CARE HOME ADULTS 18-65
Bali Hai Residential Care Home 14/16 Southbourne Grove Chalkwell Park Westcliff On Sea Essex SS0 9UR Lead Inspector
Nicola Dowling Unannounced Inspection 6th August 2007 10:00 Bali Hai Residential Care Home DS0000015419.V347766.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 Bali Hai Residential Care Home DS0000015419.V347766.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. Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Bali Hai Residential Care Home Address 14/16 Southbourne Grove Chalkwell Park Westcliff On Sea Essex SS0 9UR 01702 479867 F/P 01702 479867 Telephone number Fax number Email address Provider Web address Name of registered provider Name of registered manager Type of registration No. of places registered (if applicable) Mrs Vijay Luxmi Rattan Mrs Vijay Luxmi Rattan Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. No more than 12 service users with a mental disorder, excluding learning disability or dementia, to be accommodated. The age of the service users will be between 18 and 65 years. Date of last inspection 22nd August 2006 Brief Description of the Service: Bali Hai is a large domestic house providing care and accommodation for up to twelve residents in six single and three double rooms. There are two lounges available one of which incorporates a dining area. There is a small garden. The smoking room and laundry room are accessed through the garden. The cost of care at Bali Hai ranges from £286.45 - £672.66. Bali Hai is situated near Chalkwell Park and is close to all local amenities and services. The home is decorated, furnished and maintained to a satisfactory standard. There are no requirements for a passenger lift. Disabled access for visitors is limited to the ground floor. There is no allocated off road parking but this is normally easy to find in the immediate locality. Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The key inspection site visit took place over a seven-hour period on one day. The site visit consisted of a tour of the home, talking with staff and residents, observing the care given and reading of documents. Most of the residents were seen and three were spoken to. The manager and deputy manager were both present at the inspection. In addition nine survey forms were received back from service users and the Annual Quality Assurance Assessment (AQAA) form also used to contribute to the report. The inspector would like to thank the staff and residents for their help and hospitality during the visit. What the service does well: What has improved since the last inspection? What they could do better: Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 Page 6 Some personal information about service users is not kept private and confidential. Areas of the home are worn and are due for renewal. For the safety of the service users hot water temperatures should be better monitored. 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. Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 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 Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have good information about the home and are cared for by staff that have a good awareness of mental health needs. EVIDENCE: The manager or deputy manager of the home undertakes an assessment of the service user before they are admitted to the home. There was documentary evidence to support this. This information is held securely in the service user’s individual file. A service user confirmed that with the help of their social worker they researched the right home for them and that they were part of this process. The residents also have an individual placement contract with the funding authority. They also receive a contract of residence with Bali Hai. Both contracts are in text format and had been signed by the service user. The staff at the home have the skills to meet the needs of the service users. For example there are experienced staff that have worked with people with mental health problems for some years. These members of staff hold an NVQ qualification in care and have also received training in various mental health conditions Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have a good plan of care and are supported to take decisions about their daily life. Personal information about service users is not always kept private. EVIDENCE: Service users at this home all have a care plan and there was evidence to support this. Three of the four service users remembered having discussions with their key-workers. Care programme approach documentation was evident on file and reviews are held with residents care co-ordinators. The home also cares for people from different race backgrounds. Respecting the diversity of the service users in the home the staff ensure that all service users views are listened to and their individual preferences acknowledged. For example regular one-one key-worker meeting provide a forum for such discussion. Service users are encouraged to take as much control of their lives as is possible. For example some service users manage their own finances. Other
Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 Page 10 service users are supported by staff to budget their money. However the service user maintains the choice on how they spend their money. For example on the day of inspection one service user went out to the shops and brought a CD for themselves. Staff enable service users to take responsible risks. For example service users have the freedom to leave the home whenever they choose. The staff have taken the precaution of detailing service users appearance and dress. The staff can then take prompt action if needed to notify the police if a service user does not return when they say they will. Staff spoken to are aware of the meaning of confidentiality and how this is practiced. However service users personal information was seen pinned to a general notice board. The manager was made aware of this and after discussion agreed to remove it from general view. Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have a balanced and varied diet and lead an active yet routine lifestyle. EVIDENCE: Most of the residents have a structured week where they attend day centres run by Rethink. Service users have their own free bus passes and make their own way to the various centres. Service users confirmed this before they left for the day. One service user commented on how much they “loved” going to the day centres. For those that stay at the home daily life skills are undertaken with the staff. For example food preparation in the kitchen. The home has arranged for a holiday to Wales for all the service users in September this year. The service users also have access to trips planned by the day centres, by the home and what they arrange for themselves. For example recent trips were, out on a picnic, which service users said, was “nice” and also on a cruise ship from Southend to Tower Bridge. Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 Page 12 Staff are respectful of service users privacy and were observed knocking on service users bedroom doors before entering. Service users confirmed that their post is handed directly to them. Service users have access to all areas of the home and staff were observed interacting with them in a friendly way. Visitors are welcome. Staff support service users to maintain contact with their families, for example using the home phone. There was a mixed view about the food. Not all service users liked the menu choices. The staff address this matter regularly and ensure that each service user is asked about their likes and dislikes. Drinks and snacks are available between meals and service users were observed to help themselves. Although there are service users from different race backgrounds no special diets have been requested. Over the weekend the service users had a Barbeque choosing burgers over other foods. Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are involved in their health care that is managed well. EVIDENCE: A district nurse called to see one service user during the inspection. The service user was seen in the privacy of their own room. Most service users manage their own personal care and their style of dress reflects their personalities. Support is offered to those service users who need prompting with personal care and this is documented in the care plan. Service users spoken with were aware of their key-worker’s name and said that they saw them regularly. One service user commented, “My wishes and best interests are always respected” There is a Community Psychiatric Nurse linked to the home to provide nursing care. There was evidence of visits from social workers that have made comments on the “professionalism of staff” and that “care is of a consistently high standard” Service users attend their own health care appointments and staff will go with them if needed or requested. The service users health is monitored by the staff and by other professionals. For example weight records are kept up to
Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 Page 14 date and members of the community mental health team regularly review service users mental health. The home have medication policies in place and staff have received training in this subject. The medication at the home is regularly audited by Boots. Medication is stored safely. One service user self medicates and demonstrated what they had to do. Checks are in place to ensure that medication is not missed. Three other medication records were checked and were up to date. Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. There are satisfactory policies and procedures in place to protect residents. EVIDENCE: The home has a complaints procedure that is accessible to the service users. Service users were able to say whom they would speak to if a problem arose. There have been no official recorded complaints since the last inspection. The staff like to deal with the problem as soon as it arises to stop any problems escalating. One service user commented that I am made to feel “welcome to voice my concern”. Staff spoken with are aware of adult protection policies and procedures. There have not been any reported incidents at this home. The home do not use restraint preferring de-esculation techniques. Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 Page 16 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable homely environment. EVIDENCE: The premises are safe, comfortable and meet the needs of the service users. Service users spoken to were happy with their rooms. However some rooms are more inviting than others. This was discussed with the manager who reported that service users bring their own furniture and choose this over new furniture provided by the home. One bathroom had a faint odour, whilst in another the shower needed cleaning. This was discussed with the manager who agreed to address this in the maintenance plan. Areas of the home are worn and need replacing such as the hall and stair carpets. However service users commented that they feel “comfortable” in the home. The home is situated near to local transport and shops making them easy for the service users to use.
Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 Page 17 Generally the home is clean and tidy. The laundry area is accessible to all service users. Some do their own laundry while others rely on staff. Service users commented that there is no problem with the laundry service that they receive. The staff are aware of the importance of infection control and have received training on this topic. Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good staff team that are trained and fit to care for the service users. EVIDENCE: Recruitment documents were checked in three staff files. The required documents were all in place. The home has a thorough recruitment process to safeguard the service users and this ensures that staff employed are fit to care for vulnerable people. The home have a consistent staff team and do not employ agency or temporary workers. The service users knew the staff by their names and were observed to be comfortable in their presence. This familiar staff team enables continuity of care. One service user commented that staff “treat us with respect and care”. The manager reported that staff training is important. A new member of staff confirmed that they undertook an induction to the home. Also that they are training for a National Vocational Qualification (NVQ) in care. Other staff Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 Page 19 confirmed that they had received training in mental health and infection control as well as an NVQ in care. From the AQAA form the manager reported that emphasis is placed on teamwork and good communication. There was evidence that staff attend meetings and that there is a handover procedure to ensure staff on duty are fully informed about the service users care. Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. The home is managed and run well with the best interest of the service users in mind. EVIDENCE: The manager/proprietor has worked in the residential care setting for a number of years and has the experience to run the home well. The manager takes an active part in running the home and has an “open door” approach to staff and service users. A random selection of safety certificates was inspected. The gas and electrical certificates were up to date. There was evidence of fire safety records. Hot water temperatures are monitored however on the day of inspection the hot water in service user areas was over 50 degrees Celsius. The manager was informed of this immediately and agreed to look into this.
Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 Page 21 The manager undertakes a quality assurance system to gain feedback from service users and other professionals about the service that Bali Hai provides. The responses have been positive with comments such as “satisfied with care” and “Good relations with staff”. One outcome from the quality assurance review is that service users want to go on more cinema trips. This is an activity that the home can arrange and will give service users something to look forward to. Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 Page 22 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 3 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 2 x Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 Page 23 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 YA10 Regulation 17(1)(b) Requirement The registered person must ensure that service users private information is held securely. This relates to service users date of birth, GP, social worker and Community Psychiatric Nurse details that are pinned to a general notice board in the lounge area of the home. The registered person must ensure that odours in the bathroom are expelled. The registered person must ensure that hot water temperatures are safe for the service users to use. Timescale for action 05/10/07 2 3 YA30 YA42 16(k) 13(4) 05/10/07 05/10/07 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 Bali Hai Residential Care Home DS0000015419.V347766.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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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