CARE HOME ADULTS 18-65
Beechdale 302 Golden Hill Lane Leyland Lancashire PR5 1YH Lead Inspector
Val Turley Unannounced Inspection 09:30 6th and 22 December 2005
nd Beechdale DS0000005928.V264649.R01.S.doc Version 5.0 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 Beechdale DS0000005928.V264649.R01.S.doc Version 5.0 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. Beechdale DS0000005928.V264649.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Beechdale Address 302 Golden Hill Lane Leyland Lancashire PR5 1YH 01772 452924 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) Dalesview Partnership Mrs Hayley Elizabeth Stringfellow Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Beechdale DS0000005928.V264649.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The home is registered for a maximum of 7 service users of the category LD - (Learning Disability). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 21st September 2005 Date of last inspection Brief Description of the Service: Beechdale is a detached bungalow situated on a main road approximately 1 mile from the town of Leyland, which can be accessed via a well-served bus route. Accommodation comprises 7 bedrooms, 4 with ensuite facilities, a separate bathroom, lounge, dining room, and kitchen. There is an enclosed paved patio area to the rear of the home, which contains two outbuildings one of which is a laundry room; the second has been converted into a ‘lifestyle’ (sensory) room. Beechdale provides care for service users who require short-term admission to a care home. Beechdale DS0000005928.V264649.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over two days in December 2005 by one regulation inspector. The inspection involved observation of and discussion with the service users who lived at the home and also discussion with and observation of the staff working there, an examination of records, policies and procedures and a tour of the premises. What the service does well: What has improved since the last inspection? What they could do better: Beechdale DS0000005928.V264649.R01.S.doc Version 5.0 Page 6 Care plans should include details of the support required by service user in terms of the management their finances to avoid their independence skills being eroded. Records of all activities service users participate in outside of the home should be recorded to allow a full picture of the range and frequency of the service users involvement in such activities to be seen. Some additional work needs to be undertaken by the home to ensure that the management of medication safeguards both the service users and support staff. The homes policy and procedure regarding the protection of vulnerable adults should be reviewed to ensure that all addresses and telephone numbers have been updated. Some thought should be given to the Learning Disability Award Framework being used for the induction course. 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. Beechdale DS0000005928.V264649.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beechdale DS0000005928.V264649.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 was not assessed at this inspection. EVIDENCE: Beechdale DS0000005928.V264649.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 Care plans should be extended to ensure that service user are, as far as possible, able to make informed decisions about all aspects of they’re lives. EVIDENCE: Discussion took place with one of the service users who stated that she could make up her mind about things herself. The care plans in the home reflected the service users capacity to make decisions in certain situations and gave staff guidance as to how to support them. Staff were observed to support service users and encourage them to make decisions themselves. Although the staff spoken to were clear as to the support needs of the service users in terms of them managing their own finances, these needs were not included in the care plans. This omission could lead to confusion and may diminish the service users independence skills. Care plans included details of any limitations imposed on service users with a view to preventing any incidents of challenging behaviour. Beechdale DS0000005928.V264649.R01.S.doc Version 5.0 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,16 and 17 Although service users were supported to be as independent as possible and make decisions for themselves, recording should be improved to allow the range and frequency of community based activities to be monitored. EVIDENCE: There was evidence on service users files that service user were involved in a range of community-based activities, which included attendance at college, local clubs, pub lunches and shopping. This was confirmed in conversation with a service user who also said she would be going to some shows over the Christmas period. Recording in service users files was inconsistent and not all activities arranged in the community were recorded. Consequently it was not possible to gain an accurate picture from the files as to the range and frequency of the service users involvement in such activities. The home was well staffed to allow the service users to be supported outside of the home. A service user stated that the staff used their cars to take her out. Discussion with a service user, observation of staff and the information included in appropriate policies confirmed that the routines within the home promoted the independence of the service users. Staff included the service
Beechdale DS0000005928.V264649.R01.S.doc Version 5.0 Page 11 users in conversation and activities, service users opened their own mail and staff only entered a service users room with permission. The service user confirmed that she could choose how she spent her time and did not have to join in any organised activities. She said she often chose to spend time in her room alone. Meals were varied and appeared to be nutritious. The cultural and religious requirements of the service users were respected. As the home offered respite care, it was recognised that meals played an important part in making a service users period of respite care successful. The individual tastes and preferences of the service users were taken into account and alternatives were always available. The staff were observed to discuss the options available for lunch with one of the service users. Service users were able to eat alone if they wished and any preferences in this respect were included within service users care plans. Beechdale DS0000005928.V264649.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 20 Service users preferred routines were considered carefully to ensure that they were comfortable and relaxed in the home. The homes management of medication should be improved to safeguard both service users and support staff. EVIDENCE: Care plans were in place that described service users preferred routines and any specific support they needed in terms of being guide, moved or transferred ensuring that they felt comfortable and relaxed within the home. Discussion with a service user confirmed that she was able to make decisions about the personal support she needed. Service users were able to choose their clothes and hairstyles for example. The home had regular input from various health professionals including a physiotherapist, a speech and language therapist, a dietician and a community nurse. Service users families were involved appropriately. The homes medication policy included all relevant detail, however some additional work must be undertaken to ensure that the service users are adequately protected. As the home provided respite care the management of medication is not as straightforward as it could be, with medications and medication regimes changing on an almost daily basis. Some of the management practices within the home must be changed with a view to reducing the chance of medication errors. It is recommended that handwritten entries on Medication Administration Record sheets should be signed,
Beechdale DS0000005928.V264649.R01.S.doc Version 5.0 Page 13 witnessed and countersigned by a second member of staff. Medication should only be administered from the original containers supplied and labelled by the pharmacist. Wherever possible the service users consent to medication should be obtained. Where this is not possible this should be recorded within the care plan. Since the last inspection training had been undertaken or arranged in percutaneous endoscopy gastronomy feeding, the administration of rectal diazepam and in epilepsy. Arrangements had also been made to develop health action plans for each of the service users who resided at the home on a semipermanent basis. Beechdale DS0000005928.V264649.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The home policies and procedures that dealt with the protection of vulnerable adults were comprehensive although some minor adjustments were needed to ensure that contact details were up to date. EVIDENCE: Standard 22 was partly assessed at this inspection. A requirement made at the previous inspection had been acted upon and the information regarding the homes complaint procedures was found to be consistent across different documents across the home. The homes policy and procedure regarding the protection of vulnerable adults was found to contain all of the relevant detail including the procedure staff are to follow should they become aware of any allegations or suspicions of abuse. The contact numbers within this document should be updated to reflect current addresses and telephone numbers. Beechdale DS0000005928.V264649.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 The home was clean and hygienic providing a clean and comfortable environment for the benefit of service users and support staff. EVIDENCE: The laundry at the home was clean and hygienic. The equipment reached the required specifications and hand was facilities were situated within the laundry. Policies and procedures were in place to control the spread of infection for the benefit of both service users and support staff. Beechdale DS0000005928.V264649.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 35 Training and support is provided for staff to help ensure that the needs of the service users are being met however consideration should be given to providing induction training in conjunction with the Learning Disability Award Framework. EVIDENCE: The staff were observed to be confident in their approach and service users were comfortable and relaxes in their presence. On the first day of the inspection the staff were in the process of arranging a theme day as part of the activity programme organised for staff. They were motivated and enthusiastic in their approach and involved the service users in the process. The support staff had an understanding of the service users individual support needs. Of the staff team, 50 had achieved a relevant care qualification. The training matrix indicated that variety of training opportunities were provided for the staff team including both mandatory and specialist courses. A member of staff confirmed this. The manager stated that courses were arranged as she highlighted a need for them. Although new staff were given induction training, this was not linked to the Learning Disability Award Framework and it is recommended that this be considered as an option for new staff. Beechdale DS0000005928.V264649.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The home was well run with the manager ensuring as far as possible that the overall aims and objectives were met. The homes quality assurance processes should be extended and the results of surveys published and made available to interested parties enabling service enabling service users make informed decisions regarding their choice of home. EVIDENCE: The manager of the home had experience and training relevant to her role and there was written evidence to the effect that she had undertaken additional periodic training to maintain and update her skills. The home was well run with the manager ensuring as far as possible that the overall aims and objectives were met. The home had a number of quality assurance monitoring systems in place to ensure that the home met the needs of the service users. The home had achieved the Investors in People Award which is a quality assurance award accredited by an outside body. The views of service user and families had been sought and the responses received had been positive although the results of this survey had not been published. Publication would allow service user make
Beechdale DS0000005928.V264649.R01.S.doc Version 5.0 Page 18 an informed choice as to their choice of home. It is recommended that the views of any involved health and social care representatives be sought as part of this process. Standard 42 was partly assessed at this inspection. Since the last inspection the fire service had been consulted ensuring that the fire risk assessments and procedures in the home were appropriate to the service user group. Beechdale DS0000005928.V264649.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 2 X X X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 2 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X X 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Beechdale Score 3 X 2 X Standard No 37 38 39 40 41 42 43 Score 2 X 2 X X 3 X DS0000005928.V264649.R01.S.doc Version 5.0 Page 20 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 YA20 Regulation 13(2) Requirement Medication must only be administered from the original containers supplied and labelled by the pharmacist. The results of service user surveys must be made available to interested parties. Timescale for action 31/01/06 2 YA39 24(2) 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard YA7 YA13 YA20 YA20 YA20 Good Practice Recommendations Care plans should include details of any support service users need to manage their finances. A record should be kept of all activities the service user participates in outside of the home. Service users consent to medication should be recorded in the care plan. Medication administered through a percutaneous endoscopy gastronomy tube should be recorded on the Medication Administration Record. Medication details transcribed by hand onto a medication administration record should be witnessed and countersigned by a second member of staff.
DS0000005928.V264649.R01.S.doc Version 5.0 Page 21 Beechdale 6 7 8 YA23 YA35 YA39 The homes policy regarding the protection of vulnerable adults should be updated to reflect current addresses and telephone numbers. Induction training should be linked to the Learning Disability Award Framework accredited training. The views of health and social care professionals should be sought as part of the quality assurance process. Beechdale DS0000005928.V264649.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Chorley Local Office Levens House Ackhurst Business Park Foxhole Road Chorley PR7 1NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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