Inspection on 15/06/09 for Beaumanor House

This inspection was carried out on 15th June 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beaumanor House 12/07/07

Beaumanor House 10/05/06

Beaumanor House 27/10/05

Beaumanor House 22/05/05

Beaumanor House 25/02/05

Beaumanor House 16/12/04

Similar services:

Hillside

Applegarth

122 Scorer Street

St Marys Nursing Home

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Beaumanor House 34 Robert Hall Street Leicester Leicestershire LE3 5RB The quality rating for this care home is: zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Linda Clarke Date: 1 5 0 6 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement They reflect the We review the quality of the service against outcomes from the National Minimum Care Homes for Adults (18-65 years) Page 2 of 36 Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for adults (18-65) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Beaumanor House 34 Robert Hall Street Leicester Leicestershire LE3 5RB Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : learning disability physical disability Additional conditions: No person falling within category PD may be admitted to Beaumanor House unless that person also falls within category LD - ie Dual Disability. Service User Numbers LD/PD No one falling within categories LD/PD may be admitted into Beaumanor House when there is already 1 person of categories LD/PD already accommodated within the home. Date of last inspection: 1 2 0 7 2 0 0 7 Number of places (if applicable): 21 1 care home 21 Leicester City Council 01162664833 01162664833 Beaumanor.House@leicester.gov.uk Care Homes for Adults (18-65 years) Page 4 of 36 About the care home Beaumanor House provides personal care and support for up to twenty one people who have a Learning Disability and is owned and managed by Leicester City Council. The home is situated in a residential area, close to shops, a public house and other amenities. There is a car park to the front of the home. Public transport routes are nearby, and it is approximately ten minutes to the city centre by car. Beaumanor House has several communal rooms, which include a games room that has a pool table and a computer room with two computers that have internet access for people who stay at the home to use. All bedrooms are single, and there are bathrooms and toilets which in some instances have been adapted to meet the needs of those with a physical disability. There is a central courtyard with grass and planters, and provides benches and tables to enable people to sit outside. Care Homes for Adults (18-65 years) Page 5 of 36 Information about the service is provided to prospective and current service users within the Service User Guide, which is produced in large print and accompanied by signs and symbols to promote the understanding of the reader. Fees for staying at Beaumanor House are dependent upon a financial assessment, which is carried out by a representative of Social Services. Care Homes for Adults (18-65 years) Page 6 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 36 How we did our inspection: This is what the inspector did when they were at the care home We as it appears in this Inspection Reports refers to the Care Quality Commission. We did this inspection by visiting Beaumanor House on the 15th June 2009; we arrived at the home at 09:00 and stayed for 6.5 hours. Before we went to Beaumanor House we looked at the information the Registered Manager had sent to us, this gives us information about the home. We sent surveys to people who live at the home, and their relatives, and the staff who work at the home. We also sent surveys to health and social professionals who provide additional support, guidance and care for people who live or stay at the home. We looked at the care plans and records of five people who live or were staying at Beaumanor House and we talked with people who were at the home when we visited. We also talked with staff and asked them how they help and support people. We have written about what we found out when we visited the home and what people told us. Care Homes for Adults (18-65 years) Page 8 of 36 What the care home does well Beaumanor House provides somewhere for people to live and be cared for in an emergency situation when they are thought to be at risk of abuse or neglect. This means that they are safe. People at the home have good access to health and social care professionals and meet with them regularly, which provide support to them. Many people who have been moved into the home because they were at risk in their own home and have extra staff who help them and support them with managing their behaviour which can be challenging, they are also help them to take part in activities. Beaumanor House has a room that has two computers which people who live at the home can use and have internet access. Beaumanor House has a room which has a pool table for people to use. Care Homes for Adults (18-65 years) Page 9 of 36 The staff team are enthusiastic and work hard to look after people; the management team and staff work together well, and share information. They have helped several people who used to live at the home move out to live a more independent lifestyle within the community. People who move into the home due to an emergency or because they are risk in their own home from abuse or neglect have their rights supported when decisions are made on their behalf. All decisions are supported by a group of people who are acting in a persons best interest, when they cannot make decisions for themselves. What has got better since the last inspection Staff have received training in how to report concerns if they believe someone is at risk of abuse or neglect and have received training in how to manage and support people with behaviours that are challenging. Staff receive training which helps them understand their role and responsibility when people are deprived of their liberty and choices, because they are not able to make a decision that will ensure their safety. Care Homes for Adults (18-65 years) Page 10 of 36 What the care home could do better People who move into the home in an emergency often have other needs which they need support with, such as with their mental health. Staff have not received training on how to support people with mental health difficulties, and staff told us that they find it difficult to help people well. People who live at the home or who visit regularly for respite care are sometimes hurt by people who move into Beaumanor House in an emergency situation. We found that some people were hit or pushed, and surveys we received told us that people do not like the shouting and the bullying. This means that people who live or visit the home do not have their rights protected and are at risk. People who live at the home are not asked about who moves into their home or whether they want them to move in. Care Homes for Adults (18-65 years) Page 11 of 36 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Linda Clarke Care Quality Commission CPC1 Capital Park Fulbourn Cambridgeshire CB21 5XE Telephone: 01223 771300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Care Homes for Adults (18-65 years) Page 12 of 36 Details of our findings Contents Choice of home (standards 1 – 5)........................................................................ 14 Individual needs and choices (standards 6 – 10) ................................................... 17 Lifestyle (standards 11 – 17) .............................................................................. 19 Personal and healthcare support (standards 18 – 21) ............................................. 22 Concerns, complaints and protection (standards 22 – 23) ....................................... 24 Environment (standards 24 – 30) ........................................................................ 26 Staffing (standards 31 – 36)............................................................................... 27 Conduct and management of the home (standards 37 – 43) ................................... 30 Outstanding statutory requirements..................................................................... 32 Requirements and recommendations from this inspection ....................................... 33 Care Homes for Adults (18-65 years) Page 13 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Individual assessments are not undertaken in a timely manner and therefore the Registered Manager cannot determine whether the needs of a person can be met by the staff and the facilities of the home. Evidence: We were given a copy of the information provided to people who move into Beaumanor House, which is referred to as the Service User Guide; we were also given a copy of the homes Statement of Purpose which outlines the services the home provides. The Registered Manager told us that everyone is given a copy of the Service User Guide when they move into the home. The Service User Guide is provided in a format which includes pictures to help those with a learning disability to understand the information, which includes information about making a complaint, activities in the home, staffing and the environment. The Statement of Purpose we were given was reviewed in June 2009. Beaumanor House now provides care and support for a range of people with differing needs and from varying situations. People who have lived at the home for many years have started to move into alternative accommodation, which means there is now a small group of people who continue to live at the home, they are also planning to move out. Beaumanor House continues to provide respite care for adults with a learning disability. As many people have moved out of the home, Beaumanor House is being increasingly Care Homes for Adults (18-65 years) Page 14 of 36 used to provide accommodation to people who are at risk within the community, which means people are moving into the home in an emergency situation, which leaves very little time to plan their move into the home. Beaumanor House continues to offer planned respite care. We looked at the records of five people, which included one person who was to arrive at the home the day of our visit for respite care, along with one person who had lived at the home for some time and who was planning to move out in the near future. The three other records that we looked at were for people who had been placed in an emergency situation, where they were felt to be at risk from exploitation or abuse within the community. We found that the assessments for the person who regularly accesses respite care and the person, who has lived at the home for sometime, were reflective of their current situation. We found that one person who had moved into Beaumanor House sometime ago in an emergency situation did not have an up to date assessment when they moved into the home. An up to date assessment is now in place and the person has been given a copy to comment on, as they are hoping to move out. The records of the two other people who have moved into the home as an emergency placement did not contain an up to date assessment of their needs. The Registered Manager and staff told us that they are provided with a verbal summary as to why the person is coming into the home as an emergency placement, but that an up to date assessment is not undertaken once they have moved into the home for sometime. We spoke with the Registered Manager, and their Team Manager who were at the home when we visited, along with care staff who told us that they have little say as to who comes into the home, as decisions are made by senior management within Leicester City Council. The outcome of this means that the home and staff struggle to meet the needs of people, balancing the needs of people who live or regularly visit the home along with those who move into the home in an emergency situation, who have complex and diverse needs. We found that people move into Beaumanor House on an emergency basis have a learning disability, which the home is registered to accommodate. We found that the person’s learning disability may not in all instances be the primary reason for them moving into the home. Assessments identified that people have additional health care needs such as mental health, which the home is not registered to provide. We sent surveys to health and social care professionals, the views of both professionals were varied and indicated differing opinions as to whether the assessment of needs of people were sufficient, and whether the service was able to meet individual needs. Surveys contained additional comments which included: Managers should not use Beaumanor as a place to put any service user and hope that they will fit into the service. The service is not needs let, not enough staff and does not always cater for the group living there. The service needs to be able to meet more peoples needs who present with challenging behaviours and may need additional support. Beaumanor House is a specialist service for adults with a learning disability. This Care Homes for Adults (18-65 years) Page 15 of 36 resource provides exceptional quality care/support for long term residential and short term emergency respite placements. Mix of people at Beaumanor means it’s not a needs led service. Surveys that we sent to health and social care professionals, in some instances asked us to contact them. We telephoned a range of people and this is what they told us. I have concerns that Beaumanor struggles to meet the needs of service users, due to the range, complex needs and challenges which service users have. Beaumanor is used as a home for anyone where no alternative placement can be found. Staff in some instances have experience, but staff inexperience and number of agency staff, lead to poor communication and poor record keeping. Staff are professional, and understand the needs of service users. Good social activities provided and individual care plans. Lots of service users with differing needs, and information is not always recorded well. Diverse group of people, staff find it difficult to meet the needs of people with challenging behaviour, vulnerable adult admissions, respite and people who self harm, there needs to be clear boundaries as to what is needed. There is no Social Services alternative and therefore Beaumanor House is used to accommodate people. The person went onto say that they have experience of Beaumanor House being used to provide accommodation as other resources are too expensive. We sent surveys to staff who work at the home, views were varied but a majority of staff indicated that their ability to provide good quality care is restricted by the lack of information in individuals assessments, the complex and wide ranging needs of people who stay at the home, and insufficient training. Staff made additional comments which included:I believe we provide a quality service to all who come to Beaumanor, sometimes we do not get up to date assessments plans for emergency placements but staff work well together. We regularly have emergency placements for many different reasons and I believe the staff cope very well. I think our staff team pulls together really well to cater for all even when we have to mix mild to severe learning disabilities and challenging behaviour and mental health all at the same time. Beaumanor is not the best placement for people with challenging behaviour and our staff are not trained in mental health but we regularly have to deal with people with mental health issues. Because of the more complex needs of individuals that are now using our service the people who live at the home seem to spend a lot of time unnoticed, not uncared for, but with so much kicking off going on at the moment, this can take up most of the shift, taking up your time. We often have very little information about a service user if they come in as an emergency and staff have to make judgements as concerns arise. I do feel at times we could do with more input from Social Workers, especially when we have mental health and challenging behaviour service users coming in. Care Homes for Adults (18-65 years) Page 16 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People staying at Beaumanor House are supported to make choices and decisions about their day to day lives, however emergency admissions have adversely affected the needs and choices of people already living in the home. Evidence: We looked at the records and care plans of five people who live or stay at the home. Care plans reflected the individual needs and support each person required. A Social Worker develops a care plan, as does the home. The care plan completed by the Social Worker for people who have moved into the home due to an emergency within the community, detailed any restrictions placed on that person for their safety (please refer to the section Conduct and Management of the Home). Care plans do not take into account how individuals’ behaviour impacts on others they share the home with which means that other people living at the home experience and live with difficult situations. We spoke with three people about their care plan and they were aware of what it said, and had a good understanding as to why they had moved into Beaumanor House. We spoke with one person who told us that they had a key worker, and were aware they could discuss things with them. We found that care plans were regularly reviewed to reflect changes in individual circumstances. The care plan for the person who regularly receives respite care at the home was very comprehensive and had been produced in a format which included pictures and symbols to help the person understand what was Care Homes for Adults (18-65 years) Page 17 of 36 written. The care plan provided a detailed account as to the persons needs with all aspects of their daily lives, which included information on communication styles, and the use of non verbal interaction. The care plan enables staff to provide individual and tailored care and support, in a way which the person prefers. We found that some people who are staying at Beaumanor House manage their own money and that they retrain their bank card in order to access their money. Some people have their money managed by Leicester City Council, and individual spending money is kept on the premises so that people can make purchases. We looked at the money and financial records of transactions for three people whose records we had looked at and found them to be in good order, which means that individuals money is being managed well. When we visited one person staying at the home attended a meeting with their Social Worker and others to discuss moving out of the home, we were not able to speak with this person as they went out in the afternoon. The assessment of this person was up to date to reflect their current situation, and they had been given a copy to comment on. This shows us that the views of people are considered and that there are active measures in place to support people in making decisions. When we visited the home we spoke with two other people who were looking to move out of the home in the future, they were able to tell us where they were hoping to move to, this was another example of where people are supported to make their own decisions and choices. One person told us that they were moving to a particular place so that they could continue to attend their Church. We found that records contained risk assessments where risks had been identified, and the assessment provided information as to how the risk could be minimised, this included people who are staying at the home, who may leave the home but by doing so put them at risk of exploitation or abuse. This use of risk assessments ensures that staff work consistently to promote the well-being and safety of people without restricting their choices and freedom. Care Homes for Adults (18-65 years) Page 18 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Beaumanor House supports and arranges for people to engage in a range of activities and leisure pursuits, the ability for people to participate is influenced by the needs of people using the service and staffing levels impacting on the quality of people’s lives. Evidence: When we arrived at Beaumanor House many people were still at home, but some people later in the day went out to Colleges or Day Centres. We found care plans contained information about what people did with their days. People who had been admitted to the home on an emergency placement had in many instances additional staff support, which included one to one support. We observed staff supporting people individually or collectively to participate in board games such as scrabble. The care plan of one person stated that one to one support was used to support them attend College which included their work experience. We spoke with one person and they told us that at the weekend they had attended a concert at DeMontfort Hall, and on the following day had gone on a day trip to Skegness with people who live or are staying at the home. Someone else told us that they went to Church on Sunday, and that their sibling had taken them. Care Homes for Adults (18-65 years) Page 19 of 36 On the day of the inspection we did observe that people who live at the home, as opposed to people who have been admitted as an emergency placement, when they didnt go out to attend day care or college had little to occupy themselves during the day, and received minimal staff interaction. We sat in the lounge looking at peoples records and care plans and noted a number of people sat watching a small portable television, which was difficult to view unless you sat very closely to the screen. We spoke with one person who had been admitted into the home as an emergency placement, we spoke with them in the I.T. Suite, which has two computers with internet access. They told us that they keep in contact with friends via e-mail and that they use the internet to download and print pictures which they colour in and then display in their bedroom. They also said that they had been to the cinema and enjoyed shopping, and told us of their plans as to what they were going to buy when they next went shopping. We sent surveys to people who are staying at Beaumanor House which told us that people are encouraged to make decisions and have choices as to what they wish to do with their evenings and weekends, however some people did say that this was dependent upon staffing levels. Surveys contained additional comments which included: I like that they do things at Beaumanor and that I have made some friends here. If enough staff on duty to take me out, I like to watch television, and go to Gala bingo, the cinema and out for meals. They take me to Liverpool. At first I was a bit nervous but I am now used to it. We do dancing. I like going out to the disco, pictures and theatre better that staying in Beaumanor. We sent surveys to staff who work at the home and they told us that in some instances staffing levels, especially where their is high number of agency staff, and when people who are admitted in an emergency placement require significant support, that the ability for staff to support people who live at the home to go out can be compromised. Additional comments in surveys included: Activities provided are excellent and very often. We provide good leisure activities. Because of the more complex needs of the individuals that are now using our service the long stay residents (people who live at the home) seem to spend a lot of time unnoticed. Because of the high dependency needs of certain short stay and emergencies lots of the other service users miss out because of staffing. One person told us that they had a key to their bedroom now as someone on one occasion had been into their bedroom, and had taken things out of their wardrobe. Someone else told us that they have a key to their bedroom as they have chocolate which they keep in their room, and if they didnt lock the bedroom someone would take Care Homes for Adults (18-65 years) Page 20 of 36 it. We were able to speak with people in private, and people were aware of their rights with regards to privacy and confidential information. The dining room provides tables and chairs and has a large serving hatch, which is used by the catering staff to serve meals. We observed people staying at the home going to the serving hatch, and requesting from the menu what they wished to eat. The experience is canteen like, and does not support a homely dining experience. The dining experience could be improved by the serving hatch not being used and by individual serving dishes being placed on the tables for people to serve themselves. The menu for day was displayed in the dining room, and included choices. People we spoke with said they were happy with the meals, and we saw flexibility as to when and where people ate their meals. People who require support and specialist equipment for eating and drinking had their needs and support required detailed within their care plan. Care Homes for Adults (18-65 years) Page 21 of 36 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience Judgement: People using 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 . People have access to all care professionals but individuals emotional and physical needs are not fully met Evidence: We looked at the information provided to us by the Registered Manager within the self assessment tool before visiting the home, we read that people who receive respite care at Beaumanor House are contacted prior to their visit, to see if their are any significant changes in their care, this enables staff to support people if their needs have changed. We looked at the care plans of five people, those who live or receive regular respite care are supported by Health Action Plans, which detail the health care support they require, which includes an emergency sheet containing information should the person have to go into hospital quickly. By reading records we found that people have good access to a range of health care professionals, which included Psychiatrists, Psychologists, Speech and Language Therapists and Community Nurses. Many people who move into the home as an emergency placement require minimal or no support with personal care, but where this is required this is detailed within their care plan. People who have lived at Beaumanor House for sometime and those who receive regular respite care have their personal care needs detailed within their care plan, which includes any specialist equipment used. We were shown the assisted bath and how it works by someone who lives at the home. We looked at the medication and medication records of the five people whose records we looked at, we found that medication storage and recording was managed well, and Care Homes for Adults (18-65 years) Page 22 of 36 that medication is administered by senior staff who have received training in the safe administration of medication. Recent changes to legislation mean that care homes need to provide appropriate storage facilities for Controlled Drugs, Beaumanor House has a storage facility for this purpose, but it needs to be determined as to whether the storage facility meets the relevant legislation requirements. No one at the home is currently prescribed a Controlled Drug. Care Homes for Adults (18-65 years) Page 23 of 36 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Systems are in place for people to raise concerns, but these are not known to all. People living or staying at the home are at risk from the adverse behaviours of those they share their home with. Evidence: We sent surveys to people who live or are staying at the home and asked them if they knew what to do if they were unhappy and whether they knew how to make a complaint. The information we received in surveys told us that some people know how to complain whilst others do not. Surveys contained additional comments, which included: I would ask the staff as I dont know. I would speak to Pauline (the Registered Manager) first or staff I trust, or my allocated worker. I would speak to my Social Worker, but I have trouble to get hold of him. I would speak to the Welfare, Social Services or the doctor. I go to the staff room if I needed support to make a complaint, as I find it difficult to read and write. I would speak to my allocated worker. Tell someone in private in the office - Pauline, the Manager. We sent surveys to relatives and friends of people living or staying at the home, which asked them if they knew how to make a complaint, and whether any complaints they had made had been managed well. Surveys told us that many people do not know how to complain, but did indicate that concerns are usually dealt with well. One person wrote in their survey: - Care Homes for Adults (18-65 years) Page 24 of 36 My daughter has experienced a stay where she received injuries, after a lot of investigation from all parties; it was never concluded to enable me to know what happened. We spoke with people who had been moved into the home as an emergency placement and they were confident to express their views and knew who to speak with if they were unhappy or wished to make a complaint, individuals knew who their Social Worker was and how to contact them. When we spoke with people who live at the home, people were unsure about how to complain, but some said that they would speak with a member of staff. We looked at the complaints records of the home, and found that the home had documented complaints well, and that they had been investigated with the outcome being recorded. We noted by looking at the complaints that a relative had complained to the home when they visited their daughter and found that they were having their hair pulled by someone else staying at the home, they also were not happy that the other person living at the home was able to enter the room of their daughter, and that staff found it difficult to get them to leave. This was investigated and feedback was given to relatives. We found by looking at accident and incident records which are completed when someone living or staying at the home is hurt or injured, that there are examples of people who are staying at the home hurting others physically, staff told us of one incident where someone was “punched in the face by someone staying at the home, and that this was not an isolated incident.” The care plan for this person was reviewed, and additional staff was provided. Surveys from people living at the home also included comments about their views about others who live at the home and how this affects them. Comments included:Dont like them shouting and acting like babies. Dont like the people who come to stay that shout. Dont like the bullying, swearing, hitting or people hurting your feelings. Dont like the shouting. The Registered Manager has notified us of incidents of physical assault and other behaviour which in most instances has been carried out by people who have moved into the home as an emergency placement or when they were felt to be at risk of abuse in the community. The Registered Manager is pro-active in informing individuals Social Workers that they have physically assaulted someone, or when they display challenging behaviour, and meetings are held with health and social care professionals. We found limited support and responses to people living at the home who are assaulted. There was no evidence that any assaults of people had been considered under Social Services safeguarding adults from abuse policies and procedures, the information we received in the self assessment tool completed by the Registered Manager said that the home had made no safeguarding referrals or had taken part in any investigations, this means that people who live at the home continue to be at risk from assault by others who have been placed in the home, many in an emergency situation, who are known to have problems with managing their behaviour and have additional mental health needs. Care Homes for Adults (18-65 years) Page 25 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living or staying at Beaumanor are provided with an environment which is adequately decorated that would benefit from improvements to furnishings and fittings to create a homely and relaxing environment in which to live. Evidence: Beaumanor House has two lounges, a dining room, a games room, snoozelem and I.T. suite. The communal rooms were decorated to a reasonable standard, with individual chairs and a sofa; each lounge had a small portable television, which made it difficult for people staying at the home to see the television clearly, unless they sat close to the screen. The Registered Manager advised us that televisions have been broken and damaged by people staying at the home, and will not be replaced until such a time as the people responsible for breaking the televisions have moved out. This shows how the daily lives of people are being penalised by people who move into the home in an emergency situation who have additional needs, and how the behaviour of some people in the home affects the ability of people to relax and feel safe in their own home. The games room has a pool table along with board games, and the I.T. suite provides two computers which have internet access for people living at the home to use. Bedrooms are single and without en-suite facilities. The Registered Manager within the self assessment tool identified that the future of Beaumanor House is uncertain, which impacts on the homes ability to develop and make changes to the environment. The home has a central courtyard with grass and a seating area, and is surrounded by a large garden. The garden could be improved by being maintained. Care Homes for Adults (18-65 years) Page 26 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Staff do not receive training which enables them to support people with mental health problems effectively, but do receive training in how to support individuals with a learning disability including areas of health and safety. Evidence: The people living and staying at Beaumanor House appeared to enjoy a positive relationship with the staff on duty at the time of our site visit, and people we spoke with spoke positively about the staff. We also received surveys from people staying at the home which also told us that people find staff to be approachable and supportive. Comments included: I like all the staff, I like everything here. I like living here, I like all the staff. Some staff can be cheeky but not all the time. The daily staff rota is displayed in the main hallway, and includes a photograph of staff showing who is on duty in the morning, afternoon and evening and during the night, which means people at the home know who is going to be working with them. The staff rota also includes the photographs of agency staff that provide one to one support for some of the people staying at the home. We found that the number of staff on duty was able to provide the care and support of people during our visit, but we did note that some people received little or no interaction from staff. Beaumanor House uses agency staff for one to one support, but Care Homes for Adults (18-65 years) Page 27 of 36 also to maintain staffing levels at the home. We spoke with staff who said that in most instances staffing was sufficient, but when their were a lot of agency staff on duty this impacted on staffs ability to meet peoples needs, especially when people displayed behaviour which is difficult to manage as this is staff intensive. Beaumanor House has arrangements with the agency to supply the same staff to promote consistency, and who know about the home and the people who live there. Surveys we received from staff made the following comments about staffing levels, and the ability of staff to meet peoples needs. Reliable staffing! So much sickness at the moment, this puts a lot of pressure on the staff that turn up for work regularly, relying on agency staff on most shifts. Staff have sound knowledge and have built up positive and trusting relationships with service users. We also received surveys from relatives of people who live or stay at the home, they wrote in their surveys: The permanent staff members make you and the users feel very welcome. I do feel that they need extra members of staff. People need stability and like familiar faces. Beaumanor uses a lot of agency staff who are not sure of members routines. We looked at the training records of staff and found that 85 of staff have attained a National Vocation Qualification in Care and many staff have also attained a Learning Disability Qualification. Training records told us that staff receive training on health and safety topics which included management of challenging behaviour, first aid and health and safety. Staff have also attended training which helps them to support people well and has included health and nutrition, infection control, gender awareness and equality and diversity. We identified a significant short fall in the training staff receive in that staff receive no training that enables them to support people who have mental health needs, which are identified in the assessments of people who are brought into the home on an emergency placement. We spoke with staff who told us they feel ill-equipped to deal with many of the people at the home, who have conditions such as bi-polar disorder. Staff also said that they have not received any guidance or support on how to support people and respond to things they tell them about their experiences which have resulted in them moving into the home because they are at risk of abuse and exploitation within the community. Staff surveys also recorded staff views about staff training and their ability to meet peoples needs, comments included:I have worked here for ....years now, I have seen so many changes, at the moment I find most shifts stressful, because of staffing and the complexity of the new service users using the service. More training in specialised areas, i.e. mental health and working with people with mental health problems, not had the training to work confidently and competently. Stop having to be everything for everyone. Care Homes for Adults (18-65 years) Page 28 of 36 We were not able to look at the recruitment records for staff working at the home as these are managed by the Human Resources Department of Leicester City Council, information in the self assessment tool completed by the Registered Manager and comments from staff in staff surveys told us that staff are recruited following a robust recruitment process, which includes completing an application form, attending an interview, supplying two satisfactory written references and have a Criminal Record Bureau (CRB) disclosure, this means that people who are recruited to care and support people who are vulnerable have been vetted as to their suitability to do so. We spoke with staff who told us that they receive good quality support from the Registered Manager and their line Manager. They told us that they attend monthly meetings and have regular supervisions and appraisals with their Manager, to make sure they are working well and to deal with any concerns they may have. Staff did say that they do not feel supported by Senior Management, as they feel their concerns are not listened to when they say they are not able to meet the wide range and challenging needs of people accessing the service. Care Homes for Adults (18-65 years) Page 29 of 36 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The Registered Manager and staff are not able to support the wide range and diverse needs of people who use the service, as the environment and the training they receive are inadequate. Evidence: The Registered Manager has worked at the home since 2006, and has a qualification in social work. The Registered Manager has raised a number of concerns with senior managers about the mix of people Beaumanor House has been asked to accommodate, which have not been acted upon. The Registered Manager is not involved in decisions as to who is admitted into the home, with placements being approved only at senior management level. This compromises the welfare of existing service users as the knowledge the manager has of existing concerns and issues is not taken into account when a new service user is considered for admission. The Registered Manager has supported well those people who have been admitted in an emergency situation, which includes instances where people are being admitted as they are at risk from abuse within the community. We spoke with some of the people who have moved into the home in such circumstances, and found that their views about this were very mixed. Whilst some complimented the home and the staff for the care and support they provided, others did not wish to remain in the home having been admitted in an emergency situation. Care Homes for Adults (18-65 years) Page 30 of 36 In such situations the Registered Manager has made a referral to a Deprivation of Liberty Safeguards Officer who assesses a persons capacity to make an informed decision which is considered to be in their best interest and promotes and protects them from abuse. When it is felt that people lack the capacity to make an informed decision then legislation is used to determine their capacity. We found by looking at the records of some of the people who are staying at the home temporarily, decisions have been made, which means they cannot return to their previous home as they wish. By looking at care plans, and talking with people who are staying at the home as an emergency placement we found that they are not restricted from leaving the home, but are restricted from returning to their home address to live and that in such situations the care plan provides staff with clear guidance as to what they should do. In such instances the Police are contacted, who look for the person and return them to Beaumanor House. We found that people who have lived at the home for sometime are not supported in the same way, and that they are put at risk by people staying at the home on an emergency basis. We found that people had been physically assaulted, and surveys told us that they did not like the shouting and bullying of some people. We were informed that care plans are reviewed with health care professional involvement to minimise risk. We asked the Registered Manager as to how people at the home are consulted on the day to day running of Beaumanor, and were told that monthly meetings are held. We looked at the minutes of these meetings and found that people discuss their views about activities and meals, including holidays. Beaumanor House last year carried out a quality assurance process, which involved sending questionnaires to people who use the service and their relatives and by an individual meeting with some of the relatives of people who use the service and asking them for their views. We found that the quality assurance process had been used to produce a report which included action points for the home to address. The Registered Manager said there were no plans as yet for a similar process this year, but were aware that it needed to be undertaken. A member of staff specifically appointed, visits the home each month, to talk with people who stay at the home and the staff, and look at records including care plans and complaints received. They then produce a written report which is given to the Registered Manager and includes recommendations. We looked at these reports and found that they had recommended that a quality assurance process is put into place. Information supplied by the Registered Manager before the site visit told us that systems which promote the health and safety of people in the home, such a fire equipment, central heating and electrical appliances are regularly checked and maintained. Care Homes for Adults (18-65 years) Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 36 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 14 The registered person to 17/08/2009 ensure that the assessment of need carried out is used to determine the homes ability to support and care for the person as their needs require, preventing admissions to the home where the primary care need is not that of a Learning Disability. To ensure that the home does not admit anyone to Beaumanor House whose needs cannot be met or whose primary care need is not that of a Learning Disability. 2 2 14 The registered person to ensure that service users admitted in an emergency or unplanned situation have an up to date assessment of need carried out within a reasonable period of time following their admission. To enable the Registered Manager to determine whether the needs of the Care Homes for Adults (18-65 years) Page 33 of 36 person can be met and enable staff to have a good understanding of their needs including the reason for their admission. 3 20 13 The registered person to ascertain whether the storage facility at Beaumanor House which would be used for the storage of Controlled Drugs complies with the Misuse of Drugs (Safe Custody) Regulation 1973. To ensure that Controlled Drugs can be stored safely. 4 23 13 The Registered Person to ensure that people living or staying at Beaumanor House are protected from harm or abuse. To ensure that individuals staying or living at the home are safe. 5 35 18 The registered person to ensure that staff receive training reflective of the needs of people who use the service, which is to include mental health / disorders. To enable staff to provide good quality care for people who use the service. 6 39 24 The registered person to evaluate the quality of the service, through consultation with people who use the service, their relatives and professionals involved in their care. And to produce a written report which includes information on how the service intends to use the information to develop the service. Care Homes for Adults (18-65 years) Page 34 of 36 To provide an opportunity for people to influence the service they receive and support. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 An up to date assessment of need is carried out within ten days of someone moving into the home, when the move into the home is unplanned or an emergency placement. People are supported to understand what the meals are for the day, by the written menu being supported by pictures to encourage people to make choices and decisions. Serving dishes are placed on the dining tables so that people can serve themselves, and reduce the canteen style approach currently experienced by people living or staying at the home. A controlled drug storage facility which complies with the Misuse of Drugs (Safe Custody) Regulation 1973 be purchased and installed, should the current storage facility be found not to comply with the Misuse of Drugs (Safe Custody) Regulation 1973. People who live or stay at the home are supported to make complaints, by ensuring that they are aware of their rights, and that systems are in place for them to express concerns, which are acted upon. 2 17 3 17 4 20 5 22 Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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