Inspection on 17/11/08 for The Beeches

This inspection was carried out on 17th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Beeches 22/11/07

The Beeches 18/12/06

The Beeches 30/11/05

The Beeches 02/06/05

The Beeches 06/07/04

The Beeches 27/02/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Beeches The Frodingham Road Brandesburton Driffield East Riding Of Yorks YO25 8QY     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Eileen Engelmann     Date: 1 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Beeches The Frodingham Road Brandesburton Driffield East Riding Of Yorks YO25 8QY 01964542459 01262424563 jekcunning@btopenworld.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr John Charles Kunning Type of registration: Number of places registered: care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home The Beeches is a care home providing care and accommodation for up to 11 people under the age of sixty-five who have learning difficulties. The home is located on one of the exit roads from the village of Brandesburton, close to local amenities and within easy access of public transport. The home has been registered for a number of years and is a two-storey building. It was previously part of the local hospital for people with learning difficulties. There are 11 single rooms all without en-suite facilities, although one room has a shower. There are 4 toilets and 3 bathrooms available. The home has large gardens and is surrounded by open countryside. Car parking is available to the front and rear of the property. Information on the service can be found in the homes statement of purpose and service user guide. Copies of these are available from the manager on request. Information on fee levels for the service were not available on 11 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 34 Brief description of the care home the day of this inspection, however these can be obtained from the manager on request. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. At the time of this visit there was no registered manager in post. The acting manager has been working in the home since August 2008 and we have referred to this person as the manager throughout the text, for the purposes of this report. Information has been gathered from a number of different sources over the past 12 months since the service had its last key visit from the Commission for Social Care Inspection, this has been analysed and used with information from this visit to reach the outcomes of this report. Care Homes for Adults (18-65 years) Page 6 of 34 This unannounced visit was carried out over one day and took place with the manager, staff and people using the service. The visit included a tour of the premises, examination of staff and peoples files, and records relating to the service. Informal chats with staff and people living in the home took place during this visit; their comments have been included in this report. Questionnaires were sent out to a selection of people living in the home and staff. Their written response to these was adequate. We received 2 from staff (20 ) and 10 from people using the service (100 ). The manager completed an Annual Quality Assurance Assessment and returned this to us within the given timescale. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met by the service. However, the arrangements in place to develop the assessment information into a person centred care plan are not robust, and as a result people and families may not always have input to the development of the persons care plan. Evidence: Three peoples care and records were looked at as part of this visit, they each have been provided with a statement of terms and conditions/contract on admission and these are signed by the person or their representative. In each of the three care plans looked at during this visit there was a copy of the community care assessment and Local Authority care plan. Input from the Mental Health Team has also been recorded as part of the initial assessment process. Care Homes for Adults (18-65 years) Page 10 of 34 Evidence: Discussion with the manager indicates she is aware of the need to develop in-depth and specific care plans from the information gathered during the assessment process. At the moment the three care plans we looked at rely on the actual assessment documents to form the basis of the care plan format. The responsible individual must ensure that the home develops with each person using the service an individual plan based on the Care Management Assessment and care plan or the homes own needs assessment. This will ensure that people are involved in the care planning process, and have input into developing their own person centred care package to meet thier needs, wishes and choices. Information from the Annual Quality Assurance Assessment and discussion with the manager and people living in the home indicates that all of the people using the service are of White/British nationality. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. Staff members on duty were knowledgeable about the needs of each person they looked after and had a good understanding of the care given on a daily basis. Information from the peoples surveys showed that they were satisfied with the care they receive and have a good relationship with the staff. Two people who answered our suveys said I like living here and the staff are nice, and Its a nice home with nice staff and residents. Information from the training files and training matrix indicates that the majority of staff are up to date with their basic mandatory safe working practice training, and have access to a range of more specialised subjects that link to the needs of people using the service. Some individuals in the home have limited or no verbal communication skills but alternative methods, such as the use of Makaton and basic sign language, are used to good effect. Care Homes for Adults (18-65 years) Page 11 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system and the risk assessement process within the home are not satisfactory, and as a result staff may not be provided with the information they need to meet the needs of people using the service or recognise potential risks to peoples safety and well being. Evidence: Discussion with the manager indicated she is aware of the need to improve risk assessments and care plans to include person specific information linked to their individual needs. She told us that she plans to have an improved format completed for all people using the service by the end of April 2009. As part of this visit we looked at three peoples care plans in depth. Those looked at have not been developed from the information given by the assessment teams on admission, but rather use the assessments as the care plan. Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: The information within them showed that risk assessments are completed, but are basic and focus on keeping the person safe instead of being individualised or person centred. In one plan the Mental Health Team completed a risk management plan for challenging behaviour, this was done in 2007 and updated it in February 2008. There is no evidence that the care home staff have used the information to develop their own risk management plan or that it has been reviewed since February 2008. Staff are leaving gaps between their entries on the daily records, this is not acceptable practice and we spent some time discussing record keeping practices with the manager. She assured us she would speak to the staff as soon as possible about this. Reviews of care with the families, person living in the home and care co-ordinator from the local authority are taking place and minutes of these meetings are in the plans. Staff enable people to take responsible risks in their every day lives and have a good knowledge of which individuals have certain limitations on facilities, choice or human rights, to prevent harm to themselves or others. This information can be found within the care plans, but the quality of the risk assessments needs to be improved as discussed above. Talking to the people living in the home and watching them go about their daily business showed that some individuals find it relatively easy to maintain their independence and are able to make their choices and decisions known without a lot of input from the staff. Others require a lot more from the staff because of communication difficulties, physical support and assistance and this is managed well on a day-to-day basis. Care Homes for Adults (18-65 years) Page 13 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities within the home and community means that people who live in the home have the opportunity to maintain and develop their skills and participate in stimulating and motivating activities that meet their individual needs, wants and aspirations. Evidence: At the time of our visit in November 2008, one person was accessing Hull College three times a week and taking part in a Basic Skills course. Another individual was attending a local drama group and two individuals held down jobs with local companies. Discussion with the manager indicated that she encouraged people to take up outside interests and work opportunities, and used local networks such as Connections and Worklink to access these. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: Information from the care plans and talking to staff and people using the service indicates that while some people are fairly independant and able to use local transport services such as buses and taxis to go out and about in the community, others require assistance and support to access the community facilities. The local village has two public houses, a post office and a selection of small shops. People using the service go with staff to the nearby towns of Beverley and Driffield to do the homes shopping and visit larger retail outlets. People using the service have access to a range of social activities inside and outside of the home. One person is enrolled at a gym in Hornsea and the manager told us that she uses flexible staffing hours (bank staff) to take this individual to their classes. The home has recently employed an activities person to help develop the range of activities on offer within the home. This staff member ensures people get 1-1 time doing activities they enjoy and the activity hours are spread over morning, afternoon and evening times. Each person using the service has their own activity plan in their care file, showing what their interests are and what they want to do each week. For those who are fairly independent these plans are very detailed and show they get out every day, for those more dependant the activities provided still reflect their choices and decisions but are more limited. At the moment there are no church services in-house, but people can access the local Church of England and Methodist services in the village as and when they wish. People living in the home are encouraged to celebrate Christian festivals such as Christmas, Easter and Harvest Festival; birthdays are celebrated in different ways depending on the individuals wishes. Staff have accessed equality and diversity training through their NVQs and attended Mental Capacity Act sessions two weeks ago. However, the manager told us there is need to continue with more indepth training and development around the Disability Discrimination Act and other human rights legislation. Considerable importance is attached by the manager for people to have contact with members of their family. Where a person may not have had good contact on admission with their family, the manager and staff have made considerable efforts on the persons behalf to establish contact. Information in the care plans indicates that some individuals go to stay with their families on regular occassions, others recieve visits within the home and one person has their relative to stay in the home at Christmas and Easter. The people living in the home relate well to each other and the staff. The conversations between the people using the service and the staff were natural and Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: spontaneous, and it was evident that the people living in the home have a good sense of humour and enjoy a laugh and a joke with others. We were made welcome in the home and it was clear throughout our visit that people were interested in what we were doing and went out of their way to let us into their daily lives. Observation of the midday meal showed it was a relaxed occasion and people were encouraged to eat in the dining room. Individuals can select their favourite meals to appear on the monthly menus, through discussion at the regular resident meetings. From discussions with the staff and an examination of the records, it was evident that a reasonable balance has been achieved between healthy eating and the meals preferred by the people using the service. The activity organiser is doing baking sessions with some of the people living in the home and indiviudals are able to participate in the shopping for food and simple preparation tasks. There was no evidence, in the care plans looked at, of a nutritional assessment being completed for people using the service. Individuals are being weighed regularly and the manager told us she would contact a dietician if she had any concerns about an individuals eating/drinking needs. The home should complete a nutritional risk assessment for each person on admission, and review it on a regular basis. Care Homes for Adults (18-65 years) Page 16 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems for the administration of medication are not satisfactory, with temporary records not being kept in sufficient detail to ensure peoples medication needs are met and their health and well being is protected. Evidence: It was apparent from discussions with the staff and observation of the people using the service that people require primarily support and encouragement to do as much as possible for themselves. Whilst some individuals require some assistance with personal care such as bathing and washing, this is relatively low key and in the main consists of staff supervision and guidance. The staff are fully aware of the need to maintain peoples dignity and efforts are ongoing to achieve this whilst carrying out care tasks. When the manager updates the format of the care plans it is recommended that she ensures the plans contain details about individual wishes and routines so that peoples independence is supported and individuality is not lost. People who answered our surveys told us that they were able to make decisions about Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: what they do each day and everyone was satisfied that they could do what they wanted to during the day, evenings and weekends. The home is able to offer people a choice of staff gender for carrying out personal tasks, as the home employs three male care staff who do day and night duties. Discussion with the people living in the home indicates that they have no difficulties communicating with the staff and that they can express their preferences of staff gender for individuals giving their personal care. In general there was a very flexible approach to the peoples routines although they are expected to attend their work experience placements, college and external groups, and some individuals have small housekeeping duties to perform. Any agreements about household tasks are recorded in the persons care plan. People said that they have good access to their GPs, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Comments from the surveys indicate people are satisfied with the level of medical support given to the people living at the home. The homes medications are supplied by Boots pharmacy and are in a monitored doseage system. Discussion with the manager and checks of the training matrix indicates that only two staff have not completed any medication training (the manager said they did not administer medications) and the others have undergone a one day training course. It is recommended that all staff recieve accredited medication training and updates. Checks of the medication records showed that the majority of these are on printed medication administration record (MAR)sheets and are up to date and correct. However, the home had run out of spare MAR sheets and had written up a temporary record for one person on a sheet of paper. This temporary record did not have the persons name on it for the individual recieving the medication, the name of the medication was recorded but not the strenth, doseage or how often it was to be given and the record did not have any dates on it. This is not acceptable practice and must be stopped at once, as it could put people at risk of harm. The responsible individual must ensure that sufficient MAR records are in place and that accurate records are maintained for all medicines recieved, administered and leaving the home or disposed of, to ensure there is no mishandling. One persons medication had been hand written (transcribed) onto the medication sheets, as they had come in after the pharmacist had printed the records. We Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: recommend that where staff are writing in the details, there should be two staff signing the entry to indicate they have both witnessed that the information on the sheet (name of medication, strength and administration methods) is correct. Care Homes for Adults (18-65 years) Page 19 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that peoples views are listened to and acted upon. Evidence: The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is available in a normal print version and was not on display at the time of this visit (November 2008). It is recommended that the home consider providing the complaints format in versions that are appropriate for the people using the service such as picture format, large print or audio tape. It is also recommended that the policy is put on display in the home for easy access by people or visitors to the home. Those people who answered our surveys said they knew how to make a complaint, individuals said if they had any issues they would tell the staff, the manager, speak to my social worker or talk to the owners of the home. Checks of the records show that there have been no formal complaints made about the home or its service since the last key visit. There is a complaints form, which is available for use by anyone who wishes to raise any issues with the management team. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: The staff have all received training on the subject of safeguarding of adults (November 2008) that included the types and indications of abuse. The manager is booked onto this course for December 2008. Appropriate policies and procedures are in place in relation to the protection of the people using the service. Discussion with the people using the service indicates that they feel safe within the home and are confident that staff would help them if they had any concerns or problems. Checks of peoples finances found the records to be satisfactory and up to date, the staff ensure that people are supported to manage their monies and receipts of purchases and transactions are kept in individiual envelopes. Care Homes for Adults (18-65 years) Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people using the service are provided with a warm and safe environment, which offers them a comfortable and homely place to live in. Evidence: Walking around the home we found that the furnishings and fittings of the communal or shared areas, such as the lounge, dining room and kitchen, are domestic in nature and provide people with a comfortable environment in which to live. They are furnished and decorated to a good standard and are appropriate for the needs of the people living in the home. Discussion with the manager indicated that the chairs and settee in the downstairs lounge are to be replaced, with the new items expected to be delivered within the next two weeks. People living in the home are provided with two lounges, one upstairs and one down, a dining room, kitchen area and laundry room. There are eleven single rooms, non of which are en-suite, plus three communal bathroom and toilet facilities. There is no call system within the home, as the manager said all of the people living there are physically able to alert staff if they needed anything. It is recommended that the manager completes a risk assessment for each person as she updates the care Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: plans. Since the last visit in November 2007 all doors in the home have been fitted with automatic door closures. This was a requirement in the last report and is now met. Discussions during this visit indicate that people using the service are satisfied with the laundry service provided by the home. Infection control policies and procedures are in place, and staff have access to good supplies of aprons and gloves for use in personal care. The staffing matrix shown to us on November 17th 2008 indicated that staff are booked onto infection control training days in December 2008. Care Homes for Adults (18-65 years) Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Progress has been made to improve staffing levels in the home, induction practices and recruitment processes. As a result people are recieving more consistent care and standards within the service are getting better. Evidence: At our last visit in November 2007 a requirement was made that the registered person must ensure that staff recieve an induction into the home, which meets the Skills for Care requirements and that people are aware of their role. Checks at this visit found the requirement is met. At this visit we found that the East Riding of Yorkshire Council has been working with the home and has provided them with copies of its Induction Workbooks, which are aligned to Skills for Care. The manager is working through these with all members of staff, to provide a refresher for existing staff and a knowledge base for newer ones. At the last visit in November 2007 a requirement was made that the registered person must ensure that the home has an effective staff team, with sufficient numbers of staff to support peoples assessed needs at all times. We recognise this is an outstanding requirement from three previous reports, changes have been made in the last 12 Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: months to improve working conditions and the numbers of staff. The requirement is met. Since our last visit to the home an activities co-ordinator has been recruited to carry out 1-1 activities with individuals and free up time for other staff members to complete paperwork and care tasks. The activities person works three shifts a week during the day/evenings. Shift patterns within the home have altered to reduce the hours being worked by the staff, although the staffing rotas show staff continue to work a late shift, sleeping in shift and then an early shift. Information from the staffing rotas shows that one person is on long term sick and their duties are being covered by the existing staff, the manager and the owners (on occassion). Each shift has at least two people on duty, with additional hours provided by the activity person and the manager to give some flexibility to the system. However, it is important for the responsible individual to realise that the manager has a lot of work to do to improve the paperwork within the service. The numbers of staff on duty must be monitored on a regular basis to ensure the managers and activity persons hours are not swallowed up in covering sick leave, annual leave and gaps in the care staff hours. This will be looked at closely during our next visit to the service. At the last visit in November 2007 a requirement was made that the registered person must make sure that staff are correctly recruited and are suitable to work with vulnerable people. Two written references must be undertaken prior to employment. Checks at this visit found the requirement was met. We checked two staff files for newly recruited individuals and found that written references are obtained and satisfactory before the person starts work. We discussed with the manager the need to complete interview notes and equal opportunity paperwork to demonstrate that the home is following its policies and procedures around recruitment processes. One staff file we looked at had the safeguarding register check (POVA first) completed and the home was waiting for the Police check (CRB). Where individuals are starting work with just their POVA first check completed, ie where the home is waiting for the CRB check to come back, it is important that the member of staff is supervised at all times. Given that there is sometimes only two members of staff on duty at certain times of the day, the registered person must ensure there are sufficient staff members on duty when this person is at work to enable them to work with another staff member at all times. The only alternative is for the home to only start workers in post when their CRB is returned to the provider. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: At the last visit in November 2007 a requirement was made that the registered person must make sure that there is a staff training and development plan, which assists staff to update their skills and continue to meet the needs of the people living in the home. Checks at this visit show that this has been met. The manager has produced a training matrix showing the courses attended by each member of staff, however this matrix requires the date each person completed the training so that it is clear when updates and refresher courses are required. We were assured by the manager that this would be done immediately. At our last visit in November 2007 a requirement was made that the registered person must make sure that staff recieve appropriate training to update and improve thier skills in continuing to meet peoples needs. Checks of the staffing matrix at this visit show this requirement has been met. Staff have completed training around epilepsy and safeguarding of adults. First aid and infecton control sessions are booked for staff to attend in December 2008, and the manager is looking to source training around management of challenging behaviour. There is a rolling programme of mandatory safe working practice subjects and five members of staff (45 ) have achieved an NVQ 2 in care. Care Homes for Adults (18-65 years) Page 26 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are being made to the management processes within the service. This is resulting in better care for the people using the service and closer monitoring of the practises within the home means overall standards are getting better. Evidence: The home does not have a registered manager at the moment, and we advised that the home contact our registration team to have a new certificate of registration issued showing the managers position as vacant. There is an acting manager who has been in post since August 2008, this person has submitted their application to the Commission for Social Care Inspection to be registered as manager, and this is being processed. We have referred to the acting manager as the manager throughout this report. The manager has a degree in Social Working and experience of working in a care home setting for people with learning disabilities. The manager has also achieved their Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: Registered Managers Award. At our last visit to the home in November 2007 a requirement was made that The registered manager must make sure that there is a quality assurance system in use within the home, so that people in the home and stakeholders can be involved in the development of the home. Checks at this visit show that work is progressing towards meeting this requirement, but it will remain as a requirement on this report. The home does not have a formal Quality Assurance process in place, but is working with the East Riding of Yorkshire Council to achieve this. Discussion with the manager indicated that she has started to send out surveys to people using the service and their relatives; the collation of the most recent responses is currently underway. As part of her work to improve the standards of care and service the manager has undertaken a number of audits around care plans, training, furnishings and complaints. However, it is important that she documents the findings and outcomes of her audits as part of the quality assurance process. During this visit we discussed the need for the manager to produce an annual development report as part of the quality assurance process to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. At our last visit to the home in November 2007 a requirement was made that the registered manager must make sure that they provide the CSCI with the required information regarding incidents in the home. This must be completed within an appropriate timescale and meet the requirements of Regulation 37 of the Care Home Regulations 2001. Checks at this visit found the requirement to be met. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has started to complete generic risk assessments for a safe environment within the home. Care Homes for Adults (18-65 years) Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 39 24 The registered manager 22/12/2007 must make sure that there is a quality assurance system in use within the home so that people in the home and stakeholders can be involved in the development of the home. Care Homes for Adults (18-65 years) Page 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 15 The responsible individual 02/03/2009 must ensure that the home develops with each person using the service an individual plan based on the Care Management Assessment and care plan or the homes own needs assessment. This will ensure that people are involved in the care planning process, and have input into developing their own person centred care package to meet thier needs, wishes and choices. The manager must ensure 02/03/2009 that she develops and agrees with each person an individual plan, generated from the single Care Management Assessment/Care Plan or the homes own assessment, and covers all aspects of personal and social support 2 6 14 Care Homes for Adults (18-65 years) Page 30 of 34 and healthcare needs as set out in Standard 2. So that people using the service recieve person centred care which meets their needs and reflects their choices, wishes and decisions about thier care. 3 9 13 The manager must ensure 02/03/2009 that the risk assessment process is robust and that action is taken to minimize identified risks and hazards. Risk management strategies must be agreed, recorded in the individual plan and reviewed. So that staff can support and enable people using the service to take responsible risks, based on good information and decision making. 4 20 13 The responsible individual must ensure that accurate records are maintained for all medicines recieved, administered and leaving the home or disposed of, to ensure there is no mishandling. So that peoples medication needs are met and their health and well being is protected and promoted. 5 34 19 The responsible person must 02/03/2009 operate a thorough recruitment procedure based on equal opportunities and 02/03/2009 Care Homes for Adults (18-65 years) Page 31 of 34 ensuring the protection of people using the service. So that people using the service can be confident that the home recognises the importance of effective recruitment procedures in the delivery of good quality services and the protection of individuals. 6 39 24 The responsible person must 06/04/2009 make sure that there is an effective quality assurance system in use within the home, based on seeking the views of people using the service and which measures success in achieving the aims, objectives and statement of purpose of the home. So that people and stakeholders can be involved in the development of the service and the home can idenitfy any shortfalls in the service and take action to make improvements. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 The manager should ensure that staff are given training and support around record keeping, care planning and risk assessment/management processes. The manager should ensure that staff have access to training around equality/diversity and other human rights legislation, which will raise their awareness of peoples rights in the home and out in the community. 2 13 Care Homes for Adults (18-65 years) Page 32 of 34 3 17 The manager should ensure that every person coming into the home has a nutritional risk assessment completed and that this is reviewed on a regular basis, including risk factors associated with low weight, obesity and eating or drinking disorders. The manager should make sure, when she updates the format of the care plans, that each plan contain details about the individuals wishes and routines so that peoples independence is supported and individuality is not lost. The manager should ensure that all staff who handle medications undergo accredited medication training. The manager should ensure that where staff are transcribing medication, there should be two staff signing the entry to indicate they have both witnessed that the information on the sheet (name of medication, strength and administration methods) is correct. The manager should consider putting the complaints policy on display in the home for easy access by people or visitors to the home. The home should consider providing the complaints format in versions that are appropriate for the people using the service such as picture format, large print or audio tape. The manager should complete risk assessments, round the lack of a call system within the home, for each person as part of her review of the care plan and risk assessment processes. The responsible person should monitor the staffing levels on a regular basis and adjust the staffing levels as needed. This will ensure there are sufficient people on duty at all times to meet the needs of the people using the service and the day to day running of the home. The responsible person should ensure there are sufficient staff on duty to be able to supervise the practise of any staff member who is still waiting for their CRB to be returned and who has had a satisfactory POVA first completed. 4 18 5 6 20 20 7 22 8 22 9 24 10 33 11 34 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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