Inspection on 16/05/05 for Berkeley House

This inspection was carried out on 16th May 2005.

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 27 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Berkeley House 01/06/06

Berkeley House 19/09/05

Berkeley House 10/12/04

Berkeley House 17/05/04

Berkeley House 15/04/03

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

CARE HOME ADULTS 18-65 Berkeley House Lynsted Lane Lynsted Sittingbourne ME9 0RL Lead Inspector Sarah Montgomery Unannounced 16 May 2005 10:20am 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. Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Berkeley House Address Lynsted Lane Lynsted Sittingbourne Kent ME9 0RL 01795 522540 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) The Regard Partnership Limited CRH Care Home 23 Category(ies) of LD Learning Disability (23) registration, with number of places Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 10 December 2004 Brief Description of the Service: Berkeley House is a registered care home for 23 adults with learning disabilities. It is one of a group of homes owned and managed by The Regard Partnership. The home is situated in the village of Lynsted, roughly a mile south from the A2 at Teynham. The service is provided in three separate listed buildings set in large grounds. The Granary provides accommodation for four service users. The Windmill has five service users. The main house, The Bakery, has twelve service users. The Granary and The Windmill are selfcontained and are staffed independently from the main house. Some areas of the grounds are shared by all three homes although The Granary has independent access and an area of dedicated garden.The home has two vehicles that are used as required to provide transport to local services and amenities. Teynham is on a bus route and has a main line railway station. Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and carried out by Sarah Montgomery, Ann Block, Lynnette Gajjar and Ruth Burnham. The inspectors were at the home between 10.20am and 5pm. Sarah Montgomery and Lynnette Gajjar inspected The Granary and The Windmill, Ann Block and Ruth Burnham inspected The Bakery. Significant differences between the three units were apparent during the inspection. Most notable were staffing numbers, competency of staff, interactions between staff and service users, activities provided for service users, care planning, and cleanliness of the units. The inspectors spend much of the inspection talking with service users, and when this was not possible (due to communication difficulties), time was spent observing service users. In addition, some staff were spoken with, records were viewed, and all communal areas and some bedrooms were inspected. As stated above, significant differences between the three units were apparent. These findings will be in the evidence section of the report. However, Berkeley House is registered as one home, and the judgement and scoring in relation to the findings will reflect the overall findings. The inspectors conclude that overall, Berkeley House is failing to meet needs, and has poor outcomes for the service users. The service users are not protected from potential significant harm, as the home does not have a robust system with regard to staff files. Files viewed were chaotic, and did not contain all information as required by Schedule 2 of the Care Standards Act. Staffing in The Bakery and Granary is insufficient to meet assessed needs of service users. Staff in The Bakery did not have basic knowledge of individual needs as identified in the care plan. Over a period of 5 hours, the majority of service users in The Bakery did not receive any interaction from staff. Standards of hygiene in The Bakery are unacceptable; dried and ground-in food was present in the lounge and dining area, on both eating and seating surfaces and the floor. Service users were observed to be wearing dirty, un-ironed and stained clothing. Dried faeces were present on walls, floors and toilets. Staff morale is low. Many staff have resigned. There are high levels of sickness. Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The care given does not reflect that stated in the Statement of Purpose, the Service User guide, or individual care plans. Staffing numbers are too low to meet the needs of service users. The Responsible Individual needs to ensure that all records and documentation listed in Schedule 4 are in place. The environment needs to be upgraded to ensure the Service Users protection and safety. The number of staff on duty must meet the needs of the Service Users. All staff recruitment must follow the guidelines set out in the National Minimum Standards. The Responsible Individual must ensure that all Service Users have risk assessments in their care plan that reflect the individual’s needs and that these are reviewed and updated monthly. The Responsible Individual must ensure that Service Users Health and Safety is protected at all time. Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 7 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. Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 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 Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 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) 1, 2 and 3 The Statement of Purpose and Service User Guide do not reflect the care provided. Service users are not sure what kind of service they will receive at Berkeley House, and cannot be confident that their existing or changing needs will be met. EVIDENCE: The Statement of Purpose and the Service User Guide are written to reflect the National Minimum Standards, however the standard of care given to Service Users living in The Bakery falls well short of that stated in the documents. Service users are not supported by competent staff: when questioned, one staff member did not know the name of the service user, or any of the details in his care plan. At times, as little as three members of staff have been on duty in the Bakery. Service users and staff told the inspectors that trips out are very rare, and most of the time service users stay in the home and do nothing. These are just three examples of how Service Users rights are different to those stated in the Statement of Purpose. Service users in the Windmill and Granary are supported by staff who know their needs, although these needs are not recorded accurately in care plans. Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 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, 8, 9. Service Users changing needs are not identified. Service users are not confident that staff will know what their needs are, or what help they require. Service Users are not involved in decisions about their lives, and have no say about what happens to them or what they do. Service Users do not participate in aspects of life in the home, and their views and wishes are not valued. Potential risks to Service Users are not managed. This means service users are at risk and staff are not given enough information to help minimise the risk. EVIDENCE: The care plans of all service users living in The Bakery were read. No care plan read evidenced any review or assessment of changing needs. Some examples of this are: All aims and objectives in the care plan were recorded as not met. There has been no re assessment or review to consider changes to the aims and objectives. A care plan stated that the service user has very poor mobility. This service user has several falls. There are just two entries regarding mobility – one in Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 11 2002, which states ‘ monitor for signs of deterioration’, and another in January 2004, which stated ‘ongoing’. An assessment in February 2003 by Lambeth Forensic services recommended handrails and aids. None have been forthcoming. A care plan for activities stated the goal as being ‘to increase range of activities’. There has been no action regarding activities, or any update on this since August 2003. Another care plan had no entries under ‘strengths’. The same care plan states ‘to be offered leisure trips’. There was no evidence to support this had been carried out. Records indicate that the service user does not participate in leisure trips, and watches television every day. A care plan stated ‘ needs plenty of encouragement to participate in any activity. The same care plan later stated ‘ not to put pressure on activities as this presents risk of anxiety’. Another care plan states the service user ‘cannot cope with untidiness’ or with ‘strangers’. Inspectors observed this service user in the lounge, pacing and visibly distressed by baskets of laundry and by visitors he didn’t know. No interaction with this service user was noted throughout the inspection. The care plan states that staff are to ‘acknowledge when (service user) is unsettled’. Staff and management displayed no knowledge of this care plan. Inspectors read care plans with service users in the Windmill and Granary. All service users spoken with said their care plans were out of date, but did describe what they were doing and what they needed help with in 2002 and 2003. Service users in the Windmill and Granary said they were confident that staff knew their needs, even though they were not written down. The inspectors looked at how service users are involved in decision-making, and whether they are consulted on, and participate in all aspects of the home. We found that key worker meetings are infrequent. The majority of service users in The Bakery have not had a meeting. Two service users have had 3 meetings since November 2004. Two examples of this are: November 2004. (Service user)’would like to live in a smaller home’. There is no evidence of follow up to this with either the service user, their advocate, or their care manager. February 2005. (Service user)’would like to go on holiday’. March 2005. No discussion on previous entry. No follow up on request for a holiday. November 2004. Entry not signed. February 2005. (Service user)’would like to try swimming’. Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 12 March 2005. No mention of follow up to this request. The service user has not been swimming. When asked about consultation, service users in the Windmill said they felt involved and consulted by the staff. We asked for examples. Service users said they were consulted about food and decoration, but said they hadn’t been consulted about where to go on holiday. Service users in the Granary said they were consulted, and that staff spoke to them and included them in all decisions about the home. We asked for examples. Service users said they were consulted about personal things to do with their lives, and that they were given more control over their lives which made them feel good. Inspectors read individual risk assessments with service users in the Windmill and Granary. All risk assessments were out of date. The service users said they no longer applied, and seemed surprised that the information was wrong and years out of date. We asked the service users about the current risks, and how staff help them to manage. Service users described this clearly, and staff confirmed their description. We asked new staff how they were aware of this, as nothing is written down. They said sometimes it has been a bit hit and miss, but mainly they have watched other staff and ‘got by’. The inspectors looked for risk assessments on service users living in the Bakery. Those viewed were incomplete and did not describe the risk or the action required. Many risk assessments were out of date and did not relate to current risks. There was no evidence of any risk assessment being followed. Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 16 Service users do not take part in appropriate activities. They are left to their own devices and are not stimulated or engaged by staff. Service users rarely leave the home and are not part of the local community. Staff do not respect or recognise service users rights and responsibilities. EVIDENCE: Inspectors were told the following: ‘staff at the Bakery do not want to take service users out, they will use any excuse not to go out. If they do go out, they will just drive around in a circle and then come back to the home. Service users do not get out of the minibus. We haven’t got enough staff to go out anyway. Most of the staff do not know what they are doing. A lot of the time staff (including seniors) will wind up the service users on purpose, and then say their behaviour is too bad to take them out. Service users don’t do anything. Staff ignore them. Some service users are not spoken to from one day to the next. There is no caring happening here. A lot of the time service users do not get washed or their teeth brushed, or have clean clothes put on. Service users wear dirty clothes stained with dried Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 14 on food. Some wear the same clothes for days. They all (service users) need help with personal care but mostly we haven’t got enough staff, and staff do not want to bother with these tasks. Not even the basic things get done here. No one talks to them, no one cares for them. Staff on 1-1 duty have got no idea what they are doing. They just stand over them (the service users).They act like bodyguards. This is the worst home I have ever seen’. Records viewed, observations made, and further discussions with staff during the inspection supports the above comments. It is very different for service users living in the Windmill and Granary. Service users are encouraged and supported to lead fulfilling lives. Service users have a variety of activities in the community and at home. Staff were observed to be engaging and interacting appropriately with all service users. Service users commented to inspectors that they felt involved in the home and community, and that they were respected as individuals by staff. Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19. Service users do not receive appropriate personal support and are neglected in this area. Service users cannot be confident their emotional and physical health needs are met. EVIDENCE: Inspectors read all care plans of service users living in the Bakery. Care plans did not describe personal support needs. Most health plans were not completed. Several service users have a mental health diagnosis. There are no recorded health plans regarding support or management for service users. All service users in the Bakery were observed to be in a shabby state; their clothes were dirty and stained, men were unshaven, hair not brushed. Inspectors were told that ‘ all the service users need support with personal care, but staff can’t be bothered. They don’t even bother getting service users out of bed because it creates more work. As noted above, the majority of service users in the Bakery have a mental health diagnosis. When questioned, staff had no knowledge or experience of the needs of people with mental health problems. Few staff had experience of working with adults with learning disability or challenging behaviour. Service Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 16 users do not feel safe as staff have not got the skills required to support them through their mental health problems and challenging behaviour. As well as not being supported to dress in clean clothes, all bedrooms inspected in the Bakery were filthy dirty, some with strong smells of urine and smeared faeces. Bed linen was dirty and stained, sinks were dirty and stained. Broken furniture was present in some rooms. Service users living at the Bakery are living in a dirty house, have dirty bedrooms, and wear dirty clothes. Staff and management are neglecting to address basic care needs of service users. Service users living in the Granary and Windmill are supported by staff and receive personal support in the way they prefer and require. Service users confirmed that their physical and emotional needs are met by staff, although care plans need to be updated to reflect how these needs are met. Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23. Arrangements for protecting Service Users are not satisfactory, placing them at risk of possible harm and abuse. EVIDENCE: A service user living in the Windmill told inspectors she ‘felt listened to’ when she made a complaint. She added that staff ‘told her off for talking behind their backs’, but they were not working there anymore. A service user at the Granary made similar comments – that he felt listened to by staff, and that any complaints are resolved almost as soon as they are raised. A service user living in the Bakery told inspectors he has made complaints but nothing ever gets done. No complaints have been recorded. Inspection of service users finances revealed that service users are paying for food and for nappy sacks. The manager said that finances were in a mess, and that service users should not be paying for either of these. She agreed to arrange reimbursement to all service users who have been charged for items the company normally pay for. Staff files are chaotic. Some staff do not have a file. Files viewed did not contain references. One file contained a CRB, which listed several convictions. There were no references on file and the member of staff continues to be employed. Service users are not protected from abuse. Service users living at Berkeley house are vulnerable and are at risk of significant harm. Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 18 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, 26, 27, 28, 29, 30. Service Users do not have the benefit of living in a safe, well-maintained, homely environment. The overall quality of furnishing and fittings is poor and potentially dangerous placing Service Users and visitors at risk of injury or harm. The home is not clean or hygienic, and service users are at risk of infection. EVIDENCE: Inspectors undertook a full tour of the Bakery. All bedrooms and communal areas were viewed. Some examples of the tour are: Inspectors are concerned that the bedroom leading off from the open foyer had a vision panel in the door. Service users, staff and visitors can see into the bedroom, giving the service user no privacy. When questioned, the manager did not know why the panel was there, and gave the reason as ‘its always been like that’. Bedroom 5 has an unstable wardrobe, the window does not close, and access to the sink is blocked by furniture. There is no bedside light. Bedroom 10 has a filthy sink, bed and floor. Drawers are missing from the chest, it has no wardrobe or bedside light. The window shut with difficulty. Walls were stained and required cleaning and freshly painting. Water was Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 19 tested and cold. The sink was blocked. Bedroom 11 was very dirty. Filthy towels are used as curtains. There is no bedside light. The area around the sink is littered with pads. Bedroom 9 was filthy and smelled very strongly of urine and faeces. The service user was in bed. The toilet was dirty and smeared with faeces. The bathroom on the first floor had faeces smeared around the toilet seat. The window restrictor was inadequate. The shaving light was broken. There is just one communal area in the Bakery. This is the lounge/diner. There is not enough seating for all service users. Soft furnishings are stained and have dried food ground in. Dining tables and chairs are the same – encrusted with old food. Laundry is piled up on dining tables. The television was on throughout the duration of the inspection, although service users did not appear to be watching. Some service users had lunch in the garden. Berkeley House has ducks in the garden. All garden furniture has duck faeces on – chairs and tables. Staff did not clean the tables before service users sat down to eat. The Granary presents as homely and welcoming. Bedrooms were not inspected. The lounge and kitchen were clean and inviting. Service users spoken with were clearly proud of their home. The Windmill has a homely and comfortable lounge. One bedroom and en-suite bathroom was inspected. The bedroom was decorated and furnished to reflect the needs of the service user. She commented that she ‘loved her bedroom, but it was very cold at night’. The inspector noted that wood panelling in the fire exit (in the bedroom) had rotted, and that the garden was visible through the wood. This needs fixing. The en-suite bathroom needs decorating as the walls, floor and bath are very stained. Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 20 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) 32, 33, 34, 36. Service users are not supported by competent, effective, supervised, or trained staff. Service users cannot be confident that there are enough staff, or that the staff have enough experience or training to support them. Service users are put at risk because of the home’s inadequate recruitment practices. EVIDENCE: Over five and a half hours, the inspectors observed staff and management working with service users in the Bakery. During this time no positive interactions between staff and service users were noted. Staff did not talk to service users. Activities were not offered. Two staff were involved in folding and sorting laundry. Two staff were in the kitchen. One service user was asked what he wanted for lunch. He said he wanted a cheese sandwich and was told he couldn’t have it, he could only have salmon or paste. No other verbal or other communication was noted. Staff appeared to not know what to do. They spent most of the time standing around. Staff on 1-1 duty did not communicate with the service user. Some care plans described triggers to challenging behaviour. Staff and management were not aware, or did not take note of these triggers, and many indictors of potential triggers were present during the inspection. Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 21 Staff numbers in the Bakery are low. Staffing numbers do not allow for service users to be supported or cared for appropriately. They do not allow for service users to participate in activities in the community. They do not allow for service users to live in a clean house, or to wear clean clothes. Staff files do not contain adequate information. Some staff files could not be located. Service users are vulnerable and at risk from potential significant harm as the home has failed to carried out appropriate checks before offering staff a start date. The manager could not confirm that staff in the Bakery are supervised. When asked about supervision, one member of staff did not know what it meant. Staff in the Granary presented as enthusiastic and competent. However, staffing numbers are not adequate and do not meet the assessed needs of the service users. Staff are supervised and supported by the team leader of the Granary. Staff in the Windmill presented as enthusiastic and caring. Service users would benefit from staff receiving training in working with adults with learning disabilities. Staff are supervised and supported by two team leaders. Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 22 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, 38, 39, 40, 41, 42. The quality of care given to service users is seriously compromised by the poor management of the home. The service users do not have the benefit effective consultation so their views are overlooked and not acted upon. The health, safety and welfare of service users is compromised and not protected because of the home’s poor policy and practice. Service users are not safe or cared for. EVIDENCE: The manager has been in post for eight weeks. During this time several staff have resigned, the deputy manager has been suspended, and sickness levels and staff absence has rocketed. The manager has had eggs thrown at her car and her tyres slashed. An adult protection is on the home, and KCC Contracts have placed a level 3 flag. Staff morale is low. The home is operating in daily chaos and service users health and welfare are not being promoted or protected. Senior management have been aware of problems at the home, and have responded to this by drafting in managers from other homes, and by regular visits from area managers. This support has not gone unnoticed, but Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 23 outcomes from this support has not altered the poor quality of care or low staffing numbers for service users living in the Bakery. The manager acknowledges unacceptable standards of care, but does not offer solutions. The inspection process revealed significant shortfalls, most notably in the Bakery. The home is in crisis, and the Registered person must reflect on the coping mechanisms employed to date, and review the effectiveness in the short, medium and long term. Outcomes for service users must improve, and timescales for this have to be short to ensure service user’s quality of life is acceptable. Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 24 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 1 1 1 x x Standard No 22 23 ENVIRONMENT Score 1 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 1 1 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x 1 1 1 1 1 Standard No 11 12 13 14 15 16 17 x 1 1 1 x 1 x Standard No 31 32 33 34 35 36 Score x 1 1 1 x 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Berkeley House Score 1 1 x x Standard No 37 38 39 40 41 42 43 Score 1 1 1 1 1 1 x H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 25 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 YA1 Regulation 4(1)(a) 4(1)(b) 4(1)(c) Requirement The registered person shall compile in relation to the care home a written statement (in these Regulations referred to as the statement of purpose) which shall consist of (a) a statement of the aims and objectives of the care home; (b) a statement as to the facilities and services which are to be provided by the registered person for service users; and (c) a statement as to the matters listed in Schedule 1. The registered person shall supply a copy of the statement of purpose to the Commission and shall make a copy of it available on request for inspection by every service user and any representative of a service user. Nothing in regulation 16(1) or 23(1) shall require or authorise the registered person to contravene, or not to comply with (a) any other provision of these Regulations; or (b) the conditions for the time being in force in relation to the Timescale for action July 31st 2005. 2. YA1 4(2) July 31st 2005. 3. YA1 4(3)(a) 4(3)(b) July 31st 2005. Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 26 4. YA3 14(1)(d) 5. YA6 15(1) 6. 7. YA6 YA7 15(2)(b) 12(2) 8. YA8 12(3) 9. YA9 4( c ) 10. YA12 16(2)(n) registration of the registered person under Part 2 of the Act. The registered person shall not provide accomodation to a service user at the care home unless, so far as it shall have been practicable to do so (d) the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in respect of his health and welfare. Unless it is impracticable to carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (the service users plan) as to how the service users needs in respect of his health and welfare are to be met. The registered person shall (b) keep the service users plan under review. The registered person shall so far as practicable enable service users to make decisions with respect to the care they are to and their health and welfare. The registered person shall, for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings. The registered person shall ensure that ( c ) unnecessary risks to health or safety of service users are identified and so far as possible eliminated. The registered person shall having regard to the size of the June 20th 2005. June 30th 2005. June 20th 2005. July 31st 2005. July 31st 2005. June 20th 2005. July 31st 2005. Page 27 Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 11. YA13 16(2)(m) 12. YA16 12(4)(a) 13. YA18 12(2) 14. YA19 12(1)(a) 12(1)(b) 15. YA22 22(2) 22(3) care home and the number and nees of service users (n) consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. The registered person shall having regard to the size of the care home and the number and needs of service users (m) consult service users about their social interests, and make arrangements to enable them to engage in local, social and community activities and to visit, or maintain contact or communicate with, their family and friends. The registered person shall make suitable arrangements to ensure that the care home is conducted(a) in a manner which respects the privacy and dignity of service users; The registered person shall so far as practicable enable service users to make decisions with respect to the care they are to and their health and welfare. The registered person shall ensure that the care home is conducted so as (a) to promote and make proper provision for the health and welfare of service users; (b) to make proper provision for the care and, where appropriate, treatment, education and supervision of service users. The complaints procedure shall be appropriate to the needs of service users. The registered person shall ensure that any complaint made July 31st 2005. July 31st 2005. June 20th 2005. June 20th 2005. June 20th 2005. Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 28 16. YA23 13(6) 17. YA24 16(1) 18. YA26 16(2)( c ) 19. YA28 23(2)(e) 23(2(h) 20. YA29 23(2)(n) under the complaints procedure is fully investigated. The registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Subject to regulation 4(3), the registered person shall provide facilities and services to service users in accordance with the statement required by regulation (4)(1)(b) in respect of the care home. The registered person shall having regard to the size of the care home and the number and needs of service users ( c ) provide in rooms occupied by service users adequate furniture, bedding and other furnishings, including floor coverings , and equipment suitable to the needs of service users. The registered person shall having regard to the number and needs of the service users ensure that (e) adeqate private and communal accomodation is provided for service users; (h) the communal space provided for service users is suitable for the provision of social, cultural and religius activities appropriate to the circumstances of service users. The registered person shall having regard to the number and needs of the service users ensure that (n) suitable adaptations are made, and such support, equipment and facilities, including passenger lifts, as may be required are provided, for 20th June 2005. July 31st 2005. July 31st 2005. August 30th 2005. June 20th 2005. Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 29 21. YA30 23(2)(d) 23(2)(o) 16(2)(j) 16(2)(k) 22. YA32 18(1)( c)(i) 23. YA33 18(1)(a) service users who are old, infirm or physically disabled. The registered person shall having regard to the number and needs of the service users ensure that (d) all parts of the care home are kept clean and reasonably decorated; (o) external grounds are which are suitable for, and safe for use by, service users are provided and appropriately maintained. The registered person shall having regard to the size of the care home and the number and needs of service users (j) after consultation with the environmental health authority, make suitable arrangements for maintaining satisfactory standards of hygeine in the care home; (k) keep the care home free from offensive odours and make suitable arrangements for the disposal of general and clinical waste. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that the persons employed by the registered person to work at the care home training appropriate to the work they are to perform. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for June 20th 2005. July 31st 2005. Immediate. Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 30 24. YA34 19(1)(a) 19(1)(b)(i ) 19(5)(a) 19(5)(b) 25. YA36 18(2) 26. YA37 10(1) 27. YA39 24(1)(a) 24(1)(b) 24(3) the health and welfare of service users. The registered person shall not employ a person to work at the care home unless (a) the person is fit to work at the care home (b) subject to paragraph (6), he has obtained in respect of that person the information and documents specified in (i) paragraphs 1 to 7 of Schedule 2. For the purposes of paragraphs (1) and (4), a person is not fit to work at a care home unless (a) he is of integrity and good character; (b) he has qualifications suitable to the work that he is to perform, and the skills and experience necessary for such work. The registered persons shall ensure that persons working at the care home are appropriately supervised. The registered person and the registered manager shall, having regard to the size of the care home, the statement of purpose, and the number and needs of the service users, carry on or manage the care home (as the case may be) with sufficent care, competence and skill. The registered person shall establish and maintain a system for (a) reviewing at appropriate intervals; and (b) improving, the quality of care provided at the care home, including the quality of nursing where nursing is provided at the care home. (3) The system referred to in paragraph (1) shall provide for Immediate. June 20th 2005. Immediate. June 20th 2005. Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 31 consultation with service users and their representatives. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Berkeley House H56-H06 S23892 Berkeley House V229532 160505 Stage 4.doc Version 1.30 Page 32 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane, Maidstone Kent. ME16 9NT National Enquiry Line: 0845 015 0120 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. 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