Inspection on 13/06/06 for Ashfield House

This inspection was carried out on 13th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashfield House 15/05/07

Ashfield House 28/11/06

Ashfield House 10/01/06

Ashfield House 21/06/05

Ashfield House 09/12/04

Ashfield House 28/09/04

Ashfield House 29/06/04

Ashfield House 26/05/04

Ashfield House 16/12/03

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Bell House 105 Ashley Road Ashley New Milton Hampshire BH25 5BL Lead Inspector Liz Palmer Unannounced Inspection 13th June 2006 10:15 Bell House DS0000012384.V294873.R02.S.doc Version 5.1 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 Bell House DS0000012384.V294873.R02.S.doc Version 5.1 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. Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Bell House Address 105 Ashley Road Ashley New Milton Hampshire BH25 5BL 01425 619256 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) Bell House Homes Ltd Mrs Jillian Ann Haughey Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th January 2006 Brief Description of the Service: Bell House is a care home providing personal care and accommodation for service users with a learning disability who may also present challenging behaviours. It is owned by Bell House Homes Ltd, a subsidiary of Allied Care Ltd, which has a number of other registered properties in the area. The home is located on the outskirts of the town of New Milton, and with relatively easy access to the shops and other public amenities. The home comprises a detached, double fronted property with care parking for 4 vehicles to the front of the building and a well-maintained and accessible garden to the rear. All bedrooms are occupied on a single basis, and seven of these have an en-suite facility. There is a lounge with a television easily accessible to service users, and a separate quiet lounge and dining room. The home also has another room that is available for use by service users for recreational activities. The fees range from £954 to £2260 per week. Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place between June 13th 2006 and July 10th 2006. Two visits were made to the home where the inspector spent a total of 7.5 hours. A partial tour of the premises was undertaken, four service users were met, two were spoken to about the home and three were observed engaging in activities with staff. Care plans, risk assessments, policies, procedures and other documents were sampled. Over the course of the inspection, three staff, the registered manager and the area manager were spoken to. Two care managers and three other professionals were also spoken to and gave their views on the home and their opinion of care being given to service users. What the service does well: What has improved since the last inspection? Some areas of the home have become more accessible to service users due to one person leaving. Staff say the atmosphere in the home is calmer and that service users get treated well. Service users continue to be encouraged to get involved in the running of the home. Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 6 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. Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for ensuring prospective service users’ needs are assessed to ensure they can be met before offering them a place in the home. EVIDENCE: There have been no new service users admitted to the home since the last inspection. At the last inspection three new service users had moved in and the standard was assessed and met. During this inspection the manager explained the procedures for new admissions and the importance of receiving enough information about prospective service users to ensure their individual needs can be met in the home. The manager stated that other professionals would need to be involved for example, care managers, clinical psychologists and clinical psychiatrists where necessary. Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 9 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 the following standard(s): 6, 7 and 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A more consistent and person centred approach to care planning, risk assessing and intervention strategies would ensure service users individual and changing needs were fully met. EVIDENCE: Three care plans were looked at, some improvements have been made but more detail needs to be added, for example, one stated that support was needed with washing and dressing but it did not state exactly what support was needed. One care plan showed some evidence of a person centred approach, this would benefit all service users. Staff spoken to said they had a key worker system in place but they had not received training in person centred planning, this would benefit all care staff to support their key service users. Two of the care plans had been reviewed recently and showed evidence of service user involvement. One showed no evidence of a review since April 2005, or any evidence of service user involvement. One care plan stated the Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 10 personal goals of a service user and how they could be worked towards. Recorded evidence showed that the actions had been followed through once then appeared to stop. Another goal had been followed through twice, there was no record of whether this had stopped because it had been achieved or not. Staff spoken to said they felt things often started but were not followed through. They also said they did not get enough information to support service users’ individual needs, for example, meetings with other professionals were not always fed back to key workers. A clinical psychologist, previously involved in the care of one service user, last year, said they did not have confidence that the home could draw up and follow detailed care plans without professional input. A care manager also expressed concern about the consistency in care and care plans being followed through for another service user. Risk assessments were looked at in respect of three service users. Some risk assessments had recently been reviewed and others had not. Some were not dated. One service user was noted to have had no review since April 2005. There did not appear to be a consistent approach to reviewing risk assessments. There was evidence of service user, relatives and care managers’ involvement in some cases but not in all. Some risk assessments were linked to physical interventions. Clear photographic guidelines were seen and staff spoken to were able to describe the techniques they had been trained to use. Training had been provided to staff by an external company who have applied but not yet been approved for accreditation by the British Institute of Learning Disabilities (BILD). Physical intervention guidelines were in place for one service user although no incidents indicating the necessity for these have been reported to the commission. One of the techniques described in the physical intervention strategy as a last resort was a ‘thumb press’. This involved staff exerting pressure with their thumb on the thumb of the service user. Two staff members spoken to could describe how this was done and when it should be used as stated in the guidelines. When discussed with the manager she was unaware this technique was part of an intervention strategy and stated that to her knowledge had not been used by the home. This document had come with the service user from a previous home in the same organisation. The manager also stated that since the service user had moved into the home, three months ago, no incidents requiring physical intervention had occurred. A risk assessment on this service user stated the risk from her to other service users was high. A requirement for the risk assessments and physical interventions to be reviewed and updated to reflect the service users actual needs has been made. A clinical psychologist who has previously been involved with this service user said they were surprised that physical intervention was needed and would not recommend it for this service user. The person’s care manager was spoken to and was unaware of the physical intervention strategy. Clear reasons why an intervention strategy is needed must be in place and Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 11 consistent guidelines need to be in place to ensure service users are supported in a positive way. One service user is under a guardianship order and requires one to one staff support. No detailed guidelines of his one to one support were available for inspection. Three staff spoken to had differing opinions of his one to one needs. One stated it was only when he was outside the home. Others stated that they were unclear as to what the guidelines were for when the service user was in his bedroom. Recently, an alleged incident with potential risk to another service user was reported to the commission. The incident occurred whilst the service user was alone as the staff member working with them went to the toilet. The manager stated that the service user should not have been left alone even for a brief time. The service users care manager stated the service user needs one to one staff support at all times. There were no written guidelines for staff to work to. The incident could have been avoided if a clear protocol for working with this service user was in place. During the second visit to the home a protocol for one to one working was seen to be in place. More detail is still needed to fully meet this persons needs. This was discussed with the manager. Guidelines for this service user state that a risk assessment is carried out before the service user goes out of the home. The manager stated that this is a mental risk assessment carried out by the staff working with the service user at the time. The manager agreed that a written record of the risk assessment would better protect the service user and staff. There was some evidence of service users being able to make decisions about their daily life, for example, minutes of a house meeting showed someone requesting to visit an airport and transport records showed that this trip had been undertaken. One service user said they could choose things like, what time they went to bed and whether or not to join in an activity. Staff confirmed that service users are continuing to be encouraged and supported to make choices and that the atmosphere in the home was much calmer as a result. Bell House DS0000012384.V294873.R02.S.doc Version 5.1 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 the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements for opportunities for social activities, community access and support with relationships are in place, however this is limited by staff levels. Daily routines increasingly encourage service users’ to express their opinions however rights would be better respected if individual wishes and choices were more readily met. EVIDENCE: A structured activities programme was in place for service users. Recorded evidence showed that there were opportunities for people to go out and engage in activities, some of which reflect their personal preferences and individual choices. However, evidence suggested that some outings and in house activities were arranged in groups. One member of staff said this did not always address individual needs and preferences but rather reflected lack of staff availability to offer alternative activities. Another said that individual preferences are taken into consideration but it is not always possible to meet individual needs and activities often take place in groups of up to four people. Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 13 Examples of the activities offered to service users include, college courses, health and fitness, arts and crafts, communication, walks, trips to the pub, domestic duties such as cooking and shopping. During the first visit one service user was supported to use local shops, another was supported to attend a college course and another was involved in cooking the lunch. One service user spoken to said they were happy with the activities offered and in particular enjoyed cooking. Evidence of service users being supported by staff to maintain relationships with families and friends was seen. They are also supported to attend sessions with professionals involved in their care. The menus reflected a variety of food being offered. Service users’ choices made at the house meetings showed involvement in the planning of meals. Evidence of service users being able to participate in preparing and cooking meals was seen. Personal preferences were recorded in care plans and a healthy diet is encouraged. For example, one service user has requested to lose weight and a reducing diet has been put in place for them. No religious or cultural dietary needs are currently catered for but staff said they were aware of such issues and would take them into account if they arose in the future. Bell House DS0000012384.V294873.R02.S.doc Version 5.1 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 the following standard(s): 18, 19 and 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users’ personal support needs and physical and emotional health needs would be better met if a consistent approach to reviewing and implementing care plans was in place. Procedures for storing and administering medication protect service users. As required medication must be reviewed to ensure it is being administered as intended. EVIDENCE: Some care plans set out the personal support needed by individual service users. There was evidence of service users being supported to choose their own clothes, for example, and one service user said he can choose what time he goes to bed and gets up in the morning. However, there was no evidence of a robust system for regularly reviewing care plans. Evidence was seen of some service users being supported to attend GP appointments, dental checks and opticians and to attend appointments with other professionals. However, some staff expressed concern about health issues being followed up. One member of staff said they had been highlighting Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 15 a health issue for one service for six months before anything was done about it. They gave another example of where a health issue had not been followed up for another service user. They said concerns about residents are not always looked into and things get forgotten about. Discussions with other professional and evidence included under ‘Individual Needs and Choices’ shows that service users physical and emotional needs are not always met. The home uses a monitored dosage system, provided by a local pharmacy. Records seen were up to date and accurate. Medication was seen to be suitably stored in a locked cupboard within a lockable office. There is a general policy for how medication should be administered. This is clear and detailed and staff were observed administering the medication to service users as per the policy. Two members of staff said they had received training from the local pharmacy, one was ‘shadowing’ other staff at the moment and would not administer until they have been assessed by the manager. A requirement was made at the last inspection for ‘as required’ medication to have clearly documented doctor’s guidance written up for staff to follow. A policy for one individual’s ‘as required’ medication was seen to have been drawn up and staff spoken to were familiar with the details of the policy. The manager stated that the policy follows the doctor’s guidelines but they had refused to sign it. Details of doses were seen on the MARS sheet, as per the prescription. An error on the policy for administering one person’s medication was noticed, this error stated an incorrect maximum dose. It was corrected during the inspection. The manager stated that one individual had been prescribed their ‘as required’ medication by a consultant psychiatrist who had reviewed it at the beginning of June 2006. There was no record of this. When spoken to, this consultant said they had not prescribed this medication nor had they reviewed it. They said they had had some contact about 18 months previously but that was not about medication. A requirement for ‘as required’ medication to be reviewed for this service user was made. Bell House DS0000012384.V294873.R02.S.doc Version 5.1 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 the following standard(s): 22 and 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users would be better protected if correct procedures for reporting events detrimental to their well being were followed at all times. Service users would be better protected if issues of extra charges for transport were resolved. EVIDENCE: A complaints procedure is available to service users although no complaints from service users have been made to the home. One service user said he had no complaints but would tell staff if he had any. Since the first visit of this inspection a service user made an allegation of physical assault by a member of staff to someone outside the home, so it is not fully evident that all service users are able to make their concerns or complaints known. Ways of making the complaints procedure more accessible to service users were suggested in the last report, this must be looked into by the manager. A requirement has been made. Staff spoken to said they had received training in adult protection and whistle blowing. The home has policies in place for staff to follow. The manager is aware of reporting events under regulation 37 to the commission. A recent incident picked up during the first visit had not been reported. During the second visit an incident of potential abuse from one service user to another was seen in a service users daily diary. This had not been reported. The manager said she was sure she had sent a regulation 37 Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 17 report to the commission but could not find a copy. She said she had reported it to the care manager of the alleged perpetrator and to a duty care manager on behalf of the alleged victim. The care manager mentioned said she had no knowledge of the incident and there was no record of it being reported to a duty officer. As it was a potential adult protection the care manager followed it up with the home manager who stated that the incident had not actually occurred but that it had been recorded in the daily diary that the service user had tried to do something to another service user but was distracted by staff. The care manager requested a copy of the diary sheet which the home could not find. When pressed for the diary sheet it was found and the incident had been recorded as having happened. A requirement has been made for all incidents detrimental to the well being of service users to be reported to the commission. A requirement for all potential adult protection issues to be reported to social services has also been made. There is currently an ongoing adult protection regarding an allegation against a member of staff. Procedures are being followed and social services and the police are involved. At the last inspection a requirement was made for clear cut reasons for charging service users for transport to be recorded so that fairness was evident. This was discussed with the manager and some evidence of this being addressed was available. The information recorded does not address the issue of whether service users are paying amounts proportionate to how much they use the transport. Arrangements for charging service users are complicated as some people have it built into their contract and others are paying from their income. A requirement has been made for any charges made to service users that are extra to the terms and conditions to be clearly documented as to the reasons why and circumstances under which they will be charged. The manager stated that service users bank books were not available for inspection as their accounts are in the process of being transferred to another bank. This will be followed up at the next inspection. Bell House DS0000012384.V294873.R02.S.doc Version 5.1 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 the following standard(s): 24 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst the home is clean and well maintained the safety of service users in the home has been put at risk by procedures not being followed and areas considered to be dangerous being accessible to service users. EVIDENCE: Risk assessments are in place for the areas with restricted access, such as the kitchen and laundry. A partial tour was undertaken with the assistance of one of the service users. The laundry door was found to be unlocked, a sign on the door said it should be locked at all times. Staff confirmed the laundry should be locked and risk assessments on individual service users files also stated the laundry as a high risk area and clearly stated it should be kept locked at all times. A requirement has been made. During the first visit to the home a service user’s bedroom with an adjoining door to a vacant bedroom was found to be unlocked and the vacant room had a variety of decorating equipment left out. The room was in the process of being decorated and amongst the equipment left unattended were pots of Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 19 paint, a drill and a saw. An immediate requirement was made and this has since been addressed by the home. The issue of whether or not this door is needed as a fire exit should also be addressed by seeking advice from Hampshire Fire and Rescue Services. The home was seen to be clean and hygienic. Staff and service users confirmed that some restrictions on access to certain areas of the home had been lifted due to one service user leaving the home. The main kitchen is risk assessed as needing to be kept locked but service users have access to drink making facilities. They are also supported to cook in the main kitchen if they wish to. Service users were observed freely accessing the lounge, garden, dining room and quiet room. Bell House DS0000012384.V294873.R02.S.doc Version 5.1 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff would benefit from clarity of roles and responsibilities as well as regular support and supervision to carry out their roles. Staff receive adequate training on a range of topics but evidence found on physical intervention suggests not all training needs are met. EVIDENCE: Staff spoken to were not all clear about their roles and responsibilities and spoke of difficulties carrying out their roles due to poor communication and issues for service users not being followed through. The manager stated she has formal supervision with her staff 6 times per year, however two of the staff spoken to said they do not receive regular supervision from their line manager. They said they do not always feel well supported and one felt they should not have to ask for support. Both felt they did not always have enough information about individual service users to work consistently with them. They also said team meetings are ‘hit and miss’ and often get Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 21 cancelled. One staff member said they had received regular supervision and felt well supported. A requirement for regular supervision of all staff has been made. A training programme is in place which includes an induction programme, mandatory courses such as fire safety, basic food hygiene, health and safety and equal opportunities. Other training available includes medication, autism awareness, risk assessment and National Vocational Qualifications (NVQs). Of the eleven staff currently employed two have started NVQ level 3, three have started level 2 and two are signed up to start level 2 in September 2006. Some staff have also attended a four day conflict management course. Some staff had been trained in physical intervention by an external company. The training was specific to one service user who, as previously mentioned in the report, had not displayed any behaviour at the home which suggested they needed physical intervention. No new staff have been employed since the last inspection and the standard for recruitment has been met in the past so staff files were not examined at this inspection. Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Improvements in the management practices need to be made to the running of the home. Areas of concern include the procedures for reporting events which affect the health and welfare of service users. The home would benefit from better leadership, including consistency of information shared to staff. A system for auditing and reviewing and ensuring consistency of all care plans and risk assessments needs to be in place to ensure the health, safety and welfare of service users is in place. EVIDENCE: Incidents detrimental to the well being of service users that were found in service users’ daily records had not been reported to the commission. In one case adult protection procedures had not been followed. During the inspection Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 23 the manager stated she had reported this incident to social services but later stated she had not. Some members of staff and four external professionals who have had involvement in the home said they did not have confidence in the manager. Staff said communication was not good between staff and the managers, including senior managers in the organisation. Staff said their concerns were not always addressed. One care manager said they were satisfied with the care provided by the home although they had not recently visited the home or had contact with their client. The manager was unaware of an intervention strategy that staff had received training in for one service user which involved physical intervention techniques. The manager stated this technique had not been used nor was it necessary for the person but it had not been reviewed and removed from her file. Other evidence of out of date material was seen on service user files. Some care plans and risk assessments had not been reviewed and some were not dated so it was not possible to say if they had been reviewed or not. Areas of the home were found to be unsafe and therefore the health and safety of service users is not being maintained at all times. The pre inspection questionnaire states that regular health and safety checks are undertaken, for example, weekly fire alarm tests, temperature checks. There are contracts for electrical equipment and fire safety equipment to be serviced. Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 24 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 1 32 2 33 x 34 3 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 X 1 1 1 X X 1 X Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 25 Yes 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) (a) Requirement The registered person must ensure that all out of date care plans are reviewed and kept under regular review to reflect the changing needs of service users. This issue has been raised at previous inspections on 28/09/04, 9 and 10/12/04 and in a statutory requirement notice dated 12/01/05 The registered person must ensure that all out of date risk assessments are reviewed and are kept under regular review to reflect the changing needs of service users. Issues relating to this have been raised at previous inspections on 28/09/04, 9 and 10/12/04 and in a statutory requirement notice dated 12/01/05 The registered person must ensure that any service user who has been risk assessed as requiring physical intervention DS0000012384.V294873.R02.S.doc Timescale for action 31/10/06 2. YA9 13 (4) 31/10/06 3. YA6 12 (1) – (3) 31/08/06 Bell House Version 5.1 Page 26 has clearly recorded strategies which must be proportionate to the challenges they present. Issues relating to this have been raised at previous inspections on 9 and 10/12/04 and in a statutory requirement notice dated 12/01/05 The registered person must ensure that service users are able to make decisions and have their individual choices, wishes and feelings and addressed. Issues relating to this have been raised at a previous inspection on 9/12/04 and in a statutory requirement notice dated 12/01/05 The registered person must ensure that healthcare needs are assessed, recognised and addressed to ensure service users physical and emotional needs are met. The registered person must ensure that ‘as required’ medication is reviewed. 4. YA7 12 (2) (3) 31/08/06 5. YA19 12 (1) 07/08/06 6. YA20 13 (2) 01/08/06 7. YA22 22 (2) 8. YA23 37 This is an amended requirement from the inspection of 16/01/06 The registered person must 31/10/06 ensure that service users are provided with a complaints procedure they can use. The registered person must 01/08/06 ensure that all incidents detrimental to the well-being of service users are reported to the commission. The registered person must ensure that the home’s procedures are followed to DS0000012384.V294873.R02.S.doc 9. YA26 12 01/08/06 Bell House Version 5.1 Page 27 ensure that all incidents of potential abuse are reported under Adult Protection procedures. 10. YA23 20(1ab) The registered person must 01/08/06 ensure that any charges made to service users outside their terms and conditions, including for transport, are clearly recorded stating the reasons and circumstances under which they will be charged. This is an amended requirement from the inspections of 9 and 10/12/04, 21/6/05 and 16/01/06 11. YA24 13 (4) (c) The registered person must ensure that all areas of the home deemed high risk for service users must be made safe according the home’s risk assessment. 01/08/06 12. YA24 13 (4) (a) Issues relating to this have been raised at previous inspections on 9 and 10/12/04 and in a statutory requirement notice dated 12/01/05 The registered person must 01/08/06 ensure that a bedroom adjoining another service users bedroom must be free from hazardous equipment. Issues relating to this have been raised at previous inspections on 9 and 10/12/04 and in a statutory requirement notice dated 12/01/05 The manager must make arrangements for staff to be supervised to ensure they are DS0000012384.V294873.R02.S.doc 13. YA36 18 (2) 01/08/06 Bell House Version 5.1 Page 28 supported to do their jobs. Issues relating to this have been raised at previous inspections on 28/09/04 The manager, through 01/08/06 effective leadership must ensure procedures are followed to promote and review the health and welfare of all service users. Issues relating to this have been raised at previous inspections on 28/09/04, 9 and 10/12/04 and in a statutory requirement notice dated 12/01/05 14 Y A37 12 (1) and (4) 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 Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 29 Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 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 Bell House DS0000012384.V294873.R02.S.doc Version 5.1 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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