Inspection on 11/07/08 for 14 Beckley Close

This inspection was carried out on 11th July 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 14 Beckley Close St Leonards On Sea East Sussex TN38 9TA Lead Inspector Caroline Johnson Unannounced Inspection 11th July 2008 09:50 14 Beckley Close DS0000071892.V366926.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 14 Beckley Close DS0000071892.V366926.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. 14 Beckley Close DS0000071892.V366926.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 14 Beckley Close Address St Leonards On Sea East Sussex TN38 9TA 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) 01424 855873 01424 751641 Hastings and Rother Primary Care Trust Mr Ahmad Lalmahomed Care Home 6 Category(ies) of Learning disability (0) registration, with number of places 14 Beckley Close DS0000071892.V366926.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 6. Date of last inspection Brief Description of the Service: Beckley Close is a purpose built bungalow situated in a residential area of St Leonards-on-Sea, with nearby access to bus and rail routes. The home is registered to accommodate six adults with learning disabilities, some of whom have physical disabilities and complex needs. Accommodation consists of six bedrooms, four of which have en-suites and two that share communal bathrooms located adjacent to these bedrooms. Communal rooms comprise of two lounges, a dining room, kitchen, bathing and toilet facilities, laundry room and conservatory. There is under floor heating throughout and all facilities are at ground floor level. The loft area is purely used for storage. Prior to the home opening, bedroom accommodation was built slightly undersized for people in wheelchairs. There is a raised garden with small patio to the rear. High railings surround three sides of the property. Off road parking is available at the front of the home. In April 2008 Hastings and Rother PCT became the registered providers for this service taking over form the Kent & Medway NHS and Social Care Partnership Trust. The Trust manages nine other homes within the Hastings, St Leonards and Rother area. The property is owned by the Trust and managed by a housing association. 14 Beckley Close DS0000071892.V366926.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 1 star. This means that the people who use this service experience adequate quality outcomes. For the purpose of this report the people living at 14 Beckley Close will be referred to as ‘residents’. As part of the inspection process a site visit was carried out on 11/07/08 and it lasted from 9.50am until 6.20pm. The registered manager facilitated the inspection. Over the course of the inspection there was an opportunity to meet with and observe the residents in their surroundings. In addition time was spent with two members of care staff in private. A full tour of the home was undertaken. Three care plans were examined. In addition records seen included; staff rotas, training, medication, menus, health and safety, quality assurance and leisure activities. In advance of the inspection process four service user surveys and four health care professional surveys were sent to the home to distribute. Staff completed the service user surveys with the service users but as the majority of the residents are unable to communicate the comments provided are that of the care staff rather than of the residents. Staff also completed the health care professionals surveys. Following the inspection further health care professional surveys were sent to the home to distribute to visiting health care professionals. What the service does well: The home is well maintained and has been decorated to a very good standard. Bedrooms have been personalised and adapted where necessary to meet the individual needs of the residents. Those that are able to, have made the decision about the colour scheme for their room and in some cases families have also had input when the bedroom has been redecorated. Some of the residents have very complex needs. Each resident has a health action plan in place and information in support plans relating to health needs is based on individual needs and is sufficiently detailed. Staff remain conscientious and work hard to ensure that residents are given as many opportunities as possible to participate in activities and to make use of their local community. The use of photography and audiotapes is assisting staff in helping residents to communicate. 14 Beckley Close DS0000071892.V366926.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? The new providers have enabled the home to use agency staff where necessary so that minimum staffing levels can be maintained. The manager is not included in the staff numbers and so is able to concentrate more on managerial tasks. A very welcome change is that there is now a computer in the care home therefore enabling the manager to work from the home and not to have to go to head office to complete administration. In addition the manager is now much more involved in staff selection and he can view all recruitment checks prior to a new member of staff being appointed. Staff from MCCH, the provider for day care activities, now has three days a week assigned to the home. They arrange some in-house sessions and some sessions are community based via the home. The dining room and sensory room have recently been painted. A new cooker has been also been installed and the kitchen sink has been lowered making it more accessible for residents. There are plans to have work carried out to make the Jacuzzi bath more accessible and this will be a great benefit to the residents. Work is underway to make support plans much more person centred and when fully operational this will assist in improving the quality of care provided for each resident. Extensive work has begun on improving some of the systems and documentation. For example the Trust has a working party looking at the Statement of purpose, terms and conditions of residence and licence agreement with the housing association. It is hoped that this documentation will be available in the coming weeks. There is now a simplified complaint procedure in place. A number of policies and procedures have been reviewed and this work will be ongoing until completion. A corporate action plan has been drawn up highlighting how the Trust expects the home to operate. Each registered manager has been given the task of making the action plan more specific to their home. At the time of inspection about one fifth of the document had been completed. The trust are also looking at how they seek the views of the residents as part of their quality assurance system and they have designed questionnaires that will be carried 14 Beckley Close DS0000071892.V366926.R01.S.doc Version 5.2 Page 7 out with residents by senior management staff with support from care staff to aid with communication. 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. 14 Beckley Close DS0000071892.V366926.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 14 Beckley Close DS0000071892.V366926.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): 1,2,5 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The person centred approach to be used when updating all documentation made available to prospective residents will ensure that individuals will be able to make a more informed choice about admission to the home. EVIDENCE: In addition to a central file held in the office, in each of the residents’ bedrooms there is a folder containing the home’s aims and objectives, statement of purpose, tenancy and licence agreements, a service user contract and complaints procedure. The licence agreement is still that of the previous provider and residents have not yet been given a copy of a new agreement. Some of the information provided in the agreement is no longer relevant. The statement of purpose states the staffing arrangements as at the last inspection but they have been reviewed and increased since that time. The complaints procedure has been reviewed and is now in a simplified format. Other sections of the documents had also been updated in a more user friendly way. The manager advised that there is a working party looking into the revision of all these documents and the revised documents should be available in a few 14 Beckley Close DS0000071892.V366926.R01.S.doc Version 5.2 Page 10 weeks. There are also plans to ensure that the service user guide will be available in a variety of formats including providing an audio version. At the time of the inspection there were no vacancies. An assessment has been carried out in relation to each resident’s abilities and needs and this is updated at regular intervals. 14 Beckley Close DS0000071892.V366926.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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new care planning system when fully operational will enhance the quality of the lives of the residents even further. EVIDENCE: Three care plans were examined on this occasion. The home has revised the format for care planning to make it more person centred. A lot of work has been carried out as part of this process and the result to date is very positive. Information provided is clear and easy to read. It was evident whilst observing staff communicating with residents that staff are encouraging residents to make choices. However record keeping does not yet show this detail of information. The manager advised that they will be using photographs more widely in the future to assist in communicating with residents and encouraging them to make a wider variety of choices and 14 Beckley Close DS0000071892.V366926.R01.S.doc Version 5.2 Page 12 decisions. The use of audiotapes will also feature for one of the residents in particular. The manager advised that residents are not working on individual goals until the care plan format has been fully updated. Once this has been achieved individual goals will be set which will be specific, measurable and achievable. Risk assessments were not included in the folders shown for examination but when this was pointed out to the manager he advised that they had been stored in a separate folder and they were then added to the correct folder. There was evidence that they had all been reviewed recently. Annual reviews are held and relatives and care managers are invited. The manager advised that care managers rarely attend but a copy of the minutes is now forwarded to them. Relatives are asked their preferred location for the meeting and where possible this is implemented. Following reviews an action plan is drawn up detailing the work that needs to be carried out by staff to ensure that the individual resident’s holistic needs can be met. 14 Beckley Close DS0000071892.V366926.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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needs to continue to build on the progress made to date to ensure that residents receive a varied and stimulating programme of activities. EVIDENCE: MCCH staff provide day care activities for all residents in the home. At the time of inspection MCCH staff were working in the home three days a week. Previously residents were taken to the day centre but for a variety of reasons these sessions were not always carried out. The change to having activities via their own home has improved the frequency of activities provided for each resident. The manager advised that MCCH is reviewing how they operate and there are likely to be further changes to this in the future which will hopefully have a positive impact for the residents. Nearly all the activities carried out by MCCH staff are on a one to one basis with residents. 14 Beckley Close DS0000071892.V366926.R01.S.doc Version 5.2 Page 14 Separate to the structured programmes, it was reported that a member of night staff plans an activity programme one week in advance and this involves preparing an individual plan of activities for each resident. If these activities happen they are ticked on a chart, if not, the reason should be recorded and any alternative activity provided should also be also recorded. In some of the records seen the reason for the activity not taking place was recorded at the rear of the chart but not always. Three activity programmes were seen and the quality and outcome for residents varied. In respect of one resident’s weekly programme, some of the planned in-house activities did not happen but were replaced by increased opportunities to use the local community for shopping and café trips. Some of the planned in-house activities included pouring a drink or putting toothpaste on a toothbrush. These are activities that should happen in addition to a main activity rather than it being the main activity for a morning or afternoon. In relation to a second resident it was noted that there were four planned outings in the community. However, none of these took place and records showed that the activities recorded included, ‘one sensory session, helped put shopping away, changed bed and put laundry away’. It should be noted that the resident would not have been able to participate in any of these tasks and most of this time would be spent observing rather than participating in a task. Whilst it is important that a resident would be given opportunities to observe these tasks, this sort of activity should be in addition to rather than a main activity. In relation to the third resident the monthly programme of activities showed that opportunities for outings had increased from four to eight, attendance at a day service from three to seven and opportunities to participate in food preparation had increased from two to fourteen. In relation to the outings, it is not always clear what the purpose of the outing is for example if it is to purchase something for the resident, or if the outing were to involve opportunities for sensory development. Record keeping will generally show that the resident enjoyed the trip but no reference will be made to any other outcome achieved. However, photos are now taken of various outings to show residents at a later stage and this has helped improve communication. A staff member advised that this has also been useful for relatives so that they can see what their relatives have been doing. A staff member advised that staff support one resident on a swimming activity. This resident also receives regular physiotherapy at a hydro pool. An aroma therapist visits the home weekly to provide therapy for all the residents. One resident goes to visit their relative every weekend and a second visits their relative every other weekend. This means that if there is a driver on duty staff 14 Beckley Close DS0000071892.V366926.R01.S.doc Version 5.2 Page 15 can take all four residents out in the minibus to visit friends, lunch in the garden, day trips and picnics. It was reported that some of the planned activities in the community have to be cancelled if there is no driver on duty. The home is currently relying on agency or bank staff. The policy is that agency and bank staff are not allowed to drive the house transport if the permanent member of staff that is on duty is not a driver this means that residents cannot go out. Staff advised that where possible they take residents out to visit friends, for shopping trips and for meals out. Staff also support residents to maintain contact with their families. In one of the files seen it was noted that this resident has an advocate. The majority of residents are supported to take an annual holiday. 14 Beckley Close DS0000071892.V366926.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 the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that the health care needs of the residents are met. EVIDENCE: Detailed information is provided on how each resident takes their medication. Storage of medication was in order but the arrangements in place for storing controlled drugs are not appropriate. There were no controlled drugs stored on the premises at the time of inspection and the manager was advised that if this position were to change the home would need to make arrangements to have a suitable cupboard installed. Medication is checked daily. There are appropriate measures in place to deal with recording medication for social leave and returns. A number of the residents have complex healthcare needs. Records show that staff have received appropriate specialist training to meet some of these complex needs. Information is care plans relating to health needs is person 14 Beckley Close DS0000071892.V366926.R01.S.doc Version 5.2 Page 17 centred and is clear and detailed. Residents are supported to attend all healthcare appointments and a number of professionals visit the home to see residents and to provide specialist advice and support as necessary. In relation to one resident it was noted that there were a list of exercises included in their support plan. This was dated 2003. The manager was not clear if they were still carried out. A staff member spoken with stated that they are carried out daily but that often the resident won’t tolerate them. There is no record in place showing that they are carried out or advising staff to carry them out with the resident. Staff observed in the course of their duties were friendly and there was a good atmosphere in the home. Apart from the manager there are no other male care staff. The manager advised that they would like to appoint a male carer but very few male carers responded to the latest recruitment drive. All residents have health action plans in place and these are reviewed and updated regularly. It was noted in relation to one resident who has epilepsy that there is detailed information provided on the type of seizures experienced and how to deal with them. A record chart is in place to record the frequency of seizures. A recent seizure had been recorded and records showed that it lasted one minute and there was a good recovery. However there was no record of the type of seizure or if it differed in any way from the norm. Three of the residents have specialist chairs. It was reported that residents have regular opportunities to change their position whether it be from wheelchair to chair or to bed. However the importance of changing position either from a health or social prospective was not seen in record keeping. 14 Beckley Close DS0000071892.V366926.R01.S.doc Version 5.2 Page 18 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 the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are procedures in place to ensure that anyone wishing to make a complaint can do so. EVIDENCE: The manager advised that there have been no complaints since the last inspection of the home. There is a detailed complaint procedure in place and as stated earlier a simplified version of the complaint procedure is included in the service user guide. In addition there is an audio version in place for one resident who has a visual impairment. There is a detailed procedure in place on adult protection and prevention of abuse. All staff have are expected to receive training on the subject as part of their induction to the home. There have been two adult protection alerts since the last inspection. It appears that in each case the information was emailed to the Commission but due to an administrative error they were never received. However, records showed that all other action was taken appropriately. Records were seen in relation to the management of one resident’s finances. The manager advised that there are similar procedures in place for all 14 Beckley Close DS0000071892.V366926.R01.S.doc Version 5.2 Page 19 residents. All records seen were in order. The manager advised that residents don’t pay towards the petrol or running cost for the minibus but if a car were hired for a specific reason then the residents using the car would pay towards the cost. 14 Beckley Close DS0000071892.V366926.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): People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and decorated to a good standard. EVIDENCE: The home is generally well maintained and decorated to a good standard. At the time of inspection the dining room had recently been painted. The sensory room had also been painted and some of the equipment had yet to be put back. The manager also advised that a new cooker has been installed and the kitchen sink has been lowered making it more accessible for residents. However, residents only use the kitchen with staff support. One of the bathrooms has not been in use for some time. However, a member of the maintenance team visited on the day of inspection to examine the bath and assess what work needed to be carried out to be able to fit a hoist under 14 Beckley Close DS0000071892.V366926.R01.S.doc Version 5.2 Page 21 the bath and make it useable. This bath is also a Jacuzzi so will be of benefit to the residents once operational. All bedrooms are very personal. One resident has recently had a new television positioned on the wall to encourage him to raise his head slightly to watch it and also by doing so to correct his posture. Photos and ornaments are visible in all rooms making them look very homely. Staff also advised that one of the residents chose their colour scheme and their mum was also very involved in the decoration of their room. There are ample bathing and toilet facilities with a good variety of specialist equipment available. A large fence surrounds three sides of the property. Following advice from Environmental Health, CCTV has been installed to monitor the garden area. This was installed to deter people from throwing objects into the garden area. The manager advised that the frequency of this problem has decreased significantly. The manager meets regularly with representatives from the local community and with local community support police. Discussion was had about possible alternatives to the high fence, which is not in keeping with creating a homely environment. The manager advised that he would look into this further. A large part of the garden area is not accessible to residents but there are a number of plants and shrubs growing on this area. The manager advised that there are plans to redevelop parts of the garden to make it more accessible and spacious. The manager confirmed that there is a fire risk assessment in place and that all recommendations made as part of this process have been addressed. All areas of the home seen during the inspection were clean. Staff reported that the night staff carries out the majority of the cleaning. Care staff cleans bedrooms with residents either participating in cleaning tasks or observing them being carried out. Laundry facilities are appropriate to the needs of the residents. Records showed that the majority of the staff team have not had recent training on infection control. 14 Beckley Close DS0000071892.V366926.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): 31,32,33,35,36 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Inadequate staff training in some areas and long-term use of agency staff that have not received specialist training could compromise the quality of the care provided to residents. EVIDENCE: At the time of inspection there were four staff on long-term sickness. The manager advised that the Service leader has provided additional management support during this time. The vacant hours are not all covered but the home is using agency/bank staff to ensure that there would always be three staff on duty through the day. At the time of the last inspection there were four residents. The assessed minimum staff levels included three care staff throughout the day and two sleep-in staff at night. Shortly after the inspection the home admitted a 14 Beckley Close DS0000071892.V366926.R01.S.doc Version 5.2 Page 23 further two residents and they advised that they would be changing the night staff arrangement to one waking carer. The home was asked to review their staffing arrangements in light of the needs of the two new residents. Due to the complex needs of the residents this review needs to take place. A positive change is that the majority of the hours worked by the manager are now supernummery so that he can concentrate on management tasks. The use of agency/bank staff is also positive, as this was not previously possible. The manager confirmed that he is now involved in the selection process for new staff and that he sees all recruitment records prior to a new member of staff commencing work in the home. Although the home is using agency staff they have limited the number of staff coming into the home so as to ensure that there is continuity of workers and consistency of approach. It was noted however, that regular agency staff, some of whom are currently working full time in the home, do not receive formal supervision and are not invited to attend team meetings or away days. In addition regular agency staff will not have attended the same range of training that would be available to them if they were employed by the home. All new staff complete an induction week prior to commencing work in the home. During this induction they complete all mandatory training. Basic training consists of protection of vulnerable adults, first aid, fire safety, health and safety, infection control, basic food hygiene, communication, safe eating and drinking and medication training. A member of agency staff spoken with confirmed that for the first couple of days they followed staff and read guidelines. They stated that they were given clear guidance particularly around feeding residents. They also stated that staff handovers are very clear particularly when needs change of if there are new guidelines. During the first week of employment in the home new staff shadow an experienced member of staff and begin the home’s in-house induction. This includes being assessed on three occasions administering medication and completing a theory test before they are assessed as competent to administer medication. In addition arrangements are made for staff to attend any specialist training needed to equip them to work with the residents accommodated. Training that has been classed as essential for working at Beckley Road includes RIG (care and management of a radiology inserted gastronomy), catheter care, epilepsy, visual impairment, seating and posture and pressure care. There is a training co-ordinator in place that advises the home on a monthly basis of the staff that need training updates in each area. In relation to the specialist training, with the exception of RIG and epilepsy, there were significant gaps in the numbers of staff that have attended training on the rest of the subjects listed above. Some of the staff that have attended this training 14 Beckley Close DS0000071892.V366926.R01.S.doc Version 5.2 Page 24 received the training a number of years ago. In relation to mandatory training the manager advised that although there were a number of shortfalls several courses have been booked for staff to attend training so this would be reflected in next month’s matrix. The manager confirmed that staff have been booked to attend a course on the mental capacity act. A new policy is that all new staff that have no previous experience in working with people with learning disabilities will move on to study for the Learning Disability Qualification (LDQ). New staff that have completed an NVQ in a related area will complete sections of the LDQ. There was a record of supervision dates on display in the office. Records showed that three of the staff team have had two supervisions this year. However the majority of the staff received one supervision, and for some, this had been in January. 14 Beckley Close DS0000071892.V366926.R01.S.doc Version 5.2 Page 25 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): 37,38,39,41,42. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in place are not being used to adequately monitor the quality of care provided and as a result some of the changes that need to happen are not being made. EVIDENCE: The registered manager has been a manager for a number of years. He is a registered nurse (RNMH), has completed the RMA and also holds several other qualifications that equip him to run the service. He advised that he receives regular supervision and support. He also stated that he finds the regular 14 Beckley Close DS0000071892.V366926.R01.S.doc Version 5.2 Page 26 manager’s meetings very positive with open discussion and opportunities to share ideas and practices. Staff spoken with stated that they felt well supported by the manager and find the regular staff meetings helpful. As part of quality assurance the Trust has given each care home a very detailed action plan highlighting the changes that are to be made. The manager advised that he is working his way through this document but has a long way to go yet. It was reported that there are proposals to have annual open days and coffee mornings where relatives could be invited. This could also be an opportunity to keep relatives up to date with changes that have occurred in each home. In addition a representative from the senior management team will be visiting the home to carry out satisfaction questionnaires with residents. A member of the senior management team is visiting once a month unannounced to report on the conduct of the home. Records showed that visits last from three quarters of an hour to one and a half hours. Reports are not sufficiently detailed in that they do not include detail that the provider would need to be aware of to be satisfied that the home is being managed appropriately. For example there is reference to staff sickness and that that the manager is managing the situation but not how it is being managed or if the staff sickness is having any impact on residents. Equally the auditing of the care plans appears to be statistics rather than outcome focussed. Although the long-term sickness is being managed in that staffing levels are being maintained by the use of agency staff, staff employed via the agency will not have the specialist knowledge and skills required to care effectively for the residents. As they are not regarded as part of the staff team they are not invited to staff meetings and are not receiving supervision. Another problem that occurs is in relation to outings whereby if there is no driver on duty from the permanent staff team outings need to be cancelled. In advance of the inspection process four service user surveys and four health care professional surveys were sent to the home to distribute. Staff completed the service user surveys with the service users but as the majority of the residents are unable to communicate the comments provided are that of the care staff rather than of the residents. Staff also completed the health care professionals surveys. Following the inspection further health care professional surveys were sent to the home to distribute to visiting health care professionals. There were up to date records in place showing that all equipment has been serviced at regular intervals and that the home ensures the health and safety of the residents accommodated. The AQAA (annual quality assurance assessment) showed that a number of the policies and procedures had not been reviewed for some time. The manager advised that the Trust has recently reviewed all the policies and procedures. A number have recently 14 Beckley Close DS0000071892.V366926.R01.S.doc Version 5.2 Page 27 been updated and as they are updated they are sent to the home for inclusion in the manual. 14 Beckley Close DS0000071892.V366926.R01.S.doc Version 5.2 Page 28 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 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 X 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 2 X 3 3 X 14 Beckley Close DS0000071892.V366926.R01.S.doc Version 5.2 Page 29 N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15(2) Requirement The registered person must ensure that goals set for individual residents are meaningful and achievable and that progress can be measured. The registered person must ensure that residents have regular opportunities to participate in meaningful and person centred activities. The registered person must carry out a review of the staffing levels to ensure that there are sufficient staff on duty at all times to meet the assessed needs of the residents. The registered person must ensure that staff receive appropriate training to undertake their roles and the training provided is updated regularly. The registered person must ensure that all staff working in the home (including regular agency/bank staff) receive regular supervision). The registered person must ensure that the quality assurance system is implemented, monitored and DS0000071892.V366926.R01.S.doc Timescale for action 30/09/08 2. YA14 16(2m,n) 30/09/08 3. YA33 18(1a) 31/08/08 4. YA35 18(1) 30/09/08 5. YA36 18(2) 31/08/08 6. YA39 24 30/09/08 14 Beckley Close Version 5.2 Page 30 acted upon. 7. YA39 26 The registered provider must ensure that more effective monitoring is achieved through Regulation 26 conduct visits of the home. 30/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 14 Beckley Close DS0000071892.V366926.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 14 Beckley Close DS0000071892.V366926.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!