Inspection on 17/07/08 for Bel-Air Residential Care Home

This inspection was carried out on 17th July 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bel-Air Residential Care Home 14/12/09

Bel-Air Residential Care Home 02/01/09

Bel-Air Residential Care Home 27/10/08

Similar services:

Chesham House

Argyll House

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Extracts from inspection reports are licensed from CQC, this page was updated on 28/10/2008.

CARE HOME ADULTS 18-65 Bel-Air Residential Care Home 76 Bushey Hall Road Bushey Watford Herts WD23 2EQ Lead Inspector Claire Farrier Unannounced Inspection 17 and 21st July 2008 1:15 th Bel-Air Residential Care Home DS0000070334.V368609.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 Bel-Air Residential Care Home DS0000070334.V368609.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. Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bel-Air Residential Care Home Address 76 Bushey Hall Road Bushey Watford Herts WD23 2EQ 01923 332540 01923 332540 mo@portlandcarehomes.co.uk 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) Portland Care Homes Ltd Mr Mohammad Nooranny Dookhun Care Home 6 Category(ies) of Learning disability (6), Mental disorder, registration, with number excluding learning disability or dementia (6) of places Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability and dementia - Code MD Learning Disability - Code LD The maximum number of service users who can be accommodated is 6 2. Date of last inspection 5th September 2007 Brief Description of the Service: Bel-Air is a care home providing personal care and accommodation for six people with mental health needs. It is owned by Portland Care Homes, a private company. The home was opened in 2007 and consists of a three storey terraced house in a residential road. It is indistinguishable from the other houses in the road. The home is located close to the centre of Watford, with its shopping malls, community health facilities and hospital. There is a small parade of shops within a short walking distance and easy access to major rail, bus and road transport. All the homes bedrooms are single. All the bedrooms have ensuite toilet and washbasin, and three have an ensuite shower. There is no lift and the home is not suitable for service users with mobility difficulties. The garden at the rear is mainly laid to grass with a large paved patio. The garden is shared with the company’s sister home next door. For further information and up to date fees, please contact the manager direct. Information regarding the service is available in the Statement of Purpose & Service Users Guide. A copy of the CSCI inspection report will be available from the manager. Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. We spent one afternoon at Bel-Air, and the people who live there and work there did not know that we were coming. The focus of the inspection was to assess all the key standards. Some additional standards were also assessed. One person who lives in the home completed a Have Your Say survey before the inspection. Two members of staff also completed Have Your Say surveys, and we have used the information from these in this report. During our visit to the home we talked to all the people who live in the home. Several members of staff also gave their views about the home, and some time was also spent looking at records, care plans and staff files. We returned to the home a few days later to speak to the manager about what we had seen during our visit. We sent an Annual Quality Assurance Assessment (AQAA) form to the home in May 2008. The AQAA provides information for the Commission about the home, and the manager’s assessment of what the service does in each area. It is a document that is required to be returned to the Commission by legislation. This should have been returned to us, and in June 2008 we contacted the home to remind them to send it in. The AQAA had not been returned by the time of the inspection. The Commission received the AQAA two days after this inspection was completed. Evidence from the AQAA has been included in this report. What the service does well: There was a welcoming atmosphere to the home and it was well maintained and clean. The people who live there have made it into their home, and they are free to come and go as they please. The AQAA stated that the staff always listen to the views of the clients. One of the people who live in the home described Bel-Air as “An excellent model of a home.” One of the staff who completed a survey said, “Residents receive the best care according to their care plan and risk assessment. Residents are given the choice of what they want to do, when and where.” Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Due to the manager’s experience and previous good reports for Bellevue, which he also manages, the expectation was that this would be a positive inspection. We were therefore surprised to find the failings that we have reported on this occasion. The manager has two homes to manage, with low staff levels and new paperwork and procedures from the new company. There has been no deputy manager in post, although a new deputy started at the same time as our visit to the home. The manager did not send the AQAA to the Commission when we requested it and we had not received it before we visited the home. It is a legal requirement that the AQAA should be completed and sent to the Commission when requested. The home did not sent notifications to the Commission of incidents in the home that may affect the well being of the people in the home. The manager has informed us that appropriate notifications will been sent to the Commission in future. The home’s policies contain information that is incorrect and in some cases misleading. One example of this is the procedure for safeguarding vulnerable adults, and another is the procedure for administering medication. It was reported that Portland is in the process of reviewing the process for quality assurance, but at this time there is no system in place for monitoring the quality of care in the home. The Statement of Purpose and the Service and the Service User Guide for Bel-Air state that Bel-Air provides a service for people with mental health needs. However the home is registered for learning disability and mental health needs. The three people who currently live in the home do not have a learning disability. The company must apply for a variation to the conditions of registration, so that they describe the services provided correctly. The Service User Guide does not have all the information that is recommended and required so that people have who are planning to move in can decide if it is the right place for them. Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 7 We found five health and safety concerns during our visit to the home and we made two immediate requirements for issues that needed urgent action. The immediate requirements were to make sure that there is adequate storage for cleaning materials that may be harmful for vulnerable people, and to monitor water temperatures effectively and ensure that bath water temperatures are not dangerously hot. These have been addressed in the time between the inspection and writing this report. The temperatures of the fridge and freezer in the kitchen are regularly recorded as being outside the recommended temperatures for the safe storage of food. This means people are at possible risk from incorrectly stored food. The manager has informed us that action has now been taken to address this concern. The practice of fire drills does not follow the home’s own procedures in the fire risk assessment. There was no evidence that the fire escape route is safe for people to use in case of fire. The procedures described by the staff for handling wet sheets do not meet the guidelines for ensuring good infection control. The manager has informed us that action has now been taken to address this concern. The home’s policy on infection control states that liquid soap and paper towels should be used instead of bar soap and fabric towels. But the manager has not acted on the findings of the last inspection as he said he would, and we again saw cloth towels in the bathroom and toilet, and either no soap or bar soap provided. The service never uses agency staff, and due to the small number of permanent staff that are employed this means that some people work exceptionally long hours and unacceptably long shifts. The exceptionally long hours worked in Bel-Air mean that staff may be too tired to provide a good quality of care for the people who live there, and there is a risk of errors due to poor concentration. There is only one support worker in Bel-Air at all times, to support the three people who live there. One member of staff commented that if there were more staff, they could provide more outdoor activities for residents apart from day care. The people who live in each home have different needs. If staff were able to work with one set of residents, they may be able to be more proactive in supporting them to find their choice of work, college, or other community activities, and to expand their social lives. Bel-Air provides a service for people with mental health needs, and some people also have a cognitive disability. The staff who work in Bel-Air must have appropriate training so that they understand and can meet theses needs. One of the staff files that we saw did not have evidence of their immigration status or work permit. The care plans and risk assessments are not person centred. There is no evidence that people are fully involved in making decisions about the care and support that they receive. The care plans that we saw were not signed by the people concerned. The care plans are reactive to the symptoms and problems that each person presents. The risk assessments do not focus on encouraging and supporting people to increase their independence by managing any risks appropriately. Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 8 There is no evidence that nutrition is monitored, through checking any changes in weight and encouraging people to follow a healthy diet. The home’s procedures for administering PRN (when required) medicines and homely remedies do not protect the people in the home from the risk of errors. 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. Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 9 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 Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 10 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 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information about the service needs to be updated to ensure that people are able to make an informed choice about using the services. EVIDENCE: Since the last inspection a new company has purchased Bel-Air and Bellevue, the home next door. Three people currently live in the home and there are three vacancies. The Annual Quality Assurance Assessment (AQAA) states that the company needs to improve their marketing strategy in order to improve the home’s occupancy rates. The Service User Guide does not have all the information that is recommended and required so that people have who are planning to move in can decide if it is the right place for them. It does not contain details of the accommodation and of the staff, and it does not include the views of the people who live there, the complaints procedure, details of the fees, a copy of the contract and the most recent inspection report. Some of these are provided in the Statement of Purpose. However these documents have different purposes. The Statement of Purpose is the Home’s formal statement of the objectives and philosophy of the service. The Service User Guide should be a document that details what Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 11 the prospective residents can expect and explains clearly and accessibly what life is like in the home. The Statement of Purpose and the Service User Guide for Bel-Air state that Bel-Air provides a service for people with mental health needs. However the home is registered for learning disability and mental health needs. The three people who currently live in the home do not have a learning disability. The company must apply for a variation to the conditions of registration so that they describe the services provided correctly. The Statement of Purpose states that the home has a manager, deputy manager, senior support worker, 13 support workers and 1 domestic. It is not clear whether these numbers are specific to Bel-Air or if they are shared with Bellevue (see Staffing and Management and Administration). We looked at two care plan files and they both contained a detailed assessment that was carried out before the person moved into the home. The AQAA states, “We always carry out a full assessment of any prospective resident to evaluate the suitability of the client including visit by the client to view the Home and what we can offer.” The surveys that we received from staff stated that they feel they have the right support, experience and knowledge to meet the different needs of the people who use services. However it is not clear whether these staff were referring to Bel-Air specifically. Some of the staff that we spoke to during the inspection said that they would like additional training, specifically in understanding mental health needs and in managing challenging behaviour (see Staffing). Some of the staff work very long hours and excessively long shifts. This may have an impact on the quality of care that they can provide to meet the needs of the people who live in the home (see Staffing). Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 12 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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans and risk assessments contain appropriate information on personal and health care needs, but there is little indication of the involvement of each person in setting up and reviewing their care plan in accordance with the principles and practice of person centred planning. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) states that the care plan format has been updated, adding more body to it and making it easer to understand. The AQAA states that all residents signed their care plan. However it recognises that the service could improve the participation of people in writing their care plans, as agreed when they first move in. We looked at the files of two people, which show what care is provided for them and how it is recorded. The care plans provide appropriate details of the support that each person needs. There are risk assessments in each care plan, which provide guidance to staff in supporting people to take risks as part of an independent lifestyle. However the care plans and risk assessments are not person centred. Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 13 There is no evidence that people are fully involved in making decisions about the care and support that they receive. The care plans that we saw were not signed by the people concerned. The care plans are reactive to the symptoms and problems that each person presents. The risk assessments do not focus on encouraging and supporting people to increase their independence by managing any risks appropriately. One person has a risk assessment for ‘self secluding’ in their room. The actions for managing this risk is for staff to check on the person regularly. There is no plan for how the person may be able to choose whether to be alone or in company, and no criteria for establishing what ‘self secluding’ is and the effects of this on the person’s quality of life. Some care plans contain conflicting information. For example, the rehabilitation assessment report for one person states that they are “independent in all cold and hot drinks preparation”. But in the care plan a risk assessment states, “needs supervision to use the kitchen.” During the inspection this person used the kitchen independently and with no supervision, and prepared their own hot drink and sandwich while the staff were with the inspector. This person also has a kettle and microwave in their bedroom. The care plans do not contain goals or targets for each person, based on what they would like to achieve. The people who we spoke to said that they make decisions about what they do and how they live their lives. One person agreed on a daily activities chart in a meeting and then requested further meeting with their key worker and manager to have a less structured routine. Another person, X, chooses to go out all day, and returns to the home in the evening. Although this respects their wish for independence, adequate protocols and risk assessments and are needed to make sure that as far as possible X is safe and protected. On one occasion X was punched by someone while they were out. The police were called, but there was no safeguarding referral or investigation to establish procedures their safety. During our visit X did not return to the home at the usual time in the evening. The staff were concerned, but were not aware of any procedure to follow if X did not return to the home. On this occasion X did return soon afterwards. Bel-Air Residential Care Home DS0000070334.V368609.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 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are able to take part in their own choice of activities but they are not supported to find alternative choices to involve them in community activities that meet their needs or expectations. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) states, “The Home promotes independence, choice and the residents have the freedom to choose activities of their choice.” None of three people who currently live in the home has employment or attends a college or day care. Each person chooses what they want to do every day. One person spends most of the day every day visiting a friend. Another had agreed a structured programme, but asked for this to be reviewed and now goes out most days to the shops or a local coffee shop. The third person said that they would like to have the opportunity to work. The AQAA states that the Home would like to build up a larger database of local agencies providing education, community work and training for Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 15 activities of daily living skills, so that people have more choice. The surveys that we received from staff stated that residents are given the choice of what they want to do, when and where. They said that the service provides good inhouse activities for residents. However one person commented that if there were more staff, they could provide more outdoor activities for residents apart from day care. The staff work in both Bel-Air and Bellevue next door. The people who live in each home have different needs. If staff were able to work with one set of residents, they may be able to be more proactive in supporting them to find their choice of work, college, or other community activities, and to expand their social lives. One person buys and prepares their own food and they are given a budget by the home for this. The staff cook the main meals for the other two people. One person, Y, had a care plan to support then to prepare their own food, but Y chose to go out at lunchtime in order to avoid what they saw as a task, so the staff continue to cook for them. Although this ensures that Y has a nutritious meal every day, there is no plan in place to find more creative ways to encourage Y to take more responsibility for improving their skills for independence. Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 16 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. The staff support people to maintain their health needs and to consult other medical professionals. However they do not have sufficient training to make sure that they can understand and meet the needs of people with mental health needs and cognitive impairment. The home’s procedures for administering PRN (when required) medicines and homely remedies do not protect the people in the home from the risk of errors. EVIDENCE: The care plans contain good details of each person’s care needs. The healthcare records seen included references to hospital visits, and contact with GPs and other health professionals. These include psychiatrist and community nurses. One member of staff who we spoke to say that they have had three days training in mental health needs for people with learning disabilities. As none of the people who currently live in the home has a learning disability, this may not be the most appropriate training. Other staff have had no training in mental health needs, or in cognitive impairment, to help them to understand Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 17 and meet the needs of a resident with Korsakov’s syndrome. One member of staff said that they would like training in challenging behaviour. Although the care plans contain good records of the care and medical assistance that everyone has, there is no evidence that the home is proactive in addressing health needs. There is no evidence that nutrition is monitored, through checking any changes in weight and encouraging people to follow a healthy diet. One person is sometimes incontinent at night. This has been addressed by monitoring and recording the episodes of incontinence, but there has been no action to look at possible causes, such as the after effects of depot medication or urine infection, with action plans to address these indicators. One person looks after their own medication, and another has a regular depot injection, and has no medication kept in the home. For the third, Z, most medication is supplied in a monitored dosage Nomad box. Z also has several medications to take when needed (PRN). The medication file does not give clear details of how staff should know when these medicines are required. The manager said that the protocol is that staff always contact him, even when he is not working, for his agreement if a PRN medication is needed. There are three boxes of one medication, some that Z brought when they moved into the home, but a further supply that has been provided since then. This medication has not been needed since Z came to the home and should not have been ordered. Following the inspection the manager reported that the excess medication has been returned to the pharmacy. Z has a supply of Paracetamol to be taken PRN. However there is also a box of over the counter medication that they brought with them, that also contains paracetamol. The home has no protocol for recording and administering these ‘homely’ over the counter remedies. The protocol should be clear about which homely remedies can be given and the problems that they can be used to treat. Advice must be sought from the GP or pharmacist and it would be good practice for the GP to agree each homely remedy for each person. This would make sure that there is no interaction between the homely remedy and any prescribed medications. Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 18 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. People who use the service are able to express their views and concerns. However the procedure for safeguarding people from abuse does not comply with local guidance so there is a risk that incidents of abuse may not be reported and investigated appropriately leaving people at risk. EVIDENCE: The Portland Care Homes’ complaints procedure is satisfactory. The people who we spoke to said that they know how to make a complaint and who to speak to if they are not happy. No complaints have been recorded since the home opened. There have also have been no safeguarding referrals or investigations. However at least one incident has happened that should have been referred to Hertfordshire County Council Adult Care Services as a safeguarding concern, when X was punched by someone while they were out (see Individual Needs and Choices). The home’s policy for safeguarding people from abuse does not comply with The Hertfordshire County Council joint agency protocol. In Hertfordshire it is the responsibility of Adult Care Services to investigate all allegations or abuse (or to direct a representative on their behalf) and to involve the police if needed. The home’s procedure states that the manager should investigate, and that if the person concerned does not wish the abuse to be taken further their wishes should be respected. This could put other people at risk of similar behaviour from the abuser. Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 19 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and well-maintained environment for the people who live there. The staff maintain a good standard of cleanliness, but people may be at risk of infection because the procedures for control of hygiene and prevention of infection are not followed in practice. EVIDENCE: Bel-Air is a mid terrace family style house. It looks no different from the other family houses in the street. It is within walking distance of local shops and services and is not far from Watford town centre. The home looks well decorated and maintained. Everyone has a single bedroom with ensuite toilet and washbasin, and three rooms have ensuite showers. The bedrooms are large and furnished with comfortable furnishings. The rooms that we saw have been personalised by the people who live in them. One person has a fridge, kettle and microwave cooker in their room. The lounge/diner and kitchen are large enough for everyone to use together if they wish to. A shed on the patio outside the lounge has been furnished with a table and chairs so that people Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 20 who wish to smoke can use it. On person enjoys spending time in there reading and listening to the radio. The laundry is shared by Bel-Air and Bellevue and is sited in an outhouse in the garden. It is fitted with an industrial washing machine and tumble drier. Residents are able to use the machines for their personal laundry, but it was reported that a spare room in the house is supposed to be fitted with domestic machinery so that people can use it more readily. One person who lives in the home is occasionally incontinent of urine. The procedures described by the staff for handling wet sheets do not meet the guidelines for ensuring good infection control. The soiled laundry is carried through the house to the laundry in an open laundry basket and it is not washed separately from clothing and other laundry. It is not washed at a high enough temperature to prevent the risk of infection. In the Annual Quality Assurance Assessment (AQAA) the manager stated that the home uses the Department of Health (DOH) guide ‘Essential Steps’ and that there is a policy for preventing infection control. But only five members of staff have had training in the management of infection control and prevention of infection. The DOH guidance on infection control for care homes gives clear information on the laundry procedures that must be followed to ensure that there is no risk of spread of infection. In the last inspection report the narrative stated that the manager must replace the cotton hands towels with soft disposable hand towels in communal toilets and bathrooms to prevent the spread of infection. The manager had assured the inspector that this would be addressed and therefore a requirement was not made. However when we visited the home on this occasion, we again saw cloth towels in the bathroom and toilet, and either no soap or hard bar soap provided. The home’s policy on infection control states that liquid soap and paper towels should be used instead of bar soap and fabric towels. But the manager has not acted on the findings of the last inspection as he said he would and does not follow his company’s procedures. Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 21 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 and 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The people who live in the home are supported by a stable staff team. However due to staff shortages, people have to work excessive hours, and this may affect the quality of their work and leave people at possible risk. EVIDENCE: There are three people living in the home, but the staffing levels have not increased from when there was only one resident. There is one support worker in the home at all times during the day and the night. The Annual Quality Assurance Assessment (AQAA) states that there are 4 full time and 5 part time staff in the home. But it also states that there are 3 permanent staff in the home. The number of staff employed in Bel-Air is not clear. But on the rota 8 people are listed as working in the home over two weeks, and they also all work in Bellevue next door. The service never uses agency staff, and due to the small number of permanent staff that are employed this means that some people work exceptionally long hours and unacceptably long shifts. We saw the rotas for the two weeks during which this inspection took place. During that time, one member of staff worked nine nights in a row between the two homes. They also worked morning and afternoon shifts, including a night and a morning shift (from 9.30 pm to 2.30 pm the next day) and then the same that Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 22 night. This long shift occurred four times during the two weeks, and on one occasion this person worked a 17 hour shift, followed by 7 hour break, another 17 hour shift followed by a 7 hour break, and then another night shift of 10 hours. On several occasions members of staff worked the morning shift from 7.30 am to 2.30 pm in one home, and then the afternoon shift from 2.30 pm to 9.30 pm in the other home, with no break between. These long hours and long shifts without a break are contrary to the Working Time Directive, which safeguards staff from the risk of losing concentration by working too long. The exceptionally long hours worked in Bel-Air mean that staff will be too tired to provide a good quality of care for the people who live there, and there is a risk of errors due to poor concentration. The staff who completed surveys and who we spoke to during the inspection all spoke of the need for more staff, but said that new staff are currently being recruited. One member of staff commented that if there were more staff, they could provide more outdoor activities for residents apart from day care. The people who live in each home have different needs. If staff were able to work with one set of residents, they may be able to be more proactive in supporting them to find their choice of work, college, or other community activities, and to expand their social lives. One survey from a member of staff stated that what the service does well is in-house courses. But what the service could do better is to have more staff, and more training for staff. Everyone does the mandatory health and safety training and it was reported that other training would be available when new staff increase the numbers. Some of the staff that we spoke to during the inspection said that they would like additional training, specifically in understanding mental health needs and in managing challenging behaviour. One member of staff who we spoke to say that they have had three days training in mental health needs for people with learning disabilities. As none of the people who live in the home has a learning disability, this may not be the most appropriate training. Bel-Air provides a service for people with mental health needs, and some people also have a cognitive disability. The staff who work in Bel-Air must have appropriate training so that they understand and can meet theses needs. The AQAA stated that 1 of the 3 permanent staff has a NVQ qualification and 2 are working towards it. We looked at three staff files to check that the home has all the information that is required to confirm that the person is suited to working in the home. They all contained appropriate references and CRB (Criminal Record Bureau) disclosures. But one person has a Zimbabwe passport but there was no evidence of their immigration status or work permit. Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 23 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, 40 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home does not maintain appropriate records to monitor health and safety procedures and ensure that there is no risk to the people living in the home. EVIDENCE: The manager has worked at Bellevue for many years and he has a level 4 NVQ in management and in care. When Bel-Air opened next door to Bellevue he was registered as manager for both services. In January 2008 Portland Care Homes bought both Bel-Air and Bellevue. The manager has remained with the homes. In the Annual Quality Assurance Assessment (AQAA) the manager wrote, “The management has experience and meet all the requirement. Our evidence to show that we do it well is that our recent inspection report has been positive.” Due to the manager’s experience and previous good reports for Bellevue, the expectation was that this would also be a positive inspection. Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 24 We were therefore surprised to find the failings that we have reported on this occasion. The manager has two homes to manage, with low staff levels and new paperwork and procedures from the new company. There has prior to the site visit been no deputy manager in post, although a new deputy started at the same time as our visit to the home. The manager did not send the AQAA to the Commission when we requested it, and we had not received it before we visited the home. It is a legal requirement that the AQAA should be completed and sent to the Commission when requested. The home has not sent notifications to the Commission of incidents in the home that may affect the well being of the people in the home. The incidents recorded in the home include two when police were called to the home due to the behaviour of a former resident and one where a current resident was assaulted in the street (see Independent Needs and Choices). We should have been informed of these incidents. We have been informed that appropriate notifications will be sent to the Commission in the future. The home’s existing policies and procedures have been revised by adding the Portland Care Homes logo to them. We looked at a sample of procedures. Some, such as the complaints procedure, contain appropriate information. However others contain information that is incorrect and in some cases misleading. One example of this is the procedure for safeguarding vulnerable adults (see Concerns, Complaints and Protection) and another is the procedures for administering medication that do not provide guidelines for ‘homely’ remedies (see Personal and Healthcare Support). Portland is also in the process of reviewing the process for quality assurance, to find a system that involves the people in the home more effectively. We found five health and safety concerns during our visit to the home, and we made two immediate requirements for issues that needed urgent action. In an unlocked cupboard under the sink in the kitchen we observed items that may be hazardous to the health of vulnerable people. These include a canister of Big D Fly and Wasp Killer, a plastic container of Tesco Thick Bleach and a spray bottle of CIF Power Cream. We notified the staff member on duty, who said that these should be stored in the cleaning cupboard, but were in the kitchen as cleaning had not finished. The staff member took the items to the cleaning cupboard. However the cleaning cupboard was also unlocked and the staff member told us that this cupboard is never locked. The manager also confirmed that the cupboard was not locked, as the lock was not secure. Following the inspection, the manager has confirmed that the cleaning cupboard has been secured. Hot water from the tap in the bath of the top floor bathroom measured 45°C on the home’s thermometer. The record of water temperatures shows consistently high water temperatures in the last month, within a range from 40°C to 50°C. This may leave people at risk of accidental scalding. The record did not clearly specify which outlets are tested. Following the inspection the manager has put Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 25 a new format in place for recording water temperatures that makes it clear which outlets are tested. He has confirmed that the hot water temperature has been adjusted to a safe level. The temperatures of the fridge and freezer in the kitchen are recorded every day. But during the last month the recorded fridge temperatures have varied from 6.9°C to 12.5°C, which is higher than the recommended temperature for the safe storage of food. During the same period the recorded temperature of the freezer has varied between -19°C and -29°C, which is lower than the recommended temperature. The staff that we spoke to were not aware of the safe temperatures for food storage and there was no procedure in place for reporting and addressing temperatures that are too high or too low. We have been informed that following the inspection a new freezer and a new fridge freezer have been purchased, and a new format for monitoring temperatures has been put into place. The home’s fire risk assessment states that there should be two fire drills a year and that the record should show the length of time that the drill took and what the outcome was. The last fire drill took place in October 2007. The record of the fire drill states that “all were shown procedures to follow in the event of a fire or fire alarm sounded. All shown the fire exits and equipments.” The fire drill should be used to show that staff know what to do in case of fire, and not to give them this information. The next drill was due to take place in April 2008 but this has not taken place. If staff do not have a regular chance to practice safe procedures on a regular basis, residents could be at risk if there were a genuine fire in the home. The fire escape route from the first and second floors is through a door into Bellevue next door, and then down the fire escape in to the garden from Bellevue. The fire risk assessment does not show whether this is a safe escape route in case of fire and the manager was not able to show us a fire officer’s report to confirm that this is acceptable. Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 26 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 3 3 2 4 X 5 X 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 3 25 3 26 3 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 1 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 2 12 1 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 1 X 1 2 X 1 X Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 YA1 Regulation 4(1) Requirement Timescale for action 31/10/08 2. YA1 6 3. YA6 15(1) & (2) The company must apply for a variation to the conditions of registration, to make sure that the services that the home provides are as specified in the Statement of Purpose. The Statement of Purpose and 31/10/08 Service Users Guide must be amended to ensure that they contain all the information that is recommended and required so that people have who are planning to move in can decide if it is the right place for them. The care plans and risk 31/10/08 assessments contain appropriate information on personal and health care needs, but there is little indication of the involvement of each person in setting up and reviewing their care plan in accordance with the principles and practice of person centred planning. Measures must be put in place to ensure that residents are involved in decisions about their care, and that these are recorded appropriately. Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 28 4. YA9 13(4) 5. YA12 16(2)(n) 6. YA14 16(2)(n) 7. YA19 12(1)(a) 8. YA20 13(2) 9. YA23 13(6) Appropriate and adequate risk assessments must be put in place for all residents for situations in which there is any risk of harm or injury to themselves or others. Arrangements must be put in place so that the people in the home are able to take part in their choice of community activities outside of the home, including opportunities for employment and education. The manager must make sure that everyone in the home has a choice of varied and appropriate activities throughout the day. Meaningful activities need to be developed that meet each person’s individual needs. The registered person must ensure that appropriate care plans and recording are in place for all the residents’ health care needs, and in particular for weight management and good nutrition. The home must have a clear policy on the administration of non-prescribed, ‘homely’ remedies. This must include which homely remedies can be given, and the problems that they can be used to treat. Advice must be sought from the GP or pharmacist, and it would be good practice for the GP to agree each homely remedy for each person. The procedures and practices in the home must ensure that people are protected from the risks of abuse, and that any incidents are referred and investigated appropriately. 31/10/08 31/10/08 31/10/08 31/10/08 31/10/08 31/10/08 Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 29 10. YA30 13(3) 11. YA30 13(3) 12. YA33 18(1)(a) The manager must ensure that 31/08/08 the procedures for handling soiled laundry follow the Department of Health guidance on infection control for care homes, to ensure that there is no risk of spread of infection. The manager must make 31/08/08 provision for liquid soap and paper towels to be used instead of bar soap and fabric towels, in order to ensure that there is no risk of spread of infection. The staffing rotas show that 31/10/08 many staff work very long hours, long shifts, and do not have sufficient time off between shifts. The registered person must ensure that sufficient staff are employed in the home in order to comply with the Working Time Regulations, and to provide the services described in the home’s Statement of Purpose. All the required information as listed in Schedule 2 of the regulations, must made available before anyone starts to work in the home. This includes evidence of immigration status and work permit where required. All staff who work in Bel-Air must have an appropriate training in understanding mental health needs, so that they can provide a good quality of care and support for the people who live there. Training should also be available in behaviour management and cognitive impairment. 13. YA34 19(1)(b) 31/08/08 14. YA35 18(1)(c) (i) 31/10/08 Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 30 15. YA37 12(5) 16. YA39 24 17. YA40 13 18. YA42 23(4)(e) The registered provider must ensure that the management structure of the home provides sufficient management time and support so that the welfare and health and safety of people who live in the home is not compromised. A system for monitoring the quality of care must be established, that focuses on the consultation with the service users and other involved people, and provides feedback on the process and the results of the consultation. The policies and procedures that are used in the home must contain comprehensive information that complies with current legislation and good practice, so that they protect the people who live in the home from the risks of harm or abuse. The registered person must ensure that every member of staff takes part in at least one fire drill every year. The fire drills must be an effective practice of the home’s fire procedures 31/10/08 31/10/08 31/10/08 31/10/08 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 Bel-Air Residential Care Home DS0000070334.V368609.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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