Inspection on 05/09/05 for Bethel Care Home

This inspection was carried out on 5th 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bethel Care Home 09/10/08

Bethel Care Home 12/10/06

Bethel Care Home 02/02/06

Bethel Care Home 08/03/05

Bethel Care Home 19/05/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Bethel 41 Tennyson Way Hornchurch Essex RM12 4BU Lead Inspector Gwen Lording Unannaounced Inspection 5 September 2005 10.30am th 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. Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Bethel Address 41 Tennyson Way, Hornchurch, Essex RM12 4BU 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) 01708 475300 Mrs Mary Afolabi Mrs Mary Afolabi CRH Care Home 3 Category(ies) of LD Learning disability 3 registration, with number of places Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 8 March 2005 Brief Description of the Service: Bethel is a care home providing accommodation and support for adults with a learning disability. The proprietor is also the registered manager of the home and also manages Beulah Lodge, the home next door. The home is situated in a quiet cul de sac in a residential area of Hornchurch. The area is close to public transport, local shopping area and other amenities. All three bedrooms are single and located upstairs. The home is friendly and operates as a family type home. The home is registered to accommodate up to three residents and at the time of the inspection there were two female residents and one vacancy. Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day, commenced at 10.30am and lasted three and a half hours. The inspector spoke to one resident at length and was able to communicate with the other resident with the assistance of staff. Discussion took place with the senior carer who was in charge of the home on the day of the visit and one other carer. A tour of the home was made and a number of care records and related documentation was looked at. The Inspector would like to thank the residents and staff for their input during the visit. What the service does well: What has improved since the last inspection? What they could do better: Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 Page 6 The home must make more suitable sleeping arrangements for the member of staff on ‘sleep in’ duty at night. The decoration and general maintenance in some areas of the home need to improve to make the home more comfortable and safe for residents. The manager must review the home’s policies on managing and supporting residents with their finances to provide safeguards for both residents and staff. 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. Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 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 Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 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 and 3 The Statement of Purpose and Service User Guide must be amended to more accurately describe the communal facilities and the philosophy of the home. Prospective residents will then have the information they need to make an informed choice about whether they wish to live in the home. The assessments completed by the home and the information and reports received from other health and social care professionals means that staff have detailed information to enable them to determine whether or not the home can meet a prospective resident’s needs. EVIDENCE: The philosophy of care in the home is based on Christian principles and has close links with a local church of which the proprietor/ manager is ordained as a minister. Residents are supported to attend the Church if they wish, but this remains their choice and is respected by the home. However, the home will accept residents from other faiths and will support them fully in attending their individual preferred place of worship. This information should be included in the home’s Statement of Purpose and Service User Guide. The description in the Service User Guide of the communal facilities available to residents lists two lounges, a dining area and a visitor’s room. However, there is only one large through lounge, which includes a dining area, and this Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 Page 9 lounge can also be used to receive visitors. This description may be misleading to prospective residents and should be amended accordingly with specific detail of the communal facilities currently being provided. One of the residents has been living in the home for two years and the other resident for four years. The files of these two residents were examined and were found to contain a detailed assessment that had been undertaken prior to their admission to the home. The home had also received an assessment and care plan from the referring agency including involvement with the resident and her mother. Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 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 standard(s) 6, 7, 8 and 9 Care plans are detailed and provide staff with the information they need to satisfactorily identify and meet resident’s personal, social support and health care needs. Staff provide residents with information, assistance and support to enable them to make decisions about their own lives. However, where a resident requires support with managing their finances this must be clearly documented in their care plan. EVIDENCE: Each resident has an individual plan of care and the care plans of both residents in the home were examined. The care plans cover in sufficient detail all aspects of personal, social support and health care needs of the individual resident. Care plans were being evaluated and regularly reviewed and updated accordingly to reflect changing needs. Reviews are held and involve the resident, their relatives/ representatives and Care Management. The outcome of reviews is recorded and maintained on file. Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 Page 11 Residents require varying degrees of support with their finances. Where support is needed, the reasons for, and the manner of support must be clearly documented in the individual’s care plan and regularly reviewed. House meetings are held regularly and issues discussed and agreed are minuted. The home is friendly and is run as a ‘family’ home. Meals activities, house routines and house issues are discussed on a daily basis and all members of the home are fully involved. The daily routine is adapted dependant on the movements and preferences of individuals. Staff were observed providing residents with information, assistance and support and were respectful of their right to make decisions. Information is displayed in the lounge about the advocacy service HavCare with a photo of the advocate who visits the home. Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 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 standard(s) 12, 13,14, 15 and 16 Opportunities for social and leisure pursuits and personal development are actively promoted and supported by staff for all residents to enable them to participate in the wider community in which they live. EVIDENCE: Each resident has an individual planned activity programme, which takes account of the resident’s preferences, interests, experiences, age and capabilities related to their disability. One resident attends a specialist day centre and participates in leisure/ social activities in the home and the wider community. The other resident is studying at a local college and is independently able to participate in leisure activities in the community. On the day of the visit this resident was planning a trip to a cinema nearby. Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 Page 13 The staff prepare and cook the meals with some involvement from the residents and staff know what each person likes to eat. One resident said that she enjoyed the food and that the staff cooked “good food”. None of the residents have special religious dietary requirement but one resident requires a diabetic and low cholesterol diet. The proprietor/ manager has a professional interest in nutrition and promotes health eating as well as ensuring that the residents have culturally appropriate foods to eat. Residents are supported to maintain and establish family links and friendships inside and outside the home. One resident enjoys regular visits home to her mother and visits by family and friends to the home are encouraged and welcomed. Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 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 standard(s) 18, 19 and 20. The residents physical and emotional care needs are closely monitored and this ensures that resident’s needs are recognised and met. The medication policies and procedures are clear and staff have received training to ensure the safe administration of medication to residents. EVIDENCE: Both of the care plans examined recorded referrals to specialist health care professionals and that appointment were being kept. Records indicated that residents attend routine health screening and are seen by dentists, opticians and GP’s. One resident has diabetes, which is controlled by oral medication and diet. She does not like to have her blood sugar monitored and was frequently refusing. She now has regular appointments with the diabetic nurse and attends the local hospital every three months for blood tests. This management of her diabetes is fully documented in her care plan. There are policies and procedures for the handling and recording of medication. Only one resident has prescribed medication and the home uses a monitored dosage system (blister pack). The medicines and associated records were checked and found to be in good order. Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 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 and 23 The manager and staff make every effort to sort out any problems or concerns and make sure that residents feel confident that their complaints and concerns are listened to and will be acted upon. Some staff in the home have received training in Adult Protection/ Abuse Awareness. However, this training must be extended to include all staff working in the home to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a policy and procedure for dealing with complaints and this has also been produced in a pictorial format that is more easily accessible to this resident group. One resident spoken to about what she would do if she was unhappy with anything said she would: “Tell Pastor Mary (the proprietor/ manager) or my keyworker”. There is a written policy and procedure for dealing with allegations of abuse and whistle blowing. Some staff have received training in Adult Protection/ Abuse Awareness but this has not been extended to all staff working in the home as required in the last inspection. This requirement has been repeated in the report and must be complied with by the new timescale. Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 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 and 28 Limited improvements to the décor, furnishings and fittings have been made since the last inspection. The outstanding matters do not provide people living in the home with safe, comfortable surroundings. EVIDENCE: A requirement was made at the last inspection for the registered person to ensure that all areas of the home to be well maintained. Little progress has been made and this requirement has been repeated and must be complied with by the new timescale. A number of other areas require attention and these and the matters outstanding from the last inspection are detailed below: • Bedroom One: Peeling wallpaper, sliding wardrobe door broken, curtains partly hanging off curtain track and paint peeling off window frames. This does not provide the resident with comfortable or safe private facilities and all repairs must be undertaken with undue delay. Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 Page 17 • • Bedroom Two: Broken frame on wicker chair. This needs to be repaired or ideally replaced. Upstairs Bathroom: Metal rack and metal mirror showing signs of rust. Shower curtain missing. Shower spray can only be used as hand held as the bracket on the wall is broken. Broken wall tiles behind toilet. This not only creates a shoddy appearance but is not safe, adequate or appropriate for the needs of the residents. These items must be repaired or ideally replaced. Downstairs Shower Room/ Toilet: Evidence seen of mould and damp on walls, tiles and shower curtain. There is a strong smell of damp in this room and does not provide an appropriate or adequate facility for residents to use. Carpet on the stairs is very worn in places. This not only looks unsightly but will become a trip hazard in the near future. This carpeting must be repaired or ideally replaced. • • The sleeping facilities and arrangements for staff when sleeping in must be reviewed to ensure that any arrangements are adequate and safe for staff to use; and do not impinge on the residents use of communal areas of the home. Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 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) 33 and 36 Staffing levels are satisfactory and there is sufficient staff on duty to meet the individual needs of the residents. EVIDENCE: The home has a small, but relatively stable workforce and in discussion with staff it was evident that they understand and fully support the main aims and values of the home. There is always at least one member of staff on duty at all times during the day and in the evenings and one member of staff on sleeping in duty at night. The member of staff spoken to said that she has formal supervision approximately every two months. She has also completed supervision training so that as a senior carer she has the skills to supervise other care staff. Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 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 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 and 42 The overall management of the home is satisfactory but the lack of progress in addressing the outstanding maintenance issues from the last inspection means that people living in the home are not provided with safe and comfortable surroundings. EVIDENCE: The registered manager was not on duty on the day of the visit. Therefore the inspector was unable to discuss the lack of progress around the maintenance issues outstanding from the last inspection. The home is not being well maintained and does not provide a safe environment for residents and staff. A requirement was made at the last inspection for the registered provider to ensure that all parts of the home and any activities in which the residents participate are risk assessed, and that the appropriate controls are put into place so that unnecessary risks are eliminated or hazards minimised. This requirement has been repeated in this report and must be complied with by the new timescale. Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 Page 20 A range of records were looked at, including fire safety and accident/ incident records. Work on the installation of a fire protection/ alarm system is being progressed and is scheduled for completion by the end of the month (September). The registered provider must inform the Commission in writing when this work has been completed. Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 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 2 3 3 x x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 2 2 2 x x Standard No 11 12 13 14 15 16 17 x 3 3 3 3 x x Standard No 31 32 33 34 35 36 Score x x 3 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bethel Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 x x x x 2 x G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 23 Regulation 13 Requirement The registered person must ensure that all staff receive training in adult protection/ abuse awareness (Timescale of 19/06/04 and 31/05/05 not met) The registered person must ensure that adequate precautions against the risk of fire are taken as required by the Fire Authority. The registered person must ensure that the home is well maintained. Broken furniture and fittings must be repaired or ideally replaced and walls must be kept reasonably decorated (Timescale of 31/07/05 not met) The registered person must ensure that all parts of the home and any activities in which the residents participate are risk assessed, and that appropriate controls are put into place so that unnecessary risks are eliminated or hazards minimised.(Timescale of 31/06/05 not met) The Statement of Purpose and Service User Guide must be amended to more accurately describe the communal facilities Timescale for action 31/10/05 2. 42 23 3. 24, 26, 27 and 37 23 30/09/05 Timescale made at last inspection 31/10/05 4. 42 13 31/10/05 5. 1 4&5 31/10/05 Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 Page 23 and the philosophy of the home. 6. 6&7 15 Where a resident requires support with their finances, the reasons for, and the manner of support must be clearly recorded in the individuals care plan and regularly reviewed. The sleeping facilities and arrangements for staff when sleeping in must be reviewed to ensure that any arrangements are adequate and safe for staff to use; and do not impinge on the residents use of communal areas of the home. 31/10/05 7. 28 23 (3) 31/10/05 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 Good Practice Recommendations Bethel G55 S0000027882 Bethel V247678 050905 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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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