CARE HOME ADULTS 18-65
Beaumont College Slyne Road Lancaster Lancashire LA2 6AP Lead Inspector
Mrs Marie Cordingley Unannounced Inspection 18th January 2007 10:00 Beaumont College DS0000010024.V322345.R02.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 Beaumont College DS0000010024.V322345.R02.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. Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Beaumont College Address Slyne Road Lancaster Lancashire LA2 6AP 01524 541400 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) principal@beaumontcollege.org SCOPE Care Home 77 Category(ies) of Physical disability (77) registration, with number of places Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th December 2005 Brief Description of the Service: Beaumont College is registered with the Commission for Social Care Inspection to provide care and accommodation for up to 77 students. The college offers students a wide range of pre-vocational courses and individually tailored learning programmes, based on their own strengths and needs. Whilst education is a primary function of the college, residential care services are also provided to the majority of students who study there. As the educational standards within the college are inspected by OFSTED, inspectors from the Commission for Social Care Inspection assess standards which are associated with the residential care service provided at the college. The college is conveniently located in a residential area of Lancaster, close to a variety of facilities and amenities. Accommodation is provided over three floors and there are two passenger lifts available for the use of students. In addition to the main building, further accommodation is provided for eight students, in a separate and smaller building situated in the grounds of the college. Due to its size and layout, this building offers accommodation which is more domestic in character. Due to a reduction in the number of students living at the college, a higher proportion of accommodation is now offered on a single room basis. Plans are underway to further increase the amount of single room accommodation available in the future. Support staff (the majority of whom are qualified to NVQ level 2 or above in care) are on duty at the college on a 24-hour basis. The registered provider of this service is SCOPE, a national, non profit making organisation whose headquarters are based in London. The college has been without a registered manager for some time. However, the assistant principle is currently going through the process of registration with the Commission for Social Care Inspection. Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 5 Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection of this service included a site visit which was carried out by a team of inspectors over the course of four days. During the visit discussion took place with students, staff and managers and a number of documents were examined. In addition, a case tracking exercise was undertaken. This involved the inspectors closely examining all aspects of selected students’ care from the point of their admission to the college. A tour of the college was undertaken and time spent with students in their living areas. Prior to the site visit, students and their relatives were sent written questionnaires inviting them to express their views about standards within the college. There was a good response to this survey, later detailed in the report. Following this inspection, the overall rating for the college has been assessed as good. During the inspection, the college was assessed as proving excellent outcomes for students in a number of areas. However, some minor shortfalls were identified. In discussion, managers demonstrated a commitment to making the necessary improvements to address these shortfalls. What the service does well:
A number of completed questionnaires (59 in total) were returned to the Commission from students and their relatives. Those that responded were generally very positive about the college. All the relatives who sent comment cards said they were always welcomed in the college, could see their family members in private and felt that they were kept updated about significant events and their family member’s progress. In addition, all the relatives were satisfied with staffing levels and the overall standard of care. Other comments from relatives included; ‘’Beaumont College is the best place my son has lived at.’’ ‘’My son has a fantastic keyworker.’’ ‘’We are well impressed with all that Beaumont College offers the students.’’ ‘’We cannot praise them highly enough.’’ ‘’It is a secure, friendly and caring place.’’ ‘’I am very happy with the standard of care, which I feel is excellent as is the staffing ratio.’’ Students who responded were also very positive about life at the college. All the students who completed questionnaires said that they could make their Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 7 own choices and decisions and choose how to spend their free time (other than during college hours). A number of students questionnaires included positive comments about the college which included; ‘’There’s always someone to talk to.’’ ‘’I am very happy at the college.’’ ‘’I am very respected by all.’’ ‘’It’s a very good college.’’ Students observed during the visit appeared very content and many were seen to make their way around the college freely. On a number of occasions groups of friends were seen to meet up in one of the many communal areas. Students sharing friendly banter with each other and staff was a common sight as was students being supported on an individual basis to go out into the local community. Support staff and managers at this college work very hard to ensure that they have an in depth understanding of each individual student’s needs before they start at the college. The assessment process goes on for several months and involves lots of contact between college staff, students and their families. In addition, there are many specialists from the college who get involved in the assessment process such as dieticians, speech therapists and behavioural specialists. Written plans are generated from the information gathered during the assessment process. These plans are of an excellent standard, extremely comprehensive and very thorough. Students are involved at all stages of the planning process so that they can ensure support staff know their preferences. There are a number of processes currently in place to ensure that students are enabled to express their views and opinions and contribute to the daily running of the college. There is a students’ forum which meets on a regular basis and the college magazine powerful Voices which is edited and produced by students. There are student representatives on the college’s health and safety and equality and fairness groups. In addition, there is also a parents’ forum which has recently been formed. Students at Beaumont College benefit from an extremely high standard of catering. In particular, the college respond very well to those students who have special dietary needs and the provision of pureed or soft food is very impressive. The majority of support staff consulted during the visit demonstrated a very good understanding of their roles and a genuine commitment to promoting the rights of students. Staff were extremely complimentary about the quality and amount of training provided. One staff member said ‘’I have had more training since I started here than I have ever had in my working life.’’
Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 8 The turnover of staff is very low at the college which means students benefit from receiving their support from a familiar and consistent staff team. What has improved since the last inspection?
SCOPE have made significant progress in improving the accommodation and facilities offered at Beaumont College. A second lift has now been installed in the college to enable students to access upper floors more easily. This has reduced the occasions that students have to wait for a lift which had previously been an issue. Overhead tracking has now been fitted in the majority of areas, meaning that students can be transferred more safely and in a more dignified manner. During the site visit, a number of support staff commented on the overhead tracking, stating that it made assisting students much easier. Since the last inspection more doorways have been widened providing easier access for students who use wheelchairs. A number of windows on the ground floor of the college that were in very poor condition have now been replaced. The programme to improve bathrooms has continued and a number of these facilities which have been in need of improvement for several years have now been updated. The facilities are much more homely and equipment such as the assisted baths are of very good quality. Additional rise and fall sinks have been installed in some areas. These are appropriate for students using various types of wheelchairs. Work is currently underway to create a coffee bar within the college. This will provide an alternative to the main dining room and it is envisaged that students will run the bar themselves. It is also planned that students will be encouraged to present pieces of art and poetry in this area. There have been several changes to medication processes resulting in safer practices. The college have improved their labelling system and now ensure that there is always a witness when medication is administered by specialist technique. In addition, a master list of authorised signatories is retained to enable managers to quickly identify which staff member has signed for a student’s medication at any particular time. Changes to the quality assurance processes within the college have resulted in social care managers now spending more time with students and staff during evenings and weekends. Managers who were consulted felt that this was a positive change. One manager said ‘’You get a far better idea about what is happening when you work alongside people.’’ Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 9 The college continue to make improvements to the ratio of support staff who are qualified to NVQ level 2 or above. For adult services the national target is 50 . However, as Beaumont College on occasion accommodate students aged 16 & 17, they are working towards the children’s’ service target of 80 . Currently, there are 63 of staff members qualified and a further 30 enrolled on the course. This is a commendable achievement. The college has now been without a registered manager for 17 months. However, the current acting manager has recently applied for registration with the Commission for Social Care inspection and has almost completed the process. What they could do better:
Whilst SCOPE have made a number of significant improvements to the environment, it has been recognised for some time that the college falls short of some minimum standards. Due to the structure of the building there are some improvements that cannot be made. Some doorways within the college cannot be widened due to the steel frames supporting the building and similarly, rise and fall sinks cannot be installed in all of the students’ bedrooms. On some students living areas the kitchen facilities are not accessible and communal lounge areas are cramped. There are not an ample number of bedrooms to ensure that all students who require a single room can have one. SCOPE are currently examining these issues as they consider the long term future of the building. A number of students who responded to the written survey stated that they were not aware of the complaints procedure. In discussion with the inspector some students did not know the process to follow when making a complaint. When examining the college’s responses to complaints made by students or their representatives it was found that they had not always been adequately investigated. Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 10 This issue was discussed with the management team who were requested to ensure that all complaints are thoroughly investigated and the outcome fed back to the complainant in a timely fashion. The college run a concern incident report system. This is a very useful process which enables staff members to report issues that have caused concern but don’t necessarily warrant report under the safeguarding adult procedures. However, on viewing these reports the inspectors noted a small number of concern incident reports that should have been reported through the safeguarding adult system. Great progress has been made in improving medication processes and making them safer for students. However, a number of additional recommendations have been made to enable the college to make further improvements. These recommendations include reviewing the use of homely remedies, ensuring all the relevant details from patient information leaflets are recorded on students’ medication records and updating the procedures for recording refusals from student to take their medications. In viewing a number of staff members’ supervision records, it was found that the college lacked a consistent approach in dealing with staff members with performance issues. In a number of cases, supervision was not provided frequently enough and did not address the relevant issues. During the site visit it was discovered that a number of situations had arisen that should have been reported to the Commission under Regulation 37 of the Care Homes Regulations, 2001. This was discussed with managers who were asked to ensure that notifications were made to the Commission in a timely fashion. 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. Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 11 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 Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 12 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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Students’ individual needs are thoroughly assessed prior to their admission so that support staff can plan their care effectively. EVIDENCE: The Statement of Purpose for the college is regularly updated to provide accurate information about the service. A Service User Guide is provided and gives a good deal of information about the service, such as activities available and information about mealtimes. The college are currently working on an electronic version of the guide and it is hoped that this will be available in the near future. This guide will have software that will read to the prospective student and describe pictures. In addition, a project is currently underway involving some students who are making a film. The film is called a day in the life of a student and will form part of the Service User Guide when completed. There are extremely thorough procedures in place to ensure that the college have an in depth knowledge of a student’s needs prior to their admission. The process begins several months before the planned admission and involves lots of contact with the prospective student and their family. Initially, staff from the
Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 13 college visit the student in their own surroundings and later on in the process, students visit the college. Trial overnight stays are carried out for all students as a standard process. There is a great deal of multi disciplinary input to each student’s assessment, which includes that of occupational therapists, dieticians, behavioural specialists and nursing staff. In addition, each student’s assessment is routinely examined to identify any training needs for staff. For example, if a prospective student has a specific condition, managers will ensure that all staff are provided with relevant training before the student is admitted to the college. Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 14 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): 6,7,8,9 & 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The individual needs and choices of students are central to the support planning process. Students are assisted to take responsible, well managed risks to enhance their personal development. EVIDENCE: All students within the college have written individual support plans which are of an exceptionally high standard. The plans cover all aspects of each student’s care needs and clearly state the support they require. Students’ support plans are developed using a person centred approach. This means that the student’s own views and opinions are taken into account to as
Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 15 great an extent as is possible, and there is a notable emphasis in promoting independence and increasing opportunities. Restrictions to a student’s freedom or choices are only in place where they are necessary to safeguard their wellbeing. Where such restrictions exist, they are clearly recorded in the student’s support plan and recorded evidence is available to ensure that such restrictions have been discussed and agreed by all the relevant people. All students who filled in their written questionnaires stated that they could choose how to spend their time, apart from having to attend their lessons in the day. However, in discussion with the inspector, a small number of students said that they didn’t feel choices in daily life were always available and sometimes they were restricted, due to staffing levels for instance. Discussion regarding this feedback took place with the management team at the end of the site visit who were very keen to meet with students to discuss the issues further. There are a number of processes in place to enable students to be involved in the daily running of the college including a student’s forum and regular community meetings. Students are also represented on the health and safety board and the equality and diversity group. There is now also a parent’s network to enable parents of students to meet on a regular basis. Several parents who responded to the written survey were very complimentary about this group and felt it was very helpful to have the opportunity to meet with other parents. Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 16 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): 11,12,13,14,15,16 & 17 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Students at Beaumont College are enabled to choose from a wide range of fulfilling activities and are supported to develop and maintain relationships. The provision of meals at the college is of a particularly good standard. EVIDENCE: Students at Beaumont College enrol on a three year programme which is designed to support them through their transition into adulthood and develop their independent living skills. Education is provided alongside residential support and both the keyworker and the college’s personal development tutors work with the student following the ten foundations for independent living.
Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 17 Good evidence was seen in students’ support plans of the progress they had made during their time at the college. In addition, evidence was seen of students developing skills in real and relevant situations, for example within the local community or their individual living areas. Students at Beaumont College have the opportunity to participate in a wide range of activities. Each student’s individual plan contains a leisure timetable and community access plan. The college are working hard to enable students to enjoy activities on a one to one basis as opposed to large group outings. All students and staff who were consulted felt that staffing levels were generally adequate to facilities this. There are also lots of activities within the college including a beat box night each week. At the time of the visit, some students were organising a Valentines Ball. The college have a number of vehicles available for the use of students. Some staff members felt that there was a lack of people able to drive minibuses. However, the college are currently in the process of acquiring smaller vehicles which will not require staff to hold a special license. The college have very impressive systems in place to ensure that students’ dietary needs are met. Students undertake a full nutritional assessment before they enter the college. These assessments are carried out by the college dietician in close communication with the student, their family and any other relevant professionals. The information is then forwarded to the catering manager, who makes sure that staff are very aware of any specialised diets and that written information and daily records are kept. The catering management staff are very highly qualified and all kitchen staff hold the food hygiene certificate. Menus are on a three-weekly rotation. Six monthly reviews are undertaken, with the in-put from student council meetings. It is apparent that the catering team are very open to new ideas when developing menus. Recently, a student’s mum was invited to the college to share the secrets of her legendary curries which have now been added to the menu. There is an extensive choice of foods at each mealtime and students are made aware of the options in several ways. There is a written menu, a push button communicator which gives a verbal description and a sample meal out on display. Each option is colour coded and students can pick a card to express their preference. Time was spent with a student who had extremely complex and specific dietary needs. Records showed that only the delegated and specifically trained keyBeaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 18 workers enabled the student with her food. Although the student was unable to fully communicate, the enabling key-worker was very aware of the student’s needs and showed that there was an excellent communicative and interpersonal relationship between them. Specialised diets include gluten-free, nut-free, vegetarian and dairy-free food. The provision of pureed diets is excellent with pureed foods being reconstituted into moulds to represent the food in its original state. This makes the food look far more appealing and means that students requiring pureed food do not feel disadvantaged. The college’s award winning chef who developed this system, has spread this very good practice to other large care providers in the area who now use the same system. Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 19 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 & 21 Quality in this outcome area is good. Students’ personal care needs are carefully assessed and detailed plans are developed to ensure their needs are met. The college have excellent processes in place to ensure students’ medication is safely stored, administered and disposed of. EVIDENCE: There are very detailed individual support plans in place for all students. These plans include extremely comprehensive details about the care each student needs. The plans are based around students’ strengths and demonstrate that students and their representatives are very much involved in their development. Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 20 Detailed health information is recorded in students’ support plans and any health task that requires extra training is very clearly described to show exactly how staff should carry out the task. This is an example of good practice that is consistently carried out and ensures students’ health needs are correctly met. There are a number of specialists employed within the college including a dietician, physiotherapist and a speech therapist, who are involved in planning and monitoring students’ care. Records of professional visits form health professionals such as GPs are maintained, as are records of any illness. The college employs two qualified nurses to oversee the healthcare needs of the residents. Their role is monitored by the Primary Care Trust who have a responsibility to ensure the nursing tasks carried out by the college are carried out correctly. Meetings between the Primary Care Trust and the college are not formally recorded, this is strongly recommended to ensure this process is robust. Robust written policies, procedures and paperwork are in place that show how staff are expected to give and record medicines. This is important to ensure all staff give medicines correctly. Medicines records are continually monitored by carers and nursing staff to ensure they are completed correctly. These records have improved since the last inspection and further guidance was given to help staff make further improvements. One key area for improvement is the timing of giving medicines in relation to food. More medicines information is required to ensure they are given at the correct time, this can be obtained from the medicines patient information leaflets and transferred onto the records and/or support plans. Students are supported when they want to look after their own medicines and in all cases good paperwork and regular checks are made to ensure medicines are taken correctly. This is an example of good practice that shows students are supported to maintain independence. Written procedures for non-prescribed medicines are in place, however the college does not currently hold any stock. This was discussed with staff who confirmed that minor ailments such as headaches would be dealt with individually. This should be reviewed to ensure easy access to medicines for minor ailments such as Paracetamol for headaches. Medicines are returned to the pharmacy when no longer required and a record is made. Refused medicines should also be returned to the pharmacist, it was recognised that the procedure for this should be reviewed to prevent any mishandling. Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 21 Two support staff witness medicines given in emergencies such as those used for epilepsy and an accurate record of this is made. This is an improvement since the last inspection that helps prevent mishandling. Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 22 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures for recording, investigating and feeding back in relation to complaints need to be improved so that students feel confident that their concerns are being dealt with. EVIDENCE: There is a complaints procedure in place that states any concern raised by a student or their representative will be investigated in a thorough and timely fashion. The procedure is included in the Service User Guide and in a number of areas around the college in various formats, including audio. However, out of 31 students who responded to the written survey, 7 said that they did not know how to make a complaint. In discussion with the inspector, some students demonstrated that they were not fully aware of the process to follow, one student thought she was only allowed to discuss any concerns with the supervisor on her area and no other manager. Some students consulted also felt that when they had raised concerns about various issues they had not been followed up properly. One student who responded to the written survey said that he hadn’t been listened to on one occasion but could not remember what his concern was about.
Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 23 This issue was examined further and it was found that student’s concerns were generally recorded and investigated. However, on several occasions no record could be found that students had been informed of the outcome of an investigation. In viewing a record of an investigation that had been conducted following a concern that a student had been upset by a staff member, it was found that this investigation was not adequate. No witnesses or the student himself had been interviewed and there was no evidence to confirm that the student had been advised of the outcome. The above issues were discussed with the management team who were requested to ensure that any complaint made was thoroughly investigated and that the complainant be advised of the outcome. The college have a number of measures in place to ensure that any incident or suspicion of abuse is promptly reported and investigated. A number of management staff at the college have undergone specialist training which enables them to undertake the role of DAPAs (designated adult protection advisors) or DCPAs (designated child protection advisors). Their role is to provide advice and support to any person who reports an incident of abuse and management rotas are organised to ensure that there are a number of these advisors on shift within the college at any one time. In addition, managers at the college have access to SCOPE’s National Protection Officer who is available to provide advice and guidance at all times. A risk and vulnerability statement is completed for each student which covers health risks and personal vulnerability in areas such as community access, feeding and nutrition, physio and movement and vulnerability to abuse. This information is then used to create a vulnerability register of students who are believed to be at high risk of abuse. This can be for a number of reasons, for instance, a student who has complex, behavioural needs or a student requiring a high level of support in relation to communication. A manager is appointed to each student who is placed on the vulnerability register. Part of the process is to ensure that managers who are appointed do not have any direct line management responsibility for the area that the student lives in, therefore ensuring that they can remain objective. The manager is then required to complete a report on a weekly basis, having spoken to the student, interviewed support staff and examined the student’s individual plan. A weekly meeting is then held with the management team to go through the reports and identify if there are any causes for concern. The concern incident reporting system is another useful way that the college protect students from abuse. Staff are encouraged to make formal reports of anything that gives them concern but doesn’t necessarily constitute an abuse situation. For example, if a student was denied a requested night out due to lack of staff this would be reported as a concern incident. There are measures
Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 24 in place to ensure that all concern incident reports are examined on a daily basis and any remedial action is recorded. However, there is a need to ensure that all issues are reported through the correct channels. In viewing concern incident reports there were a small number of examples of issues that should have been reported through safeguarding adult procedures but were not. This was discussed with the management team following the site visit. Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 25 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, 29 &30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. SCOPE have made a number of significant improvements to the college over recent years. However, there are a still a number of areas that do not meet minimum standards. EVIDENCE: The college is a very spacious building providing a number of areas for students to access throughout the day. Smaller communal areas have now been provided on each living area within the college, which means students have more choice about where to spend their free time. There are a number of areas for students to socialise and a project is currently underway to provide a coffee bar where students will be encouraged to show pieces of art they have created.
Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 26 A number of improvements have been made to the college since the last inspection including a second lift to ensure that all areas of the college are easily accessible to all students. More areas within the college have been fitted with overhead tracking devices. This means that students who require assistance to transfer can be moved more safely and in a more dignified manner. A number of staff members who were consulted were very pleased about the increase in overhead tracking facilities many stating that it was much better for students. More doorways have been widened to provide better access for students who use wheelchairs. SCOPE are planning to continue with this programme and it is planned that all doors that can be widened will be done by March 2008. However, it has recently been discovered that due to the structure of the building there are some doors that cannot be widened. The college do not have enough bedrooms to ensure that all students who require a single room can be provided with one. However, this issue is addressed as part of the assessment process. Prospective students are asked about their preferences and every attempt is made to ensure that all those students who want a single room are provided with one. Some more rise and fall sinks have been installed but there are still a number of areas that do not have these. Rise and fall sinks are necessary to ensure that students using various types of wheelchairs are able to access them. However, due to the structure of the building there are some areas that cannot accommodate them. Kitchenette facilities are provided within each living area. However, some of these facilities are not accessible to students who use wheelchairs due to their size and layout. A rolling programme is in place to ensure students’ bedrooms are well maintained and nicely decorated. Since the last inspection, a number of bedrooms have been refurbished and new flooring or carpets fitted. In general, students’ bedrooms were found to be decorated to a good standard and all those viewed were personalised with students’ own possessions. Some students had been able to choose the colours of their bedroom walls and carpets. Keyholding is addressed in each student’s support plan as part of the standard assessment procedure. This means that all students who want to have a key for their room and are able to use one, will be provided with one. However, it is recommended that this issue be reviewed regularly as the inspectors were aware of one student who had initially refused a key but later changed his mind. This may be a common occurrence as students become accustomed to being away from home and increase in confidence.
Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 27 Ares within the college were found to be clean and hygienic and the laundry was reasonably clean and tidy. In discussion with laundry staff, it was confirmed that student’s personal laundry is done at the college, with each individual student’s laundry bag being washed separately. This is very good practice. The laundry assistant said that she knew about the Control of Substances Hazardous to health (COSHH), but could not produce any guidelines within the laundry area. The health & safety manager immediately made arrangements for copies of the COSHH guidelines to be placed in every cleaning room/kitchen of the college. There are policies and procedures in place for the prevention of cross infection. Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 28 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 & 36 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Students at Beaumont College receive care from well trained staff. Staffing levels are appropriate for the number and needs of students. Procedures for formal supervision and monitoring staff with performance issues must be improved to safeguard students. EVIDENCE: Staff spoken to expressed their commitment to their work. A new member of staff commented that the first impression they had of the college was that “there is a passion for care of the students. Their care and development is absolute priority to everybody who works here” Staff consulted also showed a good knowledge of the students’ needs, and how to care for them. Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 29 Staff were observed chatting with students while guiding them to their destinations, and tactfully helping in the dining room. A training officer has been appointed since September 2006 to manage the training of all staff. There are about 40 different areas of training covered in the rolling programme for all staff, alongside many other subjects which are selected for, and by, specific individual staff. These include degree level courses. Training also relates to specific students when needed. For example PEG feeding, nebuliser and suction training, and care of tracheostomy. All staff attend Disability Discrimination Act and Race Relations Act training. Some of the courses are provided by in-house trainers, some by external instructors, and some require college attendance. In order that all staff have a balance of training, there is a selection policy for attendance on courses, to ensure fairness and equality, with the aim to develop a career pathway for staff. The training officer co-ordinates this with the health and safety manager, who helps provide related training. A dedicated NVQ manager is the internal moderator, and also the link with the college. A high percentage of staff (approximately 65 ) have attained NVQ qualifications, a further 30 are currently working towards them. Staff confirmed the thorough recruitment procedure they experienced before being appointed, with completion of an application form, two references and a Criminal Records Bureau Disclosure, which includes a Protection of Vulnerable Adults (POVA) list check, being required. During term time, students are involved in the recruitment process, with their opinions being passed to the recruitment panel. Comprehensive induction training takes place, followed by foundation training. Staff commented “It’s all very interesting training, and very relevant and clear so that you are not overwhelmed”. Even a short time after recruitment, staff were able to discuss the college’s procedures confidently. The college has an excellent training programme and generally good staff morale, reflected in the very low (under 9 ) turnover of staff. New staff stated that they worked with a mentor, who guides and informs them, and gives feedback on their progress. One staff member stated “This is my favourite job of all I’ve had. I find it easy enough to follow the students individual support plans, and even though key-workers are constantly updating them, it is our role to make sure we keep up to date with the students needs.’’ Students’ individual support needs are examined to determine staffing levels in each area and staffing rotas confirm that there are sufficient levels of support workers to enable students to enjoy various activities out of college hours. Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 30 A policy for the supervision of staff is in place, but on viewing records this seemed to be inconsistent around the college. Some managers provided monthly supervision, while some staff had no supervision records for four or five months. A variety of different forms are used to record supervision and on some occasions it was found that the records had not been signed by either party. It was also confirmed in discussion with some first line managers that despite the fact that they regularly carried out supervision with support staff, they had not received any training in this area. It was also found that the college lacked a consistent approach when addressing issues of concern with staff members. When concerns about a staff member’s working practices had been identified these were not always discussed in supervision. In several examples, clear performance targets had not been agreed with staff and there was no formal process agreed to monitor and review the relevant staff member’s performance. Some records examined confirmed that some of the staff members who had given cause for concern had not received supervision for several months. These issues were discussed with the management team who were advised to review supervision procedures as soon as possible. Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 31 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39, 42 & 43. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The college is well managed and managers demonstrate commitment to constantly improving standards. The management team within the college are well supported by the registered provider – SCOPE. EVIDENCE: The college has a very well structured management team in place, each manager having responsibility for a certain area. Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 32 The combined expertise and experience held by those on the management team is extremely impressive. Throughout this inspection, the management’s commitment to continually develop and improve services was evident. The college has now been without a registered manager for some time. However, the acting manager is currently going through registration with the Commission and has almost completed the process. There remains a very good approach to health and safety at the college. There are policies and procedures in place for fire safety, moving and handling, hazard reporting, bed rail protocols, and all staff have first aid training. The health and safety manager, along with the health and safety committee meet monthly to review and audit any accidents, incidents or near misses. The college has recently undertaken a health and safety assessment with the Learning and Skills Council. This was to assess the college’s approach to the student’s “home” environment and legislative health and safety. The outcomes of this assessment were graded as excellent. Although the protocols are in place for the reporting and recording of accidents and incidents, there was difficulty accessing a continuous audit of this system. When sampling for example, if an incident or accident was recorded, the records for the follow-up action and/or outcomes were not readily available. When these were found, they did not necessarily contain adequate information, and did not give a clear picture of what happened. It is recommended that the system be reviewed to make sure that accident and incidents are recorded in a way that is readily auditable and containing full information on actions and outcomes. Although there are policies and procedures for moving and handling at the college, the health and safety manager was unable to assure the inspector that all staff were currently up to date with this training. It is recommended that all staff have moving and handling up-dates. Although there are fire procedures in place and staff are trained on these on induction, the manager was unable to give details of which staff had undergone a fire drill exercise within the last year. When fire/smoke alarms were accidentally activated, only very brief records were kept and there was no staff list of attendance at these incidents. It is recommended that the fire drill and evacuation training be reviewed to ensure that a wide selection of staff are trained and experienced in emergency actions in the event of a fire. Managers within the college reported that they felt well supported by SCOPE and felt that SCOPE were committed to addressing the remaining environmental issues within the college. A representative of SCOPE carries out a monthly unannounced visit to the college and examines a number of areas. A report of the findings is forwarded to the Commission in a timely fashion each month.
Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 33 During the site visit it was noted that a number of incidents had occurred that should have been reported to the Commission under Regulation 37 of the Care Homes Regulations, 2001 but were not. The management team were requested to review their notification procedures and ensure that all notifiable incidents are reported in future. Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 34 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 4 3 3 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 1 27 2 28 2 29 2 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 4 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 4 3 LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 3 16 2 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 4 2 x 3 x X 3 2 Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 35 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA22 Regulation 22 Requirement All complaints must be thoroughly investigated and the outcome reported to the complainant. All matters of suspected abuse or neglect must be reported under Safeguarding Adult Procedures. All notifiable incidents must be reported to the Commission for Social Care Inspection in a timely fashion. The registered person must ensure that rooms used by students have wide enough doorways for students who use wheelchairs to access. Timescale for action 31/01/07 2. YA23 13 18/01/07 3. YA42 37 18/01/07 4. YA24 13 31/03/08 5. YA24 23 The registered person must 31/03/08 provide the appropriate specialist adaptations and facilities to meet the assessed needs of students, for example rise and fall wash hand basins. The registered person must 31/03/08 ensure that students have access to dining/kitchen facilities which can facilitate various types of wheelchairs.
DS0000010024.V322345.R02.S.doc Version 5.2 Page 36 6. YA24 23 Beaumont College 7. YA36 18 All staff members must be appropriately supervised. 31/03/07 Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 37 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA1 YA25 Good Practice Recommendations The Service User Guide should be made available in alternative formats such as audio and video. The number of single bedroom should be increased to ensure that all students who request can be provided with a single bedroom. 80 of staff should hold NVQ qualifications in care at level 2 or above. Measures to involve students in the recruitment process should be formalised. Students should be provided with the opportunity to join the quality assurance group. Consideration should be given as to how students can give anonymous feedback in satisfaction surveys.
The use of non-prescribed medicines should be reviewed and updated. Patient information leaflets should be obtained and used to ensure medicines are given correctly. The procedure for handling refused medicines should be reviewed and updated. Meetings between the college and the Primary Care Trust should be recorded as evidence of good clinical governance. Records should be maintained of staff attendance at all fire drills. The recording of accidents and subsequent investigations should be reviewed to ensure that all relevant information is readily available and the audit trail is improved. A competency checklist should be developed for each student’s individual plan to ensure staff are able to provide adequate care. Procedures for dealing with staff with performance issues should be reviewed toDS0000010024.V322345.R02.S.doc and Version 5.2 ensure a more consistent thorough Page 38 approach. The recording of staff members’ health and safety training for example, moving and handling should be reviewed to ensure that accurate information can be easily accessed. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. YA32 YA8 YA8 YA39 YA20 YA20 YA20 YA20 YA42 YA42 YA3 YA36 YA42 Beaumont College Beaumont College DS0000010024.V322345.R02.S.doc Version 5.2 Page 39 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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
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