Inspection on 23/01/08 for Beech Spinney

This inspection was carried out on 23rd January 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 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 01/07/08

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 08/07/2008.

CARE HOME ADULTS 18-65 Beech Spinney Ironbridge Telford Shropshire TF8 7NE Lead Inspector Deborah Sharman Key Unannounced Inspection 23rd January 2008 09:30 Beech Spinney DS0000063123.V354306.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.V354306.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.V354306.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) Mr Barry William Lord Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Beech Spinney DS0000063123.V354306.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. 26th September 2006 Date of last inspection Brief Description of the Service: Beech Spinney is managed by Cottage and Rural Enterprises Ironbridge. The responsible individual is Mr Michael Keighley. Mr Barry Lord is the registered manager of the home. 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 £2446.75 a week. Beech Spinney DS0000063123.V354306.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. Two Inspectors carried out this unannounced key inspection between 9.30am and 6.00pm. As the inspection 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 at least all the 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 plan was also to assess progress the home had made since the last key inspection (September 2006), random inspection (February 2007) and random medication inspection in January 2007. Information about the performance of the home was sought and collated in a number of ways. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to the commission within a given timescale. The registered manager completed this document and returned it the commission. Comments from the AQAA are included within this inspection report. We had the opportunity to talk by telephone to one relative. This information in conjunction with information held about the recent history of the home, helped us to formulate a focus and plan for the inspection and has helped in determining a judgement about the quality of care the home provides. During the course of the inspection we used a variety of methods to make a judgement about how service users are cared for. We looked in detail at the care provided to three service users. We talked to five staff and the assistant manager. We were also able to talk to the registered manager although he was not available throughout the inspection. We also talked to two visiting relatives and visited service users in The Dingle Resource Centre. Due to the nature of their disabilities service users were not able to provide verbal or written feedback to us either before or during the inspection. We sampled a variety of other documentation related to the management of the care home such as training, recruitment, maintenance of the premises, accidents and complaints. We were also able to tour the premises. What the service does well: Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 6 The environment continues to meet people’s needs and is generally well maintained, clean and comfortable. People are not admitted to the service until managers and staff are satisfied their needs can be met. This is achieved by obtaining copies of other professional’s assessments and by carrying out their own assessment in addition to offering visits before admission. Care plans, which are designed to help staff know how to provide support to individuals, are detailed and easy to read. What has improved since the last inspection? What they could do better: A considerable challenge lies ahead of the service. Discussion with staff and managers shows morale to be low. Staff feel under pressure and are anxious that “an accident is waiting to happen”. The root of this appears to be staffing levels and staff shortages. Service users have complex needs. Staff and managers believe the service to be understaffed and in addition to this the loss of the cook and cleaner is putting additional pressure on care staff. Activities have suffered and access to the community is restricted. One service user had been ‘off site’ once in a continuous period of 8 days sampled. There were no plans for two respite service users to go out because two staff were rostered all week, but risk assessment stated that each person needed the support of two staff to go out. To facilitate this a minimum of three to four staff would be needed. A care plan with risk assessments was in one instance not made available to staff until two weeks after the end of a service users stay. Moreover in addition to concerns about staffing levels, inspection has shown that incidents and accidents are not being reviewed to ensure that the risk of a repeat is minimised. It is the Inspector’s view that shifts need to be better directed and staff more consistently supported. Steps are being taken to recruit an additional senior staff member. Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 7 In spite of an adult protection investigation related to gender specific care, policies, procedures and staff understanding remains contradictory and confusing and this has not reduced the possibility of further incident. It appears that service users are receiving their medication as prescribed. However little progress has been made against the requirements arising from a pharmacy inspection 12 months ago. This would ensure a more robust management of medication and would minimise the risk of error and omission. Lack of accountability in respect of controlled drugs is a particular concern. There have been a high number of allegations, investigations and staff dismissals since the last key inspection. It is reassuring that bad practice is being highlighted by staff and the management feel that they have ‘become more confident in using the adult protection referral process’. However the disproportionate number of incidents - including for example neglect and psychological abuse - is a concern and although action was taken in response to this, service users have been at risk and outcomes for some of them have been poor. Overall the environment is excellent, it is homely and meets peoples needs. In the absence of a cook and cleaner, it is imperative that standards do not slip. For example the oven in Honeysuckle Cottage was found to be extremely dirty and a professional clean is being considered. Soap must also be provided in the laundry areas. 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.V354306.R01.S.doc Version 5.2 Page 8 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.V354306.R01.S.doc Version 5.2 Page 9 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, 4. Quality in this outcome area is good. Before offering a place, the service takes adequate steps to ensure that it identifies service users needs and a new service user recently admitted for respite had a positive first stay. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Brochures that inform potential customers and other enquirers about the range of facilities and services offered at Beech Spinney were available on the premises. We explained that the Service User Guide which is due for review needs to include the weekly fee so that this information is available to service users. It was noted that the fee however is described well in the Statement of Purpose. Perusal of documentation and discussion with staff has confirmed that good information is sought about prospective service users before they are offered a place to satisfy the service that they can meet their needs. It would be good practice to date any assessments carried out to better evidence the timeliness of this. Prospective service users are also offered the opportunity to visit Beech Spinney several times before they stay overnight for the first time. For one new service user whose care was looked at in detail, this enabled him to have a positive first respite stay. However formal guidance was not made Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 10 available to staff in care plans and written risk assessments in respect of this person until two weeks after discharge. Discussion with staff showed that they appeared to be familiar with his needs. However care plans and risk assessments must be available at the time of admission to ensure that all staff know how to provide the required care to promote customer satisfaction and to reduce the risk of error, omission and accident. Managers are considering an application from a service user for whom they are not registered to provide a service. Assessments have been carried out and an application is being made to us to consider varying their registration. Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 11 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. Care plans are available and are detailed. However they are not always available to guide staff in a timely way and do not always include how all needs should be met. Risk assessments are in place but systems to review changing risks are not sufficiently robust. Service users rights to choice is understood and respected but can be limited. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans for three service users were assessed. They reflect most if not all assessed needs, but where there are omissions these are significant (given the complex needs of those cared for) e.g. eating and drinking guidance following seizure, medication administration and allergies to penicillin for example. One care plan was not put in place until two weeks after one service users discharge. Positively however care records show that care for this person was provided in accordance with assessed needs and preferences. Where guidance is available it is detailed, easy to read and considers privacy, dignity and Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 12 service users preferences and abilities. However two different sources indicated to us that staff do not have sufficient time to read the guidance available to them. This is leading to inconsistencies in practice, some customer dissatisfaction and inevitable risk. Risk assessments are in place to try to minimise risk to service users. However documentation alone will not achieve this and systems to keep risk under review are insufficient. For example, risk assessments were not in place until two weeks after a new service user’s discharge. Also accident records, not all of which were readily available, show another service user to have had a high number of falls – 15 in 6 months December 2006 to June 2007. There have been more incidents since then but record availability was erratic. Discussion with the manager showed that he is not reviewing accident records in order to identify accident trends and this prevents him from taking action to reduce emerging risks. One accident record for example, showed a staff member, contrary to the written guidance to have caught a service user to break his fall. This resulted in recorded injury to the staff member. The Manager was not aware of this. Staff support service users in the hydro pool and risk assessments state that one staff member must be pool side and that it is useful to also have a staff member in the water. Staff must have first aid training to support this activity. The Manager expressed concern that the training provided by CARE does not cover risk of drowning and we suggested that this is reviewed. Care plans and discussion with staff indicate to us that service users’ preferences and choices are known and understood. In the annual return to us, the manager has indicated that staff have become more skilled at understanding the choices and preferences of service users with complex needs and communication difficulties. Several sources of evidence indicate to us that service users preferences and choices are known and understood by staff but that external forces limit the opportunities available. This will be discussed in the next section of this report under ‘Lifestyle’. Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 13 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. Staff are aware of service users’ preferred leisure activities and ensure that these are facilitated on the premises. However the level of activity within the community based upon service users’ known interests is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the course of the inspection, service users were at The Dingle day resource opposite the registered premises as the massage therapist was working with those who enjoy this activity. Care plans outline preferred individual activities and this information tallied with information given to us by relatives. Discussion with staff showed that they are aware of how service users like to spend their leisure time. Records show that service users are facilitated daily to follow preferred activities that are possible on the premises e.g. playing ball and skittles. But there appeared Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 14 to be little alternative. All service users have had an annual holiday this year but other day-to-day community access is limited. One service user whose care was looked at in detail had been out into the community once in an 8-day period. Records as well as discussion with a number of staff and others confirm this. Staff consistently told us that activities would improve if there were more staff. Relatives expressed the same given the complex needs of those the home supports. We were told that often the only manageable option is for a group of service users to be taken for a drive as there are insufficient staff to manage the number of people using wheelchairs. The Manager also confirmed this to us. An outcome of a previous adult protection investigation was for staff to record why activities offered were not happening. Inspection shows that this is not the case. At teatime we met two people who were having respite for the week. Two staff were available to support them. We enquired what the plans were for the evening and were told ‘none’ as to support both service users out in the community four staff would be needed. To take one of the service users out would have needed a minimum of three staff to be on duty. Care plans contain good guidance about service users’ dietary and fluid intake needs. Records were sampled for two service users and showed food intake to accord with personal preference and discussion with staff showed some if not a full understanding of dietary needs and risks as outlined in the plan of care. Records sampled at the time showed fluids to have been maintained in accordance with the individualised care guidance. In the immediate period after inspection, concerns have been raised about fluid intake for one service user over a 20-hour period of ill health and this is now subject to adult protection investigation. The care plan, although it contains very detailed eating and drinking guidance, does not address the issue of intake following seizure or multiple seizures. It was agreed by telephone that medical guidance will be sought and will be incorporated into the care plan. Staff must be supported to understand how they are expected to provide nutritional care in these circumstances. Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 15 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 but very mixed. People’s experience of personal care has differed. Response to changing health needs is generally good but staff need more support to understand what is expected of them. Medication is being administered as prescribed but there are some serious weaknesses in systems and accountability. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are very detailed care plans in place which advise staff how to carry out personal care in an individual way based upon preference and mindful of privacy and dignity Service users present as well groomed and records show that bathing is provided more than once daily where required and in accordance with the plan of care. However discussion with staff and the Manager told us that due to staffing levels, the provision of personal care can feel pressured and that service users are rushed at times. Since the last inspection an invasion of privacy has resulted in a staff resignation and an adult protection investigation. The outcome of the Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 16 investigation was to ensure that gender care policies and procedures be reviewed and covered with staff in supervision. Supervisions however are not up to date and policies, practice and staff understanding of gender care remain inconsistent. Records show regular contact with a range of health professionals for example, the GP, Community Nurse and Consultant Psychiatrist. Changes in medical advice are well recorded. We have asked the home to review falls risks for one service user as the number of falls indicates current risk assessments are not working. We have also asked that medical advice about food and fluid intake following seizure is clarified and included in care plans and made known to staff. Assessment of records for two permanent residents showed mixed outcomes for routine health screening. For one person there was good evidence of dental, optical and podiatry care. For the other, changes in health were responded to, but there was little evidence of routine health screening to promote early detection of health changes. Since the last inspection policies relating to the management and administration of medication have been reviewed in response to a medication error. The medication system has in conjunction with the supplying pharmacist been simplified. Witnesses have been introduced when medication is administered as an additional safeguard and a medication handover between staff, which we were able to observe, now also takes place to ensure that systems are more accountable. We found no out of date medication and all medications in use for those residents sampled were available. Medication records were up to date, had no gaps and indicated that medication is being given as prescribed. We checked medication records for dates when service users were known to have had seizure activity and the records assured us that medications had been given. Furthermore we verified this by counting the number of signatures. We found that this tallied with the number of tablets prescribed as a short course and provides additional assurance that medication is being given as prescribed. We found records to be more accountable than previously. Where the GP has directed to give either one or two tablets, staff are now indicating in records how many have been given. This better accounts for medication usage and also seeks to protect the service user from accidental overdose. It is positive too, to see that medications prescribed to help to support behaviours on an ‘as required’ basis are not being overused and are in fact used infrequently. It remains for the service to ensure that written direction for all ‘as required’ medications are available. We were told that the supplying pharmacist is not always printing records for use by staff. This leaves staff having to transcribe prescribing direction by hand. Steps needed to reduce the risk of human error Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 17 in these circumstances have not been taken as advised at the pharmacy inspection. A staff member told us s/he had had medication training ‘years ago’. Medication training is taking place in-house and there are often no trained staff to administer medication in Honeysuckle Cottage. This puts pressure on staff from Thistle Cottage and reduces staffing there whilst medication is being administered next door. The management of controlled drugs poses some significant concern, as it is insufficiently accountable. The home’s annual return states that there have been no controlled drugs and that none are on the premises. Staff confirmed this at the time of inspection. However further assessment, showed this to be inaccurate. Records showed that on 8.6.07, 28 Temazepam tablets were checked and accepted into the premises. Administration records showed one to have been administered since that time. The whereabouts of the remaining 27 were unknown although perusal of returns records showed that they hadn’t left the premises. A subsequent search found them to be held in the medication cabinet belonging to the other unit, Thistle Lodge. Accountability for controlled drugs is further compromised by the fact that there is not a controlled drug register or controlled drugs cabinet. It was recommended at a previous inspection that this be addressed. Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 18 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. There have been a high number of allegations into poor practice, most of which have been substantiated. Whilst it is positive that whistle blowing policies are understood and are being used by staff, the number of instances are a concern and show that service users have not always been adequately protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises showed there to be no publicly available information on display informing service users and visitors how to complain should they want to. We have been told that the service listens to grumbles and complaints but that nothing changes. The manager could not evidence what action it takes to address concerns and complaints because although the annual return completed in November 2007 declares receipt of 4 complaints, 3 of which are said to have been resolved within 28 days, these were not entered into the home’s complaints log. The nature of the complaints and how they had been resolved are therefore not accessible, open and transparent. The home is not able to evidence that complaints received have been satisfactorily resolved and learned from. Although there has been some delay on occasions in reporting incidents of an adult protection nature, most have been reported and action taken to safeguard service users. The manager described it as a ‘learning curve’ and feels that they are now more confident in using whistle blowing and adult Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 19 protection procedures. He sees it as indicative that whistle blowing is working and feels that a number of staff dismissals have been a strong message that poor practice will not be tolerated. Discussion with staff did not indicate concerns about management systems; they attributed failings to the individuals concerned. However, we have reason to believe that the agreed outcomes of adult protection investigations are not always being carried out to ensure ongoing protection. Staff however do consistently believe that staffing levels make service users vulnerable. We did not look at service users finances but staff are satisfied that systems protect service users interests. We have noted however from information in care plans that the Manager is the appointee for some service users. This is not advisable and does not protect either the manager or the service user. We were made aware of some concern about the management of a service user’s possessions. The concern was significant and staff were informally investigating. The issue had not been made known to the manager, who needs to consider whether the matter is reportable under Adult Protection procedures. As discussed earlier, the Manager must review accident records to ensure that risks are reviewed and action is taken to minimise them. Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 20 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 excellent. The premises are generally well maintained and homely. It provides a warm, comfortable and personalised living environment and meets the needs of people living and staying there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The environment is designed and equipped to meet the physical needs of service users. A tour of the environment found bedrooms and communal living areas to be uncluttered, sufficiently clean and with no mal odour. Equipment was dated with when it was last serviced, water temperatures were sampled without concern, radiators limit the risk from scolds and burns and windows are restricted to minimise the risk from intruders. Fire doors were all closed which would provide protection from smoke in the event of a fire. Soft furnishings in bedrooms coordinate and are of a good quality. We could see that people’s bedrooms are personalised to reflect their interests and personalities with many photographs of friends and family. Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 21 We noted that in order for staff to observe service users in the lounge from the kitchen in Honeysuckle, the fire door has to be kept open. This opens into the corridor and obstructs most of the throughway that divides the kitchen and lounge and could be unsafe. The assistant manager said that she is reviewing this. In both laundries we noted that there was no soap available for staff to wash their hands when handling soiled linen and suggested that soap dispensers are obtained. In one laundry we found a five-litre container of liquid cleaning product to be accessible. This should have been locked away in the lockable cupboard provided. This was remedied immediately and all other hazardous products were locked away appropriately. Gloves, soap and aprons are readily available in bathroom and en suite areas for use by staff and are stored in an organised manner. There is a good system available for the storage and disposal of used incontinence pads. In kitchens we found some areas for improvement. In the kitchen where the cook is currently not at work, we found the oven to be extremely dirty with baked on debris. The assistant manager acknowledged this and said she was going to ask if it could be professionally cleaned. Temperature monitoring records could also not be produced to show that steps are being taken to reduce risk to service users from food borne illness. These were available in the other unit but we advised that products need to be dated when opened and stored in the fridge, to ensure they can be discarded when the exceed their use by dates. Steps need to be taken to ensure that these omissions are acted upon. Satisfactory systems must be in place in the absence of the cook and cleaner to ensure that standards do not deteriorate. Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 22 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. Quality in this outcome area is poor overall. Staff are keen to do well and want to meet service users needs. However staff are not being recruited thoroughly and there have been a number of instances of poor practice and dismissals. This in conjunction with concerns about staffing levels is undermining quality overall. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prior to this inspection, a random inspection found concerns about the number of hours that staff and one staff member in particular were working. This was not felt to be safe and a number of remedial actions were agreed with the manager. The inspector spoke with staff on duty at the time of this inspection and they as well as managers reflected concerns from parents that there are occasions when staffing levels are reduced to three. This impacts significantly on opportunities for people living at the home and also compromises safety. Some people need the support of two people for various activities and this cannot always be facilitated. The home has also lost its full time cook and cleaner Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 23 meaning that care staff available have more duties to carry out in the same amount of time. Discussion showed staff morale to be low with a significant amount of anxiety amongst the staff team that there is an accident waiting to happen. We noted that there is not always a senior staff member present in both units and that there is not a formalised system in place to manage and account for staff responsibilities throughout the course of a shift in the absence of a shift leader. It is particularly important when staff are stretched to ensure that staff are utilised effectively for the benefit of service users. For example at the time one service user sustained injuries from a seizure, one staff member was attending to the personal care needs of another service user and the remaining two staff were in the kitchen clearing away from lunch. It would have been prudent to ensure that at least one of these two care staff members were with service users in the lounge. A new senior post is being created from a 40-hour care post. The Manager reported feeling restricted by conditions of registration imposed by CSCI at the time the service first opened. Conditions of registration are currently subject to national review and this may enable the service to use its staffing complement more flexibly. Staffing files were in good order however not all information was available on the files reviewed, to demonstrate that the home has followed procedures and followed up references or CRB disclosures to sufficiently safeguard vulnerable people. Information relating to incidents involving staff were well documented although not in good order to establish a chain of events and a suitable outcome. It was noted however that the manager was working to address this at the time of the inspection. Staff working at Beech Spinney are totally committed to supporting the people who live there. Training opportunities were described as good and records showed that all essential training courses are attended and some courses are designed to meet the individual support needs of the people living at Beech Spinney. Supervision records were not made available to us. Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 24 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. There has been a deterioration in general outcomes since the last inspection. Service users have not been adequately protected. Action is not taken sufficiently to address risk to service users. In addition quality assurance systems are lacking to help the service to identify and respond to shortfalls. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection, the acting manager has successfully applied for registration as manager of the service. He confirmed that he has nearly finished his Registered Managers Award, which will qualify him for his role as manager of a care service. Comments have been made to us that the Manager is available less than he was. We could not disprove this from analysis of the Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 25 rota as although he is included when he works as a carer, his management hours are not included. He was not present for much of the inspection, as he was required to support the senior management team. He confirmed that he receives very regular business-like supervisions but will raise the need to focus on service users as part of his supervision process. It is also noted that the service would benefit if staffing issues were considered as part of regulation 26 visits. Maintenance systems sampled were found to be robust and we were assured that funding for remedial works where safety may be at risk are quickly forthcoming. The Fire Officer last visited in October 2007. We were assured that matters arising from this fire inspection have all been addressed and have been confirmed in writing to the Fire Service. Similarly, independent contractors for legionella risk have recently reassessed the buildings including those at Beech Spinney. Some action points have again been identified, which we were assured are receiving attention. Inspection highlighted some shortfalls in hot and cold food temperature monitoring, provision of soap and hazardous chemical safety in laundry areas and oven cleanliness. Quality assurance systems have been in place for CARE Ironbridge as a whole. This does not help Beech Spinney to identify its individual performance issues and aside from this, we were informed that the ‘global’ quality assurance system conducted from head office has ‘fallen into abeyance’. There has been insufficient progress towards making the necessary improvements identified at previous inspections and this does not appear to be supported by a robust quality assurance or development plan. At inspection we requested names and addresses of relatives and third parties to enable us to conduct a satisfaction survey, but we have not been provided with the information. There are a number of positive systems in place at Beech Spinney but they remain undermined. This inspection identified a range of concerns: staff, managers and relatives’ anxieties about staffing levels have not been addressed staff are feeling fully stretched and anxious that something is going to go wrong there is not always a management presence to direct and monitor care throughout the course of shifts high accident levels are not receiving a sufficient response the number of adult protection incidents and subsequent staff dismissals incidents are not always being fully recognized as adult protection matters in spite of the quality of care plans that significant issues are omitted and staff do not feel they have time to read them some relatives feel concerned about service provision and lack of progress. information about complaints is not readily available lack of accountability in respect of the management of controlled drugs Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 26 Overall there is a concern about the lack of progress since the last inspection and that rather than improving, concerns are growing about a service that provides care for highly dependent service users with complex needs. Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 27 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 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 2 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 1 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 1 14 3 15 3 16 3 17 1 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.V354306.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement Steps must be taken to ensure that after consultation with the service user or a representative of his, that the written plan describes how all needs in respect of health and welfare are to be met. This must be kept under review and must be revised when needs change. This will ensure that staff know how to meet all assessed needs. New requirement arising from this inspection. 2 YA9 13(4)(c) Steps must be taken to ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. This will serve to protect service users as far as possible from the risk of injury and harm. New requirement arising from Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 29 Timescale for action 28/02/08 28/02/08 this inspection. 3 YA20 13(2) Arrangements must be made for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home to ensure that all medications received are fully accounted for and that it can be evidenced that people are receiving their medications as prescribed to maximise their health, welfare and safety. Requirements arising from random pharmacy inspection Jan 07 remain not met and will be subject to a further pharmacy inspection. The registered person must not employ a person to work at the care home unless he has obtained in respect of that person all the information and documents specified by regulation. This will ensure that the person is fit to work with vulnerable adults. New requirement arising from this inspection Steps must be taken to ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. New requirement arising from this inspection To ensure the health and safety of service users and staff working long and/or additional hours risk assessments must support their activity. DS0000063123.V354306.R01.S.doc 31/01/08 3. YA34 19 (1) (b) 23/01/08 15 YA33 18(1)(a) 31/03/08 16 YA42 19 (5) (c) 18 (1) (a) 31/03/08 Beech Spinney Version 5.2 Page 30 Requirement made at Random inspection February 2007 with original target date of 16.3.07 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 YA6 Good Practice Recommendations Care plans should be in place at the time of first admission to ensure that all staff know how to provide care to meet assessed and agreed needs. New recommendation arising from this inspection. Service users should be supported to become part of and participate in, the local community in accordance with their assessed needs and individual plans. New recommendation arising from this inspection. CRB disclosures should be destroyed after they have served their purpose. Accident records should be stored on individual service user or staff members files to ensure confidentiality of information It is recommended that a Controlled Drugs cabinet is obtained and securely fixed on to a solid wall using rag bolts. It is recommended that the home obtain a Controlled Drugs register. Soap should be provided in both laundries to enable staff to wash their hands thoroughly when handling soiled linen. New recommendation arising from this inspection. Steps should be taken to improve food safety management in Honeysuckle Cottage e.g. the maintenance of cold storage temperatures, hot food temperatures, labelling products in fridge with date opened and ensuring the oven is cleaned. DS0000063123.V354306.R01.S.doc Version 5.2 Page 31 2 YA13 3 4 YA34 YA41 5 YA20 6 7 YA20 YA30 8 YA42 Beech Spinney 9 YA42 New recommendation arising from this inspection. Arrangements should be reviewed to prepare staff to prevent and respond appropriately in the event of a drowning accident. New recommendation arising from this inspection. Beech Spinney DS0000063123.V354306.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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.V354306.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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