Inspection on 01/08/06 for Bethia Cottage

This inspection was carried out on 1st August 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bethia Cottage 30/07/07

Bethia Cottage 02/11/05

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Muston Road (70)

Grayling

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

CARE HOME ADULTS 18-65 Bethia Cottage Lelley Road Preston Hull East Yorkshire HU12 8TX Lead Inspector David Blackburn Key Unannounced Inspection 1st & 2nd August 2006 08:45 Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bethia Cottage Address Lelley Road Preston Hull East Yorkshire HU12 8TX 01709 375333 01709 721727 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Milbury Care Services Limited Mrs Karina Whitehead Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for 5 service users in category LD, some or all of whom may have a physical disability 2nd November 2005 Date of last inspection Brief Description of the Service: Bethia Cottage is a purpose built home situated on the outskirts of the small village of Preston some 6 miles from the city of Hull. There is no public transport service to or from the premises. The site offers two facilities Garfield Grange and Ashlyn a two-building respite service and Bethia Cottage for longer term placements. Bethia Cottage, opened in August 2005, gives permanent care to a maximum of five service users. The large detached building provides five single bedrooms, one with an en-suite facility. The service users in the other bedrooms share bathing and toilet facilites between two. There are sufficient communal areas and a large garden provided with outdoor seating. All service user facilities are on the ground floor. The small upper floor accommodation is used for staff purposes only. Specialist lifting, moving and safety equipment is provided as necessary. Bethia Cottage offers long term accommodation for adults with a learning disability and associated health and behavioural problems including some challenging behaviour. The staff seek to provide a holistic regime offering personal care, help, advice and guidance with daily living skills and activities, a catering service, a laundry service and domestic and cleaning services. Activities are offered both on and off site. The property is owned by Milbury Care Services who also provide the care input. Good support is offered by the local Community Learning Disability Team. A Statement of Purpose and Service User Guide are available in the home. A copy of this report will be included when published. The fee level advised at the time of inspection was around £1650 per week depending on assessed needs and level of care required. Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection on which this report is based was the first to be carried out in the inspection year 2006 to 2007. The site visit was carried out over two days with a total time at the home of eleven hours. This was complemented by a number of hours preparation time off site. The focus of the inspection was on the key standards. A number of bedrooms, communal areas and services, for example the laundry facilities and kitchen were inspected. An examination was made of some service users’ care records, the home’s policies and procedures and other documents, for example staff records. Conversations were held with a number of service users. None was able to enter into any meaningful discussion and generally gave one-word answers or made gestures. Discussions were undertaken with a number of relatives and visiting health care professionals either off site prior to the visit or at the time of the visit. All discussions were in confidence. A number of staff were spoken with throughout the time of the site visit. Some of these discussions were in confidence. Care managers, general medical practitioners and some relatives had been contacted for their views before the site visit. The comments and observations they made, together with those received during discussion, are included within the relevant sections of this report. What the service does well: Service users appeared happy and well cared for. Although the majority were unable to enter into discussion or only responded with one-word answers, they seemed relaxed and enjoyed a good rapport with staff. A visiting health care professional described the service as “an outstanding facility in terms of the premises and staff.” A visitor said “I feel the care is very good. I have noticed a number of improvements in my relative since admission.” A care planning system was in operation that could be followed and understood. The information on each service user showed their needs and how they would be met. Although all service users were unable to verbalise their wishes, choices and preferences, attention had been paid to the different forms of communication they used including gestures, facial expressions and sounds other than words. This meant some feedback was gained from service users and their agreement or otherwise given to any planned course of action. Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 6 A balanced and generally nutritious diet was offered with staff well aware of service users’ individual likes and dislikes. Specialist crockery and cutlery was readily available. Personal assistance was given quietly and discreetly. A visitor said “the food is exceptionally good.” Service users were assured of protection from harm through good policies and procedures designed for their safety. Staff’s understanding of adult protection issues further promoted services users’ safety. The premises were clean, warm, and free from offensive odours. Proper attention was given to the maintenance of hygiene. This gave service users a pleasant environment in which to live. A number of verbal and written responses described the premises as “excellent”. Service users were cared for by an enthusiastic and motivated staff team. The employment of known agency staff had ensured service users had the required care input on a consistent basis. Appropriate attention had been given to matters of health and safety to ensure the home was a safe place in which to live and work. What has improved since the last inspection? What they could do better: The service user guide must be updated to include the general terms and conditions of residence. Each service user or their representative must be provided with the specific terms and conditions of residence as they affect that individual. This will ensure service users and their representatives are aware of what is, and is not, included in the weekly fee and the cost of any extras. Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 7 Further consideration should be given to increasing the range of individual activities for each service user to ensure they continue to enjoy a variety of life experiences. The means and use of transport should be reviewed to ensure service users have the maximum opportunities to access facilities and amenities outside the home. Care must be given in a proper and approved manner at all times to ensure service users’ continued health and welfare. To further safeguard service users the complaints procedure must be published and displayed in a form that meets their needs. It must be made readily available to service users and their representatives. All complaints, however made, must be recorded. Service users’ needs must not be compromised by the requirement for staff to undertake catering and domestic duties. The registered person must provide staff with the required training updates to ensure care is offered in the most appropriate manner. The registered person should undertake a full service review as soon as possible. This should include the views of service users, their representatives and other interested stakeholders to ensure the services, facilities and amenities on offer continue to meet service users’ assessed needs. 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. Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5. Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to this service. The Service User Guide did not give sufficient information for prospective service users and their representatives to be clear about the services provided to meet their needs and the charges to be made. EVIDENCE: A Statement of Purpose was available together with a brief Service User Guide. Although the Guide was available in the home it was kept in a closed drawer and therefore not readily accessible to any visitors. On examination the Guide was found to be inadequate in that much of the information required by the Care Homes Regulations 2001 was not included. The Guide must be revised to include all the required information. The published information did state that discriminatory behaviour, in any form, by anyone, would not be tolerated. A number of service users’ families stated that neither their relative nor they themselves as representative had received any statement of the terms and conditions of residence. A number were unaware of what the fees (paid by the funding authority) covered and what extras they were expected to pay. One commented “We requested a set of rules and conditions relating to our relative’s residency on several occasions but to no avail.” Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 10 On the case files examined an initial assessment and care plan was seen. This had been drawn up by a Care Manager of the placing authority. A deputy manager said this information would be assessed and a preliminary decision made as to whether or not the needs of the prospective service user could be met. If it was felt they could, then appropriate arrangements would be made to introduce the prospective service user to the home. The registered provider had devised an assessment pro forma to be used in conjunction with any assessment carried out by care managers from the placing authority. Copies of this form were seen. The previous inspection report of November 2005 had noted that assessments were not being completed. Some respondents had felt the assessment process had been poor and rushed. The files of two service users admitted after November had assessments in place. Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. There was a care planning system in place that provided staff with the information needed to meet service users’ needs. EVIDENCE: A number of case files and care plans were examined. They were well organised and easy to follow using colour coded dividers. The files seen contained information to enable staff to know, understand and be able to meet each service user’s needs. Sections of the files clearly showed the individual service user’s likes, dislikes, preferences and choices in a number of activities of daily living. The actual care plan recorded strengths and needs with the aims (what is needed) and objectives (how that will be achieved). Religious and cultural needs were noted. Care plans had been updated and signed over recent months. There was also evidence of formal reviews with the placing authorities. Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 12 Concerns had been expressed by some respondents in their written and spoken comments that care plans had been reviewed and updated primarily for the purposes of the inspection. It was not possible to ascertain whether this was the case. It was felt however that files had been updated in accordance with the need for review on a maximum six monthly basis. Records of the care given and any other significant events affecting the individual service user were now maintained. They were written concisely providing a reflection of the care given. A number of risk assessments were found on each file examined. These showed the risks associated with activities inside and outside the home. The assessments recorded the actions to be taken or the controls needed to minimise or eliminate any particular risk. Staff were aware of the need to fully assess all risks associated with any activity. They insisted service users were not denied access to any activity because an element of risk was present. Although the care plans recorded each service user’s likes and dislikes, choices and preferences for activities of daily living, the profound nature of each individual’s disabilities severely limited their ability to make day-to-day choices and decisions. Observation throughout the two site visit days showed staff’s understanding of each service user’s needs. Staff were seen and heard to consult with service users at every opportunity and nothing was done for that person without their involvement. Staff involved service users in decisions about activities, food and drink and personal care. Staff appeared to understand the meaning of gestures, movements, facial expressions and changes in demeanour and to respond appropriately. Personal money was held for safe keeping on behalf of all service users. The arrangements for receipt, recording and return of this money were satisfactory. The registered provider was appointee for one service user. The bankbook held was in the service user’s name. The families of the other service users took responsibility for their financial affairs. One visiting social care professional said that all the required documentation was available at the time of her service user’s review. Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Links with the community were improving and had begun to support and enrich service users’ social and leisure opportunities. Service users were offered meals that met their likes and choices and catered for any special dietary needs. EVIDENCE: All service users suffered from a learning difficulty often with associated physical disabilities. None was able to undertake any form of employment or benefit from attendance on further education courses. A variety of activities were said to be available in the home and at external locations. A number of those provided in-house were seen during both site visit days. Staff were involved with service users in one-to-one activities when staffing levels allowed as well as those of a group nature. Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 14 Although the premises were rather isolated, regular excursions in the home’s minibus enabled service users to make use of the wider community facilities and amenities. The staff rota had been revised to try and ensure that a driver and escort were always available. Service users appeared to enjoy going out in the minibus. Concerns had been raised among families about the lack of planned activities. There were suggestions those detailed in individual files often took place spasmodically and not on any regular basis. Some relatives questioned why their frequency improved prior to inspection. A deputy manager said rota adjustments should ensure staff were available to assist service users with planned activities. Staff should continue to look for additional activities for each service user so they can enjoy a wider variety of life experiences. A number of visitors raised the question of appropriate transport. All felt the present minibus unsuitable for the transportation of their relative. Although the minibus was unmarked many felt it was immediately recognisable as belonging to a home and that their relatives could therefore be stigmatised. It was said that a smaller vehicle had been available but this had been withdrawn. The means and use of transport should be reviewed to ensure service users have the maximum opportunities to access facilities and amenities outside the home. Visitors were welcomed and some were said to visit on a daily basis. The registered provider had a published policy regarding visitors to the home. Those routines, rules and regulations in place were designed for the safety and overall welfare of the service user. The care plans showed each service user’s personal preferences and choices in terms of retiring and rising, personal care and freedom of movement. These were only compromised when medication had to be given at specific times or for attendance at appointments. Staff devised the menus based on the recorded likes, dislikes, preferences and choices of service users. Observation by staff of a service user’s reaction to additions to the menu gave a clear indication as to whether or not a particular item was liked. A variety of food was offered and the staff felt they catered for every need. Staff were observed to assist with breakfast and lunch and with drinks during the morning and afternoon. Any assistance was given in a quiet, dignified and unobtrusive way. Special crockery and cutlery was available. Relatives described the food on offer as “exceptionally good.” One said “My relative eats everything in front of her. She always seems to enjoy it.” Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to this service. The way some personal and healthcare support was offered may compromise service users’ overall health and welfare. EVIDENCE: The pre-admission documentation and the case file detailed personal and health care needs and manner in which they were to be met. Observations at the site visit showed staff were diligent and alert to the signals, whether word, sound or movement that suggested some care input was required. Not only were staff able to interpret these signs but they also responded quickly and appropriately. While it was said that care delivery focused on service users’ privacy, dignity and independence, some evidence gained suggested this could be compromised by inappropriate practices. Discussions with health and social care related professionals revealed practices that were not acceptable. It was said medication had not been administered correctly though this had now been resolved. A potentially dangerous method of moving a service user had also been witnessed. Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 16 It was further felt proper attention was not given to certain health related aspects of care, for example the management of services users having epileptic seizures. Scrutiny of the case files revealed details of seizures were not correctly recorded. Another visiting professional felt care was not always given in the manner detailed in the care plan. Concerns were raised that the nature of disability meant that one-to-one care was often required but present staffing levels and duties could not meet this demand. The registered provider must ensure staff are aware of how individual care is to be offered to service users to maintain their continued health and welfare. Safe methods of moving any service user must be agreed and implemented. All service users were registered with a local general medical practitioner. Health care needs were recorded with details of any medical interventions noted on the files examined. Good use was made of the various professionals in the local Community Learning Disability Team. Evidence of their involvement was seen in the files examined and through the literature available to staff about specific aspects of care of people with disabilities. The necessary specialist equipment to ensure service users could use all the services and facilities provided by the home was in place. A medication policy and procedure was available. Discussion with and observation of staff carrying out medication administration and recording showed procedures were properly followed. All staff dealing with medication had completed an external training course during induction. Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to this service. There was no evidence information on the complaints process was available to service users or their representatives giving them little confidence their complaints would be listened to and acted upon. EVIDENCE: A complaints procedure was contained in the registered provider’s policies and procedures manual. No copy was directly displayed or available in the home. A number of relatives said they had requested the procedure but this had not been forthcoming. A complaints book was seen. No complaints were recorded though it was known families had recently complained and met with a senior manager of the registered provider’s organisation. A revised copy of the multi agency agreement on adult protection was available together with a staff guide and information on computer disc to be used for individual and group training. Staff said training in adult protection issues was undertaken in the home, on LDAF courses (Learning Disability Awards Framework) and National Vocational Qualification assessments. They appeared knowledgeable and confident in the actions to be taken should abuse be suspected or alleged. Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 18 The registered provider’s recruitment and selection procedure ensured the protection of service users through the obtaining of written references and enhanced disclosures from the Criminal Records Bureau. Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 29 and 30. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Service users were provided with a homely and comfortable place in which to live. EVIDENCE: Bethia Cottage is a purpose built property opened as a care home some 12 months ago. It offers accommodation for a maximum of 5 service users. The home shares the site with Garfield Grange and Ashlyn used by the registered provider as a respite centre. The site was rather isolated being over a mile from the nearest village and 6 miles from the centre of Hull. There was no public transport to the property. The premises were set in their own large secluded grounds with no external indication that the properties formed a care home. Level access was achieved to each external door. Fixtures, fittings, fabrics and furnishings were all domestic in nature reflecting the registered provider’s wish to create a non-institutional environment. The premises were maintained in a good condition both internally and externally. Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 20 Maintenance was being carried out at the time of the site visit. No recommendations were made in the last reports from the fire officer or the environmental health officer. Bedrooms were for single occupancy and furnished in a simple but adequate manner. One had an en-suite bathroom. The other four service users shared a bathroom between two. The bathrooms were located between each bedroom. They had suitable privacy locks. Specialist equipment was available including baths, ceiling tracking and mobile hoists, beds and wheelchairs. A wet floor shower and separate toilet had been installed. Bedrooms were of a good size. The layouts allowed easy access for service users and space for staff to give the necessary assistance. Corridors were wide and communal areas spacious. The premises were clean, tidy and odour free. There was a laundry area fitted with commercial machines. The walls and floors were readily cleansable. Suitable arrangements were in place for the laundering of linen, bedding, towels and personal clothing. Relatives and visitors were complimentary in their comments about the physical features of the home. They all felt it was maintained to a very high standard. Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to this service. While care was provided by an enthusiastic and motivated staff team, training updates must be given to ensure staff can continue to meet service users’ assessed needs. EVIDENCE: The staff team comprised a registered manager (presently on maternity leave), two senior support workers (currently promoted to deputy managers) and 10 support workers. Of the 13 staff employed, five had previous experience with people suffering a learning disability. Others had direct care experience in a number of settings including care homes and hospitals. There had been two changes to the original staff group appointed when the home opened. One of these had provided agency cover and was therefore known to the services users and staff prior to permanent employment. Concerns expressed by respondents about the lack of communication between, and poor motivation of, staff could not be substantiated. A communications book was now in operation and was examined. Staff in discussion appeared enthusiastic about their work. They displayed a good knowledge of the people in their care. They felt the standard of service given was good. Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 22 Staff appeared clear about their role and what was expected of them. They showed an understanding of the actions needed to meet and promote equality and diversity. One senior support worker had achieved the Registered Manager (Adults) NVQ4 award while her colleague had a National Vocational Qualification in care to level 3. Six of the 10 support workers had achieved a National Vocational Qualification in care to level 2. All recruitment and selection of staff for the home was done through the registered provider’s published procedures. A number of staff files were examined including those of the last two staff to be employed. They contained application forms, two references and the necessary clearances for example enhanced disclosures from the Criminal Records Bureau. POVA/First clearances were on also on file for some staff. The original staff had attended an intensive three-week training course prior to the opening of the home. This had included general training for example moving and handling, first aid and fire safety and specific training for example epilepsy awareness, use of equipment and challenging behaviour. Further courses had been undertaken on matters such as specialist feeding and medication methods. Staff were currently undertaking a course on the different forms of communication. Staff said there had been no updating or refresher courses in areas such as moving and handling and fire safety. The registered provider must ensure all staff have the relevant updated training. Responses on comment cards and through discussion revealed differing views on staff. Some described them as “helpful and caring” and “very good”. Others felt there was “a lack of knowledge about people with disabilities” and a “negative reaction to any constructive criticism.” Some comments suggested, “more attention was given to domestic routines than to the service users.” Staff said that a thorough clean of the home was undertaken daily and did take time away from service users. Support workers also carried out catering duties. The registered provider must ensure that cleaning, domestic and catering duties do not impinge upon the meeting of service users, needs. Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to this service. The absence of the registered manager has had a detrimental effect on the overall service offered in the home. EVIDENCE: The registered manager was on maternity to leave but expected to return in September 2006. In her absence the two senior support workers had been redesignated as deputy managers. Each had been given one day management and administration time. This situation was not seen as the best solution and led to some of the critical comments made to the inspector through discussion and responses on comments cards. A number of visiting professionals and relatives felt the home seriously lacked leadership and that the overall performance had suffered during the registered manager’s absence. Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 24 No service review had yet taken place though a deputy manager said this was under discussion. This review should take place as soon as possible to ensure the services, facilities and amenities on offer continue to meet service users’ assessed needs in the best manner. Proper attention was being given to matters of health and safety. A number of safety reports and certificates were examined. All were relevant and up-todate. Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 2 3 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 3 X 3 X 2 X X 3 X Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 26 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. Standard 1. YA1 Regulation 5(1)(b) Requirement The service user guide must be updated to include the terms and conditions of residence. Service users or representatives must be provided with the specific terms and conditions of residence including the amount and method of payment of fees and charges. This requirement is outstanding from the report of November 2005 when a timescale of 15/11/05 was set. Care must be given in a proper and approved manner at all times to ensure service users’ continued health and welfare. The complaints procedure must be published and displayed in a form that meets service users’ needs. It must be made available to service users and representatives. All complaints must be recorded. Service users’ needs must not be compromised by the requirement for staff to undertake catering and domestic duties. Timescale for action 31/08/06 2 YA19 12(1) 02/08/06 3 YA22 22(2)&(5) 31/08/06 4 YA33 12(1) and 18(1)(a) 02/06/08 Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 27 5 YA35 18(1)(a) & (c) Staff must have the required 31/08/06 training updates to ensure care continues to be offered in the most appropriate manner. 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 YA13 Good Practice Recommendations The means and use of transport should be reviewed to ensure service users have the maximum opportunities to access facilities and amenities outside the home. Further consideration should be given to increasing the range of individual activities for service users to ensure they enjoy a variety of life experiences. A full review of the service should be undertaken as soon as possible to include the views of service users, their representatives and other interested stakeholders to ensure the services, facilities and amenities on offer continue to meet service users’ assessed needs in the best manner. YA14 YA39 Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bethia Cottage DS0000062728.V303232.R01.S.doc Version 5.2 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!