CARE HOME ADULTS 18-65
Bedfordshire Cheshire Home Agate House Woburn Road Ampthill, Bedfordshire MK45 2HX Lead Inspector
Katrina Derbyshire Unannounced 26th June 2005 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. Bedfordshire Cheshire Home I51 S17666 Beds Cheshire V236548 260605 Stage 4.doc Version 1.40 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 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 (CRH) - Care Home 33 Category(ies) of PD registration, with number of places Bedfordshire Cheshire Home I51 S17666 Beds Cheshire V236548 260605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th March 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 I51 S17666 Beds Cheshire V236548 260605 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 26th June 2005. The manager Mrs. Ellis was present during most of 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 three 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’ was also made at the inspection. What the service does well: What has improved since the last inspection?
The home continues to ask the residents how they can improve the care at the home. One change that has taken place since the previous inspection is more trips out in the warmer weather.
Bedfordshire Cheshire Home I51 S17666 Beds Cheshire V236548 260605 Stage 4.doc Version 1.40 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 I51 S17666 Beds Cheshire V236548 260605 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Bedfordshire Cheshire Home I51 S17666 Beds Cheshire V236548 260605 Stage 4.doc Version 1.40 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 standard(s) 1, 2 & 4. The system in place for providing information to perspective residents is good and enables them to make an informed decision about moving into the home. EVIDENCE: The homes statement of purpose and service user guide is available and displayed in the front area of the home. These documents make very clear the services that the home can offer and the individual rights of the resident and the home. One resident who had recently moved into the home spoke about their experience on deciding to move in. They had received written information on the home and their family at their request had been fully involved in the decision making process. They had been given the opportunity to visit the home several times and partake in meals and have an overnight stay. It was noted that the policy of the home was very clear and gave guidance to staff on how they must support perspective residents, so that they could make an independent choice on moving into the home. Assessments of new residents were also in place. These documents were comprehensive and evidenced the participation of the resident in identifying their individual needs. Staff through discussion confirmed that it was these initial assessments that formed the basis for developing the care plans of the resident and directing the care that would be provided.
Bedfordshire Cheshire Home I51 S17666 Beds Cheshire V236548 260605 Stage 4.doc Version 1.40 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 standard(s) 6, 7, 8 & 9. The arrangements for resident consultation is very good with a variety of evidence that indicates that resident’s views are both sought and acted upon. EVIDENCE: Care plans were examined and all were directly linked to the assessments within the care records of each resident. Care plans gave guidance to staff on how they should support the resident; they contained sufficient information to ensure continuity of care was maintained. All residents spoken to described how they still felt in control of their own lives, they found that the homes staff empowered and supported them in living their lives. One resident whose partner lived in another home said, “ They help me with my letters and arrange for me to stay there so l can be with him”. Consultation of resident’s views was also in evidence. It was noted that the red feathers club a committee of residents were very active in the running of the home. Another resident ran the shop and residents also assisted with the bar. One resident said, “ The manager Sue and the staff they always ask us what we want, they always listen and if they can make sure it happens”.
Bedfordshire Cheshire Home I51 S17666 Beds Cheshire V236548 260605 Stage 4.doc Version 1.40 Page 10 Risk assessments were in place within the individual care files of residents. Risks that had been assessed included dietary needs, moving and handling and risk of developing pressure sores. However the frequency of review on some of these was unsatisfactory, as several had not been reassessed for over a year, this is unsafe for the residents and a requirement has been made. Bedfordshire Cheshire Home I51 S17666 Beds Cheshire V236548 260605 Stage 4.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 & 15. Links with the community are good and support and enrich residents’ social and educational opportunities. EVIDENCE: Activities available are displayed within the dining and front area of the home, film nights, holidays, local trips and quiz nights are some examples of what is available to the residents. All residents spoke of the wide range of opportunities available to them many of who also participate in daily educational programmes. Staff spoke of links with the local community and the home is well known in the Ampthill area and receives support with fundraising events. The home describes throughout its literature the importance of integration into community life; the residents who are able use local pubs, shops and parks on a regular basis and the home owns transport to assist in this. Within the care records of residents there was documentary evidence of important personal relationships to each resident. Information available enabled staff to support residents in maintaining these relationships and the
Bedfordshire Cheshire Home I51 S17666 Beds Cheshire V236548 260605 Stage 4.doc Version 1.40 Page 12 specific help that each resident needed. Parents, partners and children were fully involved in the life of the home and are welcomed by the home. One resident said, “ my mum always visits me, she thinks it is lovely here and says she is always made to feel comfortable”. Bedfordshire Cheshire Home I51 S17666 Beds Cheshire V236548 260605 Stage 4.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. The medication at this home is well managed promoting good health. EVIDENCE: Documentary evidence to show the additional healthcare support received by residents was seen in the care files of each resident. Language, occupational and physiotherapy are accessed by the home through referral and staff follow guidance from these healthcare professionals. Observations of care practice showed that alongside the meeting of physical needs the staffs approach also considered the emotional and spiritual needs of the resident. In addition documentary evidence was in place to show that the home identified and dealt with any complications in residents health, and a prompt referral would then be made to the necessary health service. Medication administration and storage was examined. The homes policy was very clear on how medication should be managed in the home and this was seen to be followed. A key member of staff has overall responsibility for ordering all required medication and provides a central point of contact for the staff team if there are any queries. The systems in place were noted to be safe and storage of medicines and record keeping were of a good standard. Qualified nurses administer medication. Bedfordshire Cheshire Home I51 S17666 Beds Cheshire V236548 260605 Stage 4.doc Version 1.40 Page 14 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) 22. The complaints procedure in the home is satisfactory and results in residents being listened to and their concerns acted upon. EVIDENCE: The complaints procedure available to all residents is simple and describes how a resident can complain, to whom and how long it will be until they can expect a response. All residents spoken with were aware of their right to complain and the different ways in which they could do this. One resident said “ some of the residents don’t like to say anything so we can raise any concerns they have through our committee”. Staff also were able to describe the home complaints procedure and their role in responding to concerns and complaints from residents. Bedfordshire Cheshire Home I51 S17666 Beds Cheshire V236548 260605 Stage 4.doc Version 1.40 Page 15 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) 28 & 30. The standard of hygiene in the home is good and creates a pleasant environment for the residents to live in. EVIDENCE: All accommodation is provided at ground floor level. There is a spacious reception area and large dining room. In addition there are smaller unit style living areas close to the individual rooms of the residents. Domestic style furnishings are in place within the units and facilities to watch television, listen to music and quiet areas are also available. The garden is also accessible from all the communal areas and resident’s bedrooms, the gardens were well kept with grass areas, flowerbeds and pathways. All areas visited were clean and free from odours. Staff when required were noted to wear protective clothing as part of the homes infection control policy and hand washing facilities were in place throughout the home. Clinical waste was seen to be disposed of in an appropriate way and a contract was in place for the safe removal of this waste. Bedfordshire Cheshire Home I51 S17666 Beds Cheshire V236548 260605 Stage 4.doc Version 1.40 Page 16 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) 33 & 35. The training and induction of staff is of a good standard so residents receive support from an efficient and effective staff group. EVIDENCE: Staff spoke of how they worked as a team for the benefit of the residents, staff meetings took place where standards of care were discussed and minutes of these were kept. Systems were in place for the appraisal of staff in which good practice was recognised and areas to further develop were identified and support systems put in place to assist the staff member in improving; copies of these documents are available for inspection. One resident said “ the staff are great, they are very kind to me, nothing is ever to much trouble”. Induction of new staff is structured and follows national guidance; staff have a named supervisor to whom they can receive additional help and support. Training records showed that all staff receive training in health and safety matters including moving and handling, fire and food hygiene. In addition staff attend training on more specialist areas that directly relate to the residents they help care for, one example of this is a workshop on multiple sclerosis. Staff were able to describe their individual learning and development and demonstrated a good level of knowledge relating to the home and the individual needs of the residents.
Bedfordshire Cheshire Home I51 S17666 Beds Cheshire V236548 260605 Stage 4.doc Version 1.40 Page 17 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) EVIDENCE: These standards were not inspected. Bedfordshire Cheshire Home I51 S17666 Beds Cheshire V236548 260605 Stage 4.doc Version 1.40 Page 18 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 3 x 4 x Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 4 4 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score x x x x 3 x 3 Standard No 11 12 13 14 15 16 17 x 4 4 x 4 x x Standard No 31 32 33 34 35 36 Score x x 4 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Bedfordshire Cheshire Home Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x I51 S17666 Beds Cheshire V236548 260605 Stage 4.doc Version 1.40 Page 19 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. 1. Standard OP9 Regulation 12, 13 & 17. Requirement All risk assessments must be up to date and reviewed in a timely manner. Timescale for action 15/11/05 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. Refer to Standard Good Practice Recommendations Bedfordshire Cheshire Home I51 S17666 Beds Cheshire V236548 260605 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection 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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