Inspection on 13/10/08 for Beaufort View

This inspection was carried out on 13th October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beaufort View 19/10/09

Beaufort View 26/10/07

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 19/12/2008.

CARE HOME ADULTS 18-65 Beaufort View 1 Beaufort Road Southbourne Bournemouth Dorset BH6 5AJ Lead Inspector Heidi Banks Unannounced Inspection 13 October 2008 08:20 th Beaufort View DS0000069692.V372874.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 Beaufort View DS0000069692.V372874.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. Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beaufort View Address 1 Beaufort Road Southbourne Bournemouth Dorset BH6 5AJ 01202 418877 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) beaufortview@tiscali.co.uk www.ventanahomes.co.uk Mr Henri Moocarme Mr Paul Anthony Greenwood Post Vacant Care Home 8 Category(ies) of Learning disability (8), Physical disability (6) registration, with number of places Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) - maximum of 8 places Physical disability (Code PD) - maximum of 6 places The maximum number of service users who can be accommodated is 8. 2. Date of last inspection 29th October 2008 Brief Description of the Service: Beaufort View was registered as a care home for up to eight people with learning and / or physical disabilities in June 2007. The home is owned by a partnership of four people who also own two other services for people with disabilities in the Bournemouth area. The home is an older-style detached property, in keeping with other properties in the neighbourhood, which provides accommodation on three floors. All bedrooms have en-suite facilities. There are three single bedrooms on the ground floor which are accessible to people who use wheelchairs. There are a further four single bedrooms on the first floor which can be accessed by a passenger lift or by stairs. The second floor, accessible only by stairs, has facilities for self-contained accommodation for one person including a bathroom and kitchen facility. A separate adapted bathroom facility is also available on the first floor which is equipped for people who have specific hoisting needs. Two separate toilets are also available for use. The home has a spacious lounge and conservatory which is also used as a dining room. The conservatory has patio doors which lead onto a paved garden area. There is a domestic-style kitchen and a laundry facility in a separate area outside the main house. Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 5 Beaufort View is situated in a residential area of Southbourne, close to local shops and amenities. A bus route to Bournemouth and Christchurch town centres is located nearby. People who use the service have access to an adapted vehicle to promote community access. There is parking for this vehicle in the home’s driveway. Fees charged by the home are based on assessment of individuals’ needs. According to information supplied by the Registered Manager in October 2008 the basic fee for the service is £973.75 per week. Further information on fair terms of contracts and care home fees can be found on the Office of Fair Trading’s website: www.oft.gov.uk. Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection of the service. The inspection took place over approximately 15.5 hours on 13th and 16th October 2008. The aim of the inspection was to evaluate the home against the key National Minimum Standards for adults and to follow up on the requirements made at the last key inspection in October 2007. At the time of the inspection people living at the home were aged between 19 and 60. This inspection was carried out by one inspector but throughout the report the term ‘we’ is used to show that the report is the view of the Commission for Social Care Inspection. For approximately 2.5 hours of the inspection process we were accompanied by an Expert by Experience from the National Centre for Independent Living. Experts by Experience is a project that involves people who use services in the inspection of those services. Their role as part of the inspection team is help us get a picture of the service from the viewpoint of people who use it. The Expert by Experience, Mr John Evans, who was accompanied by his personal assistant, spent time looking around the premises, observing life in the home and talking to the manager and a person who uses the service. His findings from the visit have been incorporated into this report. During the inspection we were able to meet all of the people who use the service and observe interaction between them and staff. Discussion took place with the manager of the home and some members of staff. A sample of records was examined including some policies and procedures, medication administration records, health and safety records, staff recruitment and training records and information about people who live at the home. Surveys were given to the home before the inspection for distribution among people who live in the home and those who have contact with the service. We received four surveys from people who use the service, six surveys from care workers, two surveys from health care professionals and one from a care manager. We received the home’s Annual Quality Assurance Assessment before the inspection which gives us some written information and numerical data about the service. A total of twenty-two standards were assessed at this inspection. Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? Risk assessments are now in place for people who use the service, generally giving clear information to care workers about the action they must take to keep people safe. Recording of people’s food intake had improved since the last inspection so that it is clearer how the home is meeting people’s nutritional needs. Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 8 The home’s complaints procedure has been reviewed giving the contact details for the Commission for Social Care Inspection. Since the last inspection of the service a practice evacuation has been carried out in the home involving care workers and service users to promote their awareness of procedures. This is important so that care workers know how to respond in an emergency. What they could do better: As a result of this inspection we are making seven requirements. Requirements are made in accordance with the Care Homes Regulations 2001 and are law. We are repeating requirements in relation to two regulations that have not been fully met within the stated timescales. One shortfall we identified at this inspection was in relation to staff training. This was made a requirement at the last inspection in October 2007 but has not been met. People who live in the home do not always receive support from care workers with enough training to fully meet their needs. The induction training that is available to staff is inconsistent and does not always meet the Common Induction Standards. In addition, only a minority of staff had received formal training in moving and handling, abuse awareness and total communication and not all care workers have received training in epilepsy. With regards to moving and handling this is of serious concern as people who use the service have complex needs in relation to their mobility and these must be met by people who have the relevant theory and practical training in this area. The manager is now taking action to ensure people receive moving and handling training in November 2008. However, it is of concern that these arrangements were not put in place within the given timescale of the last inspection. Action must be taken to ensure that care workers have all the training they need to be able to understand and respond to people’s individual needs and ensure their safety and welfare. We also made a requirement at the last inspection for the home to review their recruitment procedures to ensure that full and satisfactory information is obtained for all prospective care workers. This is to ensure that decisions to recruit staff are made based on robust information so that people who use the service are safe. The regulation has not been fully met in all cases and Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 9 therefore we are repeating this requirement. Again, it is important that the home addresses requirements made at inspection within the timescales given and ensures their recruitment practice is consistent. Medication practices in the home require review as some shortfalls have been identified where procedures are not robust enough to ensure that people receive the medication that they need and this is signed for appropriately. In addition, the home did not notify us of a medication error that occurred in the home. This must be done so that we are aware of all events in the home which have the potential to affect people’s well-being. Quality assurance systems are not fully developed in the home. There was no evidence at this inspection that the registered provider is carrying out formal visits to the home and producing a report on what they have found in accordance with the regulations. The home is developing surveys to obtain feedback from people who use the service but this has not been implemented as yet. More work needs to be done in this area to ensure that the service is identifying for themselves areas for improvement and addressing these promptly to improve outcomes for people who live in the home. We have also made twelve recommendations as a result of this inspection. Recommendations are good practice and should be given serious consideration by the provider to promote person-centred care based on best practice. 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. Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 10 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 Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 11 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home ensures that they have sufficient information about people’s needs before they move in to promote a smooth transition. EVIDENCE: We were told by the manager that in the past twelve months two people have transferred to Beaufort View from another home owned by the registered provider. The manager told us that the people concerned arrived with a support plan and information about their needs. We looked at the information for one person which included a detailed ‘life story’, an account of their daily support requirements, information regarding their health needs and about their likes and dislikes. We spoke to the person who told us that they had been able to visit the home before they moved in. When we asked them if it had been the right choice they responded ‘fifty-fifty’ but they commented that they were pleased with the freedom they had at Beaufort View and told us that their new living arrangements suited them. Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 12 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 and 9 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care workers have good levels of information on which to base people’s care and meet their individual needs. However, a total communication approach has not been fully implemented in the home which means that some individuals may be restricted in making their needs and wishes known. EVIDENCE: We looked at the care plans for two people who use the service. We saw some useful information regarding people’s daily support needs and preferred routines; ‘X usually wakes around 7-8am. He likes to have a strip wash on his bed before getting dressed. He needs 1:1 support with this.’ Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 13 For another service user it was indicated in their care plan that they prefer to sit on the floor to eat their meals using a small table. On our arrival at the home we observed the person concerned enjoying their breakfast in this way. They appeared settled and comfortable. Another person enjoys watching DVDs and television. Our observation showed that the person is enabled to do this. We noted that the home had given consideration in the support plan to the concern that the person may spend too much time watching television rather than engaging in other activities so a balance was needed in this area. There was also some useful information in care plans about how individuals may communicate their needs and wishes. For example, we read that one person ‘will choose what he wants to eat if shown options’ and ‘when asked if he wants to go to bed he will say yes or no’. All care workers who responded to the survey told us that they were always given up-to-date information about the needs of the people they support; ‘Care plans are updated every month and all information…is noted in the communication book so that people are kept up to date’; ‘We have a handover at every change of shift’. The manager told us that finding ways to promote real choice in the home was an area for development. This is because many of the people who use the service have complex needs and non-verbal communication and staff may experience difficulty understanding what people are trying to say. The manager has stated in the home’s Annual Quality Assurance Assessment that seven out of the eight people who use the service have specialist communication needs. The two care plans we looked at indicated that both people used alternative means of communication. One person’s plan stated that they knew some Makaton signs and people should use these when communicating with him. This was echoed in a report by a Speech and Language Therapist which recommended that staff help him enhance his use of key word signing. The Assistant Manager told us that staff had access to a copy of the Dorset Signs and Symbols book which they used with the individual. We spent approximately half an hour on two days observing communication between staff and the person concerned and noted that care workers did make an effort to communicate directly with the service user and understand his needs. However, we saw no evidence of Makaton being used. For the second person, their assessment indicated that they had used Picture Exchange Communication System in the past to positive effect. However, we saw no evidence of this being used in the home. The Assistant Manager said that they had tried to use this system but they did not feel it was particularly helpful. Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 14 The Expert by Experience told us that he did not think the home was a total communication environment. He said ‘I felt communication was a problem. It was very oral and one-sided in terms of the staff speaking to the residents…I felt there was a lack of communication technology and aids and the few that there were seemed to be lying around, not being used. The only obvious chart, which was very useful and practical, was the weekly rota chart in the hallway with pictures of the different staff working on that day.’ We discussed with the manager the need for the home to implement a total communication approach which is fully integrated into practice. This will be fundamental in supporting people to make choices and decisions about their daily lives. The manager has indicated in their Annual Quality Assurance Assessment that they will ensure all staff attend total communication training so that they have the necessary skills to promote people’s ability to make choices and decisions. We looked at a sample of risk assessments for two people. We saw that risks associated with medication, the environment, mobility, bathing and accessing the community had been considered. Risks were clearly identified and for most of the risks there was sufficient information for care workers about the action they must take to reduce the risk. For example, there was a risk identified that a person may become aggressive towards staff. This was accompanied by clear information on how staff must respond to this to ensure that the person’s distress is minimised and the risk of aggression is reduced. Discussion with the manager indicated a firm commitment to positive risktaking, for example, ensuring safety needs were considered to support an individual with accessing a water-sport activity and giving another person the autonomy to make choices with regards to their diet within the boundaries of a health condition. One risk assessment we looked at, however, was not so clear about actions to be taken by staff. One resident had been identified as at risk from another resident who has a tendency to mobilise very quickly in their wheelchair. The risk assessment states ‘Staff must be aware of where both X and the other resident are at all times’. However, an awareness of where both people are would not necessarily prevent an accident and more specific information, and arrangements, are needed to ensure that people are fully protected. Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 15 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 and 17 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are some elements of good practice in the home’s approach to arranging activities for people who use the service. However, some further development is needed to ensure that all individuals have appropriate levels of support to engage in activities and that staffing levels support this. EVIDENCE: During the two days of the inspection there was some evidence of various activities going on in the home. We noted that two people were attending their respective day services, others went out for walks, hydrotherapy, college and attended an in-house drama session. Records we looked at gave further evidence of activities being offered to people over the course of recent months Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 16 including shopping, going out for coffee and attending local places of interest and events including Monkey World and the New Forest Show. We noted that the home is trying to promote an individualised approach to activities rather than everyone going out in a large group which is commendable. The home has also implemented a ‘day duty’ from 10am-6pm to promote people’s access to their community. Care workers employed in the home told us that access to activities during the week was something they felt the home promoted; ‘(We) make sure if the service users want anything, want to go anywhere, they get the chance to get it or go there’; ‘The service provides many activities to keep our service users busy and entertained. I think it is good because each service user has the chance to go out for a trip, community activities and nice holiday as well’; ‘(We) try to include the service users…in society’. Records we looked at showed that there were more activities on offer to people during the week than at weekends. This was acknowledged by the manager in the home’s Annual Quality Assurance Assessment who reports that this is due to staffing levels and factors around access to transport and is an area for development. One person’s records showed that their weekends had been spent watching television or entries had been left blank. Staff also told us in surveys that staffing levels sometimes restricted access to activities at weekends; ‘During the week is fine but at the weekends there are never enough staff’; ‘Provide more staff at weekends so that more activities / outings can happen during this time’; ‘Make sure there are enough staff on all duties’. We also noted during the inspection that there were periods of the day when staff were busy providing personal care when people were placed in front of the television. It was not clear in all cases whether this was their choice. In the period of observation by the Expert by Experience he noted that there were not many obvious signs of meaningful activities being offered. We observed one person propelling themselves in their wheelchair around the lounge, apparently looking for something to engage in. There were no staff present in the lounge at the time. We noted that they went to a container in the corner of the lounge and picked put a plastic bag which had some small tubs of playdough in them. They opened these to occupy themselves. We thought that more consideration could be given to those periods of the day when there are no planned activities and many care workers are busy undertaking personal care so that individuals can make a real choice about what they want to do with their time and have easy access to these activities. Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 17 On the second day of the inspection we were told by staff that they had arranged an in-house art and craft activity but one person had not wanted to engage. The home may wish to seek advice from an Occupational Therapist about suitable activities for specific individuals to ensure the service is meeting the needs of all the individuals who use the service. The manager has told us in the home’s Annual Quality Assurance Assessment that everyone who uses the service has contact with family and friends. The manager gave us an example of the service actively promoting social contact for one person who lives in the home and supporting another person in reestablishing contact with their family. We observed a notice on the hallway wall indicating that visitors are welcome at the home at any time. Information in care plans indicated an understanding that people who use the service have rights. For example we noted that one person who has been identified as preferring some staff to carry out his personal care than others. His right to make this choice is acknowledged in the plan as well as there being information about how staff should respond when he makes this choice to minimise his anxiety and ensure his wishes are respected. The Expert by Experience reported that staff presented as respectful of people’s privacy and dignity and rights to an ordinary life from his observation of people in the home. He also told us that one person who uses the service told him that she was happy about the way she was treated. We noted that different arrangements have been put in place for people with regards to meal-times to meet their individual needs. People do not necessarily eat together in one room or at the same time. One resident told us that they had the option of eating a meal with other people or preparing their own meal and eating by themselves. They told us that this arrangement gave them independence and suited them well. We observed two people being supported to eat their lunch on a one-to-one basis which was respectful of their dignity and safety needs. We looked at the range of foods purchased by he home for people to eat. We saw that some of the foods purchased were supermarket ‘value’ brands. These included yoghurts, leeks, tuna chunks, chicken breast fillets and breaded chicken burgers. We also saw a variety of fruit and vegetables in the home and meal records showed a range of foods being offered to people including pasta dishes, fish, cauliflower cheese and roast dinners. Recording of people’s food intake was seen to have improved since the last inspection. Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 18 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 and 20 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home respects individuals’ privacy and dignity in the delivery of personal care. People also receive support from health care professionals as necessary to meet their needs. However, medication procedures are not robust enough to ensure that individuals are fully protected. EVIDENCE: Observation of care workers and people who use the service during the inspection indicated that individuals were being treated with respect and their dignity was promoted. Personal care was seen to be carried out in the privacy of people’s own bedrooms and a member of staff was seen to positively encourage this when one individual wanted to show them their leg dressings. Out of three care professionals who have contact with the home, two indicated that the home always respected individuals’ privacy and dignity while one indicated that this was usually the case. The Expert by Experience who visited the home told us that staff did seem to be respectful in terms of promoting privacy and dignity. He told us; ‘Most of the staff seemed to provide care in a Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 19 reasonably jovial fashion, had patience and perseverance and appeared to enjoy it’. He noted that one person who uses the service needed intervention from staff to ensure that their actions did not impact on other people – he stated that their ‘techniques were done in a sensitive way without any force or aggression’. A person who uses the service also told us that they were happy with the way they were treated. We looked at the records for one person who has epilepsy. Records documenting the seizures were in place. We saw that appointments with the person’s consultant with regards to their epilepsy had also been documented. There was some good detail about liaison that had taken place between staff at the home and the person’s relative, day service and specialist nurse. A nursing plan with regards to the person’s epilepsy was also on file. This stated ‘At the onset of the seizures paramedics should be summoned’. However, this conflicted with the risk assessment in place saying ‘the home’s epilepsy policy must be followed, that is 3.5 / 4 minutes after a seizure has been identified 999 / paramedics are called’. Notifications we have received from the home indicate that staff are following the protocol but with conflicting information on file it is not clear which protocol is being followed. For the second person we case-tracked there was evidence of consultation with relevant health professionals where issues had arisen to meet their needs. A risk had been identified in relation to them choking. We checked to see if a risk assessment was on file and saw that there were clear instructions for staff on the level of supervision required to make eating safe for the person and on how food should be presented. There was evidence of previous input from a Speech and Language Therapist with information on meal ideas and foods to avoid. There was also a list of signs to indicate that the person was experiencing distress with swallowing. This is important so that care workers have all the information they need to ensure the person’s safety and to seek help in the event of the person’s needs changing. All three care professionals who completed surveys told us that people’s health needs were always met by the service. Two health care professionals confirmed that the care service seeks advice and acts upon it to manage and improve individuals’ health care needs. Medication is supplied to the home by a local pharmacy. Each person who uses the service has their own medication cabinet which is attached to their bedroom wall. Medication administration record (MAR) charts are supplied by the pharmacy for use in the home. We looked at a sample of MAR charts. For one person, there were gaps in the chart for seven medicines on one date where they had not been signed for and no codes entered to indicate the reason if they had not been administered. Instructions about one dose had been handwritten on the MAR chart by one member of staff. It is recommended that any hand-written instructions are signed by two staff to ensure their accuracy. For a second person, there were gaps in recording for Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 20 two medicines. Allergies had not been documented on the MAR or ‘none known’ indicated if appropriate. For a third person the handwritten instructions on the MAR chart for a PRN (‘as required’) medication indicated a variable dose; ‘Take one or two at night when required’. The handwritten instructions had not been signed by staff making the entry. The medication had been signed for on alternate nights from 3rd October but there was no record whether one or two tablets had been administered on each occasion. We asked the manager whether there was a specific care plan in place to help staff determine whether they should give one or two tablets, or indeed not administer the medication at all given its ‘as required’ status. We were advised that a care plan of this description was not in place. We looked at the circumstances around a medication error that had occurred in the home. We were not informed about this by the home. The manager was reminded to notify us of any medication errors under Regulation 37. The MAR chart showed that the epilepsy medication the error related to had not been supplied by the pharmacy. The assistant manager told us that this had been missed when the medication had been booked in by the home. This had resulted in a person not having the medication administered for five days until their relative had picked up on the omission on their visit to the family home. The home has told us in their Annual Quality Assurance Assessment that ‘only trained staff dispense medicines’ but their plan for the next twelve months was to have all staff medication trained. Two care workers we spoke with during the inspection told us that they were not allowed to administer medication to people unless they had done their training. At the time of the inspection only a minority of care workers had undertaken training in the safe handling of medicines. We have been informed since the inspection that all care workers are to attend medication training in November 2008. The home is developing a new framework for auditing medication in the home to check that medication is being given as prescribed. We were informed by the home that they have been experiencing significant difficulties in their communication with the pharmacy who supplies their medication. This includes medicines not being supplied when requested and bottles not being labelled. A member of staff told us that they intended to contact the Pharmacist from the local Primary Care Trust for advice on this issue and contact was made during our inspection. Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 21 Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 22 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 and 23 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although there are procedures in place to respond to concerns and safeguarding issues that arise, these need to be made more robust to ensure that people are fully protected. EVIDENCE: The home has told us in their Annual Quality Assurance Assessment that they have a complaints procedure that was reviewed in August 2008. A concerns and complaints procedure is situated in the hallway of the home advising visitors that they should contact the manager or provider if they wish to make a complaint. The telephone number for the Commission is on the procedure. The procedure does not tell the reader that complaints will be responded to within 28 days although this is stated within the home’s complaints policy. The home has told us in their Annual Quality Assurance Assessment that they have not received any complaints about the service in the last twelve months. Discussion with the manager indicated that some issues had been raised by a relative who has contact with the service in relation to support provided to their family member. The manager told us that these had been responded to as they arose and at care reviews. It is recommended that the manager keeps a record of concerns that are raised and the outcome for their records – this will enable them to evidence how they respond to issues. Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 23 Five out of six care workers indicated in surveys that they knew what to do if a person using the service or their relative has concerns about the home, one indicating that they did not know what to do. The home has a procedure in place for adult protection and the prevention of abuse. We have liaised with the manager about one area of the policy that needs to be made clearer so that people know they must report suspected or incidences of abuse to the local Social Services team. The manager has agreed to make the necessary amendment. The home’s Annual Quality Assurance Assessment says ‘we need to ensure that all staff are PoVA trained’ and this was identified as an area for improvement over the next twelve months. The training record for staff shows that three care workers out of seventeen have attended some training in abuse awareness. We looked at the internal induction framework in place in the home. This does not specify that safeguarding procedures are covered. The manager told us that he has been trying to secure some appropriate training in this area for all staff. Shortly following the inspection we were advised that all staff would be undertaking in-house training in November 2008. This is important so that all care workers know how to recognise and respond to abuse and are aware of local safeguarding procedures. The manager has told us in their Annual Quality Assurance Assessment that there is a whistleblowing policy in place in the home and that this has been used to positive effect. Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 24 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 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Some areas of the home environment need improvement to ensure that the home continues to provide a well-maintained and accessible place for people to live in. EVIDENCE: During the inspection we looked around the premises including some of the bedrooms of people who use the service. The home is bright, airy and free from any offensive odours. There were some aspects of the premises that needed to be smartened up. For example, some door frames and doors were scuffed from wheelchairs passing through, there were some stains on the lounge carpet and curtains were not hanging properly in two of the bedrooms we looked in. The manager has identified in the Annual Quality Assurance Assessment that they ‘need to improve the general maintenance of the communal areas’. Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 25 The Expert by Experience told us; ‘I think the living environment was fairly comfortable for such a group home type setting. It did not feel too institutional.’ There is a garage next to the main property which contains refrigerator and freezer facilities. This was also being used as a storage area for furniture. The manager has told us in the Annual Quality Assurance Assessment that work will be taking place in the new year to convert the garage into an office space, new laundry and new food storage area. It is planned that this area will be fully accessible to people who use the service. There is a landscaped area to the front of the property. The garden area to the side of the premises was unkempt – a fence was broken and there was a broken chair lying beside the house. The manager has told us in the Annual Quality Assurance Assessment that with the plans to redevelop the area at the side of the house, ‘the whole of the outside of the property will be accessible for residents’. The home has laundry facilities in an outbuilding to the side of the property. These comprise a ‘professional’ washing machine and tumble dryer. Again, this area is part of the home’s plans for redevelopment which will ensure that the laundry is accessible to people who use the service and will promote their participation in doing their own laundry. The manager told us that he is developing a contingency plan for ensuring people’s laundry is done, possibly by an external contractor, while building work is taking place. The home has a policy on infection control which we looked at as part of the inspection process. This includes information on hand hygiene, protective personal equipment and dealing with bodily fluids. The home’s Annual Quality Assurance assessment tells us that six care workers out of seventeen have completed specific training in infection control, this being confirmed by the home’s training matrix. The manager has told us that in-house training in infection control has been arranged for November 2008 to be attended by all staff. The home presented as clean at the time of the inspection. Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 26 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 and 35 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although people who use the service are generally protected by the home’s recruitment procedures, arrangements for training care workers are inadequate. This means that care workers do not always have the necessary skills and knowledge to deliver safe and effective support based on best practice to people who use the service. EVIDENCE: A requirement was made at the last inspection for the registered person to ensure that that they do not employ a person to work at the care home unless they have full and satisfactory information in relation to them. We looked at a sample of five care worker files for evidence that appropriate pre-employment checks had been undertaken. All the files we sampled showed evidence of two written references and an appropriate check with the Criminal Records Bureau. Where one individual is awaiting their full disclosure we noted that a PoVAFirst check had been Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 27 undertaken to confirm their suitability to work with vulnerable adults and arrangements for their supervision were documented on the home’s rota. The references for a recent school-leaver were both personal references. We discussed with the manager that it would have been appropriate to have requested a reference from the person’s school who may also have been in a position to comment on their suitability. The manager told us that they do not currently verify references with the people who give them – we advised that implementing this would be good practice as it ensures they are authentic and robust. For three people there were gaps in their employment history as written on their application forms and there was no proof of identity. The manager told us that they had made sure that documentation for the two most recent employees included this information. We looked at these records and found that this was the case. While we acknowledge that the provider has recently taken steps to ensure their procedures are fully robust we note that this issue was not fully addressed within the timescale of the requirement. At the last inspection we made a requirement that the registered provider must ensure that people employed to work at the care home receive training appropriate to the work they perform including an induction programme that meets Skills for Care specifications. We looked at a sample of seven files for evidence of training. We saw evidence that individuals had received an inhouse orientation at Beaufort View. A checklist framework is in place to record this which covers health and safety procedures, care of residents, fire precautions, policies and the role of the support worker. However, this orientation does not cover all the areas indicated in the Common Induction Standards. The manager told us that they have tried to secure places on Skills for Care induction programmes run by the local authorities and we saw applications for this on various people’s files. We also saw evidence on one file that the Assistant Manager had supported a member of staff with working through the Common Induction Standards workbook. According to the home’s training matrix only five out of the seventeen care workers had done an induction meeting Skills for Care specifications. There was not always certification on files to evidence their attendance at this training or information to indicate what had been covered. Out of six care workers responding to the survey, four indicated that the induction they had received covered everything they needed to know ‘very well’ while two told us that this was ‘mostly’ the case. There was limited evidence that people have received training to meet the specialist needs of people who use the service. Out of seven files we looked at two showed evidence of people receiving training in total communication. A further one person we spoke with at the inspection told us they had received this training but there was no evidence of this on their file. Three training records we looked at showed evidence that the individual concerned had attended training in epilepsy. One person told us they had done this training Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 28 but there was no certificate on their file. Another person’s supervision notes also indicated that they had recently completed epilepsy training but again there was no certification on file. There was no evidence at the inspection that two people had received any training in epilepsy. The manager told us that there was an identified need for care workers to receive training in physical intervention techniques to support one person in the home. He told us that it had been impossible to source this training to date from the local healthcare trust but he is continuing to make efforts to secure this training for all staff to meet the need. Four out of six care workers indicated in surveys that they were being given training that was relevant to their role, one said this happened ‘sometimes’ and one said they were not receiving relevant training. During this inspection we identified shortfalls in the provision of moving and handling training to care workers which potentially puts people who use the service at risk. We have explored this more fully in the next section of the report; ‘Conduct and Management’. Comments we received from care workers included ‘I have not really started my training as it is difficult to fit in…I have lots of training coming up in November. We are kept up-to-date with new ways of working and they really make us think about what we are doing in our areas of care.’ ‘I would like to do more training’; ‘More training’; ‘We are asking for more training so we can give a good service to the residents’. The manager has told us in the Annual Quality Assurance Assessment that over the past twelve months they have enrolled two members of staff onto their NVQ Level 2, five members of staff onto their NVQ Level 3 and supported one member of staff to achieve their NVQ Level 4 and commence the Registered Managers’ Award. Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 29 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 and 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure that health and safety checks are undertaken in the home. Some potential risks to people who use the service will be reduced by the delivery of staff training which has been scheduled for the near future. EVIDENCE: The previous Registered Manager for the home left the service in August 2007, shortly after the home opened. The current manager was appointed in August 2008 and by the time the inspection took place had submitted his application to register with the Commission. The manager of the home has a professional qualification in Social Work. Since the last inspection of the service the home has also appointed an assistant manager who has achieved a National Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 30 Vocational Qualification at Level 4 in Care and is working towards the Registered Managers’ Award. There was no evidence at this inspection of written reports being produced by the provider in response to their visits to the home under Regulation 26. The manager reported that the home is just starting to implement its quality assurance process with surveys being developed to be sent to people who use the service by the end of November. It is recommended that the home expands this process to take into account the views of other people who have contact with the service including relatives, advocates and care professionals. The home has kept us informed of events such as when emergency services have needed to be called to the home and when an individual was admitted to hospital. We were not informed of a recent medication error in the home, however, and have reminded the manager that any future incidents involving medication must be reported to us in accordance with Regulation 37. The manager has told us in the Annual Quality Assurance Assessment that team meetings for staff are held on a monthly basis to promote open communication in the home. This was echoed by care workers in surveys who told us that various meetings are held including monthly supervisions, sixmonthly appraisals, team meetings and key working meetings which are used to share information and discuss issues about the team and support offered to people who use the service. We looked at a sample of health and safety records in the home. The manager has told us that water temperatures in the home are thermostatically controlled. We saw evidence of regular checks being carried out randomly on water outlets although this did not include the communal bathroom. The assistant manager checked the water temperature at the bath tap during the inspection which was found to be within a safe range. The assistant manager agreed to include the communal bath within the home’s water temperature checks to ensure it is safe. We were advised by the assistant manager that a system to check the safety of portable appliances is in place although testing was overdue at the time of the inspection. The assistant manager confirmed that appliances would be tested in the near future. We looked in two bedrooms on the first floor of the home. Window restrictors were seen to be in place to promote people’s safety. The manager of the home confirmed that a fire risk assessment had been completed by an external agency and that a practice evacuation had been carried out recently to test care workers’ knowledge of procedures and to familiarise people who use the service with an emergency drill. The home has told us in their Annual Quality Assurance Assessment that they have put in place radiator covers to protect people who use the service. Radiators we saw at the inspection were appropriately covered. For the two people we case-tracked there was evidence on their files that they require assistance from staff with moving and handling. For one person, this Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 31 said ‘2:1 support to assist with all transfers using a hoist’. There was appropriate information regarding the seating position of the person, the equipment they use and evidence of input from a physiotherapist. On the second person’s file it was written that ‘staff are to acknowledge manual handling difficulties when assisting X and are responsible for their own safe handling practice’. The plan went onto say that hoisting the person into their wheelchair ‘is to be carried out by staff based on the home’s policy of 2:1…by staff who have had their induction’. Although the home’s induction programme includes an introduction to the policy and procedures within the home, the home’s training record showed that only three care workers out of seventeen had received moving and handling training. One of the three people recorded as receiving this training had done this more than three years ago. A care worker who responded to the survey also told us that they had been in post for several months and had not done moving and handling training. We looked at the training matrix in relation to the staff rota for day shifts between 8-12 October which showed that four shifts out of ten were covered by staff who had not received moving and handling training. The remaining six day shifts included one member of staff who had received this training. The manager has told us that people who live in the home have regular input from a physiotherapist who gives guidance to care workers on people’s individual positioning needs. However, a lack of basic moving and handling instruction means that people may be put at risk by staff who do not have the necessary knowledge to move people safely. The manager has arranged training for all staff in moving and handling for 14th November 2008. The home’s training matrix indicated that eight out of seventeen care workers had attended training in emergency first aid in the last three years. We looked at the rota for the five days leading up to the inspection (8-12 October) and noted that each shift was covered by a care worker who has had this training. However, observation on the day of inspection indicated that people who use the service go out on a one-to-one basis with a care worker who may not be trained in first aid. Training in emergency first aid has been arranged by the manager for all staff on 14th November 2008. Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 2 X 1 X X 1 X Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? Yes 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 YA20 Regulation 13(2) Timescale for action The registered person shall make 30/11/08 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Prescribed medications and supplements, as stated on the MAR chart, must be signed for when administered. Where a variable dose has been prescribed, the dose administered must be clearly stated on the care plan. Where ‘as required’ medications have been prescribed, a care plan must be in place to inform staff the circumstances in which they should administer the medication and the dose that is to be given. The registered persons must review the process of booking-in medication to ensure that it is fully robust and people have supplies of the medication they Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 34 Requirement require. Meeting these requirements will ensure that people get the medication they need and that record-keeping supports this. 2. YA34 19(1) The registered provider must ensure that he does not employ a person to work at the care home unless he has full and satisfactory information in relation to them. This must include proof of the person’s identity including a recent photograph. This must also include evidence of a full employment history together with a satisfactory written explanation of any gaps in employment. This will help ensure that people who use the service are protected from harm by the people employed to work with them. This requirement is repeated from the last inspection of the service as the previous timescale of 31/01/08 has not been fully met. 30/11/08 3. YA35 18(1)(c) The registered provider must ensure that people employed to work at the care home receive training appropriate to the work they perform including structured induction training. This will help ensure that people who use the service benefit from a skilled and knowledgeable 30/11/08 Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 35 workforce who are suitably qualified to meet their needs safely and effectively. This requirement is repeated from the last inspection of the service as the previous timescale of 31/01/08 has not been met. 4. YA37 26 The registered provider must visit the home to carry out the functions specified in this regulation. They must prepare a written report on their findings which must be supplied to the manager and be available for inspection by the Commission. Internal audit systems help ensure that the home is running smoothly, meeting the needs of people who live there and ensures the regulations are being met. 5. YA39 24 The registered person shall establish and maintain a system for evaluating the quality of the services provided at the care home. This must take into account the views of people who use the service and their representatives. This helps ensure that good quality care is achieved and maintained that is firmly based on the needs and wishes of people who use the service. The registered person must notify the Commission without delay of any event in the care home which adversely affects the well-being or safety of any service user. 31/03/09 31/12/08 6. YA42 37 07/11/08 Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 36 This must include notifying us of errors in relation to medication administration. This helps protect people who use the service. The registered person must 30/11/08 make suitable arrangements to provide a safe system for moving and handling service users. Care workers who undertake tasks in relation to moving and handling people must receive appropriate training to be able to do so safely. This will help ensure that care workers have the knowledge and skills to be able to move people safely and people who use the service are not placed at risk from unsafe practice. 7. YA42 13(5) 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 YA7 Good Practice Recommendations The home should look at ways in which they can integrate a total communication approach in all aspects of their practice to ensure that people’s ability to make choices and decisions about their lives is actively promoted. Risk assessments should include enough detail to ensure that risks are fully minimised. Staffing levels should be kept under review to ensure that people’s choice to participate in activities is not restricted at weekends. Consideration should be given to those times of day when staff are busy delivering personal care to ensure that Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 37 2. 3. YA9 YA13 individuals are not left unoccupied and without staff support. 4. YA19 The home should ensure that information between care plans and risk assessments is consistent so that care workers have accurate information on which to base their intervention at all times. 5. YA20 MAR charts should indicate where people have allergies or state ‘none known’ where appropriate. Audit trails should be implemented as a system for monitoring that medication is being given as prescribed and being signed for appropriately. Handwritten entries on MAR charts should be doublesigned to confirm their accuracy. 6. YA22 The home should ensure that the complaints procedure advises the reader of the timescale in which they can expect a response to their complaint or concern from the home. Concerns raised by relatives of people who use the service should be recorded with information about their outcomes so that there is a clear audit trail of issues that are being raised and how the home is responding to them. All care workers should receive training in abuse awareness so that they are able to recognise abuse and respond to it using local safeguarding protocols. Attention should be given to the general maintenance of the inside and outside of the home to ensure it is a wellmaintained and accessible environment for people to live in. All care workers should hold a National Vocational Qualification in Care or be working towards this. References obtained for prospective care workers should be verified with the person who gave the reference. The registered person should ensure that the references obtained for prospective care workers are from the most robust sources available to them. Certificates should be held on file to evidence training that DS0000069692.V372874.R01.S.doc Version 5.2 Page 38 7. 8. YA23 YA24 9. 10. YA32 YA34 11. YA35 Beaufort View 12. YA42 has been undertaken by care workers. The home should review their arrangements regarding first aid cover in the home to ensure that people who use the service are supported at all times by care workers who have the necessary knowledge and skills to respond to an emergency. Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Beaufort View DS0000069692.V372874.R01.S.doc Version 5.2 Page 40 - 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. 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