Inspection on 10/05/06 for Bede`s View

This inspection was carried out on 10th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 28 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bede`s View 26/08/08

Bede`s View 20/09/07

Bede`s View 19/03/07

Bede`s View 11/02/06

Bede`s View 22/08/05

Bede`s View 01/03/05

Bede`s View 01/07/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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

CARE HOME ADULTS 18-65 Bede`s View St Bede`s Close Wasdale Avenue Wivern Road Kingston upon Hull East Yorkshire HU9 4HZ Lead Inspector Christina Bettison Unannounced Inspection 10th May 2006 09:00 Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 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 Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 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. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Bede`s View Address 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) St Bede`s Close Wasdale Avenue Wivern Road Kingston upon Hull East Yorkshire HU9 4HZ 01482 788078 01482 788098 Kingston upon Hull City Council Position Vacant Care Home 11 Category(ies) of Learning disability (11), Physical disability (11) registration, with number of places Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th February 2006 Brief Description of the Service: Bede’s View is a purpose built establishment, managed by Hull City Council Social Services Department and provides accommodation for eleven service users who have a learning disability. Accommodation is in single rooms although none of these are en-suite. The home consists of two bungalows each having its own kitchen and dining room/lounge area. The home has a well-equipped sensory room. A secure garden area is available for service users to utilise. The home has parking facilities. A variety of aids and adaptations are available to meet the needs of service users with mobility problems. The home is located to the east of Hull within a residential area. Shops are close by and several buses travel to the city centre. All bedrooms are for single occupancy. Weekly fees are: £886.00. Additional charges are made for the following: newspapers/magazines, hairdressing, chiropody, transport for social activities and sweets. Information on the service is made available to current service users via the statement of purpose, service user guide and inspection report. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection and took place over 2 days in May 2006. Four relative surveys were posted out of which 1 was returned, 4 visiting professionals surveys of which all were returned and 5 staff surveys of which 2 were returned. During the visit the inspectors spoke to the manager, four staff, and observed the interactions between staff and service users to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. The inspector looked around the home and looked at some records. Information received by us over the last twelve months was considered in forming a judgement. Prior to the visit the inspector referred to notifications sent to the Commission for Social Care Inspection, the event history for the home over the past year and the completed pre- inspection questionnaire. The site visits were led by Regulation Inspector Mrs. K Dee who was accompanied by Regulation Inspector Mrs. T. Bettison, the visit lasted ten and a half hours. The CSCI have serious concerns about the standard of care and management at the home and are considering issuing Statutory Requirement Notices. What the service does well: All service users have a single room that is nicely personalised to their own taste, providing them with a private area to their liking where they can spend private time or receive visitors. Relatives are very involved in the home and are made to feel welcome, making sure that family can keep in contact. A good recruitment policy is in place so that service users are protected from harm. A temporary manager from social services has been brought in to help the staff team and raise standards of care in the home. The willows bungalow was warm and welcoming on the day of the inspection and had a relaxed atmosphere. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: The manager needs to make sure that the staffing structure and levels within the home are provided so that the staff are able to meet the needs of service users. Three service users that live in the home are identified as needing individual time from staff but this is not provided meaning that service users assessed needs are not met. The senior care staff do not have enough time to carry out their duties effectively again meaning that service users needs are not met. The manager needs to make sure that service users plans and risk assessments state clearly the care that needs to be provided by staff and they must be reviewed and updated as required to ensure that service users receive the care they need when they need it. The menus need to be reviewed to ensure that service users are receiving meals that are nutritious, varied and well balanced. Staff must be provided with special training, e.g. how to deal with behaviour that may harm service users or staff and to help them to meet the special needs of the service users. The manager must ensure that during supervision, aspects of practice are discussed with staff and action is taken to make sure staff can provide care to service users and keep them safe. The manager must make sure that staff meet the complicated health needs of service users and special health advice is followed. Service users must be helped to identify and meet their health care needs. A quality monitoring system must be introduced to make sure that everyone is asked about the running of the home and improvements are made. To make sure that the home is safe and comfortable for people living there redecoration must take place and maintenance must be attended to. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 7 The manager and staff need to make sure that they meet the diverse needs of service users by providing activities that meet the individualised needs of service users. The manager must ensure that medication is handled appropriately, service users must receive their medication when they need it and accurate records must be kept, if this does not happen service users may placed at risk of harm. 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. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 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 Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Service users needs are assessed prior to admission, however consideration is not being given as whether the home is sufficiently resourced to meet their needs. EVIDENCE: Admissions to the home are usually planned over a period of time and prospective service users are provided with the information they need to make an informed choice about where they live. Each service user has their own individual file and the four of those looked at had a full needs assessment completed by the funding authority and also one from the home. One of the service users following a hospital admission was re-assessed and it was identified that he then required one to one staffing. The acting manager did not have the staff to meet this need yet the service user returned to the home. The home must not offer a place to service users when they cannot meet their identified needs or the local authority must make additional staffing resources available. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 10 Staff members on duty appeared to be knowledgeable about the needs of each service user and had a good albeit informal understanding of their specific problems/abilities and the care to be given on a daily basis. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Service users needs are met on an informal basis by inadequate numbers of staff, the quality of the service user plans and risk assessments are very basic. These shortfalls have the potential to place people at risk and mean that service users assessed needs are not met. EVIDENCE: Individual service user plans are available however they do not reflect the full range of needs and do not ensure that all aspects of health, personal and social care needs are identified and planned for. Four care files were examined as part of the inspection process. The service user plans did not include everything that is detailed in the local authority assessment/care plan and did not detail accurately what staff need to do to meet service users needs. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 12 One service user clearly needed a lot of assistance with personal care yet there was no reference to this in the service user plan. Work had been undertaken in the development of the service user plans and detailed personalised risk assessments however the standard of the documentation was not consistent. The management team need to ensure that all records are of the same standard. The home are using two different recording tools and this causes confusion when looking for information in the files One service users assessment referred to a “postural management plan” but this was not detailed in the form of a service user plan but was located in his bedroom. Where service user display behaviours that can be difficult to manage and specific techniques or methods of communication are needed in order to minimise the risks this was not found to be documented either in the form of a service user plan or behaviour management strategy. One service user who is identified in his assessment as needing one to one support is not receiving this and from examination of the medication records there is an increase in the administration of PRN medication especially on a weekend to manage his behaviour. This is unacceptable practice and a referral to the POVA team has been made in respect of this. Three service users assessments identified the need for one to one staff support however the staffing hours at Bedes View is not sufficient to be able to provide this. One of these service users has been assaulting other service user. None of the service users are able to sign to say they agree their service user plan. Relatives or representatives are asked to sign when involved and if there is no signature a reason is entered. Discussion with staff suggested that service users basic care needs were being met even though there was a lack of clear plans and guidance. This approach is dependent on staff memory and good verbal communication systems. Service users are at risk of not having their care needs met if these informal systems break down, which they do for time to time as evidenced in supervision notes. Staff members had raised this during supervision as a concern. One record said “communication needs to improve as staff need to have a consistent approach with service users.” This has also been noted at previous inspections and a requirement made for the service users plans to be well completed, and maintained and reviewed on a regular basis, the manager must take action to meet this. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 13 The majority of the service users that live at Bede’s View are very dependant and their ability to contribute to the development of the service is complex, however, discussion with three members of staff throughout the day indicated that service users are consulted by other means wherever possible. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. A limited range of activities within the home and community mean the service users do not have the opportunity to participate in stimulating and motivating activities that meet their individual needs, wants and aspirations. EVIDENCE: Service users are able to take part in a limited range of activities, both inhouse and within the community. The inspectors noted that in the morning there was little interaction between staff and service users in the Rowans bungalow. Staff did not appear motivated to interact with service users and the atmosphere in the bungalow was flat. This was the opposite in the Willows bungalow where staff were seen to be interacting well and working with service users on activities. This was Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 15 discussed with the acting manager at the end of the inspection who said that she had raised this as an issue herself on the Rowans bungalow and would speak to staff again regarding this. One service user is assessed as requiring one to one support from staff but in the morning the inspectors observed that this did not happen, discussion with two members of staff indicated that the time is not spent specifically with the individual but shared out with other service users. Another service users re-assessment states that he needs one to one staffing yet the current staffing levels are not sufficient to meet this. This service user has medication, which can be given if his behaviour deteriorates. The records show that at the weekend when the staffing levels are at their minimum that the use of this medication increases. His behaviour has slowly and consistently deteriorated since he returned to the home after a hospital admission. The staff take service users out into the community in the home’s minibus. Of the care files examined an activities programme was seen. The activity programme was identical for each service user and no individualised plans had been developed. When this was matched up against activities undertaken the timetable was not been followed. A large proportion of the activities carried out at this time are outings in the local community or to the local shops or in house activities. One service users assessment and care plan states that he enjoys going swimming as one of his activities but he has not been since June 05. This does meet the diverse needs of the service users in the home. Discussion with two members of staff indicates that family and friends are able to visit the home and can use any of the communal facilities or the service users bedroom. There is no restriction on visiting times. Staff assist service user to maintain contact via mail and telephone. The majority of service users use non-verbal or extremely limited verbal communication to express their choices and wishes and promote their independence. Any restrictions are not documented within their service user plan. One member of staff informed the inspectors of how one service user uses his eyes to look at things to indicate when he wants you to do something. This was observed later on during the inspection when he wanted to go onto his bed; he looked at the clock and the member of staff several times to indicate his need. Staff did not pick this up and the inspector discussed this with a member of staff who then responded to this request. The inspector noted in the communications book that the home did not have a TV licence for a period of weeks and service users had been unable to watch TV as a result of this. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 16 Discussion with two members of staff indicate that there is no choice at mealtimes although they have a good understanding of individual service users likes and dislikes and provide an alternative if there is something on the menu they do not like. The care staff currently do all of the cooking, at the last inspection one of the kitchens was out of use and the home employed a member of staff on a shortterm basis to do the cooking. All staff said that the standard of food provision had gone up as a result of this and service users had benefited from freshly prepared food. The staff are now ordering their provisions via the council and as a result the quality of the food purchased has improved. The home are still purchasing a large amount of prepared/frozen food due to the fact that care staff do not have the time to prepare from scratch. The fridge, and freezer temperatures are not currently being taken on a daily basis nor is the meat temperatures. The home only has one food probe between the two bungalows although the acting manager did state that they will be purchasing a second one. The fridge in the Rowan bungalow was inspected and found to be dirty and the handle broken, it required a thorough cleaning. The menu’s and provisions need to be reviewed to ensure that service users are provided with a wellbalanced, varied and nutritious diet. This was a requirement of the last inspection and the home must take action to ensure that the diet provided is adequate. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Service user’s health, personal and social care needs are not being fully met. These shortfalls have the potential to place residents at risk. EVIDENCE: Four care files were examined as part of the inspection. In two of the files the health, personal and social care needs of service users were documented but were very basic. There was insufficient information in the other two. One service user has a very comprehensive postural management plan but this was not referred to in the service user plan and was discovered accidentally. There had been no health screening undertaken although the inspectors were informed that the community nurse had been approached to undertake this for all service users and there were no health action plans available in any of the files inspected. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 18 Medication administration records were examined for five service users and although there have been some minimal improvements since the last inspection there were still gaps in signatures and record of stock held on charts did not match actual stock held. The inspectors were informed that there had been an increase in the audits carried out by the manager and senior care officers but this does not appear to have improved practice. The quality of the auditing needs to be reviewed to ensure its effectiveness. The home has an in house medication policy and procedure that has been updated and is comprehensive but is not always being followed. The CSCI had been notified of three instances of medication not been given when it should and one of these included anti epileptic medication for one service user. The investigation into this shows that this service user then went onto have seizures later that day. This does not ensure the health, safety and welfare of service users. One service user who is identified in his assessment as needing one to one support is not receiving this and from examination of the medication records there is an increase in the administration of PRN medication especially on a weekend to manage his behaviour. This is unacceptable practice and a referral to the POVA team has been made in respect of this. For another service user who should have had a medication review in March 06 this was overdue and an epilepsy management plan for another service user was not clear. The inspectors were informed that the community nurse would be updating this. For another service user who is prescribed medication PRN the protocol was unclear and misleading for staff to follow and must be updated. The home had a stock of Temazepam for one service user and this should be stored and recorded as a controlled drug. The medication practices have been identified during previous inspection visits and a requirement was made requiring the systems to improve. Urgent action is needed to meet this requirement the practice fails to protect service users and places them at risk. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a complaints system however verbal complaints are not handled appropriately and due to the unsatisfactory staffing arrangements and attitude of some staff, poor service user plans, and unsafe medication practices service users are not protected from harm whilst in the care home. EVIDENCE: The home had received three positive comments since the previous inspection, one from the Quest evaluation team thanking the staff for their co operation and support during the evaluation, one from the clinical psychologist who said she had seen some improvements in service users negative behaviours, and one from a training officer who said that the staff on a training course had a positive attitude to training. The home has a complaints procedure however verbal complaints are not handled appropriately. A complaint had been received verbally and the manager had made the decision to await receipt of it in writing before taking any action. The complaints procedure states that complaints can be made verbally and therefore must be investigated. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 20 The location of the home, restricted access, the service being provided in two separate bungalows and the lack of senior care cover give cause some concerns. (These areas are explained further in environment and staffing.) The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of service users money and financial affairs. The manager and all staff have had Protection Of Vulnerable Adults (POVA) training. The staff on duty displayed a good understanding of the vulnerable adults procedure and they are confident about reporting any concerns and certain that any allegations would be followed up promptly, and the correct action to be taken however the unsatisfactory staffing arrangements and attitude of some staff, poor service user plans, and unsafe medication practices mean that service users are not protected from harm whilst in the carehome. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The environment does not provide service users with comfortable surroundings in which to live. EVIDENCE: Bede’s View is a purpose built unit providing accommodation in two bungalows. All service users have a single room that is nicely personalised to their own taste, providing them with a private area to their liking where they can spend private time or receive visitors. Service users have access to a secured garden area. To the front of the premises the grounds are fenced, however service users privacy and dignity would be enhanced by the addition of hedging or conifer type shrubs. The main gate to the grounds is kept locked to ensure the safety of the service users and the inspector has concerns about this. It takes a long time to access the grounds. There has been some work to fit an intercom system but there has been a delay in progressing this. The acting manager said that work is to be Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 22 completed in the next two weeks. The current arrangement is not satisfactory and this was a requirement of the last inspection. Both of the bungalows have had new kitchens fitted. The lounges and communal areas although functional, look sparse particularly in the Rowans bungalow and would benefit from some homely items. Both bungalows look tired and dated and some plaster has come off the walls in places and needs making good. Some of the furniture, carpeting and décor are showing signs of wear in service users bedrooms and a plan of maintenance and renewal to address these areas needs to be developed. These were requirements of the last inspection and action must be taken to ensure this requirement is met. There is only one small office for the manager and staff to use. This covers both bungalows and is not sufficient for the needs of the home. There is no other private space for staff and managers to conduct meetings or supervisions. If they need to discuss things in private with relatives or visiting professionals there is nowhere for this to happen. The inspectors were with the manager in the office for part of the morning and each time the inspector asked for a document the manager had to leave the office and the chair had to be removed to enable the manager to gain access to the records, this poses a health and safety risk. The only space available to look at records was on a chair near the rear exit where the wheelchairs are stored. Discussion with two members of staff indicate that staff supervision and meetings have to take place at the dining table in the lounge, this is not acceptable and does not ensure confidentiality and privacy is maintained. The manager has being given the task of completing a quarterly health and safety audit and the office is one of the areas that has been identified. The timescale for this is set as ongoing. There needs to be a timescale for action to be identified. This was identified at the last inspection and action must be taken to meet this. The hoist was broken in the Willows bungalow and two service users are unable to have a bath as a result and the inspector was informed that the hoist in the Rowans bungalow will not go under the bath safely, again meaning that staff and service users health, safety and welfare is being compromised. The acting manager said that she is currently in the process of obtaining quotes for a new bath for the Willows. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 23 The home was found to be free from offensive odours, however some carpets require shampooing. The home only has a limited number of cleaning hours and the cleaning staff work hard to try and ensure the home is clean and odour free. The current cleaning hours do not allow any time for areas to be deep cleaned and the provider should review the hours to ensure that they are sufficient. This was a requirement of the previous inspection and there is no evidence that any work has been done to meet this requirement. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The current staffing arrangements are not sufficient to meet the needs of the service users and further specialised training must be provided. Staff are not adequately supervised leading to poor care practices. EVIDENCE: The current service users are very dependant and present behaviours that may pose a risk to themselves and others. The current staffing structure is inadequate to meet the complex needs of service users and does not allow for activities and meaningful interactions. Discussion with the staff indicated that the manager or senior care staff are around on a daily basis to offer informal advice and help where needed however Senior care staff who along with the manager have responsibility for all of the paperwork, reviews etc also spend most of their time on shift providing care and are part of the care staffing calculation. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 25 There is no time allocated to senior staff to undertake activities or to complete the necessary paperwork associated with the senior care role. This has an impact on medication, supervision, care planning and health and safety. There is only one senior care staff on duty after the manager goes off shift and on weekends. The senior care staff covers the management of the two bungalows but is part of the care staffing calculation of one bungalow. If the care staff in one bungalow are having a difficulty or a staff member calls in sick the senior care staff has to undertake responsibility for this therefore reducing the number of care hours provided to the service users. The registered person was requested at the last two inspections to review the staffing structure and care staff hours provided in the home to ensure that they can meet the complex needs of the service users. The manager had provided evidence that the senior staff need to be given the time to undertake managerial duties and to raise the standards in the home this has not been implemented. The manager and staff although motivated to improve the standards in the home all feel the current deployment of senior staff is preventing the home from moving forward in meeting requirements and needs to be addressed urgently. Staff supervision was previously identified as not occurring as often as required and although the quantity of supervisions has improved it was noted that the quality of supervision needs to improve to ensure that staff receive the support and guidance they need to carry out their jobs to a high standard. It is vital given the complex needs and dependency of the service users in the home. During the inspection the inspector noted the poor attitude of some staff towards service users and the manager confirmed that she was aware of this issue and was aiming to address it. The practice of holding supervision and meetings in the communal areas does not set a good example to staff. Information provided by the manager in the Pre Inspection Questionnaire indicated that there are 27 care staff of which 14 hold an NVQ level 2 or above and 3 are registered and working towards it. The majority of staff appear to be up to date with their mandatory training and crisis intervention training however the majority of staff do not appear to have undertaken any medication training that includes a competency check. Given the concerns related to poor medication practices highlighted elsewhere in this report this must be given urgent attention. Comments received from relatives include; “I have always found the staff to be very friendly and helpful…………is very happy and contented at Bede’s View, please pass on to all staff my sincere thanks for everything” and comments from professionals involved with the home Include “ in my opinion I feel that Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 26 the home is understaffed to care for the residents with such complex needs. I feel that social services should provide care to these clients and withdraw the use of bank staff” and “some staff appear to have a more comprehensive understanding than others……….advice given as requested around the management of medication…………individuals would benefit from more staff interaction”. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 27 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The Commission for Social Care Inspection is concerned about the management and standards of care in the home. There have been a high number of requirements outstanding from previous inspections and both the local authority and the management team have been slow to respond. EVIDENCE: Progress in raising the standards of care and management in the home has been slow. This is attributed in part to the slow decision making structures within the local authority that leads to an inability to make changes at a local level that will ensure more positive outcomes for service users. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 28 In addition to this the restrictions of the current staffing structure and number of care hours provided within the home mean that although the staff are willing they do not have the time within the shift to undertake all of the duties required to ensure that service users complex personal, health and safety needs are met. Staff have meetings with the managers on a regular basis and everyone is encouraged to join in with discussions and voice their opinions. The acting manager is not registered with the CSCI and needs to submit an application for registration. The registered manager ensures safe working practices by the provision of all mandatory training. The manager has provided information that regular maintenance checks are carried out and certificates are held at the home. There are risk assessments carried out for all safe working practice topics and these were recorded. Not all of them are reviewed as regularly as they need to be. All accidents and injuries or communicable diseases are reported and recorded. The home does not regularly review aspects of their performance through a programme of self-review via a quality assurance system and this needs to be addressed. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 1 3 1 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 1 ENVIRONMENT Standard No Score 24 2 25 3 26 x 27 x 28 2 29 x 30 2 STAFFING Standard No Score 31 2 32 2 33 1 34 3 35 3 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 1 x LIFESTYLES Standard No Score 11 x 12 1 13 1 14 x 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 1 x 1 x 1 x x 1 x Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 30 Are there any outstanding requirements from the last inspection? yes 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 YA3YA2 Regulation 14 (1) (2) Requirement Timescale for action 30/06/06 2 YA6 15,17 3 YA7 13 (6)(7) 4 YA9 13,17 The registered person must ensure that all aspects of the assessment can be met before admitting service users to the home and must keep this assessment under review. The registered person must 31/08/06 ensure that service user plans are developed and agreed with service users and must detail the action to be taken by staff to meet their personal, health and welfare needs. (Timescale of 1/11/05 not met) The registered must ensure 31/08/06 that where service users display behaviours that are difficult to manage or there are any limitations or restrictions on facilities, choice or human rights to prevent self harm or abuse or harm to others that this is agreed by a multi agency meeting and documented appropriately. The registered person must 31/08/06 ensure that there are Version 5.1 Bede`s View DS0000041450.V294521.R02.S.doc Page 31 5 YA14YA13YA12 16 6 YA16 12 (5) (a) (b) 7 YA17 16 individual and generic risk assessments available that are maintained and reviewed. (Timescale of 1/5/06 not met) The Registered person must 31/08/06 ensure that activities are provided that meet the diverse needs of the service users and meet their assessed needs. (Timescale of 1/6/05 and 1/5/06 not met) The registered person must 30/06/06 ensure that staff interact with service users in an appropriate manner and not exclusively with each other. The registered person must 30/06/06 ensure that service users receive a nutritious, varied and balanced diet that is attractively presented. (Timescale of 1/10/05 not met) The registered person must 30/06/06 ensure that service users are provided with sensitive and flexible staff support to maximise their privacy, dignity independence and control. The registered person must 31/08/06 ensure that service users complex health needs are met by the provision of health screening, health action plans and access to health professionals. The registered person must 31/08/06 ensure that medications are stored appropriately and administered to service users as per the instructions and that staff are appropriately trained and competent to undertake this task. (Timescale of 10/5/05 and 8 YA18 18 9 YA19 13 10 YA20 13, 15 Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 32 14/10/05 not met) 11 YA22 22 The registered must ensure that the complaints procedure is followed and service users and their advocates views are listened to and acted upon appropriately. 13 (6) The registered person must ensure that service user are protected from harm by the provision of trained, competent staff in sufficient numbers and service users plans and guidelines are prepared and followed. 16, 17, 23 The registered person must find an alternative system for main access gate to the home. (Timescales of 01/06/05, 01/11/05 and 1/4/06 not met) 16,23 The registered person must ensure that the home has a planned maintenance and renewal programme for the fabric and decoration of the building with records kept. (Timescale of 1/6/06 not met) 16,23 The registered person must ensure that there is a meeting room/office fit for purpose that is private and separate to the resident’s communal space. (Timescale of 1/6/06 not met) 16,23 30/06/06 12 YA23 31/08/06 13. YA24 30/06/06 14 YA24 31/12/06 15 YA24 31/12/06 16 YA27 17 YA28 16,23 The registered person must 31/08/06 ensure that bathing facilities and appropriate equipment is provided to meet the service users assessed needs. The registered person must 31/12/06 ensure that the communal space is comfortable, safe and fully accessible. Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 33 18 YA31 18 19 YA32 18 20 YA33 18 The registered person must ensure that staff support and promote the main aims of the home and meet the individual needs of service users. The registered person must ensure that staff have the skills and competencies to meet the needs of service users. The registered person must ensure that the current staffing levels and structure are reviewed and are sufficient to meet the needs of the service users. (Timescale of 31/1/04 and 31/10/05 not met) 31/08/06 31/08/06 31/08/06 21 YA33 18 22. YA36 17, 18 The registered person must 30/06/06 ensure that cleaning staff are employed in sufficient numbers to enable the home to be cleaned thoroughly. (Timescale of 31/3/06 not met) The registered person must 31/08/06 ensure that staff receive the support and supervision required and must include all of the areas specified in 36.4 of this standard. (Timescale of 1/9/03 not met) 31/08/06 23 YA37 18 24 YA39 The registered person must ensure that the management of the home is robust and that all outstanding requirements are met within the timescales set. The acting manager must apply to register with the CSCI. 17, 24, 26 The registered person must ensure that the home implements a quality assurance system. (Timescale of 1/7/05 and DS0000041450.V294521.R02.S.doc 31/12/06 Bede`s View Version 5.1 Page 34 1/5/06 not met) 25 YA42 24 The registered person must ensure the health, safety of welfare of the service users by ensuring that all above requirements are adhered to. 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bede`s View DS0000041450.V294521.R02.S.doc Version 5.1 Page 35 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 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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