Inspection on 26/10/07 for Beaufort View

This inspection was carried out on 26th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 6 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 13/10/08

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 08/07/2008.

CARE HOME ADULTS 18-65 Beaufort View 1 Beaufort Road Southbourne Bournemouth Dorset BH6 5AJ Lead Inspector Heidi Banks Key Unannounced Inspection 29th October 2007 09:40 Beaufort View DS0000069692.V353659.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.V353659.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.V353659.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) 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.V353659.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 Not applicable 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 three 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.V353659.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 November 2007 the minimum basic fee was £950 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.V353659.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. It was a key unannounced inspection, the purpose of which was to assess the home’s progress in meeting the Regulations and key National Minimum Standards. The on-site inspection took place over approximately thirteen hours on 29th and 30th October. During the inspection we were able to take a tour of the home and meet some people who use the service. Discussion took place with one of the owners of the home, the Responsible Individual, the manager and several members of staff employed to work at the home. A sample of records was examined including some policies and procedures, medication administration records, health and safety records and service user and staff files. Prior to the inspection, an Annual Quality Assurance Assessment (AQAA) was completed by the manager and submitted to the Commission. Surveys were distributed by the home to relatives of people who use the service, care workers in the home, care managers and health care professionals on behalf of the Commission. A total of nine completed surveys were received, information from which is reflected throughout the report. A total of twenty-two standards were assessed at this inspection. What the service does well: The home works hard to respect the choices and needs of people who use the service and promote their rights to make decisions about their lives. Observation during the inspection showed evidence of a person-centred approach to support that respects people’s individuality and ensures that they benefit from relationships and contacts outside the home. People benefit from good personal care which meets their needs and preferences and ensures they are treated with respect and dignity. The home environment has been adapted to meet the needs of people who use the service and plans are in place to promote further accessibility to all areas. Consideration has been given to individualising people’s bedrooms which have been adapted to suit them. Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 7 The provider recognises what the service does well and where improvements can be made so that there is a clear vision for the future. Some shortfalls identified during the inspection were responded to immediately demonstrating their commitment to meeting the regulations and achieving best outcomes for people who use the service. Surveys from relatives of people who use the service and care managers contained some very positive feedback about their experiences of visiting Beaufort View and observing the progress of service users; ‘There is a lovely atmosphere in the home and without exception the carers are positive, cheerful, friendly and do their job well’; ‘Excellent support provided’; ‘They…have created a terrific environment. X is definitely relaxed, happy and at home there… We are so glad Beaufort View became available at the right time’; ‘They see my service user as an asset to the service…because of the positive attitude my service user is happy’; What has improved since the last inspection? What they could do better: It is acknowledged that the home has only been open since June 2007 and therefore some areas are in the early stages of development. Six requirements and nine recommendations have been made as a result of this inspection where shortfalls exist. Some aspects of documentation in the care home were seen to require further development including risk assessment systems, documentation of people’s food intake and the home’s complaints procedure. Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 8 Procedures for recruiting staff and provision of staff training also require review to ensure that they are fully robust and people have the right training from the start of their employment to be able to work safely and effectively with service users. The home must also ensure that care workers and, so far as practicable, service users are aware of fire evacuation procedures and have the opportunity to participate in fire drills. This will ensure that, in the event of an emergency, people are kept safe from harm. A series of recommendations have been made in relation to the home’s assessment process, care plans, staffing arrangements at meal-times, medication practices, infection control procedures and implementation of a quality assurance strategy. These will help ensure that the home operates in a way that promotes good practice in all areas. 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.V353659.R01.S.doc Version 5.2 Page 9 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.V353659.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure that assessments are carried out prior to people moving into the home. These may not always be robust enough to ensure arrangements are in place to meet individuals’ needs from the point of admission. EVIDENCE: The home has told us in their Annual Quality Assurance Assessment that ‘Moving In Assessments’ are completed by the home for every service user before they are admitted. They have also told us that they liaise with people’s previous placements, family and care managers to obtain sufficient information about their needs. Assessment documentation for two people who use the service was examined. The home’s framework for assessment covers the areas of communication, disability, behaviour, risks, personal hygiene, leisure activities, relationships and eating and drinking. These had been completed to give some basic information about individuals’ needs and preferences although one had not been signed and dated by the assessor and did not clearly indicate who had Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 11 been involved in the process. It was discussed that some information in the assessment would benefit from more detail. For one individual there was also information on file that had been supplied by their parents, a transition report from their previous college placement and a care management assessment. Two surveys were received from care managers who had placed people in the home. One care manager indicated that the home’s assessment arrangements ‘usually’ ensured that accurate information was gathered and the right service was planned for individuals, the other indicating that this was only ‘sometimes’ the case. Their surveys, and discussion with one care manager, indicated that some arrangements they believed should have been in place at the point the person moved in were not. Responses from both care managers indicated that they had provided assessment documentation from the local authority to the home to ensure that the home had enough information about the service user on which to base their care. Beaufort View DS0000069692.V353659.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service benefit from a service that respects their individual needs and choices but some aspects of documentation need improvement to fully evidence this. EVIDENCE: The support plans for two service users were seen. These include information about people’s strengths, personal care needs, mealtimes, communication, activities and cultural and religious needs. Generally, information contained in the plan was detailed and useful, indicating where people are able to make choices and be involved in their care, for example, ‘X enjoys a strip wash in the mornings and will then help to choose what clothes they want to wear’. The plan then goes on to say how staff can support the service user in making choices; ‘X should be shown different items of clothing…X is able to respond to closed questions with yes or no answers.’ One care manager commented in a Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 13 survey that respecting individual needs was something the home does well and gave an example of a service user who has specific needs in relation to diversity which had been responded to with great care. Some areas of some support plans seen had not been fully completed, however, and it is recommended that the home looks to ensure that gaps in information are identified and addressed. The support plan document contains a format for goal planning and for one service user goals had been identified around visiting family. Although discussion with the manager indicated that this was being actioned, the action plan had not been completed to show who will do what by when. The home has told us in their Annual Quality Assurance Assessment that they are in the process of completing full support plans for each service user and plan to introduce a system by which they can be updated on a monthly basis to reflect changing needs. Inspection of support plans and observation of interactions between service users and staff indicated that great care is taken to ensure that people are enabled to make choices and decisions about their everyday lives. Observation showed that care workers are aware that each person has their own way of communicating their needs, likes and dislikes through non-verbal means and they were seen to be responsive to this. For example, where one person clearly wanted to leave the table following lunch, they were supported to do this. Another service user had shown signs of distress prior to lunch which staff responded to by enabling them to eat in a quieter environment which they are known to prefer. Another service user was offered a choice of what they wanted to eat. When their response was unclear, the care worker checked it out again with the service user to ensure that they understood. Discussion with the manager and staff indicated that, in practice, the home tries to promote people’s independence with due regard for their safety. This includes promoting people’s access to the community and participation in various activities. Although some consideration of risks was seen in people’s assessment documentation and support plans, this was limited and no specific risk assessment documentation was seen. It was noted that one service user, in particular, appeared very keen to be involved in kitchen activities. It was discussed that as a result of an incident in the kitchen which had posed a risk to their safety, their access to the kitchen was now restricted. There was no risk assessment documentation available to reflect this decision or to show measures that could be put in place to promote the individual’s safe access to the kitchen, or participation in cooking outside of the kitchen. The home has told us in their Annual Quality Assurance Assessment that development of risk assessments for all residents is an area identified for action over the next twelve months. Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is working hard towards providing meaningful and fulfilling activities for service users. Contact with families and friends is given high regard and there is a clear awareness of people’s rights to an ordinary life. Routines in the home, including meal-times, showed a flexible approach but some aspects of meal-time arrangements need review to ensure people’s needs are fully met. EVIDENCE: Inspection of daily records indicated that people who use the service are supported to participate in activities that are age and peer appropriate, for example, college, sailing sessions, trips to the pub and attendance at ‘Gateway Club’. Two service users also attend local day centres. In addition to this, people are enabled to access their community on a regular basis, daily records showing that trips out included visits to Bournemouth for sight-seeing and Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 15 lunch, walks to the cliff top and trips out to local shops at Southbourne and Boscombe. During the inspection, an art and craft activity was taking place in the conservatory involving one member of staff and four service users. It was noted that staffing levels at this activity were not sufficient to ensure that everyone could be engaged in what was going on. For a period of fifteen minutes residents were left by themselves listening to music, although care workers were seen to undertake regular checks on the group. Observation during the inspection also showed that at times staff were busy doing laundry and cooking which people who use the service were not involved in. This was discussed with the manager and it was suggested that the home considers involving people in these activities on a one-to-one basis. The manager acknowledged that provision of activities is an area requiring further development and talked about plans to create a more structured programme of in-house activities and ensure that regular access to hydrotherapy and swimming is secured and incorporated into individuals’ timetables. The manager spoke positively about the need for activities to be individualised and for staffing levels to be adjusted to reflect people’s needs. Discussion with staff confirmed that developing the activity programme for individuals was an area under consideration and they were being encouraged to contribute to this process. One relative responding to the survey indicated that they felt provision of a wide range of activities was an area that the home does well. A care manager spoken with indicated that the home’s progress in this area had been rather slower than expected in some respects and identified this as an area which could be improved. Discussion with the manager and staff indicated an awareness of people’s differing cultural needs and a clear account was given of the way they are supporting this in the home, ensuring that arrangements for activities are sensitive to diversity issues and people have opportunities to make choices. Relatives responding to the survey indicated that the home was very good at enabling their family member to keep in touch with them. Inspection of daily records indicated where people had made contact with their families. This was seen to include supporting people to set up e-mail accounts in order to communicate with friends and family on a regular basis. It was clear from records seen that a sensitive approach is being adopted towards individuals’ needs and wishes about contact with family and friends and that family involvement is given high regard by the service. This was confirmed by relatives who indicated in surveys that the home always kept them up-to-date with important issues; ‘They always ‘phone on home or mobile if any issues’; ‘I would say ‘communication’ would be one area I would pick out as exceptional’. Observation of practices in the home indicated that staff are aware of people’s rights to privacy and dignity in their care provision. Care workers demonstrated awareness of providing personal care in the privacy of people’s rooms, knocking on doors before entering and ensuring that routines in the Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 16 home are flexible enough to promote people’s choices. A review of minutes of staff meetings indicated that issues around privacy and dignity had been discussed. Discussion with staff indicated their awareness of the rights of people with disabilities to lead an ordinary life in their community and they showed motivation to explore various opportunities with service users and enable them to make informed choices about what they want to do. Support plans seen gave some very comprehensive information around people’s eating and drinking needs, including specialist equipment required, level of support and preparation of the meal. Lunch-time was observed in the home. Four people were supported to eat in the conservatory, two requiring minimal support from staff and the other two requiring high levels of support. Observation indicated that meal-times were unhurried and sociable. However, at times it was difficult for staff to focus on the needs of the service user they were supporting due to needs presented by other service users. Observation of practices in the home indicated that routines are flexible enough to ensure that people can eat in their own rooms if this is their choice. A framework for recording meals eaten is in place although some gaps were noted and there was not always sufficient detail about people’s nutritional intake. For example, generic descriptions such as ‘Chinese’, ‘Sandwiches’ and ‘Roast Pork Sunday Lunch’ were not detailed enough to describe the meal’s content and some days showed no reference to fruit and vegetables eaten. Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People receive personal care that meets their needs and takes account of their preferences. Some shortfalls were identified in relation to healthcare support which, when addressed, will help ensure that people receive the support they need for optimum health. EVIDENCE: Relatives and care managers of people who use the service spoke highly of the personal care offered to people. Comments received included ‘X has settled down very well and his needs are met fully, I’m very happy to say…excellent standard of care’; ‘They clearly care for X there’; ‘X is much more appropriately dressed, is ‘blossoming’ since moving to Beaufort View…’; Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 18 ’I’m very impressed with feedback from key workers who have obviously got to know X well in the short time X has lived there. They are developing a good body of knowledge about X’s needs’. Support plans seen offered a good amount of detail about individuals’ personal care needs, for example, the way in which an individual needs their teeth to be brushed to maintain good oral health and how to give assistance with dressing with regard for the person’s disability. Discussion with the manager and inspection of daily records indicated that people are supported to access some health care services as necessary to meet their needs. A specific framework for recording health care appointments has recently been put in place by the manager as it was recognised that this would be more effective than entering appointments in day-to-day records which did not always provide a clear audit trail. Discussion with staff indicated that Physiotherapists have visited the home to demonstrate how they can support service users with their exercise programme. Photographs and written instructions were seen on file and staff confirmed that, where exercises have been prescribed, these are built into individuals’ timetables. Discussion with the manager indicated that there had been some difficulty securing specialist health care services for people transferring from outside the county to date. Some people who use the service require specific support with eating and drinking. The care plan for one service user indicated that their food needed to be pureed but in practice it was seen to be mashed. The need for consistency and continuity of practice based on specialist assessment was discussed with the manager who presented as aware of the shortfalls and taking appropriate action to address them. The seizure record for one service user was seen. On two occasions in the previous month emergency services had been contacted in response to seizures. Neither seizure was fully described. Only the duration of one seizure had been recorded and times of day that the seizures occurred had not been documented in either case. It was suggested to the manager that the home looks to formalise the system of recording seizures to ensure there is enough information to share with medical practitioners. The manager reported that a Community Nurse had visited the home to provide staff with some basic information about epilepsy although this had not been documented. The manager confirmed that they have requested a referral to a Consultant around the individual’s epilepsy. The home has a medication policy which covers procedures for administering medication, drug errors and ordering and receiving medication. The medication for each individual is stored in a lockable cabinet fixed to their bedroom wall. Staff are responsible for holding the keys to the cabinets. Medication is supplied by a local pharmacy who also produce the medication Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 19 administration record (MAR) charts. Medication for two service users was seen. The MAR chart for one service user showed that staff were not signing to indicate that build-up drinks were being given as prescribed. Some information about prescribed medications had been hand-written on the MAR charts by care workers but these had not been double-signed to ensure that the information was correct. One gap was noted on an individual’s MAR chart for the previous week. Discussion with a senior member of staff indicated that the dose had been missed in error and this had been discussed at a recent staff meeting. However, there was no evidence that an incident report had been completed to reflect this or the incident had been followed up. Stesolid medication was seen in one person’s cabinet but staff confirmed that this was not used. In addition, a paracetamol suspension was stored in the cabinet but was out of date. The allergies for one service user had been recorded as ‘none known’ on the MAR chart but there was no information to indicate any known allergies for the other service user. The support plans for two service users seen did not contain specific information about how medication should be administered. A care plan provided by a local authority for one service user stated ‘Tablets can be placed on X’s tongue and a drink of water is to be available for X to sip through a straw to aid swallowing’. However, this information had not been transferred to the person’s support plan. The manager confirmed that only staff who have undertaken training in the administration of medication are given responsibility for this task. A sample of training records seen showed that some staff have undertaken basic training with the pharmacy to date. The manager confirmed that further training would be arranged for all staff in coming months. The manager was referred to the CSCI Professional website to obtain further guidance on training in the administration of medication. Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is committed to communicating with people who use the service and protecting them from harm. However, some areas need further development to ensure documentation and training are consistent and robust. EVIDENCE: Beaufort View has a concerns and complaints procedure which refers to ways in which complaints may be dealt with by the home and states that all complaints will be dealt with within 28 days of receipt. It goes on to give information about the Commission for Social Care Inspection, County Council and Local Government Ombudsman, some of which was inaccurate and rather unclear. Both relatives responding to the survey indicated that they know how to make a complaint about the care provided by the home if they need to. They also told us that the home had responded appropriately if they had raised concerns; ‘We feel they are responsive to issues and never make us feel uncomfortable’; ‘We keep a three-way diary – ie. Beaufort View, Day Centre and myself, where any concerns or issues are raised’. A care manager also told us that in their experience issues had been dealt with appropriately and rapidly. Although the home’s complaints procedure reflects the way concerns may be dealt with by the home, it was not clear at inspection that there is a comprehensive system Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 21 in place to record concerns that may arise on a day-to-day basis and show how these are resolved. The home has told us in their Annual Quality Assurance Assessment that they are looking to establish links with local advocacy services for all their residents to ensure that people are enabled to have their say. The home has told us in their Annual Quality Assurance Assessment that they have a policy in place on safeguarding adults and the prevention of abuse and whistle blowing. These were last reviewed in October 2006. Inspection of staff training records indicated that not all staff have undertaken training in abuse awareness to date. The home has told us that they plan to increase access to this training in the next twelve months and that this training will form part of the home’s core training. There have been no safeguarding adults referrals made since the home opened in June 2007. Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service benefit from an environment that meets their specific needs and lifestyles. EVIDENCE: Beaufort View provides accommodation for eight service users in single bedrooms on three floors. Bedrooms have en-suite bathing / showering facilities and there is self-contained accommodation for one service user on the second floor, suitable for a person who wishes to live more independently. There is a communal lounge and conservatory on the ground floor and a domestic-sized kitchen, which people who use the service can access with staff supervision. A tour of the home showed that people’s bedrooms have been individualised according to their personal needs and tastes. Adaptations are in place to meet the mobility needs of service users including a passenger lift to the first floor. An adapted bathroom facility is available on the first floor for Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 23 people who have specific bathing requirements. Discussion with the manager also indicated that there are plans in place to adapt specific areas of the home and garden to meet individuals’ sensory needs. The home has told us in their Annual Quality Assurance Assessment that their Business Plan includes arrangements to increase accessibility throughout the home and there is an ongoing programme of maintenance and renewal. At the time of the inspection the home presented as clean. The home has told us in their Annual Quality Assurance Assessment that they have a policy for preventing infection and managing infection control and have an action plan for work on infection control management that they still need to do. A copy of the procedure was seen, this including information on hand hygiene and hand washing techniques and the wearing of protective clothing. The home has indicated that they have not used the Department of Health guidance ‘Essential Steps’ to assess their current infection control management. Inspection of staff training records indicated that only one member of staff has undertaken specific training on infection control to date. Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 24 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some shortfalls in recruitment procedures and training mean that this is an area that requires further development to ensure that care workers are suitably qualified to meet people’s needs. EVIDENCE: Recruitment records for two staff were seen. Both showed evidence of written references and checks with the Criminal Records Bureau. All five care workers responding to the survey indicated that they were aware that the home had carried out these checks before they started work. Records indicated that one member of staff had started work on a PoVAFirst check. Although the manager was aware of the need for specific supervisory arrangements to be in place in these circumstances it was advised that this is clearly documented on the staff rota to evidence that care workers are fully supervised during this period by an experienced member of staff. There was no evidence of proof of identity on file for either care worker and records showed some gaps in people’s previous employment history. Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 25 The home has told us in their Annual Quality Assurance Assessment that they are committed to enabling staff to access National Vocational Qualifications (NVQs) in Care. At the time of the inspection, fewer than 50 of care workers were qualified to NVQ Level 2 or above. The home has an induction framework in place where care workers are introduced to their role, policies and procedures, care of residents and the home’s philosophy. However, some people’s records showed no evidence of the checklist having been completed with them. Out of five care workers responding to the survey, three felt that their induction had covered what they needed to know ‘very well’, two indicating that this was ‘mostly’ the case. The manager stated that the home intends for all new care workers to complete a comprehensive induction programme with the local authority and that places had been booked for December 2007 and January 2008. However, this means that in some cases there has been a significant gap between people starting in post and receiving their formal induction training. The manager and members of the staff team told us that health care professionals have visited the home to give informal training to staff on epilepsy and individuals’ mobility and physiotherapy needs. However, a system for recording attendance at these sessions had not been implemented. It was noted that people who use the service have communication needs but the majority of care workers have not undertaken total communication training to date. Discussion with the manager and care workers and inspection of service users’ care plans indicated that training in sensory integration, pressure area care, eating and drinking, diversity and mental capacity may also be useful and should be explored. Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 26 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is developing and implementing systems to ensure that good standards are achieved and the home is run in the best interests of the people who live there. EVIDENCE: Since the home opened in June 2007, the Registered Manager has left the service and a new manager has been appointed. The new manager has commenced the process of applying for registration with the Commission. It was discussed with the manager that the Commission had not been formally notified of the resignation of the Registered Manager and interim management arrangements. This was echoed by a Care Manager who told us that they had Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 27 also not been made aware of the change in management arrangements. Since the inspection, the manager has written to the Commission to clarify arrangements and request that the home’s registration certificate is updated to reflect the current situation. The home has told us in their Annual Quality Assurance Assessment that the home has a clear Business Plan. They have also told us that the service intends to develop systems to obtain feedback from service users, their families and carers, care managers, health professionals and advocates on the care provided. Prior to the inspection the home had not notified us of various events affecting people who use the service that are reportable under Regulation 37. The manager was informed of the regulation and has since kept us informed of incidents occurring in the home. A tour of the premises and discussion with the manager indicated that the home has an automatic fire detection and warning system. Records showed that weekly checks had been carried out of different alarm points, fire extinguishers and emergency lighting and where issues had been identified these had been resolved promptly. Records also showed that water temperatures are tested on a regular basis and were within safe ranges. A fire risk assessment has been carried out by the provider and the home’s previous manager. The home has told us that an external fire safety agency has been commissioned to provide fire safety training for all staff four times a year. Minutes of a recent staff meeting indicated that the next training session had been scheduled for 24th November. At the time of the inspection there was no evidence of fire drills being carried out in the home on a regular basis to ensure that all staff and, as far as possible, service users are aware of procedures to be followed in the event of a fire. A requirement has been made for this to be actioned by the provider. The provider has informed the Commission that they are liaising with Dorset Fire and Rescue Service around night-time fire procedures and staffing levels. Inspection of staff training records showed that only a small number of care workers have completed first aid training to date. The staff rota was seen for October, this indicating that a minority of shifts, including night shifts, did not have a qualified first aider on duty. A requirement has been made for the provider to review this to ensure that staff have the necessary knowledge and skills to deal with emergency situations and keep people safe. The manager confirmed that staff would be undertaking a comprehensive six-day induction programme before the end of January 2008 which would include all health and safety training. Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 28 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 2 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 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 2 X X 2 X Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? N/A 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 YA9 Regulation 13 Requirement The registered provider must take appropriate action to ensure that full risk assessments are in place for each service user and, where risks are identified, clear written strategies are in place to minimise risks. Timescale for action 31/01/08 2. YA17 17(2) Sch. 4 This will ensure that people’s independence is promoted with due regard for their safety and welfare. The registered provider must 31/01/08 ensure that records in place to evidence people’s food intake are sufficiently detailed. This will help evidence that the meals provided to people who use the service meets their individual nutritional requirements The home’s complaints procedure must be reviewed so that it gives clear and accurate information about the role of the Commission for Social Care Inspection. This will help ensure that people 3. YA22 22(7)(b) 31/01/08 Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 30 4. YA34 19(1) who wish to raise concerns know the appropriate channels by which they can do so. 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. The registered provider must ensure that people employed to work at the care home receive training appropriate to the work they perform. This must include an induction programme that meets Skills for Care specifications, health and safety training including first aid training, training in abuse awareness and specialist training that reflects the needs of people who use the service. This will help ensure that people who use the service benefit from a skilled and knowledgeable workforce who are suitably qualified to meet their needs safely and effectively. 31/01/08 5. YA35 18(1)(c) 31/01/08 6. YA42 23 (4A) The registered provider must DS0000069692.V353659.R01.S.doc 31/12/07 Page 31 Beaufort View Version 5.2 ensure that all care workers and, so far as practicable, service users are aware of evacuation procedures in the event of an emergency and have the opportunity to participate in practice evacuations. This will help ensure that people know how to respond in the event of an emergency and the safety of people who use the service is promoted. 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. 2. Refer to Standard YA2 YA6 Good Practice Recommendations Assessments carried out by the home should be dated and indicate who was involved in the assessment process. Gaps in individual support plans should be completed to ensure that there is comprehensive information about people’s needs, preferences and goals and how these will be met. Any restrictions to people in their home should be clearly documented in their support plans as part of a full risk assessment. Meal-time arrangements should be reviewed to ensure that care workers are able to support people who require assistance with eating and drinking without interruption. Prescribed medications and supplements, as stated on the MAR chart, should be signed for when administered. Where instructions are handwritten on MAR charts, they should be signed by two care workers to ensure their accuracy. Medicines that are out-of-date or no longer in use should be returned to the pharmacy. MAR charts should indicate where people have allergies or state ‘none known’ where appropriate. Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 32 3. 4. 5. YA9 YA17 YA20 People’s support plans should give clear and specific information to the care worker about how medication is to be administered to them. Medication errors should be followed up in accordance with the home’s policy and procedures. Audit trails should be implemented as a system for monitoring that medication is being given as prescribed and being signed for appropriately. The home should consult guidance on the CSCI website to ensure that the training provided on medication administration meets current guidelines. The provider should consult guidance from the Department of Health (‘Essential Steps’) to support their infection control management systems. Care workers should hold a National Vocational Qualification in Care or be working towards this. The home’s rota should indicate where supervisory arrangements are in place for care workers who have a PoVAFirst check but are awaiting receipt of a full disclosure from the Criminal Records Bureau. A quality assurance process should be fully implemented to ensure that the home’s development is firmly based on the views of people who use the service. 6. 7. 8. YA30 YA32 YA34 9. YA39 Beaufort View DS0000069692.V353659.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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.V353659.R01.S.doc Version 5.2 Page 34 - 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. 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