CARE HOME ADULTS 18-65 54 Beechcroft Gardens Wembley Middlesex Address 3 HA9 8EP
Lead Inspector Bernard Burrell Announced 04 April 2005, at 10:00hrs 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 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 Stationary 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. 54 Beechcroft Gardens Version 1.10 Page 3 SERVICE INFORMATION
Name of service 54 Beechcroft Gardens Address 54 Beechcroft Gardens, Wembley, Middlesex, HA9 8EP 020 8904 8258 020 8343 8876 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) PentaHact Olufunmilayo Sarah Talabi CRH PC Care Home only 3 Category(ies) of LD Learning Disability 18 Years and over registration, with number of places 54 Beechcroft Gardens Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 06/04/05 Brief Description of the Service: 54 Beechcroft Garden is a registered detached bungalow located near to central Wembley. It is registered to provide 24-hour accommodation and care support for 3 adults who have mild to moderate learning disability. The service is also suitable for people who may have mobility problems and limited verbal communication. The home is owned by the local health authority and Pentahatch provides the care. The home is located near a variety of facilities, services and public transportation routes. The home has a registered manager and 24-hour staffing cover. 54 Beechcroft Gardens Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over one day. The process was assisted by input and contributions from the manager, staff, service users and the local general practitioner (GP). The home’s mission statement outlines clearly to service users what services and assistance are offered plus how they will be supported to make the most of their lives. The home is managed well, staff respect and support service users appropriately plus service users reported satisfaction and contentment with life at the home. Service users are also offered good opportunity and support to enjoy a range of community services and facilities, plus enhance their individual lifestyles and preferences. The home was clean throughout and offers comfort and a homely atmosphere to the service users. The findings indicated the service users concerns and complaints are respected, listened to and manage appropriately by staff. Service users reported they know how to make complaints and voiced their concerns. Staff demonstrated awareness of adult protection issues and have undertaken training in this area to enhance their knowledge and practice. The inspector was satisfied the home benefits from a good management, leadership and staffing structure. The findings indicated the management approach help to enhance and promote service users rights and best interest and protect their health, safety and wellbeing. What the service does well:
Staff are listening to service users and meeting their individually assessed needs. PentaHact is now developing a new style care plan that is personcentred (PCP) and aims to capture the holistic needs of each user. Service users feel valued through the raising of their self-awareness, promotion of individual choices and building of their self-confidence plus integration and participation in community life. Staff are also supporting service users to develop their ability to travel independently by liaising with the local taxi service for example.
54 Beechcroft Gardens Version 1.10 Page 6 Good progress has been made in the methods and style that are used to communicate with service users, including the use of pictorial and graphic illustrations plus verbal techniques. Staff assist and support service users to develop and maintain beneficial links with the local GP surgery and home visits by hairdressers for example. The service users play proactive roles in planning their choices in meals, with appropriate support and health monitoring by staff. Service users are supported and encouraged by staff to take part in various community activities, for example: attendance at churches, social and cultural events, outings, St. Patrick’s Day party, visits to the local pub, bingo and Harrow concerts. Staff benefit from ongoing training and professional development in various practice areas, including adult protection and NVQ courses. The service users also benefit from the house forum ensuring their full participation in the plans and development for the home. Staff also provided examples of how they assisted service users to achieve gainful employment. What has improved since the last inspection? What they could do better:
Enhanced IT training for care support staff to help improve and develop their competence and skills further.
54 Beechcroft Gardens Version 1.10 Page 7 The monthly Person In Charge (PIC) visits need to be carried out on time and in line with regulatory requirements. Staff at the home need to develop further their knowledge, skill and competence in Person Centred Care Planning for service users. Minor internal decoration of the home is needed and plans are already in place to action this. There needs to be better support from senior management to help ensure the manager completes the NVQ Level4 training. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 54 Beechcroft Gardens Version 1.10 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 Standards Statutory Requirements Identified During the Inspection 54 Beechcroft Gardens Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Admission to the home is managed in a way that ensures prospective service users- including the current residents- are made fully aware of how their needs will be met through the assessment process and the guide to the home. EVIDENCE: All standards were inspected and the evidence indicated that each of the current service users living at the home were given adequate information about the home, the services offered, information about staffing and support, plus invited to visit and spend time before the decision was made to move in. Comprehensive and individualised care needs assessments were also carried out for each service user with input from relevant parties involved in their lives. Reviews and improvements are now been carried out with the introduction of the Person Centred Planning (PCP). The home also provides each user with a contract of terms and conditions of their residential tenancy. 54 Beechcroft Gardens Version 1.10 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Each service user contributes to the development of their care planning. This is reflected in their positive life experiences at the home. EVIDENCE: All standards were inspected and the findings indicated the mission statement of the home accurately reflected the level and types of services and support offered at the home. The service users’ guide is well written and in a style and format that is understood by the users, including the strategic plan and annual report. There was also adequate information that tells service users how to make the most of life in the home. Each of the current service users had the opportunity to visit the home and spend time there before moving in, including day and weekend visits. Multi-disciplinary assessments and reviews were also carried out before a decision made whether to offer a place. The process also involved input from the families, friends and next of kin of service users. 54 Beechcroft Gardens Version 1.10 Page 11 PentaHact is now instigating a new style of care plans for service users-Person Centre Plan (PCP). This aims to capture the holistic needs of each user, including key and social worker assessments with updates. Risk assessments plus management strategies are in place to deal with behavioural difficulties experienced by service users including anxiety triggers, personal care support, guidelines for working with each user, plus managing life outside the home. Each care plan had a section entitled: ‘My Health Action Plan,’ with pictorial aid about individual user’s health care assessments, medical appointments, letters of communication with various health agencies and professionals plus medical reviews and updates. There were signed contracts in place for each user, outlining the terms and conditions of service, the licence agreement for shared housing between service users and PentaHact. room sizes, facilities at the home, assessed care needs and support to be provided, fees and charges, rights and responsibilities, plus monthly care plan reviews and updates. Each plan was signed and dated by individual users and the home’s manager. 54 Beechcroft Gardens Version 1.10 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Service users enjoy a varied, fulfilling and healthy lifestyle in the home and local community that is reflective of their individual assessed needs and the quality of care support. EVIDENCE: Each service user is encouraged to develop a Life Book and is supported by staff to record important events in their daily lives. One service user showed her Life Book to the inspector and stated how pleased she was with the progress she has made. It contained a range of personal events, work history, relationship with friends, learning experiences, travels and special events such as her birthday celebrations. Service users are fully supported by staff to live lives that reflect individual styles and preferences. Each user is also encouraged to develop a Life Book to document their life stories. Service users are also supported and encouraged to maintain links and contacts with their friends and families. 54 Beechcroft Gardens Version 1.10 Page 13 Each service user had a variety of friends of their own choosing and there was evidence that active contact with friends and relatives were active and appropriate. The inspector observed staff knocking on service users’ room doors before entering. The service users reported they felt respected and listened to by staff and were satisfied they had choices in the types of meals they have, clothing they bought and holiday places to visit. The inspector observed staff listening and talking with service users in a respectful and attentive manner, plus reminding one user of certain boundaries and house agreed rules. The users informed the inspector they had full input in decisions about menu and meal planning. Staff confirmed the menu operates on a 4 weekly rota system but is subject to change according to the needs and preferences of service users. There was up to date recording of all foods consumed by service users plus monitoring records of each user’s nutritional and dietary intake. The kitchen environment was clean, orderly and accessible with documentation of foods in use, opening and used by dates. 54 Beechcroft Gardens Version 1.10 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The health care needs of service users are adequately assessed with good links, support and access to a range of health care services. EVIDENCE: The evidence examined by the inspector showed that the care needs of each service are adequately assessed and staff are able to offer personal and individualised support to each user. The inspector’s observation plus the evidence examined indicated service users are offered choices and opportunities to voice their needs and wishes. Each service user has a Personal Health Care Plan. The plans have clear and up to date information about service users’ health, emotional and physical assessed needs. The plans also outlined how the needs will and are being met. There are also recorded information and communication inputs from health and social care professionals. The medication policy and procedural guidelines have been reviewed and revised since the last inspection. In addition, each staff has completed appropriate basic training in the handling and administration of medication. At least three staff completed the training between 2004/5. Two other staff who
54 Beechcroft Gardens Version 1.10 Page 15 completed the medication training in 2003 are now planning to update their knowledge and competence in this area. The evidence examined by the inspector and confirmed by the manager and a care staff indicated no service user self-medicates at the home. The home has a communication book used by staff to record when medication was delivered. The inspector advised that staff should also record the quantities received in this book. The evidence examined by the inspector also showed that appropriate recording of unused medication is made with arrangements for safe return to dispensing pharmacist. The home received an inspection by the local community pharmacist every 3 months. The most recent inspection report seen by the inspector indicated overall satisfaction by the pharmacist about administration of medication at the home. The inspector was satisfied that appropriate practices are followed by staff when dealing with the illness of any service user. Verbal examples were given of proactive and prompt actions taken to address service users’ ill health. The staff and service users also have good links with the local GP surgery located within walking distance of the home. PentaHatch also has updated policy and procedural guidelines outlining the way staff are expected to deal with death and dying of a service user. The manager discussed with and showed examples to the inspector of agreements service users had with their relatives about funeral arrangements. 54 Beechcroft Gardens Version 1.10 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Services users at the home are provided with adequate apportunities and support to have their views and input into all issues at the home. The users welfare and safety are also protected by the homes staff recruitment policy. EVIDENCE: The evidence examined by the inspector verified that service users’ concerns, complaints and protection are appropriately listened to, managed and promoted. Service users have regular house meetings at which relevant issues are discussed, reviewed and action plans arranged. There are also regular staff meetings, team managers’ meetings and reviews. The home has a complaints book. Examples of complaints made by service users were recorded including action plans and outcomes. Service users were also given copies of their complaints written in appropriate format and style with pictorial communication to ensure understanding by the users. There were clear and appropriate guidelines in the Statement of Purpose/Service Users’ Guide and each service users’ folder about the complaints procedure. The evidence examined in service users care files verified that each user knew how to make verbal complaints or seek input of staff and others. The home verified that application has been made to the local MENCAP advocacy service in Brent on behalf of service users. However, there is currently a waiting list but staff expect to receive a positive response within the next few months.
54 Beechcroft Gardens Version 1.10 Page 17 The manager showed the inspector copies of each staff Criminal Records Bureau (CRB) checks and results. These were satisfactory and up to date. There were also satisfactory references on file for each staff plus documented records of training undertaken in adult protection issues for example. The inspector was satisfied that a risk/behavioural assessment was completed for each service user with ongoing monitoring of daily interactions and behaviour patterns for each user. 54 Beechcroft Gardens Version 1.10 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The service users live in a homely enviroment that is well maintained, clean and hygenic. EVIDENCE: The home is a detached bungalow located in a residential area and is similar in style to many houses in the street. It is within 10 mins walk from Wembley Park tube station with easy access to shops, supermarkets, leisure and social amenities and services. The home was well maintained and accessible for wheel chair users. It has undergone renovation of some rooms with plans to carry out additional renovation. The home has a well-maintained garden that is used frequently by the service users. The home also has appropriate security measures. Bedrooms are decorated to individual preferences, styles and choice of furnishing. Each has a hand washbasin. There is a main bathroom with shower and toilet, plus an additional toilet for the 3 users. 54 Beechcroft Gardens Version 1.10 Page 19 There is also an average size kitchen, utility room, lounge and dining area. There is no special adaptation at the home but one resident uses a walking stick. 54 Beechcroft Gardens Version 1.10 Page 20 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The staff are caring, supportive, skilled and demonstrated good insight and understanding of the needs of each service user. EVIDENCE: The evidence examined by the inspector indicated a stable staffing structure that benefits the service users. The inspector was satisfied the service users are fully aware of the staff roles at the home, including the key workers’ role. The inspector viewed updated evidence of individual staff job descriptions, tasks and responsibilities. The inspection findings indicated that at least 4 staff have either completed or currently doing NVQ2 and 3. The manager is also doing the NVQ4 but could do with additional support from senior managers to complete this. The training records examined showed that staff have completed training undertaken in first aid, health & safety, food & hygiene, medication, protection of vulnerable adults and sexuality and relationships. The manager successfully passed the PentaHact competency assessment test for mangers in February 2005. This will be reviewed in September 2005. 54 Beechcroft Gardens Version 1.10 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The service users benefit from having their views and ideas incorporated into management and development plans for the home, including promotion and protection of their health, safety and wellbeing. EVIDENCE: The findings indicated the home’s Statement of Purpose advises the service users of the professional background and experiences of the manger and staff. The manager has been working in residential and social care for about 8 years and demonstrated competency, knowledge, ability in her role. The manager showed the inspector evidence that demonstrated service users have been and are consulted about services and development at the home. The recorded evidence also verified that the individual rights of service users are respected, enhanced and promoted through various means, including right to make decision about who they invite to visit them at the home and their rights as local citizens entitled to vote and access community services.
54 Beechcroft Gardens Version 1.10 Page 22 These and other rights and responsibilities are outlined clearly and appropriately in care plans, the guide to the home and in the policies and procedures documents. The findings also showed examples of good practices and consistency in record keeping and documentation. There was evidence of health and safety checks plus monitoring been carried out for each service user. The Person In Charge must ensure that the monthly monitoring visits are carried out on time and reports written and copies sent to the Commission as required by the Care Standards Act 2000/ National Minimum Standards. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x x 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 24 25 26
Version 1.10 Score 3 3 x
Page 23 54 Beechcroft Gardens Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 3 x
Score 27 28 29 30
STAFFING 3 x 3 3 Standard No 11 12 13 14 15 16 17 3 x x x 3 3 3 Standard No 31 32 33 34 35 36 Score 3 2 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 3 2 54 Beechcroft Gardens Version 1.10 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA32 Regulation 18 Requirement Timescale for action 30 July 2005 2. YA43 26 The registered provider must ensure the manager receive adequate support to complete the NVQ care managers training. The registered provider must 30 July ensure the Person In Charge 2005 carries out the monthly monitoring visits to the home. Copies of the report must also be sent to Commission. 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 32 Good Practice Recommendations The registered provider should ensure that all staff are trained to develop their understanding and knowledge of Person Centred Care Planning. 54 Beechcroft Gardens Version 1.10 Page 25 Commission for Social Care Inspection 4th Floor, Aspect Gate 166 College Road Harrow, Middlesex HA1 1BH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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