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Inspection on 09/10/08 for Bethel Care Home

Also see our care home review for Bethel Care Home for more information

This inspection was carried out on 9th October 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Bethel Care Home 41-43 Tennyson Way Hornchurch Essex RM12 4BU two star good service The quality rating for this care home is: 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. Lead inspector: Jackie Date Date: 0 9 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Bethel Care Home 41-43 Tennyson Way Hornchurch Essex RM12 4BU 01708620985 01708475300 bethelcarehome@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Mary Modupeola Omeyele Afolabi Name of registered manager (if applicable) Mrs Mary Modupeola Omeyele Afolabi Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 6 0 care home 6 learning disability Additional conditions: That at all times there must be a minimum of one member of staff in each house. That the night staffing levels must be maintained at one member of staff sleeping in and one member of staff on waking night duty. Date of last inspection 1 2 1 0 2 0 0 6 A bit about the care home Bethel Care Home is a care home providing accommodation, personal care and support for adults with a learning disability. The service comprises of two adjacent houses and is registered to accommodate up to six residents, three in each house. At the time of the visit there were three female residents in house number 41, and three male residents in house number 43. The proprietor is also the registered manager of the home. It 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 six bedrooms are single and located both upstairs and downstairs. The home is friendly and operates as a family typehome. Residents are able to move freely during the day between both houses and join together for many activities. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home The last inspection of this service was on 12th October 2006. This inspection was unannounced and started at 10 a.m. It took place over seven hours. This was a key inspection and all of the key inspection standards were tested. Staff were asked about the care that people using the service receive and were also observed carrying out their duties. People using the service were asked to give their views on the service and their experience of living in the home. All of the shared areas and four of the bedrooms were seen. Staff, care and other records were checked. Feedback questionnaires were sent to staff, social workers and health care professionals. Feedback was received from for staff and one health care professional. Two relatives were contacted by telephone and they also provided feedback. The philosophy of care in the home is based on Christian principles and has close links with the local church of which the proprietor/manager is a minister. Services are now required to complete an AQAA (Annual Quality Assurance Assessment) and the completing the form was received in August 2008. Information provided in this document also formed part of the overall inspection. The fees for this service are from between 2099 pounds and 4800 pounds per month. This information was provided by the proprietor on the day of inspection. The inspector would like to thank the people living at Bethel and the staff for their input during inspection. What the care home does well There is a warm, relaxed atmosphere at the home, which is run as a family type home. The people that live there get on well together and are supported by staff that know them well and understand their needs. The routines of daily living and activities are flexible and varied to suit the differing needs of the people that live there, together with their religious, cultural and social preferences. People are supported to be a part of the local community. People living at the home are encouraged to express their views and opinions on these are valued and acted upon as far as possible. A relative said, my relative is comfortable and well cared for, I think that she is okay there. Another relative said, hes always clean and well dressed and not nervous at all. The health care professional said, staff appear very supportive, but allow the residents to express themselves. What has got better from the last inspection What the care home could do better Some of the medication records need to be a little better that people can be sure of getting their medication as safely as possible. Some of the finance records need to be a little better that people can be sure that their finances are robustly safeguarded. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Jackie Date Caledonia House 223 Pentonville Road London N1 9NG 020 7239 0330 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Standards 1, 2, 3 and 4 were tested. The Statement of Purpose and service user guide provides people with all 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 health and social care professionals means that staff have detailed information to enable them to determine whether or not the home can meet a persons needs Evidence: There is Statement of Purpose and Service Users Guide. The Service User Guide is user friendly and in a pictorial format to assist people to understand it. Each person had a copy of the guide in their bedroom. The most recent admission to the home was in 2006 and file of this person was examined. It contained a referral and assessment information from the placing authority and also an assessment had been carried out by the manager. The person had visited the home on several occasions before she decided to move in. The manager said that transition can be just a few hours or it can gradually build up over several visits. She also said that they have a party to welcome any new people to the home. Therefore the service obtains the necessary information about an individuals needs before they offer a service to them. Additionally people receive information that helps them to decide if they want to use the service. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live at Bethel are involved, as far as they are able, in developing and reviewing their care plans and these provide staff with the information they need to meet individual needs. Risk assessments are appropriate and people are supported to take risks according to their needs and to have the opportunity to try things and to develop the skills as safely as possible. People are encouraged and supported to be involved in decisions about what they do and what happens in the home. Their opinions are valued and listen to. Evidence: Standards 6, 7, 8, 9 and 10 were tested. Each person has a care plan and these contain information about them and the support that they need. The records of two people were case tracked. One person had signed her care plan, the other was not able to do this. Care plans are reviewed internally each month and any change or additions noted on a separate sheet. The original care plan is actually not altered which means that one would need to check all the additional sheets to see if there were any updates to the care plan. However people are supported by a small consistent group of staff who are fully aware of their needs, likes and dislikes. The manager said that they are going to redevelop the care plans as they do need to be more user-friendly. Daily notes contain details of how the person has been, what they have done and any other relevant points. There are also communication books which record one to one discussions with people. One of the Evidence: communication books seen had notes of discussions with the person about what she wanted to do. She had signed this and agreed that she would like to attend an 18 week supported employment course at a local college. Risk assessments are in place. These identify risks for people and indicate ways in which the risk can be reduced to enable people to be supported as safely as possible. The risk assessments seen were relevant to each individual. For example one person went to Nigeria last year to visit his family and there were risk assessments in relation to this trip. The service runs as a family type home and there was a very relaxed and friendly atmosphere. 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 pending on the movements and preferences of the individuals. House meetings are held fairly regularly and usually to discuss some of the bigger things. For example, holidays or Christmas celebrations. Peoples records and other information are stored in a locked cabinet in the office and staff are aware of issues of confidentiality. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are encouraged to be as independent as possible, to take part in activities and to be part of the local community. This exceeds minimum standards. People are supported to keep in contact with relatives and friends and visitors are made welcome at the home. People have meals that they have chosen, like and that meet their needs and preferences. Evidence: Standards 11, 12, 13, 14, 15, 16 and 17 were tested. All of the people living at this home attend a local church of which the manager is ordained as a minister. They all choose to do this and some are very actively involved. For example one person often plays the keyboard, another helps out in the childrens section and a third goes early on Sunday to help set things up. People are part of any social activities or celebrations at the church. They are also encouraged to support other people in the community. For example by doing some shopping for a neighbour and taking meals to other elderly neighbours. Some people have attended college courses in preparation for work and are now looking for jobs. One person has now got a job in a local charity shop. People can and do choose what they want to do during the day. On the day of inspection one person Evidence: was at a local Day Centre, one went to visit his mother, three went out together for the day and another person spent time at home. In discussions with people living at the home and from records it was evident that the people living there have a very busy social life and are supported to do what they want and what they enjoy as far as possible. People living at the home talked about holidays that they had been on and where they wanted to go in the future and were obviously involved in decisions about holidays. Last year one person was supported to go to Nigeria to visit his family. He said he was really happy to do this and would like to do it again in the future. Family and friends are always welcome to the home and one relative said everybody is very sociable. Families and friends are invited to celebrations and people are being supported to build links with their families. They are also supported to build relationships if this is what they want. There is not a set menu and people can choose what they want to eat. They are encouraged to eat healthily and this has helped some people to lose weight. None of the people living at the home have any special religious dietary requirements but some people have cultural preferences and as a result of this Caribbean and Nigerian food is cooked in addition to English food. One person needs to have a soft diet and this is provided. People said that they enjoy a take-away meal and usually have Chinese food on Friday nights. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service receive personal care that meets their needs and preferences and staff support them to get the health care that they need. People are given their prescribed medication safely. Evidence: Standards 18, 19 and 20 were tested. People using the service need different amounts of support with their personal care and information about this can be found in individual care plans. People are supported by staff that know them well and staff are aware of the amount of support that people need to maintain a good level of personal hygiene and also to maintain their independence. There is a mixed staff team and people are able to have same gender support with personal care. People using the service go to the local doctor and specialist help is received from the community learning disabilities team. Staff support people to all of their medical appointments. One health-care professional said staff appear very supportive, but allow the residents to express themselves. People have had checks from optician, dentist and when appropriate chiropodist. Records are kept of appointments and of the outcomes. People are supported to get the health care that they need and to be as healthy as possible. There are policies and procedures for the handling and recording of medication. Evidence: Medication is stored in a locked cabinet in the kitchen of one of the houses. None of the people living in the home are able to self medicate and medication is administered by staff that have received the necessary training. Medication records are kept and are up-to-date. Examination of the MAR (Medication Administration Record) found that these had been appropriately completed. There was a handwritten entry on the MAR (Medication Administration Record) and for accountability any handwritten entries made by staff must be endorsed with the date and signed initials or signature of that person. It is recommended that the medication file also contains a list of staff that are able to administer medication and a sample of their initials. This is good practice and helps to easily identify who has been responsible for administration of medication and when. This will help to ensure the people receive their prescribed medication as safely as possible. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at this home can be confident that they will be listened to if they are not happy about anything. People living at Bethel are safeguarded by the working practices and support of the staff team. Evidence: Standards 22 and 23 were tested. The home has clear policies and procedures for dealing with complaints or concerns. A user-friendly complaints procedure has been developed and is displayed in the home. Each person has a copy of this in their room. There have not been any recorded complaints in the last year. People spoken to said that they would talk to Pastor Mary (the manager/proprietor) if they were not happy about anything. There is a safeguarding adults policy and procedure and this tells staff the action they need to take in the event of abuse or suspected abuse being discovered. Staff spoken to were aware of the issues around safeguarding and of their responsibilities to the people living in the home. They had received safeguarding training. People living at the home need differing amounts of support with their finances. The manager is appointee for one person but other people have their own bank accounts and with staff support get cash when they need it. Records are kept of financial transactions and receipts obtained as far as possible. The cash held for two people was checked. One was correct and the other had too much cash. This was a slight discrepancy and the manager arranged for all of the cash held to be checked to sort this out. Although the manager said that she periodically checks the cash and records she does not sign them to indicate this. It recommended that whenever the manager checks residents cash she signs the record to confirm that this has been done. Bank statements are kept on file and the manager said that she does look at these when they arrive to check that there is no unusual expenditure. It is recommended that a Evidence: system be put in place to reconcile bank statements with records held at the home. This will offer additional safeguards for peoples finances. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People live in a clean and comfortable home that is suitable for their needs. Evidence: Standards 24, 25, 26, 27, 28, 29 and 30 were tested. The service consists of two adjoining houses that are registered as one home. There are two separate front doors but one of the fence panels has been removed from the rear garden so that people can and do come and go between each house. The lounge and dining areas of both houses are comfortable and appropriately decorated. Each person has a single room and these are appropriately decorated and furnished. They have all been personalised in different ways to reflect the interests and culture of the person. There are bathing and showering facilities suitable for the people who live there. This includes a bath chair to assist one person. There are no other adaptations to the building as the people living there do not need any. Since the last inspection the kitchens have been refurbished and parts of the home redecorated and recarpeted. Overall the environment was comfortable, homely and clean. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Staff receive the necessary training to meet peoples current needs and provide an appropriate service for them. Staffing levels allow for this. Staff have the opportunity collectively and individually to discuss their own development or any problems and developments within the service and feel supported by the manager. People using the service are supported and protected by the recruitment practices of the service. People living at the home are supported by consistent staff who know them well and who are committed to providing a good quality service. Evidence: Standards 31, 32, 33, 34, 35 and 36 were tested. The home is fully staffed and there is a small and stable staff team. Therefore people receive a consistent service from staff group that aware of their needs and how to meet them. The two houses are registered as one service and there are always at least two members of staff on duty. At night there is a waking member of staff on duty in one house and a sleep in staff in the other. Staff have job descriptions and are clear as to their individual roles in the home. Three staff have achieved NVQ level 3 in care and another is doing NVQ level 4 in care. Staff training records are kept and staff receive the training that they need to provide a service to the people living there. This includes food hygiene, moving and handling, safeguarding, epilepsy awareness and medication. In addition specific training is available to assist staff to meet specific needs of people living at Bethel. For example, a member of staff completed a short course in Afro-Caribbean haircare as one person Evidence: does not like to go to the hairdresser.. A random sample of staff records were checked during the inspection and they contained the required information to demonstrate that staff had been appropriately recruited. This included application forms, references, proof of identification and CRB checks. Staff receive regular supervision and annual appraisal. Staff meetings are held bimonthly. Staff therefore have an opportunity individually and collectively to discuss issues, concerns and the development of the service. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at Bethel benefit from a service that is well managed and where their opinions are sought and acted upon as far as possible. They live in a safe home. Evidence: Standards 37, 38, 39 and 42 were tested. The proprietor of the home is also the registered manager. She is appropriately qualified and experienced and demonstrates a clear understanding of the needs of the people living there. From discussions, records and observations on the day it was very evident that staff and the people living there are very involved in decisions about what happens at the home and that the manager listens to and values their input. The necessary health and safety checks are carried out and records are kept of these checks. These records were up to date and accurate. A safe environment is provided for the people living there. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 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 Description 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 Description Timescale for action 1 20 13 Any handwritten entries 28/11/2008 made by staff on MAR (Medication Administration Records) must be dated and signed by the person making the entry. For accountability and also to provide an audit trail. 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 20 It is recommended that the medication file also contains a list of staff that are able to administer medication and a sample of their initials. This is good practice and helps too easily identify who has been responsible for administration of medication and when. It is recommended that whenever the manager checks the cash held for each person that she signs the record. This will help to demonstrate peoples finances are safeguarded as much as possible. 2 23 3 23 It is recommended that a system be put in place to reconcile bank statements with records held at the home. This will be an additional safeguard for peoples finances. 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 © (2008) 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. - 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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