Inspection on 10/06/08 for Besford House

This inspection was carried out on 10th June 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Besford House 25/04/07

Besford House 22/05/06

Besford House 27/01/06

Besford House 23/09/05

Besford House 08/12/04

Besford House 03/04/04

Besford House 27/09/03

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Besford House 19 Besford Road Liverpool L25 2XT Lead Inspector Beate Field Unannounced Inspection 10th June 2008 09:10 Besford House DS0000035859.V362716.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 Besford House DS0000035859.V362716.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. Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Besford House Address 19 Besford Road Liverpool L25 2XT 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) 0151 498 4281 0151 488 0944 sally.jones@liverpool.gov.uk www.liverpool.gov.uk Liverpool City Council Ms Sarah Jones Care Home 18 Category(ies) of Learning disability (18) registration, with number of places Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The service should at all times employ a suitably qualified and experienced manager who is registered with the National Care Standards Commission. The matters detailed in the attached schedule of requirements must be completed in the stated timescales. A maximum of 18 younger people with a learning disability is accommodated at the care home. 25th April 2007 Date of last inspection Brief Description of the Service: Besford House is owned and run by Liverpool Social Services. The home provides support and personal care to 18 younger persons who have a learning disability. The home consists of three bungalows each accommodating six people in single bedrooms. One of the bungalows accommodates 6 people who live at the home on a permanent basis whilst the other two provide respite care and emergency care. Each bungalow has its own domestic style kitchen, laundry room, sitting room and dining room. Each bungalow has assisted baths and a walk in shower with additional aids provided as and when required. The home is situated in the Belle Vale area of Liverpool and is easily accessible by public transport and is close to shops and other community facilities. Parking is available. At the time of the inspection, the weekly cost for the service was £366.00 with the people who use the service making a weekly contribution to this overall cost depending on their benefit entitlements. A statement of purpose, which describes the services offered at Besford House, is available for relatives and social and health care professionals to refer to. A service user guide is available for people interested in using the service. Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place over 7 hours and is based on a visit to the home, information received about the service since the last inspection, by an Annual Quality Assurance Assessment (AQAA) completed by the manager and questionnaires completed by a member of staff and relatives of the people who use the service. During the site visit to the home time was spent in the office looking at a sample of records and policies and procedures and talking to the manager. A tour of the home was undertaken. The inspector spoke with the people who use the service and with staff and made observations of staff delivering care to the people who use the service. What the service does well: People who use the service made positive comments about living and staying at Besford House. Some comments include: “I like it here, staff are nice.” “ I have been here 2 nights, I like it here. Staff are nice and friendly. Food is good, my room is nice. I like watching television. I get on with the other people who live here.” “ I have been coming here for a while and I like it. I like the staff. I like the food.” “I like staying here. I like the other people who live here.” 9 relatives returned surveys to the CSCI. A number of positive comments were made about the service provided. Consultation takes place with the people who use the service and the manager is looking at new ways to improve this. The people who use the service can engage in a good range of leisure and social activities to meet their individual needs with the support of staff as appropriate. Varied and well-balanced meals are provided in homely surroundings. Permanent and short stay residents maintain regular contact with their family and families are involved in decisions affecting the care of their relative. Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 6 The home ensures that the people who use the service know how to make a complaint. This ensures that their rights are promoted. A comfortable, safe and homely environment is provided to the people who use the service. Permanent staff have access to regular training opportunities to update their knowledge and skills. What has improved since the last inspection? What they could do better: The current level of reliance on agency care staff and shortfalls in the number of domestic staff available is a concern. The service must address this unsatisfactory situation and employ permanent staff to provide continuity of care and a satisfactory domestic service to the people who use Besford House. People have been admitted to the service who are not suitable to stay there. This has placed other people who use the service at risk of emotional and physical harm. Accommodation and support must not be provided to a person unless their presenting needs can be met at the service and their needs are compatible with the other people who live there. Care plans need to provide staff with the information they need to appropriately support the people using the service. Evidence that care plans Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 7 and risk assessments are kept under review needs to be available so as to demonstrate that staff have access to up to date information. The manager and responsible individual must ensure that they inform the CSCI of any event in the care home, which adversely affects the well being, or safety of any person using the service. This information is needed so that the CSCI can ensure that the home is operating in the best interests of the people who are living there. An alternative way of transporting medication between the bungalows needs to be found so as to ensure medication is at all times securely held. An assessment must take place around the use of bed rails prior to their being utilised. This assessment needs to identify any risks to the individual concerned. Action must be taken to eliminate any risks as far as this is possible. The AQAA should provide detailed information, as this is the main way that the registered persons can let the CSCI know how well a service is delivering good outcomes to the people who use the service. 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. Besford House DS0000035859.V362716.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 Besford House DS0000035859.V362716.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): 1, 2 and 3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People have been admitted to the service who are not suitable to stay there. This has placed other people who use the service at risk of emotional and physical harm. EVIDENCE: A Statement of Purpose is available showing the services and facilities offered at Besford House and a pictorial Statement of Purpose is in place to make the information more accessible to people who use the service. Service User Guides are now available for the three bungalows. These guides are written in plain English and have pictures to aid understanding. These guides provide information on the admissions process, facilities available, staffing, activities, how to complain, protection from abuse, equal opportunities and behaviour that is not acceptable. There have been no permanent admissions for several years. There have been several people who have come to live at the home on an emergency basis since the last visit to the service. The records relating to the admissions of some of these people were seen. Two people admitted on an emergency who Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 10 are still living at the service had been suitably assessed prior to their admission. Some people who are no longer living at the service had not been appropriately admitted. The admissions process that had been followed did not suitably safeguard the welfare of the other people using the service or promote the welfare of the people admitted. There was evidence that staff did not have the right skills to support some of the people who have been admitted to the service. Records showed that some of the people who were admitted but who have since left needed significant support with their mental health and use of alcohol. Staff training records and staff spoken with said that they have received little or no training in these areas. Some placements ended following violent incidents at the home that placed other people who use the service and staff at risk. In one instance a person was admitted without an up to date assessment being carried out by their social worker. There was no evidence that the home had carried out an assessment prior to admission. The records showed little evidence of planning for the future of people placed on an emergency following their admission. Some people who were placed on an emergency have been living at the service for over 12 months. The admissions procedure for people to be placed in an emergency has been recently revised. This clearly states that a full and current assessment of a persons needs must be provided prior to any admission. A review is to be held after 24 hours of admission to identify future plans and 6 weeks thereafter. Contingency plans must also be in place by the social worker should a person present unacceptable behaviour during the placement. Further information needs to be provided in the admissions procedure in order to prevent unsuitable admission to the home. The admissions procedure needs to clearly indicate that the presenting needs of the person admitted must be needs that can be met by the staff and that the needs of the person being considered for a placement must be compatible with the people currently living at the service. The Statement of Purpose needs to be updated to reflect the changes to the admissions procedure. Besford House DS0000035859.V362716.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, 8 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are not always provided with the information they need to appropriately support the people who use the service. EVIDENCE: A sample of care plans were seen for the people who are living at the home on a permanent basis and those who are living at the home following an emergency admission. Some care plans provided sufficient information for staff around the needs of the people who use the service. Some care planning information was not dated and evidence of reviews of some care plans and risk assessments within the last 12 months was not available. The records for 2 people admitted on an emergency basis who have since left the service showed that one person did not have a care plan and the other persons care Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 12 plan contained insufficient information around the action to be taken by staff to meet their mental health and behavioural needs. Records showed that Besford House staff contact the primary carer on the day that a person is being admitted for respite. This is to obtain information regarding any changes in their needs and where necessary key workers amend the care plans. The people who use the service make decisions over their daily lives such as: what activities to participate in, whether to be on their own or with others, choosing their holiday etc. Several people who use the service were spoken with during this visit. They all made positive comments about the service. Some comments include: “I like it here, staff are nice, there is enough for me to do.” “ I have been here 2 nights, I like it here. Staff are nice and friendly. Food is good, my room is nice. I like watching television. I get on with the other people who live here.” “ I have been coming here for a while and I like it. I like the staff. I like the food.” “I like staying here. I like the other people who live here.” 9 relatives returned surveys to the CSCI. A number of positive comments were made about the service provided. Relatives said that the privacy and dignity of their relative is promoted and that their health and care needs are met. The staff usually understand the needs of their relatives. Any concerns are usually appropriately dealt with. Some comments included: “I am very impressed with the staff at the home. I know my relative is happy there and that their needs are very important to them. I am happy with the service.” “They look after everybody so well.” “I can’t think of any improvements – everybody is so happy there.” “I have always been happy with the care my relative receives.” “I am very happy with the service – the staff and management have always been very supportive.” “On the whole care is very good and there is a family atmosphere in the bungalow.” Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 13 One relative commented that they would like more information on the activities their relatives undertakes when staying at the service. This information was passed to the manager to be addressed. The people who live at the service on a permanent basis are involved and made aware of changes at Besford House through residents meetings, which are generally held every two months. This provides a regular opportunity for the people who use the service to express their opinion and where necessary they are supported by the staff to do so. The records of the last residents meeting held on 14th February 2008 were seen. This showed that the people who use the service had been consulted around food, staffing and activities. Meetings are held with people who use the service on a respite basis to establish their wishes prior to the respite beginning. Weekly meetings are also held with people who use the service on an emergency basis. The weekly meetings are not recorded. It is recommended that this information be recorded as it provides evidence of consultation with the people who use the service. The AQAA (Annual Quality Assurance Assessment) shows that a carers forum meets quarterly. This enables carers to provide feedback on the service provided. There is also a newsletter, which is a further way of keeping in touch with carers and people who use the service on a respite basis. The people who use the service are supported to take responsible risks by engaging and accessing various community facilities independently. The service has a missing person policy, which is implemented when a person who is using the service absence cannot be explained. Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 14 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 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The people who use the service can engage in a good range of leisure and social activities to meet their individual needs with the support of staff as appropriate. Varied and well-balanced meals are provided in homely surroundings. EVIDENCE: The people who use the service engage in a wide range of activities to develop new skills and to fulfil their social needs. Some of the people who use the service attend a day centre where they engage in various activities such as cooking, flower arrangement and craft. Some go to college, some work and some people have support to access the local community from a local support organisation. At the weekends and evenings the people who use the service Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 15 visit social clubs, the pub or other community facilities or relax at the home and watch television or listen to the radio. The home is a short walk from local shops, pubs, churches and other community facilities. Other parts of the city are easily accessible by public transport, which passes outside the service. The service has a range of transport options available to enable the people who use the service to access community facilities such as: Dial a Ride, taxi and staff cars. All permanent residents have a bus pass. Information about community activities is brought into the service by both the people who use the service and staff, which are displayed around the bungalows. Some surveys returned by relatives indicated that there is not always enough to do at the home and that not having enough staff can be the reason for this. There has been a change to the amount of time some people who use the service now spend at day centres. The staffing levels are currently being reviewed to ensure there are enough staff available to support people in activities now that some people who use the service are at home more days each week. The people who use the service are supported to maintain and develop contact with friends and family. The service has an unrestricted visiting policy and the people using the service are able to choose where to see their visitors. The people who use the service have a key to their bedroom in accordance with a risk assessment. They generally have access to all parts of the building and where there are restrictions due to health and safety concerns, a risk assessment has been introduced. Although the people who use the service are not directly responsible for household tasks they are encouraged to assist care workers in keeping their bedrooms clean and tidy in accordance with their abilities. Mealtimes at Besford House are flexible to meet the needs of the people who use the service. A record is kept of all meals that are provided. A menu is available and if a person has something to eat that is not on the daily menu, a record is made. The menus seen showed that varied and balanced meals are provided that would meet the cultural needs of the people who use the service. Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 16 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 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Unnecessary risks to the safety of the people who use the service are not always identified and so far as possible eliminated. EVIDENCE: Most of the people who use the service do not require any assistance with moving and handling and require minimal support with personal care. Care plans indicate any personal care assistance that is needed. Where a person requires assistance with transferring suitable specialist aids are obtained from the district nurse. A risk assessment was not in place for the use of a bed rail. There was also no bumper in place to prevent a risk of entrapment. This was brought to the attention of the assistant manager who took the necessary action to safeguard the person using this equipment. The manager has since confirmed that a protective bumper has been put in place and some staff have been provided Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 17 with training from the district nurse around the safe use of bed rails. Further staff now need to be provided with training around the appropriate use of bed rails and a comprehensive risk assessment needs to be developed around the continuing use of the bedrail. This needs to be kept under close review. A sample of records seen showed that the people who use the service have access to health professionals in accordance with their needs. The staff monitor the health needs of the people who use the service and ensure that they receive regular health checks from the dentist, chiropodist, optician as well as a periodic review of their medication by their GP. Staff support the people who use the service to attend outpatient appointments in accordance with their needs. Health Action Plans are in place for the people who live at the service on a permanent basis. An inspection of medication and records indicated that these were being given and documented appropriately. The management team administer medication and have been trained to do so. Since the last visit to the home improvements have been made to the records of medication that are used for people who stay at the home on a respite and emergency basis. A clear record is now made of the amount of medication to be given, dosage, time of day and any safety instructions on the medication administration record. A photograph of the person using the service has also been attached to each individual’s medication administration record as a further safeguard. The assistant manager reported that at the time of the visit no people using the service were administering their own medication. Since the last visit to the service the arrangements for the storage of medication have been changed to ensure that medication is kept at an acceptable temperature. Medication is transferred, from the secure area where it is held, with the medication administration records in a bag. Advice was given to the assistant manager around identifying a container that can be locked to transport the medication to the three bungalows so as to ensure that medication is secure at all times. Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 18 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 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The people who use the service have not been safeguarded by the admission of people who are not suitable to be placed at the service. EVIDENCE: The service has a complaints procedure, which is displayed in a prominent position. The procedure outlines how complaints would be resolved and the timescale for completing the investigation. The people who use the service who were spoken with knew how to make a complaint if they are not happy with the service received. Records showed that how to make a complaint is discussed with the people who use the service at residents’ meetings and the procedure is clearly outlined in the service user guides. As already indicated, the admission of some people has not been appropriate and there have been incidents at the home that placed other people who use the service and staff at risk. This is not acceptable and does not safeguard the people who use the service. The assistant manager reported that several complaints were made by the people who live in the emergency bungalow about the behaviour of other people who use the service. The records of these complaints could not be located during the visit to the service. Following the visit the manager Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 19 explained the action that had been taken as a result of the complaints. This included revising the admission procedure. The service has various policies and procedures in place for the protection of vulnerable adults. A copy of the Liverpool City Council’s adult protection procedures is available at the home. A referral had been appropriately made to adult protection regarding some incidents that had occurred at the service. The records were not clear around whether other incidents had been reported. The manager reported that all incidents had been reported. The CSCI had not been notified of incidents at the home that adversely affects the well being and safety of people who use the service. This information needs to be reported so that the CSCI can ensure that the home is operating in the best interests of the people who are living there. Following the visit the manager reported that this information had been sent to the CSCI. The CSCI has no records of this information. All permanent staff who work at the service have received training around safeguarding vulnerable adults. The service uses a high percentage of agency staff to deliver care to the people who use the service. The manager said that during the induction process the agency staff are made aware of the adult protection procedures and that training around these procedures has been provided to the majority of agency staff. Agency staff and permanent staff spoken with were aware of the procedure to follow to safeguard the people who use the service. The people who use the service are supported to manage their finances with the support of staff. A record is kept of incoming and outgoings of monies. Daily checks of residents’ finances take place by the management team. The manager said that the home is audited at regular intervals by Liverpool Social Services Finance Department; however, records of this were not seen at this visit. Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 20 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, 25, 27, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. A comfortable, safe and homely environment is provided to the people who use the service, however the lack of domestic staff means that care staff are having to carry out additional responsibilities that takes their time and attention away from the people who use the service. EVIDENCE: The three bungalows are safe, comfortable and bright and all parts of the bungalows and grounds are easily accessible to the people who use the service. The grounds also benefit from having a ramped area to increase accessibility. Flowerpots make the outdoor area an attractive place to sit. Steps are currently being taken to improve the security of the grounds. Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 21 All accommodation is provided in single bedrooms and bedroom doors have suitable locks to promote the privacy of the people who use the service whilst maintaining their safety. Some of the people who live at the home on a permanent have purchased their bedroom furniture to personalise their bedrooms. The bungalows have the required number of toilets and bathroom for the number of people using the service. These are located close to communal areas and bedrooms. Each bungalow has an assisted bath. Bedrooms have a call system. Some of the decoration in the communal areas and bedrooms in the emergency and respite bungalows is showing signs of wear and tear. The assistant manager reported that Liverpool City Council has a property services department that is carrying out ongoing works at the home. The progress of these works will be looked at further at the next visit to the home. The bungalows were all clean and tidy at the time of the visit. Some care staff spoken with were concerned that due to there being vacancies for domestic staff they are having to undertake a lot of the domestic tasks within the home. They said that this can lead to the home not getting the thorough clean it needs and means less time is spent with the people who use the service. Following the visit the manager confirmed that there are 4 vacancies for domestic staff and that care staff are having to carry out a number of additional domestic tasks. The manager and deputy manager reported that this situation has been ongoing for over 2 years but that there has been no approval from higher management to advertise for the vacancies. Although, the manager has attempted to address this by bringing care staff in to work extra hours on domestic duties, this situation needs to be resolved so there is some consistency for the people who use the service and the care staff. There is a domestic washing machine in each of the kitchens and policies and procedures are in place to minimise the spread of infection. Records showed that an up to date check had been carried out of the electrical wiring, portable appliances and of the fire alarm and emergency lighting by individuals who are appropriately qualified. Evidence that there has been an up to date check of the gas appliances was not available at this visit. A copy of these safety certificate were forwarded to the CSCI following the visit. Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 22 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 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The continued reliance on agency staffing is unacceptable, as it does not provide continuity of care. EVIDENCE: Care continues to be delivered by a large number of agency staff. There are currently 8 full time care staff vacancies, 5 night staff vacancies and 4 vacancies for domestic staff. At the last visit to the service the manager reported that there has been insufficient permanent staff at the home for the last 4 years. The manager has taken steps to try to minimise the effects of employing so many agency staff. An agreement has been reached with the agency used that, agency staff will work for a minimum of 16 weeks to promote continuity for the people who use the service and the service itself. A number of the agency staff work solely at Besford House and a key worker system has been introduced to further promote continuity of care. It was reported that some agency staff have been working at the home for 2 years. Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 23 The service must endeavour to rectify this unsatisfactory staffing situation and to employ permanent staff to provide continuity of care to the people who use the service and to improve the overall quality of care provided at Besford House. Agency and permanent staff were spoken with during this visit to the service. They said they enjoy working at the home, feel they have had and can access sufficient training to support them in their work and that the management team are supportive. The permanent staff spoken with said that there needs to be more permanent staff employed to promote continuity in the care of the people who use the service. They said care staff are covering domestic responsibilities at present as there are vacancies for domestic staff at the service and that that this can lead to the home not getting the thorough clean it needs and means less time is spent with the people who use the service. Staff from the bungalow where emergency admissions are accepted said that the behaviour of some people who have come to stay recently has been unacceptable and frightened other people who use the service and put them in danger. A survey returned by a member of staff showed that they consider they are always given up to date information about the needs of the people living at the service. Receive training that is relevant to their role and that the manager regularly gives support. They described the service as “creating a safe, supportive and confident environment for the people who use the service.” 9 relatives returned surveys and in general made positive comments about the care and support provided by staff. Some relatives commented on the high use of agency staff, these comment were: “There are too many times when agency staff are on duty I would like to see more permanent staff.” “More permanent staff are needed. I don’t feel agency staff always know my relatives needs.” “This service can improve by having more permanent staff”. Staff one to one supervision and appraisals take place with permanent staff. Supervision of agency staff who regularly work at the home has been reintroduced and the manager reported at least one supervision has taken place. This is important for monitoring the performance of agency staff that are working at the care home. Agency staff spoken with on the day of the visit said they had been supervised recently. Records show that staff meetings take place at the three bungalows. The management team also meet to discuss the operation of the service and have Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 24 recently met with the responsible individual. These meetings provide a valuable means of staff communication. All permanent staff have completed an NVQ 3 in care of adults with a learning disability. The deputy manager and two assistant managers have completed an NVQ Level 4 in care and management. At the time of the visit the records of training for the agency staff were not available. At the last visit to the service no agency staff had completed a relevant qualification in caring for adults with a learning disability. At this visit the 2 agency staff spoken with said they had completed an NVQ Level 2 in Adult Care. At least 50 of staff, including agency staff are to hold an NVQ Level 2 or equivalent qualification. Liverpool City Council has a thorough induction programme for permanent staff. Agency staff do not have access to this induction. To ensure that all agency staff have the information they need to work at the service a brief overview of the service is given and access to written information on how the homes operate and the needs of the people who use the service is made available. Given that over half of the staff working at the home are agency staff it is recommended that all agency staff receive a thorough induction. Agency staff spoken with said that the agency ensures that their training in health and safety matters such as moving and handling, food hygiene, first aid, infection control is up to date and managing challenging behaviour is up to date. There were no records available at the visit to demonstrate that all agency staff have received this essential training. Following the visit the manager provided evidence of this training for agency staff whose records were requested. All records required to be held at the home must be available for inspection by the CSCI. Records show that permanent staff have access to a number of training courses. In the last 12 months some of the courses staff have attended include managing challenging behaviour, equality and diversity and health and safety refresher courses. No new staff have been employed at the home in the last 12 months. The records relating to the employment of agency staff were seen. Confirmation that all the relevant checks detailed in scheduled 2 of the Care Homes Regulations 2001 have been carried out and details of the experience and qualifications of agency staff could not be located during the visit. This was a requirement of the last visit to the service. Following the visit the manager provided evidence that these checks had been carried out for agency staff whose records were requested. All records required to be held at the home must be available for inspection by the CSCI. Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 25 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 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The quality assurance systems for the home are not operating in the best interests of the people who use the service as there are no clear plans for making an improvement to the staffing shortfalls at the service. EVIDENCE: The registered manager of Besford House has many years experience of working with adults with a learning disability. The manager reported that she has undertaken regular training to maintain and update her knowledge and skills. Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 26 The Annual Quality Assurance Assessment (AQAA) did not provide detailed information. It is recommended that the AQAA provide detailed information as it is the main way that the registered persons let the CSCI know how well a service is delivering good outcomes. Discussion with staff showed that the manager is accessible and willing to listen to their views. Staff spoken with considered that some of the issues raised with the manager such as the lack of permanent care staff and staff having to cover domestic vacancies was beyond the power of the manager to resolve. The issue of inappropriate placements had also been brought to the attention of the manager due to the concerns about the effect of this on the other people who use the service and staff. Records show that the manager had taken steps to end placements once they were considered inappropriate. There was however a delay in finding alternative placements by Liverpool City Council. Following the previous visit to the service the CSCI requested that the Responsible Individual from Liverpool City Council present an action plan as to how the staffing shortages at the home are going to be addressed. A plan was submitted but has not to date been followed through. The manager and responsible individual have indicated that a possible resolution is filling vacancies through redeployment of staff from other residential homes. To improve the quality of the service provided at Besford House the staffing shortfalls need to be resolved. There needs to be a workable plan in place to achieve this and to ensure it supports the well being of the people who use the service. The views of the people who use the service are obtained through meetings and surveys. The AQAA shows that a carers forum meets quarterly. This enables carers to provide feedback on the service provided. There is a newsletter, which is a further way of keeping in touch with carers and people who use the service on a respite basis. A committee of people who use the service is being developed. As indicated at a previous visit to the service, the views of other stakeholders such as social and healthcare professionals about the operation of the home should also be sought. The responsible individual has begun to produce a written report of their findings following their monthly visit to the service. This provides evidence that the operation of the home is being overseen by the organisation that has the ultimate responsibility for it. The health and safety of residents and staff are promoted through regular checks and maintenance of the building and equipment used at the care home. There are range of policies and procedures available on promoting safe working practices. Permanent staff have access to training in first aid, food hygiene, infection control. Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 27 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 3 2 1 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 X 29 3 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 2 X X 3 X Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 28 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 YA2 Regulation 14 (1) (a) Requirement The registered persons must ensure that a service is only provided to people whose needs can be met at the home and who do not present a significant risk to other people using the service. This is to ensure that the welfare of the people using the service is safeguarded and promoted at all times. The registered persons must ensure that staff have the right skills and training to meet the needs of the people admitted to the service. This is to ensure that the people who use the service are appropriately supported at all times. The registered person must ensure that care plans provide staff with the information they need to appropriately support the people using the service. Evidence that care plans and risk assessments are kept under review needs to be available so as to demonstrate that staff have access to up to date DS0000035859.V362716.R01.S.doc Timescale for action 10/06/08 2. YA3 18 (1) (c) 10/06/08 3. YA6 15 (1) and (2) (b) 10/06/08 Besford House Version 5.2 Page 29 information. 4. YA18 13 (4) (c) The registered persons must ensure that an assessment of an individuals needs takes place prior to the use of bed rails, that a full risk assessment is in place around the continuing use of bed rails that includes staff being trained in the safe use of bed rails by an appropriately qualified person. This is to ensure the safety of the people using the service. The registered persons must ensure that medication is held securely at all times so as to ensure the safety of the people using the service. 10/06/08 5. YA20 13 (2) 10/06/08 6. YA23 37 (1) (e) The registered persons must 10/06/08 inform the CSCI of any event in the care home which adversely affects the well being or safety of any service user. This is needed so that the CSCI can ensure that the home is operating in the best interests of the people who are living there. The registered manager must 10/06/08 ensure that the records specified in Schedule 4 of The Care Homes Regulations 2001 are at all times available for inspection in the care home by the CSCI. This is to ensure that evidence that staff have been appropriately recruited and trained can be viewed during the inspection visit. The registered persons must ensure that there are sufficient permanent staff available to promote continuity of care for the people who use the service. DS0000035859.V362716.R01.S.doc 7. YA32 YA34 17 (3) (b) 8. YA30YA33 18 (1) (a) 10/09/08 Besford House Version 5.2 Page 30 (Previous timescale of 25/07/07 not met.) 9. YA39 24 (1) The registered persons must ensure that there are effective quality assurance and quality monitoring systems in place so that shortfalls in the service provided are identified and a plan put in place to address them. 10/09/08 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 YA8 Good Practice Recommendations A record should be made of the meetings held with the people using the service on an emergency and respite basis as this provides evidence of this consultation. 50 of care staff (including agency staff) are to hold an NVQ 2 or equivalent qualification. All agency staff to receive a structured induction training to ensure that they are suitably equipped to meet the needs of the people who use the service. The AQAA should provide detailed information as this is the main way that the registered persons can let the CSCI know how well a service is delivering good outcomes to the people who use the service. The views of other stakeholders such as GPs, social workers etc should be sought about the operation of the service. 2. 3. YA32 YA35 4. YA37 5. YA39 Besford House DS0000035859.V362716.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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. 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