CARE HOME ADULTS 18-65
Bewsey House 8 Bewsey Road Bewsey Warrington Cheshire WA7 2JW Lead Inspector
David Jones Unannounced Inspection 6th January 2006 10:00 Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 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 Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 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. Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Bewsey House Address 8 Bewsey Road Bewsey Warrington Cheshire WA7 2JW 01925 414961 01925 636485 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) Warrington Community Care Susan May Brown Care Home 18 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (18), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (18) Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. This home is registered for a maximum of 18 service users to include: * No more than eighteen service users of either sex aged 40 to 65 years with mental disorder exluding learning disability or dementia in the category (MD) are accommodated. * No more than eighteen service users of either sex aged 65 years or over with mental disorder, exluding learning disability or dementia in the category (MD(E) are accommodated. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of service users at all times and shall comply with any guidelines that may be issued through the Commission for Social Care Inspection. People who present with mobility problems may only be accommodated if the layout of the home is suitable for them and appropriate facilities and services are available to meet their needs. 21st September 2005 2. 3. 4. Date of last inspection Brief Description of the Service: Warrington Community Care, a registered charity, manages Bewsey House. The home is registered with the CSCI to provide care and support for 18 adults aged 40 years or over in the category of mental disorder, excluding learning disability or dementia. There are 18 single bedrooms on two floors, One large and three small lounges, a dining room, kitchen and laundry. There is a lift to the first floor and there are pleasant and well-established gardens to the rear. The premises have been adapted over the years but are not appropriate for people who have profound mobility problems. The home is within easy walking distance of some day centre facilities, such as Warrington Day Centre and Warrington Workspace. Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 6th January 2006. Six residents, two members of staff and the registered manager were spoken with during the inspection. The service manager also provided some information after the inspection. Staff were observed interacting with and supporting residents. The gardens and some parts of the building were looked at, as were some records along with the case notes of three residents. What the service does well:
Bewsey House is run in the best interest of residents. The registered manager is qualified, competent and experienced to run the home and meet residents’ needs. The Home provides spacious and comfortable accommodation and there are gardens for residents to enjoy. Residents receive personal support in a way they prefer and require and staff take appropriate action when residents are unwell or needs change. Packages of support and care are developed with the individual and mirror their needs and preferences. Residents speak highly of the staff and express satisfaction with the support they receive. They are responsible for keeping there rooms clean and tidy and get involved in other domestic routines including doing their own laundry and setting tables from time to time. They say life is safe and comfortable at Bewsey House. Two residents said that the best thing about Bewsey House is not having responsibility for paying bills and other pressures of life. Another resident said that the best thing about living at Bewsey House is about mastering your mental illness and the fact that staff are there to help you to talk about it. Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 Page 6 Staff present as competent and knowledgeable. They carry out their duties and responsibilities with skill, care and attention to detail. They are supervised and have one-one supervision meetings with their line manager on a regular basis. There is a comprehensive staff-training programme and more than 50 of the staff team have an NVQ at level 2 or above. When temporary staff are used they receive induction training and are familiarised with care plans and residents needs. Warrington Community Care seeks residents’ views on the quality of care; support; and facilities and services provided and provides a written report on quality issues. What has improved since the last inspection?
The statement of purpose and service user’s guide have been updated and are available for new and existing residents. These documents provide important information which residents will need when making decisions about the home. Care plans have been developed. They provide detailed information as to how residents’ needs are to be met. The information is well organised. This makes it easier to read and review. Residents’ abilities to administer their own medication are identified and appropriate arrangements are in place to ensure their safety and well being. The home’s conditions of registration have been changed to confirm that the home is not suitable for people below 40 years of age and those who have profound mobility problems. The “Lettings Criteria” document has also been changed to make sure that new residents and social workers have the information they need when considering the suitability of the home. The registered persons are taking action to make sure that working relationships with the various social work teams supporting residents are effective. These are to include a survey of the various professionals to ascertain their views as to the quality of care; support; facilities and services provided. The home maintains a comprehensive set of policies and procedures, which were reviewed and updated by senior management 10th October 2005. The vast majority of radiators have been fitted with radiator guards to make sure residents are protected. The manager assessment is that the home’s current arrangements for covering absent staff are adequate. In addition to the possibility of using agency staff to cover shifts where appropriate the home maintains three bank staff who are employed from time to time. Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 Page 7 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. Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 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 Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 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. New and existing residents have access to the information they need to make decisions about the home. EVIDENCE: Information provided by the manager confirmed that a new statement of purpose and service users guide has been produced and is available for new and existing residents. Changes have been made to the home’s conditions of registration because the home is unsuitable for people below forty years of age and those who have a profound mobility problem. The “Lettings Criteria” has been amended to reflect these changes. Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 Care plans provide residents with written confirmation as to how their needs are to be met. This information is well organised and accessible. Residents are consulted on the conduct of the home and are supported to take risks as part of an independent lifestyle. Some risk assessments require development to ensure that hazards are identified and appropriate safety measures are introduced where required. EVIDENCE: The case records relating to three residents were read as part of the inspection. Care plans provide detailed guidance as to how the respective persons needs are to be met. They are reviewed with the resident and their representatives on an ongoing basis and are updated to reflect changing needs and personal preferences. Where contact is made with a resident’s health and social care professionals in the interest of their personal health and well being appropriate records are made. The information is maintained in chronological order to facilitate future reference and review. Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 Page 11 Residents are consulted on the quality of care; facilities and services provided by residents’ surveys and are they asked about quality issues during the management visits made by the Care Co-ordinator. The manager and staff also seeks to involve residents in the conduct of the home by organising group/cluster meetings on a regular basis. Some residents participate in the group meetings but a number of others say that they are not interested in them because they are meaningless and they do not value them. This is not to say that these residents are not interested in the conduct of the home. It would be worthwhile exploring how residents may be encouraged and supported to participate further in the management and development of the home. The registered persons may wish to consider changing the cluster meetings to make them more meaningful to residents. Also involving a resident’s representative in the management structure of the home and opening staff meetings to residents and enabling them to take part in the selection of staff would be other ways of introducing opportunities for their involvement. See recommendation 1. Risk assessments and risk management is an important part of the home’s care planning and support arrangements. Copies of risk assessments are provided on each resident’s case records and are updated as and when circumstances change. Some risk assessments require further development to ensure that hazards are appropriately identified and addressed. For further information see recommendation 2 and the section of this report titled “Conduct and Management of the Home”. Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. Residents’ rights and responsibilities are respected EVIDENCE: Residents speak highly of the home and facilities and services provided. They can come and go without any restriction and are of the view that there are no rules other than where you can smoke; those to do with respecting the privacy of others and that all residents must be in their bedrooms by 12 midnight. The manager advises there are no rules as to what time a resident must go to bed and this misunderstanding will be addressed with all residents. When asked about their responsibilities some residents advise that the best thing about Bewsey House is not having responsibility for paying bills and other pressures of life. They say life is safe and comfortable at Bewsey House. They are responsible for keeping there rooms clean and tidy and get involved in other domestic routines including doing their own laundry and setting tables from time to time. Another resident said that the best thing about living at Bewsey House is about mastering your mental illness and the fact that staff are there to help you to talk about it. Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 Page 13 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. Residents receive personal support in accordance with their express wishes. Staff take appropriate action when residents are unwell or needs change and contact is made and maintained with residents’ health and social care professionals when required. Appropriate arrangements are made for the safe storage, recording and administration of medication. EVIDENCE: Staff ensure consistency and continuity of support for residents through designated key workers and the development individual care plans. Packages of support and care developed with the individual according to their needs and preferences. Residents speak highly of the staff and express satisfaction with the support they receive. Reading of case records confirms that when residents are unwell or their needs change staff make and maintain contact with their respective health and social care professionals. This helps them to get appropriate treatment and support. A visiting General Practitioner (GP) expressed satisfaction with the standard of care and advised that good working relationships are enjoyed with management and staff. Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 Page 14 The registered persons are taking action to make sure that working relationships with the various social work teams supporting residents are effective. These are to include a survey of various professionals to ascertain their views as to the quality of care; support; facilities and services provided. The home’s arrangements for the safe storage, recording and administration of medication are appropriate. Assessments as to each individual’s ability to administer their own medication inform staff as to the precise level of support each resident requires. Staff administering medication call the respective resident to the office where the medication is handed to them. This is a long established practice which residents are comfortable with. However, it is likely that new residents might appreciate their medication given to them in a more discrete manner in the interests of privacy. Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23. Appropriate procedures are in place for the protection of vulnerable adults. EVIDENCE: Robust procedures for responding to suspicion or evidence of abuse or neglect are in place including whistle blowing as in accordance with the Public Interest Disclosure Act 1998. The manager said all staff have received training or guidance on adult protection procedures. Further training needs identified by the home’s staff appraisal systems are to be addressed in due course. Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Residents live in well-maintained, comfortable, clean and hygienic accommodation with access to appropriate indoor and outdoor communal facilities. EVIDENCE: Bewsey House is located in a residential area of Warrington with easy access to the local shops and general amenities. The home is well maintained with good quality furnishings and fittings. It is set within its own grounds and there are gardens for residents to enjoy. The communal areas of the home have been redecorated and new carpets have been provided in both smaller lounges. Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 Page 17 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): 33, 34 and 35. The home has an effective staff team, with sufficient numbers and complimentary skills to meet residents assessed needs. Residents are protected by the home’s recruitment procedures. EVIDENCE: Staff present as competent and knowledgeable. They carry out their duties and responsibilities with skill, care and attention to detail. Scheduled supervision is provided six times per year. Information provided by the manager confirms that the home has a full compliment of staff with the exception of one vacant post on night duty. This is being covered by agency staff who are known to and familiar with the needs of residents. All agency staff receive induction training and are familiarised with care plans and residents needs. The manager or other senior staff provide and record this for future reference. The manager advised that the home’s current contingency arrangements for covering absent staff are adequate. In addition to the possibility of using agency staff to cover shifts where appropriate the home maintains three bank staff who are employed from time to time. Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 Page 18 Reading of staff records confirms that the home employs thorough recruitment procedures to ensure the protection of residents. However, there were no staff records relating to the three bank staff members who are employed at the home from time to time. Records required by regulation for the protection of residents must be maintained in the appropriate detail. See requirement 1. New recruits complete induction training in accordance with “Skills for Care” criteria and go on to complete foundation training before progressing to NVQ level 2 in care. More than 50 of the staff group have achieved an NVQ in care at level two or above. Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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, 40, 41 and 42. Bewsey House is run in the best interests of residents. The registered manager is experienced, qualified and competent to manage the home and meet its stated purpose. Established quality assurance procedures enable residents to express their views about the home. Policies and procedures have been reviewed and updated for the guidance of staff and in the best interests of residents. Fire practices and some risk assessments require review in the interests of the health and safety of residents and staff. Records required by regulation for the protection of residents must be maintained in the home. EVIDENCE: The registered manager is experienced in the field of mental health and has achieved the Registered Managers award and an NVQ level 4 in care. Staff speak highly of the manger and the organisation stating that support, leader ship and guidance is excellent. Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 Page 20 Feedback is actively sought from residents about the standard of support; care; facilities and services provided by anonymous survey questionnaires and by quality audits conducted by the Care Co-ordinator. The findings of the home’s quality assurance processes are published in quality summaries and made available to residents and their representatives. The views of health and social care professionals were surveyed in March 2004 and it is understood that a further survey will be undertaken in the near future as recommended. See recommendation 3. The home maintains a comprehensive set of policies and procedures, which were reviewed and updated by senior management 10th October 2005. Radiators have been fitted with guards in the vast majority of bedrooms and risk assessments are in place where radiator guards are not fitted. These risk assessments need further development because they do not accurately identify the nature of the hazard presented to the individuals and the stipulated control measures do not reduce the element of risk significantly. Unguarded radiators may present hazards to residents if their surface temperature rises above 43ËC. Thermostatic control valves fitted to radiators are designed to control the temperature in the room and if the room is cold the valves will open fully until the desired temperature is achieved. This means that a radiator fitted with a thermostatic control valve may from time to time present with hazards associated with surface temperatures above 43ËC. See recommendation 2. There were no staff records relating to the three bank staff members who are employed at the home from time to time. Records required by regulation for the protection of residents must be maintained in the appropriate detail. See requirement 1. The Fire Brigade visited the home in connection with the break out of a fire which staff had extinguished. Delays in reporting the fire occurred because staff were not aware that the fire brigade must be called to all fires in the home even those that have been extinguished. The registered persons must review staff competencies and training needs in relation to fire precautions and actions to take in the event of a fire. See requirement 2. Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 X X X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X 3 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score 3 X 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Bewsey House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 X 2 3 2 2 X DS0000027000.V271967.R01.S.doc Version 5.0 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard A41 Regulation 17 Requirement The registered persons must maintain a record of all persons employed at the care home in accordance with the requirements of regulation 17 (2) schedule 4. The registered persons must take adequate precautions against the risk of fire as in accordance with the recommendations of the Fire Officer. Timescale for action 28/02/06 2 YA42 23 06/01/06 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. Refer to Standard YA8 YA42YA9 Good Practice Recommendations The registered persons should explore how residents may be encouraged and supported to participate further in the management and development of the home. The registered persons should review risk assessments that relate to hazards presented by heated surfaces to ensure that hazards are appropriately identified and addressed.
DS0000027000.V271967.R01.S.doc Version 5.0 Page 23 Bewsey House 3 YA39 The registered persons should conduct a further survey as to the views of health and social care professionals as to the quality of care; support; facilities and services provided. Bewsey House DS0000027000.V271967.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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