Inspection on 05/11/08 for Bethany Lodge

This inspection was carried out on 5th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bethany Lodge 15/07/08

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Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Random inspection report Care homes for adults (18-65 years) Name: Address: Bethany Lodge 222 Malvern Road Worcester WR2 4PA The quality rating for this care home is: The rating was made on: zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jean Littler Date: 0 5 1 1 2 0 0 8 Information about the care home Name of care home: Address: Bethany Lodge 222 Malvern Road Worcester WR2 4PA 01905420088 01905420402 manager.bethanylodge@tracscare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: TRACS LTD care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability 8 Over 65 0 Conditions of registration: The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disabilities (LD) 8 The maximum number of serivce users to be accommodated is 8 Date of last inspection Brief description of the care home Bethany Lodge was registered by the Commission (CSCI) on 16 April 2004. In April 06 the service was purchased by the Tracscare Group who own a number of residential care homes in England and Wales. The group continued to operate the service under the company Bethany Lodge Ltd. but introduced Tracscare policies and procedures. The company registered with the Commission later changed from Bethany Lodge Ltd to Tracscare Group Ltd. in March 2008. The house is situated on the outskirts of Worcester on a main road in a residential area. It is close to all the facilities in Worcester city and close to link roads to other towns in the region. The service provides residential, personal and social care for up to eight younger adults who have Care Homes for Adults (18-65 years) Page 2 of 10 a learning disability with a primary diagnosis of Autistic Spectrum Disorder. All but one of the bedrooms are on the first floor, which is accessed by the stairs, so the majority of service users must be able to use the stairs. Each person has their own single ensuite bedroom. On the ground floor there is a lounge, a dining room, kitchen, sensory room, jacuzzi, small laundry and a private garden. The company have information about the Home that can be sent out to interested parties and there is also a web site. A copy of the Service User?s Guide could not be found in the Home so the current fees and additional charges could not be established. It was not established if the fees are included in the Guide and therefore available to the public as required by the regulations. Care Homes for Adults (18-65 years) Page 3 of 10 What we found: The purpose of the inspection was to see if the ten requirements made at the key inspection in July this year had been met. To establish this we observed how staff were supporting the people living in the home, looked at care and staffing records and spoke with the manager, deputy and some of the staff. We found that significant progress had been made in the majority of areas. It was not possible to judge if assessment and admission procedures have been improved as no new people have moved into the home. The manager has not submitted an application to us, the Commission, to be registered. These two requirements therefore remain. No new people have been admitted so it was not possible to assess the requirement about assessment and admission procedures. Two people are moving out of the service next week and the manager reported that she will be given time by the owners to recruit and train more staff and consolidate the management arrangements before admitting anyone new. The rota for the last two months showed that providing adequate staffing cover had been difficult. The recording on the rota was unclear and it took time to establish that at least five staff had been provided when all the residents were at home. Waking night staff are now being provided and the practice of two day staff sleeping in has been stopped. Care staff reported that staffing levels are much improved and that agency staff are filling the gaps that the team cannot cover. Concern was raised that the deputy is counted in the numbers on shift but then does not want to be included on the shift planner and spends a significant part of the shift in the office. There is currently one senior, grade 3, who supports the manager and deputy. The manager has been given permission to recruit another senior. To address the lack of experienced staff to lead shifts four of the care staff that have been taking on this responsibility have recently been promoted from grade 1 to grade 2. Supervision sessions have been held recently and staff meetings are being held each month. Some feedback indicated that staff being asked to shift lead felt they could be better supported and did not feel particularly valued by the Company. Staff meeting minutes should be more comprehensive so they are useful to staff who were not able to attend and provide a clear record of team decisions about how best to support the residents. The manager reported that all care plans and risk assessments have now been completed. This was achieved with help from other people in the organisation. The two sampled contained the relevant information and confirmed that a lot of work had gone into bringing these essential documents up to date. They had been reviewed each month since being developed. Staff said they had read the plans and found them accurate and useful. They felt the team have been working more consistently and this is having positive outcomes for the residents. Daily records and charts are being completed. This information is not currently being formally reviewed and summarised each month before it is filed. This is recommended to ensure peoples needs and support strategies are closely monitored. Behaviour strategy plans have been Care Homes for Adults (18-65 years) Page 4 of 10 completed for all but two of the residents. The Companys behaviour therapist and nurse have been supporting the service and there is evidence that their recommended strategies are being taken into consideration when shifts are being planned. Staff are being designated to support specific residents in the two communal areas of the house where they prefer to spend their time. One resident is being closely supervised after injuring other residents several times in recent months. Staff failed to monitor this person effectively during the lunchtime meal and an incident could have occurred without staff being present. The manager seemed unconcerned about this and felt that staff needed to gel more before communication between them improved. Every effort needs to be made to safeguard people while this resident is supported to become less anxious. Incidents are being recorded and the majority have been appropriately reported to us as Regulation 37 notifications. The incident forms have not all been signed by the manager or deputy. This is recommended to show that they are being closely monitored. The manager and deputy reported that one man was no longer being locked out of his bedroom with the aim of encouraging him to socialise. Information about this new strategy could not be located in his care plan, however, staff confirmed that the practice had stopped some weeks ago and a brief note was seen in the previous months staff meeting minutes. Good efforts have been made to provide the staff team with essential training. Courses have been planned for the next two months and the management team are aware of the courses each worker needs to attend. New staff are being supported to complete the Companys induction programme and are being provided with shadow shifts and a mentor. The manager had not submitted an application to be registered. She was reminded that it is an offence to manage a care home without doing this. She agreed to make this a priority and submit it before the end of December. The owners need to take on their legal responsibilities and ensure this happens. What the care home does well: What they could do better: The way peoples needs and behaviours are monitored and reported upon could be further improved. Staff need to be more vigilant and aware of peoples behaviour patterns so violent incidents between residents are prevented. Staffing records need to be clearer to show that enough staff are provided each day. More staff need to be recruited so there is a full team and the use of agency staff can Care Homes for Adults (18-65 years) Page 5 of 10 end. The senior team needs to be expended so experienced and fully trained staff lead each shift. The staff team needs to be better supported through regular supervision, staff meetings and ongoing training. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 2 14 (1) (C) The registered person must 31/07/2008 not provide accommodation to a service user unless there has been appropriate consultation with the service user or their representative regarding the assessment and the ability of the home to meet their needs. Placements must be in peoples best interest and the needs of current service users considered. Care Homes for Adults (18-65 years) Page 7 of 10 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 37 8 The manager must submit an 31/12/2008 application to be registered with the Commission. To provide service users with the protection that registration provides. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 Daily records and charts should be formally reviewed and summarised each month to ensure peoples needs and support strategies are closely monitored. All incident forms should be signed by the manager or deputy to demonstrate that these are being closely monitored. The manager should ensure that residents are supervised in line with their risk assessments to help prevent people being harmed by others behaviour. If the manager or deputy are counted in baseline staffing levels then they should work with the residents during this time. If the management team are unsure of what incidents need to be reported to the Commission they should contact the lead inspector for advice. Page 8 of 10 2 23 3 23 4 33 5 38 Care Homes for Adults (18-65 years) 6 7 41 41 Keep clear staffing rotas and evidence of which residents were away staying with family. Staff meeting minutes should be more comprehensive so they accurately inform staff that were not able to attend and provide a clear record of team decisions about how best to support the residents. Care Homes for Adults (18-65 years) Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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