Inspection on 30/05/07 for Beeches (The) (Seven Kings)

This inspection was carried out on 30th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 no outstanding requirements from the previous inspection report, but made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beeches (The) (Seven Kings) 01/11/07

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 Harina Morzeria Unannounced Inspection 30th May – 2nd July 2007 10:00 Beeches (The) (Seven Kings) DS0000068828.V342925.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.V342925.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.V342925.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 Consuelo Solari Care Home 10 Category(ies) of Mental disorder (10) registration, with number of places Beeches (The) (Seven Kings) DS0000068828.V342925.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 10 adults (MD) Mental Disorder with associated Mild Learning Disabilities. First inspection 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.V342925.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the first inspection of the service for 2007/8 since it was registered as a service for younger adults with a history of mental illness. In addition to the main inspection undertaken on 30th May, two further short visits were undertaken on 29th June and 2nd July by the Regulation Manager to gather information in relation to a safeguarding adults issue. The home was registered in January 2007. On 28th May only three service users were accommodated in the home as the manager planned to phase in the intake of people to enable a smooth transition between the current group of people living in the home and new arrivals. By 2nd July, five service users had been accommodated although one of them left subsequently and two other services were being transferred to alternative accommodation. The inspector and Regulation Manager spoke to two service users. The inspection takes into account issues relating to a serious incident which occurred in the home shortly after the first day of the inspection. An assessment of menus, policies and procedures, records, service user plans and the environment was undertaken. Discussions were held with staff, including the manager as part of the case tracking process. One relative and social care professionals were contacted by phone for feedback about the service. What the service does well: What has improved since the last inspection? This is the first inspection of this service and therefore the inspector can not comment on improvements. Beeches (The) (Seven Kings) DS0000068828.V342925.R01.S.doc Version 5.2 Page 6 What they could do better: The manager and staff generally provide a service which meets the service users’ needs but they must balance the rights and choices of the people who use the service with the responsibilities of the staff team to ensure that the protection of service users is safeguarded. The process of assessment must ensure that full details of service users are obtained and that the service user plans detail all the needs of service users, including their changing needs. Risk assessments must be reflective of key risks and include risk management strategies. It is also important to link the risk assessments to the service user plans. Rules on smoking, alcohol and drugs must be clearly stated in the contract. The recording systems must be improved including care plans, daily logs and reviews of care plans and show how care plans are being achieved. The staff group need to receive medication training which is specifically targeted to deal with service users with mental health needs and includes 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. Service users need to be allowed to have varied and balanced meals at flexible times with full access to the kitchen at all reasonable times. All staff, the proprietor and the acting manager must attend mental health awareness training in order to equip them to understand and meet the needs of the particular group of people they are caring for as the staff must have the skills and competencies to provide appropriate care which meets service users’ needs. Other training that all staff must complete to include adult protection and food hygiene training. The homes premises must be suitable for its stated purpose, accessible, safe and well maintained to meet service users’ individual and collective needs. A suitably qualified, competent and experienced manager must be employed to run the home to meet its stated purpose, aims and objectives. The manager must be registered as a “fit” person to manage the home by the CSCI. The manager must demonstrate a clear sense of direction and leadership which staff and service users understand and can relate to the aims and purpose of the home. Beeches (The) (Seven Kings) DS0000068828.V342925.R01.S.doc Version 5.2 Page 7 The registered persons to ensure that a lone working risk assessment is undertaken in order to protect staff and service users when staff are working alone. Efficient systems must be in place to ensure there is routine monitoring of the service by the proprietor, carrying out monthly Regulation 26 visits and providing a quality assurance and monitoring process to ensure efficient running of the home. Staffing levels must be kept under review, so that there are sufficient staff on duty at all times to ensure the protection of service users and staff. 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.V342925.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.V342925.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 poor 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 must be 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. The admission procedure must take into account the impact of the admission of a new service user on existing service users to ensure that the welfare of all concerned is safeguarded. 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. The home provides long-term placements to people with serious and enduring mental health problems, who are subject to the care programme approach(CPA). Beeches (The) (Seven Kings) DS0000068828.V342925.R01.S.doc Version 5.2 Page 10 Hence mental health professionals, such as community psychiatric nurses and specialist social workers continue to remain involved. There was evidence that service users’ needs are assessed and this begins 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, however the service user plan must cover all aspects of service users’ needs and aspirations. Evidence was seen that the service users are involved in the care planning process as much as possible. As part of the admission process assessment information is gathered from the referring agency as required by Regulation. The registered manager as well as the operations manager carried out the assessments. However it is clear that there has been a lack of thorough sharing and examination of information of a person’s past history resulting in inappropriate placements being made, placing prospective and new service users at risk. Evidence taken from a subsequent inspection of the admission of service users indicates that there was a serious failure to understand the consequences of one person’s behaviour on others in the home or those being admitted to the home which led to two serious incidents occurring when service users were unsupervised and a gross failure to safeguard people living in the home occurred. Evidence was seen when tracking service user files, that a gradual introductory process takes place enabling them to have a gradual transfer into the home from their previous placement, either from another care home or hospital. 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. However, the contracts must also include rules on smoking, alcohol and drugs. Service users sign their statement of terms and conditions, along with the registered manager and this confirms acceptance of the document by both parties. Beeches (The) (Seven Kings) DS0000068828.V342925.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. However, these must be 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. However, risk assessments must be reflective of key risks and include risk management strategies. It is also important to link the risk assessments to the service user plans. EVIDENCE: A random sample of service user plans were assessed. Preliminary assessments are carried out by the operations manager and the care service manager following referrals. Beeches (The) (Seven Kings) DS0000068828.V342925.R01.S.doc Version 5.2 Page 12 A transitional service user plan is drawn up upon placement which is then compiled into an individual plan after six weeks. This was being completed for one service user on the day of the inspection. The service users had a service user plan, which shows what they can do and what they like. This did not include any goals or specify any ways of working with the service users. There wasn’t a behaviour management plan outlining particular behaviours relating to individual service users and the action to be by staff in the event of this behaviour being displayed. There were no clear guidelines on managing challenging, aggressive or sexualised behaviour. The manager said that the support plans are constantly reviewed in house as they are still getting to know the residents. 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 service user spoken to on first the day of the inspection expressed the view 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 held with minutes recorded. At this forum service users bring suggestions and contribute to life in the home e.g. activities, furnishings, menus and health and safety. Service users also express their views informally and in key-worker sessions. General 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 resident and indicate ways in which the risks can be reduced. However, these need to be extended further to cover all areas of risk. For example, smoking, aggressive and sexualised behaviour as well as other behaviours as identified from the person’s background. 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. In the case of the most recently admitted service user, a key risk, though assessed was not linked to the service user plan. This was discussed with the manager as an area that was required to be addressed in order to ensure that staff are aware of the actions required in dealing with the risks identified. The benefit for the service user would be ensuring his safety as well as protecting others living and working in the home. The risk assessments must be kept under regular review and updated on an ongoing basis. 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. Residents’ records and other information are stored in a lockable cabinet in the office and staff are aware of issues of confidentiality. Beeches (The) (Seven Kings) DS0000068828.V342925.R01.S.doc Version 5.2 Page 13 Beeches (The) (Seven Kings) DS0000068828.V342925.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 adequate 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. However, far more consideration must be given to balancing the rights and choices of service users with the overall responsibility to safeguard the welfare of all people living in the home. EVIDENCE: Service users have access to a range of leisure activities but the inspector was informed that lack of motivation is a major issue. An activities room is being Beeches (The) (Seven Kings) DS0000068828.V342925.R01.S.doc Version 5.2 Page 15 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 the service users spoken to stated that she enjoyed attending the day centre as well as going out to the cinema, restaurants, pub, bowling and karaoke. 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 needs, choices and wishes. The operations 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. Often the service users take the opportunity to go out individually with their families. However, far more consideration must be given to balancing the rights and choices of service users with the overall responsibility to safeguard the welfare of all people living in the home. The inspector is concerned that some staff appeared to condone behaviour which was inappropriate and a risk to others in the mistaken belief that this promoted service users’ choice and rights. The service users are offered a key to their own bedroom which can be locked from inside and outside and the key to the front door of the home, subject to a risk assessment. The service user spoken to was aware of her right to complain as well as their rights to good quality care. As such they sign up to their service user plans, their statement of terms and conditions and are encouraged to be involved in giving feedback on the service via service user meetings and key work sessions. 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. Staff prepare and cook the 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 has diabetes and is supported to eat appropriately. The inspector noted that the kitchen is locked except during certain periods of time. The reason given for this was for service users’ health and safety. However, it would be the Commission’s expectation that all individuals have the choice and freedom of movement and access to all parts of the home and grounds. A range of drinks and snacks should be available at all times and service users should have full access to kitchen facilities. Hence, the Beeches (The) (Seven Kings) DS0000068828.V342925.R01.S.doc Version 5.2 Page 16 management must review the reason behind the decision to lock the kitchen as it has an impact on all service users. It was clear from viewing service user meetings that they were also unhappy about this issue. Service users can choose when and where to eat but usually eat in the dining area. All staff involved in handling food must complete food hygiene training to promote the health and safety of the service users. There are no restrictions on visitors to the home and service users can receive visitors in their own rooms if they wish. Two of the three service users accommodated have family involvement and their family are consulted regularly by the manager. Beeches (The) (Seven Kings) DS0000068828.V342925.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. However all staff must undertake full medication training in order to ensure the safety of the service users. EVIDENCE: Service users receive personal support in a way they prefer, with a lot of encouragement provided to enable them to carry out their personal support tasks in a way that maintains their independence, privacy and dignity. There was evidence that service users’ needs, based on assessments, were recorded and they were carried out to promote their health, safety and welfare. Beeches (The) (Seven Kings) DS0000068828.V342925.R01.S.doc Version 5.2 Page 18 Staff are skilled to observe changes in the general healthcare needs of service users and make interventions as appropriate to ensure their safety. However the inspector is concerned that not all staff have 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 assessed indicated that they had input from other health professionals such as the dentist, chiropodist and the opticians. Service users also may be engaged in therapeutic work externally, e.g. anxiety management groups, drug and alcohol management, ‘impact team’ as part of a behaviour management strategy and building their esteem and confidence. As far as possible service users are given the opportunity to independently attend their appointments, as part of taking responsibility for their healthcare. On the day of the inspection one service user was being encouraged by staff to get out of bed in order to attend his dentist appointment. 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 procedures are in place. Medication records are completed, contain required entries and are signed by appropriate staff. However, staff handling medication, had very brief training in the handling and administration of medication. The medication training for care staff must be accredited and must include: 1. Basic knowledge of how medicines are used and how to recognise and deal with problems in use 2. The principles behind all aspects of the homes policy on medicines handling and records A requirement has been made that further training is provided to the staff group , which is 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. Beeches (The) (Seven Kings) DS0000068828.V342925.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 poor 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. The safety and welfare of people living at the home have been jeopardised by the failure of the registered persons to protect them from abuse. Staff working in the home must receive training in Adult Protection/ Abuse Awareness 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 and the records examined showed that all complaints, both verbal and written, are recorded with details of investigation, any action taken and the outcome for the complainant. At the time of inspection one complaint had been logged which was appropriately handled and recorded by the manager. One resident 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.V342925.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 the all relevant Local Authority Adult Protection protocols is kept in the home for the guidance of staff. However not all staff working in the home have received detailed and thorough training in Adult Protection/ Abuse Awareness although they were aware of it via induction and from training received at their previous places of employment and were aware of the action to be taken if there were concerns about the welfare and safety of service users. A requirement has been made that all staff must receive full adult protection / abuse awareness in order to ensure that there is a correct response to any suspicion or allegation of abuse. At the time of writing this report a serious incident occurred which happened after the first visit. All relevant agencies were immediately contacted and support was given to the service users involved. However, the nature of the incident indicates that the manager must ensure that sufficient detailed information is gathered at the time of admission, to ensure that vulnerable residents are not put at risk by the behaviour of others in the home. As a result of the incident three service users are no longer living at the home and the registered persons have voluntarily agreed that no one else will be admitted until the investigation is concluded and there has been a thorough review of the factors which led up to the incident. The safety of people living in the home was jeopardised because of a number of factors: • The process of admission of service users in to the home failed to take into account the risks posed by others accommodated or being considered for admission the staffing levels, particularly at night, were insufficient to offer appropriate levels of supervision to vulnerable adults the staff team failed to balance the rights and choices of people living in the home, with a legal duty to safeguard and protect service users • • The service users guide states “ we aim to offer a safe place ------- to live where you should be protected”. There is evidence that the registered persons failed to deliver a service in accordance with this statement. Beeches (The) (Seven Kings) DS0000068828.V342925.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 adequate 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 is newly registered and has been altered to provide spacious facilities with all furnishings and fittings in place. On the first day of the visit the home was clean, tidy and in very good decorative order. Service users contribute to the maintenance of some aspects of the communal areas as well as their private spaces. Only three residents were accommodated on the first day of the visit. The inspector noted that eight rooms have en-suite facilities and two residents will share a bathroom/toilet which is located between the two rooms. Beeches (The) (Seven Kings) DS0000068828.V342925.R01.S.doc Version 5.2 Page 22 Two service users showed their rooms to the inspectors which had been personalised. The inspector was also able to see other unoccupied rooms which are well decorated. All bedrooms are lockable and have lockable space for the storage of valuables. The house is well served for bathrooms and toilets. There is a separate toilet on the ground floor. All were found to be clean, with fresh towels and soap, and have suitable locks. 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 Acts Regulations. None of the service users currently accommodated need any specialist equipment at present. An exterior building is being developed to provide additional leisure facilities. The building work has reduced the area of garden space. Some effort has been made to cordon off the building site, to safeguard the service users. On the second evening of the inspection, water was leaking from an upstairs shower room, into the ground floor lounge. This presented a significant hazard to people living and working in the home as the water was running down the light fitting. Staff took action to prevent injury, and on the third day of the inspection the inspector was told that the fault had been rectified. Beeches (The) (Seven Kings) DS0000068828.V342925.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 poor 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 must receive training that is appropriate to the needs of service users. Staffing levels are not adequate to meet the individual needs of the service users at all times. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. EVIDENCE: It was clear from the interviews and informal discussions held with the fairly new group of 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 fairly good understanding of the needs of service users but some of the Beeches (The) (Seven Kings) DS0000068828.V342925.R01.S.doc Version 5.2 Page 24 feedback received from staff suggested that at times, meeting service users’ needs could be quite a challenge. It was noted that staff were not provided with training that was specific to the needs of the service user group e.g. managing challenging behaviour and mental health awareness. This is of significant concern to the Commission, as the service is registered to provide care only to this client group. However experienced or qualified staff may be in social care they must have an understanding of mental health issues in relation to the diagnosis and the needs of residents accommodated in the home. Some service users accommodated in the home take drugs such as cannabis. The registered manager stated that as part of the development plan they are seeking a training provider to deliver training that is specific to the service user group with mental health needs. Staff should also be provided with training regarding drug use and its effects and interactions, particularly with prescribed medication. Once acquired, this would provide better understanding for the staff in meeting 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 two people on both the early and late shifts, excluding the manager. At the time of the first day of inspection night cover was provided by one person doing waking nights. A lone person working risk assessment must be carried out . The latter is extremely important as one person works on night duty with service users who have complex needs. The assessment must detail the risks involved and the actions taken to reduce the identified risks. As the result of two serious incidents in the home when there was only one member of staff on duty, the staffing levels were increased to two staff at night. The home does not include facilities for staff to “sleep in” and be on call. Therefore both staff must be awake. Alternatively, the number of people accommodated must be reduced to nine, to allow for one bedroom to be used for staff accommodation. The staff team is newly formed with many having experience of working in the care field but not specifically in the area of mental health. A requirement regarding this has been made elsewhere in this report. Staff must also complete food hygiene and safeguarding adults 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 was one file in which a second reference was not on the file and the manager indicated that she had requested it several times from the referee to no avail. The manager has been advised to seek a further referee who can provide a reference and to explore why the referee was unwilling to provide a reference. This must be carried out without undue delay to ensure compliance with Regulations. Beeches (The) (Seven Kings) DS0000068828.V342925.R01.S.doc Version 5.2 Page 25 There is a regular programme of individual supervision, with a forward planning programme on display. 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, however staff are able to informally meet with the manager as she makes herself accessible to them. They also use the team meetings as another way gaining support. The operations 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 must reflect full discussions held with service users and how staff are progressing with the individual care plans. Beeches (The) (Seven Kings) DS0000068828.V342925.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, 43 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users may be at risk from living in a home which is run by an inexperienced manager although a new manager was due to start work in July. 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 not adequately promoted and protected. EVIDENCE: The manager is registered with the CSCI and has experience of working as a senior in a mental health home for over six years but not as a manager and does not have a qualification related to mental health. She has begun the Beeches (The) (Seven Kings) DS0000068828.V342925.R01.S.doc Version 5.2 Page 27 ‘registered managers award’ course. However, the inspector was informed in writing, prior to the inspection that she intends to resign from her post for personal reasons but will stay in post until a replacement has been recruited. The new manager was due to start work on the second of July2007. The current manager is supported by the operations manager 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 meeting. Quality assurance survey questionnaires are in place and these will be undertaken once the home has been operational for approximately a year. The proprietor is required to check the quality of care in the home through monthly Regulation 26 monitoring visits. These reports are to be made available to the Commission upon request. 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. However the operations manager is also managing another care home, and therefore lacks dedicated time to support the manager and ensure that the home operates to fully safeguard the people who are accommodated. At the time of the safeguarding incidents the operations manager was out of the country but did provide telephone support. Checks show that the home’s records were found to be up to date and secure with confidential files stored in locked cabinets. However, some gaps were found in the level of daily recording which must be clear and linked to the service user plans reflective of the current situation in the home. 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, 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. A lone working risk assessment must be carried out . The latter is extremely important for the reasons set out previously in this report. The assessment Beeches (The) (Seven Kings) DS0000068828.V342925.R01.S.doc Version 5.2 Page 28 must detail the risks involved and the actions taken to reduce the identified risks. Beeches (The) (Seven Kings) DS0000068828.V342925.R01.S.doc Version 5.2 Page 29 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 1 3 1 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 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 2 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 2 2 3 3 2 2 Beeches (The) (Seven Kings) DS0000068828.V342925.R01.S.doc Version 5.2 Page 30 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14 Requirement New service users to be 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 by others living in the home. New service users to be admitted to the home only if the home can demonstrate capacity to meet the assessed/ specialist needs of the individuals in a safe environment. The registered person is required to ensure that an individual care plan is drawn up in consultation with each service user detailing how the service user’s needs in respect of his health and welfare are to be met. The care plans must be reviewed and updated as required in line with the National Minimum Standards for Care Homes for Younger Adults. Each care plan must include a comprehensive risk assessment DS0000068828.V342925.R01.S.doc Timescale for action 16/07/07 2 YA3 14 16/07/07 3 YA6 14/15 31/08/07 4 YA9 13 31/08/07 Beeches (The) (Seven Kings) Version 5.2 Page 31 which is reviewed regularly. 5 6 YA16 YA17 16 16 Rules on smoking, alcohol and drugs must be clearly stated in the contract. Service users to be allowed to have varied and balanced meals at flexible times with full access to the kitchen at all reasonable times. Medication training for staff to be arranged which is specifically targeted to deal with service users with mental health needs. Training to be 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 must receive full adult protection / abuse awareness training in order to ensure that there is a proper response to any suspicion or allegation of abuse. The homes premises must be suitable for its stated purpose, accessible, safe and well maintained to meet service users individual and collective needs. 31/08/07 16/07/07 7 YA20 13/18 31/10/07 8 YA23 13(6) 31/10/07 9 YA24 23 16/07/07 10 YA33 18 11 YA35 YA32 18 Sufficient and suitably 16/07/07 qualified/ competent staff must be employed in the home at all times to maintain the health, safety and welfare of service users. All staff must attend mental 31/07/07 health awareness training in order to equip them to understand and meet the needs of the people they are caring for. Staff must have the skills and competencies to care for the particular group of people DS0000068828.V342925.R01.S.doc Version 5.2 Page 32 Beeches (The) (Seven Kings) 12 YA37 YA38YA43 9 13 YA39 26 14 YA42 18(a) they look after. Further training regarding food hygiene and drug awareness must also be provided. A suitably qualified, competent 16/07/07 and experienced manager must be employed to run the home to meet its stated purpose, aims and objectives. The manager must be registered as a “fit” person to manage the home by the CSCI. The manager must demonstrate a clear sense of direction and leadership which staff and service users understand and can deliver the aims and purpose of the home. Efficient systems must be in 31/07/07 place to ensure there is routine monitoring of the service by the proprietor, carrying out monthly Regulation 26 visits and providing a quality assurance and monitoring process to ensure efficient running of the home. The registered person to ensure 31/07/07 that a lone working risk assessment is undertaken in order to protect staff and service users when staff are working alone. 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.V342925.R01.S.doc Version 5.2 Page 33 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.V342925.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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