Inspection on 21/07/08 for Bellevue

This inspection was carried out on 21st July 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bellevue 04/12/09

Bellevue 02/01/09

Bellevue 27/10/08

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOME ADULTS 18-65 Bellevue 78 Bushey Hall Road Bushey Watford WD23 2EQ Lead Inspector Claire Farrier Unannounced Inspection 21st July 2008 2:00 Bellevue DS0000070332.V369043.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 Bellevue DS0000070332.V369043.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. Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bellevue Address 78 Bushey Hall Road Bushey Watford WD23 2EQ 01923 490570 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 7 Category(ies) of Learning disability (7), Mental disorder, registration, with number excluding learning disability or dementia (7) of places Bellevue DS0000070332.V369043.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 fall within the following categories: Learning Disability - Code LD Mental Disorder, Excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is 7 2. Date of last inspection 4th July 2007 Brief Description of the Service: Bellevue is a care home providing personal care and accommodation for seven people with learning disabilities, who may also have a mental illness. It is owned by Portland Care Homes, a private company. The home was opened in 1991 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. Six are on the first and second floor, and one on the ground floor has en-suite facilities. 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. 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. Bellevue DS0000070332.V369043.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 and evening at Bellevue, 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. Three people completed Have Your Say surveys 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 most of 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 talked to the manager about what we had seen during our visit. The manager sent some information (the Annual Quality Assurance Assessment, or AQAA) about the home to CSCI before the inspection, and his assessment of what the service does in each area. Evidence from the AQAA has been included in this report. What the service does well: What has improved since the last inspection? The home was sold to Portland Care Homes in January 2008 and the company has put new policies and procedures in place, including a new assessment format. Everyone does the mandatory health and safety training and it was reported that other training will be available when there are more staff in the home. Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 6 What they could do better: Due to the manager’s experience and previous good inspection reports, 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 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. Two requirements from the last inspection report were not met. These were that the kitchen must be refurbished and the kitchen units must be replaced, and that safe methods approved by the fire officer must only be used for wedging open doors. The manager has informed us that action has now been taken on both of these requirements, so they have not been repeated in this report. 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. One safeguarding issue was not referred to Hertfordshire County Council adult care services to be investigated. 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 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 Bellevue 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. One member of staff commented that if there were more staff, they could provide more outdoor activities for residents apart from day care. Another said that they are worried about the health and safety of the staff. 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. 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. Most of 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. There is no evidence that nutrition is monitored, through checking any changes in weight and encouraging people to follow a healthy diet. We found four health and safety concerns during our visit to the home. Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 7 The temperatures of the fridge are regularly outside the recommended temperatures for the safe storage of food. Some of the fire doors are held open by artificial means, which means that they would not close automatically if there was a fire in the home. There was no record of fire drills in the home. If staff do not have a regular chance to practice safe procedures on a regular basis, residents could be at risk if there was a fire in the home. The radiators in the hall and first floor landing do not have a cool surface cover, and there is no risk assessment to show that people are protected from the risks that a hot radiator may present. The manager has informed us that action has now been taken to address all these concerns. 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. Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 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 Bellevue and Bel-Air, the home next door. Five people currently live in Bellvue and there are two 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 the prospective residents can expect and explains clearly and accessibly what life is like in the home. Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 10 The Statement of Purpose and the Service User Guide for Bellevue state that Bellevue provides a service for people with learning disabilities and mental health needs. The manager confirmed that this means that people who live in the home have a mental health illness that is secondary to their learning disability. This is not clear in the Statement of Purpose and should be amended so that there is no confusion about the services that the home provides. The Statement of Purpose does not provide the required contact details for CSCI and for the local authority. The Statement of Purpose states that the home has a manger, deputy manager, senior support worker, 13 support workers and 1 domestic. It is not clear whether these numbers are specific to Bellevue or if they are shared with Bel-Air (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 Bellevue specifically. Some of the staff who 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). Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 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 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. There is Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 12 no evidence that people are fully involved in making decisions about the care and support that they receive. For example, one person has a care plan for ‘physical needs’ that has the aim, “To monitor all needs and maintain positive health.” There is no indication of the person’s view and personal goals, and the care plan has no programme towards supporting the person’s independence in maintaining positive health. Most of the care plans that we saw were not signed by the people concerned. All the surveys we received from people who live in the home stated that the carers always listen and act on what they say. However they also all said that only sometimes do they make decisions about what they do each day. 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, X, has an assessment dated 2005 for verbal aggression. This stated, “Thankfully X has not physically assaulted anybody within the home.” There was no behaviour plan to improve X’s behaviour and to assist them to have control. During the last year there have been several incidents when X has been verbally abusive to another resident, and verbally and physically abusive to staff. There have also been two complaints from a local shop about X’s abusive and aggressive behaviour, and a complaint that X shouted at people in the street. The actions following these incidents were to discuss the persons behaviour with them, and advise them not to visit the shop that made the complaints. The incidents between X and the other residents are addressed by separating the two people as far as possible. All these actions are reactive to incidents that have happened, and there is no management plan to help X to understand and control their own behaviour. The care plan for X is to ask X to calm down and escort X to the bedroom. The care plan also says that staff should listen to X when X has a concern, but there is no follow up to this. The care plan also states, “All doors to be locked at night to stop X leaving the premises and go for a walk about in the back garden or out in the street.” These actions are at best a punitive reaction and at worst a physical restraint (see Concerns, Complaints and Protection). The care plan makes reference to a risk assessment, but there was no risk assessment in the care plan file. There is no care plan for the other resident, to make sure that they feel safe in the home. Another person, Y, has an ongoing problem with abuse of alcohol. Y’s care plan states that a room check is required periodically for evidence of alcohol hoarding. Also that staff are to monitor Y in the home and community, to check Y’s bag, and when possible carry out a body search and room search. There is no indication that this is part of a management plan that has been agreed by Y, or of an assessment of Y’s capacity to agree with these actions. The actions are again at best a punitive reaction and at worst a physical abuse. The manager explained that the care plans are not effected in a punitive manner, and that they are part of a plan agreed by each person. However this is not recorded. And if staff read and follow the care plans as they are written, they may be guilty of restraint or physical abuse (see Concerns, Complaints and Protection). Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 13 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. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) states, “Residents attend day care facilities of their choice and the Home is always willing to encourage other residents to enrol in educational programme of their liking.” Three of the five people who currently live in the home attend day care during the week. No one attends college or any other form of education. Two people have no programme of daytime activities in the home or in the community. The AQAA states that the Home would like to build up a larger database of local agencies providing education, community work and training for 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 inBellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 14 house 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 Bellevue and Bel-Air 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 member of staff said in the survey, “The service could do more involving the residents in leisure activities and taking them out on trips and visits to family etc. However we are at present short staffed; when we are fully staffed I am confident that we will do much better concerning these activities for the residents.” Two people buy their own food, and they are given a budget by the home for this. One of these cooks the ready made meals that they have chosen, and the staff cook the main meals for the other people in the home. People can choose what they want to eat, and they are encouraged to help with the cooking. However we did not see any evidence of this during our visit. Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 15 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 are not proactive in promoting good healthcare for the people in the home. 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 the psychiatrist and community nurses. 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 any 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 had input from a dietician, which is recorded between 2003 and 2006. There was concern about this person’s weight, and the record shows comments from the dietician that addresses this: “Advised not to eat crisps, biscuits, sweets.” “Dietician visited and warned X that they are very overweight.” “Is advised to cut on sweets.” But there is no care plan to support X to eat a healthy diet as advised by the dietician. X has Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 16 been weighed regularly, and this shows a continuing weight increase. This health concern is not being addressed in the home as a serious issue that affects the wellbeing of the person concerned. Another person buys and prepares their own food (see Lifestyle). But there is no recorded monitoring to ensure that they choose a healthy diet, and that they eat appropriately to maintain good health. The only reported monitoring is of food that is thrown away because it is out of date. A psychiatrist review for one person showed that there has been an improvement in their behaviour and their interactions with other people. But this is not recorded in the care plan, and there is no active care plan for achieving similar improvements. The home has sound systems in place to manage people’s medication safely. We checked a sample of medication records, which were free of errors, with no signature gaps found on the MAR (medication administration record) charts. Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 17 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 poor. 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, and there is a risk that incidents of abuse may not be reported and investigated appropriately leaving people at risk. EVIDENCE: The home’s complaints procedure is satisfactory. The surveys from people who live in the home stated that they know who to speak to if they are not happy, and they know how to make a complaint. The complaints file contained a letter of complaint from a relative. This is currently being investigated as a safeguarding issue. However the safeguarding referral was not made by the manager, and he did not respond to the complaint properly. The home’s policy for safeguarding people from abuse does not comply with The Hertfordshire County Council Adult Care Services agreed joint agency protocol. In Hertfordshire it is the responsibility of Adult Care Services to investigate all allegations or abuse (or to direct a representative of their choice to conduct an investigation) 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. However the manager of Bellevue is very experienced, and the last inspection report stated that a copy of the Hertfordshire County Council Protection of Vulnerable Adults Procedure was available to all staff and those Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 18 staff spoken to were aware of its contents. The surveys that we received from staff on this occasion stated that they know what to do if a service user, relative, advocate or friend has concerns about the home. Therefore the manager should be aware of the proper procedures to follow to ensure that the people who live in the home are safeguarded from the risk of abuse. Two care plans we saw detail actions that are at best a punitive reaction and at worst a physical restraint (see Individual Needs and Choices). If staff read and follow the care plans as they are written, they may be guilty of restraint or physical abuse. Bellevue DS0000070332.V369043.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, 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 if the procedures for control of hygiene and prevention of infection are not followed in practice. EVIDENCE: Bellevue 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 appears to be clean and well maintained. Everyone has a single bedroom, and one has an ensuite shower. The bedrooms are furnished in a homely style, and the rooms that we saw have been personalised by the people who live in them. The lounge, dining room and kitchen are large enough for everyone to use together if they wish to. Some of the bedrooms have been redecorated since the last inspection, but the kitchen has not been refurbished as required in the last inspection report. At that time we said that some of the kitchen worktops were Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 20 damaged and cupboard doors and handles were ill fitting. The tiling on the walls looked unsightly in areas and the flooring was worn and patchy. We have been informed that following the inspection the kitchen has been refurbished. The home employs a part time cleaner and the home appears to be clean. The Portland Care Homes policy on infection control states that liquid soap and paper towels should be used instead of bar soap and fabric towels. This is in line with Department of Health guidance on infection control for care homes. However we saw no paper towels available in any of the bathrooms and toilets in the home. Some had liquid soap, but some had a fabric towel and others had hard soap available. In one bathroom there were neither soap nor towel of any kind available. Bellevue DS0000070332.V369043.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 leaving people at risk. EVIDENCE: There has been no change in the staffing levels in Bellevue. There are two support workers in the home during the day, and one at night. The Annual Quality Assurance Assessment (AQAA) states that there are 6 full time and 7 part time staff in the home. But it also states that there are 5 permanent staff in the home. The number of staff employed in Bellevue is not clear. But on the rota 10 people are listed as working in the home over two weeks, and 7 of these also work in Bel-Air 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 weeks during which this inspection took place and the previous week. On both Sundays there was only one support worker in the home. During the two weeks, one member of staff worked nine nights in a row between the two homes. They also worked morning and afternoon shifts, Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 22 including a night and a morning shift (from 9.30 pm to 2.30 pm the next day), and then the same that 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 Bellevue means 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. 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 who completed a survey stated, “Since February staffing issues is a major concern. Due to the shortage, staff have got to overwork themselves without being left with choices. Due to the Health and Safety of the staff I’m really worried. However there have been interviews and candidates have been selected for the positions but it’s just a long process.” 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. Everyone does the mandatory health and safety training and it was reported that other training will be available when new staff increase the numbers. Some of the staff who 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 completed a survey said that they would like to go on some informative training in dealing with Mental Health issues and Learning Disabilities. The AQAA stated that 3 of the 5 permanent staff have 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 and there was no evidence of their immigration status or work permit. Bellevue DS0000070332.V369043.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 Bellevue and Bel-Air. 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, the expectation was that this would also be a positive inspection. We were Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 24 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 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 resident, and one when a resident had hospital treatment. Appropriate notifications have been sent to the Commission since this inspection. 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). 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 four health and safety concerns during our visit to the home. The temperatures of the fridge and freezer in the kitchen are recorded every day. But during the last month on 16 occasions the recorded fridge temperatures have been over 5°C, which is higher than the recommended temperature for the safe storage of food. There was no procedure in place for reporting and addressing temperatures that are too high or too low. The record does not state which fridge and freezer the record refers to. In addition to the main fridge/freezer in the kitchen, there is a separate chest freezer in the kitchen, and a fridge in the dining room used by the person who buys and cooks their own food (see Lifestyle). We have been informed that following the inspection the freezer has been replaced, and a new format for monitoring temperatures has been put into place. We saw no record of fire drills in the home. 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 door at the top of the stairs from the ground floor to the first floor is held open due to the thickness of the carpet. This has been noted in previous inspections, but no action has been taken to ensure that the door remains closed. The door at the top of the stairs to the second floor was closed, but a door wedge was seen nearby. The staff reported that the wedge is used to hold the door open when the cleaner is vacuuming. We have been informed that following the inspection the door wedges have been removed and automatic door closers have been fitted to the doors on the stairs. Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 25 The radiators in the hall and first floor landing do not have a cool surface cover and there is no risk assessment to show that people are protected from the risks that a hot radiator may present. We have been informed that following the inspection radiator covers have been fitted. Bellevue DS0000070332.V369043.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 2 23 1 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 X 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 2 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 3 X 1 X 1 2 X 2 X Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES 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 6 Requirement Timescale for action 31/10/08 2. YA6 15(1) & (2) The Statement of Purpose and 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. 31/10/08 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. Measures must be put in place to ensure that residents are involved in decisions about their care, and that these are recorded appropriately. 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. DS0000070332.V369043.R01.S.doc 3. YA9 13(4) 31/10/08 Bellevue Version 5.2 Page 28 4. YA12 16(2)(n) 5. YA14 16(2)(n) 6. YA19 12(1)(a) 7. YA23 13(6) 8. YA33 18(1)(a) 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 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. The staffing rotas show that 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. 31/10/08 31/10/08 31/10/08 31/10/08 31/10/08 Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 29 9. YA34 19(1)(b) 10. YA35 18(1)(c) (i) 11. YA37 12(5) 12. YA39 24 13. YA40 13 14. YA42 23(4)(e) 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 Bellevue must have an appropriate training in understanding mental health needs and learning disabilities, so that they can provide a good quality of care and support for the people who live there. 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. 31/08/08 31/10/08 31/10/08 31/10/08 31/10/08 31/10/08 Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 30 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 YA22 Good Practice Recommendations All complaints should be recorded appropriately, to show the process and outcome of the investigation. Bellevue DS0000070332.V369043.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. Extracts may not be used or reproduced without the express permission of CSCI Bellevue DS0000070332.V369043.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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