if appropriate) and/or a suitable independent representative for each service user. This requirement is carried forward again - it was not met. 4 YA6 15 A care plan for each resident must be prepared which gives clear guidance to staff on the way in which each person’s individual needs are to be met. Goals must be included, and broken down into measurable tasks with specific timescales. This requirement is carried forward again - it was not met. Risk assessments must be in place for all identified risks, so that risks are minimised and people can be supported to take responsible risks in their lives. All of the people who live here must be able to access a regular variety of meaningful and educational activities both in and out of the home, of their choice. This requirement is carried forward again - it was partly met. 7 YA19 12(1) Healthcare needs of the people who live here must be met, so that people are supported to be as healthy as possible. The home’s medication policy must be relevant to the practices in the home. The home’s premises must be suitable for its stated purpose; DS0000071733.V365378.R01.S.doc 31/07/08 5 YA9 13(4) 31/07/08 6 YA12 16(2)(m) and (n) 31/07/08 31/07/08 8 YA20 13(2) 31/07/08 9 YA24 23 31/07/08 1 Beech Close Version 5.2 Page 29 accessible, safe and well maintained; and meet the individual and collective needs of the service users in a comfortable and homely way. Scuffed paintwork must be redecorated. This requirement is carried forward again. 10 YA24 16(2)(c) The stained and tatty furniture 31/07/08 must be cleaned and repaired, or replaced. The stained carpets must be cleaned or replaced. This requirement is carried forward from the inspection in August 2007 – the timescale was not met. 11 YA30 23(2)(d) The kitchen must be thoroughly cleaned and kept clean. This requirement is carried forward from the inspection in August 2007 – the timescale was not met. 12 YA32 18(1)(c) All staff must be trained for the specific conditions of the service users. Evidence should be maintained of this training. This requirement is carried forward again. 13 YA33 18(1)(a) There must be an adequate number of staff on duty to meet the needs of the residents. This requirement is carried forward from the inspection in August 2007 –it was partly met. 14 YA37 9 The home must be managed by someone who is competent to do so, so that the outcomes for the DS0000071733.V365378.R01.S.doc 27/05/08 31/07/08 31/07/08 31/07/08 1 Beech Close Version 5.2 Page 30 people who live here improve. 15 YA39 24 An effective quality assurance 30/09/08 and quality monitoring system that meets the requirements of the regulations and NMS must be developed so that residents are able to make their views about the home known. This requirement is carried forward again. 16 YA42 23(4)(c) Tests of the fire alarm system must be carried out as required to make sure the system works well and keep residents safe. An immediate requirement letter was sent to the home regarding this (in August 2007). This had been met but not maintained. 17 YA42 18(1)(a) All staff must receive regular training in all aspects related to health and safety so that the people who live here are kept as safe as possible. 31/07/08 27/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA17 Good Practice Recommendations Staff should make sure that people are offered a varied range of nutritious and healthy options to choose from for each meal. 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Regional Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 1 Beech Close DS0000071733.V365378.R01.S.doc Version 5.2 Page 32 - 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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