Inspection on 01/11/07 for Beeches (The) (Seven Kings)

This inspection was carried out on 1st November 2007.

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

Other inspections for this house

Beeches (The) (Seven Kings) 30/05/07

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Beeches (The) (Seven Kings) 45 Norfolk Road Seven kings Ilford Essex IG3 8LH Lead Inspector Ms Harina Morzeria Unannounced Inspection 1st November 2007 10:00 Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beeches (The) (Seven Kings) Address 45 Norfolk Road Seven kings Ilford Essex IG3 8LH 020 8590 4340 020 8590 4340 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) Tealk Services Ltd Manager not yet registered with CSCI Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 10 adults (MD) Mental Disorder with associated Mild Learning Disabilities. 30th May 2007 Date of last inspection Brief Description of the Service: The Beeches (Seven Kings) is a care home registered to provide personal care and accommodation for individuals between ages 18-65 with a history of mental illness, who need support in order to live in the community. The home is located on a residential street in Ilford and is close to all community facilities. These include a wide range of shops, pubs, the post office, town centre and parks. The Beeches consists of ten single bedrooms, three of which are located on the ground floor. Access to the first floor is via stairs. There are two reception rooms on the ground floor, one of which is used as a dining/lounge area, for relaxation and viewing television. The second room is mainly used by service users who smoke. A rear garden with a patio area is being constructed with a large room at the back of the garden for service users to use as an activities area when it is completed. It is easily accessible from the kitchen and smoking area. A group of staff are on hand to provide twenty-four hour care and support to service users. A statement of purpose is made available to all service users and/or their relatives in the home and each individual is provided with a service user guide. Fees are charged at £750.00 - £1000.00 per week. Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit was the second key inspection of this home, following a first inspection in May 2007. This visit took place on 1st November 2007 and lasted for six hours. The provider has appointed a manager who is not yet registered with the CSCI. Hence, the acting manager, staff and three of the service users were briefly spoken to. All areas of the house were seen. Staff, care and other records were checked. Care staff were asked about the care that service users receive, and were also observed carrying out their duties. Feedback surveys were sent to the service users, relatives and staff and a good response was received from the staff and two service users. The inspector contacted two social workers to seek feedback but no response was received at the time of writing this report. What the service does well: What has improved since the last inspection? The requirements made at the previous inspection have now been met. New service users are admitted only on the basis of a full assessment undertaken by a person competent to do so, taking into account any specialist needs and risks that may be posed to others living in the home. The home can demonstrate capacity to meet the assessed/ specialist needs of the individuals in a safe environment. Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 6 An individual care plan is drawn up in consultation with each service user detailing how the service user’s needs in respect of his/her health and welfare are to be met. The care plans are reviewed and updated as required in line with the National Minimum Standards for Care Homes for Younger Adults. Each care plan includes a comprehensive risk assessment which is reviewed regularly. Rules on smoking, alcohol and drugs are stated in the contract. Service users have varied and balanced meals at flexible times with full access to the kitchen at all reasonable times. Medication training for staff was arranged which was specifically targeted to deal with service users with mental health needs. Training was provided to the staff group regarding medication interactions and reactions as well as side effects of many of the anti psychotic drugs taken by service users with mental health needs. All staff have received safeguarding adults training in order to ensure that there is a proper response to any suspicion or allegation of abuse. The homes premises are suitable for its stated purpose, accessible, safe and well maintained to meet service users’ individual and collective needs. Sufficient and suitably qualified/ competent staff are employed in the home at all times to maintain the health, safety and welfare of service users. All staff have attended mental health awareness training in order to equip them to understand and meet the needs of the people they are caring for. Staff have the skills and competencies to care for the particular group of people they look after. Further training regarding food hygiene and drug awareness has been provided. A suitably qualified, competent and experienced person has been employed to run the home to meet its stated purpose, aims and objectives. The manager is in the process of applying to be registered with the Commission’s registration team. Systems are in place to ensure that there is routine monitoring of the service by the proprietor. A lone working risk assessment has been undertaken in order to protect staff and service users when staff are working alone. Serious deficiencies noted at the time of the first inspection, relating to admission assessments, care planning and safeguarding have now been adequately addressed. Improvements have been noted in all aspects of service delivery, since the last inspection. However, the Commission would want to see evidence of sustained improvement before awarding a category of good, in personal and health care support, concerns, complaints and protection, staffing, and conduct and management of the home. What they could do better: Records must be kept of all medicines received, administered and leaving the home or disposed of in order to ensure that there is no mishandling. Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 7 The registered person must operate a thorough recruitment procedure in order to ensure the protection of service users. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have information, which they could rely on in making a decision to live at The Beeches (Seven Kings). The process of assessment is now more robust so that people who use the service are assured that their needs would be thoroughly assessed and know that the home they enter will be able to meet their needs. Service users have the benefit of a statement of terms and conditions/contract which details the obligations of the registered persons in meeting their needs. EVIDENCE: Service users have access to information through the home’s Statement of Purpose and Service User Guide. The Service User Guide is in a format that is suitable to the service user group and provides an option for conversion to larger prints or alternative languages upon request. The home provides long-term placements to people with serious and enduring mental health problems, who are subject to the care programme approach(CPA). Hence, mental health professionals, such as community psychiatric nurses and specialist social workers continue to remain involved. Only one service user has been admitted into the home since the last inspection. There was evidence that the service user’s needs were assessed by Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 10 the manager over a long period if time and this process began prior to admission to the home. A preliminary assessment is undertaken just prior to admission and during the course of their initial stay a secondary assessment of need is undertaken. The findings from these assessments feeds into a transitional service user plan. As part of the admission process assessment information is gathered from the referring agency as required by Regulation. The manager carried out the assessment for the admission of this service user. A thorough sharing and examination of information of the person’s past history was undertaken and the impact of this person’s admission into the home and on the other service users was considered. The inspector was informed that a clinical consultant will also be employed in the near future, and will be involved in the initial assessment process for each new service user and guide the team when any information is required or any issues arise with any service user. Evidence was seen when tracking the service user’s file, that a long and gradual introductory process took place enabling her to have a gradual transfer into the home from her previous placement from hospital. This inspection identified significant improvement in the process of admission and assessment. Each service user has a signed contract setting out the obligations of the provider and the service user and this included details of a trial stay. This document outlines the obligations of the registered provider as well some of the key rights of the service user. Service users sign their statement of terms and conditions, along with the registered manager and this confirms acceptance of the document by both parties. On the basis of this first admission the following the previous inspection, the procedure is considered satisfactory. However, evidence of sustained improvement is required before the outcome can be confirmed as good. Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each service user has a care plan which is detailed and tailored to meet individual needs. Service users are consulted and involved in decisions affecting their lives and are reassured that information held on them is handled in line with the home’s policy on confidentiality. Service users are involved in negotiating their daily routines and objectives and are encouraged to live life to their full potential subject to a risk assessment. EVIDENCE: At the time of the inspection, three service users were accomodated in the home and only one was newly admitted. All three service user plans were checked by the inspector. An initial assessment is carried out by the manager following a referral and another assessment of need is undertaken during the Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 12 introductory period. The findings from these assessments feed into a transitional service user plan which is transformed in here to a detailed care plan once the trial period for each individual is over. All the service users are subject to the Care Programme Approach and have appropriate professionals involved in their future care. Through discussion, the inspector was satisfied that the staff were aware of the service users’ individual needs and were ensuring that they provided appropriate care to each individual, which is reflected in an individualised care plan. The care plans examined for the three people using the service are individualised and person centred, based on each person’s specific needs, outlining how these will be met by staff. The care plans give details of how each person likes and needs to be supported. There was evidence to show that the service users have been involved in the development of their care plans. For example, for one person a number of areas were identified in the care plan but the service user and her key- worker had selected two of the most important areas that the person wanted to achieve /work on first which were managing finances and weight management. Evidence was seen of one to one discussions held with the service users showing that staff work consistently with the service users to achieve their goals. Evidence was seen that for the most recently admitted service user, the care plan describes the person’s behaviours, why they may exhibit these behaviours and what to do if they have a mental health breakdown. This will ensure that all staff have correct and full information about individuals and how to work with them. As stated above a transitional service user plan is drawn up, upon placement which is then compiled into an individual plan after the trial period is over. Evidence was seen that one service user was appropriately assessed and admitted into the home since the last inspection. This person was admitted into the home two days prior to this inspection and a transitional care plan was in place for her. One other service had a comprehensive care plan in place which shows what they can do and what they like and included her goals as well as specific ways of working with her. The manager and key worker aim to review service user plans monthly, three monthly and six monthly. Evidence of initial reviews taking place was seen during case tracking. The care plan for one other person is due to be reviewed and updated. The service users spoken to on the day of the inspection said that they are given good support from the staff in making decisions about their lives. The service users are involved and consulted on various aspects of life in the home. Evidence was seen of service user meetings planned, however only some meetings are attended but others do not always take place as service users are not always willing to attend the meetings. Informal ways of seeking people’s views are used such as during outings or when undertaking activities in the home. Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 13 Suggestions are sought about activities, furnishings, menus and health and safety. Service users also express their views informally and in key-worker sessions. For example, a service user likes karaoke which was arranged inhouse, another service user likes playing board games which were purchased for her and staff were seen to play with her. DVDs and music tapes have been bought for them as well. On the day of the inspection, the inspector, noted that one person really enjoyed the one to one interaction with the staff member whilst playing a board game. Service users also express their views informally and in key worker sessions. Risk assessments are carried out in discussion with service users and relevant specialists. These are recorded in the individual plan. These identify risks for the service users and indicate ways in which the risks can be reduced. The inspector was informed that all known risks have been risk assessed and evidence was seen on file that risk assessments are in place. The manager was in the process of reviewing a risk assessment for one service user and update it. This would ensure that staff are fully aware of the risks posed by individuals living in the home and what action will be required to minimise identified risks and hazards, enabling all service users to lead independent and safe lives. There is a policy in place in the event of a person going missing from the home and staff spoken to were aware of it. Service users’ records and other information is stored in a lockable cabinet in the office and staff are aware of issues of confidentiality. On the basis of this first admission following the previous inspection, the procedure is considered satisfactory. However, evidence of sustained improvement is required before the outcome can be confirmed as good. Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities for social and leisure pursuits and personal development are actively promoted and supported by staff for all service users to enable them to participate in the wider community in which they live. Service users are provided with varied and nutritional meals, staff promote healthy eating and individual preferences are catered for. Visitors are made to feel welcome in the home and service users are supported to maintain and establish family links and friendships. EVIDENCE: Service users have access to a range of leisure activities and staff were seen to work hard to motivate people to become involved in their chosen activities. An activities room is being built at the back of the garden area and when ready, will be used for in house activities. Currently all the service users are independent, choosing to carry out their own activities. They all have leisure passes which they can use to access recreational and fitness facilities. One of Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 15 the service users spoken to stated that she enjoyed attending the day centre as well as going out to the cinema, restaurants, karaoke. All the service users’ have individual activity plans, for example, one service user has enrolled back at university to complete his degree in computer science at Goldsmith University. This has resulted from a consistent approach by staff to encourage him to comply with his medication which in turn has stabilised his mental health condition resulting in him in having the motivation to go back to studying. He goes to university independently. One other person has chosen to enroll at college on a food hygiene training course and also attends a local day centre. The most recently admitted service user does not enjoy going out, preferring to stick to a regime indoors and enjoys playing board games which have been obtained for her. The inspector was informed that the person is still settling in and a suitable activities programme will be compiled with her when she is ready. The routines for daily living are flexible and the service users can make choices in major areas of their life. The routines, activities and plans are individually focused and can be quickly changed to meet the individuals changing moods, needs, choices and wishes. The manager and staff are aware of and actively promote the rights of the service users to make informed choices, providing links to specialist support when needed. This includes developing and maintaining family and personal relationships. Family and friends are welcomed and their involvement in daily routines and activities is encouraged with the service users’ agreement. The service users are offered a key to their own bedroom which can be locked from inside and outside. The key to the front door of the home is offered subject to a risk assessment. At the time of inspection none of the service users had the front door key but did have the keys to their own rooms. A community risk assessment is in place and staff interact with service users constantly so that they are aware of the risks to service users when out in the community and are aware of the company they keep so that they can be given appropriate to advice when going out. Each service user has responsibilities for their personal space as well as making a contribution to a communal activity, which is agreed with them. As part of promoting their rights, service users have access to advocacy services, and they are given advice about how to access these services. The service users also have social workers and families who can advocate on their behalf. They are also aware that they can have access to independent advocacy services if they wish to contact them. Staff prepare and cook meals with involvement from the service users and the menu for the week ahead is discussed at the weekend. However, the menu is very flexible as most of the service users change their minds on the day and are therefore offered alternatives. One of the service users is vegetarian and is supported to shop for Asian vegetarian food items and encouraged to prepare it by the manager and the staff so that her dietary needs can be met appropriately. Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 16 The kitchen is accessible to the service users at all times and appropriate food stocks are purchased with the involvement of the service users. They accompany staff to do the shopping. Service users can choose when and where to eat but usually eat in the dining area. Most of the staff now involved in handling food have completed food hygiene training to promote the health and safety of the service users. Advice was given the manager to ensure that all staff whether full or part-time or agency to complete the basic training including food hygiene. Visitors are encouraged to visit at any reasonable time and are encouraged to see their relative/friend in the lounge or another room in privacy. Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 20 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are prompted and encouraged to take responsibility for their own personal care. The service users’ physical and emotional health care needs are monitored and this ensures that service users’ needs are recognised and met. The medication policies and procedures are clear. Staff have undertaken medication training in order to ensure the safety of the service users. EVIDENCE: Service users receive personal support in a way they prefer, with encouragement provided to enable them to carry out their own personal support tasks in a way that maintains their independence, privacy and dignity. Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 18 There was evidence that service users’ needs, based on assessments, were recorded and they were carried out to promote their health, safety and welfare. Staff have completed some training in working with people with mental health issues and are therefore able to observe changes in the general and specific healthcare needs of service users and make interventions as appropriate to ensure their health and safety needs are met appropriately. Staff have now received specific mental health training in order to recognise and deal with mental health breakdown. The service users were all registered with a GP and records seen indicated that they had input from other health professionals such as the dentist, chiropodist and the opticians. One of the service users has indicated that he wishes to be engaged with the drug rehabilitation team but this referral is in the early planning stages and will be forwarded when the service user is ready to engage with the professionals. The manager stated that as far as possible service users are given the opportunity to independently attend their appointments, as part of taking responsibility for their own healthcare. However, at the time of the inspection all three service users required support from staff to attend any health care appointments. Records were maintained where service users attended health related and professional appointments. Service users may see professionals privately in their rooms or in one of the offices at The Beeches. A medication policy and procedure are in place. Medication records are completed, contain required entries and are signed by appropriate staff. Staff handling medication, have had training in the handling and administration of medication, with further training specifically targeted to deal with service users with mental health needs and includes specific training regarding medication interactions and reactions as well as side effects of many of the anti psychotic drugs taken by service users with mental health needs. Medication storage was satisfactory as was the recording of drugs administered by staff. However, the inspector noted that PRN medication for one service user was found to contain seven less tablets which were not accounted for in the MAR chart. The manager must ensure that accurate records are kept of all medicines received, administered and leaving the home or disposed of in order to ensure that there is no mishandling. Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People who use the 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 manager and staff make every effort to sort out any problems or concerns and make sure that the service users feel confident that their complaints and concerns are listened to and will be acted upon. Staff working in the home have received training in safeguarding adults in order to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has policies and procedures for dealing with complaints. The complaints log was examined and no complaints have been recorded since the last inspection. The complaints procedure is that all complaints verbal and written, would be recorded with details of investigation, any action taken and the outcome for the complainant. Two service users spoken to about what they would do if they were unhappy with anything, said that they would speak to the manager or their key worker. The complaints policy is displayed in each room and the corridors, with information about how to contact the Commission, if the complainant remains dissatisfied with the outcome of any investigation. Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 20 There is a written policy and procedure for dealing with allegations of abuse and whistle blowing. Staff, as part of their induction are taken through the adult protection guidelines of the home and a copy of all the relevant Local Authority Adult Protection protocols is kept in the home for the guidance of staff. All staff working in the home have now received training in safeguarding adults and staff spoken to were aware of the action to be taken if there were concerns about the welfare and safety of service users in order to ensure that there is a correct response to any suspicion or allegation of abuse. The inspector was able to establish in discussion with staff that during the training provided discussions were held with the staff team about their duty to balance the rights and choices of people living in the home, with a legal duty to safeguard and protect service users. Following a safeguarding adults alert earlier in the year, the registered person has demonstrated improved practice in relation to safeguarding people who live at The Beeches. There have been no further complaints or allegations drawn to the attention of the Commission. Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25,26,27,28,29,30 People who use the 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 provides a comfortable environment for service users, with wellmaintained communal spaces. Service users bedrooms are suited to individual tastes/preferences and promote their independence. The décor, furnishings and fittings in the home are of a good standard and the home is clean and hygienic. EVIDENCE: The home was newly registered in January 2007 and has been altered to provide spacious facilities with all furnishings and fittings in place. On the day of the visit the home was clean, tidy and in good decorative order. Service users contribute to the maintenance of some aspects of the communal areas as well as their private spaces. Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 22 Only three service users were accommodated at the time of the inspection. The inspector noted that eight rooms have en-suite facilities and two service users will share a bathroom/toilet which is located upstairs between two rooms. One service user showed her room to the inspector which had not yet been personalised as she had recently moved into the home from hospital. She and her family have been made aware that the room can be personalised. The inspector was also able to see other unoccupied rooms which are in good decorative order. All bedrooms are lockable and have lockable space for the storage of valuables. A good standard of cleanliness was found in all parts of the home. Laundry facilities were satisfactory and policies for the control of infection were in place. Service users are involved in doing their laundry as part of maintaining their independent living skills and most were quite happy with this. Hand washing facilities were appropriately placed throughout the home and the services and facilities complied with the Water Supply Regulations. In order for the home to be registered the premises underwent a thorough check from all relevant authorities and met the requirements of the local fire service and environmental health department, health and safety and building Regulations. None of the service users currently accomodated need any specialist equipment at present. An exterior building has been built to provide additional space for leisure facilities. The building was almost ready at the time of this inspection however it is yet to be decorated and equipped before it can be used for its stated purpose. A large decking area has also been converted for the service users which can be used during fine weather. Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive care and support from a committed and motivated staff team. The staff team are receiving training that is appropriate to the needs of service users. Staffing levels are adequate to meet the individual needs of the service users at all times. The procedures for the recruitment of staff must be robust in order to provide safeguards for people living in the home. EVIDENCE: It was clear from the interviews and informal discussions held with staff that they were motivated and committed to the service user group. A basic requirement during recruitment is that staff have achieved NVQ level 2 qualification. Hence all the staff have NVQ Level 2 qualifications and two staff have been referred to go on NVQ Level 3 courses from October 2007. From interviews and discussions held with staff, it was clear that they had a good understanding of the needs of service users. The staff confirmed that Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 24 they were provided with training that was specific to meet the needs of the service user group they are looking after e.g. managing challenging behaviour and mental health awareness. Hence, they have an understanding of mental health issues in relation to the diagnosis and the needs of service users currently accommodated in the home. The registered manager stated that as part of the home’s development plan they are seeking to appoint a clinical consultant to provide support and guidance to the staff group when dealing with specific mental health issues. It is envisaged that this person will also be involved in the initial assessment process as and when needed. Staff have also now received training regarding drug use and its effects and interactions, particularly with prescribed medication so that they can better understand the needs of service users. Staff have been making contacts with external professionals as and when the need arose in order to ensure that service users get specific support when they most need it. The normal pattern of cover is for two people on both the early and late shifts, including the manager on the early shift. The manager informed the inspector that when he is out at meetings or doing assessments, a second member of staff is scheduled to cover the shift, ensuring that there are always two people on duty at any time. At the time of inspection night cover was provided by one person doing waking nights, and one person sleeping in as the number of people accommodated has been reduced to nine, to allow for one bedroom to be used for staff accommodation. The manager is aware that staffing levels must be kept under review and increased as the number of service users accomodated in the home increases. A lone person working risk assessment has been carried out and staff are aware of actions to take in an emergency when working alone. This must always be kept under review as differing situations may arise needing different reactions from the staff team. Staff have now completed food hygiene and safeguarding adults training. Agency staff employed in the home have also done this training. All staff have a copy of their job description and were clear of their role in providing care and support to service users. Staff interviewed confirmed that they were in receipt of a statement of their terms and conditions. Most of the recruitment files seen contained all the requirements of Schedule 2 of the Care Homes Regulations 2001. However, there were two files in which a second reference was not on the file. The manager is required to comply with the Regulations stated in the above Schedule when recruiting staff, in order to safeguard people accommodated in the home. This must be carried out without undue delay to ensure compliance with Regulations. There is a programme of individual supervision. Staff spoken to indicated that the sessions held, were both useful and regular. Supervision covers philosophy of care, care practice and training and development. This meets the minimum requirements of this standard, and staff are able to informally meet with the Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 25 manager as he makes himself accessible to them. They also use the team meetings which are held regularly as another way gaining support. The manager demonstrated a good understanding of equality and diversity issues throughout the recruitment, induction and training process. A range of staff from different ethnic backgrounds work in the home. The daily records are now reflective of discussions held with service users and how staff are progressing with the individual care plans. Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a home which is well-run and are supported by a manager who is experienced but not yet registered with the Commission. Service users’ rights and best interests are safeguarded by the home’s recordkeeping policies and procedures. Service users’ and staff health, safety and welfare are adequately promoted and protected. EVIDENCE: A manager has been employed by the provider who is experienced. The manager has yet to be registered with the CSCI by the Commission’s Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 27 Registration team and has applied for this. He has experience of working as a manager in a care home for over six years and has worked in the care field for over twenty years. The manager informed the inspector that he is applying to complete/achieve a certificate in mental health training level 3. The manager is supported by the operations manager and the provider to run the home. Service users and staff commented that the manager and operations manager always make themselves available and deal with any issues to the best of their ability. There is a quality assurance policy and procedure in place, which would include seeking the views of the service users regularly via holding the service user meetings. Quality assurance survey questionnaires are in place and these will be undertaken once the home has been operational for approximately a year. The proprietor checks the quality of care in the home through monthly Regulation 26 monitoring visits. These reports were made available to the inspector. The home’s standardised policy and procedures files is available and staff are required to read and sign these on a regular basis. There is a clear organisational structure that is available to staff, service users and their relatives. The operations manager supervises the registered manager and this is in line with regulation. Checks show that the home’s records were found to be up to date and secure with confidential files stored in locked cabinets. A range of records were looked at including fire safety. There was evidence that actions were taken to promote the health and safety of service users and this included staff training in health and safety and individual training records reflect this, safety signage, fire drills and procedures, risk assessments on safe working practice topics, fire training for staff and the maintenance of updated gas and electrical certificates. It was observed that environmental health officers visited the home prior to the home opening and there were no outstanding issues to date. COSHH risk assessments are carried out. Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 3 3 3 3 Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 29 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. 1 Standard YA20 Regulation 13/18 Requirement Timescale for action 31/12/07 2 YA34 19 Records must be kept of all medicines received, administered and leaving the home or disposed of in order to ensure that there is no mishandling. The registered person must 31/12/07 operate a thorough recruitment procedure in order to ensure the protection of service users. 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 Good Practice Recommendations Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beeches (The) (Seven Kings) DS0000068828.V354112.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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