CARE HOME ADULTS 18-65
Beech House 49 Crockhamwell Road Woodley Reading Berkshire RG5 3JY Lead Inspector
Stephen Webb Unannounced Inspection 28th February 2006 10:30 DS0000011350.V279787.R01.S.doc Version 5.1 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 DS0000011350.V279787.R01.S.doc Version 5.1 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. DS0000011350.V279787.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Beech House Address 49 Crockhamwell Road Woodley Reading Berkshire RG5 3JY 0118 969 8373 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) londonroad@tiscali.co.uk Milbury Care Services Limited Mrs Marina Diane May King Care Home 6 Category(ies) of Learning disability (6) registration, with number of places DS0000011350.V279787.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30th June 2005 Brief Description of the Service: The unit is home for up to six adults with a learning disability and some associated challenging behaviours, and is operated by Milbury. The home is within a converted and extended house with a large enclosed rear garden, and currently provides individual bedrooms for five residents. The unit is within walking distance of the facilities of Woodley High Street. DS0000011350.V279787.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out between 10.30am and 2.30pm on 28/2/06. The manager was off duty and the inspector spoke with two of the seniors in carrying out the inspection, which also included the examination of key records, a tour of the unit and some time spent with the service users, whose needs meant that little direct feedback was possible. The seniors managed the needs of service users effectively alongside the requirements of the inspection. They ensured that one service user, who tends to become distressed when new people visit, was well supported by staff throughout the visit to minimise his anxiety. There were four staff on duty during the inspection, one of whom was an agency worker, and this appeared sufficient to meet the needs of the four service users who were in. One was out at day centre. What the service does well: What has improved since the last inspection?
Improvements have been made to the unit’s written statement of purpose, though it remains undated. As part of the unit’s refurbishment plan, the kitchen had been completely refurbished and was having all new appliances installed. A number of new permanent staff have been appointed to the unit team, which should help in improving and maintaining the care planning records. DS0000011350.V279787.R01.S.doc Version 5.1 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. DS0000011350.V279787.R01.S.doc Version 5.1 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 DS0000011350.V279787.R01.S.doc Version 5.1 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): 1 Prospective service users/their representatives, have the necessary information to make an informed choice about the unit. EVIDENCE: A previous requirement to improve the content of the Statement of Purpose had been addressed since the previous inspection. However, the document remains undated, which makes it hard to know when it is due for review. It is suggested that the date of review be added to the document to enable it to be reviewed annually as required. DS0000011350.V279787.R01.S.doc Version 5.1 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 The existing care plan records do not clearly express the current needs and goals of service users. EVIDENCE: Some of the service user plans contained detailed information about significant people, likes and dislikes and individual support requirements, but others remain partially complete and often undated. The Person Centred Planning (PCP) files would benefit from some category separation to enable efficient navigation to relevant documents. However, some of the identified goals were dated November 2004, and there was little record within the daily logs, of progress or work on the set goals in between reviews. Communication passports were on file but again were often undated and some did not have the service user’s name on. Some of the medical appointment records were also not up to date. DS0000011350.V279787.R01.S.doc Version 5.1 Page 10 Risk assessments were present but some dated from 2000 with no record of subsequent review. Statutory annual reviews and in-house interim reviews were reported to have taken place, but copies were not always on file. Undated in-house reviews were also present. The care planning and recording systems require a thorough review as a matter of priority. All documents should be dated and signed. Copies of all reviews should be retained on file. DS0000011350.V279787.R01.S.doc Version 5.1 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 the following standard(s): 14, 17 The service users are able to engage in a range of appropriate social activities. They are offered a suitable diet and are supported to make choices about the menus. EVIDENCE: All of the service users have regular day centre sessions on a planned rota, across three day-services providers, including sensory room sessions, music and art sessions and swimming. Two service users regularly go trampolining and one goes to computer sessions. Within the unit a music therapist visits fortnightly, and service users do puzzles, play games and have access to art materials. Some of the service users take part in household tasks including table laying and clearing, and meal preparation. Two of the group go out regularly with relatives.
DS0000011350.V279787.R01.S.doc Version 5.1 Page 12 There are plans in place for a range of day trips and outings during the current refurbishment of the unit to reduce the anxiety of service users. The service users are now more involved in choosing what they would like on the menus, during weekly meetings, though records of their choices are not maintained clearly at present. The unit has a range of photographs of meals to assist them in this. The refurbishment of the kitchen was almost completed and this will hopefully help to engage the service users to a greater degree in food preparation. DS0000011350.V279787.R01.S.doc Version 5.1 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 the following standard(s): 19, 20 The current health records do not clearly indicate the level to which service users’ health needs are met. Service users are protected by an effective medication management system. EVIDENCE: As noted earlier, whilst some of the healthcare records indicated up-to-date appointments, this was not the case for all of them, particularly chiropody and optician records. The healthcare recording system should be reviewed and records maintained up to date at all times. Examination of the medication management system indicated that medication management was effective, and appropriate records were in place. The unit is planning to change over to a monitored dosage system shortly. DS0000011350.V279787.R01.S.doc Version 5.1 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 the following standard(s): 22 The service users were unable to indicate whether they felt their views were listened to. The most recent complaints record was incomplete. EVIDENCE: The unit has an appropriate complaints procedure in place. The complaints log indicated that the most recent complaint had been from a neighbour in October 2005, regarding damage to their fence by a service user. The log record was incomplete, in that there was insufficient detail regarding the outcome of the complaints investigation. Full details of complaints should be logged in accordance with the standard. DS0000011350.V279787.R01.S.doc Version 5.1 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 the following standard(s): 24, 25, 27 The current environment is not particularly homely, but will be greatly improved on completion of the refurbishment works. The service users’ bedrooms are adapted to meet their needs. Toilets and bathrooms remain shabby but are to be completely refurbished as part of the current works. EVIDENCE: The unit was in the process of a full refurbishment, with work to the kitchen being almost complete and other work in progress. New dining furniture had been purchased for the conservatory/dining room. One of the service users is to get an en-suite shower, which will be a very positive development. The lounge is to be fully redecorated and the worn furniture is being replaced, the communal bathrooms are also scheduled for refurbishment. New flooring options are being explored in some areas.
DS0000011350.V279787.R01.S.doc Version 5.1 Page 16 The individual bedrooms reflect the needs of their occupant, with some being homely, while others are by necessity more minimalist. Work has been done to increase the tolerance of one service user to items of furniture in their bedroom. There are also plans for replacement of the garden fencing and the provision of additional planting in the enclosed rear garden, which is currently underdeveloped. DS0000011350.V279787.R01.S.doc Version 5.1 Page 17 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): 36 The service users are supported by a staff team, which has changed considerably since the previous inspection, and will need to be supported and developed to become fully conversant with their needs. EVIDENCE: Seniors meet informally, daily with the manager, and minuted meetings take place every two weeks. Monthly, minuted team meetings should also take place, though the minutes indicate that these had been less frequent than this. Now that eight new permanent staff have been appointed, the team meetings should be held more regularly as part of building the new staff team. New staff receive a two week unit induction, during which they read and countersign the policy/procedure documents. A detailed written record is completed and signed by supervisee and supervisor. They then attend a range of foundation training provided by Milbury. DS0000011350.V279787.R01.S.doc Version 5.1 Page 18 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 To date the views of service users and other interested parties have not been regularly sought as part of a cycle of quality assurance, review and development of the unit and this system will need to be established. EVIDENCE: To date regular quality assurance surveys have not been carried out in the unit, but there is a plan to undertake this shortly. The resulting report should be made available to service users and their representatives and copied to the CSCI. This should inform the annual development plan for the unit which should also be copied to the CSCI on completion. DS0000011350.V279787.R01.S.doc Version 5.1 Page 19 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 3 2 X 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 2 23 X ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 3 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 2 3 X X X 2 X X X X DS0000011350.V279787.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 Requirement The manager must ensure that care planning records are reviewed and updated in accordance with the standard. The manager must ensure that the health care system and its records are reviewed in order to meet the standard. The manager must ensure that complaints records are complete in accordance with the standard. The manager must forward the report arising from the quality assurance survey to the CSCI The manager must forward the annual development plan the CSCI on completion. Timescale for action 28/05/06 2 YA19 12(1) 12(2) 12(3) 22, 17(2) Sch 4(11) 24(1)(a) 24(2) 24(3) 24(1)(b) 24(2) 24(3) 28/05/06 3 4 5 YA22 YA39 YA39 28/03/06 28/05/06 28/05/06 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 YA1 Good Practice Recommendations Consider adding the date of review to the statement of purpose, to aid annual review of the document.
DS0000011350.V279787.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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