Inspection on 01/07/09 for Beck Farm House

This inspection was carried out on 1st July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beck Farm House 18/06/09

Beck Farm House 02/07/07

Beck Farm House 05/07/06

Beck Farm House 02/12/05

Beck Farm House 25/07/05

Beck Farm House 07/12/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Beck Farm House Beck Farm House Beck Lane Barrow upon Humber North Lincs DN19 7AF The quality rating for this care home is: one star adequate 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: Rob Padwick Date: 0 1 0 7 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. They reflect the 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 Care Homes for Adults (18-65 years) Page 2 of 37 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 37 Information about the care home Name of care home: Address: Beck Farm House Beck Farm House Beck Lane Barrow upon Humber North Lincs DN19 7AF 01469532988 NOTKNOWNYET beckfarm@tiscali.co.uk Voyagecare.com Voyage Ltd care home 7 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 7 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Learning disability Code LD, maximum number of places: 7 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 37 A bit about the care home Beck Farm House, registered August 2004, is a detached property in Barrow-onHumber, providing care and accommodation on two floors, to 7 adults with learning disability. Young adults with very complex needs and particular disabilities and people that present behaviour that may pose a risk to themselves or others are placed in the home as stated in the homes statement of purpose and as a result programmes of care and behaviour management are very defined and strongly adhered to. All rooms are single with ensuite facilities. There are sufficient and suitable communal areas and an enclosed garden. Shops and services in Barton are accessed by car daily and service users often walk to Barton as part of their exercise plan. Fees for people living in the Care Homes for Adults (18-65 years) Page 5 of 37 home are based on a standard fee with additional charges for individualised packages of care based on their assessed needs. We were told these currently range from £1,600 to £2,114.50 with additional charges for hairdressing, private chiropody and transport. Care Homes for Adults (18-65 years) Page 6 of 37 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: one star adequate 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 37 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This inspection report is based on information received by the Care Quality Commission since the last key inspection of the home on 2nd June 2007, including information gathered during a site visit to the home. The site visit was unannounced and made by two inspectors over a period of six hours. A senior staff member was available throughout the period of our site visit and as well as speaking to her, Care Homes for Adults (18-65 years) Page 8 of 37 we talked staff who were on duty and people living in the home. We looked round the building, including the bedrooms and shared areas of the home and we inspected the records of peoples care, staff files, health and safety documents and other records kept by the service. Other information used included feedback from people living in the home and their relatives, Professional people who know the service well and official notifications sent to us by the home. This information helps us to reach judgments about the service provided. The manager completed an Annual Quality Assurance Assessment (AQAA) about the home to help us with planning our inspection, however unfortunately this was not received until after we visited the service. Fees for people living in the home are based on a standard fee with additional charges for individualised packages of care based on their assessed needs. We were told these currently range from £1,600 to £2,114.50 with additional charges for hairdressing, private chiropody and transport. Care Homes for Adults (18-65 years) Page 9 of 37 What the care home does well People using the service and their relatives have information that is easy to read to help them know what to expect from the home. The needs of people using the service are thoroughly assessed to help staff know how to support them and whilst people using the service have a variety of complex conditions and specialist needs they are generally supported well to take part in a range of community activities and have holidays away from the home. The home is safe and meets the individual needs of people using the service in a comfortable way. People using the service are provided with single bedrooms that are decorated to their individual tastes which provide them with a space where they can spend time alone or see visitors and they are generally supported well to maintain contact with friends and relatives. New staff are properly checked to ensure they are safe to work with people living Care Homes for Adults (18-65 years) Page 10 of 37 in the home and the home has a registered manager who is qualified and competent to carry out her role. What has got better from the last inspection The home has appointed a deputy to help support the manager in carrying out her role. People using the service have continued to be supported to maximise their independence with things like cooking and helping to keep their rooms clean and some are now self administering their own medication and creams, following an assessment of their ability to do this safely. Care Homes for Adults (18-65 years) Page 11 of 37 What the care home could do better A maintenance and renewal plan for the home and repairs and redecoration are attended to in a timely manner. This is to ensure people living in the home have an environment that comfortably meets their needs. Support plans for people using the service must accurately reflect their assessed needs and be regularly evaluated and kept up to date. This is to ensure they reflect the current needs of people living in the home Up to date records of the use of restraint must be available in order to inform staff debriefs following their use and provide an audit tool for reflective practice. This is to ensure people using the service are safeguarded from harm. Care Homes for Adults (18-65 years) Page 12 of 37 The Registered Person must ensure an up to date record of complaints about the service is available for inspection and the complaints procedure should be further developed to ensure concerns of people living in the home will always be referred to an independent advocate. This is to enable people living in the home to know their rights will be protected and their views and concerns taken seriously. Sufficient numbers of appropriately trained staff must be on duty at all times. This is to ensure people the needs of people living in the home can be met and that they are safeguarded from abuse. The Registered Person should ensure staff are provided with regular team meetings and opportunities for debriefing following episodes of challenging behavior, in order to ensure a consistency of approach in meeting the needs of people living in the home. Care Homes for Adults (18-65 years) Page 13 of 37 Menu choices for people living in the home should be further developed to ensure choices about these are not restricted and enable individual wishes for these to be better met. The Registered person should ensure new staff are provided with induction training concerning the complex needs of people living in the home in order to ensure their level of knowledge about these can be properly checked. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 14 of 37 If you want to speak to the inspector please contact Rob Padwick St Nicholas Building St Nicholas Street Newcastle upon Tyne Tyne and Wear NE1 1NB 01912333300 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 15 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 16 of 37 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are appropriately assessed by a range of professionals to ensure it can meet their needs and information about the home is available to help those thinking about using the service to make a decision about it. Evidence: The home was established to provide a specialist service for people with learning disabilities and difficulties in managing their behaviour and its statement of purpose described it as being able to meet Challenging behavioural and complex needs. A service user guide has been developed to help those thinking about using the service to make a decision about it. We inspected the case files of people living in the home and these contained copies of Local Authority Community Care Assessments and care plans, together with other assessments carried out by a range of professionals. This information had been developed into individual support plans to help staff ensure their specialist and complex needs can be appropriately met. We observed however inconsistencies in implementing some of the information in the support plans and this together with the skills, experience and training Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: provided for staff, compromised their ability to provide a service that can safely meet the collective needs of people living in the home. Over the past year the service has experienced certain difficulties concerning the management of behaviour of some people living in the home and we were told prompt contact with the relevant placing authorities had correctly been made to keep them informed and ensure needs could be better met if the home was unable to do this safely. Whilst we were unable to find relevant documentation about this at the time of our visit, the manager subsequently agreed to provide this for us. Care Homes for Adults (18-65 years) Page 18 of 37 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. Whilst people living in the home are generally able to make choices about their lives further development and more consistent and accurate recording in their support plans would enable staff to ensure their individual needs and wishes are better met. Evidence: Support plans for people using the service had been developed to help staff assist them and to help them with making decisions and choices about their lives. Whilst the support plans inspected contained evidence of a personalised approach, with pictures and words together with daily recordings, risk assessments and monitoring and evaluations of needs, the quality of these was variable and in need of a more consistent approach. One of those inspected gave details inconsistent with that outlined in the Local Authority care plan which means staff may not always have up to date working knowledge about their use and people living in the home are placed at potential risk of harm. A requirement is made on these about this. Over the past year the service has experienced a number of staffing changes and a change in management arrangements with a number of more experienced staff leaving Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: the service. Whilst there was evidence staff read and agree to their understanding of support plans, there was evidence this was not always occurring. The group of people living in the home have a variety of complex needs which may pose a risk to themselves and others using the service. Whilst feedback from professionals indicated behaviours were managed very positively on the whole, some support plans contained inconsistencies in guidelines concerning the use of restraint and no up to date record for the times this had been used was immediately available as it was locked away. A requirement is made about this to inform staff debriefs and enable an audit tool for reflective practice to be provided. People living in the home told us they were able to make choices and could generally do what they wanted and we saw evidence of people going out on a regular basis and one to one sessions with key worker staff. However feedback from them indicated they were not always consulted and that choices were restricted and we saw an example where a behavioural incident had followed, where someone was told he could not go out due to staff not having the right skills and training and when sanctions were used which were not fully agreed. (See Staffing section) Care Homes for Adults (18-65 years) Page 20 of 37 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people living in the home can participate in a variety of activities to ensure their lifestyle needs and wishes are met, further development of the staff support for these would enable their individual choices for these to be better met. Evidence: The group of people living in the home have a variety of complex needs and specialist conditions that continue to need high levels of support, but despite this they are able to participate in a range of activities. The home has a flexible routine to enable the needs and wishes of people using the service to be met however, as previously noted there were times when issues of staff training and availability limit these. On the day of our visit one individual was out with his key worker at a nature reserve and we saw others go out on the homes bus for a trip to the pub. Three of the people using the service currently attend college placements and although these had stopped for the summer, there was evidence the service worked hard to support them wherever possible. A relative told us how staff were Very helpful in supporting my visits since she was No longer able to drive and we saw evidence people were able to make visits home to their Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: families for holidays and at weekends. There was evidence people using the service are supported to maximise their skills to enable them to be as independent as possible. We saw staff supporting them to tidy their rooms and encouraging them to take responsibility for helping with household tasks and some of them made cups of coffee for us. People living in the home are encouraged to eat a healthy diet and we saw evidence that a variety of meals are provided to ensure their nutritional needs can be met. Some of those using the service have specialist conditions which mean they have difficulties in managing a correct intake, however whilst there was some evidence that advice from a dietician about these, this was not always reviewed and there was some evidence menu choices restricted individual choices of others living in the home. A recommendation is made about this. Care Homes for Adults (18-65 years) Page 22 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the health and personal care of people living in the home are generally met, more accurate and up to date recording would enable staff to provide more consistent support to ensure individual needs are better met. Evidence: The people living in the home are generally independent in relation to personal care and there was evidence they are supported and prompted by staff with these. Feedback from people using the service was generally positive and indicated staff generally treat them well and listen and act on what is said. However, in relation to recent changes amongst the staff team, a relative told us I feel they could have supported residents better by using key workers and small teams working with individuals consistently, instead of too many different staff. The support plans for people living in the home contained information about their health needs to ensure these are met. Whilst all of those inspected contained Health Action Plans and evidence of involvement and liaison with a range of professionals and monitoring of needs, there was evidence these needed to be further improved, with more consistent recording and more up to date information. There was evidence people living in the home are supported to attend regular appointments with health professionals in the community, although the file of one individual indicated they had not seen a GP since Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: they had been admitted, which had been some time previously. People using the service have a variety of specialist and complex conditions and some have behaviours that pose a challenge to others. Whilst the service has policies and procedures relating to the way staff support them with these and evidence of risk assessments and guidelines, there was a lack of specialist information to guide staff and other details needed to be more consistently recorded and clear, as some of this was contradictory as previously identified. This means new staff may not always support people in a way that has been fully agreed and requirements have been made about this elsewhere in this report. (See Needs and Choices). Policies and procedures were available to guide staff in the safe administration of medication to people living in the home and staff training provided on this and requirements were made about this previously. We saw evidence of regular checks of medication and the service has correctly notified of us of any errors concerning these. A recent pharmacy inspection confirmed the service was following good practices and a recommendation made that regular monthly prescriptions are seen by the homes staff before the pharmacy supplies medicines to the home to enable checks for any changes and make sure all medicines required have been listed correctly. We carried out a further check of the medication kept in the home on this visit and found records for these continue to be satisfactory. Care Homes for Adults (18-65 years) Page 24 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the service is good at reporting significant events concerning people living in the home, further development of the staff skills and numbers would enable them to be better protected from potential harm Evidence: There were policies and procedures to ensure the concerns and complaints of people living in the home are taken seriously and feedback received indicated both they and their relatives were generally aware of these. Whilst the service reports incidents concerning significant events occurring within the home, a case file we inspected contained evidence of an individual feeling bullied, for which we could find no record of action taken to resolve. Whilst the manager had appropriately involved an independent advocate to help respond to concerns raised by people using the service following a high number of unacceptable incidents, the complaints log contained no record about these. The service must keep an up to date record of complaints about the service and it is recommended the policy for these is further developed to enable concerns of people living in the home to be always referred to an independent advocate in order their rights can be protected and their views and concerns taken seriously. Staff confirmed as a result of recent changes and lack of availability of appropriately trained staff, it was difficult sometimes to manage the behaviours of people using the service and confirmed an increase in these required a more consistent approach and more staff meetings and debriefs needed. A requirement is made about this. Care Homes for Adults (18-65 years) Page 25 of 37 Care Homes for Adults (18-65 years) Page 26 of 37 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 using the service live in a home that is kept safe, homely and comfortabl; however improved maintenance arrangements would enable their needs to be better met. Evidence: The service is situated in a detached cottage in Barrow-on-Humber and provides care and accommodation on two floors, to 7 adults with learning disability. Young adults with very complex needs and particular disabilities and people that present behaviours that may pose a risk to themselves or others are placed in the home. All of the bedrooms are single with en-suite facilities and there are sufficient and suitable communal areas and an enclosed garden. At the last key inspection of the service we made a requirement there is a maintenance and renewal plan for the home and that repairs and redecoration are attended to in a timely manner. Whilst there was evidence of some ongoing work and repairs and decorations to various parts of the building, there were other areas still showing signs of wear and tear. We were told however, a new kitchen had been ordered and that new furniture was on order for the lounge. The service has a handyman who is shared between three other homes and we were told staff access him at Beck Farm House once every three weeks. We were told support staff sometimes help out with decorating in their own time, however these arrangements do Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: not appear affective enough. Whilst we have the option of considering action about this, because there is evidence of ongoing work (though not part of a formal programme) the previous requirement is repeated. Care Homes for Adults (18-65 years) Page 28 of 37 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. Whilst being caring and committed to meeting their needs, the current staff shortages and lack of appropriately skilled and experienced staff mean the needs of people using the service may be compromised. Evidence: The service has continued to experience staffing difficulties since our last key Inspection and whilst these were generally satisfactory at a random visit we subsequently made, the provider must address this issue as a matter of priority. As previously noted, a number of long standing staff have left the service in recent months and despite new staff being recruited, staff told us this has resulted in times when it has been difficult to ensure there are sufficient numbers of trained staff with the right skills to safely meet the needs of people living in the home.(See Complaints and Protection). A relative confirmed this stating I Have always been happy with the care provided, but unfortunately they have had a number of more experienced staff leave over the past 9 months and this change has had a negative effect on certain residents. The Manager has also gone part time and running 2 homes at present, so there (has been) a lack of consistent support to more vulnerable residents which is effecting some behaviours. There has been a significant increase in the number of safeguarding alerts made to the Local Authority concerning issues relating to the management of unacceptable behaviours during this time and staff told us this had resulted in some of them being placed under additional pressure. Whilst people living in the home are funded for 1:1 staff hours for specific activities and Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: community participation, there was evidence of a continuing shortfall of staff on duty to cover the assessed needs of people living in home and case files inspected provided evidence of occasions when activities had been restricted due to a lack of sufficiently trained staff. Similarly, whilst there was evidence of staff meetings being held, staff told us these need to be increased with more opportunities for debriefing. A recommendation is made about this. The staff files inspected contained evidence that recruitment of new staff was generally carried out to a satisfactory standard, with references taken up and Criminal Records Bureau checks carried out. There was evidence new staff follow an induction to the home with subsequent mandatory training. However, whilst it was possible to confirm they had registered for electronic e Learning courses about these, it was difficult to check their progress and level of skills, together with little evidence of induction training on the specialist and complex conditions of people living in the home. A requirement and recommendations are made about this. Care Homes for Adults (18-65 years) Page 30 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst there are management and administrative systems in place to ensure the service can monitor itself, more robust checks should be developed to ensure more accurate and consistent records are kept that enable the rights and best interests of people using the service to be better safeguarded. Evidence: The registered manager has significant experience and has worked in the home for approximately three years, but had recently reduced her working hours due to personal commitments. Alternative arrangements have been developed to cover this with the appointment of two seniors and a deputy. Whilst staff comments about her were generally positive, they indicated a sense of loss in a direction and leadership and this was echoed in the comments received from a relative The Manager has (also) gone part time and running two homes at present, so there (has been) a lack of consistent support to more vulnerable residents which is affecting some behaviours. Quality Assurance systems were in place to monitor the effectiveness of the service, with questionnaires issued to a range of people who know it well. Professionals comments noted Staff are welcoming and Beck Farm is one big happy family with those from Care Homes for Adults (18-65 years) Page 31 of 37 Evidence: people using the service including I think Beck Farm is wonderful. I am happy here . Relatives however, whilst being generally positive identified More choice is needed and that it Could do more on activities. Monthly checks are made by senior staff from the parent company as required and although we could not find up to date records for these, we were subsequently provided with them. Whilst these identified audits of different aspects of the home and areas for improvement, there was evidence further action was needed to implement these, particularly in relation to staff development and accurate record keeping. There was evidence of checks to ensure the health and safety of people living in the home is promoted, with up to date certificates and servicing of a range of equipment. Satisfactory records were kept of work carried out. However, whilst regular hot water temperature checks were being made, there was nothing recorded where remedial action was required. Care Homes for Adults (18-65 years) Page 32 of 37 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 1 24 23 The registered person must ensure that there is a maintenance and renewal plan for the home and repairs and redecoration are attended to in a timely manner. 30/10/2007 Care Homes for Adults (18-65 years) Page 33 of 37 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 Description 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 Description Timescale for action 1 7 15 The Registered person must ensure Support plans for people using the service accurately reflect their assessed needs and that they are regularly evaluated and kept up to date. This is to ensure they reflect the current needs of people living in the home. 15/12/2009 2 9 13 The Registered Person must 15/12/2009 ensure up to date records of the use restraint are available to inform staff debriefs following their use and enable an audit tool for reflective practice to be provided. This is to ensure people using the service are safeguarded from harm. The Registered Person must 15/12/2009 ensure an up to date record of complaints made about the service is available for inspection. Page 34 of 37 3 22 17 Care Homes for Adults (18-65 years) 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 Description Timescale for action This is to ensure the rights of people living in the home are protected and their concerns taken seriously. 4 23 33 The Registered Person must ensure there are sufficient numbers of appropriately trained staff on duty at all times. This is to ensure the needs of people living in the home can be met and that they are safeguarded from abuse. 5 24 23 The Registered Person must ensure there is a maintenance and renewal plan for the home and that repairs and redecoration are attended to in a timely manner. This is to ensure people living in the home have an environment that comfortably meets their needs. 6 35 18 The Registered Person must 15/12/2009 ensure all staff are up to date with mandatory training and provided with service specific training. This is to ensure the needs of people living in the home can be safely met. 7 39 17 The Registered Person must ensure accurate records are 15/12/2009 15/12/2009 15/12/2009 Care Homes for Adults (18-65 years) Page 35 of 37 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 Description Timescale for action kept in the home. This is to ensure the rights and best interests of people using the service can be safeguarded and promoted. 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 17 The Registered Person should ensure menu choices are further developed to enable individual preferences of people living in the home to be maximised and not restricted by the needs of others. The Registered Person should ensure the complaints procedure is further developed to ensure concerns will always be referred to an independent advocate. This is to enable people living in the home to know their rights will be protected and their views and concerns taken seriously. The Registered Person should ensure staff are provided with regular team meetings and opportunities for debriefing following episodes of challenging behavior, in order to ensure a consistency of approach in meeting the needs of people living in the home. The Registered Person should ensure new staff are provided with induction training concerning the complex needs of people living in the home in order to ensure they have the right skills and their level of knowledge about these can be properly checked. 2 22 3 32 4 35 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or 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. 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