CARE HOMES FOR OLDER PEOPLE
Beacon Way (3) 3 Beacon Way Rickmansworth Hertfordshire WD3 7PQ Lead Inspector
Marian Byrne Key Unannounced Inspection 10:00 7th and 12th March 2007 X10015.doc Version 1.40 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.V332703.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 Older People. 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.V332703.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Beacon Way (3) Address 3 Beacon Way Rickmansworth Hertfordshire WD3 7PQ 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) 01923 896579 01923 896579 FP beaconway@walsingham.com 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.V332703.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th February 2006 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.V332703.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out over two site visits by one inspector. Four service users were present at some time during the inspection. The inspector spoke with three members of staff all supplied by an agency. There were no permanent staff on duty on the first day of the inspection. On the second day there were two permanent staff members on duty. The Manager was on annual leave. What the service does well: What has improved since the last inspection? What they could do better:
The staffing in the home must be address as a matter of urgency. On the day of the first inspection the home was staffed by staff supplied by an agency. The Registered Manager and her line manager were both on annual leave at the time of the inspection and one member of staff was on long term sickness.
Beacon Way (3) DS0000019279.V332703.R01.S.doc Version 5.2 Page 6 There was one other permanent member of staff in the home. Rota’s showed that there were many days where there was only agency staff on duty. When the inspector arrived at the home, a service user opened the door. He was closely followed by a member of staff who looked at the inspector and then walked away. The inspector was given full access to the home and the service users without her identity been asked for or checked. There were two service users in the home at that time. The inspector asked the member of staff why he did not check her identity he was unable to answer but later said that he was providing one to one care for one of the service users. This means that the other service user was left unattended. The home was very dirty and unkempt. The carpet in the sitting room was very stained. The shower rooms were stained and had overflowing bins. The service users rooms were uncared for and very dusty. Two were poorly furnished. One contained a chair that was stained with a substance that could be associated with incontinence. One room did not have any curtains. One service users had an alarm by his bed and door. This was held in place by placing a mat over it and attaching the mat to the floor with brown parcel tape. The carpet was blue. There were sheets hanging over doors drying and clothes drying on the radiators in the small sitting room. The home was cluttered with objects stored in corners of rooms and on the landing. One newly admitted service user was concerned that a bulb was flickering and he was unable to switch it off as he is frightened of the dark. The units in the kitchen had doors missing. The kitchen was locked to prevent one service user, who was said to have poor hygiene, from gaining free access to food in the fridge. There was no soap or paper towels in the kitchen. Care plans inspected did not contain sufficient information. For example a recently admitted service users was said to be an ‘unknown quantity’ due to his previous life style and the assessment recommended that there were two staff with him. He returned from visiting his mother in a care home accompanied by an outreach worker. He was then in the home with one staff member and two other service user one who was having one to one care. 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. Beacon Way (3) DS0000019279.V332703.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beacon Way (3) DS0000019279.V332703.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments are carried out by the home. EVIDENCE: The assessment are carried out and service users have an opportunity to visit the home prior to moving in. Beacon Way (3) DS0000019279.V332703.R01.S.doc Version 5.2 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans did not contain sufficient information to ensure the safety of the service users or staff. Service users health care needs are not fully met. Service users were not treated with respect, their right to dignity and privacy was not upheld. EVIDENCE: One service user assessment stated that due to his previous life style that his needs and his temperament were unknown. He was known to have been aggressive in a previous residence. Because of this he should have two members of staff when he goes out. He was out on the day of the inspection with one outreach worker. When he returned from his outing he was in the home with two other service users (one of whom staff member told the inspector was having one to one care) and one member of staff. This member of staff took his own food in from home and ate it the dining room where he was out of sight of the service user he was assisting on a one to one basis. Throughout the inspection the inspector did not once observe him engage the
Beacon Way (3) DS0000019279.V332703.R01.S.doc Version 5.2 Page 10 service users in any form of conversation or any interaction. One service user did not have curtains in his room. His room was facing out to the front of the home and towards a public road. The general dirty and unkempt state of the home did not show that the service users were being respected. There was a high turnover of agency staff in the home, thus making continuity of care difficult for the service users. The administration of medication appeared to be in order. Beacon Way (3) DS0000019279.V332703.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of continuity of staff makes the goal of enabling service users to achieve their optimum lifestyle impossible. EVIDENCE: One service user who had lived in isolation with his mother for many years lived an usual lifestyle in so far as he sleeps in a chair at night. His room contained two chairs and nothing else. The staff in the home on the day were unable to show the inspector a care plan that would assist him to move to a more conventional lifestyle or what, if any, effects sleeping in a chair would cause him. Because of this man’s background it had been decided that he couldn’t use the kitchen safely, the kitchen was now locked to all service users for a trial period. The risk assessment on this stated that staff should ensure that service users should have full access via staff to the kitchen at all times. At the time of the inspection there was one member of staff on duty providing one to one care for one of the service users making it impossible for him to be aware of the needs of the other service users. When the inspector inspected the kitchen there was neither soap or paper towels for staff and service user to ensure hygiene despite lack of hygiene being cited as one of the reasons that
Beacon Way (3) DS0000019279.V332703.R01.S.doc Version 5.2 Page 12 the service users could not use the kitchen freely. There were no visitors at the time of the inspection, as already stated one service users was taken by on out reach worker to visit his mother in a residential care home. Another service user was at college, because she was accompanied by an agency member of staff they had to use public transport to get back to the home. Though not particularly far, this is not a straightforward journey and took a very long time. The inspector did not observe meal times. Beacon Way (3) DS0000019279.V332703.R01.S.doc Version 5.2 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users were not protected from abuse. EVIDENCE: The inspector entered the home and had free access without anybody checking her identity. One service user was having one to one care leaving two other service users without anybody to meet their needs. One of these was a service user who was described and an unknown quantity that had been aggressive at a previous residential home. Beacon Way (3) DS0000019279.V332703.R01.S.doc Version 5.2 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment was not suited to the care of vulnerable service users. It was not clean, pleasant or hygienic. EVIDENCE: The environment of the home was very dirty and unkempt. The carpet in the sitting room was very stained. The shower rooms were stained and had overflowing bins. The service users rooms were uncared for and very dusty. Two were very poorly furnished with no personal effects. One contained a chair that was stained with a substance that could be associated with incontinence. One room did not have any curtains. One service users had an alarm by his bed and door. This was held in place by placing a mat over it and attaching the mat to the floor with brown parcel tape. The carpet was blue. There were sheets hanging over doors of the small sitting room drying, there were also
Beacon Way (3) DS0000019279.V332703.R01.S.doc Version 5.2 Page 15 clothes drying and on the radiators in the small sitting room. The home contained clutter it was stored in corners in rooms and on the landing. One newly admitted service user was concerned that a bulb was flickering and was unable to switch it off. His care plan stated that he is frightened of the dark. The units in the kitchen had doors missing. The kitchen was locked to prevent one service user who was said to have poor hygiene from gaining free access to food in the fridge. There was no soap or paper towels in the kitchen. Beacon Way (3) DS0000019279.V332703.R01.S.doc Version 5.2 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staffing of the home does not meet the service user’s needs. EVIDENCE: The home is reliant on temporary agency staff to meet the needs of the service users. On the day of the inspection there were only temporary agency staff working. Staff rotas revealed that this was not unusual. The permanent staff include the Registered Manager and two care staff one of whom was on sick leave. The Registered Manager and her line manager were both on annual leave, leaving one permanent member of staff to meet the needs of the service users. There is no core of staff who know the service users well. There were no new staffing files to inspect. Staff spoken told the inspector what training they had however there was no way of evidencing this. As already stated in this inspection report service users were not considered to be in safe hands at all times. Beacon Way (3) DS0000019279.V332703.R01.S.doc Version 5.2 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not well managed and is not run in the best interests of the home. EVIDENCE: On the day of the inspection the manager was on annual leave as was her line manager. One member of staff was on long term sickness leaving one permanent member of staff available to service users. The home is staffed by agency staff. This is not acceptable and must be addressed. As the staff change it is not possible for the ethos of the home to be recognised this would indicate that the home is not run in the best interests of the service users. This home is for people who have a learning disability two of the service users repeatedly asked the inspector who was going to be there all night.
Beacon Way (3) DS0000019279.V332703.R01.S.doc Version 5.2 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 x COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 1 1 X X X X X X 1 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X X X X 1 Beacon Way (3) DS0000019279.V332703.R01.S.doc Version 5.2 Page 19 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 OP19 Regulation 23 (2) (b) Requirement 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. This time scale will not be extended further. This requirement was not met, failure to meet this requirement could lead to a notice of legal action being taken. Arrangements should be made in a timely manner for repair and maintenance of equipment in general or individual use to ensure its continued safety. This standard was not inspected on this occasion. 3 OP7 15 (2)(b) The Registered Manager must ensure that care plans contain sufficient information and instruction to staff to ensure that the service users needs and
DS0000019279.V332703.R01.S.doc Timescale for action 30/04/07 2. OP19 23(2)(n) 30/06/07 15/04/07 Beacon Way (3) Version 5.2 Page 20 4 OP8 5 OP10 6 OP12 7 8 OP13 OP14 9 OP18 10 OP19 wishes are met in full. The Registered Manager must ensure that the health care needs of the service users are met. 12(4)(a) The Registered Manager must ensure that the dignity of the service user is upheld at all times. 12(2) The Registered Manager must ensure that service users are assisted to take part in age, peer and culturally appropriate activities. 16(2)(m) The Registered Manager must ensure that service users are part of the local community. 12(2) The Registered Manager must ensure that the service users are encouraged to exercise control and choice in their lives. 13(4)(c) & The Registered Manager must 13(6) ensure that service users are protected from potential abusive situations at all times. 23(2)(b) The Registered Manager and the Registered Provider must ensure that the home is well maintained. 12(1)(a) An immediate requirement was left on this. The Registered Manager must ensure that the home is clean at all times. An immediate requirement was left on this. The Registered Manager must ensure that the home is staffed with permanent skilled staff. The Registered Manager must ensure that service users are in safe hands at all times. The Registered Provider must ensure that the home is well managed and run in the best
DS0000019279.V332703.R01.S.doc 15/04/07 12/03/07 15/04/07 15/04/07 15/04/07 15/04/07 07/03/07 11 OP26 23(2)(d) 07/03/07 12 13 14 OP27 OP28 OP30 OP31 OP33 18(1)(a)& (b) 18(1)(c)& (i) 12(1)&(5) 30/04/07 30/04/07 30/04/07 Beacon Way (3) Version 5.2 Page 21 15 OP38 12(i) interests of the service users. The Registered Manager must 07/03/07 ensure that the health and safety of the service users is maintained at all times. 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 Beacon Way (3) DS0000019279.V332703.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Hertfordshire Area Team Capital Park Fulbourn Cambridge CB21 5XE 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
© 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 Beacon Way (3) DS0000019279.V332703.R01.S.doc Version 5.2 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
