Inspection on 26/08/08 for Bede`s View

This inspection was carried out on 26th August 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bede`s View 20/09/07

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 18/06/2009.

Key inspection report 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 26th August 2008 09:24 Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Bede`s View DS0000041450.V369900.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 Manager post vacant Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Bede`s View DS0000041450.V369900.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 to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD, maximum number of places 11 The maximum number of service users who can be accommodated is: 11 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.V369900.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is a one star. This means that the people who use this service experience adequate quality outcomes. This service has improved significantly since the previous inspection, however there has been inadequate attention given to the refurbishment of the building and the provision of satisfactory moving and handling equipment. A number of requirements have been made in relation to the environment and a warning letter will be sent to the provider. Because of the lack of improvement in the environment the overall quality rating has remained as adequate however the quality ratings in most of the other outcome areas have improved to good. This visit was unannounced; Prue Blake (the manager) and the staff team assisted us throughout the visit. During the visits we observed people’s experiences of living at Bedes View so that we could understand what it was like for people to live at this service. Throughout the visit we looked at the environment, and made observations on the staffs’ approach to and their ability to support people. We also checked some samples of documents that related to people’s care and safety. These included needs assessments, daily records, care and health plans, risk assessments and staff training records. Before the visit the registered manager had completed an Annual Quality Assurance Assessment report (AQAA). This report provides information about how the service operates. We have used some of this information within the report. Before the site visit we also looked at a range of other information we had received about the service since the last inspection. This includes information provided by local authority agencies, the home’s monthly reports, adult protection referrals and complaints made about the service. Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 Page 6 • • • • People who use the service were given surveys (in picture formats) none of the people were able to complete these so none were returned. Staff that work at the service were given surveys and seven were returned. Relatives were given surveys and none were returned. Placing social workers were given surveys and none were returned. On the day of the visit staff, a visiting relative and a visiting community nurse were spoken to and their comments have been included in this report. This was a key inspection and we checked all the key standards. Feedback was given to Prue Blake (manager) and advice and guidance was also given throughout the visit. The inspector would like to thank the people who live at the service and the staff for their co-operation during our visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: This service provides a home for people with a learning disability and other complex needs in two bungalows in the community. Each person has an up to date assessment to give a clear picture of what peoples needs are so that appropriate care and support can be provided. 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. Where people present behaviour that may be a risk to themselves or others, plans are in place and updated regularly so that risks can be reduced and people are protected from harm. Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 Page 7 Each person has a health action plan which helps to make sure that their health needs are met and the medication is well managed. The people who live in this home participate in the community and are helped to lead a full and active lifestyle taking into account their age and individual needs. Both bungalows were warm and welcoming on the day of the visit and had a relaxed atmosphere. The staff team are trained and supervised and were observed to be attentive and treated the people that live in the home with dignity and respect. All of the people have a single room that is nicely personalised to their own taste. Relatives are very involved in the home and are made to feel welcome, making sure that family can keep in contact and people are supported to make choices about how they live their lives by family members and advocates where appropriate. What has improved since the last inspection? The home has a new manager who is very experienced and competent to manage this service effectively. Plans, risk assessments and behaviour management plans now state clearly the care that needs to be provided by staff and people are getting consistent support. People are being helped to try out new activities and are being supported to regularly attend activities that are planned both in house and in the community. The senior care staff now work off the care staff rota meaning that they have more time to carry out their duties properly and supervise the care staff so that people’s needs are met. Staff numbers have increased to 3 care staff on each bungalow on each shift and the addition of 2 programme workers who facilitate activities both in house and in the community, this means that the staff can meet all of the needs of the people that live there and carry out all of their duties safely. Some staff have been provided with special training, e.g. how to deal with behaviour that may harm people that live in the home or staff and to help them to meet their special needs, however this still needs to improve further. Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 Page 8 Staff are now given time with their manager to discuss their practice, training and support. A system that helps to improve the standards in the home has started to make sure that everyone is asked about the running of the home and improvements are made. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Bede`s View DS0000041450.V369900.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.V369900.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. This is what people staying in this care home experience: 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. EVIDENCE: 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. Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service. People’s needs are met by a stable, caring and competent staff team that know people well. Plans, risk assessments and guidelines are in place to guide any new staff in how to meet peoples complex needs and keep them safe, however some further development of these will enhance the service provided. EVIDENCE: Two care files were examined as part of this inspection. Both included a profile that gave an initial overview of the person, their history, needs, likes and dislikes. Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 Page 12 People’s individual plans were detailed to ensure that staff are aware of their needs and are able to provide appropriate and consistent care to meet their needs. However there were some gaps in the areas covered i.e. there were no care plans needs identified for finances, culture and faith needs and contact with families. Medication plans also needed further development. For one person it had been identified elsewhere in the file that they were trying to lose some weight and had actually been very successful with this but there was no mention of this in the care plan. Also the medication plan only listed the medication that the person was taking and not what it was for or the side effects for staff to be aware of. For the other person it stated that their parents brought in money for them when staff asked for it, there were a number of goods and services that staff felt this person could benefit from if more money was available to improve their quality of life. The manager was advised to request that the care management team review this practice and ensure that people’s rights are upheld. All care records were in lever arch files, however files would benefit from being tidied up and streamlined, as some information was duplicated and some hard to follow. It was clear that people’s needs were being met and there were good diary records to indicate what care had been delivered on a daily basis. Both care files examined included recent reviews attended by the LA and family or advocates as appropriate. Most of the people that live at Bedes View have specific needs re communication; both files examined contained a communication passport and these were seen in use on the bungalows. Where people display behaviours that can be difficult to manage and specific techniques or methods of communication are required in order to minimise the risks, behaviour management strategies are in place. However, for one person, the use of restrictive physical interventions are used on occasions to prevent self harm or the risk of harm to others. This was not detailed in the plan and must be addressed so that all staff are aware of the techniques to be used and when. Whilst plans had been clearly written, detailing directions for staff 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. Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 Page 13 There were risk assessment tools for moving and assisting, activities; bowling, cinema, swimming, fire, visitors, burns and scalds, use of the mini bus, however a risk assessment could not be located for the safe use of bed side rails and this must be addressed to ensure people are kept safe from the risk of harm. Relatives told us;“They take care of my son, he is happy there” “Good communication they keep me informed of what (persons name) is doing, weekly outings and generally what is going on his life” “At the present time (persons name) appears to be well cared for” Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12,13,15,16 and 17 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the 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. People are provided with a nutritious and well-balanced diet that meets their needs and takes into account their likes and dislikes. 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 Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 Page 15 needs/likes/dislikes in respect of activities and lifestyle choices had been identified and recorded. Religion had been recorded and whether the person is practising or not. Risk assessments were in place for activities that posed a risk. Two programme workers have been appointed to plan and implement more regular activities and events to improve people’s quality of life. Information received from staff and from the care records indicated that people’s opportunities to access leisure opportunities both in house and out in the community have improved significantly. The staff take people out into the community by public transport or locally for walks. People are going swimming, bowling and gardening. People regularly attend the local community centre and staff commented that the organisers at the community centre know the people by their first names. Al of the people went in small groups on holiday either to Southport or Blackpool and in December they all went on a trip to London by train. They stayed overnight and went to the theatre either to see “Mamma Mia” or “the Lion King”. Everyone went to the pantomime at Christmas and to see “Footloose” at the Hull New Theatre and they all enjoyed a Christmas party at a local club that their families also attended. One of the people is a Rugby League supporter and has a season pass and attends all home games and 3 people have a season pass for the football and go to all home games. Some people have been going to pottery class at a local garden centre. People are supported to receive visits from their parents/relatives and contact is welcomed. The manager and staff promote a healthy eating menu but try to balance this with people’s likes/dislikes and special treats on occasions. Any restrictions are clearly documented in the care file and agreed to. A relative spoken to on the day of the visit told us that the home is much better, her son is much more contented now that he has got a structured timetable. She said she visits him at the home and she regularly takes him back to her house, which he enjoys. She said he does gardening, goes swimming and bowling on alternate weeks and he has been to the theatre and went to London a trip. She said it was lovely that he went and kept saying “London” and she received a postcard. Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 Page 16 She told us that all of his health needs are met, the staff and managers are lovely and that she can’t speak highly enough of the place. Two staff spoken to told us that people seemed much happier now, more trusting of staff and very relaxed and settled and activities are happening a lot. The menus contained a variety of meals that included fresh fruit and vegetables and took into account people’s likes and dislikes that were highlighted in care files. We were informed that the menus had been assessed by the Social Services catering officer and the dietician and were found to be satisfactory. The kitchens and catering provision has been assessed by the environmental health department and awarded a rating of “B” which is good and the home have achieved the “Healthy Heartbeat” award. Relatives told us; “They take them out for walks, holidays and outings etc” Bede`s View DS0000041450.V369900.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service. People’s health needs are met by the provision of health screening, plans and good recording of outcomes and medication is well managed. EVIDENCE: Two service users’ care files were examined as part of the inspection process this evidenced that people’s healthcare needs are met. Health screening had been completed and health plans were in place. However of the two examined one was much more detailed and accurate than the other. In one file it detailed a person that some ongoing women’s issues, problems with cataracts and hard skin on their hands however none of this had been included in the health action plan. The health plans need to be further Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 Page 18 developed to ensure that all of people’s health needs are included and that the quality of the work is consistent regardless of which staff member completes it. However the record of outcomes was very good and records evidenced that people’s health needs were being met and access to GP, dentist, optician, chiropody, community nurses, consultants and therapists was being facilitated on a routine basis for all of the people. A community nurse at the home on the day of the visit told us that she has been facilitating nurse led clinics weekly at the home and these had been going on for about a year. She said that the staff work well with them and she has seen masses of improvement in the development of health plans, and maintaining records. She told us that the staff team are open and honest and when she gives advice staff always follow the advice, she said she has lovely relationship with them, they are always welcoming and will ask for support when its needed. She said the staff approach to the people who live in the home is lovely; always kind, warm and considerate and she has no concerns. There are currently no people self-medicating and there was no one prescribed controlled drugs at this time. There are written policies and procedures in place for staff to adhere to regarding administration of medication. PRN protocols were in place to give staff clear instructions of when and what dosage needs to be administered. On the day of the visit two staff from the pharmacy were undertaking an assessment of the medication systems, policies and procedures, storage and records. They commented that everything was in good order and all staff had been trained and deemed competent in the administration of medication. One person whose file was examined takes their medication covertly with food, a best of interest meeting had been held but there was no evidence that health professionals had been consulted, this must be addressed and health professionals’ advice and input into the decision making process included in the records. Bede`s View DS0000041450.V369900.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service. Complaints are handled appropriately meaning that people are confident that their concerns will be listened to, taken seriously or acted upon. The staff team are aware of the Protection of Vulnerable Adults policies and procedures and their responsibility within these and the detailed individual plans, behaviour management strategies and attention to health needs ensures that people are protected from abuse, neglect and harm. 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 one complaint to the home since the previous inspection from a relative, which had been resolved satisfactorily. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of money and financial affairs. Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 Page 20 Most staff have completed training in the Protection Of Vulnerable Adults Policies and Procedures and therefore understand their responsibilities within this and the detailed individual plans, behaviour management strategies and attention to health needs ensures that on the whole people are protected from abuse, neglect and harm. There have been 3 safeguarding adults referrals made to the Local Authority relating to one of the people that lives in the home using an inappropriate method of social interaction with another person that lives in the home. The manager told us that they had had very good support from the health professionals from the Community Team Learning Disability. There was evidence on file of meetings and plans developed for the ongoing management of this situation. One other referral related to a minor assault from one person to another again there was evidence that this was being managed pro actively. Staff spoken to in the bungalow told us that there is always one staff member on duty in the lounge to ensue everyone’s safety at all times. Bede`s View DS0000041450.V369900.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28, 29, 30 People who use the service experience poor quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service. The staff team have helped people to personalise their bedrooms and the home is warm and welcoming, however the inadequate provision of meeting rooms and an office, lack of appropriate moving and handling equipment and bathing facilities and the poor attention to maintenance and redecoration significantly affects the outcomes for the people that live in the home in that they live in a home that due to environmental issues does not meet their needs. EVIDENCE: Bede’s View was built quite some time ago as a purpose built unit providing accommodation in two bungalows. Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 Page 22 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. Since previous inspections all of the bedrooms have been decorated and some personal items purchased to make them more individualised and homely. 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. A number of previous inspections have highlighted significant concerns about the fabric of the building and the fact that it is not fit for purpose. The manager stated that an architect has visited and drawings prepared for refurbishment of the home, however the senior manager for the service told us that the decision is now with the PCT who hold the budget and that there have been significant delays. CSCI are seriously concerned about the delay and the poor environment is hindering the staffs ability to provide a high quality service to the people who live in the home and there are significant health and safety concerns. A moving and handling assessment was carried by Hull City Council Moving and handling advisor on 21/1/09 and his recommendations are detailed below:• Difficulties arising from the use of a mobile hoist and space restrictions in bedrooms, staff told us about this and it was detailed in the moving and handling assessment as follows; - “reversing out of a bedroom into a service corridor used by staff and other clients whilst supporting a client in a sling, could carry the risk of a foreseeable accident occurring. In addition by relying on opening a clients door to create more space, staff may inadvertently expose the client to passers by. Potentially this could be a breach of Article 3 of the Human Rights Act 1998; - no one shall be subject to inhuman or degrading treatment. Conclusion; - While use of a mobile hoist remains a practical option when considering how to met the transfer needs of the clients, strategically placed ceiling track could reduce the difficulty of the task; help protect the clients dignity and reduce the cumulative effect on staff of having to push/pull heavy loads” Other Issues identified throughout the visit from observations and discussion with managers and staff are as follows; - Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 Page 23 • 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. It is very cramped and there is only room for one person to use it safely. On the day of the visit a file was seen to fall off an overfilled shelf and nearly struck the manager on the head. 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. Staff currently use the conservatory or lounge, which is meant to be peoples communal space and affects their quality of life. As an interim measure the sensory environment/room has been turned into an office for the senior care officers to use and for meetings, this has taken a communal area away form the people who live there. • 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. Around both bungalows there is damaged plasterwork and chipped paint work. The bath in the Rowan bungalow is inadequate for the needs of the people who live there. It is a very old bath that lowers to the floor and staff told us for one person (a tall large man) that they hoist him up and lower the bath however there is still a significant gap and staff have to manually manoeuvre the person into the bath. In addition to this once this person is in the bath it is a very snug fit with no space for lying down and relaxing. This makes the experience a very uncomfortable one and not a relaxing enjoyable experience, as it should be. Wheelchairs and specialist chairs do not fit through the doorways very well, creating bumps and knocks to the person and damage to the walls and risk of injury to both staff and the people who live in the home form knocks and jolts. Staff told us and we observed that there is a very little storage space, meaning that cupboards that house boilers and tanks are used for storage and wet clothes are dried in the bathrooms. The windows are very old and instead of glass they are plastic, this has now past its best and cannot be seen through or cleaned. Staff report that the window frames are very drafty. • • • • • Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 Page 24 • • Staff report that flooring in the bathrooms is slippery when wet despite being slip proof. Staff report not enough ventilation in the kitchens, the doors have to be kept closed when cooking to ensure the safety of the people who live there and the windows are very small. All carpets are very stained and worn. The provision of cleaning hours has been increased and staff told us that this has helped to keep the home clean, however on the day of the visit two of the care staff were working a flexi shift to undertake a deep clean of the kitchens. This does not appear to be good use of care staff hours and this practice should be reviewed. • • Relatives told us; “As far I am concerned the home does everything well, it could be made look more presentable and new furniture.” Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service. People’s needs are met by a stable and competent staff team that are aware of peoples complex needs and are able to meet them, however the poor quality training records do not evidence that staff have received all of the training they need to do their jobs effectively. EVIDENCE: There has been significant improvement in the numbers and deployment of staff since the previous visit. We were told that Senior care Officers now work off rota and are better able to undertake their management tasks and duties and offer the care staff better supervision and support when needed. There are 3 care staff per bungalow per shift and in addition to this two programme workers have been appointed to plan and implement activities for Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 Page 26 people both in house and out in the community. Care staff have some flexi shifts occasionally enabling more people to get out on planned trips etc. The home currently has 2 x 32 hours and 1 x 16 hour vacancies which are covered by staff working additional shifts, casual and agency staff. The 2 x 32 hour vacancies have been filled by two existing council staff but they cannot yet be released from their posts and the 1 x 16 hour vacancy is a maternity leave which has been advertised. 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. We were told that the provision of training was severely affected by the floods in 2007 when the training section was flooded; once this was rectified there was huge backlog of training to catch up. The training plans and records did not evidence that all staff were up to date with their mandatory training and that service specific training was being provided. We were told that this was due to the records not being up to date rather than the staff not being up to date. The organisation must ensure that training records are maintained and kept up to date to evidence that staff are receiving the training they need to undertake their jobs properly and meet peoples needs. The home has over 50 of staff qualified to NVQ level 2. Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service. The home is well managed and people’s complicated needs are met by a stable, competent and caring staff team however the building and environment is not fit for purpose and this could seriously affect the quality of life for people if not addressed with some urgency. EVIDENCE: Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 Page 28 The previous manager has retired and a very experienced and competent manager has filled the post. 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. 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 home now benefits from a stable, consistent and competent staff team and the changes to the staff numbers and deployment of staff has significantly improved the quality of the service being provided. The manager has commenced a quality assurance programme and the people that live in the home, their families and advocates have been consulted about the service. As part of the inspection all of the maintenance records were examined and those seen were in order. The managers and staff have worked very hard to improve the service being provided at Bedes View. The development of care and health plans, provision of activities and holidays, improved staff numbers and deployment of staff and the positive attitudes and atmosphere in the home is meaning that people who live there have a much better quality of life. However CSCI have serious concerns about the building; health and safety concerns, poor fabric of the bulding and inadequate provision of suitable moving and handling equipment is hindering the development and quality of the service to the people who live there. Bede`s View DS0000041450.V369900.R01.S.doc Version 5.2 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 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 1 25 1 26 X 27 2 28 1 29 2 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 X x 3 X 2 X Version 5.2 Page 30 Bede`s View DS0000041450.V369900.R01.S.doc 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 YA6 Regulation 15 (1 and 2) 17 Requirement 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. Timescale for action 31/12/08 2. YA9 13,17 The registered person must 31/12/08 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 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 DS0000041450.V369900.R01.S.doc 3. YA19 13 31/12/08 4. YA24 16,23 31/12/08 Bede`s View Version 5.2 Page 31 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) 5. YA24 16,23 The registered person must 31/12/08 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 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 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) 31/12/08 6. YA32 18 (1a and c) 7. YA33 18 (1a) 31/12/08 8. YA33 18 (1a) 31/12/08 9. YA36 17 (6 f) 18 (2) The registered person must 31/12/08 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) DS0000041450.V369900.R01.S.doc Version 5.2 Page 32 Bede`s View 10. YA37 9 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. 31/12/08 11. YA39 17,24,26 The registered person must 31/12/08 ensure that the home fully implements a quality assurance system that ensures that the views of everyone are taken into account and improvements in the home are made. (Timescale of 1/7/05, 1/5/06, 31/12/06 and 30/06/07 not met) The registered person must 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) 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 all staff are provided with service specific training so that people’s complex needs are met. (Timescale of 30/06/07 not met) The registered person must ensure that staff are provided in DS0000041450.V369900.R01.S.doc 12. YA13 16 (2 m and n) 31/12/08 13. YA31 18 (1a) 31/12/08 14. YA35 18 (1c) 31/12/08 15. YA18 13 31/12/08 Page 33 Bede`s View Version 5.2 sufficient numbers to enable people to receive personal support in the way in which they prefer and require. 16. YA35 18 (1) 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. 31/12/08 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.V369900.R01.S.doc Version 5.2 Page 34 Care Quality Commission Yorkshire and Humberside St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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