Inspection on 27/01/06 for Besford House

This inspection was carried out on 27th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 9 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 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 08/07/2008.

CARE HOME ADULTS 18-65 Besford House 19 Besford Road Liverpool L25 2XT Lead Inspector Leila Mavropoulou Unannounced Inspection 27th January 2006 12:30 Besford House DS0000035859.V281164.R01.S.doc Version 5.1 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.V281164.R01.S.doc Version 5.1 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.V281164.R01.S.doc Version 5.1 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.V281164.R01.S.doc Version 5.1 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 person with a learning disability is accommodated at the care home. 23rd September 2005 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.V281164.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that lasted four and half hours. During this time five service users were spoken to and three members of staff. Service user records and other records were inspected such as: fire records, staffing rota, etc. In addition, a tour of the building was carried out. What the service does well: What has improved since the last inspection? The system of administering medication has improved as the service has introduced a monitored dosage system. This allows staff to account more easily for service users prescribed medication. The registered manager has developed the service Statement of Purpose in a pictorial form, to make it easier for service users to understand its’ content. Besford House DS0000035859.V281164.R01.S.doc Version 5.1 Page 6 The registered person is obtaining information from the service user primary carer before each respite visit and is documenting changes in service users needs to promote their health and welfare. What they could do better: 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.V281164.R01.S.doc Version 5.1 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.V281164.R01.S.doc Version 5.1 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): 1,2,3,4 The registered manager would assess the needs of permanent service users to assess their suitability for the service. EVIDENCE: A Statement of Purpose is available showing the services and facilities offered at Besford House. The pictorial Statement of Purpose has been developed to make the information more accessible to service users. The registered manager should review the service Statement of Purpose to ensure it continues to reflect staff training/qualification and number of respite places offered. There has been no permanent admission for many years. However, the service admission procedure show that service users needs would be assessed by the suitably qualified person from the care home and that the assessment would be over a prolonged period to ensure that the service would be able to meet the service user needs. In recent months, the service has had a number of emergency admissions. The Care Management Assessment is forwarded to the home promptly. However, discussion with the registered manager indicated that some emergency admissions at the care home have been for a significant time. In recent months one service user placed as an emergency admission displayed inappropriate behaviour causing physical harm to staff, which was reported to the Commission. Two of the bungalows are used for respite care. An initial Care Management Assessment was completed for service users to access the service at Besford House and a copy of the assessment is kept at the care home. However, the Besford House DS0000035859.V281164.R01.S.doc Version 5.1 Page 9 registered manager should ensure that the home is represented in the review of service users care package and a copy of the review kept at the care home. Besford House DS0000035859.V281164.R01.S.doc Version 5.1 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 the following standard(s): 6,7,8,9,10 Service users plans showing how their needs would be met are reviewed regularly to ensure that the appropriate care and support is provided. EVIDENCE: The service user plans have been reviewed since the last inspection to show their current needs. Risk assessments and service user plans have been developed for service users on respite. Besford House staff contact the service user primary carer on the day of their admission for respite. This is to obtain information regarding any changes in service user needs and where necessary amend the service user plans and risk assessment accordingly. Service users make decision over their daily lives such as: what activities to participate in, whether to be on their own or in the group, choosing their holiday etc. The service users are supported to manage their finances with the support of staff as identified in their service user plan. A record is kept of incoming and outgoings of monies and the home is audited at regular intervals by Liverpool Social Services Finance Department. Besford House DS0000035859.V281164.R01.S.doc Version 5.1 Page 11 The service users are involved and made aware of changes at Besford House through the service user meeting, which is held monthly where they are supported by the staff to express their opinion. Service users 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 service user absence cannot be explained. The home has a policy on confidentiality of information and service users records are kept in a secure place. The registered person must ensure that all agency staff are aware of the service policy on confidentiality to promote the safety of service users. The recording of service users personal information has improved to promote service users right to privacy of information relating to them. Besford House DS0000035859.V281164.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14,15,16,17 Service users engage in a range of leisure/social activities to meet their individual needs with the support of staff. EVIDENCE: The service users engage in a wide range of activities to develop new skills and to fulfil their social needs. All of the permanent service users attend a day centre where they engage in various activities such as: cooking, flower arrangement, etc. Where necessary staff would support service users to access activities. The service has a range of transport facilities to enable service users to access community facilities such as: Dial a Ride, taxi, staff cars etc. Information about community activities is brought into the service by both service users and staff, which are displayed around the bungalows. The home is a short walk from local shops, pubs, restaurants, churches, etc. Other parts of the city are easily accessible by public transport, which passes outside the service. The service users have holidays, which are included in their weekly fees. Brochures are brought into the care home where service users are supported by staff to choose their holiday. Usually, the service user go abroad for a Besford House DS0000035859.V281164.R01.S.doc Version 5.1 Page 13 holiday, sometimes as a group or individually. Last year service users holidays were: - a Mediterranean Cruise, trip to Rhodes and Blackpool. Service users are supported to maintain and develop contact with friends and family. One of the permanent service users visit their parents for the weekend whilst others have regular visit at the care home. The service has an unrestricted visiting policy and service users are able to choose where to see their visitors. Service users rights to privacy is respected as evidence as all service users have a key to their bedroom and the manner in which service users are supported with personal care etc. Service users have access to all parts of the building. Service users are not responsible for household tasks. However, they assist care workers in maintaining certain parts of their bedroom such as: tidying drawers, book shelves etc. Mealtimes at the care home are flexible to meet the service user needs. A record is kept of all meals provided to service users. Discussion with the registered manager indicated that service users requiring special diet would be catered for. Besford House DS0000035859.V281164.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Service users health needs are being met. However, this could be improved through the employment of permanent staff to deliver service users care. EVIDENCE: Most of the service users do not require any assistance with moving and handling and require minimal support with personal care. However, where a service user on respite requires assistance with transferring suitable specialist aids are obtained from the district nurse. The registered manager informed the inspector that she has been assured by the agency that the temporary staff supplied have current moving and handling certificates. Discussion with service users, staff and entries in the service users daily records show that they choose when to go to bed and make decision over their daily living activities. Currently, the service is unable to provide a key worker system to service users because of the level of agency staff used at the care home. The staff monitor the health needs of the service users and ensure that they receive regular health checks from the dentist, chiropodist, optician and review of their medication by their GP. Staff would accompany service users to outpatient appointments. Service user medication is administered through a monitored dosage system and a record is kept of medication administered to service users. However, Besford House DS0000035859.V281164.R01.S.doc Version 5.1 Page 15 the registered person must ensure that a record is kept of medication received into the care home. Currently, none of the service user administer their medication. However, discussion with the registered manager indicated that service user would be able to self-medicate following a risk assessment. Besford House DS0000035859.V281164.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The service has various policies and procedures in place to protect service users from all forms of abuse. However, with the level of agency staff used it is difficult for the management team of the service to assess the level of staff understanding of the policies on abuse. EVIDENCE: The service has a complaint procedure, which is displayed in a prominent position. The procedure outlines how complaints would be resolved and the timescale for the completing the investigation. There has been no complaint since the last inspection. The service has various policies and procedures in place for the protection of vulnerable adults. The service uses a high percentage of agency staff to deliver care to service users. Thus, the management of the home is unable to evaluate the level of staff knowledge and understanding abuse either through the staff induction or one to one supervision, as agency staff currently does not receive individual supervision at the care home. The registered manager must ensure that the agency demonstrate that staff have an understanding/training on understanding abuse. Besford House DS0000035859.V281164.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,27,28,29,30 The home is well maintained both internally and externally. However, the two bungalows used for respite care communal areas could be improved to make it more homely. EVIDENCE: The bungalows are safe, comfortable and bright and all parts the bungalow and grounds are easily accessible to service users. The communal areas could be used for a variety of purposes. The furnishings in the bungalow used by the permanent service users reflect their taste and preferences. However, the two respite units are “plain”. Efforts should be made to make these bungalows more “welcoming” through pictures, bedding etc. All accommodation is provided in single bedrooms and are furnished to meet the needs of the service users. The bedroom doors have suitable locks to promote service users privacy whilst maintaining their safety. Some of the permanent service users have purchased their bedroom furniture to personalise their bedroom. The bungalow has the required number of toilets and bathroom for the number of service users. These are located close to communal areas and service users bedrooms. Each bungalow has an assisted bath and a call system in service user bedroom. Besford House DS0000035859.V281164.R01.S.doc Version 5.1 Page 18 The domestic washing machine is in the kitchen and policies and procedures are in place to minimise the spread of infection. Besford House DS0000035859.V281164.R01.S.doc Version 5.1 Page 19 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): 33,34,35,36 The service must employ permanent staff to provide continuity of care to service users to improve the quality of care provided Besford House. EVIDENCE: Service users care is being delivered primarily by agency staff. There are only three permanent staff out of a staff group of twenty-five. The registered manager tries to ensure that the same agency staff is sent to the home to provide some level of continuity of care to service users, which cannot be guaranteed. The staffing level is flexible to meet the changing needs of the service users as observed during the inspection. One service user returned to Besford House early from the day centre and additional hours were worked by an agency staff to care/observe the service user. The recruitment of permanent staff is robust to promote the safety of service users as two written references are obtained and a Criminal Record Bureau check is obtained before the employee is able to commence their employment at the care home. The permanent staff have attended the following training recently: managing physical and verbal aggression, fire awareness, learning disability training and two of the management team are following the Post Qualifying Social Work Award. The registered manager has one-to-one supervision with the permanent staff. The last team meeting was in December 2005. Currently, the registered manager does not provide individual supervision to agency staff. The Besford House DS0000035859.V281164.R01.S.doc Version 5.1 Page 20 registered manager should implement a system of monitoring the performance of agency that are work at the care home regularly. Besford House DS0000035859.V281164.R01.S.doc Version 5.1 Page 21 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): 37,39,40,41,42 The level of permanent staff does not facilitate the registered manager to implement effect change at Besford House, to improve the quality of care given to service users. EVIDENCE: The registered manager of Besford House has many years experience of working with this service user group. She has good rapport with service users and staff. Observation and discussion with service users and staff showed that she is accessible and willing to incorporate the views of other stakeholders to improve the quality of care provided at Besford House. The registered manager has not implemented the service quality assurance system, to demonstrate the continuing improvement in care provided at Besford House. In addition, the Responsible Person monthly visit report is not being forwarded to the Commission. The homes policies and procedures are developed by Social Services central policy unit and distributed to the various services. They are review regularly to reflect changes in legislation and best practices. Service users records are well maintained and kept in a secure place. Besford House DS0000035859.V281164.R01.S.doc Version 5.1 Page 22 The health and safety of service users and staff are promoted through regular checks and maintenance of the building and equipment used at the care home. However, the safety of service users could be improved through permanent staff being employed at Besford House, as the care home would be directly responsible for all staff training. The registered manager maintains a record of all incident/accidents at the care home and the Commission is informed of all significant incidents to service users and staff. This is evidence in the number of incidents report received by the Commission. There is a current Public Liability Insurance and there are clear lines of accountability with external management. Records are kept all expenditure at the care home. Besford House DS0000035859.V281164.R01.S.doc Version 5.1 Page 23 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 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 2 32 2 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 1 3 3 2 3 Besford House DS0000035859.V281164.R01.S.doc Version 5.1 Page 24 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA10 Regulation 18 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 provide continuity of care to ensure that service users needs are met. The registered person must confirm with the agency that staff have a current moving and handling certificate. Timescale for action 30/03/06 2. YA18 18 30/03/06 3. YA20 13 4. YA23 13 5. YA31 18 The registered person must 30/03/06 ensure that an accurate record is kept of service users medication received into the care home. The registered person must 30/03/06 ensure that all staff working at the care home receive training in the management of physical and verbal aggression. The registered person must 30/03/06 ensure that the employment of any person on a temporary basis at the care home will not prevent DS0000035859.V281164.R01.S.doc Version 5.1 Page 25 Besford House service users from receiving such continuity of care as is reasonable to meet their needs. 6. YA32 19 The registered person must 30/03/06 ensure that staff employed in the care 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 service users receive continuity of care, by ensuring that staff have the necessary skills and qualifications to meet the needs of the service users. The registered person must ensure that the care home develop a system to monitor the continual improvement in the quality of care provided to service users. The registered person must ensure that their monthly visit report is forwarded to the Commission. The registered person must ensure that all staff have the necessary training to promote the health and safety of the service users including agency staff. 30/03/06 7. YA33 18 8. YA39 24 & 26 30/03/06 9. YA42 13 30/03/06 Besford House DS0000035859.V281164.R01.S.doc Version 5.1 Page 26 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 YA1 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 person must ensure that agency staff are aware of the service policy on confidentiality of information. The registered person should implement a key-worker system to meet all of the requirements of this standard. The registered person should implement a key-worker system to meet all of the requirements of this standard. 2. 3 4 YA10 YA18 YA36 Besford House DS0000035859.V281164.R01.S.doc Version 5.1 Page 27 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.V281164.R01.S.doc Version 5.1 Page 28 - 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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