CARE HOME ADULTS 18-65
Beech Care Ltd 99 Dunes Road Greatstone New Romney Kent TN28 8SW Lead Inspector
Geoff Senior Unannounced Inspection 30th May 2006 10:30 Beech Care Ltd DS0000023334.V295373.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beech Care Ltd DS0000023334.V295373.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beech Care Ltd DS0000023334.V295373.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Beech Care Ltd Address 99 Dunes Road Greatstone New Romney Kent TN28 8SW 01797 362121 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) Beacon Care Holdings PLC Mr David Leslie Hussey Care Home 6 Category(ies) of Learning disability (5), Physical disability (1) registration, with number of places Beech Care Ltd DS0000023334.V295373.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The resident with a physical disability should also have a learning disability 4th October 2005 Date of last inspection Brief Description of the Service: Beech Care, 99 Dunes Rd, Greatstone is registered as a Care Home for up to six adults with a learning disability. Beech Care Ltd. is the registered Provider. The Registered Manager, Mr David Hussey is in day to day control of the functioning of the Home. The home is a detached property set in a residential area of the seaside village of Greatstone. The accommodation comprises six single bedrooms for the service users. There is a large lounge/dining room with access to the enclosed rear garden. Car parking is available to the front of the property. Local facilities (shop, pub, post office and GP) are all within walking distance. The fees range from £510.00 to £1102.29 per week. Beech Care Ltd DS0000023334.V295373.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and was undertaken on 30/05/06 and commenced at 10:30 am. In the course of the visit the inspector met and spent time with the manager, and spoke generally with all staff on duty. The level of functioning of the service users precluded the opportunity for any meaningful verbal interaction. However the inspector observed, throughout the visit, the staff’s attention to the service users’ immediately expressed needs, their patient, friendly and respectful manner and their treatment of each service user as an individual. The Inspector viewed the premises and inspected a range of records; care plans, daily records, staff files and training records. On the 31/05/06 and the 1/06/06 the inspector was able to speak with and note the comments and response to questions of family and friends of two service users. What the service does well: What has improved since the last inspection?
The home has addressed some of the requirements and recommendations of the last inspection report. They have been met or have actions planned. Staff training has progressed. A number are undertaking NVQ level2. Adult protection training has been attended. The Manager has completed NVQ level 4 care and management and attained the RMA. Beech Care Ltd DS0000023334.V295373.R01.S.doc Version 5.2 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. Beech Care Ltd DS0000023334.V295373.R01.S.doc Version 5.2 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 Beech Care Ltd DS0000023334.V295373.R01.S.doc Version 5.2 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): 2,5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Contracts need to be personalised. Staff indicated a good understanding of service user support needs. Positive relationships were observed between staff and service users EVIDENCE: Standard Beacon Care agreements were seen on file, they were not however not individualised, nor signed by all interested parties. Five of the six service users have lived at the home for a number of years. There was no record on file of an initial assessments being undertaken. A Pre place assessment had been undertaken by Head Office in respect of the most recent admission and a report sent to the Home. Discussion with staff and specific guidelines on file indicate that service user needs have been identified, generally recorded and are being addressed Beech Care Ltd DS0000023334.V295373.R01.S.doc Version 5.2 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): 6,7,9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Care plans are generally clear and accessible. Care in respect of a specific health need requires more attention. Staff have a good understanding of resident’s rights and endeavour to enable decision making and consultation. EVIDENCE: Care plans contain an improved level of information in a more accessible format. Staff need however, to ensure that daily records refer to and crossreference with, identified goals on care plans to evidence the service provided. Some omissions were identified at this visit. The manager reported at this visit that he has discussed the ‘how to’ detail with staff but has still to complete the written guidelines in the individual care plans to ensure consistency. Beacon Care is now in process of introducing PCP essential lifestyle plans. The first has yet to be completed.
Beech Care Ltd DS0000023334.V295373.R01.S.doc Version 5.2 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): 12,13,15,16,17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Staff have a good understanding of service users general support needs. Service users would benefit from involvement in a more varied activity programme. There is an open and relaxed feel to the home. Service users are offered choice and variety for all meals and special dietary needs are catered for. EVIDENCE: It was previously noted that, whilst the Inspector appreciated that the majority of the service user group are near or beyond retirement age and prefer a quieter environment there was little information available to evidence the appraisal or application of meaningful activity or pastimes. There has been some development in this area in that a written programme of individual
Beech Care Ltd DS0000023334.V295373.R01.S.doc Version 5.2 Page 11 activity is on file. There was however, little in the daily record to suggest the implementation of the programmes. The home hopes to take delivery of` a vehicle in the next two weeks and intends that it will be available for transporting service users to and from trips out and social venues. Beech Care Ltd DS0000023334.V295373.R01.S.doc Version 5.2 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): 18,19,20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Personal and healthcare needs are generally well supported. Service users would be better protected by staff training in medication. EVIDENCE: The manager agreed at the previous inspection to review the training and competency assessment of staff involved in medication administration, recording and storage. This has yet to be completed. Competency assessments have been undertaken but staff training needs have yet to be fully addressed. The manager was contacted by a training organisation during the inspection. A date and venue has yet to be identified. Current storage arrangements need to be reviewed. The home is not in possession of a dedicated cabinet, which may compromise security. This should be risk assessed. Beech Care Ltd DS0000023334.V295373.R01.S.doc Version 5.2 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a written complaints system. Staff have an awareness of Adult protection issues. EVIDENCE: All staff have now attended AP training (12/8/05) Manager is also ‘trained to train.’ Staff file indicates all relevant checks undertaken prior to appointment. Relatives spoken to confirmed awareness and willingness to use comp proc if they felt necessary Beech Care Ltd DS0000023334.V295373.R01.S.doc Version 5.2 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): 24,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There is a good standard of décor and cleanliness within the home. It provides a homely and welcoming environment in which to live and work EVIDENCE: At the time of inspection the premises appeared to be clean, tidy and free from undue odours. Laundry facilities though domestic in scale are reportedly adequate for the needs of the home. Specific equipment has been provided to assist staff and service users where the need has been identified Beech Care Ltd DS0000023334.V295373.R01.S.doc Version 5.2 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): 32,34,35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Recruitment practices provide for the protection of service users. Improvements to the induction programme are recommended. The staff team is well supported and supervised by the management and is clear about its roles and responsibilities. EVIDENCE: Staff files viewed showed appropriate checks had been undertaken prior to appointment or unsupervised access to service users. All staff have been offered NVQ level 2 training. The induction records for staff were checklist only and were not obviously linked to LDAF/Skills for care programmes. Beech Care Ltd DS0000023334.V295373.R01.S.doc Version 5.2 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): 37,39,42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home is being well managed, providing a caring and supportive service EVIDENCE: Monthly monitoring visits are carried out by company representatives to ensure that the standard of care and relevant documentation is maintained and the premises are in good order. Service user /family satisfaction questionnaires are now in circulation. Responses and results have yet to be collated. Beech Care Ltd DS0000023334.V295373.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 2 3 X 4 X 5 1 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 3 X X 3 x Beech Care Ltd DS0000023334.V295373.R01.S.doc Version 5.2 Page 18 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 YA20 Regulation 18 Requirement Staff should receive training appropriate to the requirements of the standard(this was a requirement at the last two inspections) Staff, in sufficient numbers, to complete the training requirements of the standard The registered manager develops and agrees with each prospective service user a written and costed contract/statement of terms and conditions between the home and the service user. Timescale for action 31/08/06 2 3 YA32 YA35 YA5 18 5 31/08/06 31/08/06 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. Refer to Standard YA14 YA12 Good Practice Recommendations Home to evidence appropriate assessment and implementation of leisure and developmental
DS0000023334.V295373.R01.S.doc Version 5.2 Page 19 Beech Care Ltd activities.(this was a recommendation at the last inspection) 2. YA6 Care plans to include necessary guidelines for staff and daily records to indicate the completion of the identified tasks.(this was a recommendation at the last inspection) Beech Care Ltd DS0000023334.V295373.R01.S.doc Version 5.2 Page 20 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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