Inspection on 30/11/05 for The Beeches

This inspection was carried out on 30th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Beeches 17/11/08

The Beeches 22/11/07

The Beeches 18/12/06

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 08/07/2008.

CARE HOME ADULTS 18-65 Beeches The Frodingham Road Brandesburton Driffield East Riding Of Yorks YO25 8QY Lead Inspector Karen Ritson Unannounced Inspection 09:30 30 November 2005 th Beeches The DS0000019735.V267373.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 Beeches The DS0000019735.V267373.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. Beeches The DS0000019735.V267373.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Beeches The Address Frodingham Road Brandesburton Driffield East Riding Of Yorks YO25 8QY 01964 542459 01262 424563 jekcunning@btopenworld.com 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) Mr John Charles Kunning Susan Melvin Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Beeches The DS0000019735.V267373.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th January 2005 Brief Description of the Service: 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 Brandsburton. It is close to local amenities and within easy access to 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. One room has a shower. There are 4 toilets and 3 bathrooms available. The home has a good sized garden and is surrounded by countryside. There are car parks at the front and rear of the property. Beeches The DS0000019735.V267373.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 30th November 2005. The manager was available throughout the inspection, which took nine hours to complete including preparation time and time for writing the report. Four service users were spoken to and all made positive comments about their care. Their comments are detailed in the main report. There was a friendly informal atmosphere throughout the inspection, with staff and service users being happy to talk with the inspector. What the service does well: What has improved since the last inspection? What they could do better: 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. Beeches The DS0000019735.V267373.R01.S.doc Version 5.0 Page 6 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 Beeches The DS0000019735.V267373.R01.S.doc Version 5.0 Page 7 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): None of the above standards were assessed on this occasion. EVIDENCE: Beeches The DS0000019735.V267373.R01.S.doc Version 5.0 Page 8 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): 6,7 and 9 Service users know their needs and personal goals are reflected in the care plan. EVIDENCE: Service users have a plan of care which covers all required areas and is kept under review. Service users, keyworkers and any involved third parties sign the plan. The service user who receives one to one funding now has all these extra funded hours recorded separately. This service user signs agreement regarding the time spent on a one to one basis. All day to day activities are recorded in file notes and these are cross-referenced with the chosen interests and wishes of each individual. Risk assessments are included in care plans and service users said they were assisted to take part in all chosen activities with restrictions where appropriate. Beeches The DS0000019735.V267373.R01.S.doc Version 5.0 Page 9 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): 12 and 17 Service users’ social and cultural needs are met. EVIDENCE: Service users said they were able to take part in activities they enjoyed, such as horse riding, shopping, going out to the pub or swimming. Staffing is in place to allow service users to be accompanied to their chosen activities. Service users also said they enjoyed the meals and were involved in planning. None of the service users have a specialist diet, but all are following a healthy eating plan. Beeches The DS0000019735.V267373.R01.S.doc Version 5.0 Page 10 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): 20. Service users are protected by the homes policy and procedure on medication. EVIDENCE: The medication policy has been amended to include the procedure for non compliance. Beeches The DS0000019735.V267373.R01.S.doc Version 5.0 Page 11 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): Neither of these standards was assessed on this occasion. EVIDENCE: Beeches The DS0000019735.V267373.R01.S.doc Version 5.0 Page 12 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): 24 Service users live in a homely, safe environment, but kitchen cupboards must be replaced. EVIDENCE: The kitchen units that needed to be replaced at the last inspection had still not been replaced at this inspection, however, the homes’ action plan following the inspection informed CSCI that the units had now been replaced. The home is well decorated and homely. A working kitchen for residents is planned in the near future. Redecoration of a service users room was taking place on the day of inspection. The hallway and two bedrooms have been redecorated since the last inspection. Fire alarm and emergency lighting checks are now regularly completed. Beeches The DS0000019735.V267373.R01.S.doc Version 5.0 Page 13 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): 32,33,34,35 and 36 Service users are potentially not fully supported due to insufficient staff recruitment and the homes’ methods for recording training of staff and supervision. EVIDENCE: Over 50 of staff are now working towards NVQ level 2 in care. Although the home covers all shifts, more staff are required and existing staff are covering extra shifts. The manager said that she had attempted to recruit suitable staff but had so far not been successful. The existing staff said they could cover shifts without working excessive hours as some were on part time contracts but were working full time. Service users said they were not restricted over what they could do because of staff shortages. Staff recruitment must be a priority. Staff receive TOPSS induction and foundation training, however, these records need to be updated. Staff supervision notes were seen. Supervision is regular but notes are not very detailed. Staff said they could talk to the manager at any time and that much supervision was informal according to need. A template may help the manager cover all required supervision areas. Existing staff have been suitably recruited. Beeches The DS0000019735.V267373.R01.S.doc Version 5.0 Page 14 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): 39. Service user views inform practice within the home. EVIDENCE: The home carries out six monthly quality assurance audits, where service users and other third parties are surveyed and the results fed back to staff and service users. Service users said they had a say regarding how things were run at the home and that there were regular times when they could air their views about what could be improved. Beeches The DS0000019735.V267373.R01.S.doc Version 5.0 Page 15 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 X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 2 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Beeches The Score X X 3 X Standard No 37 38 39 40 41 42 43 Score X X 3 X X X X DS0000019735.V267373.R01.S.doc Version 5.0 Page 16 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 28/02/06 1. YA33 18 (1)(a) The registered person must ensure that the home has an effective staff team, with sufficient numbers and complimentary skills to support service users assessed needs at all times. (Previous requirement - timescale 1/05/05 - not met timescale 31/07/05 not met.). Beeches The DS0000019735.V267373.R01.S.doc Version 5.0 Page 17 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard YA32 YA35 Good Practice Recommendations 2. 3. 3 YA36 50 of care staff should have achieved an NVQ 2 qualification by the end of 2005. The registered person should ensure staff working in learning disabilities service use the Learning Disability Award Framework - accredited training to provide underpinning knowledge for progress towards achieving Nova’s. All recording must be up to date. (Previous requirement - timescale 1/05/05 - not met). Staff supervision notes should be more detailed. Beeches The DS0000019735.V267373.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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