Inspection on 23/09/05 for Besford House

This inspection was carried out on 23rd September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Besford House 10/06/08

Besford House 25/04/07

Besford House 22/05/06

Besford House 27/01/06

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 08/07/2008.

CARE HOME ADULTS 18-65 Besford House 19 Besford Road Liverpool L25 2XT Lead Inspector Leila Mavropoulou Unannounced Inspection 23rd September 2005 03:00 Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Besford House DS0000035859.V253438.R01.S.doc Version 5.0 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 Liverpool City Council Ms Sarah Jones Care Home 18 Category(ies) of Learning disability (18) registration, with number of places Besford House DS0000035859.V253438.R01.S.doc Version 5.0 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. A maximum of 18 younger person with a learning disability is accommodated at the care home. The matters detailed in the attached schedule of requirements must be completed in the stated timescales. 8th December 2004 Date of last inspection Brief Description of the Service: Besford House is owned and run by Liverpool Social Services. The home consists of three bungalows each accommodating six residents in single bedrooms. The home provides support and personal care to 18 younger persons that have a learning disability. One of the bungalows accommodates 6 permanent residents whilst the other two provide respite care to residents in order to give their primary carer a break. Many of the residents have been going to Besford for many years on a regular basis within the council’s policy of accessing respite care. Each bungalow has its own domestic style kitchen, laundry room, sitting room and dining room. Each bungalow has assisted baths and walk in shower and additional aids would be provided as when required. The home is situated in the Belle Vale areas of Liverpool and is easily accessible by public transport and is close to shops and other community facilities, which residents are able to access. The bungalows have two members of staff and there is always one of the management team on duty. Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection late on Friday afternoon to enable the inspector to observe the admission of the residents going to the home for respite and to have the opportunity of seeing the care provided by the staff. The inspector spoke to four members of staff, observed meal preparation, admission of residents; spoke to six residents and the manager on duty. In addition other residents records and other records were inspected such as: fire book and accident book. What the service does well: What has improved since the last inspection? What they could do better: Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 6 The quality of agency staff provided to meet the needs of the residents could be improved by the management of the home ensuring that the staff the agency sends to the home have some understanding of the needs of people with learning disability and the under lying principles of promoting the residents independence and their right to respect and dignity. The current excessively high percentage of agency staff being used in the home would indicate that only their physical care needs are being met, as the residents do not have the opportunity to build a relationship with the staff and the staff do not work with the residents long enough to get to know their needs, understand their communication or behaviour. The induction of the agency staff must reviewed to ensure that they have the necessary information to meet the needs of the residents. Thus, it is essential that the existing care plans and risk assessments are more detailed and explicit to ensure that clear instructions are given to all staff on how to be meet the identified needs of the residents. The manager must ensure that the residents ensure that the residents on respite have care plans and risk assessments in place to ensure that their needs are met and to promote their health and safety. The manager must review the existing method of recording the residents’ medication as it is not clear and makes auditing of residents medication difficult. The manager must ensure confidential information is only recorded in the resident’s file and that incident of aggressive behaviour is reported to the Commission. 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. Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,4, Residents are assessed prior to admission to ensure that the home is able to meet their needs. EVIDENCE: The home has a Statement of Purpose, which outlines the services and facilities provided at Besford House. It is easy to read and contains the necessary information to assist prospective residents in making a decision about the suitability of the home. The staff at the care home would assess the prospective resident needs prior to admission when there is a permanent vacancy. However, there has been no permanent admission for several years at the home. Discussion with the manger on duty indicated that new residents coming to home on respite would visit the home several times before actually staying at the home. This is to ensure that the homes has the staffing, skills and where necessary equipment and facilities to provide the necessary care to the resident. For new residents accessing respite care at Besford House the manager receives a Care Management Assessment showing the needs of the resident. However, in some of the residents files inspected the home has not devised their own care plan and risk assessments for the resident. Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9,10 The care staff knowledge of the needs of the resident does not promote the resident choice or meet their individual needs. EVIDENCE: Inspection of a sample of respite residents files show that they a care plan and risk assessment is not devised by the staff at the home to show how the residents needs would be met. The permanent resident files show that care plans and risk assessment are in place. However, they should be more detailed to provide clear guidelines to care staff how to meet the assessed needs of the resident. This must also include details on how to manage physical aggression, as entries in one the daily record book showed incidence of aggressive behaviour, which was not identified in the resident’s care plan. Observation during the inspection showed that the family rang the home with current information about the residents coming to home for respite and discussion with the manager on duty indicated that the residents behaviour would vary depending on what was happening at home. Thus, it is important that the home review their admission procedure to ensure that they are proactive in obtaining information from the primary carer prior to the resident arriving to ensure that if necessary their care plan and risk assessment are amended for the period of respite. Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 10 Observation during the inspection showed that the residents do make choices about their daily lives and are assisted by staff to manage their finances. The inspector observed staff maintaining records of incoming and outgoing payments to residents from monies given to the staff for safekeeping. Observation of residents’ activities shows that the residents are encouraged to maintain an independent lifestyle as possible. However, the management of the home must undertake their own risk assessment for the residents to ensure their safety and consideration of the change of environment. These should be developed with the resident or their representative to ensure that they are aware of any restrictions and why and that they consent is given where necessary to protect the residents and staff. The manager must develop specific protocols for staff to promote the health and welfare of residents that have specific health needs. These protocols must be linked to the resident’s health needs as identified in their care plan. The residents’ information is kept in a secure place. However, the registered person must ensure that personal information of residents is only kept in their personal records and not in the daily communication book. T Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 The residents access various community facilities to promote integration in all aspect of community life. EVIDENCE: Discussion with the residents, staff, inspection the residents’ individual activity programme and observation demonstrate that the residents participate in a range of activities either on their own or with staff to develop new skills, maintain existing skills and to maintain relationships. Many of the residents make regular visit to their family and visit places where they can meet and make friends with other people who do not have the same disability. Currently, three residents attend college or day centres. Visitors are welcomed to Besford House throughout the day and the resident can choose where to see their visitor. Observation showed that the residents are able to choose to be on their own or join in activities with the other residents. All of the residents access entertainment in the community of their choice. The residents commented that they were happy with the quality of food provided. The home has a set menu. However, alternatives meals are Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 12 available for the resident that wish something different to that on the menu and a record is kept of food provided to residents. Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 The staff monitors the residents health to ensure that they receive appropriate treatment and support to promote good health. EVIDENCE: The residents at Besford House currently do not require any assistance with moving and handling. The permanent residents require minimal assistance with personal care from the care staff. Staff at the care home would accompany the resident to outpatient clinic and visit to their GP. The permanent residents files show that they access regular health reviews from their GP, dentist, optician and chiropodist. Since, the last inspection the home has changed from using a monitored dosage system to administering medication from bottles and packets. This has resulted in all medication have to be handwritten on the residents medication records. The pro-forma used currently for the recording of service user medication administered does not enable residents’ medication to be checked easily. The registered manager must review the existing system of recording the resident medication and ensure that the system complies with the Royal Pharmaceutical Society guidelines. Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The home has a complaint and other procedures to protect the residents. EVIDENCE: The home has a complaints procedure and staff support and encourage the residents, to raise any concerns that they have either informally through discussion with the registered manager or formally by putting it in writing. The permanent staff at the care home have received training on the Protection of Vulnerable Adults and managing challenging behaviour. Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,27,30 The home has undergone significant refurbishment over the past year to improve the physical environment for the residents. EVIDENCE: All parts of the home are easily accessible to all of the residents. The homey, the home was clean throughout. The communal areas can be used for different activities and are bright and well lit by natural light. Some of the armchairs in the sitting rooms were recently replaced. The manager must carry out a detailed risk assessment of the all the bungalows to ensure that risks are minimised through environmental risk assessment, with particular reference to the kitchen areas. Some of the bedrooms are very personalised with the residents belongings such as music centres, televisions etc. Small electrical appliance tests are carried out on electrical appliances in the home. The home in the last year has had a new assisted bath and walk in shower installed to promote the safety of the residents and provide choice in bathing facility. The laundry facility is located in the kitchen to promote a domestic environment for the residents. However, the registered manager must ensure that risk assessments are in place to prevent the spread of infection and Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 16 appropriate procedures are in place for the washing of soiled laundry. The home has policies and procedures in place for the control of infection. Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33 The staff at the care staff provided, to meet the needs of the residents do not have the necessary skills to provide quality care to the residents. EVIDENCE: Discussion with the manager on duty indicated that the home now only has two permanent carers working at the home and that agency staff has been used for sometime to cover the care staff rota. The management of Besford House requests that the same staff is sent to the home to ensure that the residents have some degree of consistency/continuity of care. Observation of agency staff interaction with the residents showed that they did not know how to deal effectively with a given situation and the manager who was on the bungalow at the time had to provide the necessary care and support for the resident. Discussion with the staff confirmed that they did not have the basic understanding of the needs of the residents’ i.e. promoting independence and their rights to choice. The latter was evidenced in presentation of teatime meal and lack of choice, even though the residents had the capacity to express their wishes. The staffing level in the bungalows is sufficient to ensure that staff have the necessary time to find out the residents wishes and to do uninterrupted work with the residents. Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 18 Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 40,41,42 The health and safety of the residents could be improved by ensuring that agency staff used having the necessary skills and training to meet the needs of the residents. EVIDENCE: Social Services policy department reviews the homes’ policies and procedures regularly and copies are forwarded to the care home. The homes policy and procedures are developed to protect the residents and staff and ensure the home is working in accordance with the relevant legislation. The residents’ records are kept securely and residents or their family could access their records in accordance with the home’s access to records policy. The registered manager must ensure that all agency working in the care home have the had training in food hygiene, moving and handling, infection control and are formally made aware of the home’s fire procedures. The home maintains records of weekly fire alarm tests; fire drills emergency lighting tests etc. and the home’s fire equipment are serviced regularly. The Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 20 home carries test the temperature of the hot water monthly at outlets used by the residents. Inspection of the daily records and entries in the accident book showed two occasions when a resident hit a member of staff. These incidents must be reported to Commission. Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 2 3 x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 x 2 2 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 3 3 x x 2 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 2 2 2 x x x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Besford House Score 2 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x 3 2 2 x DS0000035859.V253438.R01.S.doc Version 5.0 Page 22 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 15 Requirement The registered person must ensure that all service users have a service user plan showing how their assessed needs would be met and any risk identified how they would be minimised. The registered person must ensure that the staff working in the care home is suitably qualified, experienced and competent to meet the health and welfare of the service users. The registered person must ensure that the service user plan is developed with the service user, where possible. It must set out how the residents’ needs would be met. The registered person must ensure that all risks identified for service users are risk assessed and appropriate strategies are put in place to minimise the risk. The registered person must ensure that information relating specifically to service users are kept in their personal records. The registered person must ensure continuity of care of the residents to ensure that their DS0000035859.V253438.R01.S.doc Timescale for action 01/11/05 2 YA3 18 01/11/05 3 YA6 15 01/11/05 4 YA9 13 01/11/05 5 YA10 17 01/11/05 6 YA18 18 01/11/05 Besford House Version 5.0 Page 23 needs are met, 7 YA20 13 The registered person must ensure that an accurate record is kept of service users medication received into the care home, administered and returned to the pharmacist to ensure that an audit can be made of service user medication. The registered person must ensure that the risk assessments are carried out for all parts of the home to promote the safety 01/11/05of the service users. The registered person must ensure that policies are in place for the washing of soiled laundry. The registered person must ensure that the employment of any person on a temporary basis at the care home will not prevent service users from receiving such continuity of care as is reasonable to meet their needs. The registered person must ensure that staff employed in the home has qualifications suitable to the work that he is to perform, and the skills and experience for such work. The registered person must ensure that the residents receive continuity of care by ensuring that the home staff with the necessary skills and qualifications to meet the needs of the service users. The registered person must ensure confidentiality of service user information through only recording pertinent information about the service user in their personal records. The registered person must ensure that all staff have the necessary training to promote DS0000035859.V253438.R01.S.doc 01/11/05 6 YA24 13 01/11/05 7 YA30 13 01/11/05 8 YA31 18 01/11/05 9 YA32 19 01/11/05 10 YA33 18 01/11/05 11 YA41 17 01/11/05 12 YA42 13 01/11/05 Besford House Version 5.0 Page 24 13 YA31 37 the health and safety of the service users including agency staff. The registered person must 01/11/05 notify the Commission of any incident of physical aggression to service users or staff. 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 YA6 Good Practice Recommendations The registered person should review the home admission procedure for respite residents to ensure that the home has current information about the service user needs and where necessary amend the service user plan and risk assessment. The registered manager must ensure that choice of meals given to the service users is recorded. 2 YA17 Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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. Extracts may not be used or reproduced without the express permission of CSCI Besford House DS0000035859.V253438.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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