CARE HOME ADULTS 18-65
Bedfordshire Cheshire Home Agate House Woburn Road Ampthill Bedfordshire MK45 2HX Lead Inspector
Katrina Derbyshire Unannounced Inspection 15th November 2005 15:40 Bedfordshire Cheshire Home DS0000017666.V266406.R01.S.doc Version 5.0 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 Bedfordshire Cheshire Home DS0000017666.V266406.R01.S.doc Version 5.0 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. Bedfordshire Cheshire Home DS0000017666.V266406.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Bedfordshire Cheshire Home Address Agate House Woburn Road Ampthill Bedfordshire MK45 2HX 01525 403247 01525 840244 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) Leonard Cheshire Mrs Sue Ellis Care Home 33 Category(ies) of Physical disability (33) registration, with number of places Bedfordshire Cheshire Home DS0000017666.V266406.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Adults and elderly Specialist Care for Severe Physical disabilities, for 12 persons Date of last inspection 26th June 2005 Brief Description of the Service: Bedfordshire Cheshire Home is a purpose built single storey home for service users with a physical disability. All the rooms are for single occupancy and five rooms have en-suite facilities. All the rooms have a small-designated garden/patio area. The home is split into four areas that all have their own communal lounge/dining, kitchen, bathroom and toilet facilities. In addition, the home has various other rooms for recreation, activities and therapeutic interventions. The home is situated on the outskirts of Ampthill with good road links to local towns and the motorway. The home has attractive grounds and ample parking. The home has a designated respite/short stay placement and also offers day care for up to three service users. The home also has transport available for accessing community services and leisure facilities. The home is part of the Leonard Cheshire Foundation. Bedfordshire Cheshire Home DS0000017666.V266406.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 15th November 2005. The manager Mrs. Ellis was present throughout the inspection. During the inspection many of the areas within the home were visited and the inspector spent time with many of the residents’ in the unit areas of the home and dining room. The care of two residents’ was examined in depth by looking at their records and interviewing the residents’ and staff who look after them. Observations of care practice and communication between the residents’ and staff was also made at the inspection. What the service does well: What has improved since the last inspection?
The way the home looks at possible risks to the residents has improved. The home had always made sure that risks residents may face had been assessed in many areas, these included how residents moved around, their diet and if they were at risk of falling for example. However the home had not been very good at reviewing these risks on a regular basis, this meant that although the residents needs may have changed the home had not updated their assessment and some were out of date. The homes staff now have made sure that this had been updated so residents assessed needs were up to date. Bedfordshire Cheshire Home DS0000017666.V266406.R01.S.doc Version 5.0 Page 6 What they could do better: 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. Bedfordshire Cheshire Home DS0000017666.V266406.R01.S.doc Version 5.0 Page 7 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 Bedfordshire Cheshire Home DS0000017666.V266406.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed at this inspection. Bedfordshire Cheshire Home DS0000017666.V266406.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 The risk assessment systems in the home are sufficient to provide guidance to staff on the action they should take to protect the residents. EVIDENCE: Risk assessments were seen within the care records of the residents. Risk assessments had been carried out in the following areas, nutrition, falls, moving and handling in addition personal safety had also been covered. Risk assessments were noted to identify individual risks to residents and then guidance was given to staff on the support that they should provide to reduce that identified risk to the resident. Risk assessments had now been reviewed in a timely manner so changes in personal circumstances of the residents had now been taken into account and the risk assessments adjusted accordingly. Staff confirmed that they had responsibility for ensuring that all these records were kept up to date. Bedfordshire Cheshire Home DS0000017666.V266406.R01.S.doc Version 5.0 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 17 Dietary needs of resident’s are well catered for with a balanced and varied selection of food available that meets resident’s tastes and choices. EVIDENCE: Several residents commented on the standard of food provided at the home, all residents felt that it was of a good standard and they believed that they had a wide variety of options and choice available to them. Menus in the home showed that nutritionally balanced meals were provided that included fruit and vegetables. The majority of residents use the large dinning space within the home; this area provides sufficient furnishings and facilities for residents to enjoy their meals. Some residents required a prescribed nutritional supplement to meet their dietary needs, of those examined it was noted that the correct dosage and method of administration was in use, and clear guidance was in place to qualified nursing staff on the required regime. Residents spoken to were very clear on their own rights and responsibilities whilst living in the home. All commented on the “good amount” of information available to them when they moved into the home and this was supported by a
Bedfordshire Cheshire Home DS0000017666.V266406.R01.S.doc Version 5.0 Page 11 comprehensive document that was made available to all residents. Residents were aware of how they should be treated, that they still had the right to be treated as any citizen would and where they could go if they believed that their treatment was not acceptable. Bedfordshire Cheshire Home DS0000017666.V266406.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Personal support is offered in the home in such a way to protect and promote resident’s privacy and independence. EVIDENCE: Observations of care practice were made throughout the inspection in varying areas of the home. On all occasions staff were noted to approach residents in a respectful manner and address them in a way chosen by that resident. Protective clothing was used when necessary in the provision of personal care to maintain hygiene standards alongside necessary equipment for the safety and comfort of the resident. Residents spoke of choosing their own clothing, hairstyle and personal items and confirmed that staff assisted them in doing so. Bedfordshire Cheshire Home DS0000017666.V266406.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The staff’s level of knowledge and understanding of Adult Protection issues is good and this assists in protecting the resident’s from abuse. EVIDENCE: The home had a clear policy that provided guidance and instructions to staff in protecting vulnerable adults. The policy included types of abuse and these included physical, emotional and social examples. Staff and their training records confirmed that they had also received training in this area. On questioning staff they were able to accurately report to whom they would report any alleged abuse and how this reporting would be carried out, this matched the guidance contained within the local Protection of Vulnerable Adults policy. Bedfordshire Cheshire Home DS0000017666.V266406.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 The décor and furnishings in the home are clean and provide a basic pleasant environment for the residents to live in. EVIDENCE: The home provides single room occupancy to 33 residents. In addition a range of communal facilities are available these include, small sitting rooms, kitchenettes, activity room, therapy room and large dining space with a bar. A shop is also open to residents and this is run by one of the residents at the home. Areas were noted to be clean and tidy throughout although the décor was chipped and faded in some areas. The home is making plans to remedy this and the manager said that the home would soon undergo a planned refurbishment programme. Bedfordshire Cheshire Home DS0000017666.V266406.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed at this inspection. Bedfordshire Cheshire Home DS0000017666.V266406.R01.S.doc Version 5.0 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 & 42 The systems for the management of Health and Safety are good and protect the residents from harm. EVIDENCE: The home was noted to have a comprehensive policy for the management of Health and Safety in the home. Fire safety was maintained through regular alarm tests and the time these were carried out were all recorded alongside safety checks of fire equipment, by a specialist contractor. Staff had all received training in a variety of Health and Safety subjects and these included food hygiene, moving and handling and infection control. Certificates or copies of certificates of attendance are maintained within the training files at the home. Residents and their representatives had been asked their opinion on the services offered by the home as part of the quality assurance system. The results and how the home acted upon the views of the residents were available for inspection.
Bedfordshire Cheshire Home DS0000017666.V266406.R01.S.doc Version 5.0 Page 17 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 X X X X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 4 17 Standard No 31 32 33 34 35 36 Score X X X X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Bedfordshire Cheshire Home Score 3 X X X Standard No 37 38 39 40 41 42 43 Score X X 3 X X 3 X DS0000017666.V266406.R01.S.doc Version 5.0 Page 18 NO 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. Standard Regulation Requirement Timescale for action 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 Bedfordshire Cheshire Home DS0000017666.V266406.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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