CARE HOME ADULTS 18-65
Beacon Way (3) 3 Beacon Way Rickmansworth Hertfordshire WD3 7PQ Lead Inspector
Louise Bushell Unannounced Inspection 19th October 2005 10:30 Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 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 Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 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. Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Beacon Way (3) Address 3 Beacon Way Rickmansworth Hertfordshire WD3 7PQ 01923 896579 01923 896579 beaconway@walsingham.com 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) Walsingham Tammy Louise Finch Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (6), Physical disability (1) of places Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th January 2005 Brief Description of the Service: 3 Beacon Way is a two storey semi detached house that ha been extended and converted to accommodate up to six service users who have a learning disability. The accommodation comprises of a lounge, dinning room, additional small lounge, kitchen, laundry, toilet and an office that provides sleeping facilities for the person sleeping in. On the ground floor there is also a single occupancy bedroom that can support a service user with a physical disablement. There are five bedrooms on the first floor together with a bathroom, shower room and an additional toilet. The home is situated in a sought-after residential area of Mill End on the out skirts of Rickmansworth. There is a small parade of shops and a local pub near by. A local bus service connects with Rickmansworth town centre and a railway station. Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first unannounced inspection of the inspection year and was conducted mid morning to early afternoon. The majority of time was spent with one service user, seeking his views and opinions about the home. An agency worker was on duty throughout the inspection and provided some valuable information to support the process. This was a positive inspection with a number of the key inspection standards being assessed. Currently there are only four service users residing at Beacon Way with two vacant beds. Referrals have been received and the assessment processes are underway. The manager and permanent staff were not present throughout the Inspection so limited information was gathered, however, through case tracking and further research suitable evidence was gathered to determine the sound management of the home in the service users best interest. What the service does well:
There are many area’s from those inspected in which the service performs well. Following the last inspection a new care planning system has been introduced which focuses on the needs of the service user being at the centre of the provision of care. The system is based on the principles of person centred planning. Progress and implementation of the documents that support the care plan are in place to identify and highlight individual goals of each service user. These are then reviewed periodically. Whole life reviews occur and this ensures that the goals are reviewed in the best interest of the service users. Service user meetings occur once a month with external input and pictorial minutes available for inspection. Internal residents meetings are also conducted to ensure that the views and opinions of service users are sought. Walsingham provides a detailed and well-structured induction and foundation training to all new staff. This is also linked with the National Vocational Qualification and the Learning Disability Awards Framework (LDAF). Inspection of these documents provided evidence that mandatory training sessions are provided to all new staff as well as key training, which is service user specific. Feedback from the agency member of staff determined that she had received an induction prior to working with the service users and had specific training to ensure she was able to meet their individual needs. There is also a “need to know” file in place for bank and agency workers which details key facts regarding the procedures in house and the specific needs of the service users. During the inspection staff were observed to support all service users in a respectful and dignifying manner ensuring that they were respected at all times. The relationship between staff and service users appeared balanced. Care plans and assessments are well structured with a clear system in place for effective reviewing and goal setting with each service user. The home clearly strives to support, develop and maintain each service users daily living
Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 Page 6 skills and encourages independence. Through the tracking of one service users plan it was clear that support and advice had been provided for them to gain employment in the past and now work based training / experience. The service users also appear to have positive community links and are able to access the community independently or with appropriate support. Good systems are in place for the management of risk with service user and generic risk assessment being well organised and structured to encourage the taking of controlled risks. All controlled substances that are hazardous to health are locked away and each material has a data sheet detailing the actions to be taken in an event of an accident. Service users are regularly consulted with in many forms, monthly service user meetings occur on site, there is also a service users forum which those interested can attend with support as required. Walsingham actively encourage the positive involvement of service users and a newsletter and personal letters are circulated to all informing them of significant changes in the company. An annual establishment business plan is in place and has been reviewed to highlight the development plans for the home. The documents show clearly that service users have been involved throughout the process. What has improved since the last inspection? What they could do better:
Areas identified as requiring further works and action are as follows; The manager must complete an entire internal and external audit of the decoration, equipment and furniture. Internally the home is in need of redecoration. Many areas have chipped paintwork and much of the decoration is dated and looking tired and worn. Specific area’s requiring close attention are the main hallways both upstairs and downstairs, the small hallway between the kitchen and lounge and the downstairs toilet. The two bathrooms upstairs require some minor works on the grouting around the seals to the bath and the shower tray as the tiles have become mouldy. Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 Page 7 The kitchen is need of replacing / revamping and redecorating. A number of cupboard doors are missing from the kitchen and the work surfaces are worn and could pose as an issue for infection control and cross contamination of foods. All individual care plans must be reviewed and signed by to ensure that a clear implementation date is known, with any changes shown. Personal contact sheets must be completed. Goals sheets must be completed in accordance with the new care planning and goal setting system used. All service users must have a completed inventory on file, which is an active working document, updated and reviewed. On the day of the inspection an immediate requirement was left with regards to the kitchen door being propped open. This was remedied on the day. 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. Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 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 the following standard(s): 5 Each service user has a written contract stating the terms and conditions of their residency, thus empowering each service user to have the protection of their individual rights. EVIDENCE: The contract includes the terms and conditions within the home and the rights of the service user. The contract is in a pictorial format and clearly outlines the rights and responsibilities of the service users. The format used allows the service users to have an opportunity of understanding. The document details all areas required under the National Minimum Standards. Each service user is supported to sign their contracts and have an understanding of the information held within. Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 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 the following standard(s): 6, 7, 8, 9 & 10 Individual needs and choices within the home are being promoted to encourage and empower service user self-determination, participation and consultation. Individual needs and choices are reflected in the service user care plan ensuring changing need and goals are reviewed, met and developed. EVIDENCE: Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 Page 11 All service users have an individual care plan and an allocated key worker to support them. Individual daily notes and guidelines for the service users were observed. All service users are supported within the Care Management Framework and frequent Whole Life reviews occur to ensure changing needs are continuously assessed and reviewed. The ethos within the home promotes that the care plans of each individual are owned by the individual. Currently the management, staff and service users are still working on the new care planning system introduced to ensure and develop a person centred approach to all work. The system appears to be effective as working document and focuses on service users individual goals and aspirations. Once fully operational this will be effective. Consultation is key; service users are supported trough external advocacy groups. Service users meetings are held once a month and minutes were available for inspection. Additional meetings also occur with support from the advocacy groups. Service user satisfaction questionnaires are produced twice yearly, further seeking the views of the service users. Walsingham Community Care also encourages attendance at the service user forums that take place. Thus encouraging feedback and consultation at all stages. Walsingham actively encourage the positive involvement of service users and a newsletter and personal letters are circulated to all informing them of significant changes in the company. An annual establishment business plan is in place and has been reviewed to highlight the development plans for the home. The documents show clearly that service users have been involved throughout the process. All information within the home is handled with care and respect. All personal notes and files detailing information on the service user are locked away. Each service user has a multitude of risk assessments completed with their individual involvement where appropriate. Some service users have also signed the risk assessments where able. The risk assessment system in place is effective and ensures that infringements do not occur without detailed records and evidence supporting the notion. Risks are regularly reviewed and support service users in taking risks as part of an independent life style. Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 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): 11, 12, 13 & 17 Personal development opportunities are encouraged for all service users ensuring interactions within the local community and that individual rights and responsibilities are recognised and supported. EVIDENCE: Inclusion into the local community is encouraged thus enabling integration into community life. Service users attend a variety of different day centres and colleges accessing courses suitable to their individual needs and aspirations. Discussions with the service users with support from staff determined that they have a variety of day activities to be involved within. Following case and file tracking it was clear that inclusion and integration into community living is encouraged. Service users are supported as appropriate to access the community independently. One service user has recently resigned from his part time job and is now accessing community based work experience and training sessions. The service users have has access to transport. Staff support and encourage all service users to maintain and develop social, emotional, communication and
Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 Page 13 independent living skills. The involvement and encouragement of the service users in a variety of tasks was observed throughout the inspection. The home is centrally located, and is within a short distance from shops and the local community amenities. The home values and seeks to reflect racial and cultural diversity of service users through celebration of, and awareness of different cultures, religions and festivities. During the inspection staff and service users were observed to interact equally with one another. Service users are supported appropriately to take part in activities. Individual needs, choices and preferences appear to be always considered. Service users access the local community services frequently and visit the local area, enjoying going out for lunch and shopping. Menu’s were on display and demonstrated that service users are offered and supported in choosing a healthy, well balanced and nutritious diet. Support and advice as required is gained from a dietician. Choices are actively sought with the menu and service users are able to express their preferences in the service users meeting. Daily choices are always available with alternatives available at all times. Service users were observed being actively offered choices throughout the inspection. Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 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): 19 & 21 Service users physical and emotional health needs are met, thus ensuring that the manager and staff actively and appropriately support the service user to take control of all health care issues. EVIDENCE: Clear and concise information was available in each service users care plan to demonstrate the internal systems in place to empower, monitor, record and support the provision of meeting all service users health care needs. Records were observed in service users files determining the issues as they arise and the support that they have received. A number of specialist referrals have been made by the staff, ensuring that monitoring systems are in place so that potential problems are identified and dealt with at an early stage. All service users are offered and / or supported in receiving a minimal annual health checks. All personal and health care support is well maintained ensuring individual needs, choices and preferences are met at all times. All care provided is individual and tailored to each person, with service users needs, choices and preferences being promoted. Ageing, illness and death of a service user appears to be handled with respect and dignity. Each service user has a pictorial plan in place, which describes their personal wishes in such an event of illness and death. The plans are good working examples of actively trying to seek the views of the service user,
Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 Page 15 whilst supporting them and giving them an opportunity to understand the process. Some of the plans were completed and held on the files, whilst others where still in the process of being completed. It is recommended that these are completed to ensure service users wish’s are expressed and documented to empower and dignify their individuality. Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 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 & 23 The complaints procedure within the home is sufficient and adequate in order for the service users to feel that their individual views are listened too. Staff receive training in adult protection procedures enabling them to make an accurate and clear response to abuse issues, there is a need for the remaining staff to complete this training. EVIDENCE: A comprehensive complaints procedure is in place, which details that all complaints are responded to within 28 days. A record of complaints is maintained detailing actions and outcomes as necessary. All service users have been informed about the complaints procedure. This is also on display within the home. The complaints procedure is a good example of a clear record system, detailing the complaints, and the actions that have been taken to resolve the issue. Service users feedback that they are able to raise any issues and concerns with the staff at all times. The ethos and culture promotes an open transparent approach to complaints. Service users stated that they are listened to and appropriate actions are taken. Detailed induction and foundation training is available and completed by all staff regarding adult protection issues and protocols. There is a need for those staff who have not yet completed the external training to do so to ensure a base line awareness of the entire team at all times for the support and protection of the service users. Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 Page 17 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, 28 & 30 Service users live in a homely, cosy environment. However there is a need for the home to complete an internal audit of all decoration to ensure that a plan for renewal and redecoration is in place to maintain a safe and comfortable environment. EVIDENCE: At the time of the inspection the home was comfortable and domestic in scale and style and was fully accessible to service users. However, given the ages of the majority of the service users, Walsingham needs to give serious consideration to the long-term development of the home. Five bedrooms were on the first floor with one on the ground floor. There are no bathroom facilities on the ground floor. Although a significant volume of internal redecoration and replacement works is required, it must be noted that in general it is well presented and the service users commented that they feel at home. The general communal areas are bright, airy and free from any offensive odours. The general cleanliness of the home was maintained to a satisfactory standard. Carpets in some of the communal areas require replacing. The kitchen is need of replacing /
Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 Page 18 revamping and redecorating. A number of cupboard doors are missing from the kitchen and the work surfaces are worn and could pose as an issue for infection control and cross contamination of foods. Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 Page 19 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): Standards not inspected on this occasion. EVIDENCE: Standards not inspected on this occasion. Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 41 & 42 The home is well managed, thus ensuring that all service users are provided with a quality service individually tailored to meet needs. Systems for effective health and safety management are in place, works are still required within the home to ensure the safety is maintained. EVIDENCE: The staff and management of the home have implemented effective systems to ensure that the changing needs of all services users are being met. The manager is qualified and competent to run the service in meeting its stated purpose, aims and objectives. Many of the records required by regulation are well maintained, up to date and accurate. There is a need for the manager to ensure that all inventory details and personal details are in place in each service users files. Once fully completed the details and the records held relevant to the service users are a good example of an effective, well maintained and managed system. Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 Page 21 Risk assessments are well organised and are empowering of the service users taking and experiencing acceptable and managed risks. There is a need for the kitchen to be refitted, refurbished and redecorated to ensure that the safety standards can be maintained. Cupboard doors were missing from the units and the work surfaces were tired and very worn, which could give rise to increased risk in infection control and cross contamination with food preparation and storage. Fire doors must not be propped open with means other than those recommended by the fire authority. This was addressed at the inspection. Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X 3 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X X X 2 X 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Beacon Way (3) Score X 3 X 2 Standard No 37 38 39 40 41 42 43 Score 3 X X X 2 2 X DS0000019279.V261427.R01.S.doc Version 5.0 Page 23 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 2 Standard YA23 YA24 Regulation 18 (1) (a) 13 (6) 23 (2) (b) Requirement All staff must attend adult protection training. A renewal and redecoration plan must be in place with all works required actioned with a plan of works with reasonable working time scales. It must include renewal of the kitchen, redecoration and worn carpets. Works are required for the replacement, renewal, refurbishment and redecoration of the kitchen. (See also Regulation 23 (2) (b) ) All personal details pertaining to the service users records must be current, complete and up to date. An inventory must be completed for each service user. Fire doors must not be propped open other than by means recommended by the fire authority. Timescale for action 28/02/05 25/11/05 3 YA42YA30YA28 13 (4) (a) & (c) 28/02/05 4 YA41 17 (1) (a) 15/12/05 5 YA42 23 (4) (c) (iii) 19/10/05 Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 Page 24 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 YA6 Good Practice Recommendations The registered person should ensure that service users sign to say they have been involved with and agree with their care plan. The registered person should ensure that the service users care plan records the success or otherwise of goals / targets. (These recommendations have been carried forward from the previous inspection). The registered person should continue to develop and refine the confidentiality agreement for service users. It may be advisable to consider tying it in with the service user contract and / or a Walsingham Families Charter. The registered person should continue to complete the documents regarding to the wishes and the plans of the service users when they pass away. 2 YA10 3 YA21 Beacon Way (3) DS0000019279.V261427.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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