CARE HOME ADULTS 18-65
Bell`s Piece Bell`s Piece Hale Road Farnham Surrey GU9 9QZ Lead Inspector
Fiona Cole Unannounced Inspection 1st November 2005 09:00 Bell`s Piece DS0000013567.V263357.R01.S.doc Version 5.0 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 Bell`s Piece DS0000013567.V263357.R01.S.doc Version 5.0 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. Bell`s Piece DS0000013567.V263357.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Bell`s Piece Address Bell`s Piece Hale Road Farnham Surrey GU9 9QZ 01252 715138 01999 999999 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) Leonard Cheshire Tracy Maxine Davies Care Home 13 Category(ies) of Learning disability (12), Learning disability over registration, with number 65 years of age (1) of places Bell`s Piece DS0000013567.V263357.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The age/age range of the persons to be accommodated will be: 12, 30-60 years and 1 over 65 years 14th June 2005 Date of last inspection Brief Description of the Service: Bells Piece is a large detached house that has been converted to provide a care home for younger adults with learning disabilities operated by the Leonard Cheshire Foundation. The home is located in attractive grounds at the end of a private driveway on the outskirts of Farnham. There are local shops and other amenities close by. Sharing the grounds of the home is a Horticultural and Craft Centre which service users have opportunity to work in. The home is spacious and offers mostly single bedroom accommodation on both floors, one with en-suite facilities, some with small kitchen areas and others are self contained flats including one shared flat. There are a variety of communal rooms on the ground floor. The home has car-parking facilities for several cars. Bell`s Piece DS0000013567.V263357.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the second in the CSCI year 2005/6 and was conducted with the support of the administrator and three support workers on duty that day. The manager was not present for most of the inspection as she was working outside of the home, but returned to assist with queries for a two-hour period in the afternoon. Five staff were on duty altogether and seven service users were spoken with during the course of the inspection. The inspector spent the first part of the inspection with the administrator and the support staff checking the shared parts of the home and looking at care plans and other documentation. The home has been developed and improved in recent years offering additional en-suite facilities and all rooms now have a wash hand basin. The second part of the inspection was spent with service users, many of whom showed the inspectors their rooms and spoke about their day and life at Bells Piece. The inspector was pleased to see that everyone seemed happy living in the home. The home had a comprehensive statement of purpose, which accurately described the services provided by the home. The service plans in place were Detailed and are reviewed on a regular basis to ensure they reflect the service users needs. What the service does well:
The relationship between service users and staff was observed to be relaxed and friendly, creating a warm and homely feel. Service users were encouraged and supported to be as independent as possible and they all appeared to lead busy and interesting lives, which included attending the Horticultural Centre day care leisure activities shopping church and skills and literacy. Bell`s Piece DS0000013567.V263357.R01.S.doc Version 5.0 Page 6 In recent years the registered provider has implemented a good system of person centred care planning which identifies each individuals personal and health care needs and how these are to be met. The system has a very user focussed approach with evidence to confirm the service users were consulted and maintain control of their lives. Service users are only admitted following a full assessment undertaken by the managers who are able to demonstrate the homes capacity to meet the assessed needs. Each service user has a clearly set out care plan and all the service users are registered with a local GP. There were satisfactory facilities and procedures available for the safe reception storage disposal administration and recording of medication. Arrangements are in place to meet the service users care needs in a respectful way that affords both privacy and dignity. Staff are very committed to encouraging service users to take part in the daily activities that are offered in the home and to participate in the running of the premises where appropriate. Full support is provided to enable individual choice in daily living activities. It was stated by the home manager that the use of agency staff had been eradicated which was of benefit to service users through increased continuity of care. What has improved since the last inspection?
The area of risk assessment, risk management has greatly improved both in the building sense where the laundry room now complies with legislative requirements, and the service users care plans now reflect how the home meets need appropriately and safely. The recording storage and disposal of Criminal Record Bureau Disclosures Has been addressed and no longer is a requirement. The on-call policy has been revised and all staff given the necessary training to ensure they understand how to implement it when necessary. Bell`s Piece DS0000013567.V263357.R01.S.doc Version 5.0 Page 7 What they could do better: 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. Bell`s Piece DS0000013567.V263357.R01.S.doc Version 5.0 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 Bell`s Piece DS0000013567.V263357.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 The home was found to be operating effectively in respect of these standards. There was a good standard of information available about the home to be a help to prospective service users to make an informed choice as to whether the home would be a suitable place to live. EVIDENCE: The home has recently reviewed and revised their statement of purpose and service user guide. These have been made more user friendly and incorporate More pictorial representations. There was also evidence that staff took time to explain these documents to service users, both in residents meetings and on a key worker basis. Sampling of care plans provided evidence that the home has established a sound process of assessing needs and aspirations and this was being further enhanced by the development of person centred care planning. Bell`s Piece DS0000013567.V263357.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Evidence gathered at this inspection indicated that each of these standards were being met effectively. This gives confidence that each individual’s needs and aspirations were being recognised and met. EVIDENCE: Service users were aware that plans were in place and they contained information about them, their needs and wishes. The home also operates health care records, which help to ensure a holistic picture of the person is maintained. Daily diary notes and discussion withy service users and staff provided evidence that service users were encouraged to be as independent and in control of their lives as possible. It was evident that robust risk assessments had been produced in consultation with the individual, as far as possible, and any restrictions were only applied where the level of risk was considered unacceptable. Bell`s Piece DS0000013567.V263357.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16. The evidence collected during this inspection showed and confirmed the home meets each of the assessed standards. This meant the home was able to demonstrate that service users were encouraged and supported to lead as independent and fulfilling life as they were able. EVIDENCE: The relationship between staff and service users was observed to be relaxed and friendly, creating a warm and homely feel. Service users were encouraged and supported to be as independent as possible and they all appeared to lead busy and interesting lives. All of the service users had been on holiday at differing times and regular outings were very much enjoyed by the service users. Service user rights were only limited where risks were assessed as being unacceptable. For example some service users walked home from their daily activity unsupervised others were collected by staff. Service users confirmed that staff helped them keep in contact with relatives and friends.
Bell`s Piece DS0000013567.V263357.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 The home meets each of the assessed standards. The home was able to demonstrate that service users health and personal care needs were met appropriately. EVIDENCE: The recording of medication was of a good standard all records were complete Service users medication profiles correlated with the medication administration records. Discussions with staff and service users reinforced that the home worked hard to ensure that health and personal care needs were consistently met. Bell`s Piece DS0000013567.V263357.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The home meets each of the assessed standards and was able to demonstrate that service users were adequately protected and that service users views were important and acted upon. EVIDENCE: All of the service users who spoke with the inspector knew they could approach staff at any time if they had a worry or a problem. They felt that staff were always willing to listen to them and help in any way they could. The manger offers an open door policy and this was seen as very beneficial as problems would be dealt with quickly. This was confirmed by the observed interactions between service users and staff throughout the inspection day. All staff were said by the registered person to have completed vulnerable adult protection procedures training, and were thereby aware of the action to take should they have a concern or if an allegation of abuse was made. This was confirmed by four of the staff members who spoke with the inspector during the course of the inspection. Bell`s Piece DS0000013567.V263357.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30 The home was able to demonstrate they met all of the assessed standards with the exception of standard 24, which was almost met, (see below) and provided a good level of accommodation appropriate to the needs of the current service users. EVIDENCE: The home has been developed and improved in recent years and now offers wash hand basins in all rooms and some additional bathroom and en-suite facilities. The home is clean and hygienic and service users stated they are proud of the work they do to keep it clean and comfortable. All rooms have a locking front door and are not accessed by staff without service user consent. There was no handrail present by the back door to the terrace of the shared flat to ensure safety for the service users. The registered person must ensure a handrail is fitted beside the back door to the terrace of the shared flat, and paint the step white to ensure that all service users are aware of the step, especially those with a visual impairment.
Bell`s Piece DS0000013567.V263357.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35,36 The home demonstrated well how it met each of the assessed standards. Staff appeared to be enthusiastic and committed to supporting service users, with training and development given a high priority. EVIDENCE: The relationship between service users and staff was seen as relaxed and friendly, creating a warm and homely feel. Service users are encouraged and supported to be as independent as possible. Training and development of staff has been given a high priority, the inspector was shown a detailed costed training programme in place and with supervision being undertaken by the manager deputy and two other senior support workers on a regular basis. Bell`s Piece DS0000013567.V263357.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38, 39, 40, 42, 43 The home demonstrated their ability in meeting all of the assessed standards, And was seen to be well run with sound and accountable management support. The manager is supported by staff in providing clear and consistent leadership in the home with all staff illustrating an awareness of their roles and responsibilities. The homes record keeping and health and safety policies protect all service users. EVIDENCE: Training and development of staff is a high priority and the training programme shown to the inspector offered a wide range of refresher as well as new training to all staff. Over fifty per cent of staff are NVQ trained and the manager has attained NVQ4 and is enrolled to begin The Registered Managers Award in 2006. The manager ensures that families are kept fully informed about the welfare of the service user.
Bell`s Piece DS0000013567.V263357.R01.S.doc Version 5.0 Page 17 Information from service users and staff confirmed that the management style was open and the registered manager is approachable at all times. Weekly meetings were held for staff and all were encouraged to contribute to the development of the home. Records required for the protection of service users and sampled on the day of the inspection were well maintained, accurate and up to date. Bell`s Piece DS0000013567.V263357.R01.S.doc Version 5.0 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 3 3 3 X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X 3 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Bell`s Piece Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score X 3 3 3 X 3 3 DS0000013567.V263357.R01.S.doc Version 5.0 Page 19 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard 24 Regulation 13(4) 14(1)(2) 23(2)n Requirement The registered person must ensure a handrail is fitted beside the back door to the terrace of the shared flat, and paint the step white. Timescale for action 01/12/05 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 Bell`s Piece DS0000013567.V263357.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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