Inspection on 28/01/08 for Beechlawns

This inspection was carried out on 28th January 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beechlawns 27/01/09

Beechlawns 16/05/07

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Beechlawns 20 Wood Street Wollaston Stourbridge West Midlands DY8 4NW Lead Inspector Lesley Webb Key Unannounced Inspection 28th & 29th January 2008 09:00 Beechlawns DS0000069593.V354980.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 Beechlawns DS0000069593.V354980.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. Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beechlawns Address 20 Wood Street Wollaston Stourbridge West Midlands DY8 4NW 01384 835050 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) Select Health Care (2006) Limited Vacant post Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Learning Disability (LD 7) The maximum number of service users to be accommodated is 7. 2. Date of last inspection 16th May 2007 Brief Description of the Service: Beechlawns is a large detached property located in the Wollaston area of Stourbridge. It is situated in a quiet residential area and is within walking distance of the local village, which has numerous shops, public houses and other local amenities. The town centre of Stourbridge can be accessed by public transport. There is a small car parking area at the front of the property. The gardens are situated to the rear and side of the property. There is a ramp leading to the front door and into the garden. The Home was initially registered in 1993 to provide care for seven adults with learning disabilities. Resident accommodation is on the first and ground floor. The Home has a stair lift. All users accommodated on the first floor are fully mobile. There are seven single bedrooms. Residents bedrooms are all decorated individually and reflect residents differing tastes and personality. Residents can bring some of their own furniture if they wish. The Home has two bathrooms one with separate walk in shower. There are toilets located on the ground and first floors. There are two lounge areas and a dining room. Beechlawns provides care for residents with a range of learning disabilities and with complex communication, mental and health care needs. A statement of purpose and service user guide are available to inform residents of their entitlements. The manager was unable to supply up to date fee information. Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We carried out this inspection over two days, with the home being given no prior notice of the visit. Time was spent examining records, talking to residents, staff and observing care practices, before giving feed back on the findings of the inspection to the acting manager and supervisor. Prior to the inspection the home supplied information to the Commission for Social Care Inspection (CSCI). Also five residents surveys were completed and returned to the CSCI. Information from both these sources was also used when forming judgements on the quality of service provided at the home. The people who live at this home have a variety of needs. We took this into consideration when case tracking two individuals care provided at the home. For example the people chosen consisted of both male and female and have differing communication and care needs. An Expert by Experience accompanied us during part of the inspection. This is someone who receives a care service themselves and also has a disability. Their findings are also included in this report and used as evidence when deciding on the quality of service provided at the home. This was the second inspection of Beechlawns since new owners purchased it in 2007. The atmosphere within the home is inviting and warm and we would like to thank everyone for his or her assistance and co-operation. The quality ranting for this service is 1 star. This means the people who use this service experience adequate quality outcomes. What the service does well: We found some evidence that residents are supported to make their own decisions and choices. For example one resident was seen going to their room for a lie down in the afternoon and another was seen choosing to sit it the quiet lounge away from other residents. We were also informed that one resident has chosen to have their bedroom painted blue. We received three surveys completed by relatives of individuals living at the home. All were happy with the efforts made by the home with regarding to maintaining contact, stating they ‘always’ helps their relative to keep in touch. We observed two evening meals being prepared and served during our visit. On one occasion staff were making a lasagne themselves rather using a convenience ready meal. The records of residents’ daily choices including supper and in addition there is a audit completed with the resident to determine whether they enjoyed the meals provided, which is an excellent initiative. As at the previous inspection we saw that there was plenty of food Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 6 in the home (including fresh fruit and vegetables) and examination of records demonstrated that staff were following the daily menu plan. Efforts are made to promote residents rights to privacy, dignity and choice with regards to personal care and support. For example residents are able to choose when they wish to get up. When we arrived in the morning at 9.40 a.m. one resident were still in bed and the home employs both male and female staff so that residents are able to choose which gender to support them. The management of medication in this home is good, offering protection to residents. We looked at medication and records of three residents and found all to be in good order. Formal systems for complaints ensure these are dealt with appropriately. For example there is a comprehensive complaints procedure and this has been reproduced in a pictorial format for residents. Three relatives surveys were received by the CSCI prior to the inspection. All confirm they know how to make a complaint, two that the home ‘always’ responds appropriately and one ‘usually’. The home has a large, bright kitchen that is clean and tidy. A ready supply of personal protective equipment, liquid soap and paper towels were seen to be in place and staff were witnessed using this, promoting good infection control. We sampled maintenance and service records and found these to be largely up to date and in good order, promoting the health and safety of residents. What has improved since the last inspection? Improvements to information relating to services and the home have been made ensuring people have access to detailed information. For example the statement of purpose now includes details of room sizes and qualifications of staff conditions of residency now include details of fee levels and additional charges. Care plans are now reviewed every month, again with detailed and informative records in place. There continues to be improvements in the number of opportunities residents can take part in activities in the community. During both days of the inspection we witnessed residents going out as a group and records confirm this is now a regular event. Activities that residents have participated in since the last inspection include meals out at pubs and restaurants, visits to a centre that has sensory facilities, outings to Merry Hill and other shopping centres. A member of staff has also been identified to take responsibility for arranging activities. Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 7 A previous recommendation to introduce pictorial menus as an aid to communication and choice is in the process of being acted upon. As the Expert by Experience explained, “A staff member is currently putting together a picture menu for people to use regularly with all the foods people like to eat, she said she was going to make it colourful and big so people who can’t speak are able to point at to what they would like. This is great to hear, and could be used by everyone as often people are unsure of what things are until they’ve seen a picture”. A Requirement was made at the previous inspection that arrangements must be made to ensure that all staff have a clear understanding of adult protection and whistle blowing procedures, to ensure that residents are not at risk of harm or abuse. The training matrix details eight of the eleven staff having undertaken adult protection training. Also at the previous inspection a Requirement was made to make arrangements to ensure that physical and verbal aggression by a resident is understood and dealt with appropriately by staff, to ensure that residents are not at risk of harm. Again it was pleasing to find that all staff have completed specific training in understanding the behaviours of one resident. We toured the building and saw that the refurbishment of the home continues. A number of improvements have already taken place or are underway which include refurbishment of the ground floor bathroom, replacement of the boiler, redecoration of bedrooms, doorframes being repaired and dining room decorated; all providing an comfortable and homely environment for residents to live in. Good progress has been made since the last inspection to ensure that staff either hold or are in the process of obtaining a National Vocational Qualification (NVQ). The home employs a total of eleven staff; all apart from one person who is due to retire have completed an NVQ II or above or are working to obtain one. All but one recommendation relating to medication have been met, reducing risks to residents. The medicine policy has been reviewed, protocols for ‘when required’ medication for behaviour management now include details of the medication prescribed and residents allergy status is documented on their medicine record charts in order to ensure their safety. All agency and bank staff are now instructed in fire safety evacuation procedures, with records maintained, promoting the health and safety of residents. What they could do better: There are admission procedures in place that if implemented would ensure prospective residents needs are known and assessed prior to admission. Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 8 These were not followed when the most recent resident moved to the home. Staff confirmed that when the individual moved into the home they did not know or understand their particular needs. This is unacceptable as it not only impacts on the individual concerned but also has the potential to impact on those already living at the home. Very little evidence could be found of a person centred approach to care being imbedded in the home. Person centred plans are still incomplete, little evidence could be found that plans are being completed with the involvement of the resident and no staff that were spoken to demonstrated understanding of the values and principles of this approach to care, with all thinking it was about documentation rather than how support is delivered to individuals. Care plans were in place for some identified needs but missing for others and in some instances contained inaccurate information. Residents are at risk of not having all needs met. We found that residents with more diverse communication needs find it harder to have their opinions listened to. Many of the staff have worked at the home for a considerable time. Those that were spoken to informed us that this has helped them to communicate with residents and understand what their needs are. None that were spoken to were able to inform us of the contents of communication plans, giving the view that these are not used as working documents. At the previous inspection we found risk assessment documentation confusing and were informed that the new owners have introduced new documentation. At this inspection we were informed that one residents risk documentation has been reviewed and put on to the new format but that everyone else’s remains as at the previous inspection. Many of the assessments are generic and not based on individuals’ specific needs or abilities. The layout of the building affects not only freedom of movement but opportunities for residents to participate in developing life skills. As the Expert by Experience found when looking around the building, “The laundry room was in the cellar and people are not able to go down due to heath and safety, as the stairs are very steep. This is unfair, as people should be supported to do their own laundry and not be kept from rooms in their own home. The kitchen is also a problem for some as they have steps going into the room. For one person in particular she finds the steps too difficult and does not access the kitchen because of this. This access needs to be addressed”. Work must now be undertaken to ensure residents can undertake activities on an individual basis in order that their individual needs and preferences are recognised and met (promoting a person centred approach to care). We noted that residents appear to eat the same things each day despite there being a choice available. It was also noted that on some occasions choices on the menu are limited. A previous recommendation that ‘taster’ sessions could Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 9 be organised from time to time in order that staff could assess whether residents’ tastes have changed and give them the opportunity to try different foods has not been actioned. It is also recommended that residents be given the opportunity to be involved in food shopping, as this is currently not taking place. When walking round the home we found the shower – room door did not have a handle or lock and a toilet door that did not close fully or have a lock. Action must be taken to address these issues to ensure residents’ rights to privacy and dignity are upheld. Systems for monitoring the of health care needs of residents need to be improved to ensure effective monitoring can take place and the health needs of residents are met Staffs informed us that residents with communication needs are reliant on them to raise concerns on their behalf, but were not able to explain what systems are in place to support them to do this. It is recommended that systems are introduced such as regular key worker meetings, increasing the frequency of residents meetings and introducing as a set item on the staff meeting agenda ‘concerns to be raised by staff on behalf of residents’ in order to promote residents rights to complain. We looked at three residents’ finances and carried out an audit of money, which tallied with the records maintained. The financial records for all three all contained receipts for meals (lunch and dinner) taken outside of the home. In addition to this receipts evidence that on some occasions residents have paid for the purchase of two meals at one sitting. No evidence could be found of the home contributing to these meals. These practices have the potential to place residents at risk of financial abuse and as such an Immediate Requirement Form was issued during the inspection instructing that these practices must cease with immediate affect until written confirmation is in place that the funding authority agrees with these practices. A toilet on the first floor was out of commission on the day of inspection and we were informed it is going to be replaced with a linen cupboard. As we explained to the manager this would need agreement with the CSCI due to the reduction of facilities impacting on choices for residents. We were shown the ‘old post room’. This is a room that is fixed to the building next to the kitchen that is made of wood and plastic sheeting. We were informed this is used for a resident who smokes. This room does not comply with the Smoke Free Regulations and action must be taken to address this and to ensure the safety of residents. The laundry is sited in the cellar. There is mould appearing all over the laundry walls and ceilings and there is a damp odour. We also noted a build up of lint by the dryer and holes in the walls and to the ceiling. Advice should Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 10 be sought from the Health Protection Agency with regards to the laundry facilities to ensure infection control standards are maintained. As at the previous inspection staff still require specialist training. Staff demonstrated little knowledge regarding the principles of person centred approaches. Work must be undertaken in other areas including nutritional awareness, risk management, equal opportunities, LDAF and the Mental Capacity Act to ensure staff are suitably qualified for their positions and to support residents. We were informed that the funding authority has agreed additional one to one hours for a named resident but that these were not yet in place due to staff not currently being recruited to undertake the additional hours. We explained that if additional hours had been agreed in order to meet the residents needs alternative arrangements such as employing a regular agency worker should be put into place until such time a permanent support worker can be recruited. Greater effort must be made to ensure recruitment practices safeguard residents. We looked at the staff files of five permanent staff, including the newest member of staff. In all we found discrepancies. We also looked at the records of agency staff that have completed sifts at the home during December 2007 and January 2008. These also contained omissions. None of the staff files that we sampled contained evidence that staff receive regular, formal supervision in order to support them fulfil their roles. All staff received an annual appraisal in 2007 however upon examination of the records of these none were found to have been completed in full. We were informed by the acting manager that she has previously been a registered manager of an older persons home and that her experience is mainly of older persons and people with mental health needs and that she does not hold any qualifications relating to learning disabilities. On some occasions her lack of experience of learning disabilities was evident. For example she was not able to explain the principles and values of person centred approaches to care or communication aids to support this process. During both days of inspection we observed a fire door wedged open. We also found that two of the permanent staff have not participated in a fire drill within the last 6 months. This is of concern as both work during the night when reduced staffing levels and the lack of training poses greater risk to residents in the event of a fire. In addition to this West Midlands Fire Service completed an audit of the home in 2007 making some requirements, none of which we found to have been complied with. Due to our concerns we issued an Immediate Requirement form during the inspection instructing that action be taken to reduce the risk of injury to residents in the event of a fire. A full list of recommendations is contained at the back of this report. Please contact the provider for advice of actions taken in response to this Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 11 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. Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 12 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 Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 13 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): 1,2,4 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally people who may wish to consider this home and their representatives have the information needed to decide if it can meet their needs. Further work must be undertaken to ensure admission processes and practices are consistently applied in order that the needs of residents will be met. EVIDENCE: Two of the four recommendations identified in previous inspections are now met. For example the statement of purpose now includes details of room sizes and qualifications of staff and both residents files that were sampled contained conditions of residency that include details of fee levels and additional charges. The service user guide still needs further work as this does not include all information as detailed in the Care Homes Regulations 2001, Regulation 5 and is still not available in formats suitable for residents. Although improvements have been made to the contents of documents, as they are not available in alternative formats this poses a potential barrier to communication and information sharing with residents and prospective residents. There are admission procedures in place that if implemented would ensure prospective residents needs are known and assessed prior to admission. Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 14 These were not followed when the most recent resident moved to the home. For example records and discussions with staff confirm only one short visit to the home was undertaken prior to the person moving in, full and detailed information was not obtained regarding the residents needs until after they have moved into the home and residents already residing at the home were not consulted to find out their views and opinions on the new resident. Records indicate that the decision to move the individual to the home was based on filling beds. Staff confirmed that when the individual moved into the home they did not know or understand their particular needs. This is unacceptable as it not only impacts on the individual concerned but also has the potential to impact on those already living at the home. For any future admissions to the home full assessments of needs, consideration of those already living at the home and a range of trial visits must be undertaken to ensure the home can be confident that they can care for individuals and meet their needs. Prior to the inspection five residents surveys were received by the Commission for Social Care Inspection (CSCI). All were completed with assistance from staff employed at the home. Of the five, three state the individuals are unable to communicate verbally and could not respond to questions, one states they were asked if they wanted to move into the home and one that they were not. One states they received enough information about the home before moving in so that they could decide if it was the right place for them and one that they did not. These views confirm that admissions processes are not being followed for all. Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 15 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 and 9. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are not always involved in decisions about their lives and do not always play an active role in planning the care and support they receive. EVIDENCE: Through examination of two residents files, discussions with the acting manager, staff and by observations made by the Expert by Experience we found that some improvements have been made with regards to care planning, involving residents in decision making and risk management but that further work is still required. For example it was a positive to find that care plans are now being reviewed on a monthly basis (records being detailed and informative) however very little evidence could be found of a person centred approach to care being imbedded in the home. The person centred plans of two people were examined, one that had not been completed in full and the other that contained out of date information that had been completed at the residents previous home. The acting manager confirmed that no plans had yet Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 16 been completed in full. Little evidence could be found that plans are being completed with the involvement of the resident and no staff that were spoken to demonstrated understanding of the values and principles of this approach to care, with all thinking it was about documentation rather than how support is delivered to individuals. For example we were informed that some residents now have ‘communication passports’. However these were found to be diaries in order that staff at day centres can communicate with the home. Also the acting manager made a comment that they did not like the use of colour pens for completing of person centred plans. When asked why she replied, “I don’t know it’s just my preference”. We explained that it might be in the residents’ best interest as a visual aid to communication to use colour. Staff have not received training in this area and their lack of understanding was reinforced further when the Expert by Experience spoke to staff. As he states, “I asked if people had any Person Centred Plans active at the moment and staff said yes they all do, but I asked for an example but she could not think of one at the time”. Care plans were in place for some identified needs but missing for others and in some instances contained inaccurate information. For example a moving and handling assessment had been completed for one person giving a score of 22 (assessment states any score above 10 requires a plan of care) but no care plan and neither file sampled contained care plans for health care or activities. Also another resident has a care plan that states there are no restrictions of choice and freedom in place, however there are security coded locks at the entrance of the home and steps that restrict movement in the home that contradict this plan. We explained to the acting manager that a deprivation of liberty assessment should be undertaken to ensure compliance with the Mental Capacity Act and to ensure where possible freedom of movement is not restricted. It was also noted that none of the care plans sampled contained specific timescales for action or evidenced the involvement of the residents. We found some evidence that residents are supported to make their own decisions and choices. For example one resident was seen going to their room for a lie down in the afternoon and another was seen choosing to sit it the quiet lounge away from other residents. We were also informed that one resident has chosen to have their bedroom painted blue. Further work should be undertaken to ensure routines are flexible to meet residents needs and choices and not solely for the smooth running of the home. As the Expert by Experience observed, “We then sat down to talk to people, one gentleman asked staff for a cup of tea. Once the staff had made the tea they asked him to go into the dining room to drink it. The gentleman did not initially want to go but he did move to the dining room after encouragement. I asked staff why he needed to drink it in the dining room and they said it was in case he spilt the drink. Could the staff not support him to have a side table for him to use in the lounge, or sit with him to offer support, if needed? I was also disappointed to see that the person was not supported to make his own cup of tea”. Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 17 We found that residents with more diverse communication needs find it harder to have their opinions listened to. Many of the staff have worked at the home for a considerable time. Those that were spoken to informed us that this has helped them to communicate with residents and understand what their needs are. None that were spoken to were able to inform us of the contents of communication plans, giving the view that these are not used as working documents. For example one persons file contains ‘flash cards’. These have been developed as aids to communication. No member of staff knew of their existence or what they might be used for. They were found to be stored in a file indicating that they are not used. The need for staff to receive further guidance and training was also reinforced by observations made by the Expert by Experience. As he states, “I then asked about how staff communicates with this lady, as she uses no words. Staff said she uses some signs she has developed herself and staff let each other know what they mean. I suggested these should be written down in a communication plan for her. I also asked if speech and language had been involved with anyone, a staff member said they should have been involved a long time ago for people, as it may be too late for some people to learn new ways communicating. This isn’t the right attitude for staff, as speech and language could be very valuable to the people I have met today. One person who does have speech, I found difficult to understand and at times his staff found difficult as well. This issue should be addressed and therapists used to support people in developing their own communication plans”. At the previous inspection we found risk assessment documentation confusing and were informed that the new owners have introduced new documentation. At this inspection we were informed that one residents risk documentation has been reviewed and put on to the new format but that everyone else’s remains as at the previous inspection. We found assessments in place for areas including activities, medication, finance, electrical equipment, independence and behaviour however many of these were generic and not based on individuals’ specific needs or abilities. It is recommended that a system be introduced to link care plans and risk assessments to ensure effective monitoring takes place and to promote a holistic approach to care management. Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 18 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 and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Efforts are being made to increase opportunities for residents to participate in social and recreational activities. Further efforts should be undertaken to ensure these are person centred. Generally residents are provided with a varied and balanced diet with staff trying to ascertain whether residents have enjoyed their food. EVIDENCE: We found that generally staff are aware of the need to support residents to develop their life skills but that this process could be improved. For example both residents files that we sampled contained an independent living matrix that details activities such as making a cup of tea, dusting and putting clothes away. Staff then complete indicating if a resident completed a task successfully with or without assistance. On the matrix of the first residents file Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 19 we sampled no tasks were recorded as being undertaken apart from two outings and the second persons assisting to make drinks. The layout of the building affects not only freedom of movement but opportunities for residents to participate in developing life skills. As the Expert by Experience found when looking around the building, “The laundry room was in the cellar and people are not able to go down due to heath and safety, as the stairs are very steep. This is unfair, as people should be supported to do their own laundry and not be kept from rooms in their own home. The kitchen is also a problem for some as they have steps going into the room. For one person in particular she finds the steps too difficult and does not access the kitchen because of this. This access needs to be addressed”. It is recommended that an assessment of the premises is undertaken by a qualified person such as an Occupational Therapist to ensure every effort is made by the home to ensure residents have freedom of movement and can undertake life skills of their choice. There continues to be improvements in the number of opportunities residents have to take part in activities in the community. During both days of the inspection we witnessed residents going out as a group and records confirm this is now a regular event. Activities that residents have participated in since the last inspection include meals out at pubs and restaurants, visits to a centre that has sensory facilities, outings to Merry Hill and other shopping centres. Work must now be undertaken to ensure residents can undertake activities on an individual basis in order that their individual needs and preferences are recognised and met (promoting a person centred approach to care). As the Expert by Experience found when talking to people about activities, “We talked about holidays and staff said how everyone likes to go away together as they have lived together for so long, and are use to being together. Although the staff member then went on to say the recent holiday they went on for people with disabilities was great as people were able to go to bed when they had enough, as in other holiday destinations often if one wants to go back everyone has to do the same. This implied that people don’t all have the same interests, wants and needs for a holiday and should not be going in one big group holiday. One person I meet had finished going to a day centre last year and currently does not do a lot with his time. Staff are looking for something for this person to do, as he currently goes for a ride in the mini bus, to pick up and drop off someone else he lives with. This is not a very purposeful activity for this person”. Staff that we spoke to confirmed that activities have increased but that very few one to one activities take place. For example one person explained, “they are going out more, they just needed motivating. All residents always go out together because we need one member of staff to drive the bus and two to help the residents so it doesn’t leave enough staff for others”. We received three surveys completed by relatives of individuals living at the home. All were happy with the efforts made by the home with regarding to Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 20 maintaining contact, stating they ‘always’ helps their relative to keep in touch. We saw that efforts are made to ensure daily routines promote residents’ independence, however further work should be undertaken, again to promote a person centred approach to care. For example, we observed one resident freely moving around the home and choosing to walk in the garden and staff were seen sitting spending time with residents on a one to one basis, chatting and watching television together. As at the previous inspection we saw that care plan folders contained a range of ‘consent’ forms, some of which have been signed by relatives on their behalf due to lack of understanding. Recommendations made at the previous inspection relating to consent documentation and training of staff on the Mental Capacity Act have not been actioned. This should be given priority to ensure not only that the homes practices are compliant with legislation but also to ensure residents rights are upheld. We observed two evening meals being prepared and served during our visit. On one occasion we were pleased to see that staff were making a lasagne themselves rather using a convenience ready meal. The records of residents’ daily choices including supper and in addition there is a audit completed with the resident to determine whether they enjoyed the meals provided, which is an excellent initiative. As at the previous inspection we saw that there was plenty of food in the home (including fresh fruit and vegetables) and examination of records demonstrated that staff were following the daily menu plan. We did note that all residents appear to eat the same things each day despite there being a choice available (this being the same also as at the previous inspection). It was also noted that on some occasions choices on the menu are limited. For example the choice of evening meal on the first day of our visit was sausage and chips or toad in the hole (both being sausage based). We were informed that residents can choose something different if they wish but no one was able to tell us how residents with communication needs would be able to do this. A previous recommendation that ‘taster’ sessions could be organised from time to time in order that staff could assess whether residents’ tastes have changed and give them the opportunity to try different foods has not been actioned. It is also recommended that residents be given the opportunity to be involved in food shopping, as this is currently not taking place. As the Expert by Experience explained, “I asked who does the food shopping and I was told the shopping list is written from the 4 weekly menus and the manger tends to do a weekly shop. I asked if people who live here go along, but the staff member said people find the supermarkets too busy and don’t like to go. I thought this was strange as staff had earlier said to me that residents like to go to Merry Hill to buy clothes, which is a very busy place”. A previous recommendation to introduce pictorial menus as an aid to communication and choice is in the process of being acted upon. As the Expert by Experience explained, “A staff member is currently putting together a Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 21 picture menu for people to use regularly with all the foods people like to eat, she said she was going to make it colourful and big so people who can’t speak are able to point at to what they would like. This is great to hear, and could be used by everyone as often people are unsure of what things are until they’ve seen a picture. The staff member did show me a picture menu book the provider had sent to them and was aiming to develop theirs like it. The staff member said they could not use this particular menu, “as they have modern meals on it, not like the meat and 2 veg people here like and are use to having”. I felt this attitude was a bit worrying as lots of people have lots of different taste buds and may enjoy trying new things”. Nutritional screening tools have been completed (meeting a previous recommendation) and a body mass index calculator is now in place at the home, but as yet this has not been used. Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 22 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 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally the health and personal care that residents receive is based on their individual needs. EVIDENCE: Efforts are made to promote residents rights to privacy, dignity and choice with regards to personal care and support. For example residents are able to choose when they wish to get up. When we arrived in the morning at 9.40 a.m. one resident were still in bed and the home employs both male and female staff so that residents are able to choose which gender to support them. There are ‘consent’ forms regarding same or cross gender care. As mentioned earlier in this report action must be taken by the home with regards to consent/capability to ensure the homes practices and documentation comply with the Mental Capacity Act. When walking round the home we found the shower – room door did not have a handle or lock and a toilet door that did not close fully or have a lock. Action must be taken to address these issues to ensure residents’ rights to privacy and dignity are upheld. Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 23 At the previous inspection we recommended that the practice of undertaking hourly checks during the night for residents be reviewed and only undertaken if agreed within a multi-disciplinary forum to ensure residents rights to privacy are not encroached upon. It was disappointing to find that records completed by night staff confirm that these checks still take place, with no evidence of need or best interest. Also at the previous inspection we were informed that one resident had been assessed by an Occupational Therapist (O.T.) as to whether they needed a wheelchair. We were told that the O.T. had thought this unnecessary but would not supply a wheelchair for use outside. The manager said that relatives had agreed to purchase one for this purpose on behalf of the resident. We suggested that before this takes place the manager speaks with the O.T. to confirm that the resident needs a wheelchair for outside. We were also informed that a second person is also awaiting an assessment from an O.T. because of deteriorating mobility. During this inspection we were informed that three residents have had assessments completed by the OT who then made a referral to Wheelchair Services. Wheelchair Services visited the home and said that the residents do not meet the criteria for wheelchairs. We were unsure with the information presented if the residents have been assessed as needing wheelchairs in the community or not and the acting manager could not offer any further information. This situation should be investigated and clarified to ensure residents receive the appropriate support. Systems for monitoring the of health care needs of residents need to be improved to ensure effective monitoring can take place and the health needs of residents are met. All files sampled contained health appointment sheets that detailed the date and what healthcare professional they saw but none contained sufficient detail of why the visit took place, actions taken or outcome. We also found weight-recording sheets in place on residents’ files, but two of the three we sampled were blank. At the previous inspection we saw that the ‘Priority for Health Screening’ was in place but only partially completed. We were informed that area manager had made contact with the relevant agencies to request their assistance with completion of these. At this inspection these were no longer in place. We were informed that they have been archived, as they could not get help from outside agencies to complete them. We advised that the home contact the Primary Care Trust to discuss this in order that residents living at the home are not disadvantaged. The management of medication in this home is good, offering protection to residents. We looked at medication and records of three residents and found all to be in good order. All but one recommendation made at the last inspection have been met. For example medication policies have been amended, consultants have written protocols for the use of PRN (as and when required) and accurate medication balances are recorded. The homes medication policy states that competency assessments will be completed for staff that administer medication. We could only find evidence of this occurring Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 24 for one member of staff, with the acting manager confirming she has not undertaken any since being employed at the home. It is recommended that these be introduced to ensure staffs’ practices with regards to the administration of medication comply with good practice. Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 25 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 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all residents are supported to express any concerns. Formal complaints procedures ensure complaints are responded to appropriately. The protection of residents has improved; however further work with regards to financial practices is required. EVIDENCE: Formal systems for complaints ensure these are dealt with appropriately. For example there is a comprehensive complaints procedure and this has been reproduced in a pictorial format for residents. Since the last inspection the complaints log has been amended to include all details and aspects of a complaint. Three relatives surveys were received by the CSCI prior to the inspection. All confirm they know how to make a complaint, two that the home ‘always’ responds appropriately and one ‘usually’. In addition to this five residents were also received, all completed with assistance from staff. Two state due to being unable to communicate verbally they were not able to answer questions and three that they know who to speak to if not happy. Due to some of people who live at this home having potential barriers to communication we looked to see what systems are in place to ensure residents with communication needs are not disadvantaged from raising concerns. Staffs informed us that residents with communication needs are reliant on them to raise concerns on their behalf, but were not able to explain what systems are in place to support them to do this. As one member of staff explained, “if unhappy, sit and listen, try and work out, talk to key worker and Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 26 manager. Its harder for those who can’t talk, especially if staff do not know they very well”. It is recommended that systems are introduced such as regular key worker meetings, increasing the frequency of residents meetings and introducing as a set item on the staff meeting agenda ‘concerns to be raised by staff on behalf of residents’ in order to promote residents rights to complain. There are policies and procedures regarding vulnerable adult abuse. There was also a copy of the Local Authority multi-agency procedures ‘safeguard and protect’ plus a copy of the ‘no secrets’ guidance available at the home as is good practice. A Requirement was made at the previous inspection that arrangements must be made to ensure that all staff have a clear understanding of adult protection and whistle blowing procedures, to ensure that residents are not at risk of harm or abuse. The Acting Manager informed us at this inspection that all but one member of staff have now completed vulnerable adults training. However the training matrix and certificates on staff files do not confirm this. For example the training matrix details eight of the eleven staff having undertaken adult protection training and two of the staff files sampled contained certificate that were over three years old. It is recommended that any staff member who received training over three years ago undertake a refresher course to ensure their knowledge reflects changes in legislation and good practice, offering further protection to residents. Also at the previous inspection a Requirement was made to make arrangements to ensure that physical and verbal aggression by a resident is understood and dealt with appropriately by staff, to ensure that residents are not at risk of harm. Again it was pleasing to find that all staff have completed specific training in understanding the behaviours of one resident. In addition to this the acting manager and supervisor are undertaking another course for managing behaviour and are hopeful others will be able to undertake this in the near future. We looked at three residents’ finances and carried out an audit of money, which tallied with the records maintained. The financial records for all three all contained receipts for meals (lunch and dinner) taken outside of the home. For example one contained receipts confirming they had paid for six meals, the second person eight meals and the third nine meals. In addition to this receipts evidence that on some occasions residents have paid for the purchase of two meals at one sitting. The Acting Manager confirmed that residents have been paying not only for their own meals but also for staff escorting them in the community. No evidence could be found of the home contributing to these meals. The homes Statement of Purpose states ‘three full meals are provided each day’ and Contracts of Residency do not state that if a resident chooses to have one of the three main meals provided outside of the home this is not covered within the basic contract fee. The Statement of Purpose and Contracts of Residency do not include any information regarding residents having to fund staff meals when being escorted in the community. These practices have the Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 27 potential to place residents at risk of financial abuse and as such an Immediate Requirement Form was issued during the inspection instructing that these practices must cease with immediate affect until written confirmation is in place that the funding authority agrees with these practices. Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 28 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally the design and layout of the home ensures residents live in a safe, well-maintained and comfortable environment. EVIDENCE: We toured the building and saw that the refurbishment of the home continues. A number of improvements have already taken place or are underway which include refurbishment of the ground floor bathroom, replacement of the boiler, redecoration of bedrooms, doorframes being repaired and dining room decorated; all providing an comfortable and homely environment for residents to live in. All of the communal areas are warm, comfortable and clean. A toilet on the first floor was out of commission on the day of inspection and we were informed it is going to be replaced with a linen cupboard. As we explained to the manager this would need agreement with the CSCI due to the reduction of facilities impacting on choices for residents. The Expert by Experience also identified this when they toured the premises, as they Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 29 explained, “Looking around the home I was disappointed to hear the provider are removing the upstairs toilet and replacing it with a linen cupboard. Once this toilet is removed it will only leave one toilet in the bathroom for people to use. This is not adequate enough for people, as often people like to take their time in the bathroom, when others may need to use the toilet. I’m also a little confused as to why people need a linen cupboard over a toilet, as people should have the room in their bedrooms to keep their own linen. Walking around the home it did look and smell clean and had some nice furnishings. I was told one lady is about to have her bedroom redecorated and has chosen her own colour scheme, blue”. The home has a large, bright kitchen that is clean and tidy. We found a good supply of food stocks, including a choice of cereals, tinned foods, fresh fruit, vegetables and salad. A ready supply of personal protective equipment, liquid soap and paper towels were seen to be in place and staff were witnessed using this, promoting good infection control. We noted that the window frame by the sink was stained and fly screen soiled. Also in the fridge we saw that some items were not dated when opened but that fridge and freezer temperatures are being recorded. A radiator is located next to the fridge that was very hot to the touch. The acting manager confirmed that a written risk assessment is not in place for this. This should be completed to ensure all necessary actions are being taken to reduce the risk of injury to staff and residents. We were escorted around the external grounds of the building. Garden areas were seen to be well tended. Repairs are needed to steps that are uneven to reduced risk of injury from falls. We were informed that the home intends to talk to the fire department regarding changing fire routes out of the garden to promote safety of residents, which is a positive. We were shown the ‘old post room’. This is a room that is fixed to the building next to the kitchen that is made of wood and plastic sheeting. We were informed this is used for a resident who smokes. This room does not comply with the Smoke Free Regulations and action must be taken to address this and to ensure the safety of residents. For example the room is completely enclosed, with no ventilation and does not have the appropriate signage. As mentioned earlier in the report a number of doors do not have locks fitted and in some instances are missing handles, compromising the privacy and dignity of residents. All of the residents’ bedrooms are decorated to a good standard and include items that reflect residents’ personalities. When looking in bedrooms we noted that one resident’s room felt cold compared to everyone else’s. The radiator was on in this room and the only explanation we could find for this was that this room has no secondary glazing compared to other bedrooms. It is strongly recommended that this be investigated and if the room temperature is found to be affected by the lack of double glazing this be provided to ensure temperatures are maintained to a comfortable level. Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 30 The laundry is sited in the cellar. There is mould appearing all over the laundry walls and ceilings and there is a damp odour. A member of staff told us that the extractor fan had become broken and that once repaired the area would be redecorated. We also noted a build up of lint by the dryer and holes in the walls and to the ceiling. Advice should be sought from the Health Protection Agency with regards to the laundry facilities to ensure infection control standards are maintained. Infection control policies were on display to inform and advice staff. Appropriate storage facilities for the storing and sanitizing of mops were also seen to be in place. Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 31 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): 32,33,34,35 and36. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff in the home are not trained, skilled and in sufficient numbers to support the people who live there. EVIDENCE: Good progress has been made since the last inspection to ensure that staff either hold or are in the process of obtaining a National Vocational Qualification (NVQ). The home employs a total of eleven staff; all apart from one person who is due to retire have completed an NVQ II or above or are working to obtain one. As at the previous inspection staff still require specialist training. As mentioned earlier in this report staff demonstrated little knowledge regarding the principles of person centred approaches and agreed that they needed training. The Expert by Experience reinforced this. As they explained, “Being around the home I felt some value base training for the staff team would be very beneficial. At times I did feel uncomfortable with the way staff spoke to people, in their words and body language. I also felt uncomfortable when a staff member encouraged a person to throw a ball through a hoop whilst he Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 32 watching TV, as this person didn’t want to do it. I felt, at times, the staff see themselves as carers to children and not supporters to adults”. We were shown documentation and staff confirmed that courses have been arranged by the company that owns the home put many recently have been cancelled. It is a positive that staff have undertaken challenging behaviour and adult protection training, however work must be undertaken in other areas including nutritional awareness, risk management, equal opportunities, LDAF and the Mental Capacity Act to ensure staff are suitably qualified for their positions and to support residents. It is also recommended that further work be undertaken to expand the training matrix that is in place within the home. Currently this does not contain all training that staff have undertaken or need and is not effective for monitoring purposes. Rotas evidence that there are three support staff on duty per daytime shift and the manager is supernumerary. When discussing staffing levels with the acting manager and other staff there was some confusion with regards to the needs of one resident. We were informed that the funding authority has agreed additional one to one hours for this person but that these were not yet in place due to staff not currently being recruited to undertake the additional hours. We asked if the funding authority had given a specific date when these hours should commence and if they were under the impression the hours were in place to support the resident. No one in the home could confirm the funding authorities understanding in this area. We explained that if additional hours had been agreed in order to meet the residents needs alternative arrangements such as employing a regular agency worker should be put into place until such time a permanent support worker can be recruited. As already mentioned earlier in this report staffing levels impact on the number of one to one activities residents can participate in. When looking at staff rotas we had some difficulty assessing what staff have undertaken shifts due to the poor quality of recordings. For example correction fluid was found to be used, records do not include surnames with some first names being the same for more than one member of staff and rotas do not identify which people undertaking shifts are agency workers. It is recommended that improvements be undertaken with the compilation of staff rotas to allow for ease of reference and improved monitoring. We found that staff meetings take place but the frequency could increase to ensure staff receive further support in order to carry out their roles. We looked at the staff files of five permanent staff, including the newest member of staff. In all we found discrepancies. For example, one member of staffs file states they were dismissed from their previous employer. No evidence could be found that this had been risk assessed or monitored when recruited to the home. Other discrepancies include gaps in employment history with no written explanation, two written references for one employee but one of these was supplied by a former colleague rather than the manager of the establishment where the person had worked previously, missing Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 33 photographs, lack of forms of identification and risk assessments for staff commencing employment for receipt of a full enhanced CRB disclosure. We were informed at the previous inspection that a review of all staff files was going to be undertaken by the new personnel officer and missing information collated. The missing information and documentation we found at this inspection evidences this has not taken place. We also noted that one some staff files risk assessments have been completed for medical conditions. All state regular monitoring and reviewing should take place. No evidence of this occurring could be found. We also looked at the records of agency staff that have completed sifts at the home during December 2007 and January 2008. Some of these contained evidence that they have an enhanced CRB disclosure and the date of issue, others do not. All contained a ‘carer’s profile’ which contained details of experience and training. None of these included the dates when training has been undertaken. A printed statement on the profile states ‘all mandatory training is up to date or in the process of undertaking’. This indicates that staff may not hold up to date certificates and therefore may not be suitably qualified. Work should be undertaken by the home to verify what training agency workers have undertaken including dates achieved to ensure all people working in the home are suitably qualified. None of the profiles contained evidence relating to NVQ qualifications or any specialist training. A recommendation was made at the last inspection to ensure that staff receive full and structured induction training suitable for the work they are to perform, and in order to meet the specialist needs of the residents. The induction record for the newest member of staff does not demonstrate this. It was noted that the induction took place over one day. We question how staff can retain information when so much is given in one day. The acting manager produced a copy of the Common Induction Standards workbook, explaining that this is going to be introduced into the home. Until this is the case this recommendation will remain. None of the staff files that we sampled contained evidence that staff receive regular, formal supervision in order to support them fulfil their roles. For example one member of staffs records evidence they received two supervisions 2007, another four, another one and two that they had not received any. We were informed that one of the staff who has no record of supervisions has these completed by the area manager. All staff received an annual appraisal in 2007 however upon examination of the records of these none were found to have been completed in full. Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 34 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): 37,39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The overall management of the home is starting to improve with the manager and her staff team now trying to raise standards so that residents’ health, safety and welfare is better promoted. EVIDENCE: The acting manager has been in post since September 2007. We were unable to examine the acting managers recruitment documentation and training certificates, as these are stored at the company’s head office. She informed us that the holds a NVQ level 2 and 4 in care and is due to start the Registered Managers Award. In addition to this she informed us that she holds all mandatory training. We discussed what this consisted of and were informed Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 35 courses undertaken were the same as care staff. We recommend that as manager she should undertake courses that offer more in-depth knowledge than those provided to care in order that she has the appropriate knowledge to monitor staff practices. We were informed by the acting manager that she has previously been a registered manager of an older persons home and that her experience is mainly of older persons and people with mental health needs and that she does not hold any qualifications relating to learning disabilities. We recommend the acting manager undertake learning disability qualifications to ensure she has the appropriate knowledge to manage the home and meet residents’ needs. During the inspection the acting manager appeared willing to work with us and gave explanations on how she wants to improve services within the home, however on some occasions her lack of experience of learning disabilities was evident. For example she was not able to explain the principles and values of person centred approaches to care or communication aids to support this process. Greater care must also be made by the acting manager to ensure all staff are aware of visitors in the home. For example we had arranged for an Expert by Experience to accompany us on the inspection. We explained who this person was, the reason for their presence and what they would be doing. The acting manager did not ensure staff were fully informed. As the Expert by Experience explained, “During a conversation with a staff member who showed us around the home, he thought I was thinking about moving into the home. It became clear this staff member did not know why I here, which is disappointing”. There is a quality assurance system in place that is not yet fully operational. We were informed that surveys have been sent to stakeholders and families but as yet only one has been returned. It was noted that surveys are not available for staff to complete. It is recommended that these be implemented as a further aid to quality monitoring. A development plan was not available to view, with the acting manager unsure if one existed. The Area manager in line with Regulation 26 of the Care Home Regulations 2001 undertakes regular visits and copies have been forwarded to CSCI. It is a positive that the use of Widget symbols is included in residents surveys as aids to communication for residents but further improvements could be made with the use of colour and large print. The use of independent advocates to support residents to complete these would also enhance the process further. Information supplied by the home prior to the inspection in the form of its AQAA was found to be basic in parts and did not inform the reader regarding protection, finances, infection control, staffing levels, health and safety and health care. The home has a quality assurance policy in place that appeared to have part missing. Audits have been completed for health and safety, care, medication and food. Some of these were not dated, making them difficult to track. We sampled maintenance and service records and found these to be largely up to date and in good order. For example the central heating was serviced October 2007, electrical items tested October 2007, the chair lift serviced Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 36 January 2008 and a five-year electrical wiring certificate issued December 2004. The training matrix in the home states that of the eleven staff employed eight have undertaken health and safety, seven moving and handling, first aid, food hygiene and infection control and nine fire training. When we looked at the certificates maintained in the home we found that in some instances some were out of date reducing the numbers, for example in moving and handling. Work must be undertaken to ensure all staff undertake training in all mandatory areas to ensure they are suitably qualified to support residents. It was also noted that all of the driver/maintenance person’s certificates have expired. West Midlands Fire Service completed a fire safety audit of the home on 22 May 2007. They agreed that as an acceptable temporary measure a hook and eye catch could be used on a fire door in a resident’s bedroom until an electro magnetic hold open device connected to the fire alarm is installed. They also instructed that the procedure for the hook and eye must be documented in the fire risk assessment and all staff trained accordingly. They also accepted the installation of a stair lift, instructing that the chair must always be stored at the bottom of the stairs. They instructed that this procedure be documented in the fire risk assessment and all staff trained accordingly. On both days of the inspection we observed that the stair lift chair was stored at the top of the stairs, inspection of the fire risk assessment found that it does not contain information regarding the hook and eye catch, location of stair lift chair or training of staff and the Acting Manager was unable to confirm if staff have received training in these particular areas. During both days of inspection we also observed a fire door (main office) wedged open. On the first day this was wedged with a large chocolate tin and the second a dining room chair. We also found that two of the permanent staff have not participated in a fire drill within the last 6 months. This is of concern as both work during the night when reduced staffing levels and the lack of training poses greater risk to residents in the event of a fire. Due to our concerns we issued an Immediate Requirement Form during the inspection instructing that action must be taken to reduce the risk of harm to residents in the event of a fire. Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 37 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 2 2 2 3 x 4 2 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 2 33 2 34 2 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 2 2 x LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 x 2 x 2 x x 2 x Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 38 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 YA23 Regulation 13(6) Requirement That the practice of residents funding their own and care staffs meals when out in the community cease until written confirmation is in place that the funding authority agrees with these practices – Immediate Requirement Form issued during inspection. Action must be taken to reduce the risk of harm to residents in the event of a fire. This must include – Complying with the contents of West Midlands Fire Service report dated 22 May 2007; Ceasing the practice of wedging a fire door and; Ensuring all staff participate in a dire drill at least every 6 months. Timescale for action 29/01/08 2. YA42 17(2) 23(4) 04/02/08 Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 39 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations To expand the service user guide to ensure that it contains all of the details required by the Care Homes Regulations 2001, Regulation 5 such as details regarding fees and who will be responsible for paying them and information regarding additional charges. To consider producing the service user guide in formats suitable for residents. For any future admissions to the home full assessments of needs, consideration of those already living at the home and a range of trial visits must be undertaken to ensure the home can be confident that they can care for individuals and meet their needs. To ensure that care plans cover all aspects of personal and social support and healthcare needs as set out in the National Minimum Standards 2. The Home should continue to introduce and complete a person centred approach (such as essential life style planning) and reproduce care plans in formats suitable for service users. That care plans contain specific timescales for action and evidence the involvement of residents and/or their representatives. To continue to pursue referrals to speech and language therapists with regard to support in establishing communication passports for residents. That deprivation of liberty assessments be undertaken to ensure compliance with the Mental Capacity Act and to ensure where possible freedom of movement is not restricted. Further work should be undertaken to ensure routines are flexible to meet residents needs and choices and not solely for the smooth running of the home. That staff receive guidance regarding the contents of Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 40 2. YA2 3. YA6 4. YA7 5. YA9 communication plans and that these are used as working documents to ensure residents’ needs are met. To expand risk assessments in order to ensure that they more accurately describe who is at risk, the nature of the risk, existing controls measures and any additional measures, which are required. That risk assessments be completed based on individuals different needs and capabilities to promote a person centred approach to risk management. That a system be introduced to link care plans and risk assessments to ensure effective monitoring takes place and to promote a holistic approach to care management. That greater efforts are made to support residents to develop life skills. To consider referrals to specialists for support with introducing activities such as O.T.s To re-establish a pictorial activity board or programme. That an assessment of the premises is undertaken by a qualified person such as an Occupational Therapist to ensure every effort is made by the home to ensure residents have freedom of movement and can undertake life skills of their choice. Work should be undertaken to ensure residents can undertake activities on an individual basis in order that their individual needs and preferences are recognised and met (promoting a person centred approach to care). Consideration should be given to arranging holidays based on residents’ individual needs and preferences rather than all residents going on holiday as one group. To continue to ensure that any restrictions on choices are negotiated with all individual service users and advocates. Outcomes to be recorded in service user plans and reviewed regularly: for example the decision to not to provide bedroom door keys, front door keys, and the opening of service users mail. If residents cannot give their consent, then staff should consider making decisions in their best interests as in compliance with the Mental Capacity Act 2005. To consider calculating residents’ ideal weight utilizing a Body Mass Index scoring system and including this on nutritional screening tools. 6. 7. YA11 YA14 8. YA16 9. YA17 Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 41 To consider introducing ‘taster’ sessions to help in determining residents’ choices and preferences. That menus be reviewed to ensure choices do not consist of the same products. That residents be given the opportunity to be involved in food shopping. To review the practice of hourly checks undertaken during the night for service users. (If this level of monitoring is deemed necessary it must be discussed and agreed as part of a multi-disciplinary team with outcomes and guidelines for staff to be documented in individual care plans). To actively pursue an O.T. assessment for one resident and confirm: that the technique used in mobilizing is appropriate, and whether or not a wheelchair is needed for long distances. To provide appropriate locks and door handles to all bathing and toilet facilities to ensure the privacy and dignity of residents is maintained. To continue to pursue other professionals to assist in the completion of Priority for Health screening tool (and for support staff to complete relevant sections of the booklet where required). The Primary Care Trust should be contacted if the home has difficulty obtaining support from health professional in order that residents living at the home are not disadvantaged. To continue to pursue screening for breast, cervical and testicular cancer (enlisting the assistance of the community learning disability nurse if possible). To consider introducing a system for monitoring (or make reference in a care plan), regarding staff being observant for any abnormalities, which could potentially relate to breast or testicular cancer. To liaise with the district nurse to determine whether a resident requires one and half hourly checks during the nighttime for catheter care. The home should clarify with the OT if residents have been assessed as requiring wheelchairs or not to ensure residents receive the appropriate support. Health care records should be improved to include details Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 42 10. YA18 11. YA19 of appointments; actions and outcomes to ensure the health needs of residents are met. Weight recording sheets should be completed on a regular basis. All prescribed creams and lotions should be dated when opened and state which part of the body they should be applied to. That medication competency assessments be completed on a regular basis for all staff that administer medication to ensure staffs practices comply with good practice. That systems are introduced such as regular key worker meetings, increasing the frequency of residents meetings and introducing as a set item on the staff meeting agenda ‘concerns to be raised by staff on behalf of residents’ in order to promote residents rights to complain. It is suggested that the manager seeks the advice of the Local Authority commissioners with regard to bedroom furniture which as been paid for by individual residents when the home was run by the former owners. Written records must be maintained of the outcomes from these discussions and any action taken. It is recommended that any staff member who received adult protection training over three years ago undertakes a refresher course to ensure their knowledge reflects changes in legislation and good practice, offering further protection to residents. To repair and resurface the driveway and make safe the steps at the rear of the premises. To seek advice from a relevant agency to ensure the building and surrounding grounds complies where possible with the Disability Discrimination Act 2005. To action any recommendations made and to forward evidence of outcomes to the Commission. That advice is sought from CSCI registration team with regards to taking out of commission a toilet and replacing with a linen cupboard. That the window frame and fly screen in the kitchen are cleaned. That all food items stored in the fridge are dated when opened. 12. YA20 13. YA22 14. YA23 15. YA24 Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 43 That an assessment of risk is completed for the radiator that is not guarded located next to the fridge. That repairs to the external steps be made. That action is taken to ensure the ‘old post room’ complies with the Smoke Fee Regulations. That the reason for the lower room temperature in a residents bedroom be investigated and if the room temperature is found to be affected by the lack of double glazing this be provided to ensure temperatures are maintained to a comfortable level. To treat damp in laundry area and redecorate affected areas. That the build up of lint by the dryer in the laundry is removed to reduce the risk of fire. Advice should be sought from the Health Protection Agency with regards to the laundry facilities to ensure infection control standards are maintained. To provide staff with nutritional awareness training. To provide management and staff with person centred planning training. To provide staff with training in risk management and the Mental Capacity Act 2005. Clarification should be sought from the funding authority with regards to the date additional hours are being funded for a named resident. Regular agency workers should be put into place to undertake these hours until such time as a permanent support worker can be recruited. Staffing levels should be reviewed in order that residents can participate in one to one activities. That improvements be undertaken with the compilation of staff rotas to allow for ease of reference and improved monitoring. To complete audit of existing staff personal files and replace missing information as required by the Care Homes Regulations 2001, Regulation 19 and Schedule 2. To ensure that agency staff are suitably qualified and have Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 44 16. YA30 17. YA32 18. YA33 19. YA34 appropriate experience to work at the home with written records maintained. To ensure that appropriate clearance checks are in place for agency staff prior to them commencing duties. To ensure that staff receive full and structured induction training suitable for the work they are to perform, and in order to meet the specialist needs of the residents. A written record must be maintained at the care home. To ensure that all staff receive equal opportunities including disability equality training. To provide induction and foundation training for staff by an accredited learning disability awards framework (LDAF) provider. To complete an up to date training needs assessment for the staff team and establish a training and development plan. A copy to be forwarded to the Commission. To ensure that all staff have an up to date training and development assessment and profile in place. To review the training matrix in order that it details all training staff have participated in. That all staff receive regular, formal supervision in order to support them to fulfil their roles. To continue to ensure that all staff have had an annual appraisal and to ensure this is completed in full. That the frequency of staff meetings increase to ensure staff receive further support in order to carry out their roles. That the acting manager undertakes courses that offer more in-depth knowledge than those provided to care in order that she has the appropriate knowledge to monitor staff practices. That the acting manager undertakes learning disability qualifications to ensure she has the appropriate knowledge to manage the home and meet residents’ needs. To continue to fully implement effective quality assurance and quality monitoring systems based on seeking the views of service users, stakeholders, families and advocates. There should be an annual development plan for the home Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 45 20. YA35 21. YA36 22. YA37 23. YA39 based on a systematic cycle of planning-action-review. That staff surveys be implemented as further aids to quality monitoring. Further improvements should be made to residents’ surveys for example with the use of colour and large print. The use of independent advocates to support residents to complete these would also enhance the process further. That greater detail be included in the Annual Quality Assurance Assessment when next completed in order that the home can evidence it is monitoring its own practices. Work should be undertaken to ensure all staff undertake training in all mandatory areas to ensure they are suitably qualified to support residents. The driver/maintenance person should hold up to date certificates in fire, moving and handling, first aid and health and safety. 24. YA42 Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 46 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Beechlawns DS0000069593.V354980.R01.S.doc Version 5.2 Page 47 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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