Inspection on 09/06/08 for Bevis House

This inspection was carried out on 9th June 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.

Other inspections for this house

Bevis House 25/04/07

Bevis House 08/06/06

Bevis House 22/11/05

Bevis House 29/07/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

Ravenhurst

Polesworth Group 64 Long Street

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Bevis House 5 Newholmes Monyhull Hall Road Kings Norton Birmingham B30 3QF Lead Inspector Monica Heaselgrave Unannounced Inspection 9th June 2008 09:40 Bevis House DS0000062630.V366527.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 Bevis House DS0000062630.V366527.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. Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bevis House Address 5 Newholmes Monyhull Hall Road Kings Norton Birmingham B30 3QF 0121 444 2184 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) South Birmingham Primary Care Trust Mrs Dorothy Margaret Fisher Care Home 6 Category(ies) of Learning disability (6), Physical disability (6), registration, with number Sensory impairment (6) of places Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can accommodate six people with a learning disability under 65 years. 25th April 2007 Date of last inspection Brief Description of the Service: Bevis House was purpose built as a care home, on the site of what was previously Monyhull Hospital. South Birmingham Primary Care (NHS) Trust manages the staff and the home and Family Housing Association owns the premises. Bevis House is a bungalow, which presently accommodates five men. The men all have a Learning Disability, some have impaired mobility, and some have some behaviour that challenges. The accommodation is spacious, well decorated and comprises of six single bedrooms, a communal lounge, and a dining room. Each room is comfortably furnished and fixtures and fittings are modern. The toilets, bathroom, and shower room are fitted with equipment to support people with their personal care. There is an adequate supply of aids such as pressure relieving equipment and mechanical beds to enable staff to support people with their care, safely. The rear garden is level and paving slabs have been re-laid to ensure people can move around safely. Staff and residents are in the process of developing this area into a ‘secret garden’ for people who live there, to enjoy. The CSCI inspection report is available in the home for visitors who wish to read it. The current scale of charges for the home is £1511.95 per week. The fees payable to Family Housing Association are £127.35 per week. Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The visit was carried out over one day; the home did not know we were going to visit. Prior to the fieldwork visit a range of information was gathered to include notifications received from the home, previous reports and the manager completed a questionnaire about the home - Annual Quality Assurance Assessment (AQAA). Three service users were “case tracked” and this involves discovering individual experiences of living at the home by meeting or observing them, discussing their care with staff, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files and health and safety records were reviewed. Discussions took place with the Team leader who is currently overseeing the running of the Home, and members of the staff team were spoken with. Written records (including personal files, care plans, staff files, safety records and other documents) as well as direct observations were used to inform the judgements made in this report The inspector looked around the building to make sure that it was warm, clean and comfortable. There were no immediate requirements after this visit. This means that there was nothing urgent that needed to be done to make sure people stayed safe and well. What the service does well: Staff treat each person as an individual and talk to people in a way that shows they respect them. Staff support people to make decisions about their day-today lives. Staff are good at understanding how people express themselves. Each person has a care plan so that staff know how best to care for people, meeting their needs and their wishes. They are supported to keep appointments and do things to help them stay healthy and well. This includes having a balanced diet, eating healthily and enjoying their food. The food is nice and people have a healthy diet. People choose what they want to eat. People had been supported with their personal care so that they looked and felt good about themselves. People living at Bevis House have a house that Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 6 meets their needs. They can move around the house easily because it is a bungalow. It is clean and comfortable with nice fixtures and fittings so it is a nice place to live. Bathing and toilet facilities are fitted with the type of equipment people need. There are regular checks to make sure the equipment used at the Home is safe to use. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available in an easy read format to help people to make decisions about whether or not this service could meet their needs. Their strengths and support needs are properly assessed to make sure they can get the care they need. People have a written contract, so that everyone is clear about his or her rights and responsibilities. EVIDENCE: The information provided to people to help them understand what the home can offer is contained in two documents, these are called the Statement of Purpose and Service User Guide. These were looked at and showed that all the relevant and required information to meet this standard was included. They were produced using pictures making them easier to understand. Information taken from the AQAA (Annual Quality Assurance Assessment) indicates that the Home is seeking to develop these further to include digital photographs of the home and shared space. They also have plans to work with the Speech and Language Department to enable them to produce the documents in a format that can be more easily understood by the people who live in the Home or are intending to live in the Home. Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 9 It is positive to see that the management team has continued to review and improve the way that information is presented to help people using the service to better understand what specialist services the home can provide. There are five people currently living at Bevis House, with one vacancy. The Clinical Team Manager who is currently overseeing the running of the home is dealing with a referral. Discussion with her and information taken from the AQAA show that admissions are not made to the home until a full needs assessment has been undertaken. The assessment is conducted professionally and sensitively and involves the individual and their family or representative, where appropriate. There were good examples given of how the Home is preparing to meet the needs of the prospective new resident. Sampling of care files confirmed that each person living at Bevis House has a contract that includes a statement of terms and conditions with the Home. This ensures people have a good idea of what to expect from the Home. Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are detailed and kept up to date to make sure that people get the support they want in ways that suit them. Risks are properly assessed, so that people have opportunities to experience different things, and to learn and develop. Staff encourage people to do things so that they can play a full part in the day-to-day life of the home. EVIDENCE: Three peoples’ care plans were looked, they were up to date and set out in detail the care required to be carried out by staff. There was a wealth of information about likes and dislikes, and daily routines for each person, outlining the things that are important for each individual, and giving staff detailed guidance about how they like to be supported. These had been produced using pictures making them easier to understand. Care plans sampled had been regularly reviewed. Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 11 Each care plan had a really nice laminated profile that provided personal and unique detail concerning that individual and how they like things done. For instance ‘I am inquisitive and will look through cupboards’. ‘I love my cards and will keep them beside me all the time.’ ‘I enjoy routine and like things to be organised’. This information enables staff to understand what the person needs and what their behaviour is communicating. A section on ‘Understanding’ supports each plan. This detailed the type or form of communication the person chooses to use. Examples of this were ‘putting on a coat to indicate wanting to go out’, ‘someone doesn’t like something they will indicate this by pushing it away’ ‘worried or agitated they may begin to push or grab people’. Makaton pictures and symbols and other gestures to show what a person is saying were also described clearly, which lessons the frustration for the individual in making their needs known. This detail promotes choice. Words and phrases regularly used by the individual and understanding their behaviour aids staff understanding, which in turn leads to the individual communicating their choices. Care plans represent individual interests such as ‘visits to cafes, tea rooms, pubs, sweets, shopping, and these were up to date. It was positive to see that the care plan identifies what people can do for themselves, and looks at all areas of the individuals life. This detail ensures the diverse needs of an individual are identified in a person-centred way. This is particularly important where people cannot easily communicate their needs verbally, and it is evident staff have used their observations well in promoting the best practice for the individuals in their care. People are supported to make choices about what and when they eat, when to go out, and how to spend their time. On the day of the inspection one of the men chose to stay in bed for the morning. Another man took his dinner to the kitchen and put it in the bin and proceeded to look in the cupboard taking out eggs. He indicated to the staff that this was his preferred choice. A third person due to attend the day centre, chose not to go and staff respected this. These choices are promoted further by the behaviour management strategies seen on individual files that gave information on how best to support peoples’ choices. Care plans were supported with risk assessments, which identified specific risks around behaviour or aggression and the best approach to use to diffuse anxiety. Risks concerned with everyday living tasks had been identified so that people living in Bevis house could still do the things they enjoy but with specific staff support to keep them safe. This included; epilepsy, fire, using knives, hot drinks and meals, bathing and showering, support during the night, locked Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 12 front door, hazardous substances, car travel, hot weather, inappropriate behaviours, falls, being assaulted by other people living in the home and making allegations about staff. The only restrictions placed on individuals are to ensure their safety and these included an alarmed front door, hazardous products locked in cupboards and locked laundry, boiler room and store cupboard. Records of resident meetings showed that staff asked people what activities they would like to do, the men had a trip to Weston the previous day. Other records seen of a ‘tick’ style showed people in the Home to indicate their preferences and experiences and these were positive. There is good information to show staff spend time explaining and exploring what options are available and staff are good at recording this. Information provided in the AQAA supported the person-centred care planning approach. Bevis House DS0000062630.V366527.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported to take part in activities, so that they get to do the things that they like that are important to them. They are able to make use of local facilities, and are supported to stay in touch with people who mean a lot to them. They are able to make positive choices about the food they eat, so that they enjoy their meals and have a balanced diet. EVIDENCE: Everyone living in the house is able to enjoy opportunities to do things that they value on a regular basis. Apart from attending a Day Centre on a regular basis, records also showed that some people enjoy many activities both in and outside of Bevis House. Lunches out, walks, shopping, out for a drive, visits to parks, massage therapy, church, foot spa, listening to music, watching T.V., visits to local cafés for a drink and the cinema. For some individuals they have established social routines that are very important to them. It is also important to have some flexibility and it was positive to see that people do change their Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 14 minds, as observed on the day, and staff respected this. One person was not particularly enthusiastic about attending the Day Centre and so stayed at home. It was positive to see that all of the people living at Bevis House are encouraged to do things that will maintain or develop their independence skills. This might involve doing jobs around the house or going out into the community with a member of staff. Records show that they are able to access local facilities on a regular basis. A recent activity to Weston was particularly enjoyed, one person said, ‘I liked it at Weston and we had something to eat there’. There has been a recent house party that was particularly successful in engaging residents’ family members, some of whom staff said had not visited the Home before. Two of the people living at Bevis House said, ‘ We enjoyed the party and friends came’. Staff spoken with said they are keen to continue to build social opportunities in and around the house so that contact with families is actively supported. Previous problems with appropriate transport being available were discussed. Most staff felt that the seven-seater car was sufficient and that a minibus should not be the ‘norm’ as people should be going out in small groups. Access to the car was described as appropriate for the needs of one person who finds steps difficult to negotiate. The option of a borrowed mini bus is also available on those occasions when the numbers are greater. Bevis House operates a rolling menu programme based on the known likes and dislikes of the residents, and they are encouraged to play an active role in choosing and collecting the food shopping. Individuals’ specific eating habits and preferences set particular challenges in making sure that they get a healthy and balanced diet, but records provide evidence that this is generally well achieved. The small size of the home means that individual choices can be easily facilitated if anyone wants something different. This was seen directly when one person ‘binned’ his lunch and went to the kitchen to choose an alternative. At the beginning of lunch three people were seated and initially the staff were seen to be waiting for the return of the other two residents who were out with staff. However after a few minutes one staff member decided lunch should go ahead, it was nice to see that the people living in the House are not treated as a ‘group’ and that there is flexibility of routine recognising individuality. The people living in the home were dressed appropriately to their age, gender and activities they were doing. Bevis House DS0000062630.V366527.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are well cared for by staff that know them well, so that they are supported in ways they like and helped to stay well and healthy. Proper arrangements are in place to make sure that they get their medicines at the right time and in the correct amounts. EVIDENCE: Bevis House provides care to people who have high dependency levels. Their health care needs are complex, all of the people who live there have a learning disability. Some people have difficulties with communication, restricted mobility, epilepsy, incontinence or challenging behaviour. Bevis House has been consistent in informing the Commission about incidents resulting in injuries or illness and showed how they manage this to protect the people who live there. The morning routines are busy; staff provided appropriate one to one support to meet the personal care needs of the people living at Bevis House. This was unrushed and in line with the routines seen in the individual care plans. Records included individual Health Action Plans. These are personal plans about what a person needs to stay healthy and what healthcare services they Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 16 need to access. They were produced using pictures making them easier to understand. Two health care plans were sampled at this visit. There was good information about individuals’ personal care needs and preferences. Discussion with staff showed good understanding of peoples’ routines so that they receive care in a manner they need and like. Records sampled included individual moving and handling assessments stating how staff support individuals with their mobility, some people had eating and drinking guidelines developed by the Speech and Language Therapist for staff to follow to ensure that the person does not choke. Three bedrooms were looked at to see if people had the aids or equipment they needed to stay healthy, a range of aids was available to include pressure relieving mattress, mechanical bed to allow easier access and sleeping positions, permeable flooring and personal bed alarms, and a fan for one person who tends to get very hot. There is sufficient waking night staff appropriate to the night time needs of the people living at Bevis House. Staff are aware of the need to offer personal care in private to maintain peoples’ dignity. Both male and female staff are employed, which enables the people who live at Bevis House to have a male staff to assist them with their personal care needs. The morning routine for one person was discussed. Accessing the bathroom facility potentially compromises the dignity of the individual. There are also implications for infection control, although staff do follow infection control procedures. This situation could be improved so that the outcome for the individual is a better one in terms of accessing the bathroom in private. Records showed that people have regular appointments with healthcare professionals such as dentists, GPs, Speech and Language Therapists and Psychologists. The outcome of this contact had been documented so that staff had accurate information about individuals’ state of health. On the day of the visit one person had been to the G.P. Sampling of records showed staff had written up the outcome of the treatment and the next appointment was booked in the diary, this ensures everyone is aware of health changes and what needs to be done to support the individual in this area. People’s healthcare needs had been well monitored. Records were seen which demonstrated that individual’s weight, bowel movements and fluid intake are regularly monitored. At the time of the last key inspection some concerns were expressed about the maintenance of records relating to irregular bowel habits. Improvements had been made and this requirement has been dealt with satisfactorily. It was positive to note that prompt action is taken to respond to people who appeared unwell. One person had a temperature and was off their food. Staff were keeping the individual under observation and had administered medication. This was to be followed up with the G.P. if there was no Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 17 improvement. The people living at Bevis House cannot easily communicate that they are ill or in pain, staff use their knowledge of the individual to identify when someone appears to be unwell, and act on this accordingly, this ensures people get the treatment they need without delay. At the time of the last key inspection a concern was expressed about medication administration and management. The monitored dosage pack for one person’s medication at night had a tablet in it, however staff had signed the Medication Administration Record (MAR) to say that it had been given. Improvements had been made so that a daily audit of all medication is now undertaken. Staff are checking and completing medication audit tools, which highlights quickly if an error has been made ensuring this is picked up and remedied without delay. The system of storing, administering and recording medicines kept in the home was looked at and it was established that people are protected by robust procedures. Medication was observed to be securely stored in locked cabinets, staff had received training in the safe handling of medicines to further safeguard service users health and well being. Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 21 and 22. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at Bevis House are protected from abuse, neglect and selfharm. Staff understand their role in safeguarding adults, and this is enhanced further by training of staff in safeguarding being regularly arranged by the Home. Staff have the skills to manage physical and verbal aggression but this could be improved further by ensuring any management plans are available to guide staff in this area. EVIDENCE: An easy read complaints procedure is available to each person who lives at Bevis House making it more accessible for people with communication support needs. The information seen in care files supports that provided in the AQAA. The levels of learning disability of most of the people living in this house mean that formal processes may have limited relevance. People who live at Bevis House are dependant on the vigilance of members of the staff team to notice changes in demeanour, behaviour or “body language” as indicators that something might be amiss. The organisation has been proactive in seeking to develop the ways in which people can let them know about things that concern them. There is a compliments and complaint file. This showed that concerns and complaints raised with the Home had been appropriately managed. Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 19 There have been several developments since the last inspection that show the service has identified more robust complaints management. For instance the Trusts Policies and Procedures are circulated with a ‘Read and Sign’ to all Staff. This ensures staff are regularly reminded about how important their role is in advocating on behalf of the people they support. Monthly visits from the organizations representative, and audits completed by managers from other homes, showed that this area of practice is regularly reviewed. The Commission has been appropriately notified of incidents that have occurred in the Home. Regulation 37 reports have been completed and forwarded for information demonstrating how the Home has managed these. The ‘Cornwall Audit’ has been carried out at Bevis House by the Trust. This covers all areas of care to ensure that the Home is using best practice and ensuring the safety of the people living at Bevis House. The AQAA gives good examples of improvements since the last inspection, for instance staff now record and report incidents and ‘near misses’ to ensure they can learn from these. Staff records show that the care team have received training in the Protection of Vulnerable Adults, and refresher training is booked regularly in this area. Protection matters are placed on the agenda for formal supervision sessions with staff and staff meetings so that everyone has a good understanding of abuse and what to do about it. Staff files also contain evidence of appropriate checks being made with the Criminal Records Bureau before employment. Local Multi-Agency Guidelines for safeguarding adults are in place. Some of the people living at Bevis House have behaviours that can be difficult. Reactive strategies were in place that stated how staff are to respond to and manage individual’s behaviours. One person’s strategy was amended and updated in January 2008. The updated version was not on file. Discussion with the key worker demonstrated that he could not remember what the updates were. This was supported by a discussion with a second staff member. This was then brought to the attention of the acting manager, who said they were still waiting for the typed version, but as she had only recently stepped in to oversee the running of the Home she had been unaware of this delay. She agreed that a six month delay was unacceptable and said that as an organisation they are intending to review the process to improve consistency across the organisation. It was positive to see that staff had attended Studio 111 training. This provides them with techniques of physical intervention to manage individuals’ behaviour. It is important that the plan they are working to is available on the Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 20 file to ensure staff are meeting these needs in the agreed manner, with consistency, and safely. The arrangements in place to secure and manage the personal finances of the people living at Bevis House were sample checked. The amounts held tallied with the record as appropriate. There are improved handover arrangements between shifts to ensure finances are secure. Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 29, and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Bevis House provides a physical environment with specialist aids and equipment to meet the needs of the people who live there. It is a wellmaintained, pleasant, and safe place to live. EVIDENCE: Bevis House is a six-bed bungalow, which is spacious and has everything on one level, so is suited to the needs of the men who live there. The house is spacious, nicely furnished, and comfortable. The shared spaces in the house include a comfortable lounge and a separate dining room. There is an enclosed private garden at the rear of the house, with plans to develop this further into a secret garden. The people who live in Bevis House are supported to maintain the cleanliness of their own rooms and are encouraged to get involved with the housekeeping of the home. Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 22 Bathroom and toilet facilities are fitted with appropriate aids and adaptations to meet the needs of the people who use the service. One bathroom is located near to the office and just off the main corridor. Accessing this potentially compromises the dignity of one of the people living at Bevis House. Consideration of improved access was discussed with the Team Leader. There have been lots of improvements to the bungalow over the last twelve months. The people living in the Home have chosen a new adapted bath for the bathroom more suited to the changing needs of the people in the Home. A tour of the bungalow showed that bedrooms had lots of personal possessions, and bed linen appropriate to their gender. Artwork and canvases have been put up around the bungalow making it homely. The paving to the kitchen entrance of Bevis House has been re-laid providing a level and safer surface for people to utilize. The kitchen is functional and spacious, and it was positive to see that the people who live at Bevis House do go into the kitchen to get drinks, help with food preparation and choose their own meals. The men who live in this property have specialist needs; they are dependent on staff and their environment to stay safe. For this reason there are alarmed doors so that people can exit when they choose to, but staff are aware of their whereabouts and can quickly offer assistance and support. The home is a pleasant, safe place to live. The house is kept clean, hygienic and tidy and provides a homely and welcoming environment to live in. Observations indicated that the men could move freely around the house without being inhibited by steps or other obstacles. The AQAA advised that people living at Bevis House are supported to complete house and room audits monthly to highlight any areas requiring attention or repair. Samples of completed audits were seen to verify this. This is positive practice ensuring people are supported to have some influence over their environment. It was good to see that Health and Safety issues are reported and dealt with promptly ensuring the bungalow is kept in a good state of repair and safe. Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate numbers of staff ensure people have the support they need. Staff have received specialist training which means the needs of people in Bevis House are understood and met in a caring and skilled manner. The arrangements for the recruitment, and development, of staff indicate that the main focus is providing a quality service. With this in mind a clearer definition of the senior staff arrangements is needed. EVIDENCE: People living at Bevis House benefit from being supported by a competent staff team. Due to their complex needs continuity of care is of particular significance to them. Staff demonstrated a good understanding of the people in their care, that they are sensitive to and respectful of peoples routines, habits and behaviour patterns. The staffing complement meets with the needs of the people who live at Bevis House. Some people have complex needs and require a higher staffing ratio. The rota shows that appropriate staffing levels have been maintained, and on those occasions when they have been short staffed the manager has informed the Commission. The existing team members who work as bank staff or agency staff cover one current vacancy and absences. On the day of the Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 24 inspection there were five staff on duty, three of these were permanent staff, one bank and one agency. The care manager has not worked in the home since April and interim management arrangements were made known to the Commission at that time. The Clinical Team Leader has been overseeing the daily running of Bevis House, supporting the two existing senior support workers. One senior staff member was on a day off and the other was on annual leave. In discussion with staff members they said that they undertake this role between them and they have an on-call system if they required support. It is important that at all times there is a senior member of staff who is appropriately qualified, experienced and competent in managing the Home. This was discussed with the Clinical Team Leader who recognises that this situation will have to be reviewed, to ensure those staff have the necessary qualifications to effectively undertake this position. At the time of the last inspection some recommendations were made to improve practice. Discussion with staff and information provided in the AQAA demonstrates that further improvements have been made. Staff said that there are regular staff meetings where they can discuss changes and restructure. On the day of the visit the night staff were having a staff meeting with the Team Leader working towards streamlining practice so that the outcomes for the people who live at Bevis House are improved. The home has a rolling programme for both mandatory training and specialist training which is relevant to the individual needs of people living in the home. Staff training records and discussion with some staff members identified that training opportunities continue to be offered on a regular basis. The training matrix showed that staff had undertaken a variety of training; Total Communication training with S.A.L.T. (Speech and Language Therapy) to improve their skills in communication. Moving and handling, First aid, Food hygiene, Epilepsy, Autism, Fire safety, Medication, Protection of Vulnerable adults, Healthy eating, and Studio III (a technique of physical intervention). All staff have had, or are in the process of, completing Health and Safety in the Workplace training level 2. On the day of the visit two staff were undertaking their exam. Staff at Bevis house have, or are currently working towards, their NVQ level 2. This ensures the staff team are equipped to undertake their role in a skilled manner. The AQAA informs that an annual review of each staff members job description has taken place to highlight any areas staff feel they require further training or mentoring to enable them to reach competence in all areas of their role. Yearly appraisals have been implemented which provide a performance and development review for each member of staff. Previous inspection reports show that there is an established induction process so that staff fully understand their role and responsibilities. Staff also Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 25 undertake the Learning Disability Award Framework (LDAF) training so that they understand and have the skills to meet the needs of people who have a learning disability. The AQAA advises that appropriate checks had been made to make sure that staff were suitably experienced and qualified to work with vulnerable adults. Staff records sampled included the required recruitment records including evidence that a Criminal Records Bureau (CRB) check had been undertaken. This ensures that suitable people are employed to work at the home. Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Bevis House is generally well run for the benefit of the people who use it. There have been lots of improvements over the last twelve months in how the service is managed and monitored. Managers from outside the Home visit regularly and their reports show that the views of the people who live at Bevis House are considered. Important checks are carried out around the Home to ensure the safety of the people living and working there, and staff know about fire safety so they can keep the people who live there safe. EVIDENCE: Unfortunately the manager was not present for this and the previous inspection. The Commission was informed of the current temporary management arrangements for Bevis House. It was not possible to make a fair assessment of the management style. However there have been many Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 27 achievements in terms of ensuring previous requirements made by the Commission, being addressed. Better outcomes for people living at Bevis House have been noted in several areas - flexibility of routines, availability of activities, and improved auditing of medication systems ensures people who live at Bevis House are being well looked after. There have been improvements in maintaining staffing levels and ensuring regular visits by external managers to the Home to monitor its progress. We asked the Provider to fill out an Annual Quality Assurance Assessment, (AQAA). The AQAA contained relevant information that was supported by the records sampled in the home, discussions with staff, and observations of the practice. The Clinical Team Leader is currently overseeing the running of the home, and as she has only been on site for a short while she is still in the process of reviewing and addressing those matters that require her attention. As stated previously there are indications that the team would benefit from a clearer delegation of senior support. Staff said they elect the shift leader amongst themselves. It is important that the senior workers have the necessary qualifications and skills to effectively carry out this role so that everyone knows who does what to ensure that outcomes for the people who live at Bevis House continue to improve. There has been an improvement in carrying out monthly checks to monitor the care practice, meeting a previous requirement. Five reports were looked at and showed improvements that have been made to ensure better outcomes for the people who live there. The dining room was rearranged to give extra space for people to move between the kitchen and diner. The lounge was rearranged so that people were more comfortable and could move around easily. One persons morning routine was reviewed and increased activities provided to minimise frustration. Menus have been varied and new digital photographic cue cards are to be provided to support people making choices of food. South Birmingham Primary Care Trust has a quality assurance system. The system has all the elements for seeking views, analysis of findings and feeding this back to all concerned. Information provided in the AQAA shows that there are platforms for seeking the views of people living at Bevis House, such as, one to one and group meetings on what they want. A range of methods is utilized to support communication such as pictures, photos, books, gestures and verbal communication. Monthly house audits were seen showing the views regarding the home, and weekly activity sheets demonstrated that people are supported to plan their activities, (meeting a previous requirement). The work already done in this regard needs to be collated to show how the views of the people living at Bevis House have been used to guide its future development. Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 28 A number of checks are made by staff to make sure that peoples health and safety is maintained. Records showed that the fire alarm system had been tested in June 2008 and serviced to make sure that it was working properly. A fire drill was carried out in January 2008 and fire training in February 2008, meeting a previous requirement. Staff had undertaken health and safety, safe food handling and infection control training. This ensures a safer environment for the people who live in the Home, and safe food handling practices prevent people getting ill from unhygienic food handling. Records of checks on the fridge and freezer and water temperatures have been completed appropriately. Accident and incident recording was appropriate and notifications had been sent to the Commission as is required by legislation. Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 29 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 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 3 35 3 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 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO 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 Regulation Requirement Timescale for action 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 YA23 YA27 YA31 Good Practice Recommendations An up to date reactive strategy should be in place so that staff know how to support the individual with their behaviour. A review of the access route to the bathroom should be considered in order to promote privacy and dignity. A review of the qualifications and experience of those staff acting as senior support workers should be undertaken to ensure they have the necessary skills to undertake this role. The results of the quality assurance system should be made available to the people living at Bevis House to show how they have influenced the improvements made. 4. YA39 Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: 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 © 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 Bevis House DS0000062630.V366527.R01.S.doc Version 5.2 Page 32 - 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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