CARE HOME ADULTS 18-65
Bennett House 16 Bennett Road Crumpsall Manchester M8 5DX Lead Inspector
Steve OConnor Unannounced 28th June 2005 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 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 Stationary 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. Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Bennett House Address 16 Bennett Road Crumpsall Manchester M8 5DX 0161 795 4003 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Alcohol and Drug Services Responsible Individual - Ms Elizabeth Smith Care home only (PC) 16 Category(ies) of Past or present alcohol dependence (A) (16) registration, with number of places Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19.10.04 Brief Description of the Service: Bennett House is a residential care home providing care and therapeutic support for up to 16 alcohol dependent men. The Alcohol and Drug Service (ADS) manage the service, which is a registered charity. The home is situated in the Crumpsall area of Manchester, close to local amenities and public transport links. It is sited on a residential street and is of the same size and style as other houses surrounding it. It has a small car park to the front and a garden at the rear. Bennett House offers accommodation in 10 single bedrooms, 3 self contained flats and 2 bed-sits. The flats and bed-sits are designed to help people prepare for moving back to independent living in the community. Communal space is provided in the basement and on the ground floor along with kitchen and laundry facilities. Admission to the home is on the basis that people have already made a commitment to abstinence and a treatment programme including group work, one to one sessions and links with services within the community, is offered. Stays at the home are time limited, dependent on the needs of the individual and the funding made available. The home is not staffed in the evenings and at weekends (although an ‘on call’ service is available) and therefore, the philosophy of the home is based on people taking responsibility for themselves and for supporting others.
Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 28th June 2005. During the inspection, time was spent speaking with people who live at the home, talking to staff and management and people’s files, records and other relevant documentation were examined. At the last inspection the home needed to do some additional work updating its policy on recruitment, discipline and grievance to take account of the new Protection of Vulnerable Adults (POVA) guidance. This work had been completed. In the last 12 months the CSCI has not received any complaints about the service. The previous registered manager had left the home since the last inspection. The deputy manager had been promoted to manager and was in the process of applying to become the registered manager. As this inspection only looked at a limited number of standards the report should be read together with the previous and any future reports to gain a full picture of how the home is meeting the needs of the people living there. What the service does well:
The home provides a therapeutic service to men who want to stop using alcohol and to deal with the problems in their lives that alcohol has caused. It is important that people who come to live at the home want to solve these problems and that the home is able to offer the support people need. The home does well in making sure that it gains a lot of information and the views of people before offering them a service. There are times when the home has to make the decision that either the person is not ready to start to deal with their alcohol use, that a person may have a negative affect on the other people at the home or that the home just does not have the environment or resources to meet a person’s needs. This makes sure that the group has the motivation to address their problems and can work together to give each other support. The average length of stay at the home is around 12 months. During this time people develop the skills to resolve their problems and learn/relearn the skills they need to live independent lives in their community. The home has both the physical environment and the therapeutic and social programmes to provide the support people need to achieve these goals.
Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 Page 6 The home places a great deal of importance on providing the atmosphere and opportunities for people to take back control over their own lives and to take the decisions that will affect their future. One way that the home encourages this is through people supporting each other to find solutions and ways to move forward. People meet in different groups to talk about issues they have in common and to give each other advice and encouragement. A person feeling part of the community and taking opportunities to use the social, leisure, educational and occupational facilities available is an important part of a person’s stay with the home. To help achieve this each person works closely with a ‘keyworker’ to find out what the person wants to do and what information and support is needed. There were many examples of the social and leisure activities that people had decided they want to try and organised themselves. There are also examples where the home has supported and encouraged people to take up further education opportunities such as GCSE in maths and English and gaining access to nursing college. The home recognises that people’s issues around alcohol do not automatically stop when they leave the home and move into their own homes. They offer people who have moved on the opportunity to pop in and see the staff at any time and also to meet with each other every Thursday to discuss any problems they are facing but also to give support to other people who have left and those still on the programme. What has improved since the last inspection? What they could do better:
The home had been carrying a vacancy for a project worker since the appointment of the new manager (from the existing staff team). This was because ADS, the organisation who manage the home, thought that they had to wait until the manager had been registered with the CSCI. This meant that the manager had to carry on her keyworker role. The CSCI had not placed any conditions on employing staff and ADS could have clarified the situation by contacting the CSCI. If the ADS have any uncertainties in relation to the registration of managers or any other matter relating to the role of the CSCI then it should discuss these with the CSCI at the earliest opportunity.
Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 Page 7 The premises of the home is in need a some minor repairs in the garden area and some of the decoration and furnishings are looking a little dated and tired. There has been money put aside to buy new carpets in all bedrooms and replace the kitchen. The home also plans to look at redecorating some of the communal areas in the near future. These areas will be looked at again at the next inspection. The manager has only recently been appointed to the post. As the manager she now has new responsibilities for the health and safety of people and staff within the home and so needs to have the information and training to be able to carry out this role. 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. Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 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 standard(s) 2 The home’s referral and admission policies, procedures and systems ensure that people’s needs are fully identified before they come to live at the home. EVIDENCE: Before anyone comes to stay at the home the purchasing authority have to provide and in-depth Community Care Assessments. In addition a detailed preadmission assessment is carried out at the home before any decision was made as to whether the service could meet a service user’s needs. The home’s in-house assessments were carried out on an on-going basis through the initial few weeks of a persons’ stay and they were supported by the keyworker to be fully involved in the assessment process. Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 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 standard(s) 6, 7 and 9 The home had supported people in encouraging them to make decisions and choices and to take informed risks as part of their daily lives. People’s needs and goals had been fully identified and reviewed on an ongoing basis. Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 Page 11 EVIDENCE: The home allocated each person with a ‘key worker’ who, together developed an initial four-week care plan. After this the care plan was reviewed and then developed into an individual structured group work programme and an individualised care plan which addressed such issues as education, finances, health, housing and counselling (which was offered though an external service provider). The care plan was reviewed and updated every three months. Any restrictions of choice or decision-making such as access to medication or finances, the use of alcohol and non-prescribed drugs were clearly stated in the terms and conditions and in the Service User Guide. These restrictions formed part of the therapeutic process and had to be agreed by people as a condition of admission. People were encouraged and supported to take responsibility for the decisions that impacted on their lives and were provided with group and one to one meeting to express their choices. The home had developed a Risk Assessment and Management Policy and procedure that allowed them to identify risk situations, behaviours and needs. Risk assessments and intervention plans had been developed and used to record all identified risk behaviours and situations. The plans contained clear guidance to staff on preventative and reactive measures needed to support people who were fully involved in the assessment process. Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 Page 12 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 standard(s) 12, 13, 15 and 16 The home supported and encouraged people to participate in the opportunities offered to them for social, leisure, educational and community based activities. People were supported to maintain and develop relationships with their families and the home’s routines gave people responsibility over their daily lives. Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 Page 13 EVIDENCE: The home supported and encouraged people to access a wide range of educational opportunities using local adult and further education facilities providing courses in skills development, language, leisure and occupation. People were provided with information to help them in making choices about participating in development opportunities. Advice and support was also provided around issues of benefits and housing. All the people living at the home were able to access the community independently and were provided with a range of information about community facilities and services. The keyworker role included working with people to identify and support access to these services. The Manager stated that the home would support those who wish to make or maintain contact with their families and the importance of people’s family support was recognised by the manager. People determined the level of contact they maintained with their family and friends. The home would support people to maintain these relationships. Any restrictions on visitors and contact with family and friends were stated clearly in the contract terms and conditions and Service User Guide. On admission, people agreed to abide by a set of ‘house rules’ that were made available to and discussed with the person before admission. These were set out clearly in the Statement of Purpose, Service User Guide and Contract agreement. Any restrictions on choice form part of the therapeutic programme and were understood and accepted before arrival. The house routines were flexible and partly set by people themselves in terms of meal times. Part of the therapeutic programme and philosophy of the service was the emphasis on peer group support and relationship building so that people did not isolate themselves. Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 Page 14 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 standard(s) 18, 19 and 20. The home supports and encourages people to maintain their personal and healthcare needs. The home had the policy, procedures and systems in place for the administration of medication to maintain people’s health and wellbeing. Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 Page 15 EVIDENCE: People living at the home did not require hands-on personal care support. If standards of personal care became an issue then the home would encourage people to maintain their health and hygiene. If due to illness, support was required with activities such as dressing then this could be provided on a short-term basis. On arrival people were registered with one G.P practice with which the home had developed a good working relationship. People were supported and encouraged to access the G.P service, opticians, chiropodists, dentists and other health specialists. The health needs of people were well documented in the individual files and access to specialist health services such as District Nurses, Speech Therapist and Occupational Therapists were seen. The medication administration system recorded all deliveries and returns of medication. The majority of people retained responsibility for administering their own medication and were provided with the support and resources to do this. If a person required further support in managing their medication the home was able to offer this, with the person’s written consent and agreement. The recording of administering medication needed to be clearer. It was recommended that the home use a separate format to record the administering of individual doses of a person’s medication. Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 Page 16 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 standard(s) 22 and 23 The home had the policies, procedures and systems in place that encouraged people to raise their concerns and to be protected from harm. EVIDENCE: The complaint procedure was clearly described in the Service Users Guide and set out the stages and timescales of the process and included information for contacting the CSCI at any time. It was clear, readily available and stated that people could raise their concerns and worries through the Residents’ Meetings and Community Group sessions that were held on a daily basis. The home had an Adult Protection and ‘Whistleblowing’ policy and had signed up to the Manchester Multi-Agency Adult Protection Policy. All staff had participated in Adult Protection training. The new POVA guidelines had been incorporated into the home’s recruitment and disciplinary and grievance policies. Although no one required an appointee, it was a condition of admission that all benefit entitlement was paid directly to the organisation. Personal allowances, other relevant benefits and allowances were then given directly for people to manage themselves. Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 Page 17 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 standard(s) 24 and 30 The home provides people with a homely and well-maintained premises. Policies, procedures and systems are in place to provide a clean and safe environment. EVIDENCE: The home was well maintained and clean with domestic furnishings and fittings. The premises are accessible to all people and have the layout and space to meet people’s needs. Due to the layout of the premises the home cannot offer a service to people with high mobility needs. People living at the home had responsibility for maintaining the cleanliness of the home and a cleaning schedule set out the tasks required. Information about safe food handling and preparation was available in the kitchen. The temperatures of the fridges and freezers were monitored and recorded on a regular basis. Issues relating to the cleanliness of the home were brought up and discussed at the regular meetings. The laundry facilities consisted of a domestic washing machine and dryer. Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 and 35 Despite the team carrying a project worker vacancy the home still had sufficient well-trained and skilled staff to provide the therapeutic support people required. The home had the recruitment policies, procedures and systems in place to protect people. EVIDENCE: The home was carrying one project worker vacancy. The manager had maintained her own case load to ensure that there was no impact on people’s group and one to one support. A part time worker had been employed to support the group work and people to attend health appointments and social activities. After discussions regarding the vacancy the home would be advertising the post as soon as possible. Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 Page 19 The staff team consisted of the Manager, a Deputy Manager, support workers, a staff member with responsibilities for finance and a full time cook. The therapeutic nature of the service provided meant that the home is not staffed during evenings and weekends. The hours of support they provided was sufficient to meet people’s needs. The Manager and Deputy were on-call during the evenings and weekends and the system for call-out was well established. All information and documents relating to the recruitment of staff, as set out in Schedule 2 of the Care Home Regulations 2001, was available for inspection. Criminal Records Bureau disclosure certificates were seen for the staff team. All the staff team had a copy of the General Social Care Council Code of Practice. The home offered an extensive in-house training and development programme through the main organisation, ADS. Individual staff training needs had been identified through the job supervision and job appraisal systems. Although staff training had been logged and recorded, there was no evidence of any system in place that would identify the need for refresher training in key areas. Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 and 42 The home has the systems in place to allow people to express their views and influence the direction of the service. The policies, procedures and systems are in place to promote and protect people’s health and safety. EVIDENCE: The manager had only recently been appointed to their current position. As manager of the home they have responsibilities under the relevant health and safety legislation and regulations. The manager must be provided with the required training for them to undertake their health and safety responsibilities. The home operated a quality assurance system called the Research, Outcome, Monitoring and Evaluation (ROME). This consisted of gathering feedback and the views of people, their family and other service professionals through the use of internal audits, meetings and discharge questionnaires. Information from this was fed through the management structure of the organisation to inform practice developments.
Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 Page 21 The home had an annual plan called an ‘Action Plan’. This set out the performance targets and aims of the home over the coming year. The home had an ongoing sysytem of reviewing and up-dating policies and procedures according to changes in best practice, legislation and the requirements of the Care Home Regulations 2001. The Registered Provider and other senior members of the organisation undertook monthly inspection visits as part of their responsibilities under Regulation 26 of the Care Home regulations 2001. The home had clear policies, procedures and systems in place covering food safety, COSHH and health and safety issues. Clear action plans provided detailed guidance. The Fire log was seen and there was evidence of regular monitoring and servicing of, fire extinguishers, fire alarm system, fire drills and emergency lighting. The service had undertaken a fire risk assessment. Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 Page 22 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 3 x x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 x Standard No 31 32 33 34 35 36 Score x x 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Bennett House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 x 3 x x 3 x F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 Page 23 NO 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 37 Regulation 9 Requirement The manager must be provided with the required training for them to undertake their health and safety responsibilities. Timescale for action 1st November 2005 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. Refer to Standard 20 35 Good Practice Recommendations It was recommended that the home use a separate format to record the administering of individual doses of a person’s medication. Although staff training had been logged and recorded, it was recommended that the home develop and implement a system that would identify the need for refresher training in key areas. Bennett House F55 F05 s21604 Bennett House v235313 D240605 stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 9th Floor, Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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