CARE HOME ADULTS 18-65
Belmont Stone Street Stanford North Ashford Kent TN25 6DF Lead Inspector
Julian Graham Unannounced Inspection 10:15 1 December 2005
st Belmont DS0000023333.V263515.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 Belmont DS0000023333.V263515.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. Belmont DS0000023333.V263515.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Belmont Address Stone Street Stanford North Ashford Kent TN25 6DF 01303 813084 01303 813084 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) Counticare Limited Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Belmont DS0000023333.V263515.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users under the age of 18 to be restricted to one whose D.O.B is 17/09/1985. All staff to have current CRB checks. Date of last inspection 5th September 2005 Brief Description of the Service: Belmont is situated in the village of Stanford North, between Folkestone and Ashford. It is a large country house providing accommodation and personal care for six residents with a learning disability. The home is owned by Counticare, a registered provider of approximately 15 homes in the East Kent area. Communal areas comprise a lounge, music/quiet room, dining kitchen area, conservatory and laundry room. Within the grounds of Belmont is a large outbuilding which provides a recreational area for music, relaxation and arts and crafts, and the manager’s office. The home has use of a minibus and a car to access the wider community, as the village has no amenities other than a local pub. There is no regular public transport to the home. Belmont DS0000023333.V263515.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 10.15 and lasted approximately five and a half hours. Four of the six residents were at home at the time of the visit and were spoken with. They appeared relaxed and cheerful with staff, and one said, “I’m happy at Belmont, I am”. Another said “I like the staff.” The other two residents were out for the day ice skating. Lunch was shared with the residents and staff. Staff were observed directly and indirectly as they were working with the residents. The deputy manager and the housekeeper/support worker were spoken with, and a team leader was interviewed privately. Time was also spent with the manager, and various records were looked at. A tour of the premises was undertaken. What the service does well: What has improved since the last inspection?
Arrangements for protecting residents from abuse have improved. Good understanding of the action to be taken if an allegation of abuse is made, was demonstrated by the manager and staff. Eight out of twelve staff have now received training on adult protection, and a good policy and procedure is in place. There is a whistle blowing policy, although this could be clearer. Staff have also had SCIP training. Belmont DS0000023333.V263515.R01.S.doc Version 5.0 Page 6 Recruitment policies have been amended and are satisfactory, and POVA and CRB checks are being undertaken. Other policies and procedures are in the process of review. Monthly “theme” evenings with much resident participation have been introduced. The staff shift planner has been updated, and residents have contributed to the review of menus. 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. Belmont DS0000023333.V263515.R01.S.doc Version 5.0 Page 7 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 Belmont DS0000023333.V263515.R01.S.doc Version 5.0 Page 8 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): EVIDENCE: Not inspected on this visit. Belmont DS0000023333.V263515.R01.S.doc Version 5.0 Page 9 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): 7,8 Residents are receiving support from staff to make decisions about their lives, and participate in the life of the home. EVIDENCE: Care plans were not examined on this occasion. A sample viewed at the last inspection was clear and well maintained. There was evidence to show that the home is supporting residents to make choices and decisions that affect their lives. One resident, for example, was supported by staff in his decision to stay living in the home. Staff promoted the appointment of an independent advocate in this instance to help this person in stating his case. Staff were very clear that residents have the right to make choices; and one resident during the inspection was heard saying with confidence “ it’s my choice”, when referring to something she was doing at the time. House meetings are held regularly in which residents are given the opportunity to make decisions about their everyday lives, including for example, what goes on the menus. See also the section in this report on staffing, relating to when residents’ ability to exercise choice in relation to activities may be limited. Residents were seen being encouraged to take part in routine household chores.
Belmont DS0000023333.V263515.R01.S.doc Version 5.0 Page 10 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): 11,12,13,14,16,17 Opportunities for residents to take part in social, leisure and work activities are regularly given during the weekdays, but less so at weekends. The development of independent living skills is encouraged. Routines are flexible. Residents have a healthy and varied diet and enjoy their meals. EVIDENCE: Plans for residents’ day care activities during the week are currently being reviewed, and those completed were seen. They showed full and fairly busy schedules, some of which include sessions at the company’s day care facility, the Martello centre. Close examination of residents’ daily notes showed that activities are varied and range from games and puzzles indoors to horse riding and golf. One entry referred to one resident “wanting to be on their own” when offered an activity. The record stated that staff checked several times to make sure this was the case and respected the decision. Some residents were seen with items that are not age appropriate, but are nonetheless very important to them. Staff are very aware of the difficulties in this regard and are seeking alternatives to offer the residents concerned. Staff gave good examples of how
Belmont DS0000023333.V263515.R01.S.doc Version 5.0 Page 11 residents are encouraged to do things for themselves, for example, putting on their socks. A team leader who was interviewed and who works some night shifts, was clear that it is up to residents when they rise and retire. Where they were able to, residents said they enjoy their meals. One resident confirmed that she helps to prepare main meals and also make cakes. This person said that she and the other residents helped decide what went down on the revised menu for the winter months. This menu looked varied, interesting and nutritious. Belmont DS0000023333.V263515.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): 19 The home is good at supporting residents access social and healthcare professionals. EVIDENCE: Over the past twelve months, two residents have needed major operations, and the home has supported and cared for them well during this difficult time. A lot of work has been undertaken by the staff team as a whole in gathering and recording information relating to the behaviours of a resident, in order to assist the Community Learning Disability Team in providing the home with the best advice and support. Two residents have been referred to the speech and language therapist and are currently undergoing assessments. Belmont DS0000023333.V263515.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): 23 Understanding of abuse issues has improved resulting in better protection for the residents. EVIDENCE: The manager is clear regarding the action to take in the event of being informed of any allegation or suspicion of abuse. The team leader, who was interviewed privately, demonstrated good understanding of abuse issues. Since the last inspection, eight staff have attended training on adult protection, and arrangements are being made for the remaining four staff to receive the training. Staff have also attended SCIP training as required from the last inspection. Staff recruitment practice has improved and offers protection for residents by ensuring that the appropriate checks are made, including POVA and CRB checks and references. Policies on adult protection are satisfactory, and the manager said that checking staff understanding on adult protection and whistle blowing feature regularly in supervision. Whilst there is a written policy on whistle blowing, this could be clearer in stating that no recriminations will be taken on staff reporting concerns in good faith. Belmont DS0000023333.V263515.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): 24,26,27,28,30 Environmental standards are good, and residents are living in a safe, well maintained and spacious home. The dining room chairs are unsatisfactory, however. EVIDENCE: A brief tour of the home revealed good standards generally. The home is spacious and well decorated, and provides a comfortable and homely environment for the residents. The premises was at a comfortable temperature and was very clean. The dining room chairs are plastic and not very sightly, and are not at the right height for the table. This makes for uncomfortable sitting. The manager said that new dining room furniture has been requested from the owners, and this a requirement of this report. Bedrooms viewed are decorated according to individual needs and tastes, although not all contain all the items of furniture listed in the National Minimum Standards. For example, some do not have a comfy chair. It is a recommendation of this report that an audit of the bedrooms in undertaken, a record made of individual wishes, and items provided where requested subject to risk assessment. Paper towels in wall-mounted dispensers are available in bathrooms and toilets and also in the laundry.
Belmont DS0000023333.V263515.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): 31,33,34,35,36 Residents are being supported by competent and committed staff, who are being well trained and supervised. The number of staff available at weekends still needs reviewing. Recruitment practice has improved. EVIDENCE: Staff presented very well during the visit, demonstrating a positive residentcentred approach to their work. They were seen interacting with residents with care and purpose. Those spoken with were clear as to their enabling and supportive roles, and said they enjoy working in the home and feel well supported by the manager. It was clear through observation of and discussion with staff that there is a high degree of motivation to provide a good service to the residents. Training opportunities continue to be provided regularly, and staff are receiving regular recorded supervision. Training on moving and handling, basic food hygiene and infection control needs updating for some staff. Examination of a staff file revealed improvement in recruitment practice, and the written recruitment procedure has been amended satisfactorily. With regards to staffing levels, weekend arrangements are still requiring review. Every other weekend, one resident stays with family, and staffing is reduced to two. This limits the degree of choice and opportunity residents are able to exercise, with residents sometimes having to all go out in a large group, which may not be what all of them want. When activities can be planned in advance, it is noted that a third staff member is provided on occasions.
Belmont DS0000023333.V263515.R01.S.doc Version 5.0 Page 16 The manager was able to demonstrate that her administrative responsibilities are not being unduly compromised by working some shifts “on the floor”. Rotas showed that for on average three out of the five shifts per week, she is supernumerary to the care staff. Belmont DS0000023333.V263515.R01.S.doc Version 5.0 Page 17 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): 37,38, 40,42 The residents and staff are benefiting from the clear management approach of the home. EVIDENCE: The manager is continuing to grow in confidence and ability. She is completing The RMA training and is also undertaking a range of other training courses to maintain and update her knowledge, skills and competence. These include adult protection, SCIP, fire, First Aid, health and safety and medication. Through discussion and observation, staff and residents appear to be responding well to her leadership, and the open and friendly atmosphere in the home was noted. Policies and procedures are being reviewed and no obvious health and safety hazards were noted. (See staffing section on training needed on basic food hygiene, moving and handling and infection control.) Quality assurance was not inspected on this occasion; although it is noted that the two requirements made at the last inspection relating to this matter, resident surveys and Regulation 26 visits by the registered person, still need addressing. Belmont DS0000023333.V263515.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 x x x x x Standard No 22 23 Score x 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score x 3 3 x x Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x 2 3 3 x 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 x 16 3 17 Standard No 31 32 33 34 35 36 Score 3 x 2 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Belmont Score x 3 x x Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x 2 x DS0000023333.V263515.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 YA20 Regulation 13 Requirement The updating of the policy and procedure in respect of medication to continue, and to include ordering, receipt and disposal, homely medication, covert administration, errors and refusal. (timescale of 05/11/05 not met.) Suitable dining room furniture to be provided. Staffing levels at weekends to be reviewed. (timescale of 05/10/05 not met.) Staff to receive training on infection control (outstanding), moving and handling and basic food hygiene. Resident feedback surveys to be undertaken annually, and the results made available to the residents, their representatives and to the commission. Unannounced Regulation 26 visits to be undertaken in accordance with regulation. Visits to include discussion with residents and staff. (timescale of 05/09/05 not met.) Timescale for action 01/01/06 2 3 4 YA24 YA33 YA35 23 19 13,18 01/02/06 01/01/06 01/03/06 5 YA39 24 01/03/06 6 YA39 26 01/01/06 Belmont DS0000023333.V263515.R01.S.doc Version 5.0 Page 20 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 2 3 4 Refer to Standard YA7 YA7 YA13 YA26 Good Practice Recommendations Evidence to be available of consultation with residents and their representatives regarding the use of “baby” monitors in bedrooms. Residents’ toiletries kept in staff sleep in room to be reviewed and risk assessed. Company signage to be removed from home’s minibus. Audit of residents’ bedrooms to be undertaken with regards to furniture and fittings. Belmont DS0000023333.V263515.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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