CARE HOME ADULTS 18-65
Beamont Way (32) 32 Beamont Way Amesbury Wiltshire SP4 7UA Lead Inspector
Roy Gregory Unannounced Inspection 14 March 2008 02:00
th Beamont Way (32) DS0000067906.V359736.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 Beamont Way (32) DS0000067906.V359736.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. Beamont Way (32) DS0000067906.V359736.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Beamont Way (32) Address 32 Beamont Way Amesbury Wiltshire SP4 7UA 01980 676788 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) Sharon Anne Arnott Glen Arnott Wendy Kirk Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Beamont Way (32) DS0000067906.V359736.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st October 2006 Brief Description of the Service: 32 Beamont Way is a detached modern house on a development of similar properties. It provides accommodation for four adults in single rooms, all but one having the added benefit of en suite facilities. Shared spaces comprise of a kitchen, utility room, dining room, conservatory living room, bathroom and enclosed garden. The home is situated close to bus stops, as well as being within walking distance of Amesbury town centre. It is easily accessed from the A303 trunk road between London and the West Country. The basic fee level is £750 per week. This does not include items such as transport, toiletries, newspapers and social outings. Beamont Way (32) DS0000067906.V359736.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 3 star. This means the people who use this service experience excellent quality outcomes.
The unannounced visit for this inspection took place between 2:00 p.m. and 8:30 p.m. on Friday 14th March 2008. The inspector, Roy Gregory, spoke in private with three of the four people that lived at the home at the time. The inspector joined two of them with staff at the evening meal and joined social interactions in the sitting room and kitchen. The registered manager, Wendy Kirk, was available during most of the visit, as was the provider Sharon Arnott for the first hour. Additionally there were conversations with two members of staff. The inspector looked at care plans and daily records to compare observations of care and residents’ perceptions with written records. Other records consulted included those relevant to staff recruitment, supervision and training. All shared areas of the home were visited and two bedrooms were seen with the agreement of their occupants. Survey forms were received from each of the people that live at the home. Wendy Kirk completed an “Annual Quality Assurance Assessment” for the Commission, which included many strands of information about the home. Also available at the inspection visit were the returns from the home’s own annual survey of people living there and their supporters, carried out in October 2007. Since the visit there has been telephone contact with a specialist nurse who visits one of the people in the home. What the service does well:
The survey forms returned by people living at the home were entirely positive in content. This matched with how they spoke about living at the home, and how they had responded previously to the home’s own annual survey in October 2007. Relatives who visited the home also expressed a positive and satisfied view through their responses to the home’s quality assurance survey. Comments that had been added included: “cannot be faulted”; “quick and very pleasant response to telephone calls”; “continues to be five star”. A care manager wrote: “The home cares for some people who have a very high level of need. They do this very well.” The home had a welcoming, homely feel. People had put some personal possessions in communal rooms, and bedrooms were very personalised. Good quality furnishings were provided throughout. People liked their rooms, and the house as a whole. Beamont Way (32) DS0000067906.V359736.R01.S.doc Version 5.2 Page 6 One person had moved into the home since the previous inspection. There were good records of how their needs were assessed. They had visited the home for a meal, and then for an overnight stay, so they and the people already supported by the home could meet each other. Important links were made with a specialist nurse before the person moved in, and an occupational therapist was consulted to ensure the person was provided with environmental aids. The specialist nurse found the staff group keen to understand and meet the needs of the person, and has viewed the placement as wholly appropriate. Care plans were in place for all people, with evidence of monthly review and of people’s agreement to contents. Plans guided staff on the aims of care planning as well as the ways in which to provide support. For one person, routines were identified as important to them. Another person disliked any set patterns, so their care plan emphasised the need for a range of activities that could be implemented or dropped at short notice. A person living at the home said: “this place means freedom”; when asked what this meant, they said: ”freedom to do things, and not to have to do things just because others do”. People consistently said they made choices and decisions, individually and together, about how they used their time. Daily care records and observations of practice confirmed this was so. Some people were assessed as able to spend some time alone in the house. There was a risk assessment about how someone could go out shopping alone in safety. People were very accustomed to using public transport to town and further afield. People received active support to maintain individual interests, which varied from craftwork at home to stage shows and motorcycle events. People went to a variety of daytime and evening centres and clubs of their choice. One person had a paid job for one day a week, and another had voluntary jobs in a charity shop and at an animal sanctuary. People helped with meal preparation and clearing, and chose where to take meals. Evening meal choices were generally discussed over breakfast; on occasions, three different main meals were cooked in order to meet individual choices. There was evidence of plentiful provision of fresh fruit and vegetables, and of people’s active participation in shopping. It was also seen that people had access to snacks and drinks, as they required. One person had been enabled to learn about cookery related to their cultural heritage. All support plans showed that people received annual health checks and that all medical appointments were recorded and tracked by people’s key workers. One person had a particular set of health care needs and a link had been made with the relevant community nurse, who in turn had delivered training to the staff group. Relevant charts were maintained by staff in the person’s room to inform the ongoing joint work with the person by home staff and the nurse. For the same person there was a care plan about pain relief, which included an agreed protocol for administering “as needed” medication. Beamont Way (32) DS0000067906.V359736.R01.S.doc Version 5.2 Page 7 Each bedroom had a wall-mounted medications cabinet, in which just the individual’s medicines and administration chart were kept. This was a good way of minimising risk of errors and incorporating use of medicines into an individual’s preferred routines, in private. Staff meetings included consideration of any incidents that had arisen, how they were addressed and how they might have been approached differently. The staff training programme included how to work with aggressive behaviours. Each person living in the home was allocated a key worker. Wendy Kirk had introduced a checklist for key workers to ensure their essential tasks were covered every month. These tasks included reviews of support plans, cleaning duties, and checking availability of medications and spending money. A person’s description of their key worker’s responsibilities matched with the content of the checklist. The provider had invested significantly in a distance learning resource that provided staff with certificated renewable training as it became due. The home maintained an annual training plan that ensured staff remained in-date with all training. It was likely that all support staff would achieve a National Vocational Qualification in care by June 2008. There were good records of two-monthly individual supervision of staff by Wendy Kirk. Records showed she challenged staff to consider why people might have shown certain behaviours, and why different approaches to care and support tasks differed in effectiveness. Wendy Kirk was familiar with the home’s workings at all hours of the week. She gave an effective lead to staff in the home. They in turn appreciated the quality of supervision and consistency of training that they received. People living in the home were at ease with staff and with Wendy Kirk. They understood the key worker role and felt valued and supported by staff. What has improved since the last inspection?
Following recommendations at the previous inspection, near relatives of all people living at the home had been provided with copies of the service user guide. The questionnaire used for people who live at the home had been overhauled. Work on this had been shared with the people being supported. The form used was now in a colourful, pictorial form that allowed for indication of answers, with space for additional comment if required. A new training package in awareness of and reporting abuse had been obtained, and all staff received refresher training in this area every year. In addition, during 2007 the staff team received training from a police officer of the local Vulnerable Adults Unit, with emphasis on accurate recording of incidents and use of body maps where appropriate. A diary had been introduced for use by the on-call manager, to ensure an exact record was made of any call to them at the time it happened. Beamont Way (32) DS0000067906.V359736.R01.S.doc Version 5.2 Page 8 The people who live at the home had expressed a wish through their house meeting to paint the fences and shed in the garden. They had been supported to complete this work during 2007, with pleasing results. Staff worked significant periods, including overnight “sleeping in”, on their own. They had the benefit of a lone working policy, as recommended at the previous inspection. 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. Beamont Way (32) DS0000067906.V359736.R01.S.doc Version 5.2 Page 9 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 Beamont Way (32) DS0000067906.V359736.R01.S.doc Version 5.2 Page 10 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 & 4. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People’s needs are assessed so that they are only offered a place if their needs can be met. They are given good information, and the chance to visit and stay overnight, to help them decide if the home is right for them. Beamont Way (32) DS0000067906.V359736.R01.S.doc Version 5.2 Page 11 EVIDENCE: There had been one new admission to the home since the previous inspection. The person concerned had been living in a “supported living” setting, but their needs in respect of personal and health care had become more than could be sustained there. The person acknowledged that at the time of admission, their preference was to remain where they were. They confirmed they were involved in the assessment of their needs, together with their care manager and staff of the home. Wendy Kirk said the emphasis in assessment was to ensure the person could retain maximum independence and retention of skills. The Community Care Assessment showed a good fit between assessed needs and what the home offered. There was evidence of attempts by Wendy Kirk to obtain better information from the previous care provider. The home’s own “needs and skills assessment” acted as an effective starting point for devising the person’s care plans. In line with the home’s procedures, the person visited the home for a meal, and then for an overnight stay, so they and the people already supported by the home could meet each other. Links were made with community nurses in advance of admission. The person was provided with a copy of the home’s service user guide. Following recommendation at the previous inspection, near relatives of all people living at the home had been provided with copies of the service user guide. Wendy Kirk was planning to invite people to help create a “virtual tour” guide for anyone interested in applying to live at the home in the future. Beamont Way (32) DS0000067906.V359736.R01.S.doc Version 5.2 Page 12 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 – 9. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People’s assessed needs are reflected in care and support plans, which are reviewed and changed as necessary. People are supported in making decisions about their everyday lives. Risks are identified, and assessed in such a way as to encourage safe participation in a range of activities. Beamont Way (32) DS0000067906.V359736.R01.S.doc Version 5.2 Page 13 EVIDENCE: Care plans were in place for all people, with evidence of monthly review and of people’s agreement to contents. Plans guided staff on the aims of care planning as well as the ways in which to provide support. One feature of the plans was a skills assessment, and there were examples of these being updated. This aspect of planning ensured people’s abilities were recognised and enhanced. Another standard component was a personal profile. People had signed these, and were clearly well aware of their respective care plans. However, a greater sense of ownership might be encouraged by considering ways in which people could make a more direct input to their documentation, for example by adding words, pictures or decoration. People consistently said they made choices and decisions, individually and together, about routines and spontaneous activity. Daily care records and observations of practice confirmed this was so. For one person, adherence to routines was identified as important to them. Another person disliked any feeling of obligation to set patterns, so their care plan emphasised the need for a range of activities that could be implemented or dropped at short notice. Meal times were used as a natural venue at which conversation was promoted between people. They made weekly decisions about division of household tasks. There were also minutes of monthly house meetings. One person living at the home said: “this place means freedom”; when asked what this meant, they said: ”freedom to do things, and not to have to do things just because others do”. Individual risk assessments supported people to take charge of their lives. For example, most people were assessed as able to remain alone in the house for varying periods of time. They had prominent information in their rooms about how to contact staff by telephone, and their competency to do that was checked regularly with them. One person described the content of their particular risk assessment for being “home alone”. They were fully aware of the tasks they had agreed not to undertake when support was not available. Another person had a risk assessment about going out shopping without staff support. This was backed by evidence that guidance and practice had been made available concerning road safety and use of a mobile phone in emergency. Staff were guided by the assessment to ensure the person was equipped with all agreed safety measures on going out. Beamont Way (32) DS0000067906.V359736.R01.S.doc Version 5.2 Page 14 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 – 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Varied activities give people opportunities to maintain leisure interests, to develop skills and to access the community. Relationships with families and friends are encouraged. People participate in everyday tasks and their rights are respected. A healthy diet is offered, and mealtimes are conducted as people want. Beamont Way (32) DS0000067906.V359736.R01.S.doc Version 5.2 Page 15 EVIDENCE: People went to a variety of daytime and evening centres and clubs of their choice. One person had a paid job for one day a week, and another had voluntary jobs in a charity shop and at an animal sanctuary. All support plans aimed to facilitate access to resources that fitted with individual social needs and interests. One person had opted out of going to a club that was very much enjoyed regularly and together by the others. There were appropriate staffing arrangements to ensure individual choices could be supported. People were very accustomed to using public transport to town and further afield. People received active support to maintain individual interests, which varied from craftwork at home to stage shows and motorcycle events. People made constant choices between enjoying the privacy and resources of their rooms, and mixing with one or more of their fellow residents and with staff. Minutes of the house meeting for January 2008 showed they had discussed holiday wishes for the year, and had agreed to plan a holiday together rather than separately. In 2007 they had enjoyed going away in pairs. Care plans included facilitating contact with people’s families and friends. Two people had mobile phones, and all people could use the house telephone in private if they wished. There had been a party in the summer of 2007 to celebrate the home’s first year of working. Family members and also neighbours of the home had attended the party. People agreed on division of chores in the home and garden. They were supported to keep their rooms and clothes clean. One person did all their own cleaning and laundry. People helped with meal preparation and clearing, and chose where to take meals. On this occasion, one person chose not to join the evening meal because they had eaten a large meal earlier in the day when out, and another person was not feeling well and chose to eat later on their own. A person confirmed that on occasions, three different main meals were cooked in order to meet individual choices. Evening meal choices were generally discussed over breakfast. The February 2008 house meeting minutes showed a person was satisfied that their earlier proposal for more rice and pasta dishes had been acted on. There was evidence of plentiful provision of fresh fruit and vegetables, and of people’s active participation in shopping. It was also seen that people had access to snacks and drinks, as they required. The staff training programme included training in diet and nutrition. One person had been enabled to learn about cookery related to their cultural heritage, and further avenues about their cultural identity were being explored, as they wished. Beamont Way (32) DS0000067906.V359736.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 – 21. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides personal support in line with people’s preferences and needs. There are good links and systems to ensure physical and emotional health needs are met. People are protected by the home’s medication procedures. Beamont Way (32) DS0000067906.V359736.R01.S.doc Version 5.2 Page 17 EVIDENCE: All support plans showed that people received annual health checks and that all medical appointments were recorded and tracked by people’s key workers. One person had a particular set of health care needs and a link had been made with the relevant community nurse, who in turn had delivered training to the staff group. Relevant charts were maintained by staff in the person’s room to inform the ongoing joint work with the person by home staff and the nurse. For the same person there was a care plan about pain relief, which included an agreed protocol for administering “as needed” medication. The care plan was signed by the person receiving care, their key worker and their GP. Good liaison had also brought about provision of a wheelchair for the person. The specialist nurse said she was impressed by the concern shown by staff of the home to understand and to meet the person’s needs. She added that Wendy Kirk had advocated strongly on the person’s behalf to secure attention from health services. For a person with diabetes there was a related care plan. They conducted their own tests of blood glucose levels. The care plan included agreement on how to dispose safely of sharps. Their key worker ensured diabetic clinic appointments were made and kept. The home had established experience of liaising with mental health services. For one person there had been work and training on identifying triggers to behaviour issues and how to help the person negotiate periods when they felt like rejecting care. For another person, care plan guidance ensured staff took account of emotional needs alongside meeting personal care needs. Wendy Kirk had undertaken a training course about death and bereavement issues for people with a learning disability. She linked this to other learning about mental capacity issues, and work with a palliative care nurse. Each bedroom had a wall-mounted medications cabinet, in which just the individual’s medicines and administration chart were kept. This was a good way of minimising risk of errors and incorporating use of medicines into an individual’s preferred routines, in private. Staff were provided with training in safe handling of medications. Wendy Kirk signed for individual competency to support use of medicines after a member of staff had been observed and had undertaken the training. Effective working arrangements had been made with the supplying pharmacy. Beamont Way (32) DS0000067906.V359736.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. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There are appropriate procedures, including staff training, to protect people from harm, and to receive and act on complaints. EVIDENCE: Before each monthly house meeting, people were given a sheet they could use to help them to make comments, with the assistance of key workers if they wished. The form drew attention to the possibility of voicing any complaint or concern, through the meeting or elsewhere. Wendy Kirk said it was also stressed to people they could raise concerns through the home about anywhere else they went. For example, a person had felt uncomfortable in a voluntary working situation and this had been responded to, resulting in a different placement being found. The monthly quality monitoring undertaken by the manager includes provision to take account of any complaints that have been made in the previous month. No complaints had been received through the formal complaints procedure, which people were made aware of through pictorial displayed information and in the service user guide. This may reflect the openness of everyday communication between people in the home and the staff that support them, so emergent issues are recognised and addressed. Beamont Way (32) DS0000067906.V359736.R01.S.doc Version 5.2 Page 19 There was a copy of the local inter-agency vulnerable adults procedures in the office. This was introduced to staff as part of induction, along with abuse awareness training. A new training package in awareness of and reporting abuse had been obtained, and all staff received refresher training in this area every year. In addition, during 2007 the staff team received training from a police officer of the local Vulnerable Adults Unit, with emphasis on accurate recording of incidents and use of body maps where appropriate. This followed an allegation by a former resident against a member of staff, who had been suspended whilst inter-agency investigations were carried out. No malpractice was identified but the manager and staff recognised that there were things to be learnt from the experience. A diary had been introduced for use by the oncall manager, to ensure an exact record was made of any call to them at the time it happened. Staff meetings included consideration of any incidents that had arisen, how they were addressed and how they might have been approached differently. The staff training programme included how to work with aggressive behaviours. Everyone who lived at the home had information in their rooms about a local advocacy service, and also knew how to contact their respective care managers. In the newsletter to family members, relatives had been advised about where they could obtain information about the Mental Capacity Act. A training package about that legislation had been ordered for use with staff. People needed varying levels of support with managing their personal monies. Each resident was satisfied with the arrangements they had individually come to for this aspect of support. One person’s care plan showed the support they needed in order to withdraw cash and keep it safely. Safeguards were in place in the form of recording, monitoring and keeping receipts and there were regular checks by the manager. Beamont Way (32) DS0000067906.V359736.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, 29 & 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides a homely environment, maintained and kept clean to a high standard. Beamont Way (32) DS0000067906.V359736.R01.S.doc Version 5.2 Page 21 EVIDENCE: The home had a welcoming, homely feel. People had put some personal possessions in communal rooms, whilst bedrooms were very personalised. Good quality furnishings were provided throughout. The people who live at the home had identified a wish to paint the fences and shed in the garden. They had been supported to complete this work during 2007, with pleasing results. At the evening meal table, Wendy Kirk informed the people there that the provider had agreed that day to provision of new outdoor furniture, in response to a request from the house meeting. The home received regular maintenance checks by the provider, with rapid responses to any shortfalls identified. A repair to a table was being undertaken at the time of inspection visit. Firm plans had been made for redecoration of some rooms later in the year, when their occupants would be away on holiday. For one person, the staff had sought and obtained advice from an occupational therapist to improve the person’s access in the house. This had resulted in provision of appropriate aids. All parts of the home were fresh and clean. Whilst service users had a responsibility for the basic cleanliness of their rooms, and to assist with cleaning communal areas, written procedures and check sheets showed that staff had responsibility for deep cleaning. This included, for example, the utility room, and weekly support to bedroom cleaning. Key workers were responsible for en suite facilities, and for three-monthly spring-cleaning of bedrooms. Specific guidance for spring-cleaning was in place, and a chart showed when in the year it should take place for each bedroom. Beamont Way (32) DS0000067906.V359736.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 – 36. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People are supported by competent, trained staff, who experience regular supervision and are supported by an employer committed to staff development. Recruitment practices ensure people are protected from being cared for by unsuitable staff. Beamont Way (32) DS0000067906.V359736.R01.S.doc Version 5.2 Page 23 EVIDENCE: Job descriptions for support workers were based on a person-centred approach to the work. Each person living in the home was allocated a key worker. Wendy Kirk had introduced a checklist for key workers to ensure their essential tasks were covered every month. These tasks included reviews of support plans, cleaning duties, and checking availability of medications and spending money. A person’s description of their key worker’s responsibilities matched with the content of the checklist. The provider had invested significantly in a distance learning resource that provided staff with certificated renewable training as it became due. All courses included marking of written tests in-house by Wendy Kirk, and externally by the training provider. The home maintained an annual training plan that ensured staff remained in-date with all training. There was an expectation that staff would attain National Vocational Qualification in care to at least level 2. It was anticipated that all support staff would achieve this by June 2008. Staff worked significant periods, including overnight “sleeping in”, on their own. They had the benefit of a lone working policy, as recommended at the previous inspection. There was always a manager on call, either Wendy Kirk or the provider. When necessary, staff members would work additional hours in order to facilitate choices made by people in the home. Some recruitment had taken place in the previous year. There was evidence that people living in the home had been involved in selection. Applicants had been invited to spend time with people in the house. One applicant had interviewed well, but had not been appointed because one person said they would not feel comfortable to receive personal care from them. All staff had been subject of vetting by the Criminal Records Bureau and take-up of two references prior to being appointed. Induction of new staff was in line with recognised “core induction standards”. There were good records of monthly individual supervision of staff by Wendy Kirk. Records showed she challenged staff to consider why people might have shown certain behaviours, and how different approaches to care and support tasks differed in effectiveness. Members of staff said they valued both the level and nature of supervision, and the approach to training. Beamont Way (32) DS0000067906.V359736.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 & 42. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The registered manager provides leadership and direction so people benefit from a well run home. Quality assurance systems include obtaining the views of service users and their supporters to monitor and improve the service. There are systems in place to identify and promote the health and safety needs of residents and staff. Beamont Way (32) DS0000067906.V359736.R01.S.doc Version 5.2 Page 25 EVIDENCE: Wendy Kirk holds the Registered Managers award. She meets weekly with the provider, Sharon Arnott, so they each remain up to date on matters in which they may become involved as duty managers. Wendy Kirk worked some hours as part of the home’s support rota, and some specifically to undertake supervisory and management tasks. She was familiar with the home’s workings at all hours of the week. Together with senior staff from Beamont Way’s “sister” home, she was involved in sessions with a management coaching consultant. This was to include some work with the house team, to help identify areas of development in team dynamics. A monthly quality audit tool showed active monitoring of all aspects of managing the home, checking for example formal staff supervision, reviews of care plans and environmental issues. Any issues for attention were readily identified this way. The home’s annual internal quality assurance exercise had taken place in October 2007. Questionnaires had been received from five regular visitors to the home. In response to “overall impressions of the home”, four had scored 5 out of 5 and one scored it 4 out of 5. Other comments that had been added included: “cannot be faulted”; “quick and very pleasant response to telephone calls”; “continues to be five star”. A care manager wrote: “The home cares for some people who have a very high level of need. They do this very well.” In response to a recommendation at the previous inspection, the questionnaire used for people who live at the home had been overhauled. The need to do this had been shared with the people being supported. The form used was now in a colourful, pictorial form that allowed for indication of answers, with space for additional comment if required. All responses were positive, which matched with responses to the survey sent to people in connection with this inspection, in February 2008. In person, all people in the home expressed confidence in their ability to raise matters at any time, through their house meetings and individually with key workers and with Wendy Kirk. They considered their views were taken seriously and acted upon. They confirmed the home’s “annual quality assurance assessment” document, as required by the Commission, had been shared with them when Wendy Kirk was completing it. There were good systems in place for monitoring and attending to health and safety matters. There was a record of monthly fire training for residents and staff. Staff received training in manual handling, first aid, food hygiene and infection control. Staff who were drivers were permitted to take people out in their cars, subject to proof of satisfactory insurance cover. The documentary proof for one person was out of date. Beamont Way (32) DS0000067906.V359736.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 3 2 4 3 X 4 4 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 3 30 4 STAFFING Standard No Score 31 3 32 4 33 3 34 4 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 4 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 3 4 X 4 X X 3 X Beamont Way (32) DS0000067906.V359736.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation Reg 13(2) Requirement Arrangements must be made to purchase and install a controlled drug cupboard that meets the current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007. Timescale for action 31/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA42 Good Practice Recommendations Consider ways in which people could be encouraged to contribute directly to their support plans in order to make them more personal. Ensure that for any member of staff using their private car for transporting people, proof is held of adequate and up to date motor insurance. Beamont Way (32) DS0000067906.V359736.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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
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