CARE HOME ADULTS 18-65
Bedes View St Bedes Close Wasdale Avenue Kingston upon Hull HU9 4HZ Lead Inspector
Kishion Dee Unannounced 22 August 2005
nd 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 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 Stationary 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. Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Bedes View Address St Bedes Close Wasdale Avenue Wivern Road Kingston upon Hull HU9 4HZ 01482 788078 01482 788098 Kingston upon Hull City Council Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Position Vacant Care Home 11 Category(ies) of LD Learning Disability (11) registration, with number PD Physical Disability (11) of places Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 1st March 2005 Brief Description of the Service: Bede’s View is managed by Hull City Council Social Services Department and provides accommodation for eleven service users who present challenging behaviour as a result of their learning disability. The home is located to the east of Hull and is located within a residential area. Shops are close by and several buses travel to the city centre.Personal care is provided to all residents along with meals and laundry provision. Accommodation is in single rooms although none of these are en-suite. Although all on one site the home is split into two units (phases). Each phase has its own kitchen and dining room/lounge area. The home has a well-equipped sensory room. A secured 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 those residents with mobility problems. Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was carried out with the two acting managers, staff and residents of Bedes View. The inspection took 7 and a half hours and included a tour of the premises, examination of staff and resident files and records relating to the service. Five members of staff on duty were spoken to and their comments and viewpoints are included within this report. The current service users are unable to communicate verbally and therefore the inspector used direct and indirect observation. Several service users were seen during the course of the inspection. Service users were seen to be involved in individual activities. What the service does well: What has improved since the last inspection?
The homes policies, procedures and practices have improved since the last inspection and are more consistent with other council homes. This provides staff with guidance around practice resulting in a safer environment for residents. New specialist beds have been purchased and staff said that these have improved the comfort for the people who use them and makes the care tasks easier to complete.
Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 Page 6 Re-decoration, new curtains, and blinds and renewal of some furniture and carpets has improved the environment. The staff all said that the atmosphere at the home has improved and staff morale has improved. Staff said that they are now provided with clearer instructions about how the home is to be run, what they must do to improve things and what is expected of them. Documentation is much better organised and although there is still further work needed it has significantly improved since the last inspection. What they could do better:
The staffing levels and structure needs to be reviewed within a short period of time. The current staffing arrangements are not satisfactory and do not meet the needs of the home. This is a vital aspect of improving the service and ensuring that the home reaches the required standard. Medication records needs to be improved to ensure that all signatures are in place for medications received and administered by staff, so that there is no mishandling of medication and the residents health is looked after. Care plan records do not always accurately reflect the care being given on a daily basis and reviews of care plans and risk assessments must be reviewed on a regular basis. The menus need to be reviewed to make sure that the diet provided is nutritious, varied and well balanced. The environment needs further work to provide a homely and comfortable environment for the residents. The kitchens in both bungalows are showing signs of significant wear and are in need of replacing. This was a requirement of the previous inspections and the provider must carry out this work. The main gate to the grounds is locked and the inspector has concerns about this. It takes a long time to access the grounds and the registered person should consider other options. The current arrangement is not satisfactory. Regular recorded supervision of staff needs to be carried out at least six times a year to ensure that the staff receive the support and guidance they need to carry out their jobs to a high standard. Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 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 standard(s) 1 & 3 Residents are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met by the service. 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 resident has their own individual file and the three of those looked at had a full needs assessment completed by the funding authority and also one from the home. Staff members on duty were knowledgeable about the needs of each resident and had a good understanding of their specific problems/abilities and the care given on a daily basis. Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 Page 10 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 standard(s) 6 & 7 & 9 Limited progress has been made on improving arrangements to identify and meet the health, personal and social care needs of the residents. These shortfalls have a potential to place service users at risk. EVIDENCE: All residents have an individual plan of care and risk assessments on file. Improvements have been made to the way in which staff record, review and risk assess the care needs and expectations of the residents. This requires further work to ensure that all records are of the same standard. Some risk assessments are out of date and require review. None of the service users are able to sign to say they agree their plan of care. Relatives or representatives are asked to sign when involved and if there is no signature a reason is entered. The majority of the residents in Bede’s View are very dependant and would have limited capabilities of contributing to the development of the service and associated documentation. However, talking to four members of staff throughout the day indicated that residents are included wherever possible. Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 Page 11 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 standard(s) 12 & 13 & 17 The current staffing arrangements does reduce the number and range of activities being provided. EVIDENCE: Residents are able to take part in a limited range of activities, both in-house and within the community. The staff take residents out into the community on day trips with the home’s minibus. Of the files inspected an activities timetable is on file. 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. Discussion with three members of staff indicates that this is usually due to the number of agency staff on each shift. Agency staff have not received the relevant medication training to be left at the home if staff take residents out on their timetabled activity. Inspection of the menu’s and food stores indicate that some work is needed in this area. A number of the meals include convenience foods with limited nutritional content. In looking in the food stores a lot of the products were basic or value range. Discussion with two members of staff indicate that there is no choice at mealtimes although they have a good understanding of
Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 Page 12 individual residents likes and dislikes and provide an alternative if there is something on the menu they do not like. The menu’s need to be reviewed to ensure they provide a balanced, varied and nutritious diet. Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 Page 13 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 standard(s) 19 & 20 Not all service user’s health, personal and social care needs are being fully met. These shortfalls have the potential to place residents at risk. EVIDENCE: Of the three files looked at all the health, personal and social care needs of residents were documented within the plan of care. The staff have a good understanding of the residents support needs. This is evident from the positive relationships, which have been formed between the residents and staff. All the individual care plans seen during this visit clearly document the visits and input each resident has received from various outside professionals, including local GPs, diabetic nurses, epilepsy nurses, chiropody, dentist, optician and hospital outpatient clinics. Staff spoken to, said that they would accompany the resident’s to any appointment or support them to attend independently if wished. Information within the care plans indicates that the resident’s health is monitored on a regular basis and any concerns are promptly referred to the appropriate specialist. Medication records were checked against the records held for four people, none of these were accurate and some recording systems are not clear as to the number of tablets administered. This has been identified during previous inspection visits and a requirement was made requiring the systems to improve. This shortfall has the potential to place residents at risk. The home must take action to ensure that medication systems and recording is accurate.
Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 Page 14 Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 Page 15 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 standard(s) 23 Service users are now protected from abuse whilst in the care home. EVIDENCE: The home does have an Adult Protection Procedure and staff have undertaken protection of vulnerable adults training. There have been instances of issues arising during the last two years that have required referral to the police/social services for investigation. All the members of staff involved in this investigation are no longer working at the home and the investigation has concluded. 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. They are confident about reporting any concerns and certain that any allegations would be followed up promptly, and the correct action taken. Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 Page 16 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 standard(s) 24 & 28 & 30 The environment does not provide service users with safe and comfortable surroundings in which to live. EVIDENCE: Generally the home is presented in a pleasant manner. The decoration is varied and bright, offering stimulation to residents. Some of the furniture and carpeting is showing signs of wear. Discussion with the acting manager indicates that new furniture and carpets have been purchased in some areas and some re-decoration has taken place. There is further furniture and furnishings on order and it is felt that by the next inspection all of this will be in place. The blinds and furniture in the conservatories have been replaced and this improvement ensures the privacy of residents using them. The home was found to be free from offensive odours. The home only have 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 does not allow any time for areas to be deep cleaned and the provider should review the hours to ensure that they are sufficient.
Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 Page 17 The two kitchens are showing signs of deterioration, these have deteriorated further since the last inspection and the home should ensure that these meet the current standards of the environmental health department. The acting manager said that they are expecting the work to commence shortly but this was the same at the last inspection and the provider must take action to ensure the necessary work is carried out. One of the baths has been replaced since the last inspection. 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 locked and the inspector has concerns about this. It takes a long time to access the grounds and the registered person should consider other options. The current arrangement is not satisfactory and this was a requirement of the last inspection. Action must be taken to resolve this. Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 &33 & 35 & 36 The number and deployment of staff and the current staffing structure is not sufficient to meet the needs of the residents. EVIDENCE: The current service users have a high level of care needs and that staff spend the majority of time carrying out these tasks, this impacts on other activities and limits the amount of time staff can spend doing other tasks. The home regularly use agency staff to cover for vacancies and sickness, the agency does try to provide the same staff where possible. The staff on duty were knowledgeable about the needs of the residents. Staff spoken to said that morale has improved since the acting manager has been in post. Senior care staff who along with the manager take responsibility for all of the paperwork, reviews etc also spend the all of their time on shift working on the floor and are part of the care staffing calculation. There is no time allocated to senior staff to undertake activities or to complete the necessary paperwork associated with the senior care role. This does have an impact on a lot of areas in the home. Supervision is not carried out as often as it should be and in speaking to a senior member of staff supervision sessions have to be ‘fitted in as and when the shift allows. This reduces the number of staff working on the floor. There is also only one senior on duty after the manager goes off shift
Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 Page 19 and on weekends. The senior covers the management of the two bungalows but are part of the staffing calculation of one bungalow. This means that if there is a problem on the bungalow they are not rota d to work on then they have to go to that bungalow. It is also the same if a member of staff rings in sick they then have to spend the time trying to find cover reducing the number of staff on the floor. The current staffing structure must be reviewed swiftly to ensure the staffing levels and structure meets the needs of the residents and the home. The council has a detailed training programme which staff can access. This provides staff with mandatory training and specialist subjects linked to the needs of the service users. Staff supervision files show that individuals are not receiving formal supervision six times a year. This practice must be improved on to ensure that staff receive the support and guidance they need to carry out their jobs to a high standard. Discussion with the staff indicated that the manager or senior care are around on a daily basis to offer informal advice and help where needed. Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 & 39 & 43 The acting manager has a good understanding of the areas which the home needs to improve. Progress forward has been limited by the current staffing arrangements. EVIDENCE: The acting managers has a good understanding of the areas in which the home needs to improve. There has been positive developments within the home particularly in terms of bringing the policies and practices in line with other council homes. All staff spoken to said they felt staff morale was improved that their views were listened to and valued and that changes were happening for the better. Progress in some areas has been limited due to the restrictions the current staffing structure and levels and this must be addressed urgently. Staff have meetings with the managers on a regular basis and everyone is encouraged to join in with discussions and voice their opinions. The home does not regularly review sufficient aspects of their performance through a good programme of self-review via a quality assurance system and
Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 Page 21 this needs to be done. This was a requirement of the last inspection and action must be taken to ensure this is completed. Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x 3 x x Standard No 22 23
ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x x 2 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x x x 2 Standard No 31 32 33 34 35 36 Score 2 x 1 x x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Bedes View Score x 3 1 x Standard No 37 38 39 40 41 42 43 Score 2 x 2 x x x 3 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA 6 & 9 Regulation 14, 17 Requirement The registered person must ensure that care plans are developed and agreed with service users and these must describe the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations, and achieve goals. Where appropriate. Risk assessments must be updated and evaluated regularly. The registered person must ensure that residents receive a nutritous, varied and balanced diet which is attractively presented. The registered person must ensure that the medication records are completed accurately and that medication held matches the documentation. The registered person must ensure that the kitchens meet the requirements of the environmental health department. The registered person must find an alternative system for main access gate to the home. Timescale for action November 1st 2005 2. YA 17 16 October 1st 2005 3. YA 20 13, 15 10/05/05 NOT MET 14/10/05 30/06/05 NOT MET 01/11/05 01/06/05 NOT MET 01/11/05
Page 24 4. YA 24 16, 23 5. YA 24 16, 23 Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 6. YA 24 16, 23 7. YA 36 8. 3 9. YA 39 The registered person must ensure that the maintenance and renewal of the furniture and furnishings is completed. 17, 18 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. 18 The registered person must ensure that the current staffing levels and structure and reviewed and are sufficient to meet the needs of the residents. 17, 24, 26 The registered person must ensure that the home implements a quality assurance system. December 1st 2005 01/09/03 NOT MET 30/11/05 October 31st 2005 01/07/05 NOT MET 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard Good Practice Recommendations Bedes View 20050822 Bedes View IR J54 v228381 s41450.doc Version 1.40 Page 25 Commission for Social Care Inspection 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
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