CARE HOME ADULTS 18-65
The Beeches 48 The Drive Ilford Essex IG1 3JF Lead Inspector
Harina Morzeria Unannounced Inspection 14 June 2005 12:30 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 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 Stationary 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. The Beeches G55_S0000028719_The Beeches_V232788_140605_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Beeches Address 48 The Drive, Ilford, Essex IG1 3JF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8518 3704 the beeches48@onetel.net.uk Mr Chanan Singh Sidhu Ms. Linda Morris CRH Care Home 8 Category(ies) of LD Learning disability (8) registration, with number of places The Beeches G55_S0000028719_The Beeches_V232788_140605_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The Beeches is registered for 8 younger adults with a learning disability and associated mental health problems. Date of last inspection 23 November 2004 Brief Description of the Service: The beeches is registered to care for younger adults with moderate learning disabilities and associated mental health problems. The home is situated on a busy main road in a residential area in the London Borough of Redbridge. It is within easy reach of a park and the main town centre in Ilford which is accessible by public transport. All service users occupy their own single rooms which are well furnished and decorated. The service users are supported by the manager and staff to maintain their independent living skills, go to the day centres, attend college for various courses as well as accessing community facilities locally. Service users are also encouraged to work part time in paid jobs or work as volunteers in charity shops if they wish. Activities are organised both within the home and via various club memberships. Personal care is provided on a 24-hour basis, and a health care needs are met by staff supporting service users to attend appointments with health professionals.
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This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 12:30 p.m. The inspector spoke to three service users during the inspection and two staff members who were on the afternoon shift as well as the deputy manager. Three service user files were inspected as well as some staff policies and procedures. What the service does well:
The standard of the decor, furnishings and fittings are well maintained and an ongoing refurbishment programme is in place. This provides the service users with an attractive and comfortable place in which to live. The home supports the service users to exercise choice and control over their lives in order to promote their independence. The routines of daily living and activities are flexible and varied to suit each young persons expectations, preferences and capacities. The service users feel at home and relaxed at the Beeches because the staff pay close attention to meeting their individual needs. The service users said that they enjoyed living at the Beeches and were very positive about the quality of care they are receiving. The service users said that they are asked about things that affect them in the home and are kept informed about any changes and events that take place. Regular discussions and meetings take place between the staff, the service users as well as their relatives. All necessary health care services are accessed for the service users in order to meet their assessed and specialist needs. Each service user has a weekly programme of activities outlined in an activity plan. Hence the service users are supported by staff to attend college, go to the day centre, go shopping and for walks as well as going to the cinema, restaurants, and pubs locally with the staff during the evening and weekends. Holidays are also planned with the service users and one of the service users excitedly told the inspector about their recent holiday in April to Lanzarote, which they enjoyed very much.
The Beeches G55_S0000028719_The Beeches_V232788_140605_Stage 4.doc Version 1.30 Page 6 Visiting times are flexible and visitors are welcome at any reasonable time. The staff selection and recruitment policy and procedure as well as the home’s induction training is well implemented. What has improved since the last inspection? What they could do better:
At the time of the inspection, although care plans were available for each service user, it was not clear if these were reviewed and updated on a monthly basis. Ongoing reviews and updating of care plans must improve, to ensure that staff know what to do for each service user and to ensure that changing needs are identified and met. The involvement of the service users and relatives in the written care plans made by the home needs to be increased. Monthly monitoring visits must be carried out as required under Regulation 26 by the responsible individual with copies of the report being forwarded to the CSCI, in order to demonstrate the internal quality monitoring of the service. The Beeches G55_S0000028719_The Beeches_V232788_140605_Stage 4.doc Version 1.30 Page 7 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 Beeches G55_S0000028719_The Beeches_V232788_140605_Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Beeches G55_S0000028719_The Beeches_V232788_140605_Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3,and 4 Prospective service users’ individual needs are assessed, and they know that they will be met. They visit and test drive the home, including getting to know the other people who live there. Service users’ safety is promoted through a satisfactory system of risk assessments. EVIDENCE: There have been no new admissions since the last inspection. However the inspector was satisfied that at the time of the previous placement, the service user and his family were informed about the home and the services provided within the home. A full assessment of his needs was carried out by professionals before the placement was offered to him. The service user had visited the home before moving in so that he could be sure it was the right place for him. His case file contained an assessment by his social worker as well as the home’s manager, of his needs and wishes. The manager had put together a plan of care setting out how this persons needs and wishes would be met by the home. She had also completed a risk assessment to ensure that any risks identified could be managed by the home. The Beeches G55_S0000028719_The Beeches_V232788_140605_Stage 4.doc Version 1.30 Page 10 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 standard(s) 6,7, & 9 Each service user has an individual care plan which outlines the service user’s needs and personal goals. Service users are consulted about their lives and encouraged to make independent decisions as far as possible. Appropriate risk assessments are in place for activities undertaken by the service users in order to promote their independence. EVIDENCE: As stated above, each service user has a care plan which outlines the service user’s individual needs and how these will be met. The inspector looked at the care plans for three service users living in the home and noted that each plan outlines their needs and how these are met. Service users spoken to said that they are given choices and asked by staff about what they would like to do on a daily basis, if they don’t already have an activity planned. The service users knew who their key workers were and said that they would talk to them or the manager if they had any problems. The Beeches G55_S0000028719_The Beeches_V232788_140605_Stage 4.doc Version 1.30 Page 11 There are comprehensive risk assessments for all the different activities that service users take part in and they are supported by staff to carry out their chosen activities, within this framework. Daily records showed that staff write what the service users have done daily which show that they aim to meet the service users needs on a daily basis. The individual plans of care for each service user would be improved by increasing further, the involvement of the service users and their relatives, so that these plans reflect as accurately as possible the needs and wishes of the service users themselves. Care staff in the home must review the care plans at least once a month and update these to reflect each service user’s changing needs. The Beeches G55_S0000028719_The Beeches_V232788_140605_Stage 4.doc Version 1.30 Page 12 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 standard(s) 11,12,13,14,16,and 17 Service users have opportunities for personal development and are able to take part in age and culturally appropriate activities. Service users are encouraged to engage in appropriate leisure activities within the local community. Their rights are respected and responsibilities are recognised in their daily lives by staff. The meals in this house are good, offering both choice and variety and cater for special dietary needs. EVIDENCE: The daily routine is set by the activities that the service users are engaged in which are outlined in the daily activity plan. The service users confirmed that they do activities that were listed on their activity plans. The staff also ensure that these routines promote individual choice and freedom of movement. One service user spoken to had a day off work and told the inspector where he works and what type of work he does in a cafeteria. He said he enjoys the work. The Beeches G55_S0000028719_The Beeches_V232788_140605_Stage 4.doc Version 1.30 Page 13 Service users also talked about going out to the pub, the cinema and restaurants as well as other outings with the staff and via club membership on a regular basis. They also talked about the recent holiday some of the service users had been to in Lanzarote. They also discussed a short break in Ireland which has been planned for next week. Most of the service users’ families are closely involved with them and their daily lives and therefore have a lot of input into what happens in the home. The families also take the service users out for day trips, weekend stays at home as well as on special occasions. Service users said they are asked the evening before to choose from the menu, what they would like to eat the following day. They often go out to buy those ingredients and then help the staff to prepare the meals. Special diets are also catered for. The Beeches G55_S0000028719_The Beeches_V232788_140605_Stage 4.doc Version 1.30 Page 14 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 standard(s) 18,19 & 20 Service users receive personal support in the way that they prefer and require. The daily records also show that the service users’ physical and emotional health needs are met appropriately within the home. Service users are protected by the homes policies and procedures for dealing with medicines. EVIDENCE: Through case tracking and inspection of daily records and a discussion with, staff and service users, the inspector was a satisfied that the service users’ health is adequately monitored and any problems identified are dealt with quickly. Each service user has a designated key worker, who ensures that they receive the support and advice they need quickly. On the day of the inspection, the deputy manager took a service user for a specialist appointment. A record is maintained of current medication for each service user and only staff who have received medication administration training are allowed to administer medication. On the day of the inspection two of the most recently appointed staff were receiving this training. They confirmed that they were not allowed to administer medication until they had received this training. None of the service users administer their own medication and they are risk assessed as not being competent to do so safely.
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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 standard(s) 22 and 23 The home has a satisfactory complaints policy and procedure which is also available in picture format. All the staff working in the home receive training in adult protection/abuse awareness to ensure a proper response for reporting any suspected or witnessed abuse. EVIDENCE: There is a written policy and procedure for the protection of vulnerable adults and all care staff receive abuse awareness training as part of their induction training. Further training courses are arranged for staff on an ongoing basis and the deputy manager stated that a number of staff had attended a training session on this subject a fortnight ago, held at another home. On the day of the inspection the two new staff spoken to had not yet done the full adult protection training however they confirmed that they had read the home’s policy and procedure as well as received some basic training from the deputy manager regarding this and would know the process to follow should an incident occur. The home has policies and procedures in place in relation to reporting and investigating complaints. Service users said they felt able to make complaints and raise issues if they need to. Examination of the complaints log showed that three complaints were recorded and appropriately dealt with. The staff and manager at the home work hard at sorting out problems before they become complaints and make sure that service users and their relatives feel confident that their complaints and concerns will be listened to and acted on. Service users said that their views are listened to. They said that they would tell their key worker or the manager if they had any problems. All complaints are recorded, as well as details of any investigations carried out. The Beeches G55_S0000028719_The Beeches_V232788_140605_Stage 4.doc Version 1.30 Page 16 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 standard(s) 24, 28 and 30 Service users live in a homely and comfortable environment. Shared spaces are spacious and sufficient for the numbers of people living in the home. The home is clean and hygienic. EVIDENCE: The house is in keeping with other properties on the street. A tour of the downstairs part of the premises showed that it is decorated and furnished in a homely manner. All of the service users spoken to said that they liked their rooms and were comfortable and safe in them. All parts of the home seen were clean and tidy. The Beeches G55_S0000028719_The Beeches_V232788_140605_Stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 34 and 35 All staff have job descriptions which clearly outline their roles and responsibilities. Staff are qualified, competent and sufficiently experienced to carry out their tasks. The home has a recruitment policy and procedure which is adhered to, ensuring that service users are safeguarded by a robust recruitment process. EVIDENCE: The home has a relatively stable staff team and only two new staff have been recruited since the last inspection. They confirmed that the home’s recruitment procedure had been followed when they were recruited. Staff records examined showed that following recruitment, they are required to attend induction training after which staff are continually encouraged to attend ongoing training. Staff stated that they receive a lot of support and supervision from the manager as well as their colleagues, enabling them to carry out their jobs efficiently. Service users spoken to said that staff are very kind and caring towards them. A number of staff have worked there for a number of years and have built up a good knowledge and understanding of the needs of each service user. Staffing levels were sufficient in order to ensure the service users’ needs continue to be met. The Beeches G55_S0000028719_The Beeches_V232788_140605_Stage 4.doc Version 1.30 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 42,43 Service users benefit from living at the Beeches because the home is run in their best interests. The home is good at making sure that the service users are kept safe whilst living at the Beeches. EVIDENCE: Feedback from both the service users and staff was positive about the way in which the home is run. The manager has been in post for a number of years and has the necessary qualifications and experience to run the home well by providing a safe environment and making sure that the health, safety and welfare of the service users are met by the staff working in the home. Staff spoken to said that theyd received a lot of support and encouragement from the manager and the deputy, which helps them to carry out their jobs competently. However, the inspector is concerned that monthly Regulation 26 visits are not being carried out by the responsible individual. These reports are necessary to demonstrate that the registered providers have in place a satisfactory system
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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 3 3 3 x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x 3 3 Standard No 31 32 33 34 35 36 Score x 3 x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Beeches Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 3 3 G55_S0000028719_The Beeches_V232788_140605_Stage 4.doc Version 1.30 Page 21 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 6 Regulation 15 Requirement The manager to ensure that all service user plans are reviewed and updated monthly in order to ensure that their changing needs are being met at all times. The registered person must ensure that the monthly monitoring by the Responsible Individual is carried out and the reports forwarded to the CSCI prompltly. Timescale for action 31/8/05 2. 39 26 31/7/05 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 6 Good Practice Recommendations The individual plans of care for each service user would be improved by increasing further, the involvement of the service users and their relatives, so that these plans reflect as accurately as possible the needs and wishes of the service users themselves. The Beeches G55_S0000028719_The Beeches_V232788_140605_Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford Essex IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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