Inspection on 20/09/07 for Bede`s View

This inspection was carried out on 20th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 17 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 19/03/07

Bede`s View 10/05/06

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 Key Unannounced Inspection 20th September 2007 09:15 Bede`s View DS0000041450.V351554.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 Bede`s View DS0000041450.V351554.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. Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 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 sheila.carmichael@hullcc.gov.uk Kingston upon Hull City Council Mrs Sheila Ann Carmichael Care Home 11 Category(ies) of Learning disability (11), Physical disability (11) registration, with number of places Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD and Physical disability - Code PD The maximum number of service users who can be accommodated is: 11 19th March 2007 2. Date of last inspection 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 and physical disabilities. 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. 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. Client contributions to the weekly fees range from £51.95 to £78.00. Additional charges are made for the following: newspapers/magazines and sweets, hairdressing, chiropody and transport for social activities. 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.V351554.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was a key inspection and the unannounced site visit took place over 1 day in September 2007. Three relatives’ surveys were returned; three surveys were returned from the people that live at the home, and two staff surveys were returned. During the visit the inspector spoke to the registered manager and several staff, to find out how the home was run and if the people who lived there were receiving the right care to meet their needs. The people that live at Bede’s View have complicated needs and are not able to tell the inspector of their views therefore in this report comments from relatives and observations of care practice have been used to help to form a view whether peoples needs are met or not. The inspector looked around the home and looked at records. Information received by the CSCI since the previous inspection was also considered in forming a judgement. Prior to the visit the inspector referred to complaints received and 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. A random inspection was carried out at the home on 22nd May 2007 and findings from that visit are incorporated within this report. The CSCI have had serious concerns about the standard of care and management at the home however since the previous inspections both random and key, managers and staff have been working hard to improve the standards at the home and ensure the people that live there are always put first, at this visit significant improvements were noted. The site visit was led by Regulation Inspector Mrs C Bettison and the visit lasted seven hours. What the service does well: People that live in the home and their relatives are provided with information that is easy to read so that they know what to expect from the home. All of the people 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. Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 6 Relatives are very involved in the home and are made to feel welcome, making sure that family can keep in contact. A relative commented, “the staff at Bede’s View keep me informed of my brothers activities and well being and I was recently invited to a review” and “I believe the staff working at Bedes View are doing a good job” Another relative commented “they ask and listen to my suggestions and act on them where appropriate, as long as the present standard of care is maintained, we all will be happy” A good recruitment policy is in place so that service users are protected from harm. All of the people have an up to date assessment completed by the local authority. Each person has an individual care file that has a lot of information which helps to make sure that people get the care and support they need. Each person has a health action plan which helps to make sure that their health needs are met. Both bungalows were warm and welcoming on the day of the inspection and had a relaxed atmosphere and both had been decorated. The care staff were attentive and treated the people that live in the home with dignity and respect. What has improved since the last inspection? The home is being managed better so that all of the things that need to get better do. Staff commented, “I feel that as a team we work very hard. The service users always appear happy, there seems to be a happy and relaxed feeling at Bede’s View” and another stated, “the staff team work well together and service users are really well looked after”. Assessments now include all up to date information to give a clear picture of what peoples needs are so that appropriate care and support can be provided. Where people present behaviour that may be a risk to themselves or others, a plan is now in place and updated regularly so that risks can be reduced and people are protected from harm. For most of the people plans and risk assessments and behaviour management plans now state clearly the care that needs to be provided by staff and people Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 7 are getting consistent support, as a result of this peoples difficult behaviours have reduced. There has been improvement in the provision of activities, however this still needs to improve further. Most peoples health needs are now written in the plan and action taken to meet them, however this needs to be completed for all of the people that live in the home. People’s medicines are looked after well and staff are assisting service users to take their medicines safely. When people have medicines that are taken “when needed” the instructions for staff are now clear when and why they can help people to take it. Meals are now being provided that are nutritious, varied and well balanced and take into account people’s health needs and likes and dislikes. The houses are safe, homely and comfortable for the people to live in. What they could do better: For most of the people plans and risk assessments and behaviour management plans now state clearly the care that needs to be provided by staff and people are getting consistent support however the manager needs to ensure this is the case for all of the people that live in the home. People need to be helped to try out new activities and be supported to regularly attend activities that are planned both in house and in the community. There needs to be enough staff in the home so that the staff can meet the needs of the people that live there and carry out all of their duties safely. On relative commented to the question how do you think the care home could improve: “more permanent staff” and “better care taken with the washing”. Staff commented: “I do feel that at present we are using the agency care staff, I feel that we need to ensure we use regular and familiar staff at Bedes”. The senior care staff must be given enough time to carry out their duties properly so that peoples needs can be met. Staff must be provided with special training, e.g. how to deal with behaviour that may harm people that live in he home or staff and to help them to meet their special needs. Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 8 Staff need to be given time with their manager to discuss their practice, training and support. A system that helps to improve the standards in the home must be started to make sure that everyone is asked about the running of the home and improvements are made. 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. Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 9 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.V351554.R01.S.doc Version 5.2 Page 10 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): 2 People who use the service experience good outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People that live in the home have a range of assessments carried out by professional people this means that people’s individual needs are identified and are able to be met. EVIDENCE: There have been no new admissions to the home since the previous inspection. However the Local Authority have undertaken re assessments of all service users in order to clarify if the home is able to meet their complex needs and is adequately resourced. In addition to this assessing particular manage, eating and practical support to needs. a wide range of professionals have been involved in areas of need, i.e. behaviours that can be difficult to swallowing and mobility and have provided guidance and the staff team to help them to meet peoples complex Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 11 Each person has their own individual care file. All 11 service users are assessed as critical by the local authority and all have multiple disabilities, complex health needs, communication deficits, significant sensory impairment and some present behaviour that can be difficult to manage and pose a risk to themselves and others. Most of the people are identified as needing 2:1 support for all personal care tasks and assistance with moving around the home and out in the community. Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 12 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 and 9 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. There have been significant improvements in the quality of care plans, risk assessments and behaviour management guidelines meaning that on the whole peoples needs are now being met however the quality of the documentation is still inconsistent, meaning that some peoples needs may not be met. EVIDENCE: It was noted at the random inspection carried out on 22/5/07 “The inspector was informed that 2 x SCO from another service had been coming into the home to assist with updating and improving the service users care files, specifically to ensure that service users plans were detailed. Two files were supposed to be completely finished and two still half way through, one of each of these were examined as part of the visit and Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 13 unfortunately although care files had been tidied up and some old documentation removed, the quality of the service user plans was still poor. There had been very little detail added that would give staff clear direction in how to meet the complex needs of the service users. Progress in this area has been slow and does not meet the timescales for improvement set by the CSCI. Risk assessments did not appear to have had much attention, one moving and assisting assessment was dated 4/4/06 and has not been reviewed or updated since then. One of the service users had a risk assessment for the use of bed side rails, that stated they must be monitored throughout the night at half hour intervals, there were no records available to evidence that this was taking place. Service users are still not having their care needs reviewed at least 6 monthly.” The managers and staff in the home have worked very hard to improve the standards in this area. Three care files were examined as part of this site visit. It was noted that files had been tidied and duplicated documents had been removed leading to clearer direction for staff however there were still some inconsistencies in the quality of the information and recording depending on which staff had responsibility. All of the plans contained areas for people to improve their independence skills however small this might be. For example one person was being enabled and encouraged to communicate more effectively using objects as “terms of reference”, from the notes this appeared to be working well and reducing the times that the person became frustrated when staff couldn’t understand what they wanted. This person had detailed behaviour management plan and a risk and relapse plan prepared by the community nurse. For another person that lives in the home it was noted in the care file that the community care assessment had been adequately updated to include increases in behaviour that had been difficult for staff to manage and had in the past resulted in other people that live at the home being subjected to assault. The team from health and the psychologist had been involved and had helped to prepare detailed behaviour management guidelines for staff to follow and had been providing some advice and practical support to the staff team. This had resulted in the staff being better prepared and skilled to manage these behaviours better and read the signs and triggers and as such there had been a major reduction in these behaviours. There had only been one reported incident since the previous site visit in March 2007. Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 14 Whilst most of the plans had been clearly written, detailing directions for staff, some still haven’t, there were inconsistencies in the quality of the records. This needs to be addressed to ensure that all plans and records are prepared and maintained in a consistent manner. There were risk assessment tools for moving and assisting, activities; bowling, cinema, swimming, fire, visitors, burns and scalds, use of the mini bus, use of bed rails, some of which had been reviewed however the quality of these documents was inconsistent depending on which of the senior staff had responsibility. There was evidence that peoples needs had been reviewed regularly however in some cases people had been reviewed three times in the same month by the same group of people and the same issues discussed and actioned. From discussion with the senior manager for learning disability services it seems that the care management team undertake a “Fair access to care” review meeting, the health team undertake a “health review” meeting and then the home undertake their own “person centred” review. This is not best practice and does not ensure that people who use the service and their relatives are at the heart of the planning and means that they would have to attend three different meetings. This needs to be addressed to ensure that one meeting is held that is “person centred” and everyone inputs their own areas of interests and takes action to address items raised and one set of notes is produced. Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 15 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): 12,13,14,15,16 and 17 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. A range of activities provided within the home and community mean the people that live in the home have the opportunity to participate in stimulating and motivating activities that meet their needs, however this needs to be better planned and maintained to ensure that peoples diverse needs, wants and aspirations are identified, planned for and met. EVIDENCE: The managers and staff in the home have worked very hard to improve the standards in this area. There was evidence in care files that people’s needs/likes/dislikes in respect of activities and lifestyle had been identified and Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 16 recorded. Religion had been recorded and whether the person is practising or not. Risk assessments were in place for activities that posed a risk. Information received from staff and from the care records indicates that peoples opportunities to access leisure opportunities both in house and out in the community have improved significantly. The staff take service users out into the community by public transport or locally for walks. Some plans have now been developed for service users and although some of the activities appeared to be same i.e. swimming, bowling, movement to music at the local community centre and shopping there was evidence that activities were being individually provided and not in large groups and were taking into account service users needs. The manager stated that when they receive the increase in staffing (see staffing section of this report) and in particular two programme workers, this will enable them to identify needs, likes and wants and prepare individual plans. The manager confirmed that the staff are aiming to consider service users diverse needs and as such one service user is now being supported to attend Hull KR rugby games and is currently enjoying this. Staff were keen to talk about the recent holidays that they had supported people to go on. A group went to Butlins Skegness and another small group to Blackpool. Staff had helped the people to prepare photo albums as memories of their holidays and the staff team had clearly enjoyed taking the people and felt that the they had really enjoyed themselves by their reactions. Family links continue to be good in the home; relatives commented on their involvement and in their relative’s life and stated that staff keep them informed and that communication is good. The menus contained a variety of meals that included fresh fruit and vegetables and took into account peoples likes and dislikes that were highlighted in care files. The inspector was informed that the menus had been assessed by the Social Services catering officer and the dietician and were found to be satisfactory and that home are in the process of going for the “healthy heartbeat” award. Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples health needs are generally met by the provision of detailed health action plans, and support from health professionals however the incomplete plans, recording and monitoring systems means that for some people their health needs may not being fully met. EVIDENCE: Three care files were examined as part of the site visit. The managers and staff in the home have worked very hard to improve the standards in this area, they have worked in partnership with the community nurse in facilitating the development of health action plans. Most of the people that live in the home have now had a full health screening completed and the development of an action plan. Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 18 However there are inconsistencies in the quality of this work depending on which senior staff had responsibility and the time constraints of the community nurse, however significant improvements were noted both in the planning and action taken to meet peoples health needs. Staff must be supported to ensure that the quality of the documentation is consistent and that all of the people’s health needs are met. There was evidence in the files of regular appointments with the GP, consultants, specialist epilepsy nurse, dentist, chiropody, physiotherapist, psychologist and dietician. Best of interest meetings had been facilitated to ensure robust decision making regarding health interventions for service users, i.e. dental treatment and epilepsy treatment. Monitoring of care files and records was much improved there was evidence of health issues noted in diary sheets now being addressed more quickly and treatment provided where necessary. Medication systems were examined; departmental policies and procedures were in place and the home have their own addendums to the procedures to ensure that staff had the necessary guidance. One of the senior care officers now takes responsibility for the medication and she appeared to be very competent, she has worked very hard to overhaul the systems and ensure they are robust. Storage of all medications was found to be satisfactory; medications were stored appropriately and stock control was effective. The home did not have any controlled medication however some medication was being stored and recorded as CD as best practice and a cabinet and register was in place. Transcribing records were checked and found to be satisfactory, medication administration records were satisfactory. Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system. People that live in the home and their representatives are now listened to and protected from abuse whilst in the care home. EVIDENCE: The home has a detailed formal complaints procedure provided by Hull City Council. Complaints are now being logged and records kept of all action taken to resolve issues. There had been no complaints either to the home or the Commission for Social Care Inspection since the previous inspection. From the care files examined it was evident that people who display behaviours that are difficult to manage now have behaviour management guidelines. Any restrictions or limitations to service users are documented in the form of a service user plan or behaviour management plan. For one person that lives in the home it was noted in the care file that the community care assessment had been adequately updated to include increases in behaviour that had been difficult for staff to manage and had in the past resulted in other people that live at the home being subjected to assault. The continuum team from health and the psychologist had been involved and had helped to prepare detailed behaviour management guidelines for staff to Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 20 follow and had been providing some advice and practical support to the staff team. This had resulted in the staff being better prepared and skilled to manage these behaviours better and read the signs and triggers and as such there had been a major reduction in these behaviours. There had only been one reported incident since the previous site visit in March 2007 and this was not directed at other people that live in the home. 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. From discussion with staff and staff training records it was evident that most of the staff including the manager and senor staff have received training or briefing on the Protection Of Vulnerable Adults Policies and Procedures and their responsibilities within this. Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment provides people with comfortable and safe surroundings in which to live and meets their individually assessed needs however consideration is not been give as to maintaining confidentiality by the provision of adequate office space and a meeting room. EVIDENCE: Bede’s View is a purpose built unit providing accommodation in two bungalows. All of the people that live there 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. Since previous inspections all of the bedrooms have been decorated and some personal items purchased to make them more individualised and homely. Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 22 People have access to a secured garden area. To the front of the premises the grounds are fenced and the main gate to the grounds is kept locked to ensure the safety of the people that live there and an intercom system is fitted. The lounges and communal areas are functional, and since previous inspections some pictures and decorative items have been purchased to make it more homely. 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 manager stated that the resources section of Hull City Council have visited to consider alterations to the building to provide an adequate office space and meeting room, they are going to obtain an architect and when drawings are prepared they will put in a bid for capital expenditure to enable this to happen. A plan of maintenance and renewal still needs to be developed. These were requirements of previous inspection and action must be taken to ensure this requirement is met. The home has only had 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, the manager stated that she has met with the building cleaning unit to review the hours to ensure that they are sufficient. She stated that she expects the hours to be increased. This was a requirement of the previous inspections and must be addressed. Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 23 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): 31,32,33,34,35 and 36 People who use the service experience adequate outcomes in this area Although some improvements to the numbers of staff were noted the current staffing arrangements are still not sufficient to meet the needs of the people that live in the home. Both mandatory and specialised training must be provided to all staff and although improved staff are still not adequately supervised and supported. EVIDENCE: The numbers, skills and deployment of staff has over a number of inspections continued to cause significant concerns about the services ability to meet the complex needs of the people living at Bede’s View. During the course of the previous site visit in May 2007 an inspector undertook an observation on the Willow bungalow using a tool developed specifically for use during inspection activity. “An observation of five service users wellbeing and interaction with staff was conducted over a two-hour period in one of the lounges. It was noted that when staff approached service users or were approached by them the Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 24 interaction was warm, caring and friendly. However the interaction was noted to be fleeting as the staff members were very busy and instead of three staff members permanently supporting six service users, one senior care staff member was absent for a large portion of the time. When they were present they were completing management tasks and full attention to the service users was not possible. Overall the observation confirmed that although the staff team were generally caring and meant well, the current service users were very dependent and present behaviours that may pose a risk to themselves and others and the current staffing structure is inadequate to meet the complex needs of service users and does not allow for activities, meaningful interactions and the protection of people that live in the home”. Requirements were made to increase staffing levels in the home and ensure that senior staff were taken off the rota to enable to undertake all of the tasks they are responsible for. The management team have undertaken a staff review and agreed that they need a minimum of three care staff per shift per bungalow, in addition to this two programme workers are to be drafted in from elsewhere within the council to support the provision of daytime activities and stimulation for the people that live in the home. It was noted at this inspection that additional monies had been agreed by the council to enable the additional staff to be recruited and these posts are about to be advertised. In addition to this the senior staff have been taken away from their caring role and have been undertaking management and supervisory roles. This has made great impact on the quality of the paperwork, medication systems, provision of activities and food, and the instruction and deployment of care staff. Without exception all of the care staff said that this has helped hugely because they know there are areas of management tasks that didn’t get done and when visitors arrived this meant that the senior had to leave the care side and left the care staff short, this doesn’t happen anymore. This must now become a permanent arrangement and the new care staff posts filled as quickly as possible to enable the service to continue the progress already made and ensure positive outcomes for the people that live in the home. The support and supervision of staff has improved, senior care staff working off shift has enabled them to support staff in their day to day work and the provision of formal supervision has improved however some staff still have not received the quantity of supervision required, this seems to be particularly night staff. This still needs to improve to ensure that staff receive the support Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 25 and guidance they need to carry out their jobs to a high standard. It is vital given the complex needs and dependency of the people that live in the home. The majority of staff have had a personal performance plan interview in the last year. Although staff commented that they are receiving a lot of training some staff are still not up to date with their mandatory training. Some staff have received some service specific training particularly in intensive interaction which has been very beneficial to the staff given the complex needs of the people living at Bede’s View. Training needs to be given a high priority in the coming months and the development of a training plan and provision of training to all staff to ensure their competence. A training plan is in the process of being developed and the home does have 50 of staff qualified to NVQ level 2. Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 26 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 and 42 People who use the service experience adequate outcomes in this area This judgement has been made using available evidence including a visit to this service. People are now receiving a service that is safe and their overall needs are being met, the home is being well managed and showing significant signs of improvement, however these improvements must continue and new staff posts recruited to ensuring that all of the peoples needs can continue to be met. Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 27 EVIDENCE: The managers and staff have worked very hard to improve the standards in the home, there was an overall sense of positivity and cheeriness in the home both with staff and the people that live there. Managers and staff commented that they understood why the improvements were needed and that they feel they are now getting somewhere. The manager is registered with the Commission for Social Care Inspection. The manager has undertaken a wide range of training related to the post of manager and has completed NVQ 4 in Management and the Registered Manager’s Award covering the appropriate care components. She has over 20 years previous experience in a managerial and caring role. The manager is supported by four senior care officers who are now working off rota, this has benefited the home is ensuring that all management tasks can be undertaken. The management team and staff group have made very good progress towards raising the standards of care and there have been significant improvements made in the development of care plans and risk assessments, provision of food and activities and the identification of and meeting of health needs, this now needs to be sustained and further developed to ensure that peoples needs continue to be met. Staffing will be improved further with the appointment of new staff and attention to supervision and training being increased. As part of the inspection all of the maintenance certificates were seen and were up to date. Staff were not all up to date with their mandatory training. The Local Authority has a quality assurance system, however the QA system has not yet been fully implemented within the home and needs further development. Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 28 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 3 3 x 4 x 5 x 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 2 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 2 32 2 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 x 2 x 1 x x 3 x Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 29 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 YA6 Regulation 15 (1 and 2) 17 Requirement Timescale for action 31/03/08 2. YA9 13,17 3. YA12 16 (2 m and n) 4 YA13 16 (2 m and n) The registered person must continue the improvements being made in the development of service user plans for all of the people that live in the home so that are aware and able to meet peoples needs. The registered person must 31/03/08 continue the improvements in the individual and generic risk assessments and ensure that they are maintained and reviewed regularly so that people are protected from harm. The Registered person must 31/03/08 ensure that service users are able to take part in valued and fulfilling activities so that their individual needs are met. (Timescale of 1/6/05, 1/5/06, 31/08/06, 18/05/07 and 22/05/07 not met) The registered person must 31/03/08 ensure that service users are enabled to access a wide range of activities in the community and that there cultural and diverse needs are recognized and met. (Timescale of 31/08/06 and 30/6/07 not met) DS0000041450.V351554.R01.S.doc Version 5.2 Bede`s View Page 30 5 YA18 13 6. YA19 13 7 YA24 16,23 8. YA24 16,23 9. YA31 18 (1a) 10. YA32 18 (1a and c) 11. YA33 18 (1a) The registered person must ensure that staff are provided in sufficient numbers to enable people to receive personal support in the way in which they prefer and require. The registered person must continue the improvements in the development of health screening; health action plans and access to health professionals and records of outcomes are maintained so that peoples health needs are met. The registered person must ensure that there is a planned maintenance and renewal programme for the fabric and decoration of the building with records kept to ensure that the home is safe and comfortable for the people that live there. (Timescale of 1/6/06, 31/12/06 and 30/6/07 not met) The registered person must ensure that there is a meeting room/office fit for purpose that is private and separate to the communal space so that people’s privacy is maintained. (Timescale of 1/6/06, 31/12/06 and 30/6/07 not met) The registered person must ensure that enough staff are provided in the home to ensure that they are able to undertake all of the tasks associated with their role and within their job description. (Timescale of 30/06/07 not met) The registered person must ensure that staff have the skills and competencies to meet the needs of service users. (Timescale of 31/08/07 and 30/06/07 not met) The registered person must ensure that the new staffing DS0000041450.V351554.R01.S.doc 31/12/07 31/03/08 31/03/08 31/08/08 31/12/07 31/03/08 31/12/07 Bede`s View Version 5.2 Page 31 12. YA33 18 (1a) 13. YA35 18 (1c) 14 YA35 18 (1) 15 YA36 17 (6 f) 18 (2) 16. YA37 9 17. YA39 17,24,26 levels and structure are implemented following the review and are sufficient to meet the needs of the service users. The registered person must ensure that cleaning staff are employed in sufficient numbers to enable the home to be cleaned thoroughly. (Timescale of 31/3/06, 30/06/06, 31/08/06, 18/5/07 and 22/05/07 not met) The registered person must ensure that all staff are provided with service specific training so that peoples complex needs are met. (Timescale of 30/06/07 not met) The registered person must ensure that the home has a training plan and that staff are up to date with mandatory training so that staff are competent in their role. The registered person must ensure that staff receive the support and supervision required and must include all of the areas specified in 36.4 of this standard so that staff are competent in their role. (Timescale of 1/9/03, 31/08/06, 18/05/07 and 22/05/07 not met) The registered person must ensure that the home continues to be managed effectively. Policies and procedures are implemented and that compliance with the care standards act, regulations and other legal requirements are adhered to. The registered person must ensure that the home fully implements a quality assurance system that ensures that the views of everyone are taken into account and improvements in DS0000041450.V351554.R01.S.doc 31/12/07 31/03/08 31/12/07 31/12/07 31/03/08 31/08/08 Bede`s View Version 5.2 Page 32 the home are made. (Timescale of 1/7/05, 1/5/06, 31/12/06 and 30/06/07 not met) 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.V351554.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. Extracts may not be used or reproduced without the express permission of CSCI Bede`s View DS0000041450.V351554.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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