CARE HOME ADULTS 18-65
CARE Bagatelle 116 Burnmill Road Market Harborough Leicestershire LE16 7JG Lead Inspector
Judith Roan Unannounced 13 June 2005 17:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service CARE Bagatelle Address 116 Burnmill Road Market Harborough Leics LE16 7JG 01858 468776 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) CARE (Cottage & Rural Enterprises Ltd) Michael Keighley RI Vacant Care Home 10 Category(ies) of LD Learning disability 10 registration, with number of places CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: No additional conditions of registration apply. Date of last inspection 16.1.05 Brief Description of the Service: The home situated close to the centre of Market Harborough is a period residence that has been sympathetically renovated maintaining many of the period features. The property provides single accommodation with ensuite facilities for eight service users with a learning disability and two self-contained flats. The propety has large gardens which service user help to maintain. The Management team and staff provide a home that meets the needs and secures the welfare and social inclusion of the people who live there. Day activities are organised and supported from another CARE provision at Shangton. CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission of Social Care Inspection is upon the outcomes for Service Users and their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting 2 service users and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. The inspector also spoke with other service users at different times during the visit. The inspector also received comment forms from service users, families, care managers and a questionnaire completed by the homes manager. The inspection took place during the late afternoon and evening over a period of 3 hours and was carried out on an unannounced basis. The registered manager Jon Hearnshaw has moved to CARE Shangton. Catherine Gilbert is now acting manager and has recently made an application to be the registered manager. The inspector would like to thank all the service users and staff for their support during the inspection. What the service does well:
The service at Bagatelle provides single en-suite bedrooms for all service users. The rooms have been decorated and include many of the service users own belongings. There are several communal rooms where service users can spend time relaxing. The home has access to two independent flats that service users can move into as they develop daily living skills. Service users are supported to develop skills in preparation to a move to more independent living. As service users are supported to be as self-sufficient as possible, risk assessments are in place in support of these activities. There is a good induction-training programme for all new staff. Ongoing training and development of skills is encouraged and supported. Support workers at the home have received additional training in supporting a service user as their needs change.
CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
Ensure that support workers are aware of how to access information about the service provided at the home. A requirement is made for the acting manager to ensure that this undertaken Information within the care plans needs to demonstrate how support workers were to support service users with their daily routines. In discussion with a staff member ‘daily routines’ information is contained on each floor with the diary. The member of staff was new and said that all of the service users were fully aware of their routines and often reminded the staff. It would be beneficial that individual routines were available rather than a general one for the group. A recommendation is made to improve practice in relation to care plan information. Rotas need to reflect any additional support at the home identified in service users care plans. A requirement is made for the acting manager to review staff rotas to ensure that there is adequate staffing on at times when service users need support. The acting manager is also required to ensure that there is adequate support available to support service users to maintain their environment and be free of offensive odours. CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 7 Respond to maintenance requests made by service users in a timely manner. A requirement is made for the acting manager to ensure that the procedure for home maintenance is effective. The home’s extensive grounds look over grown and require regular attention. It is recommended that the acting manager review the arrangements for grounds maintenance. 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. CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 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 standard(s) 1, 2, 5 The assessment process enables service users to make an informed choice about the service provided at the home. EVIDENCE: The home has a statement of purpose and service user guide that is clear and informs readers on the service provided at the home. At the time of the inspection however no one could produce a service user guide and service user spoken with were unaware of the document. The acting manager must ensure that all support workers have access to a copy and that service users have their own copies. Both documents need to be reviewed in light of recent management changes at the home and contact details for the Commission for Social Care Inspection. Service users needs were reflected within their care records and there was evidence of an ongoing assessment for a service user who’s needs have changed. Individual contracts are agreed with service users setting clearly the terms and conditions with the home. These contracts now include details of costs related to annual holidays that were subject to a requirement at the last inspection. CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9, 10 Service users can be confident that care plans reflect there needs and will be fully involved in their preparation. Service users can be assured that information about them is kept in an appropriate manner. EVIDENCE: Care plans are reviewed and contain details that enable service user to be supported in a way that they have chosen. One of the care plans reviewed clearly states that the service user needed one to one support for several daily living tasks. In observation of rotas, discussion with the service user and staff it was clear that this was not happening in practice. The acting manager must ensure that the service users needs are met within the home. Service users at the home spoken with confirmed that they meet with staff on a regular basis to discuss and plan future events. Of the nine comment forms received by the inspector prior to the inspection three service users would like to be more involved with decision making within the home. One service user commented that he was concerned about how hard staff had to work when there was not a full complement of staff due to illness. He was concerned that service users were left in the home while the member of staff transported
CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 11 other service users to the workshop. In discussion with the acting manager she was able to confirm that this was a rare occasions due to illness and that service users remaining at the home could safely remain as they all had a home alone assessment. It is important that the acting manager discuss this issue with all service users at a future house meeting to give reassurance. Risk assessments were completed within files seen and service user spoken to confirmed that they had been fully involved within discussions. The main focus of the service at the home is to ensure that service user have maximum independence. Staff work on a consistent basis with service user to reach their goals. A vacancy at the home has been created by a recent move for one service user into independent living and this has enabled another service user to take the next step to independence by moving into one of the flats. The home has dedicated office space and service user records are stored safely within a locked cupboard. CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15, 16, 17 Service users rights and choice within their daily routines are respected. EVIDENCE: Service users are supported to have positive relationships with family and friends that are part of an agreed individual’s routine. Service users spoken with during the inspection confirmed that support was available. The files however did not reflect the routines. The inspector was informed that individual routines were stored with the diaries on each floor. The member of staff said that most of the service users were fully aware of their routines and could remind/inform any new staff what they were The service user guide has been updated with information relating to costs charged to service users for holidays. The home make a contribution to the cost and pays staff wages. Service user have to pay the remaining costs for travel and accommodation for themselves and staff. Meals at the home are part of ongoing support to enable service users to make healthy choices. The service user files need to demonstrate how service users
CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 13 are supported to choose a healthy option as part of their future personal development. Meals seen in preparation at the home were healthy and enjoyed by service users. Service users had the choice at what time they could cook the meals so did not all eat together. Support was given on an individual basis according to need. The inspector was able to see how a service user who required a special diet was supported with the provision of additional vegetables. During the week the main meal of the day is available at the workshop or college. Service users have indicated on comment forms that they liked the food and confirmed when asked by the inspector that they had a choice in what to eat. CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20, 21 The administration, storage and disposal of medication protect service users. Changing personal care needs are monitored but are not totally met by the support in place at the home. EVIDENCE: The inspector was able to confirm that all medication was stored safely within a locked medication cabinet within the office. This office remains locked when not in use. The records were correctly completed. Service users confirmed on the comment forms that staff respected their privacy and the inspected noted that staff member knocked on doors before entering rooms. It was observed that staff took time to listen to service users and respond positively. The inspector was informed that one service user who had lived at the home for several years was showing signs of deterioration in their health. The community nurse is monitoring and appointments had been made to see a consultant. The staff at the home had acted professionally in seeking specialist support. Support workers have also undergone specific training on dementia so they are aware of how best to support the service user presently and in the future. CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 15 It is a concern that there is no additional support identified for this service user at the home. A support worker confirmed that the service user could become agitated when they are not supported on a one to one basis in the community. The inspector also observed that the service users room showed signs that they needed more support to maintain the environment in a safe and hygienic manner. CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 Protection of Vulnerable adult policies and procedures ensure that service users are protected. EVIDENCE: The home has clear policies on adult protection. There is now a dedicated member of staff based at the Shangton site responsible for the co-ordination of all Protection of Vulnerable Adult issues. Support workers have received training and are fully aware of the whistle blowing policy. There have been no incidents to report since the last inspection at the home. Service user confirmed for the inspector that they were aware of whom to talk to if they were concerned about another person abusing them. One family member made the comment that they were unaware of the complaints procedure. The acting manager must ensure that all families have a copy of the complaints procedure. CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 28, 30 The homely and comfortable environment enables service users to choose how they would like to live. The home did not fully provide a clean and hygienic environment. EVIDENCE: The inspector found the home to be generally well maintained, clean and hygienic. However one service users bedroom viewed by the inspector had an offensive odour and dirty clothes were left on the floor. The service users care plan indicates that support workers need to be vigilant in supporting the service to manage their personal care and laundry. The homes acting manager must ensure that support is given to meet the identified needs. The home has various communal living spaces which service users are able to access. All bedrooms have en-suite bathrooms. Another service user spoken with said that they were unable to open their bedroom window. This had been reported to the housing association some time ago. It was agreed that action would be taken to remedy this.
CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 18 The home has extensive grounds that were being maintained by service users. They were overgrown and this concerned one service user. The acting manager needs to review the present maintenance arrangements to ensure that the gardens are well maintained. CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35 The recruitment policies and practices protect service users. Competent and trained staff supports service users. EVIDENCE: The organisation has a sound recruitment practice and the inspector was able to see that all relevant information had been gained on a new member of staff at the home. The member of staff informed the inspector that they were confident after completion of their induction training within the home. They were able to confirm that they were supervised during their basic training. The Learning Disability Award Framework is fully implemented with staff working for CARE. Training opportunities for support workers are available and supported by a training officer based at the Shangton site. A support worker spoke of additional training that she and colleagues at the home had attended to extend their knowledge and skills in dementia care for people with a learning disability. The inspector was informed that the training has enabled the staff team to support a service user whose needs had changed recently. CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 Service users can be confident that their views inform the way the service is managed and developed. EVIDENCE: At the time of the inspection service user were being supported to complete a questionnaire to obtain their views about the service offered by the home and opportunities within the day service. Service users confirmed that they had regular meeting to discuss issues they wanted to raise. Service users were observed to have confidence in speaking with support workers. Nine service users commented on the forms returned to the Commission for Social Care Inspection that they liked living at CARE Bagatelle and felt that they were well cared for. Comments received from care managers were positive with all aspects of the service.
CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 21 One comment from a relative said the service was ‘Really Marvellous’ and others had a positive view. CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x x 3 Standard No 22 23
ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 3 3 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 x x 3 x 2 Standard No 11 12 13 14 15 16 17 x x x x 3 3 3 Standard No 31 32 33 34 35 36 Score x x x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
CARE Bagatelle Score 2 3 3 3 Standard No 37 38 39 40 41 42 43 Score x x 3 x x x x C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 23 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 YA 18 YA 33 Regulation 18 (1)(k) Requirement The manager needs to review the need to provide aquaqaute level of staff within the home at times to meet the needs of all service users. The manager must ensure that maintenance requests are dealt with in a timely manner. The manager needs to ensure that adequate support in available to support service users to maintain their environment and be free of offensive odours Timescale for action 30 July 2005 2. 3. YA 24 YA30 23(2)(p) 16 (2)(k) 30 July 2005 30 July 2005 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 1 YA6 YA24 Good Practice Recommendations That all staff have acces to information about the service and that all service users have a copy of the service user guide. That information on the daily routines of service users are within care plans held at the home. The manager needs to review the arrangements for garden maintenance
C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 24 CARE Bagatelle CARE Bagatelle C51 C08 S1642 Care Bagatelle V231898 Stage 4 130605.doc Version 1.30 Page 25 Commission for Social Care Inspection First Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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