Inspection on 01/07/08 for Beech Spinney

This inspection was carried out on 1st July 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beech Spinney 05/03/09

Beech Spinney 23/01/08

Beech Spinney 26/09/06

Beech Spinney 27/02/06

Beech Spinney 05/07/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Beech Spinney Ironbridge Telford Shropshire TF8 7NE Lead Inspector Deborah Sharman Unannounced Inspection 01 July & 03 July 2008 09:15 Beech Spinney DS0000063123.V367420.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 Spinney DS0000063123.V367420.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 Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech Spinney Address Ironbridge Telford Shropshire TF8 7NE 01952 432065 01952 432209 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) www.care-ltd.co.uk CARE (Cottage and Rural Enterprises Ltd) Manager post vacant Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. Pre-admission assessments must be undertaken on all individuals admitted to the home. An Occupational Therapist report must be produced and forwarded to the Commission within six months from the date of registration. All service users must have a Person Centered Plan initiated within three months from the date of registration. There must be a minimum of three care staff on duty from 7 am - 10 pm in the five-bedded residential unit and two staff in the respite unit. There must be a minimum of two waking staff on duty throughout the night and formal on-call arrangements in case of emergency. All new staff must complete the LDAF induction. LDAF foundation training must commence/continue at the earliest opportunity. Service users on respite/emergency placements and those in long term placements must occupy separate premises including day space, facilities and equipment, unless benefits for both groups can be demonstrated. 23rd January 2008 Date of last inspection Brief Description of the Service: Beech Spinney is managed by Cottage and Rural Enterprises Ironbridge. The responsible individual is Mr Erik Whitehouse. The Registered Managers post is vacant and is being covered by an acting manager. Beech Spinney is registered with the Commission for Social Care Inspection as a residential Care Home for a maximum of seven adults with learning disabilities and additional complex needs. The registration consists of a five single bedroom permanent home known as Honeysuckle House and an adjoining two-bedroom respite facility. The respite home (Thistle Lodge) has a dedicated staff team and runs independently from Honeysuckle House. All bedrooms have spacious en suite bathrooms and have access (via a tracking hoist if required) to large assisted bathing and showering facilities. Communal space at Honeysuckle House comprises of a large kitchen, dining room and lounge. The gardens are landscaped and easily accessible. Beech Spinney also has use of a resource centre that boasts an indoor pool and a fully equipped sensory room. The Statement of Purpose says that fees average £2539.73 a week. Beech Spinney DS0000063123.V367420.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 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out over two days, the 3rd and 8th July 2008. On the first day two Inspectors carried out this unannounced key inspection, one between 9.15 and 7.00 with a pharmacy Inspector assessing medication for the greater part of this time. On the second day, we returned to clarify some outstanding matters and to talk to staff who had been out with residents on the first day. On this second day an expert by experience accompanied us. An ‘expert by experience’ is a person who, because of their shared experience of using services, and / or ways of communicating, visits a service with an Inspector to help them get a picture of what it is like to live in and use the service. The second day began at 4pm when residents were likely to be at home and finished at 8pm. As the inspection visit on the first day was unannounced this means that no one associated with the home received prior notification and were therefore unable to prepare. As it was a key inspection the plan was to assess all National Minimum Standards defined by the Commission for Social Care Inspection as ‘key’. These are the National Standards, which significantly affect the experiences of care for people living at the home. The service was aware of our intention to return on the second day. As this inspection was the second within 6 months, we did not ask the service to send us another self assessment or Annual Quality Assurance Assessment (AQAA). But we used an action plan submitted to us outlining how the service intended to improve, to provide a focus for the inspection and to measure progress made against the organisation’s stated intent. It is currently our policy not to send surveys to relatives and we were not able to speak to relatives on the day of inspection. We have however spoken to a relative who made contact with us after this inspection and prior to writing this report. During the course of the inspection we used a variety of methods to make a judgement about how service users are cared for. People living at Beech Spinney are unable to verbally tell us about their experiences living there. On the first day we assessed the care provided to two people in detail using care documentation and discussion with staff and managers. We sampled a variety of other documentation related to the management of the care home such as medication for a range of people, staff training, recruitment, staff supervision, accidents and complaints. Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 6 We toured the premises on the first day also looking at how the premises meets the assessed needs of those whose care we were examining in detail. We also spoke to staff in detail who were on duty in Thistle Lodge. On the second day the Inspector observed care in Honeysuckle House, spoke to two staff from Honeysuckle House and also spoke with the Acting Manager and Interim Service Manager. An expert by experience and his helper were present for part of the second day. They met everyone who lives there, toured the premises and talked to staff. The new acting manager was available throughout the two days to answer questions and assist with the inspection process. The Interim Service manager was available on the second day to receive feedback and to help to clarify matters arising from the first day. All this information helped to determine a judgement about the quality of care the home provides. What the service does well: What has improved since the last inspection? There have been a number of improvements since the last inspection. A new acting manager has been appointed and is intending to apply for registration with us. There is a new interim service manager and the permanent position is currently being advertised. The organisation, new interim service manager and acting manager are responding to the concerns about the service previously raised by the funding authorities and us, the Commission for Social Care Inspection. Consequently, since the last inspection, staffing levels have been reviewed and improved. Honeysuckle House now has at least 4 care staff on duty instead of 3. Care staff are no longer having to cook and clean in addition to their caring responsibilities, as an enthusiastic cook and cleaner have been appointed. In addition new senior posts have been created to ensure that there is always a Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 7 senior staff member available to advice and support staff in both Thistle Lodge and Honeysuckle House. As a result of these improvements, staff feel happier. They feel better-supported, more able to report concerns and less pressurised and anxious. Staff report service users to be calmer and happier as the atmosphere within the home is more positive, their care is less rushed, and they are going out more. Staff are more aware of how to meet the significant and specific health needs of people living there. They say that they are learning from the new manager, who has a background in health and who is role modelling good practice to them. For example, changes in bowel and skin conditions were reported promptly to District Nurses and three pressure mattresses were quickly obtained to reduce the risk of skin breakdown. There is also better evidence that one person’s fluid intake is being more accountably managed and that he is well hydrated. We now consider medication to be adequately managed. A review of one person’s medication has reduced the number of seizures s/he is experiencing. A new vehicle has been obtained since the last inspection enabling most residents to go out more often. Concerns raised about aspects of the environment have been addressed. There is less risk of food borne illness as hot food and cold food storage temperatures are being better monitored and evidenced and an unacceptably dirty oven has been replaced with a new and improved model. What they could do better: There have been a number of important improvements made since the last inspection. This has reduced the immediate risks to residents and is providing a basic foundation upon which to move forward. It is important now that essential routine health screening is provided regularly to all those people who live there to enable any changes in health to be detected early. It is important that the quality of peoples’ day-to-day lives continues to be developed and improved. This will start by ensuring that people have contracts informing them of their rights and responsibilities, that care and care guidance is person centred, that people have the tools they need with which to communicate, that information is available to people in accessible and usable formats, that people are helped to make choices in relation to all aspects of their lives and as a priority in respect of activities, holidays and meals. Guidance and knowledge about equality and diversity is very lacking. Peoples religious needs for example, are not identified or known and therefore cannot be met. Staff told us they don’t know the religions of any of the people living there and this information is not assessed at admission. Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 8 New staff must receive full moving and handling training at induction before working with service users. Existing staff must be provided with on going regular refresher moving and handling training. A policy is required to determine the required frequency that this training should be repeated to refresh staff’s knowledge. This will minimise the risk of moving and handling accidents to service users and staff. There is evidence of two recent injuries to staff whilst moving and handling a person living there. This also puts service users at risk. Mobility assessments for a person at risk of falls have been reviewed but this does not sufficiently address the risk of falls and the person has continued to fall. We have advised the manager to contact Telford and Wrekin’s Falls Coordinator and to specifically undertake falls assessments for those at risk. A policy is required about who funds meals eaten out in the community, when for example people have lunch out in a pub or restaurant. The service is funded to provide three meals per day and service users have been paying in full for their own meals out. They have not been told that this is expected and senior managers acknowledged that this should not have been happening. We have been assured that in consultation with peoples representatives that refunds will be agreed and paid. The recruitment of staff has improved on the whole but a more robust system is required to track pre employment checks received before allowing newly recruited staff into vulnerable peoples homes for initial induction training. The service is aware that whilst improvements have been made, there is still much to achieve before they can be considered to provide a good service. However, they are now demonstrating the potential to make the necessary changes. 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. The summary of this inspection report can be made available in other formats on request. Beech Spinney DS0000063123.V367420.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 Beech Spinney DS0000063123.V367420.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5. Quality in this outcome area is adequate. New service users experiences of respite care are good but steps are needed to ensure residents and staff are provided with a full range of information in appropriate formats. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are no vacancies in Honeysuckle House and no new admissions have been made. A new service user admitted for respite care to Thistle Lodge had experienced positive first visits. Staff described how people considering staying at Thistle Lodge have the opportunity to visit, how a manager assesses their needs before a place is offered and how they feel well briefed verbally and in writing about the needs of the person before they come to stay for the first time. We could see from documentation that Local Authority assessments of the person are available and that the service undertakes its own assessment visits. The assessor is obtaining some good information about the person at these pre admission visits that will help the person to have a comfortable and happy stay. Staff were clearly aware of specific important details such as preferred routine, how s/he likes toast and jam in morning including how it should be Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 11 cut, a ‘sparkly’ person who can make needs known and who likes meals with gravy and likes the lunchbox to be packed in a certain way. From talking to staff however it is clear that systems are in place to help them, with the exception of religious needs, understand how to meet people’s immediate needs upon admission. They are clear that written assessments and care plans are available prior to admission and that they read them. They explained how draft care plans are available upon admission, which are then tweaked upon discharge and dated. This explains why it appeared that care plans were not available until the day the person was discharged. Discussion about this has helped them to understand how this in the event of an incident would make them vulnerable to criticism and the importance of accurately dating and reviewing care documentation. It must be evident which plans of care were available on which dates and when they have been reviewed and amended. Some significant issues are however being overlooked at the assessment stage. These include equality and diversity such as religious beliefs, preferences and cultural norms, gender specific issues related to personal grooming for example, the needs of parents and carers and how the persons disability impacts on the care and support that will be needed. The person whose care was looked at in detail for example had profound physical needs, requiring support with all transfers but the ‘disability’ section of the assessment was left blank with no details provided. From a tour of the environment it appeared that there are no easy chairs in communal areas to meet her physical needs, but this had not been assessed and resolved and the person was having to sit in a wheelchair at all times with the only place to relax being away from social contact in the bedroom. There was nothing available to instruct staff not to transfer the person to communal seating and this could have put her at risk. Information available about the service should be improved. Guides, which have been recently reviewed, are not on display and are not currently geared to the capacities of people living there. The Service User Guide does not tell them what the weekly fee is although this information is in the Statement of Purpose. Furthermore we were told that people living and staying there have never been issued with contracts to inform them of all parties’ rights and responsibilities. The outcome being for example, that service users have been fully meeting the costs of eating out, when this was not the intention. Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is adequate. The service understands the right of individuals to take control of their lives and to make their own decisions and choices. However, this does not always happen in practice. Communication methods are basic and need further development. There is little recognition of how to support diversity. This limits individual’s independence, options and choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Perusal of care documentation and discussion with staff about a new service user admitted for respite care showed the service user to have had a happy and settled stay with her choices known and respected. Care plans are available to tell staff how to provide care in accordance with immediate needs and preferences. In Honeysuckle House bulky care plans which staff don’t have time to refer to on a day to day basis have been supplemented by briefer ‘grab sheets’ which in conjunction with more detailed Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 13 information, staff rated as 8/10 for usefulness. Care plans do not include any reference to equality and diversity issues such as religion, traditions, personal grooming reflective of gender issues such as make up preferences, body hair or menstruation where assessment showed it to have an impact on behaviour. One staff member was aware of the need to consider femininity in personal grooming but was concerned as she was unsure of steps she could take when this conflicted with the wishes of people’s parents. A range of useful and appropriate risk assessments reflecting the persons needs and abilities are completed prior to admission (but should be dated accurately to reflect this and should be signed by the assessor) and staff were aware of measures they should take to minimise risk. The only omission we identified for the new service user was that the appropriateness and risks posed by the communal lounge chairs had not been considered. A senior staff member explained that she would not transfer the person into these chairs as she considered the risks to be too high. There is no written guidance to assess this or to inform all staff and no alternative has been considered. Discussion with staff showed that they understand they are responsible for protecting people from risks. Staff need to be helped to also understand how supported and minimised risk taking adds value and meaning to peoples lives, enabling them to develop their potential. Omissions in care guidance for specific significant needs identified previously for a permanent resident have been addressed and from discussion with staff we could see that they are better aware of the persons needs and how they should meet them. Specialist advice and guidance in relation to falls management however remains required, as further falls have been incurred. For the people whose care we looked at in detail, care plans detail preferred communication styles and staff were aware of these. The Expert by Experience looked in more detail at how people are supported to communicate. He said: ‘A senior staff member showed us around the home and introduced me to everyone. I asked how people communicate, he said one lady uses objects of reference and others point at a booklet they have put together with photographs of different places. I asked another staff member … and she did not know about the objects of reference and did not mention the book of photographs. This particular staff member said people communicate with the sounds they make or their eye contact. It’s worrying the staff team are not all clear and communicate the way people need them to. If a person uses objects of reference they should be using them all the time and have them around the home.’ Managers accepted the need to improve this, which they say will start when they commission person centred care training which was being sourced at the time of the inspection. Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 14 Care records show that peoples’ immediate preferences are responded to. For example, one person went to a music night but wanted to return home after half an hour and this was respected. Where a resident is sleepy, routines are adapted around this. However service users currently are not involved in menu planning, grocery shopping, there is not a choice of meals provided routinely and the holiday this year has been chosen for them. They are going in one group, including those people who are known not to get on very well. The service agrees that this is an area for development. Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 15 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): 12, 13, 14, 15, 16, 17. Quality in this outcome area is adequate. People are supported to maintain contact with family. The frequency of activities is improving but activities are not yet sufficiently individualised. The quality of meals has improved. However people are not involved in choosing the meals they eat. Not all people are currently being supported to have their meals at a time and place to suit them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the first inspection day everyone except one person went out for the day in the newly acquired vehicle and enjoyed lunch out. People receiving respite care went to their usual day centre enabling them to maintain their contacts and established routines. Discussion with staff and assessment of records show the frequency and range of activities to have increased and this to have positively impacted on the Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 16 people. Records for one person for June 2008 showed visits to the Long Mynd, to a Chinese restaurant in Shrewsbury, to Ironbridge for lunch twice , to Norbury Junction, to Oswestry, to Bridgnorth twice and for a walk twice. In house activities for this time period included a foot massage, a foot spa, a music night, skittles, use of the hydro pool, regular contact with family as well as a hair, chiropody, dental and another medical appointment. At other times the person goes to ‘The Dingle’ opposite the accommodation for on site day activity. Community access has improved in part due to the provision of a new vehicle. Although staff commented that a second vehicle is needed to provide people with choices. The activity programme is group orientated rather than geared to the individual. Discussion with staff indicated that they want to break away from the group activity approach to cater for individuals known interests and hobbies and are slowly beginning to do this with one service user having visited the Molyneux football stadium and a visit to Manchester United’s Old Trafford planned for another. We assessed the need however to more fully promote peoples access to community facilities such as the theatre, cinemas, night clubs, leisure centres etc. This is what the expert by experience found: ‘One person and her staff said she likes to go ice-skating, this was good to hear. Also the home is encouraging people to access a night club that is organized by a local self-advocacy group. This is really good, especially as one person told me how much he likes music. The home has also started to support people to a music night on a Monday that is next door. I’m pleased to see staff recognizing how important music is to people, but it would be better for people to access music nights in the community. Lots of places have tribute nights, karaoke nights and people may even like to go and see live bands in big arenas. The home had recently had a minibus that the home uses regularly. Its great people are out most days but I felt they were always in a group going on day trips. I think it would be better for people to engage in more meaningful activities, rather than just going in the bus a lot. People should be encouraged to be part of their local communities as individuals. I was also disappointed to hear the people use a day centre that is next door to their home. This makes me feel uncomfortable, as people need to be out in the community, using community venues to access things. I was pleased to hear people access the local pub regularly and staff said the staff at the pub know people’s names and are very friendly. Staff said people really enjoy going. This is good and I’d like to see people accessing more places in their local community and getting to know local people . Looking at the timetable and around the home, I felt there a lack of activities to do within the home. People seemed to either watch the TV or have some Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 17 time out in their bedrooms. I felt the home should have more things available inside to encourage people to develop their skills and keep people more active’. ‘I also felt the activity sheet for the week should not only be for staff but in a fun picture format for the entire home to see what’s planned’. Given the short time that the new managers have been in post it is an achievement that they have booked a holiday for service users. It has been chosen because it can meet service users needs and is a reasonable distance to travel. Managers accept however that next year they must aim to involve service users more in choosing where and who they go on holiday with. The Expert by Experience also identified this and reported: ‘Holidays, last year people went separately but this year everyone is going together in September to Southport. It concerned me that everyone was going together and whether he or she had a choice and who and where he or she was going on his or her holiday. This alarmed me more when a staff member said 2 of the people that live in the home don’t get on very well and often use the separate communal areas to keep apart from each other. I feel people that don’t get on with each other shouldn’t be living together especially not going on holiday together.’ Staff are anxious about the two individuals who do not get on well at all. Managers explained that once on holiday people will be supported to undertake individual activities but accepted the feedback about developing options with improved consultation for next years holidays. It is positive that a cook is now employed so that staff do not have to undertake cooking duties at the expense of caring responsibilities. We talked to the new cook who said she loves her job, is very enthusiastic, understands peoples dietary needs and likes and dislikes. She is introducing people to a range of different tastes and foods she said. Staff said the quality of food has improved. We observed people eating their evening meal. They were all being supported to eat in an appropriate manner and pace on a one to one basis. Everybody was eating the same meal, it was late, it had been a long and busy day and some service users appeared distressed and were not enjoying their meal as much as they could have because staff said they were tired. The acting manager is aware of this and aims to ensure evening meals are eaten earlier to avoid this distress and to ensure a reasonable proportion of the evening remains for activities after having eaten. It is also important that meals times are regular to support medication, health regimes and general well being. Staff have received training to help them understand conditions where people have difficulty swallowing. Concerns that one persons swallowing was deteriorating have been followed up by referral to a specialist and a swallowing assessment has been carried out. Written guidance is in place which staff are aware of. In addition a new chair has been provided on trial to better support Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 18 the residents head whilst eating to reduce the risk of choking. Talks are underway about how to fund this chair should the trial show it to be suitable. Discussion with a number of people showed that at the moment there are no menus and other than by knowing what people like are not influenced by service users who are also not involved in grocery shopping. A choice of meal is not routinely available, although we are told that a different meal is provided if it is known that someone dislikes the meal on offer. The expert by experience also assessed this and says: ‘I was very shocked to hear that people do not have a choice at mealtimes. They have a cook who prepares breakfast, cooks a hot meal at lunchtime and at tea time, a light meal that staff prepare. I asked how the cook knows what to cook and they said they are aware of people’s dietary needs and meals are made accordingly. I feel really sad that people here do not have a fun picture menu that they can choose from. Its very worrying that people do not have choices around food, this should not be in question. People should be involved in writing the shopping list, going to the supermarket to buy the food and joining in to prepare the food. People should be encouraged to make choices and be as independent as possible.’ Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is adequate. Access to health care services is beginning to improve for people living at Beech Spinney and there is evidence of peoples immediate health needs being met. The provision however of ongoing and routine health screening is in its infancy to ensure that changes in health are identified at an early stage. The risk to service users and staff from moving and handling accidents is not sufficiently addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Upon admission to respite care a new service user had been assessed as having no health needs and was taking no medication. But records show that personal care was provided in accordance with her assessed needs and preferences, that she slept well and was checked regularly. Drinks offered to her and fluid intake was monitored as was food intake. Toileting records evidenced well-being and care provided. We met this person briefly on the morning of the first day and she appeared healthy, happy and well groomed. New documents have been introduced in Honeysuckle House to ensure that all care given can be better evidenced and to ensure greater accountability Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 20 amongst staff. From these new records we could see, that the person in Honeysuckle House whose care we looked at was also supported regularly with daily personal care and grooming. Staff told us that the provision of personal care is now less rushed and more pleasant for individuals as the staffing ratio is higher. The Expert by Experience asked about the management of peoples health needs: ‘I asked staff how they know if people are unwell, staff said they are aware of people’s different medical conditions and look out for signs that may be common to that condition. Staff also said they regularly fill in a body chart for any marks they may see, regardless if they know the cause of it. One person has a Doctors appointment coming up due to his finger being sore. I’m pleased the staff are clear in what to do and act on it.’ Senior and care staff told us that they are happier with how people’s health care needs are being met. One person said ‘everything is very positive and moving quickly’. We are ‘moving in the right direction’ and things are now ‘on an even keel’. This person said staff are being ‘a lot more responsive than in the past’. S/he said they are working well with community health professionals. S/he said staff are taking action when it is needed rather than waiting for key workers to come on duty. He described how the new manager ‘is teaching us a lot and raising our awareness’. For example a red skin area was identified for one client and another had had no bowel movement. The District Nurse came out and saw both people. S/he said the nurse was not overly concerned but dressed the pressure area. He also said that following a referral to them by the manager, the district nurse came out and as a result 3 pressure mattresses were delivered within 2 days for 3 people living in Honeysuckle House to reduce the risk of skin breakdown. Other staff told us that health needs are being met ‘a lot better’. A further staff member explained that this is because communication is better. They said appointments are not being missed now because staffing levels are better and communication is better and because the new paperwork helps. The Manager however is aware of the need to improve systems to ensure health appointments are not missed and intends to introduce an electronic reminder on the computer system for each person. For the second person whose care we assessed, we could see how a medication review with the Consultant the day before had resulted in a change to medication to try to reduce the number of seizures which were affecting the persons quality of life. We have since been told that this had had a positive impact. Seizure patterns are being monitored. The immediate risks to this persons health and safety are being better managed. Staff are aware of protocols put in place and their role in monitoring, reporting and safeguarding the persons well being. The manager notified us also of a service user who Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 21 was admitted to hospital when changes to her seizure pattern were recognised. An infection was diagnosed and she was discharged with appropriate treatment. Accident records show the person whose care we tracked to still have sustained 6 falls in the prior 3 month period with a further 3 incidents involving injuries to staff members supporting his moving and handling. Falls assessments have not been undertaken as distinct from moving and handling assessments and the staff involved in the accidents had not had sufficient training at the point of induction or timely update training. The manager had identified this as an omission and training related to the moving and handling needs of residents had been organised and took place in between day one and two of our inspection. We have advised the acting manager to seek specialist advice from Telford and Wrekin’s Falls Coordinator and to carry out specific falls assessments for those at risk. The pharmacist inspector also visited the home as part of the key inspection to establish what progress Beech Spinney had made in meeting the requirements made during a random inspection on the 28th February 2008. In summary we found that there had been improvements in the recording and handling of medicines. We found that the medication records had improved in some areas. We found no gaps in the signature record and abbreviations identifying why medication had not been given were being used appropriately. We found, where abbreviation had been used, that explanations to the circumstances for nonadministrations were recorded on the back of the Medicine Administration Record (MAR) charts. We found that discarded medication was being recorded appropriately in the disposal record book. We found that the receipt of medication was also being recorded but the practice of carrying forward medication from the previous month into the new month had not been fully implemented. This meant that a starting point for the audit trail of the receipt, administration and disposal of medicine within the home could not be established for some medication. The home was still using the very confusing and time-consuming twice-daily count back system to check that medication had been administered. Using this system and making assumptions it was possible to establish a starting point for the audit trail for some medication. The problem with this system was that not all of the medication found within the home was being recorded and scrutinised. The home was advised to ensure that at the start of each month the home had an accurate record of all the medication present within the home. The home was also advised to simplify the system for checking that medication had been administered. We found at the last inspection that the home had developed a number of protocols to provide further guidance to staff when administering when required or as directed medication. At the last inspection a number of issues with these protocols had been identified and guidance on how to address these Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 22 issues was given on the day. Unfortunately during this inspection it was found that none of the issues with these protocols had been addressed. The acting manager commented that previous managers had not made her aware of this issue and that was the reason why the issue had not been tackled. Minutes of a team meeting in early June 2008 show that staff raised the need for guidance regarding maximum doses of ‘as required’ medication for all service users.’ It was agreed that now the acting manager was aware of the issue she would address it as soon as possible with the help the specialist nurse and send copies of the new protocols to CSCI. We found that Beech Spinney had obtained and installed two Controlled Drug cabinets, one being located in Thistle and the other in Honeysuckle. Controlled Drug registers had also been obtained and one was in use on the respite unit. Advice was given on how to improve the recording in this Controlled Drugs register. We found that there were improvements in the storage of medicines. We found that the medication room had been tidied and the residents’ medication was much better organised. The fridge temperatures were being monitored on a daily basis and the fridge was being maintained at between 2 and 8°C. Medication that required cold storage conditions was being kept in the fridge. Concerns were again expressed about the home not keeping in stock some of the when required medication because it was rarely used. The home was reminded of its duty to ensure that all prescribed medication was available for use. There have been two medication errors since the last inspection. The acting manager has investigated both but records had not been completed due to a shortage of time the acting manager explained. Training records indicate that staff involved had not been fully trained in medication practice at the time of the errors although they had received detailed and documented induction instruction and assessment in medication practice. Training could not be evidenced for a further staff member involved in an error because the staff member has not provided a certificate to the home and we were told that staff will be receiving letters about this. Training records show there to be 3 medication-training courses. Twelve staff completed distance learning medication training in 2006 and 2007 and a further ten staff more recently in May and June 2008. Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is adequate. Complaints are being taken seriously and are investigated and responded to in detail. People can be assured therefore their concerns will be listened to. Systems to track, account for and learn from complaints must improve however. Steps have been taken to better protect people living at Beech Spinney but additional actions are required to further minimise risks to them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A number of staff said that they feel people are now safe living at Beech Spinney because staffing levels have improved and systems accounting for care along with communication have improved. Staff reported feeling ‘less frightened’ to raise concerns. Others said that they now feel their concerns about the service are listened to and acted upon. Most staff have received training about abuse and protection and could tell us about their responsibility to report poor practice, abuse or neglect. Most bank staff however have not received Abuse training. The issues should be reinforced regularly in team meetings. Information about how to complain and what to expect having complained is available for visitors in the entrance to the home. This is not in an accessible format to inform the people who live or stay there how to complain. The expert by experience said ‘the complaints procedure wasn’t clear enough for people to see and access.’ Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 24 Since the last inspection two people, a professional and a relative have made complaints. We could see that both had been meticulously investigated and responded to in writing. A trainer who was concerned by the immature behaviour of staff during training made a complaint. This was upheld. Numerous issues raised by a relative via a social worker about staffing, the appropriateness of their relatives clothing, a cancelled appointment etc were not upheld. Complaints are not held centrally in a book or register and as a result it was difficult for the manager to recall the details. It will also be difficult to identify trends in complaints, to report them to us openly and to learn from them as part of quality assurance systems without a central record. This is supported from the outcomes of regulation 26 visits which have also identified difficulties in locating complaints records. Concerns about the safety of one service user have been investigated through multi agency adult protection procedures. The service cooperated with the investigation. The concerns were not upheld but were attributed to poor communication. Action has been taken to improve systems and communication and practice in relation to the previous concerns is now more accountable. There have been no physical incidents between service users and no restraints. However the service of a behaviour therapist have been engaged to help reduce the conflict between two people living there who ‘wind each other up’ causing distress to themselves and others. We observed checks being carried out in respect of service users money. Systems seem to be robust and accounts are well maintained and expenditure is accounted for. Perusal of these records showed us that people are funding their own lunches out and are therefore in effect paying for this meal twice. A policy is not in place to guide staff about this, but this will be addressed and we have been assured that the service will agree compensation with service users and or their representatives. The previous manager remains the appointee for some service users. The issue of appointee ship is starting to be addressed by multi agency partners. Inventories of people’s possessions are not in place. The manager could show us that this process has begun but it has not been achieved by the date set within the action plan provided to us. This is important, as expensive equipment belonging to a service user cannot be accounted for. This was identified at the last inspection and since then steps have been taken to agree compensation in conjunction with Social Services and the person’s relative in their best interest. The manager has investigated concerns raised at the last inspection and she is satisfied that first aid training covers drowning accidents sufficiently and that Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 25 there is always a staff member qualified in first aid when people are being supported to use the hydro pool. We can see from training records that all staff have first aid qualifications, but attention must be paid to expiry dates. Where there have been concerns about practice these have been investigated. One staff member has been suspended under disciplinary procedures and although we were not notified of this, we have been assured that it was not for any matter affecting the health or welfare of service users. We should always be informed. The matter has now been investigated and resolved. Where matters are investigated, records must always be completed. Staff have at the time of inspection been provided with moving and handling training by an external trainer. We were told that this training was commissioned to address the specific moving and handling needs of people living at Beech Spinney. This will serve to better protect residents and staff as prior to this training, systems were not providing adequate protection and three staff sustained injuries. This had also put residents at increased risk. The service now needs to better develop its response to falls, seeking specialist advice to work towards reducing the number of service user falls. Systems to better track pre employment checks for applicants before they are allowed access to vulnerable people as part of their induction training are also required to reduce risks to people. This is discussed more fully under ‘Staffing’. Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is good. Equipment and facilities are generally very well provided but a more creative response is needed to help people with high support needs better enjoy and benefit from the premises provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff are happy that they are provided with sufficient facilities to do their jobs and to meet peoples needs. The building is purpose built, equipped with integral tracking hoists in people’s individual bedrooms and ensuites and fully accessible for people with disabilities. A number of improvements have been made since the last inspection to improve hygiene and reduce the risks of illness to service users. The cooker, which had been very dirty, has been replaced and hand-washing products have been provided in both laundries. Food storage and cooking temperatures are being monitored with records of this available. We pointed out that the temperature of one freezer had been consistently one degree above the Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 27 recommended safe range for many weeks. We were told the plan is to replace it. All hazardous chemicals were found to be locked away and did not pose a risk to any service users. We toured the environment and found it to be clean with no malodour with private rooms personalised. A carpet cleaner has been purchased to keep carpets clean in recognition that one person spends a lot of time on the floor. The garden is pleasant and accessible and there are plans to develop a sensory garden and raised vegetable beds to provide activity and stimulation for residents. Equipment such as overhead tracking hoists and high low baths and trolley showers meet the physical and privacy needs of the people whose care we looked at in detail. Equipment and products to meet the toileting needs of these residents were available in their private rooms promoting privacy, dignity and good infection control practice. We found however that there wasn’t an easy chair available in the lounge to meet the needs of the one resident staying for respite care. This had not been assessed. Staff felt the communal seating would be unsafe for her to use and described how she has to rest on her bed if she becomes uncomfortable in her wheelchair. This is an environmentally created barrier, which would adversely affect her inclusion in the life of the home during her stay. Team meeting minutes from February 2008 show that staff raised the issue of how existing communal chairs are not meeting the needs of some residents. During our tour, we found the kitchen door to be closed on the first occasion and open on the second. When it is open, it blocks almost the entirety of the corridor at the intersection with the kitchen, dining room and lounge. The action plan submitted to us says that this will be addressed. The acting manager was not aware of this. We reminded her to ensure that if any changes are made that they comply with building and fire regulations. It is important that care home premises meet people’s physical needs and on the whole, the service is well resourced in this respect. A home should be much more than this though. The expert by experience who described the building to the Inspector as ‘like a hospital’ made these observations: ‘The decoration of the home felt quite bland. The home didn’t feel very personal to the people that live here, they had some photographs in the porch area and that was all I could see. The people that live here are young adults with high support needs and the home, I feel, doesn’t reflect this. It would be good to have a lot more colour around the building, photographs of people, pictures that can stimulate people. For people with high support needs I was really disappointed to see the lack of accessible information, especially in picture format. For example the board with the staff team on, that said who were on shift that day was all in words. They should have photos of staff. Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is adequate. A developing staff and new senior team supports Service users. These new teams now need time to consolidate in order to bring about further improvements to the care and lifestyles of people living at Beech Spinney. An increase in staffing numbers per shift assures service users that they will be supervised and supported by sufficient numbers of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff are visibly happier, were cooperative throughout the inspection and are keen to support the service to improve for the people living there. The atmosphere was tangibly better that at the previous inspection in January, earlier this year. Discussion with five staff members confirmed this. Additional senior posts have been created and this in conjunction with the approach of the new acting manager led all staff to tell us that they now feel well supported on a day-to-day basis. Staff reported receiving formal supervision but it appears that for some this is more regularly provided than for others. Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 29 When we arrived for this unannounced inspection 5 staff including a senior were on duty in Honeysuckle House plus the cook and two further staff including a senior in Thistle Lodge. Another staff member arrived later to take part in a training course. All staff that we spoke to confirmed how staffing levels had increased from 3 to a minimum of 4 in Honeysuckle House during waking hours and sight of the rota confirmed this. Staff working in Thistle Lodge said that they are no longer ‘pulled across’ to support residents in Honeysuckle House and feel that they are consequently better able to meet the needs of respite guests. Although 75 care hours per week in Honeysuckle House have not been recruited to, staff confirmed that they are no longer working excessive hours and no longer feel obliged to do so. Vacant hours are being covered by agency staff who we noted on occasions were working long hours of for example 52 and 48 hours per week. Night staffing levels have not changed. There is a waking night carer in both units. The manager has assessed this as potentially unsafe as should someone with epilepsy require the support of two staff members during the night, this would, given the layout of the premises mean that staff working together to react to need in one unit would be unable to hear or monitor people in the other unit. There have not been any incidents but this is currently being discussed with the funding authority. Staff feel communication has improved. Communication books are being well used and an improved handover system has just been launched to ensure the accountability of handovers provided to staff coming on shift. Staff are aware of the new system and are committed to the benefits it will bring. There have been previous concerns about recruitment processes not fully protecting vulnerable people. Consequently, we assessed how 4 new staff had been recruited. We are satisfied that 3 had been recruited safely. Processes were far less satisfactory for the 4th person, a support worker. We found that all checks were obtained after the person’s employment start date; this included a Criminal Record Bureau check and 2 references. Additionally, there was no evidence that a POVA first check had been carried out, although we were told it had been requested. This is a check that tells the employer whether the applicant is included on a national central register as unsuitable to work with vulnerable people. We were initially told that this person had not started working with service users but had commenced induction training off site whilst awaiting checks. Further discussion showed us that this person would have been in vulnerable peoples homes reading care plans in the office at some point during the induction and would have progressed to shadowing carers during this initial training. They therefore had access to vulnerable people and information about vulnerable people. This person was not included on the rota for the times s/he had been in peoples homes and it was not possible therefore for the service to demonstrate that there was a robust and coordinated approach to ensuring only fully checked personnel have access to vulnerable people. It could not be evidenced that this person had been Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 30 allowed contact with vulnerable people during training only after checks had been received. In addition, a mentor documented as responsible for supervising a new staff member without full checks had not been nominated to protect residents and comply with the new regulations. There is a training coordinator and it is positive that trainers external to the service teach some of the training provided to staff. Staff spoke highly of the training opportunities provided. Induction for new staff including bank staff has been extended to a month and all staff have been provided with induction to national standards. Almost 50 of staff including bank staff have an appropriate National Vocational Qualification and this will be exceeded when the 5 people currently studying have completed successfully. Moving and handling training must improve at induction and on an ongoing basis for existing staff, some of which until the week of inspection had not received refresher training for two and three years. Also a new senior staff member had not received full moving and handling training to include practical training during induction. It was these staff who were involved in moving and handling accidents. This made service users, staff and the organisation vulnerable. We were told that there is not currently a policy about the required frequency for refreshing this training and that this will be addressed. Similarly other than induction training, full medication training to a recognised level had not been provided to staff involved in medication errors since the last inspection, putting service users at risk. Induction training was documented and detailed and assessed medication administration competence and knowledge. This has now however been addressed. Twenty-two staff have completed medication training between 2006 and 2008 with 10 having completed it this year. Out of 28 staff all but one, has first aid training. However expiry dates must be closely monitored. Most staff have completed health and safety training. Significantly less staff have completed training specific to service users needs and we were assured by a senior manager that the priority is to provide training in person centred care and planning and that training is currently being sourced. The expert by experience talked to a staff member about her training and reports that: ‘She did have lots of knowledge around the people that live here and lots of training around medical and practical needs. I would like to have heard the staff have some value base training, having a person centred approach and even knowledge on Valuing People. Overall I felt the staff to be very nice but felt they should be a lot more creative around people with high support needs. People need more visual and Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 31 pictorial things, be supported to be more independent, have choices around everything they do and be part of their local community.’ Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 32 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. Quality in this outcome area is adequate with the potential to be good. The new acting manager has with the support of the Organisation made some improvements to the service for the benefit of people living there within a short period of time. People living there are now safer. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Our last inspection was six months ago. A new acting manager started in post 3 months ago and she now intends to apply for registration with us. Everybody we spoke to, without exception spoke highly of her and the changes she has implemented. Three staff members said: I have the ‘greatest respect’ for the new manager. She described how she has improved communication and that morale is improving. The staff member Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 33 went on to say ‘she came here when things were critical. She has worked very hard and can see things are improving. Care support workers are less frightened to have their say. She’s rubbing off on people’. There is now a ‘better management team who are more supportive’. The ‘support is fantastic now’ – ‘concerns are listened to’. Of the new acting manager s/he said, she is ‘lovely, fantastic, firm but fair, brilliant because she’s very approachable but straight to the point, she doesn’t mince her words, she lets us know but she’s nice with it’ and ‘we want to keep her’. The acting manager described how she had felt well supported by the organisation and the staff team who ‘want to see us back on our feet’. Additional senior posts have been created to ensure there is always a senior present to advise staff in both units within the home. Staff are benefiting from this but the manager is mindful that the appointments are new and the seniors require support. An additional assistant manager post has been created temporarily, so an assistant manager each has designated responsible for one of the units. However, each assistant manager only has management time one day per week. The roles and responsibilities are under review. We could see from documentation that the manager had received one supervision in the three months she had been in post, and although another was due she described having daily support. Evidence of four regulation 26 visits between October 2007 and April 08 was shown to us. Regulation 26 visits should be carried out monthly to oversee service quality and records of such should be available. Those we saw are being carried out to a good standard and in some detail, taking into consideration the views of staff and observations of people living there. Information within them must now be used to influence the development and improvement of the service. There is no evidence of this currently and no evidence that quality assurance tools are in place to help the manager monitor and develop all aspects of the service’s performance. Service and maintenance documentation was not assessed in detail at this inspection, as this was generally satisfactory at the last inspection, six months ago. We queried progress on one or two matters arising from the last inspection however. We found that regular tests for legionella are being carried out, hot food temperatures are being taken prior to serving to prevent food borne illness to service users as are cold food storage temperatures. The chest freezer is consistently one degree too warm without corrective action having been taken. We were told that this freezer will be replaced. We were also assured that the premises are being safely managed from the results of an independent fire risk assessment carried out in May 2008, which Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 34 concluded that risks are low. Similarly in May 2008 an independent health and safety audit was carried out. The report was not available to us but we were told that although more issues had been identified corrective action had been and was being taken. Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 35 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 2 2 2 3 X 4 3 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 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 3 33 3 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 1 X X 2 X Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 36 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 13(2) Requirement Appropriate detailed information relating to medication must be kept, for example, in risk assessments, protocols and care plans to ensure that staff know how to use and monitor all medication including when required and as directed medicines so that all medication is administered safely, correctly and as intended by the prescriber, to meet individual health needs. Timescale for action 31/07/08 2 YA42 13(5) This requirement was not met at this inspection July 2008. Suitable arrangements to 31/07/08 provide a safe system for moving and handling service users must be made. This must include providing full moving and handling training to new staff prior to undertaking the moving and handling of service users and refresher training to staff at sufficient intervals. New requirement arising from this inspection July 2008. Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 37 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 YA5 Good Practice Recommendations Each service user living permanently and receiving a respite service should be issued with a contract that is regularly reviewed and updated outlining the rights and responsibilities of all parties in line with national minimum standard 5 and amended Care Homes Regulation 5a 2006. New recommendation July 2008. Care plans should be accurately dated from prior to admission to demonstrate that they are in place to guide staff prior to the first admission. Any changes made thereafter should be clear and dated to evidence the changes made and on what date. New recommendation arising from this inspection July 2008. Person centred care should be developed. Strategies should be developed to support service users to make choices and decisions about their lives on a day to day basis including in relation to activities, meals and holidays. To achieve this the service should actively develop appropriate communication systems and tools for people to use. 4 YA11 New recommendation from this inspection July 2008. Steps should be taken to ensure people have opportunities to fulfil their spiritual needs. This will involve assessing these needs for all existing service users and at the point of admission for new service users, including this information in plans of care and supporting staff to understand and meet any needs identified. New recommendation arising from this inspection July 2008. Service users should be supported to become part of and participate in, the local community in accordance with their assessed needs and individual plans. DS0000063123.V367420.R01.S.doc Version 5.2 Page 38 2. YA6 3 YA7 5. YA13 Beech Spinney 6 YA19 Recommendation arising from January 2008 inspection. Progress identified but activities need to be more individualised. Steps should be taken to reduce the number of falls incurred by service users. This should involve seeking advice from Telford and Wrekin’s Falls Coordinator and carrying out specific falls risk assessments for people at risk of falling. New recommendation from this inspection July 2008. The home should ensure that at the start of each month it has an accurate record of all medication present within the home. Also the home should simplify the system for checking that medication has been administered during that month. 7 YA20 8 YA22 New recommendation from this inspection July 2008. A complaints log should be available and should be maintained. This will demonstrate that complaints are managed openly and will help the service to monitor and learn from trends in complaints. New recommendation from this inspection July 2008. Steps should be taken to develop and implement a policy in respect on how meals eaten out in the community are funded. New recommendation from this inspection July 2008. The environment should be reviewed to ensure that it meets the needs and preferences of people with high support needs. E.g. Décor / use of colour, pictures to stimulate, availability of accessible information, accessibility of communication tools, personalisation of communal spaces. New recommendation from this inspection July 2008. The extent to which communal seating meets the needs of service users including respite service users should be reviewed with someone competent to assess suitability. New recommendation from this inspection July 2008. Steps should be taken to ensure that service users are protected from risks posed by staff involved in induction training before all pre employment checks have been received back. These staff should not be allowed access to people’s homes during induction prior to the receipt of DS0000063123.V367420.R01.S.doc Version 5.2 Page 39 9 YA23 10 YA24 11 YA24 12 YA34 Beech Spinney checks. A member of staff who is sufficiently experienced and qualified should be nominated to supervise the new worker during the induction stage. New recommendation from this inspection July 2008. Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Beech Spinney DS0000063123.V367420.R01.S.doc Version 5.2 Page 41 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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