Inspection on 23/10/07 for Beauly Way

This inspection was carried out on 23rd October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Beauly Way 28/06/06

Beauly Way 05/01/06

Beauly Way 17/06/05

Beauly Way 11/01/05

Beauly Way 28/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Beauly Way 4 Beauly Way Rise Park Romford RM1 4XD Lead Inspector Julie Legg Unannounced Inspection 23 – 30th October 2007 10:00 rd Beauly Way DS0000027835.V353421.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 Beauly Way DS0000027835.V353421.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. Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beauly Way Address 4 Beauly Way Rise Park Romford RM1 4XD 01708 756624 01708 372293 darren@outlookcare.org.uk 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) Outlook Care Darren Alan Osborne Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th June 2006 Brief Description of the Service: Beauly Way is a purpose built care home that is operated by Outlook Care and is registered for 6 people (all male) with a learning disability. The home is situated in a residential area (Rise Park) of Romford. The home is close to a number of bus routes and a parade of local shops are within walking distances. Romford town centre is accessible where there are a number of large department stores, pubs, restaurants and a cinema. The home has six bedrooms; one of these is on the ground floor. The other five bedrooms are on the first floor. There is a spacious lounge, separate dining room and kitchen. There are toilets on both floors, a shower room on the ground floor and a bathroom on the first floor. At the back of the house there is a secure garden, where a sensory room (summerhouse) is also available for the benefit of the service users. There are no parking restrictions in the street outside the home. The home’s Statement of Purpose is made available to service users on request and a copy is kept in the office. Every service user/ relative has been given a copy of the home’s Service User Guide. The fees for the home are £1170.67 a week, this does not include hairdressing, toiletries, holiday spending money or any other sundries. This information was given by Darren Osborne (manager) on 23rd October 2007. Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over a day. The manager was present for the duration of the inspection and was available for feedback at the end of the inspection. Discussions took place with the manager, deputy manager and care staff. Care staff were asked about the care service users receive and were also observed carrying out their duties. Staff were also asked about their recruitment, induction programme and ongoing training within the home. Information about Beauly Way was also gathered from service users, relatives and other people (advocate, social worker, community nurse) who visit the home. A tour of the home was undertaken and all of the rooms were seen to be clean and free from any offensive odours. Service users’ files were also case tracked; including risk assessments and care plans, together with the examination of staff files and other home records. These records included medication charts, financial transactions, staff rotas, menus and accident/incident records and staff recruitment procedures. Additional information relevant to this inspection has been gained from the Annual Quality Assurance Assessment, Regulation 37 notifications and Regulation 26 reports. We had a discussion on the broad spectrum of equality & diversity issues and the manager was able to demonstrate a good understanding of the varied needs around religion, sexuality, culture, disability and gender. The inspector had a discussion with the manager as to how the people living at the home wished to be referred to in this report. The manager stated that the home and the organisation use the term ‘service user’. This is reflected accordingly throughout this report. The inspector would like to thank the service users, the manager and staff for their input during this inspection. What the service does well: The home has a very experienced manager and a dedicated staff team that are committed to the service users and the quality of care they receive. The manager and the staff work with the service users to enable them to retain a level of independence and to exercise choice and control over their lives. Some of the service users require a high level of support in meeting some of their Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 6 needs and every effort is made to work closely with other professionals to ensure their needs are met. It was evident that the home is run in the best interests of the service users. Every effort is made to ensure that their views and of significent others are taken into account on any decisions in relation to the running of the home. An advocate who visits the home stated, “ The service users feel that their views are listened to and that they are very happy with their life at Beauly Way”. Relatives that were spoken to were very complimentary of Beauly Way, “We are extremely satisfied with the care Z gets, we couldn’t ask for anything better” and “Darren (manager) and all of the staff are brilliant”. One of the service users stated, “I love it here, they really look after me”. What has improved since the last inspection? What they could do better: Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 7 No requirements or recommendations were identified from this inspection, however the manager continues to identify areas for improvement across the service. The service has performed extremely well and has received quality assessments of excellent in four of the eight outcome groups. However, the manager and staff team may wish to use the Commission’s Key Lines of Regulatory Assessments, (KLORA), available on the CSCI website, to see how they can achieve quality assessments of excellent in all eight outcome groups. 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. Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 and 4 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Prospective residents and their relatives/representative are able to obtain the information that they need in order to be able to make an informed choice about moving into the home. Information is available in a format which helps people with limited communication and literacy skills to be able to understand about living at the home. The staff in the home understand the importance of gathering detailed information about prospective residents, to assist them in providing a service which will identify and meet the individual needs of the resident. EVIDENCE: There is a Statement of Purpose and a Service Users’ Guide which detail the aim and philosophy of the service, and which contains relevant information to assist someone considering moving into the home, or local authorities who wish to commission the service. The Statement of Purpose has recently been reviewed and updated. The Service Users’ Guide has been produced in a pictorial format, which can be understood by some of the people who currently Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 10 live at Beauly Way. This information enables a prospective resident to know what the home is like, and to be involved in the decision-making process. There are currently five people living at Beauly Way and one of them was able to describe what it was like to move from one home to another. He said that staff had visited him at his other home and he came for visits before moving in. This corroborates the statement in the Annual Quality Assurance Assessment that a prospective resident would be offered the opportunity to visit and have a meal, to stay overnight or for a weekend. This will help all parties in making the decision as to the suitability of the placement. Information from the care manager (social worker) also corroborated that the admission of the prospective resident had been robust and had enabled him to visit the home prior to any decisions being made. Outlook Care has a comprehensive admission policy and procedure. The admission policy states ‘that all prospective residents’ needs would be assessed prior to them moving into the home’. Most of the current residents have lived in the home for a number of years and their admission assessment has been reviewed and updated since the previous admissions. The service user who moved in a year ago had a comprehensive care management assessment and other information was also collated from his previous home and health professionals. There was a detailed transition plan, however the manager stated that they would look to produce a pictorial transition plan with the next prospective resident. The manager visited the prospective resident three times in his previous home; talking to him, care staff and health professionals and looking at records. The prospective resident visited Beauly Way on a number of occassions prior to him moving in; he visited with staff, and then on his own, followed by an overnight stay and finally a weekend stay. He has settled well and has built up a very positive friendship with one of the other service users. He has also visited his previous home on two occassions; once to see the people he used to live with and then to see that the home had indeed closed down. He has chosen not to stay in contact with the people he use to live with. He stated “I love it here, I don’t want to go back”. Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 11 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): 6,7,8 and 9 People who use this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. All of the service users’ identified needs are reflected in up to date care plans and risk assessments. This ensures that their needs are being appropriately met and that they and others are safeguarded. The service users, with assistance, are able to participate in all aspects of life in the home and to make decisions about their lives. EVIDENCE: The manager and staff have ensured that the service users are involved in all decisions about their lives. There is a care planning system in place that is clear and concise. Each service user has an individual person centred care plan (PCP) and this information is also provided in pictorial format. The PCPs cover areas of the service user’s life, such as, things that I am good at, likes and dislikes, things that I need help with, how I communicate and things that are Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 12 important to me. One service user does not like to have a shower, does not like dogs but likes 60’s music and going to his clubs. Another service user likes to hold small objects. Another service user will put his head on top of the staff’s head or sing ‘pop goes the weasel’ or ‘twinkle twinkle little star’ when he is happy and when he is angry he says ‘clanad’. These PCPs were completed with the involvement of the service users and their relatives (if appropriate). One service user sat with the manager and was able to complete his PCP using a voice activated computer and choosing what pictures he wanted to use. Another service user’s PCP is photographs of himself showing what tasks he can do and what tasks he needs assistance with. Whilst verbal communication is limited with most of the residents, the staff have spent some considerable time in learning about the different ways service users communicate, for example, through noises, body language and facial expressions. Service users’ files indicated that person centred plans have all been regularly reviewed and updated. All of the service users are involved in regular meetings with their keyworkers, where their PCP is reviewed. Relatives and an advocate from People First are also involved with the service users and assist them in decision –making within the home, such as, the recent redecoration and refurbishment of their bedrooms, menu planning, where to go on holiday and the recruitment of potential staff members. Care plans were examined alongside the daily records and compared with the support being given. The care staff know the service users extremely well and give a verbal and written handover. Each service user has their own daily record sheet, which is completed by the care staff. These daily records reflect the assistance that has been given on a day-to-day basis and how service users are involved in the life of the home. All of the service users can put their clothes in the washing machine and with some assistance put their clean clothes away. Some can lay the table whilst all of them can lay their place mats. One service user can make a cup of tea and a sandwich and another can make instant whip. One service user stated, “I like helping and laying the table”. All of the service users use the Hoover (to varying degrees) with support from the Housekeeper and are involved with menu planning and food shopping at the local supermarket. Two of the service users are particularly keen on recycling and have become the ‘champion’ recyclers; sorting out the paper, cardboard, tins and plastic. Two of the service users hold the key to their bedroom door. One of the service users had been shopping at the weekend to buy new bed linen and curtains for his bedroom and another service user who has been reluctant to go out is now able to go to the local garage supported by 2 members to staff to buy his own bars of chocolate. Staff on duty demonstrated a good understanding of the different needs and abilities of each resident and were observed to interact with the residents in a calm, respectful and caring manner, demonstrating an appropriate balance between friendliness and professionalism. Staff were observed to explain Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 13 actions and decisions to residents in an adult manner, relevant to each person’s particular needs and abilities. There was also evidence of the flexibility of daily routines, to take into account the preferences of each resident The advocate contributed to the inspection, stating that she was satisfied that the staff team work effectively to promote choices for the diverse needs of the people who live in the home, and to enable them to lead fulfilling lives. Service users are encouraged to take reasonable risks and there were detailed risk assessments, guidelines and protocols in place and these were linked to individual need. These assessments covered activities both within the home and in the community. All of the service users have complex needs, resulting in some restrictions to their liberty, in order to safeguard them. Restrictions were appropriate and reasonable. Risk assessments seen were appropriate and had been reviewed. There was evidence that these assessments have been regularly reviewed and updated. Scores of 4 for this group of standards have been awarded in recognition of the high standard of care being provided, to ensure that people who live at Beauly way have their individual needs and choices met. Beauly Way DS0000027835.V353421.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): 12,13,14,15,16 and 17 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users are encouraged to make choices about their lives and have the opportunity for personal development within the home. Social and recreational activities are tailored to meet their preferences and abilities but more community-based activities could be developed. Service users are encouraged to have appropriate personal and family relationships. Their rights are respected and they are supported to take responsibility for their actions. EVIDENCE: The staff team demonstrated a commitment to encouraging the service users to develop their skills and interests, both in the home and in the community, whilst recognising that service users have differing interests and abilities. Service users’ care plans identify lifestyle choices, such as, local leisure activities, activities within the home and family contact. The service users have Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 15 opportunity for personal development but the manager has recognised that service users’ leisure activities could be more individualised and varied. In the Annual Quality Assurance Assessment under ‘what we could do better’ it states ‘to explore new opportunities within the community’. One of the service users attends a local authority day service twice a week; two service users attend an evening club twice a week. Three of the service users enjoyed a holiday at Centre Parcs, whilst the other two service users decided they did not want to go on holiday but have enjoyed day trips instead. Other trips have included trips to Southend, going out for meals, afternoon tea, discos and occasionally bowling. Two service users used to go swimming but have now decided they no longer wish to go. Some of the service users go shopping for their own toiletries and clothes and one service user enjoys cycling accompanied by a member of staff. Activities within the home include music therapy, hand and feet massage, painting and accessing the sensory room. The garden is secure and the service users enjoy playing football in the garden. Two of the service users attend church on Sunday and one service user now attends a Synagogue on a Friday. The home has access to their own mini bus. One service user stated, “I enjoy going to my clubs and I am going to a Halloween disco on Saturday”. None of the service users are involved in a sexual relationship, however the manager was clear that any service user would be supported if they wished to have a consenting sexual relationship with another person. Most of the service users receive visits from families and friends and staff have supported one service user in contacting his brother. Some service users go out with their families and one service user goes on holiday every year with his parents. One service user has a difficult relationship with his parent who has their own issues. Meetings with other professionals and the service user have taken place and certain measures have been put in place to safeguard the service user. The manager and staff at Beauly Way have dealt with this difficult situation very sympathetically. There are no restrictions on visiting times to the home and during the inspection one of the service users went out for lunch with his parents. They stated, “We feel very welcome when we visit”. All of the service users receive visitors; some more regularly than others. Service users can see their relatives/friends in the lounge, the dining room, the garden, the sensory room or the privacy of their own bedrooms and there are no restrictions on visiting times. However one of the service users has a difficult relationship with his parent, who has their own health needs and at the present time they are not in contact. There are no ‘set house’ rules and service users were observed to move freely around the home. On the day of the inspection one of the service users was attending a day service, one service user went out for lunch with his parents, another service user had a lie in and the other two service users watched television, listened to music and assisted with household chores. Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 16 Staff have overall responsibility for the cleaning of the home; a housekeeper works three days a week, however the service users are able to participate at varying levels, such as, dusting their bedrooms, putting their clothes away, putting their laundry into the washing machine, sorting out the recycling and laying the dining table for meals. The menu is set weekly; this is carried out on a Sunday with all of the service users using pictures of different meals. The menu is in pictorial format and situated in the dining room, often the service users decide that they want something different and this was evident on the day of the inspection as two of the service users had a jacket potato with different fillings and the other service user asked for sandwiches. Service users’ care plans also state food likes and dislikes such as, ‘I like fish and chips, and I do not like pizza, shepherds pie or quiche’. Dietary requirements are catered for; one service user cannot tolerate diary products and has Soya alternatives. The Speech and Language Therapist has been involved with another service user who needs his food cut into small pieces and his plate needs to be raised. One of the service users is Jewish, however it is his choice that he does not follow a Kosher diet. The staff do encourage the service users to eat a healthy diet and fresh fruit is always available and offered as snacks, however biscuits, crisps and cakes are also available in moderation. Friday night is ‘take away’ and the service users decide on either fish and chips, Chinese or Indian. Food store cupboards, the refrigerator and freezer were inspected and all foods were appropriately stored. Beauly Way DS0000027835.V353421.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): 18,19,20 and 21 People who use this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users receive support in the way they prefer and their physical and emotional needs are met. Service users’ wishes regarding their death are clearly recorded; this should ensure that their final wishes are respected and carried out. None of the service users are able to administer their own medication. There are policies and procedures in place to ensure that this is carried out safely. EVIDENCE: Care plans and daily records were examined and discussed with the manager. The care plans clearly identify health and personal care needs and there are clear guidelines on how staff should support service users. These care plans are in pictorial format, showing what the service users are good at and what assistance is required for each task. All of the service users require some assistance with their personal care, though they are encouraged to do as much Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 18 as possible for themselves. Some service users prefer to bath and others to shower, some prefer in the mornings and others in the evening. Staff have very clear views on how much or how little assistance is required and the service users’ preferences regarding their style of dress. Some service users are able to indicate what clothes they would like to wear and for others it is done through process of elimination by staff holding up certain items of clothing for them to choose what they want to wear. One service user had jeans and a casual shirt on, another had trousers, shirt and jumper and another service user was wearing jeans and a t-shirt. Some of the service users with support from staff are able to buy their own clothes, whilst other are supported to choose from a catalogue. All of the service users had haircuts that were in keeping with current fashions, in particular one service user had a particularly trendy hairstyle and he stated, “When I went to the shop I looked in the books and picked out a picture and said I want my hair cut like that”. A relative stated, “He is always dressed nicely”. Records inspected showed that service users have very comprehensive personal health records and health action plans and these are currently being put into an easy read format. All of the health action plans have been reviewed and updated. The manager is very pro-active in promoting good health and involving health professionals. There is evidence to show that service users have been supported to access dental care, opticians, chiropody, community learning disability nurse, psychiatrist, speech and language therapist, GP, district nurse and hospital out-patient appointments and hospital admissions. All service users are weighed monthly and any losses and gains are noted and advice is sought from the community nurses and GP. One service user on admission to the home complained of toothache (this was something that he had complained about in his previous home). The service user was supported by his key worker to visit the dentist and subsequently had to have four teeth extracted under general anaesthetic at the local hospital. He stated “I had to have my teeth out, X (key worker) came with me and I wasn’t too frightened’. He has also accessed an optician and consequently has been to see an ophthalmologist as an outpatient. Another service user has epileptic seizures in which have become more frequent and again medical advice has been sought and a drug review has been undertaken and other measures have been put into place to safeguard the service user. A health professional stated in a recent survey, “any recommendations I make are always carried out. Communication is very good”. Two of the relatives felt that there had been an improvement in their son’ semotional well-being since moving into Beauly Way. One stated, “He is much happier and calmer and seems more aware”. Another service user has a friend who visits and she stated, “He is a lot happier and smiles more”. There are policies and procedures for the handling, administration and recording of medication within the home. Evidence on staff files showed that staff have received medication training and competency assessments and Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 19 there is also a list of staff (with their signatures) stating that they are competent in the administration of medication. Medication Administration Record (MAR) charts and the medication cupboard were checked and found to be correct. Three of the service users’ medication was audited and the amount given and the amount remaining reconciled with the MAR charts. Beauly Way has robust medication audits; these are undertaken by the manager and the Service Manager during their monthly Regulation 26 visits and all medication is checked at each staff handover. Recently one of the service users passed away and his death caused much sadness amongst the service users and the staff. Both service users and staff attended the funeral. Through talking about his death, staff were able to talk to some of the service users about their ‘wishes and support on death and dying’. One service user’s preferred wishes are that ‘he would like to be buried next to his Mum and Dad and go to heaven with them’ and ‘he would like to be cared for at Beauly Way if he became ill’. The manager is currently trying to find the location of his parents’ graves. Where service users have not been able to communicate their wishes, relatives have been involved with this process. This is a difficult subject for staff to discuss with service users, however this appears to have been dealt with in a sensitive manner. Scores of 4 for this group of standards have been awarded in recognition of the high standard of personal and healthcare support being provided to people who live at Beauly Way. Beauly Way DS0000027835.V353421.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 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The service users’ views are listened to and acted upon. Service users are protected by the policies and procedures and the monitoring systems within the home. EVIDENCE: The home has a clear complaints procedure, which is available in written and pictorial format. A copy of the procedure has been made available to all of the service users and to their relatives and advocate. There have been no complaints recorded since the last inspection (June 2006), however the manager welcomes complaints and suggestions about the service and we are confident that the manager would take any concerns/complaints seriously and would deal with them appropriately. Not all of the service users are able to verbally communicate their needs and likes and dislikes, however their care plans clearly detail how each service user indicates their needs, likes and dislikes. An Advocate (People First) regularly visits the home and there are regular house meetings where concerns and complaints can be discussed. The Advocate stated, “Darren (manager) and the staff are very supportive to the service users and listen to their views and take into account their needs and their wishes”. Two of the service users were asked, ‘who would you talk to if you were unhappy with anything at the home?’ One service user said, “I would tell Darren”, the other service user said, “I would talk to Y Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 21 (keyworker)”. Relatives that were spoken to all said that if they had a problem they would talk to Darren or Y (deputy manager). One relative stated, “I spoke to Darren about something fairly minor and it was dealt with straight away, we have every confidence in him and the staff”. Service users are encouraged to participate in decision-making within the home; colour schemes for their bedrooms, planning of menus and activities and some involvement with staff recruitment. The home has policies and procedures for the safekeeping and expenditure of service users’ money. The finance department of the organisation monitors service users’ money, which is held in safekeeping by the home. There is a procedure in place that all monies are checked at each staff handover. The responsible individual when carrying out regulation 26 visits will also monitor service users’ finances. One of the service users is under the Court of Protection, which means all of his expenditure is dealt with through a receiver. Service users are supported to make purchases and receipts are kept for all expenditures and records of money held. Two service users’ money was checked and money held corresponded with expenditure and receipts. The home has comprehensive ‘safeguarding adults’ policies and procedures; these include the local authority (London Borough of Havering) policy and procedure, the Department of Health ‘No Secrets’ and the organisations’ policy and procedure. The manager was clear in what incidents needed to be referred to the Local Authority as part of the local ‘safeguarding adults’ procedure. There has been one incident that has been dealt with under the ‘safeguarding adults’ procedure; this incident involved a service user but not a member of staff. Appropriate strategies have been put in place with the involvement of the service user, his advocate, the manager and staff at Beauly Way and the community Learning Disability team. Staff members that were spoken to were very clear on what constituted abuse and their responsibility in reporting any potential or actual abuse. Staff files indicated that all members of staff have attended ‘safeguarding adults’ training and this subject has been dealt with in staff meetings. There was also evidence that staff have undertaken training in self-injurious behaviour, understanding challenging behaviour and management of aggression. This training shows them how to respond appropriately to physical aggression and when to use physical intervention or other alternatives. Any acts of physical intervention would be clearly recorded by the manager. Beauly Way DS0000027835.V353421.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): 24,25,26,27,28 and 30 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home is very homely and provides the service users with a clean, comfortable and safe environment. Service users’ bedrooms suit their needs and are decorated and furnished in a way that suits their lifestyles. The communal rooms and garden complement and supplement the service users’ individual rooms. EVIDENCE: A tour of the home was undertaken including the service users’ bedrooms. The home was purpose built in1990. It is situated in a quiet residential area of Romford but accessible to community facilities and services. The home is decorated and furnished in a homely fashion and all areas of the home were well maintained, clean, tidy and free from any unpleasant odours. The home has a robust infection control policy and would seek advice from external specialists if and when required. Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 23 The home consists of six bedrooms; one of these bedrooms is one the ground floor. All of the bedrooms are of a reasonable size and all have recently been redecorated and refurbished. All of the service users were involved in choosing the colours and some have been involved in choosing the soft furnishings. Bedrooms were very individual with some having lots of personal possessions and others choosing to have the minimum of things displayed. Two service users choose to lock their bedroom doors. All bedrooms are fitted with suitable locks that offer privacy but can be opened in an emergency from the outside. Other redecoration and refurbishment has also taken place within the home; the kitchen/diner is now two separate rooms and both have been completely refurbished and redecorated. The hallway has been redecorated and new carpet has been fitted. There are adequate toilets and bathrooms that have appropriate adaptations i.e. grab rails and these rooms have also been redecorated. The kitchen was clean and tidy and has recently been completely refurbished and redecorated. The kitchen is suitable for residents to carry out domestic tasks, such as, washing up, making cups of tea and preparing snacks. Where there are concerns regarding the health and safety of service users using the kitchen, a full risk assessment is completed to minimise risk. The laundry room was clean and tidy and with clear instructions both written and pictorial format on how to use the washing machine. There are gardens to the front and rear of the home. The back garden is secure and used by service users, where they are able to play football and other games. There is also a summerhouse that has been made into a sensory room, which is used by all of the service users. On the day of the inspection, decorators commenced painting the exterior of the home. Beauly Way DS0000027835.V353421.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): 32,33,34,35 and 36 People who use this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users are supported by qualified and competent staff. Staffing levels are satisfactory and there are sufficient staff on duty, who have the appropriate skills and training to meet the needs of the service users. The procedures for the recruitment of staff are robust and provide safeguards for service users living in the home. Staff receive regular supervision and annual appraisals, which is beneficial to the service users EVIDENCE: Duty rotas were inspected (these were in both written and pictorial format) and they correlated with the staff on duty and there were sufficient staff on duty to meet the needs of the service users. There are two staff on duty on each shift and one waking night staff and extra staff are bought in on Tuesdays, Fridays and Sundays to offer 1:1 support. The manager is supernumerary to the rotas; this allows him to carry out his managerial tasks. Staff retention is satisfactory and sickness levels are low. The manager uses ‘bank’ staff to cover any vacant shifts; these staff are known to the service users and are therefore familiar with their needs. Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 25 There is a clear recruitment procedure and policy. Staff files are kept secure in a locked filing cabinet. Two staff files were inspected (these were of the most recent employed members of staff). These files showed robust recruitment procedures had taken place; a completed application form, two written references, health screening questionnaire, copies of qualifications, driving licence, passport and a current Criminal Records Bureau (CRB) checks. Staff that were spoken to confirmed that a face-to-face interview had taken place and that their employment did not commence until satisfactory references and CRB check were received. There was also evidence on files that all new members of staff undertook an induction programme and were subject to a satisfactory probation period. Equality and Diversity is monitored through the recruitment and selection procedure. The staff group are from diverse cultures and backgrounds, some of which are different from the people living in the home. However, staff have undertaken training in ‘valuing people’ and this ensures that the cultural, spiritual and other diverse needs of the service users are understood and met. There was evidence on staff files that an induction programme has been undertaken as well as food & hygiene, first aid, health & safety, fire awareness, moving & handling, safeguarding adults, epilepsy awareness, person centred planning, medication and positive response training. Only one member of staff has to complete the Learning Disability Award framework and another member of staff is to commence her NVQ 3 in the near future. All of the remaining staff have completed their NVQ 2/3. The deputy manager has completed an appraisal and supervision course and has been put forward to undertake formal management training. Staff files indicated that staff are receiving supervision in line with the National Minimum Standards, which states ‘at least six times a year’. There was also written evidence that staff have received annual appraisals and that staff meetings are held regularly and well attended. Staff that were spoken to confirmed that supervision and staff meetings were taking place and that as well as formal supervision, the manager had an open door policy, which meant they could go to him at any time. Staff spoke very highly of Darren (manager) and comments were, “He is a really good manager, he encouraged me to go for promotion”, “I have never had a manager like Darren before, he always listens and he is very supportive”. Service users, relatives and the advocate also spoke highly of the staff. Amongst the comments were “ I really like Y (keyworker), she really helps me”, “The staff are really nice, I don’t want to live anywhere else”. “Darren and the team are absolutely brilliant, they are so committed”. “Darren and the staff are so supportive to the service users”. A score of 4 has been given in recognition of service users being supported by a very competent, effective and qualified staff team. Beauly Way DS0000027835.V353421.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): 37,38,39, and 42 People who use this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home is managed by a qualified and experienced manager who also has very sound management practices, this means service users’ health, safety and welfare are promoted and protected. Service users can be confident that their views underpin the self-monitoring, review and development of the service. EVIDENCE: The manager has been in post since June 2006 but previously managed another home within the organisation. He is committed to providing and Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 27 improving the good quality of care at Beauly Way. To achieve this he works closely with health professionals, social workers, advocacy service, relatives and the Commission. He has completed many courses including NVQ 4 in Care, the Registered Managers’ Award, Certificate in Management Studies and is a trainer in Positive Response Training. He has sound knowledge of both strategic and financial planning and how the operational plan for the home fits in with these. He has responsibility for the financial budget of the home and is aware of his budgetary limitations. In previous discussions with the service manager and discussions with the registered manager it is clear that the home has effective and regular support from the organisation and that there are clear lines of accountability. A score of 4 has been given in recognition of the manager’s leadership and the benefit that the service users receive in living in a home that is well run and in their best interests. Discussions with the manager showed he was able to describe a clear vision of the home based on the organisation values. It was evident that he was able to communicate a clear sense of direction and demonstrated a sound understanding and application of good practices particularly in relation to continuous improvement of the service. The manager has carried out spot checks out of ‘normal hours’ and this is supported by regular supervision of all the staff and other quality monitoring systems, such as, service users’ meetings and feedback from the advocacy service. A quality assurance questionnaire has also been undertaken with information gathered from service users, health and social care professionals, relatives and the advocacy service. A health professional’s written comments stated, “Communication is very good and the level of information given by the home is very satisfactory. The manager and staff always make me feel welcome”. A relative had written, “Darren is very helpful I am very satisfied with the care”. An annual development plan has been completed reflecting the comments and views from the surveys. Regulation 26 visits are regularly undertaken by the responsible individual to monitor and report on the quality of the service. Copies of these reports are sent to the Commission. During the course of the inspection the manager was observed leading from the front, by directly engaging with service users, relatives and staff. There was a high level of praise from service users, relatives and other professionals. All of the staff spoke highly of the manager and how well they felt supported by him. There was evidence that staff receive regular supervision and yearly appraisals, regular staff meetings and direct observation of their care practices. The manager was able to demonstrate his knowledge and commitment to equality and diversity issues, which are given priority in caring for the service users. It was also evident that the manager followed the policies and procedures of the home and organisation. Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 28 As previously stated record keeping remains of a consistently high standard with records being kept securely locked in accordance with the Data Protection Act. All of the working practices in the home are safe, within a risk management system. The manager proactively monitors the home’s health & safety performance and consults other experts and specialist agencies when necessary. Risk assessments were in place for fire, first aid, infection control and moving & handling. Staff have the benefit of a structured induction in line with the Learning Skills Council. Refrigerator and freezer temperatures are taken and recorded daily and food that was stored was covered and dated. Fire drills are taking place regularly; fire extinguishers received their annual check in May 2007 and the fire risk assessment has been completed and recently updated. The annual Gas safety certificate is dated April 2006; the five-year electrical safety certificate is dated June 2003. Regular audits are undertaken to check for compliance to the National Minimum Standards and good compliance in health & safety is maintained through the organisational management group and any incidents/accidents are reported to the board of the organisation as a key performance indicator. Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 29 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 3 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 4 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 4 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 4 4 4 4 X X 3 X Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Beauly Way DS0000027835.V353421.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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. 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