Inspection on 09/05/07 for Benjamin House

This inspection was carried out on 9th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Benjamin House 26/03/08

Benjamin House 05/09/07

Benjamin House 15/08/06

Benjamin House 15/03/06

Benjamin House 28/07/05

Benjamin House 06/12/04

Benjamin House 27/04/04

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Creative Support

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

CARE HOME ADULTS 18-65 Benjamin House 41 Ormerod Road Burnley Lancashire BB11 2RU Lead Inspector Mr Jeff Pearson Unannounced Inspection 9th May 2007 09:30 Benjamin House DS0000009525.V331764.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 Benjamin House DS0000009525.V331764.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. Benjamin House DS0000009525.V331764.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Benjamin House Address 41 Ormerod Road Burnley Lancashire BB11 2RU 01282 835926 01282 414506 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) Mrs Bridget Mary Healy vacant post Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Benjamin House DS0000009525.V331764.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The home will accommodate up to 10 adults up to the age of 65 years who have mental health problems Date of last inspection 01/05/07 Brief Description of the Service: Benjamin House is part of Healy Care Dispersed Home Scheme which consists of three terraced properties. An additional property is used an office facility. The properties are situated on the same road, in what is primarily a residential area. Benjamin House is close to the resources available in Burnley town centre. It is registered to accommodate 10 adults under the age of 65 with a mental illness. The accommodation available is homely and domestic in style. There is a lounge, a room for smoking and a dining kitchen with conservatory area. There are ten single bedrooms eight with en-suite toilets. Two of the bedrooms are situated on the ground floor. Staff are on duty to provide support 24 hours per day. Transport is occasionally available to enable service users to visit relatives and for outings within the community. Written information about Benjamin House, including the service users’ guide and last inspection report were available in the lounge of the home. At the time of the inspection visit the range of fees was between £455.00 and £1200.00 per week. Toiletries, hairdressing private chiropody was not included in the fees. There were voluntary optional charges for entertainment and transport. Benjamin House DS0000009525.V331764.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Benjamin House on the 9th May 2007. The visit took 7½ hours and was carried out over one day by two inspectors. A random unannounced inspection had been carried out at the home on 1st May 2007. A letter following the random inspection will be made available on request, from the Commission to members of the public or other enquirers. The files/records of two people using the service were examined as part of ‘case tracking’, this being a method of focusing upon a representative group of residents. The residents were also spoken with during the inspection. Discussion took place with people using the service, a Senior Support Worker and staff. Various documents, including policies, procedures and records were looked at. Some of the accommodation and facilities were viewed. Prior to the visit, questionnaires had been forwarded to the home for the residents, their relatives, or representatives to make comments about the services provided; none were returned to the Commission. Prior to the site visit, the registered person (home owner) had been requested to complete and return a pre inspection questionnaire, providing details about the management and organisation of Benjamin House. The Commission did not receive this information. At the time of the key inspection visit there were 9 people living in the home. What the service does well: The atmosphere in Benjamin House was relaxed and friendly, relationships amongst every one seemed generally good. One person said they liked living at the home another praised the staff describing them as “good, outstanding and supportive.” People were being supported to keep in touch with families. “I stay with my sister regularly explained one person” Support was being given with medical and health appointments. Benjamin House DS0000009525.V331764.R01.S.doc Version 5.2 Page 6 Most people said they liked the home, particularly their own rooms which they had been able to personalise with their own belongings and keep locked with their own keys. People living at Benjamin House were being enabled to help with staff recruitment, which meant they could have some say in who worked at the home. What has improved since the last inspection? What they could do better: A manager must register with the Commission, to take legal responsibility for the day-to-day running of the home. Guidelines for protecting people from abuse were in need of changing, to make sure managers and staff do the right thing if there is a suspicion or an allegation of abuse is made. There needed to be better ways of making sure peoples needs can be properly met before they move into the home. Individual care plans still needed to include full details of all their health, behavioural and emotional needs and how they are to be met, to ensure staff know exactly what to do for each person. Any changes in care needs and support must be written in care plans, to provide clear up to date instructions for staff. To make sure people are respected, staff needed to more thoughtful when writing records about people. Improvements were needed with medication practises, records and staff training, to make sure people get their medication safely and at the right time. Individual risk taking was not being properly assessed and staff were not being given clear instructions on how to reduce or manage any risks. Benjamin House DS0000009525.V331764.R01.S.doc Version 5.2 Page 7 Better arrangements needed to be made, to make sure people living in the home have enough staff support for activities and outings in the community. More staff were needed to ensure there always enough staff on duty to provide proper support. So people remain satisfied with the food provided at Benjamin House, they should be involved as much as possible with the catering, including shopping. To make sure people feel confident in making complaints, improvements needed to be made listening to what they say and dealing with their concerns and requests. To protect people living in the home, proper checks still needed to be carried out before letting staff start work in the home and new staff needed to be properly supervised. For the well-being and protection of people living in the home, staff needed to be trained in dealing with difficult behaviours. People living in Benjamin House, their relatives and others still must be formally asked if things are okay, to make sure the home is being run in their best interests, the home owner must show plans are in place to make improvements. Work needed to be carried out to improve a number of areas of the home for the well being and safety of the residents, for example making sure light bulbs get replaced and general maintence is carried out. 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. Benjamin House DS0000009525.V331764.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 Benjamin House DS0000009525.V331764.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): 2,3,5 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The admission process did not ensure all needs and abilities were properly considered and planned for, before people moved into the home. EVIDENCE: The records of the most recently admitted residents were looked at, assessment information was available. This had been obtained from various sources, including health care professionals, hospitals and as part of the CPA (Care Programme Approach). There were some records to show the residents had been involved with the assessment process. For example, by being visited in hospital and one person’s notes showed they had visited Benjamin House become familiar with the home, routines and staff. One person did not have a care plan drawn up, significant complex and specific individual needs had not been properly considered and planned for, therefore it was not clear that their needs were being appropriately met. Staff had not been provided with training in relation to specific individual needs, this meant, people who using the service with specialist needs may receive a poor quality of care. (See Individual Needs and Choices) Benjamin House DS0000009525.V331764.R01.S.doc Version 5.2 Page 10 Only one of the files seen included an agreed contract outlining the terms and conditions of residence. This did not include any details of the fees payable or funding arrangements and the section about voluntary contributing to the homes transport and entertainment fund had not been completed, therefore people using the service and their families were not clear about what is covered by the fee and may find they need to make additional payments for services. There were no policies and procedures providing details of the admission process, to ensure the residents’ needs are properly considered and to make sure they receive appropriate support and assistance when moving into the home. Benjamin House DS0000009525.V331764.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): 6,7,9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A lack of good care planning and effective management of risks; meant that people using the service were not being properly and safely supported. EVIDENCE: One person with complex needs did not have a plan drawn up by staff at the home, which meant staff had not been provided with written important instructions on providing proper support. Although plans seen included some useful information, they were lacking in finding out about peoples’ needs, explaining details of their needs and in providing the actions for staff to follow to meet needs. For example, mental health needs had not been properly identified and instructions for responding to specific behavioural needs had not been clearly noted, or they were vague, the plans had not been updated when peoples’ needs changed. This meant staff did not have information about peoples’ individual illnesses, how it affects them, and what they should do to Benjamin House DS0000009525.V331764.R01.S.doc Version 5.2 Page 12 support them. Staff were unaware of the contents of some plans, they said they had not really been given instructions about responding to peoples’ needs and that they had to learn as they went along. Observation of support practices showed people were being supported to make some choices and decisions in their daily lives. People had signed in agreement with their plans, but the plans lacked detail and there was no clear evidence to show they were being used in a meaningful way, significant limitations had not always been properly agreed in the care planning process. Staff were not being instructed how to respond to relapses in conditions which may affect peoples’ decision making ability. There was a significant lack of appropriate detailed assessment of risks, and the plans for staff to follow, for example, in response to violent behaviour, suicidal tendencies, self harm and going out independently. Consideration had not been given to the severity or likelihood of the risks; possible triggers had not been made known. One care plan seen included differing details to the risk assessment, the risk assessment stated – compliant with medication, but the plan stated – none compliant. Benjamin House DS0000009525.V331764.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): 12,13,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Opportunities for people to take part in community and leisure activities; have their rights respected and responsibilities recognised were limited. EVIDENCE: People living at Benjamin House spoke of the various activities which had been on offer, including clubs, swimming, project work, day centres, pubs, flee markets, sports/fitness centres, shopping and TV. One person had recently got a voluntary job in a charity shop. During the inspection some people went out into the local community. Due to staff shortages some activities were not always being carried out when planned. People spoken with explained how they looked forward to going out, but dont always get the opportunity because staff get sent out to work in the other homes, “its upsetting when you are Benjamin House DS0000009525.V331764.R01.S.doc Version 5.2 Page 14 looking forward to a planned activity and its suddenly cancelled” said one person. Staff said there are not always enough people on duty to provide support with group or individual activities, and that a lot of time was being spent on household chores. People spoken with explained they were keeping in touch with members of their families and friends, by telephone, visits, or short breaks away. The house rules were displayed in the home, they had been written some time ago; some matters such as respecting others had not been included. Some people spoken with felt the rules of the house were not always kept, for example in respect of smoking, which meant restrictions were unclear and not upheld. Records showed house meetings were being held to discuss group matters including outings, menus and activities. People spoken with were not confident that their suggestions and request would be acted upon. There were still no details in the plans of care about the residents’ responsibilities with regard to housework, which included responsibility for their own bedroom, laundry and other household tasks such as cleaning communal areas, shopping and cooking. This meant this work had not been properly agreed and recognized as skill development. Staff said they did not always have time to provide support with domestic tasks. Records showed various meals were being provided to suite individual tastes, diets and preferences. Meals were provided at various times to fit in with peoples’ living patterns. Some people spoken with said some of the recent food bought had been of poor quality and not to their liking; they were concerned that the change in purchasing arrangements had been to cut costs. This meant; recognition was not being given peoples food preferences and to the value of enabling people to develop social skills when shopping in the community. Concerns were raised, that petty cash was not always available in time to go shopping for provisions when they were needed. Benjamin House DS0000009525.V331764.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): 18,19,20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Arrangements for managing personal needs, healthcare and medication did not always effectively support peoples dignity, health and well-being. EVIDENCE: There were some elements of good practice seen, for example, the inclusion of specialist health professionals in the care of people living at the home. However, the directions in care plans for staff were not precise in how to meet needs or sufficient in detail for staff to know exactly what actions to take. For example, when assisting with matters such as personal hygiene. One person spoken with said medical health checks had been arranged. One record showed GP involvement, but how a physical condition was to be managed had not been included in the care plan. Weight was not always been recorded or monitored in response to identified needs. Some comments written by staff in daily records did not always respect peoples’ dignity; mention being made of telling people off. One person spoken with did not feel her specific needs were being dealt with sensitively enough. Benjamin House DS0000009525.V331764.R01.S.doc Version 5.2 Page 16 One of the bathroom doors would not close properly, which meant peoples’ privacy was not sufficiently maintained. Suitable arrangements were in place for people, where appropriate to manage their own medication. Medication storage was satisfactory, however, two items were not being locked in the locked cupboard. Medicines should be stored securely to help prevent mishandling and misuse. Good practice was seen in relation to managing medication for home leave and medication storage. All staff who deal medication had received some training. Records showed one person’s medication had been given at morning and bedtime, but the medication remained in the dosage system. Hand written entries on records had not been signed, or witnessed as correct, a record had not been kept of the medication being received into the home. Individual guidelines had not been devised for ‘when necessary medication’ A prescribed item, requiring a specific method of administration, had no written protocol for its use and staff had not been trained to administer this item. The senior support worker was advised to address this matter at the time of the visit. Medication policies and procedures were available, but there were no policies and procedures on hand, in relation to promoting good health care for people using the service. Benjamin House DS0000009525.V331764.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): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all arrangements were effective in ensuring peoples’ concerns were acted upon and their wellbeing protected. EVIDENCE: People spoken with were aware of the homes’ complaints procedure and a copy had been displayed in their bedrooms. Although those spoken with were very much aware they may contact the Commission at any time, the procedure did not include contact the details of the Commission or other agencies such as Social Services, this matter therefore needed attention. This meant their rights to ensuring their concerns are taken seriously and acted upon may be supported. It was apparent from discussion with people living and working at Benjamin House, that they were not confident that their concerns would be properly listened to and dealt with by the homeowner, this had resulted in some issues being referred to the Commission. This matter was discussed with the senior support worker. It was advised a more neutral approach be used to investigate complaints, and further support and guidance given to enable people to raise issues in an appropriate way. The ‘Abuse Policy’ was found to be mostly satisfactory but; some details were unclear and contradictory. For example, the policy stated “all reports of abuse, no matter how minor, should be immediately be investigated and acted upon by the person in charge” and “it is the responsibility of the manager to ensure Benjamin House DS0000009525.V331764.R01.S.doc Version 5.2 Page 18 all accusations are followed through and investigated with or without consent of the person. All cases should be referred to social services without delay.” The policy then goes on to explain the action to be taken in the absence of consent, “in line with the victims wishes”. There is an emphasis in the policy of ‘investigating’ reports of abuse; instead of getting the basic details to pass on to the people who are responsible for dealing with such matters, which means people may not be properly protected from the risk of abuse and neglect. A signature sheet was seen indicating staff had read and understood the policy. Staff spoken with expressed an awareness of their role in reporting safeguarding matters. Records showed five staff had undertaken ‘in house’ POVA (protection of vulnerable adults) training, with their results being sent away for checking. Benjamin House DS0000009525.V331764.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): 24,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s quality of life was not enhanced by their environment, as some parts of the home presented as being unsafe and unpleasant. EVIDENCE: Some people living at Benjamin House indicated they were generally satisfied with the accommodation provided, in particular their own bedrooms. Most had en-suite toilets and keys to their rooms. They had been supported to personalise their rooms with their own belongings, such as pictures, televisions and music systems. Some parts of the home were seen to be of a satisfactory standard, in particular the lounge, which was pleasantly decorated and had a good standard of furnishings. The laundry had suitable equipment and facilities for washing. Benjamin House DS0000009525.V331764.R01.S.doc Version 5.2 Page 20 However, there were several matters in need of attention, for example, carpets in en-suite toilets and one bedroom were stained, one bathroom door would not close, a shower mat looked mouldy underneath and presented as a potential hazard for harbouring bacteria. Part of the home was foul smelling, staff said they did not always have time to clean the home properly. There was a dip in the floor on upstairs corridor significant tripping hazard. In the kitchen was a space where a dishwasher had been removed about a year ago, leaving exposed pipe work and gap in concrete flooring. Ventilation in the smoke room may not be adequate as a notice on the window stated ‘cant be opened until the lock is fixed’ and the extractor fan was noisy and dirty. In the basement area, a light fitting was hanging down off the wall and there was water dripping from a pipe into a bucket. A glass panel next to front first door was cracked. One person living at Benjamin House expressed concerns about the lack of maintence at the home, in particular that there was no light bulb at the bottom of the cellar stairs where the residents did their laundry. There had been no general maintence carried out at the home for eight weeks. A list was being kept of matters needing attention but these were not been attended to. For example, records showed the defective light fitting had been reported to the home owner on 12/03/07 and several light bulbs had been reported as needed replacement on 02/04/07. Benjamin House DS0000009525.V331764.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): 32,33,34,35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staffing arrangements were insufficient in providing people living in the home with appropriate support. EVIDENCE: People living at Benjamin House, were generally appreciative of the staff team, but concerns were expressed about changes in the team and the lack of staff to provide support with activities and outings. Two people said they thought the standard of care and support at the home had “gone right down”. There was evidence to indicate service users had been involved in recruiting staff, which meant they had some say in who worked with them. The records of the latest staff to be recruited were examined most checks had been properly completed. However, the employee had been started without a CRB (Criminal Records Bureau) certificate and the application form did not request a declaration of any previous offences, or any previous disciplinary action, therefore there were no confirmed assurances about such matters. The staff member had also supported people away from the home when not Benjamin House DS0000009525.V331764.R01.S.doc Version 5.2 Page 22 accompanied by another staff member. None of the other staff recruitment records were available in the home. Records showed that the newest member of staff was undergoing structured induction training programme. However, it was apparent no initial training had been carried out in the employees first week at the home. Three staff were undertaking NVQ (National Vocational Qualifications) level 2. Although two staff had undertaken approaches to mental health training, there was no evidence to indicate staff had received specialised training in relation to aggression and more challenging behaviours such as self-harming. The staff rota showed that on most days there were two staff on duty during the day and evenings, this meant their were not always enough staff to provide for the needs of the people accommodated, for example, providing support with appointments, activities and one to one support. There was not always a senior support worker on duty. Staff expressed concern that they did not have time to provide proper support for the people living in the home that they were getting behind with paper work and felt too much time was spent on domestic chores. Staff morale was described as low due to insufficient staffing levels, which had resulted in their holidays having to be rearranged to ensure there was enough cover at the home. Staff felt the homeowner did not appreciate their work and commitment; and that their opinions were not valued. Benjamin House DS0000009525.V331764.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): 37,39,42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living in the home did not benefit from competent, effective leadership and management of the service. EVIDENCE: Evidence included within this report indicates shortfalls in relation to the management and daily running of the home. There were several requirements and recommendations outstanding from previous inspections. Since the last inspection visit, changes had again been made in the management team of Benjamin House, the previous house manager, had transferred to another home in the organisation. There was no registered manager at the home and the Commission had not received an application for this position. The senior Benjamin House DS0000009525.V331764.R01.S.doc Version 5.2 Page 24 support worker in charge at the time of the site visit was being expected to manage the home. Staff expressed dissatisfaction with higher management at the home. The pre-inspection questionnaire for the home had not been filled in and returned to the Commission, therefore, some information was not readily available to show how the home was being run. House meetings provided some opportunity for people living at the home to be consulted and voice their opinions, however, as previously indicated some people were not confident their views were listened to and acted upon. The senior support worker on duty; said there had not been any quality assurance surveys for people living at the home. There was no annual development plan available. Previous inspection reports have identified significant matters for improvement; these have not been implemented within agreed timescales. Records showed fire equipment was being tested and fire drills had been carried out. Engineers were checking smoke alarms at time of the visit. Evidence was seen of portable electrical appliance testing and water temperatures were being monitored. The senior support worker said health and safety risk assessments had been completed. Training in safe working practices had been arranged or was ongoing. Benjamin House DS0000009525.V331764.R01.S.doc Version 5.2 Page 25 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 X 2 2 3 1 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 1 X 1 X X 2 X Benjamin House DS0000009525.V331764.R01.S.doc Version 5.2 Page 26 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 YA6 Regulation 15(1) Requirement Timescale for action 22/06/07 2 YA6 15(1) 3 YA6 15(2)(b) 4 YA9 13(4)(b) To make sure people get the individual care and support they need, all service users must have a written plan, detailing their needs and how they are to be met. To make sure people receive 20/07/07 proper care and support, service users plans must include all identified needs and provide clear detailed instructions for staff, on how to meet these needs. Timescale of 29/09/06 not met. To make sure people always 20/07/07 receive proper care and support, the plan of care must be kept under review and updated in response to changing needs. Timescale of 15/09/06 not met. To make sure a reasonable 20/07/07 balance is achieved between independence and personal safety, risk assessments and management strategies must be completed on service users engaging in activities which may affect their health or well-being. (Timescales of 01/09/05, DS0000009525.V331764.R01.S.doc Version 5.2 Benjamin House Page 27 5 YA9 6 YA13 7 YA18 8 YA20 9 YA20 10 YA20 11 YA24 12 YA30 12/05/06 and 15/09/06 not met) 13(4)(c) To make sure people are supported as safely as possible, risk assessments and risk management strategies must be completed in response to service users behavioural needs. 16(2)(m) To promote personal fulfilment and skill development, arrangements must be made to ensure service users are enabled to join in chosen social and community activities. 12(4)(a) In order to ensure peoples’ personal privacy, action must be taken to ensure bathroom doors close properly. 13(2) To make sure people are 17(1)(a) properly supported with their medication, clear written instructions must be made available to staff in relation to administering medication requiring specific procedures. 18(1)(c)(i) To make sure people are properly and safely supported with their medication, all staff assisting with medication requiring specific procedures; must be suitably trained and assessed as competent to provide this assistance. 13(2) To help ensure people receive 17(1)(a) their medicines correctly, accurate records must be kept of medicines being administered to service users. 23(b) To make sure people have a safe and comfortable environment, arrangements must be made to ensure the home is kept well maintained and in good order. 23(2)(d) To make sure people live in live in pleasant, hygienic surroundings, arrangements must be made to keep all parts of the home clean and action DS0000009525.V331764.R01.S.doc 20/07/07 22/06/07 20/06/07 09/05/07 29/06/07 15/06/07 22/06/07 13/07/07 Benjamin House Version 5.2 Page 28 13 YA33 14 YA34 15 YA34 16 YA35 17 YA37 18 YA39 taken to thoroughly clean carpets. (Timescale of 27/10/06 not met) 18(1)(a) To make sure people are properly supported, action must be taken to ensure there are enough suitably qualified and experienced staff to work in the home. 19(1)(b) For the protection of people living in the home, applicants for work must be required to declare any convictions and cautions as part of their application form. (Timescale of 15/09/06 not met) 19(11)(c) For the protection of people living in the home, when a new employee starts work without a criminal record certificate, they must not accompany service users away from the home, unless a qualified and experienced staff member accompanies them. 18(1)(c)(i) For the protection and well being of people living in the home, arrangements must be made to train staff in dealing with challenging behaviours. 8(1)(b)(iii) To make sure the home is effectively managed, a suitable manager must apply for registration with the Commission. (Timescales of 05/05/06 and 29/09/06 not met) 24(1) To make sure the home is operated in the best interests of the people living there, a formal system for reviewing and improving the quality of care provided at the home must be implemented. (Timescales of 01/10/05 and 26/05/06 29/09/06 not met) 04/08/07 22/06/07 22/06/07 27/07/07 27/07/07 29/07/07 Benjamin House DS0000009525.V331764.R01.S.doc Version 5.2 Page 29 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 Refer to Standard YA3 YA16 YA17 Good Practice Recommendations Prior to admitting new service users, proper arrangements should be made to ensure their needs can be met. To promote and respect peoples’ dignity and worth, a more sensitive approach needs to be given to report writing. To make sure people remain satisfied with the quality and variety of food provided, they should be involved as much as possible with all catering arrangements, including shopping for provisions. To make sure people get their medication as and when they need it, clear criteria should be defined on an individual basis, when service users are prescribed when necessary and variable dose medication. Hand written entries on medication administration records should be signed and witnessed to confirm they are correct. The arrangements for enabling people to raise concerns and complaints should be reviewed and developed to ensure their opinions and views are properly listened to and where possible acted upon. Staff should continue to be supported to undertake appropriate training, as specified by the National Minimum Standards for Younger Adults, so they have the appropriate skills and knowledge to support people living in the home. To make sure the managers and staff ensure the protection of people living in the home, the abuse and protection policy should be amended to provide clearer details about consent issues, and should not include instructions for ‘investigating’ abuse issues. 4 YA20 5 YA22 6 YA32 7 YA23 Benjamin House DS0000009525.V331764.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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 Benjamin House DS0000009525.V331764.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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