Inspection on 10/08/05 for Bethany

This inspection was carried out on 10th August 2005.

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

Other inspections for this house

Bethany 21/09/07

Bethany 11/12/06

Bethany 01/02/06

Bethany 24/02/05

Bethany 04/10/04

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

CARE HOME ADULTS 18-65 Bethany 190 Hawthorn Road Bognor Regis West Sussex PO21 2UX Lead Inspector Mrs A Taggart Announced Wednesday, 10 August 2005, 1pm The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bethany Address 190 Hawthorn Road, Bognor Regis, West Sussex, PO21 2UX. Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01243 866260 LArche Organisation Post Vacant CRH(PC)-Care home only 5 Category(ies) of LD(E) - Learning disability over 65, 1 place registration, with number of places LD-Learning disability - 5 places Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 5 persons in the category LD (persons aged 18-65) and one person in the LD/E category (person over the age of 65) with a learning disability. Date of last inspection 25/2/05 Brief Description of the Service: Bethany is registered as a care home providing personal care for a maximum of five adults with learning disabilities. The property is a detached house situated in a residential area on the outskirts of Bognor Regis. The accommodation for service users is arranged on two floors and included five single bedrooms two on the ground floor and three on the first floor. The lounge, kitchen,quiet area, conservatory and laundry are located on the ground floor. The third floor of the house is used for living-in staff. Bethany is one of three homes operated locally by LArche, a voluntary organisation. The Responsible Individual is Mr. Chris Bemrose and the registered Managers post is currently vacant. Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out at 1pm to ensure residents in the home would be present during the visit. The visit lasted for 3.5 hours during which a tour of the building was undertaken and all resident’s bedrooms were seen. Four care plans were read with identified issues tracked and five staff files were seen. Residents in the home were out attending day care facilities, the inspector spent time talking to three people on their return. Records including health and safety, maintenance and staff training were seen, including risk assessments and residents finances. Prior to the inspection the last two reports were read, as was any correspondence or documentation relating to the service. A preinspection questionnaire had been completed by the home and this document was used to provide additional information to inform the visit. Six relative/visitors comment cards were received prior to the visit and all made positive comments about the home. The Responsible Individual Chris Bemrose was present in the home and the acting manager Ben Stockdale assisted with the visit. After discussion with the acting manager and people living in the home, the term “residents” has been used throughout the report. What the service does well: Residents say they are happy and that they enjoy living in the home. The home offers a comfortable and homely environment for the people who live there. There are a large variety of day care facilities and activities available and residents are encouraged to be as independent as possible. The people living in the home are well integrated into the local community and are supported in developing relationships. The staff team at the home are kind and caring and have developed good relationships with the people they support. Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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. Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 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 standard(s) 1 2 3 4 5 6 There is sufficient information available for prospective residents and their families to make a choice about whether they would like to live in the home. Comprehensive assessments are undertaken and visits to the home encouraged. EVIDENCE: There is a corporate Statement of Purpose and Service User Guide available, setting out the aims of the L’Arche community and detailing the facilities available. The document is individualised by each home in respect of staffing and specific services and the Service User Guide is also available in an accessible format using words and symbols. When a prospective new resident is identified a comprehensive assessment procedure is undertaken to ensure that the home can meet the needs of each individual. Wherever possible families and other care professionals are involved in the process and in order to ensure compatibility with other residents, visits to the home for a meal or short stay are encouraged. Each resident receives a contract setting out the mandate of the organisation and the terms and conditions of occupancy. The contract is signed by the resident or their representative. Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 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 standard(s) 6 7 8 9 10 There is sufficient information available to ensure that staff members are informed of the care needs of each resident. Risk assessments are undertaken and information is appropriately stored. EVIDENCE: Comprehensive care plans are in place to advise staff members about the specific support needs of each resident. The plans include information on personal care needs, food and diet, communication, sexuality and finance. Personal goals and aspirations are also recorded. Risk assessments are in place covering mobility, independence and environmental risks. There is clear evidence that residents are encouraged to be as independent as possible and one resident said that they went to the local shops and church without staff support. Residents also help with tasks around the house and are supported to wash their own laundry. Care plans are reviewed on a regular basis with a full annual review undertaken involving families and other care professionals or advocates. Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 Page 10 Care plans and personal records are stored in a locked file in the home’s office. At present the care plans are held as part of a much larger file containing comprehensive information and documentation regarding each resident. It was suggested that the care plans were stored in such a manner as to make them easily accessible to staff and easier to review. At the present time there are no person centred plans in place for residents, the acting manager said that there was a plan in place to implement these in the near future. Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 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 standard(s) 11 12 13 14 15 16 17 The people living in the home are supported to follow individual lifestyles and are given opportunities to use community facilities and develop friendships and relationships. EVIDENCE: There are a wide variety of activities available to residents including day-care facilities, college, clubs and groups and there is also easy access to facilities in the local community. The ethos of L’Arche is one of community and residents are encouraged to meet and socialise with residents and staff living in the other homes. There are regular community meeting where residents are encouraged to participate in the development of the organisation and weekly house meetings are held to discuss issues and identify wishes and aspirations. One resident said “It’s good living here, I make my own sandwiches, go to the shop on my own and I like the community morning”. Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 Page 12 Another person said, “I like it here, I went to London to see Joseph and I have made posters and completed a project on Egypt which is displayed in the workshop”. Annual holidays are organised either with resident’s families or other community members. L’Arche is a Christian community where there is an emphasis on worship and spiritual development. Records show that people are supported to attend inhouse worship or churches of their choice. People are also free not to attend should they wish to make that choice. The care plans contain information regarding supporting residents through personal relationships and sexuality issues and contact with families and friends, is encouraged. There are telephones available on the first and second floors of the home and residents can make phone calls in private. A variety of food available and menus are discussed and agreed at the weekly house meeting. If they choose to do so, residents are involved in the cooking in the home and the kitchen has pictures in place on cupboard doors to assist residents in using equipment and implements. The acting manager said that there was a plan in place to develop a pictorial menu book using photographs and pictures in order to assist people in making an informed choice. The home caters for vegetarian meals and one person requires a gluten free diet. One person was seen making their own packed lunch for the next day and personal files showed evidence of residents being involved on the purchase of food. A discussion was held with the acting manager in response to an incident form which detailed actions taken, when a resident displayed what was perceived to be “difficult behaviour” during mealtimes. It is recommended that behaviour management plans be reviewed with relevant professionals, in order to ensure that appropriate responses to behaviours are carried out by all staff members. Discussions should also be held with staff around flexibility for residents at mealtimes. Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 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 standard(s) 18 19 20 21 The health and personal care needs of each resident is assessed and recorded in the care plan. Medication is appropriately stored and administered and specialist health needs are met. EVIDENCE: Personal support needs are recorded in the care plans and residents are encouraged to be as independent as possible. There is evidence of input from a variety of healthcare professionals including speech and language therapists and the community learning disability team. Residents said that they were able to see their doctor at the local medical centre and also said that they have regular access to a dentist and chiropodist. The emotional wellbeing of residents is also assessed and there are behaviour plans in place with people having access to psychiatrists and psychologists where necessary. The home has an agreement with a local pharmacist and a monitored dose system is used. Staff members who administer medication receive the relevant training. The storage and recording of medication was found to be in good order. If possible people can stay in the home until the end if their lives but should a Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 Page 14 resident need nursing or specialist care, a case conference would be held to agree where this would best be accessed. Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 23 The residents of the home feel that their views are listened to and acted upon. Complaints are recorded and investigated and staff receive training in protecting vulnerable adult from abuse. EVIDENCE: The home has a complaints procedure a copy of which is included in the Statement of Purpose and Service User Guide. The document is also produced in an accessible format using words and symbols and a copy is posted on the notice board. In the past six months one complaint has been recorded and has been appropriately investigated by the acting manager. Informal complaints or ”grumbles” are recorded in the care plans or discussed at the weekly house meetings. The residents in the home said they felt happy about discussing their problems with staff members and felt that they would be taken seriously. The home has a copy of the West Sussex Adult Abuse policy and staff members attend the relevant training. The organisation also has a “whistle blowing” policy which staff members are made aware of during induction. The members of staff on duty at the time of the visit were aware of their responsibilities, should they suspect an abuse has occurred. Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 25 26 27 28 29 30 Communal areas of the house are comfortable and homely but there are still outstanding issues regarding the levels of hygiene and good work practice regarding resident’s private bedrooms. EVIDENCE: There is a lounge and an attractive conservatory- style dining room available and the kitchen is domestic in style. The home is furnished in a homely and comfortable manner with a large attractive garden to the rear. There is also a quiet area near the kitchen where residents said they enjoyed looking at the large fish aquarium, which has recently been purchased. The carpet in the lounge is very worn and the acting manager said it was due for renewal. The carpet in the hall in also very worn and was due to be replaced the day after the inspector’s visit. Each resident’s bedroom is personalised with pictures, posters and ornaments and all have and television and music systems. Despite a recommendation being made at the last visit the sinks in most resident’s rooms are still very dirty with layers of toothpaste and scale on the Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 Page 17 sinks and tile surrounds and in some rooms toothbrushes were dirty and thick with dried-on toothpaste. Some beds required clean bed linen and one duvet was very stained. Several bedroom carpets need shampooing, as they are stained and unhygienic. It is now a requirement that assessments are carried out to ensure residents are supported appropriately with cleaning tasks and bedrooms must be kept clean and hygienic to ensure infection control. For the most part toilets and bathrooms were clean but all toilets and sinks drains were very badly stained and lime-scaled, which is also a source of infection. The upstairs bathroom is in need of re-furbishment. The end of the bath panel is broken, tiles have mould between them and there is evidence of a longstanding leak behind the toilet, which is causing an unpleasant smell. The responsible individual said he would refer the problem to the landlord of the building immediately. A new assisted bath chair and electric power shower have been purchased for the downstairs bathroom in order to meet the changing needs of one resident and hand-rails and grab-rails are in place to aid mobility. Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 32 33 34 35 36 The people living in the home are supported by a committed and caring staff team. Recruitment procedures are robust and staff receive training relevant to their job description. EVIDENCE: The L’Arche ethos is one of community and staff members live in the residential homes, sharing lifestyles and opportunities for personal development with residents. The staffing structure of Bethany states that if there are three or more residents in the house at any time they must be supported by at least two staff members and this is sufficient numbers to meet the assessed needs of the current residents. People said the staff group supporting them are kind and caring and interactions were seen to be friendly and supportive. To ensure the protection of residents the L’Arche organisation practices a robust recruitment procedure and the four staff files seen at the visit contained all of the necessary documentation including CRB checks and references, records in the home show that staff members support residents with a variety of activities and interests and there is at present a stable staff group at the home. Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 Page 19 New staff members receive an induction programme in line with current guidelines during which time they undertake mandatory training including first aid, infection control and health and safety. Further training courses are also available such as challenging behaviour, abuse and neglect and medication. At the present time 50 of staff hold NVQ 2 and one person holds a first aid certificate. The staff on duty at the home confirmed that formal supervisions are in place and that sessions are recorded. The acting manager said he has a plan in place to carry out yearly appraisals. Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 38 40 41 42 43. The home is currently being run by a committed and caring acting manager but would benefit from the appointment of a registered manager. Policies and procedures are in place to ensure staff members receive guidelines and direction. EVIDENCE: The home is at present without a registered manager and is being run by an acting manager who has worked for the L’Arche organisation for a number of years. Staff members spoke highly of Mr. Stockdale and said he was approachable, hard working and committed to providing a caring environment for the people he supports. The responsible individual said that a review of the management structure of the organisation is underway and hopefully a decision will soon be made with regards to the designation of a new registered manager. Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 Page 21 There are a variety of forums for residents to make their feeling known including house meetings, monthly community mornings and annual meetings to update the house mandate. One resident receives support by an advocate and families say they are informed and involved in their relative’s care. Policies and procedures are regularly reviewed and updated and are introduced to new staff members at induction. Monies held on the service in respect of residents are securely stored and records and receipts for expenditure are kept on file. One record book and the corresponding cash were checked at the visit and were found to be correct. Records seen at the visit included fire, health and safety and risk assessments. Maintenance and service records including gas and electrical testing were seen and all were in good order. Providers visit reports are completed on a monthly basis and accident and incident forms are completed as necessary. To ensure that both residents and staff are protected from the risk of scalding, water temperatures should be recorded when monthly health and safety checks are carried out. The home is currently awaiting the arrival of a new insurance document and the acting manager said he would forward a copy to the inspector for reference. As previously stated in this report, to ensure the health and safety of residents, levels of cleanliness in the home should be increased and the leak repaired in the bathroom. Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 2 3 3 2 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bethany Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 2 2 3 H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA26 Regulation 16 Requirement Risk assessments should be completed to ensure residents in the home are provided with sufficient support to keep their rooms clean and hygenic (outstanding from the last inspection) Sinks and toilets should be descaled, the leak in the bathroom repaired and carpets cleaned to ensure that the home is clean and free from infection. Timescale for action 25th September 2005 2. YA30 16 25th september 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA6 YA7 YA27 Good Practice Recommendations Consideration should be given to storing thecare plans in a way that is easily accessible for staff. Behaviour plans should be reviewed to ensure staff members follow a consistant approach to challenging behaviour. Consideration should be given to the complete refurbishment of the first floor bathroom. Bethany H60-H11 S14397 Bethany V234784 090805 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 2nd Floor, Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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