Inspection on 21/11/06 for Beck House

This inspection was carried out on 21st November 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beck House 26/10/05

Beck House 25/04/05

Beck House 08/11/04

Beck House 29/04/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Beck House 2 Manor Court Beckspool Road Frenchay South Glos BS16 1NT Lead Inspector Paula Cordell Key Unannounced Inspection 21st November 2006 09:30 Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beck House Address 2 Manor Court Beckspool Road Frenchay South Glos BS16 1NT 0117 9573177 0117 9566050 mclarke@themanorhouse.org 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) Mrs Marilyn Joan Clarke Mrs Wendy Elizabeth Newell Care Home 14 Category(ies) of Learning disability (14), Physical disability (14) registration, with number of places Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 14 persons aged 19 - 64 years May accommodate one named person with Learning Disabilities who has Dementia 26th October 2005 Date of last inspection Brief Description of the Service: Beck House is located in the village of Frenchay approximately four miles from the centre of Bristol. It is in a semi rural location close to Frenchay Common and there are shops and other community amenities within one mile of the home. The home is one of four within the Manor House Organisation, which also provides day care at the Bingham Centre. Beck House is adjacent to The Manor House and shares this site with the day centre and respite care service for children with disabilities, Alice House. The other home Kendall House is in Warmley. Beck House is registered to provide accommodation and personal care to fourteen people with a learning disability. Presently the home has three vacancies. The provider stated that they had no intention of filling the vacancies enabling single occupancy of bedrooms. This is a commitment from the home to meet the National Minimum Standards. Presently there are two double rooms. There are plans for an extension of the home that could lead to the provision of all single bedrooms. The philosophy of the home and the organisation is concerned with dignity and respect, independence, participation, valuing people, equality, and rights and working together. The registered manager is Ms W Newell. The fees at the time of producing this report are in the range of £627-862 depending on the care needs of the individual. Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The purpose of the visit was to review the progress to the requirements from the inspection in November 2005 and monitor the services provided to the residents living at Beck House. There have been no additional visits during this period. The home has been keeping the Commission for Social Care Inspection informed of incidents that affect the wellbeing of the individuals living at Beck House and the provider has sent monthly appraisals of the service. The inspection was conducted over a period of 5 hours. The inspector had an opportunity to meet with four staff, the residents and a visiting relative. Many of the residents accommodated at Beck House are non-verbal and communicate using gestures and sounds. This made it difficult for the inspector to seek the views of the residents living at Beck House. An opportunity was taken to view the home and a number of the records relating to the management of the home and plans of care for three of the residents. The home has demonstrated compliance with all the requirements and recommendations from the last inspection. What the service does well: The home has supported residents with a learning disability for many years. A number of residents have lived in the home for the past forty years since childhood. The service provided to them has grown and developed and moved with the changing needs of the residents and is based on current good practice and legislation. There is a strong commitment to provide residents with an individual lifestyle living within a homely environment. Residents have a wide range of activities available to them. All residents have access to an external day centre in the community five days per week, demonstrating a commitment to providing residents with activities and occupation. Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There is one outstanding requirement and recommendation relating to the refurbishment of the kitchen and consideration to purchasing a dishwasher. A planned refurbishment and extension is commencing in December to address these outstanding requirements. Two immediate requirements were left with the home relating to the safe storage of oxygen in respect of one individual and to ensure that only competent staff administer it, ensuring the safety of the individual concerned. In part this was responded to at the time of the inspection relating to the storage of the oxygen canisters. The second immediate requirement is that the provider must ensure that food is delivered safely from the Manor House to Beck House. Residents must benefit from more opportunities to access the community in the evenings and at weekends supported by the care staff. Residents should have clear guidelines developed documenting their preferences for taking their medication. This should include agreement with the prescribing doctor and the pharmacist, that medication can be administered with food. This should be kept under review. Residents would benefit from generic risk assessments being kept under review. Residents would benefit from the home’s quality audits being completed in accordance with the corporate policy. Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 7 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. Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5, Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home was meeting the changing needs of the residents and there is good, clear and accessible information to enable residents to make a decision about whether to move to Beck House. Good assessments processes are in place ensuring the home is able to meet the needs of prospective residents. The home is commended on the management of the transition and the admission process put in place for the two recently admitted residents. EVIDENCE: The home has a statement of purpose, service user guide and individual contracts. This meets with the legislation and the National Minimum Standards. This is in an accessible format, including the use of plain English, symbols and photographs. In addition this has been reviewed since the last site visit. Copies of this were available in the main hall of the home. These were viewed at the last inspection. The home has an established group of residents, living in the home and recently two of the residents from the Manor House (another home situated on the same site) have moved to Beck House. Good examples were seen in care folders that the residents were fully assessed prior to moving to Beck House, involving the prospective residents, their relatives and other professionals and Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 10 key staff from the Manor House. The transition from the Manor House to Beck House was managed well with the residents having many planned visits prior to moving to the home ensuring that Beck House was suitable and taking into account the compatibility of the other residents already accommodated. This process was organised over a two-month period to ensure that it was appropriate for the individuals. This is commendable. Other than the two residents that moved to the home from the Manor House in the latter part of 2005 the last person to move was in 1990. The home was evidently meeting the care needs of the residents presently accommodated at Beck House. Plans of care were being reviewed and adapted to meet the changing care need of the individuals accommodated involving other professionals in the process. The home has successfully made an application to the Commission for Social Care Inspection to include one named resident with dementia to the certificate of registration. It was evident that staff had received training relevant to the needs of the individual including dementia, loss and bereavement training. It was evident that the home was meeting the care needs of the individual however; this must be kept under review to ensure this does not compromise the care of the other individuals living in the home. A visiting relative stated that the home provides excellent service to the individuals and that they are kept informed of the changing needs of their relative. Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from clear documentation detailing their support needs and how these were being met. Risk assessments were commendable in detail and the variety of activities that are covered ensuring residents safety is not compromised, and not curtailing independence or participation both in the home and the community. EVIDENCE: Three residents plans of care and associated records were seen. There were good examples of person centred planning involving the individual, their relatives and other professionals. These were being kept under review. Care plans were evidently derived from an assessment drawn up by the placing authority and the home. Assessments and the management of risks arising from care plans both in the home and the community have been undertaken. The variety of activities that are recorded is commended which includes hobbies, activities in the home and Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 12 all trips taken in the community. Documentation provided evidence that the risk assessment tools ensure the safety of residents and staff but did not curtail or inhibit residents and encourage independence and community participation. This is good practice. Residents had opportunities to voice their opinions at care reviews and at regular resident meetings and via the quality assurance audit in the form of a questionnaire. The home uses communication aids to enable and encourage discussions in meetings and in the day-to-day activities in the home. Staff stated that some of the residents use makaton (a sign language for individuals with learning disabilities) whilst no formal training was given staff are taught the common signs that are used by the individuals as part of their induction and reviewed periodically at team meetings. Residents and staff interactions were positive. Conversations were inclusive of the residents. Some of the residents have limited communication and staff were patient and showed a willingness to assist residents and spend time to fully understand what was being said. The atmosphere in the home was relaxed and friendly. Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have structured day care less apparent was activities which encourage access to the local community in the evenings and at weekends. Residents are assured their safety on all aspects of their daily living. Good relationships are built with relatives and friends. Residents have available to them a varied and nutritious diet. However, concerns are raised in how this is delivered to Beck House from the Manor House and the risks to both staff and residents. EVIDENCE: Activities were reviewed. Care documentation demonstrated that all residents had a structured day placement and attendance at a variety of day centres. From discussions with staff it was evident that activities organised at the day centres was varied and included accessing the community. Less apparent was how the home was supporting residents to access the community. Daily Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 14 records lacked any real detail on activities undertaken and whether residents were offered trips out. Whilst it was evident that residents were going for short walks in the local community and attending activities organised on site less apparent was trips out into the community. Staff stated that there has been a lack of drivers working in the home and that there have been some difficulties in gaining access to the shared transport, which has to be pre-booked. The inspector was informed that some of the residents enjoy skittles, which is organised on a Friday in Kingswood, however in a four-week period the residents have only attended once. Staff stated that residents enjoy going for meals and swimming but there was no evidence that this was supported or organised by the care staff in the home, but by their day centres. Again there was evidence that residents enjoy shows at the local theatre but again this was not happening. Although a member of staff stated that they were planning a Birthday outing for one of the residents to the theatre and a meal out to a local Chinese but this was not till March 2007. Whilst this is good practice it is questioned why these cannot happen on a more regular basis and link to the individuals plan of care. It was evident that the home was organising a variety of activities over the Christmas period, including a party where relatives and friends were being invited, a trip to the pantomime and a meal out for those residents that want to take part. A relative confirmed they had been invited and stated that the parties organised were both enjoyable and well supported by friends, relatives and the staff. Family and friend contact is encouraged and supported whereby the residents invite people for lunch or tea and some resident’s stay with their families for weekend visits and holidays. Staff support residents to maintain contact with relatives and friends. This includes telephone conversations and arranging visits and organising transport. A record was in place confirming this. This formed part of the home’s quality audit. This is good practice. It was clear from talking with the staff that this was seen as a fundamental role of the carer to support individuals in making and maintaining relationships with friends and relatives. Staff stated that all main meals are prepared at the Manor House and residents have a choice available. Where residents prefer a snack this can be made at Beck House. Staff stated that residents did not get involved in the catering and preparation of the meals so this does not hinder residents independence but releases care staff to spend more care time with individuals. This should be kept under review to ensure that this does not hinder the independence of the individuals or that an opportunity is taken away that reflects ordinary living. Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 15 A member of staff was observed carrying both the lunch, which was hot, and later during the site visit the evening meal, on a tray from the Manor House to Beck House. Concerns were raised by the inspector about the safety of completing this task both to staff and residents. An immediate requirement was left for the home to risk assess the task and take appropriate action ensuring the safety of all concerned. This must be kept under review and reflect the daily weather conditions. Residents have a varied and nutritious diet. From discussions it was evident that they enjoyed the food and that this was discussed at residents meetings and where requests have been made these had been included in the menu. Residents are asked daily what they would like to eat and there are always alternatives to the planned menu. Staff stated residents can help themselves to drinks and snacks and there were fruit bowls strategically put in the kitchen. Care plans included information sought from dieticians. The catering staff completes a quality assurance audit on menus, which includes seeking the views of residents on the food that is available to them. This is good practice. Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s personal and health care needs were being met. Procedures and practices relating to medication safeguarded residents, however this must be extended in respect of one individual relating to the use of oxygen. EVIDENCE: Residents care files provided evidence that they were referred to appropriate health professionals within a multi disciplinary team. All visits and outcomes to the General Practitioner and any other professionals are recorded to provide a history and quick reference guide. Care plans clearly documented the personal and health care needs of the residents. These were being kept under review and demonstrated a person centred planning approach. Each individual had a health action plan that detailed how to ensure an individual’s well being is maintained. Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 17 The home is commended on the assessment and the plans of care that have been developed for monitoring and ensuring an individual is safe during an epileptic seizure. A concern was raised about the storage of oxygen, which was stored by a radiator (this was rectified at the time of the site visit) and not on a trolley or attached to the wall as described in the home’s risk assessment and policy. In addition not all staff had attended training on the administration of the oxygen. Documentation seen lacked a record of the strength and the required dose. These shortfalls must be addressed. An immediate requirement was left with the home to ensure that only competent staff administer the oxygen and the storage. A record must be kept of administration, as this is a prescribed by the individual’s consultant psychiatrist. The senior carer had commenced this process and was contacting the company responsible for delivering the oxygen for advice on the storage, recording and training. The registered manager confirmed by telephone that the oxygen is now stored in a locked cupboard in accordance with the home’s risk assessment. Staff training records indicated that staff members had received training in physical and emotional health related issues for example “supporting residents who are getting older, bereavement and loss, supporting residents with challenging behaviour and First Aid. Policies and procedures for receiving, storing, administering and disposing of medications were examined and correct. The administration charts were legible and continuity of administration was shown with a signature from the person dispensing. Staff administer medication and have received training in “medication Competency”. A member of staff stated that some of the residents prefer to take their medication in food, and this is done with the residents consent and in front of them. Staff stated that this is not documented but done by all the staff. It is strongly recommended that this be clearly documented in the plan of care and kept with the individual’s medication record. The home should take advice from the prescribing doctor and the pharmacist to ensure that this is appropriate. The member of staff was aware of the issues of consent and the individual’s right to refuse medication. The General Practitioner provides regular visits and support to the home. Good relationships were reported. Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. Residents are safeguarded by the home’s procedures and practices on responding to a complaint or an allegation of abuse. Good safeguards are in place affording the individuals protection. EVIDENCE: The home has a robust complaints procedure in place. Residents meetings cover concerns or complaints. The home has not received any complaints as evidenced via the pre-inspection questionnaire, the complaints book or as evidenced via the minutes of resident meetings. The home has procedures for the protection of individuals living in the home including an abuse, bullying, anti-racism, financial, gifts and a whistle blowing policy. Staff were aware of the procedures to safeguard residents. Staff have signed the policies as read and understood. This is good practice. Staff have attended training on abuse and demonstrated awareness when spoken with on the procedures to follow and what constitutes abuse. One member of staff has only worked in the home for a period of a month and stated that this had been discussed during their initial induction and formal training is planned for December. This is good practice. Staff records demonstrated that in addition to abuse training, staff have attended antidiscriminatory training as part of the corporate induction training. This is good practice. Good practice would be that the abuse training was on a rolling Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 19 programme with periodic updates, at the time of the site visit staff were not aware whether this was the case. Training records provided evidence that staff attend yearly updates on ‘Nonviolent Crisis Intervention’ and this was compulsory training for all staff. Finances were checked. These were found to be satisfactory and safeguards were in place to protect the individual’s monies including regular checks, receipts and two staff signatures. Financial Policies are in place as seen on a previous site visit ensuring the safety of resident’s property and finances. Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a homely, comfortable and clean environment, which meets their individual, and collective care needs. This will be enhanced by the refurbishment plan and the inclusion of a lift to aid individuals with mobility issues and residents being provided with their own private space. EVIDENCE: Beck House is a detached property in the grounds of the Manor House. The home was clean, well decorated and well maintained. Accommodation is on three floors and there were two staircases accessing the second and third floors. The home has three double rooms. All bedrooms have adequate furniture as per the standard and a sink. All bedrooms seen were personalised and reflected the individual’s taste. Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 21 It was noted that many of the bedrooms are not fitted with a lock to enable the individual privacy. Risk assessments were in place detailing the decision process. Staff stated that none of the residents have a key to their bedroom door. It was noted at the last site visit one of the residents had moved from a double bedroom to a single room, which is further from the staff sleep in room. It was noted that the individual’s care plan from social services, which forms part of the contract with the home, stated that the individual must be close to the staff and should not have a sink in their room for fear of flooding and there was a risk with plug sockets. The home has responded to the requirement to ensure that a risk assessment is in place identifying the risks and the strategies in place to ensure the individual’s safety. The home is registered for individuals with a physical disability. There are two ground floor bedrooms. However it must be noted that the only access to the other two floors is by a staircase and would not be suitable for individuals with a physical disability. All communal areas were on the ground floor including a lounge, conservatory and spacious kitchen. The kitchen is looking tired and worn on drawer fascias. A requirement was made at the last site visit for this to be replaced. Staff confirmed that this is being replaced as part of the refurbishment and extension that commences in December 2006. No further requirement is made. Residents have access to a secure garden to the rear of the property. Bathrooms are lockable, which can be overridden by staff in the event of an emergency. It was noted that two of the bathrooms did not contain toilet paper, hand towels and soap. Whilst this was resolved during the site visit this had been mentioned at the last site visit. There is manual handling equipment including a bath chair and toilet raisers. Some residents have specific seating to improve posture and assist with mobility. Evidence was available that the equipment in the home was checked at periodic intervals. Evidence was provided that repairs were responded to in a prompt manner, and that routine audits were completed relating to the fitness of the premises and appropriate action was taken where required. The home has had planning agreed to extend Beck House to provide additional accommodation for six individuals. As part of the extension the home is planning to install a lift. The Commission for Social Care Inspection has yet to receive an application for the changes to the premises and the home’s registration. Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 22 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 adequate. This judgement has been made using available evidence including a visit to this service. Whilst the home is commended on the level of training and support mechanisms for staff, a review of staffing is required to ensure that this is adequate to meet the social needs of the individuals living in the home. EVIDENCE: On the morning of the site visit there were two care staff working in the home supporting one resident and two domestic staff. In the afternoon there were three care staff supporting eleven residents. Whilst these staff stated that this is adequate to meet the care needs of the residents. However, as discussed in the section on lifestyles evening and weekend outings were infrequent in accessing the community. Staff stated that there have been some difficulties organising activities due to the lack of drivers and the availability of the shared mini-bus. This must be reviewed to ensure that there is adequate staff to meet residents social care needs. A recommendation would be to review the planning of the rota to ensure that a driver is working to enable residents to fully access the community. Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 23 There was a senior care staff on duty at all times as evidenced via the duty rota and discussions with staff. On the day of the inspection it was noted that the two staff on duty were relatively new within the last month. However, the level of training both had attended was commendable and further training was planned for December 2006. Both staff stated that once they have completed their induction they would be enrolling to complete a National Vocational Qualification in care. This is good practice. Evidence was provided that both staff were undertaking a formal induction and this was being monitored by the manager. As already mentioned senior carers were responsible to manage the shifts on a daily basis and administer the medication. From conversations with staff it was evident that they were aware of their roles and the expectations of the service. Job descriptions were in place to guide staff. Staff described good support networks in the team including supervisions, team meetings and ongoing training. Documentation was seen supporting this. Supervision records were not seen but evidenced via discussion with staff on duty on their frequency. These were audited by the home and were part of the Home’s business plan and quality targets. This is good practice and demonstrated a proactive service that regularly reviews the quality of the service. There was a training plan for each member of staff. Training records indicated a commitment to ensuring that staff attend regular training relevant to their role based on the care needs of the individuals. Health and safety training was in place including periodic updates. These included manual handling, first aid, food hygiene and fire and all staff attend non-violent crisis intervention, which is updated annually. This level of training is commended. Other training noted was person centred planning, equality and anti-discrimination practice, dementia, loss and bereavement, supporting individuals with autism to name a few. Recruitment information was not seen on this occasion in the absence of the registered manager. However, this was seen at the last inspection and noted to meet with the National Minimum Standards and the Care Homes Regulations. Once a member of staff is employed in the home. They complete a comprehensive induction after which they will proceed onto completing an NVQ 2 or 3 in care. There is an expectation for senior care staff to have an NVQ 3 in care. The pre-inspection questionnaire evidenced that that four care staff out of fourteen have an NVQ 2 and one person is in the process of completing. The home is demonstrating a commitment to ensuring that 50 of the workforce have an NVQ 2 or equivalent. Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 24 Staff were knowledgeable about their roles as carer and the care needs of the individuals living in the home. There was a strong commitment to providing individuals with a quality service in a homely atmosphere. Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 25 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a well managed and safe home. However this would be enhanced if the home applied the quality assurance tool that is in place and kept generic risk assessments relating to health and safety under review. EVIDENCE: Staff spoke positively about the management support from both the registered manager and provider. It was evident that the atmosphere in the home was open and inclusive. Staff described a high job satisfaction in working for the organisation and the commitment to training. At the last site visit the home was commended on the quality assurance tools that are available in the home to monitor the quality of the service provision. However, it was noted that these had not been completed in some areas in accordance with the home’s policy for example audits on activities had not Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 26 been completed in the last twelve months when in the past this had been done six monthly, resident questionnaires had not been sent since February 2005 and these was meant to be annually, transport re staff documentation had not been checked annually in accordance with the policy. It is recommended that this be re-introduced as this is seen as good practice and would highlight to any shortfalls. The provider completes a monthly audit on the home in respect of the Care Homes Regulations. These are comprehensive and include an action plan for the manager to follow to address any shortfalls. The Commission for Social Care Inspection is receiving copies. Health and safety in the home was monitored both by the manager and an organisational health and safety committee. Where shortfalls are identified these were responded to promptly and appropriately. Health and safety training for staff was in place to ensure that residents are protected and supported by competent staff. The home has a number of generic risk assessments including storing of chemicals, safe handling of food and various tasks that staff and residents may complete where there is an element of risk. Whilst the documentation is clear and describes safe procedures these had not been formally reviewed in the last twelve months. It was noted that the organisational policy on risk assessments did not guide staff on the frequency of reviews. Fire records including the fire risk assessment were found to be in order including the checks on the equipment, fire drills and training. The home has an extensive policy file to guide staff and support the residents. Staff stated that these had been discussed as part of the induction process. A significant number of the policies have been reviewed in the last twelve months. It was evident that the residents were the focus of the policies and procedures. This inspection did not focus on the financial viability of the home. There was no evidence that the financial viability of the service was threatened in any way. The organisation has a business plan. Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 27 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 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 x 33 2 34 x 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 X 16 4 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 3 x 2 x X 3 x Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 28 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 YA20 Regulation 13 (2) Timescale for action The registered person shall make 21/11/06 arrangements for the safekeeping of medicines received into the home – Ensure that oxygen is stored in accordance with the manufacturers guidance and the home’s risk assessment. The registered person shall 21/11/06 ensure that the persons employed receive training appropriate to their role. -Only staff that have been assessed as competent to administer oxygen. The registered person shall 21/12/06 consult with service users about their social interests and make arrangements to enable them to engage in local, social and community activities in relation to recreation, fitness and training. The registered person shall have 22/11/06 regard for the safety of residents and staff in the transportation of food delivered from Manor House to Beck House and complete a risk analysis. The registered person shall 21/12/06 DS0000003349.V314007.R01.S.doc Version 5.2 Page 29 Requirement 2. YA19 18 (1) (c) 3. YA14 16 (2) (m) 4. YA17 13 (4) 5. YA33 18 (1) (a) Beck House having regard to the size of the home, the statement of purpose and the number and the needs of the service users ensure that there are adequate staffing. Ensure adequate staffing to meet the resident’s social care needs 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. Refer to Standard YA20 Good Practice Recommendations Resident’s preferences in relation to the administration of medication must be documented and where this is given with food, discussion with the prescribing GP or the pharmacist to check that it is appropriate. Generic risk assessments should be kept under periodic review. Complete the quality audits in line with the corporate policy involving residents and their relatives. 2. 3. YA42 YA39 Beck House DS0000003349.V314007.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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