CARE HOME ADULTS 18-65
Beattyville Gardens (116) Diamond Lodge 116 Beattyville Gardens Ilford Essex IG6 1JZ Lead Inspector
Harina Morzeria Unannounced Inspection 19 April 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beattyville Gardens (116) G55_S0000025887_Beattyville Gdns_V223946_190405_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Beattyville Gardens (116 Address Diamond Lodge, 116 Beattyville Gardens, Ilford, Essex IG6 1JZ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8503 9411 020 8550 4511 Norwood Ravenswood Ms Johannah Diffley CRH Care Home 6 Category(ies) of LD Learning disability (6) registration, with number of places Beattyville Gardens (116) G55_S0000025887_Beattyville Gdns_V223946_190405_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Residents with mild to moderate learning disabilities Date of last inspection 18 November 2004 Brief Description of the Service: Diamond Lodge is a care home registered to look after six younger adults with learning and physical disabilities. It is run by Norwood, a not for profit Jewish organisation. Hence, the ethos of the home is based around Jewish beliefs, customs and faith. The home is situated in a residential location, close to the local shopping area, providing easy access to all local amenities, nearby leisure facilities and transport services. Service users have mild to moderate dependency needs. They are cared for in suitably adapted premises and all service users occupy their own single rooms, which are well furnished and decorated. All service users are supported by the manager and staff to maintain their independent living skills, attend college for various courses as well as accessing community facilities locally as well as at the John Steiner Centre (Jewish Community Centre) in Barkingside. Activities are organised both within the home and within the local community, and service users are encouraged to attend college, day centres and local clubs. Personal care is provided on a 24-hour basis, and healthcare needs are met by staff supporting service users to attend appointments with health professionals. Beattyville Gardens (116) G55_S0000025887_Beattyville Gdns_V223946_190405_Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced. It started at 9.30am and lasted for six hours. The inspector spoke to four service users during the course of the day and attended the staff meeting in the afternoon following which, a group discussion was held with staff present at the meeting. The registered manager was present during the visit. A tour of the home took place and a number of staff and care records were inspected, as well as individual service user files. What the service does well:
The standard of the décor, furnishings and fittings are well maintained with an on-going refurbishment programme in place. This provides the service users with an attractive and comfortable place in which to live. The home supports the service users to exercise choice and control over their lives in order to promote their independence. The routines of daily living and activities available are flexible and varied, to suit each young person’s expectations, preferences and capacities. The service users said that they are asked about issues that affect them in the home and are kept informed about any changes and events that take place. Regular discussions and meetings also take place with the service users as well as relatives’ meetings. All necessary healthcare services are accessed for service users in order to meet their assessed and specialist needs. Each service user has a weekly programme of activities outlined in an activity plan. Hence, the service users are supported by staff to attend college, going to the gym, library and attending activities provided at the John Steiner Centre, as well as going to the cinema, restaurants and pubs locally with the staff during the evening. Visiting times are flexible and visitors are welcome at any reasonable time. Beattyville Gardens (116) G55_S0000025887_Beattyville Gdns_V223946_190405_Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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. Beattyville Gardens (116) G55_S0000025887_Beattyville Gdns_V223946_190405_Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Beattyville Gardens (116) G55_S0000025887_Beattyville Gdns_V223946_190405_Stage 4.doc Version 1.30 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 standard(s) 2, 3, and 4 Prospective service users’ individual needs are assessed and new service users would only be admitted on the basis of a full assessment undertaken by people who are trained to carry out assessments. Their family members and representatives are also involved in the assessment process. New service users are informed that they will only be offered a place in a home which can meet their needs. After a meeting to discuss the placement, the new service user is given an opportunity to visit the home and stay there for a trial period, before they decide if they want to live there permanently. EVIDENCE: There have been no new admissions to this home since October 2003. However, the inspector was satisfied that at the time of the previous placement, the service user and his family were informed about the home and services provided within the home. A full assessment of his needs was carried out by professionals before a placement was offered to him on a trial basis. The manager made sure that the special equipment he needed was in place before he came to live in the home. There was evidence on service user files that service users’ needs are reassessed regularly and care plans are updated if their needs change. Family members and other professionals involved in the care of each individual service user are fully consulted and involved.
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The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 Each service user has an individual care plan called - Individual Personal Plan (IPP). This outlines the service users’ needs and personal goals. Service users are consulted about their lives and encouraged to make independent decisions as far as possible. Appropriate risk assessments are in place for activities undertaken by the service users in order to promote their independence. EVIDENCE: As stated above, each service user has an Individual Personal Plan, which outlines the service user’s individual needs and how these will be met. The inspector looked at the Individual Personal Plan for three service users living in the home and noted that each plan outlines each service user’s needs and how these are met. Service users spoken to said that they are given choices and asked by staff about what they would like to do on a daily basis. All service users knew who their key workers were and said that they would talk to them or the manager if they had any problems. During the inspection, the inspector noted that the staff asked service users what they would like to do during the evening, confirming choices that they would have made previously and being flexible enough to change plans if the service user decided not to go ahead with any plan previously agreed.
Beattyville Gardens (116) G55_S0000025887_Beattyville Gdns_V223946_190405_Stage 4.doc Version 1.30 Page 11 There are comprehensive risk assessments for all the different activities that service users take part in and the service users are supported by staff to carry out their chosen activities, within this framework. Daily records showed that staff write what the service user has done every day which reflects their care plan and daily activity plan. The IPPs are also re-assessed and updated to reflect any changing needs. Beattyville Gardens (116) G55_S0000025887_Beattyville Gdns_V223946_190405_Stage 4.doc Version 1.30 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 16 and 17 Service users have opportunities for personal development and are able to take part in age, peer and culturally appropriate activities. The home is particularly good at being able to meet the cultural and religious needs of people from a Jewish background. Service users are encouraged to engage in appropriate leisure activities within the local community. Their rights are respected and responsibilities are recognised in their daily lives. Service users enjoy their meals and are asked on a daily basis to choose from the menu, which they have already agreed. They often help the staff to prepare meals. Special diets are catered for, especially the provision of Kosher diets, in line with Jewish faith and customs. EVIDENCE: The daily routine is set by the activities that the service users are involved in which are outlined in their daily activity plan. The service users confirmed that they do the activities that were listed on their activity plans. It also showed
Beattyville Gardens (116) G55_S0000025887_Beattyville Gdns_V223946_190405_Stage 4.doc Version 1.30 Page 13 that these routines promote individual choice and freedom of movement. Service users also talked about going out to the pub, the cinema and restaurants as well as outings with the staff on a regular basis. Service users showed the inspector photographs of a holiday abroad that they had all been on last year and were planning a similar holiday this year. Most of the service users’ families are closely involved with them and their daily lives in the home and therefore have a lot of input into what happens in the home. The families also take them out for outings, weekend stays at home, as well as on special occasions. One service user, when he arrived at the home, was considerably over weight, needing special equipment. The staff in the home have supported him greatly through a diet and exercise regime by offering a healthy diet and activities that he enjoys, resulting in a vast reduction in his weight, hence improving his health condition. The inspector is impressed with the way in which the staff have worked hard in assisting the service user to maintain his healthy lifestyle. Beattyville Gardens (116) G55_S0000025887_Beattyville Gdns_V223946_190405_Stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 Service users receive personal support in the way that they prefer and require. The daily records also show that the service users’ physical and emotional health needs are met appropriately within the home. The organisation has reviewed their medication administration policy and procedure and all the staff have now received updated medication administration training. EVIDENCE: Through case tracking and inspection of daily records and discussions with staff and service users, the inspector is satisfied that the service users’ health is well monitored and any problems identified are dealt with quickly by taking the person to the doctor in the first instance and follow up action taken promptly if required. Each service user has a designated key worker, who ensures that they receive the support and advice they need quickly. The records confirmed that service users are seen by dentists, opticians, chiropodists, district nurses and doctors. A record is maintained of current medication for each service user and all the staff working in the home have received updated medication administration training. None of the service users administer their own medication.
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The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 The home has a satisfactory complaints’ policy and procedure and service users said that their views are listened to. They said that they would be able to tell their key worker or the manager if they had any problems. All the staff working in the home receive training in Adult Protection/abuse awareness to ensure a proper response for reporting any suspected or witnessed abuse. EVIDENCE: There is a written policy and procedure for the protection of vulnerable adults and all newly recruited care staff receive abuse awareness training during their induction training. The staff spoken to as part of the inspection process confirmed that they have received training regarding this and were clear as to their responsibilities to report any potential abuse and what the reporting lines should be. The home adopts the organisational complaints’ procedure, which is also available in a picture format for people who cannot read well. There have not been any complaints logged since the last inspection. All complaints are recorded, as well as details of any investigations carried out plus the outcome of the investigation, within set timescales. Beattyville Gardens (116) G55_S0000025887_Beattyville Gdns_V223946_190405_Stage 4.doc Version 1.30 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 standard(s) 24, 25, 26, 27, 28, 29 and 30 Service users live in a homely and comfortable environment. Bedrooms, communal areas and toilets and bathrooms meet their needs and promote their independence. Shared spaces are spacious and sufficient for the numbers of people living in the home. Specialist equipment is available for those service users who require it. The home is clean and hygienic. EVIDENCE: The house is in keeping with other properties on the street and a tour of the premises showed that it is decorated and furnished in a homely manner. The lounge area has recently been re-painted and a new settee suite was recently purchased. Service users were involved in choosing this. All the service users occupy single rooms, which are nicely decorated and contain their personal possessions, reflecting their individual choices and personalities. All the service users spoken to said that they liked their rooms and were comfortable and safe in them. One of the downstairs bedrooms has an en-suite bathroom and this room has been allocated to a service user who requires specialist bathing equipment to maximise his independence.
Beattyville Gardens (116) G55_S0000025887_Beattyville Gdns_V223946_190405_Stage 4.doc Version 1.30 Page 18 All parts of the home were clean and tidy and so were the bathrooms and toilets. There is a small garden at the back of the house accessed via the kitchen and the dining room. Some of the paving on the pathway in the garden is broken and cracked, requiring urgent attention before the garden is safe for some of the service users to access. The manager has taken steps to limit access to the garden and a risk assessment is in place. See Requirement No. 1. Beattyville Gardens (116) G55_S0000025887_Beattyville Gdns_V223946_190405_Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36 All staff have job descriptions which clearly outline their roles and responsibilities. Staff are competent and sufficiently experienced to carry out their tasks. Staffing levels are satisfactory and there are sufficient staff on duty to meet the individual assessed needs of the service users. There is an organisational procedure for the recruitment of staff, which is robust and provides safeguards for people living in the home. EVIDENCE: The home now has a relatively stable staff group. In discussion with staff, it was evident that they fully support the main aims and values of the home. Staff have developed a good knowledge and understanding of the Jewish culture and faith via the induction and ongoing training provided by the organisation. The information on the duty rota was consistent with the names and delegations of staff on duty. Service users said that the staff are kind and caring towards them and know what they need.
Beattyville Gardens (116) G55_S0000025887_Beattyville Gdns_V223946_190405_Stage 4.doc Version 1.30 Page 20 The manager informed the inspector that only one vacancy exists now which they hope to fill soon. There is only occasional use of peripatetic staff, who are familiar with the service users in the home and therefore are aware of their needs and how to meet these. Staffing records examined showed that, following recruitment, they are required to attend the organisation’s induction training, after which, certificates showed that staff continually attend on-going training and receive support and supervision from the management, enabling them to carry out their jobs efficiently. Staff members spoken to confirmed this. Beattyville Gardens (116) G55_S0000025887_Beattyville Gdns_V223946_190405_Stage 4.doc Version 1.30 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38 and 39 The home is being managed well by the current manager, who is sufficiently experienced, qualified and competent to run the home and meets its stated purpose, aims and objectives. EVIDENCE: The current manager has been in post in this home since the past six years and has the qualifications and experience to run the home well by providing a safe environment and making sure that the health, safety and welfare of the service users is met by the staff working in the home. Staff spoken to said that they receive a lot of support and encouragement from the manager, which helps them to carry out their jobs competently. However, some staff expressed dissatisfaction with the wider organisational structure and procedures which they felt were inhibiting them. The inspector has informed the manager to address this with the staff and individual staff members were advised to raise these issues during their supervision sessions in order to work out strategies for support to tackle these issues. The
Beattyville Gardens (116) G55_S0000025887_Beattyville Gdns_V223946_190405_Stage 4.doc Version 1.30 Page 22 inspector attended a staff meeting where issues were openly discussed and staff were informed by the manager of any changes and recent developments and their views were sought about these. Following the staff meeting, the inspector was able to hold a group discussion with the staff group, when some of the above concerns were expressed. The inspector was satisfied that there is a good level of monitoring being carried out by lay monitors working within the organisation, who regularly undertake visits and who are representatives of relatives in the Parry Group (a group of parent representatives). A rabbi also visits the home on a monthly basis in order to assess that the home operates within Jewish laws. Inspection of a sample of records showed that regular tests to emergency lights and fire alarms had been carried out. An auditor appointed by the organisation also carries out regular financial audits and evidence of the latest visit carried out was seen by the inspector which was satisfactory. However, the inspector still remains concerned that monthly Regulation 26 visits are not being carried out by the Responsible Individual. Although the frequency of the visits to the home has improved, these visits are still not being carried out monthly. These reports are necessary to demonstrate that the registered providers have in place satisfactory systems for monitoring the welfare and safety of service users, and to ensure that the service is operating in accordance with its aims, objectives and legal requirements. This requirement has been repeated over the previous inspections and must be fully complied with, otherwise Enforcement action will be taken by the Commission for Social Care Inspection to secure compliance. See requirement No. 2. Beattyville Gardens (116) G55_S0000025887_Beattyville Gdns_V223946_190405_Stage 4.doc Version 1.30 Page 23 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 3 3 3 x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Beattyville Gardens (116) Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 2 x x x x G55_S0000025887_Beattyville Gdns_V223946_190405_Stage 4.doc Version 1.30 Page 24 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 24 Regulation 13 Requirement The manager to ensure that the paving in the garden area is repaired to ensure service users safety at all times when using the garden. The registered person must ensure that the monthly monitoring by the Responsible Individual is caried out and the reports forwarded to the inspector promptly. (timescale of 30/04/04 not met). Timescale for action 31/07/05 2. 39 26 30/06/05 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 Good Practice Recommendations Beattyville Gardens (116) G55_S0000025887_Beattyville Gdns_V223946_190405_Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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