Inspection on 16/04/05 for George Beal House

This inspection was carried out on 16th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

George Beal House 18/04/08

George Beal House 19/04/07

George Beal House 10/04/06

George Beal House 29/11/05

George Beal House 04/10/04

George Beal House 17/04/04

George Beal House 08/03/04

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

CARE HOME ADULTS 18-65 George Beal House Off Williamson Road Kempston Bedfordshire MK42 7HL Lead Inspector Rachel Geary Unannounced Inspection 16th April 2005 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. George Beal House Version 1.10 Page 3 SERVICE INFORMATION Name of service George Beale House Address Off Williamson Road Kempston Beds MK42 9AP 01234 857300 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) Bedfordshire County Council Care Home 16 Category(ies) of LD - Learning Disablility (16) registration, with number of places George Beal House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Service Users may also have additional physical disabilities. Respite Care - Named young people under the age of 18 who currently use the respite care service may continue to do so. The manager must inform the CSCI when these young people reach adulthood, and this exception will be removed. Date of last inspection 4th October 2004. Brief Description of the Service: George Beal House is a local authority care home providing long term residential accommodation to ten adults with profound multiple disabilities (learning and physical). At the time of this inspection, the home also had six beds that were being used to provide respite care to adults, and one young person aged seventeen. No further young people will be admitted to this home. The home is situated in Kempston town in close proximity to local facilities and transport routes. The building consists of three interlinked bungalows, each with its own lounge/dining area, bedrooms, bathrooms and kitchenette. In addition, there is a shared lounge, link area, sensory room, laundry facilities, staff rooms/offices and an industrial kitchen. The organisation of the home and building is institutional in a number of aspects. The long term plans for this home is re-provision however, there are no known timescales for this to take place. A good sized sensory garden surrounds the building and there is parking spaces to the front of the home. The home has close links to the local community nursing service, who provide support and advice as required. George Beal House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The previous announced inspection of George Beal House had primarily concentrated on support systems and the management of the home. To this end, this inspection focused on assessing outcomes for service users. A number of requirements and recommendations from the October inspection report have therefore not been assessed in full on this occasion. These will be carried over and assessed at the next inspection of this service. This inspection was unannounced and started at 09.40 on a Saturday morning. It took place over almost seven hours. The inspector spent the majority of the inspection within ‘B’ bungalow observing practice and speaking to service users, staff and an assistant manager. Records were also examined, and a partial tour of the premises took place. What the service does well: What has improved since the last inspection? A number of improvements have been made including the appointment of a new agency manager, who is providing clear guidance and direction for the staff team. Other improvements include an increase in external activities for service users, the provision of overhead hoists in some bedrooms and plans to refit two bathrooms. In addition, the home has introduced a secondary care planning system, completed reviews for all service users, arranged holidays for all but one service user, secured funding for a new intercom system, increased the number of service user referrals to local advocacy services, and increased training for staff. George Beal House Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. George Beal House Version 1.10 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 Standards Statutory Requirements Identified During the Inspection George Beal House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 5. The home’s Service User Guide provides some useful information for prospective service users and their representatives, enabling an informed decision about admission to the home. EVIDENCE: A Service User Guide and Service User Contract had been completed since the last inspection of this home. Both documents were illustrated with pictures to help service users to understand them. An updated copy of the home’s Statement of Purpose had not yet been received by the CSCI at the time of writing. George Beal House Version 1.10 Page 9 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 and 7. Systems and staffing levels at night do not promote individual choice for service users. Care plans do not provide enough clear and consistent information to ensure that service users’ holistic needs are met. EVIDENCE: George Beal House Version 1.10 Page 10 Care plans contained some useful information but were still limited in the objectives being set and how these were to be achieved. In addition, at times guidelines and information were not clear and inconsistencies were noted. An example of this was the care for one service user’s hair. One plan stated ‘weekly’ care, a new secondary plan stated ‘regular’ care, and a member of staff verbally stated that it should be daily care. Staff said that service users’ families and representatives were being contacted for relevant information as part of a new care planning system however, it was not clear how this information was being used. It was discussed that any information provided by families etc should be easily identifiable. Plans were not yet user friendly. On a positive note, there was some evidence that service users were being encouraged to develop their own skills i.e. through personal care and household tasks. Discussions had previously taken place regarding the home’s intercom system which is used to monitor service users at night time. Previous inspections had requested that the home consider alternatives that promote service users’ privacy, dignity and human rights. The agency assistant manager said that funding had been secured for a more appropriate intercom system, but this had not yet been installed. The inspector learnt that due to the layout of the building and staffing levels at night, service users wishing to stay up later than 8.30/9pm would need to be in their bedrooms so that they could be monitored through the intercom system. It was noted that the home had introduced some decision making/consent forms for issues such as this. Due to the profound disabilities of service users, part of this process involved getting a thumbprint as agreement from each individual. The inspector was concerned about this arrangement and stressed that this could only be used to demonstrate that information had been shared with individuals rather than this being an indicator of consent. Representatives of service users were also requested to give their consent however, it was discussed that at times this would also be inappropriate, and that important decisions should be made as part of a multi agency approach. George Beal House Version 1.10 Page 11 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) 12, 14, 15 and 17. The home has made some positive steps towards meeting service users’ recreational needs. Choice and participation for service users with regard to meal preparation and planning is poor. There are also concerns relating to the arrangements for the provision of soft/pureed food. EVIDENCE: On arrival, two of the six service users living in ‘B’ bungalow were up and having breakfast. One service user was staying with his family, and three were either enjoying a lie in or were in the process of getting up and dressed. Plans were in hand for one service user to go out for lunch at a local pub, and for two service users to go to the circus later in the day. Appropriate support was provided to service users with regard to meals. This was provided at the individual’s own pace, and staff encouraged service users to feed themselves as far as possible. George Beal House Version 1.10 Page 12 Meals were being prepared in a central industrial kitchen. Service users did not therefore participate in meal planning or preparation, and external suppliers were delivering food in bulk. Breakfast on the day of this inspection was a choice of cereals or toast/bread. The inspector queried if service users could have a cooked breakfast and was told that as the cook was not yet on duty, this would require a member of staff to leave the bungalow to prepare this, or that scrambled eggs, beans etc could be produced in the unit by using a microwave. Until reprovision of this service takes place, the possibility of providing hobs in each unit was discussed as a way of offering more choice to service users, whilst at the same time, providing for a sensory experience. Staff on duty felt that there were service users who would enjoy an occasional cooked breakfast. Meal times had been discussed at the previous inspection of this home. During this inspection, the inspector observed how one service user due to having a lie in, only had one hour between breakfast (a honey sandwich), and a cooked lunch of stew, dumplings, potatoes, cauliflower and green beans followed by a dessert of rice pudding. It was discussed that there needed to be more flexibility, particularly at weekends, regarding meal times. The inspector was told that there was only one choice of meal available unless a specific request was provided to the cook. It was discussed that menus consisted of primarily traditional British meals, and that limited options were available to reflect the cultural needs of some service users (including respite customers). Take away meals were being accessed on an infrequent or individual basis. The assistant manager said that menus were in the process of being revised. A small number of service users required soft or pureed food. Meals were being provided from the main kitchen in a hot trolley, and then liquidised as a whole by staff within the bungalow. The inspector discussed that this was poor practice and that each food item should be liquidised separately to give the meal an attractive appearance, and to enhance individual’s sensory experiences. A shortage of drivers had previously been discussed. It was pleasing to hear that the number of trained drivers had increased and there was evidence that service users’ activities were increasing as a result of this. In addition, one member of staff said that the manager was encouraging service users to use their mobility allowances to access other methods of transport, such as taxis, in a bid to increase opportunities for integrating within the community. See also ‘conduct and management’ of the home section of this report. Some of the communal entertainment equipment within ‘B’ bungalow was old or not working. There was no DVD player, and staff said that only the radio worked on the music system. George Beal House Version 1.10 Page 13 The home had still not provided telephone points in bedrooms or a cordless telephone for use by service users. One service user went to phone her mum during this inspection and staff spoke of getting a mobile phone for her, at a cost to herself. It was discussed that as she would only use this on an irregular basis that it would be more cost effective for her to contribute to a telephone service provided by the home. One service did not attend day care, and this was reportedly a positive choice made by the individual in question. Staff questioned whether or not this should be reviewed from time to time due to the person’s specific health care issues. The inspector endorses this as an approach. In addition, due to systems such as finances, staffing rotas, individual responsibilities, covering shortages in other bungalows, staff handovers etc, the inspector was told that ‘days off or at home’ for service users, realistically meant only between the hours of 10.30am and 2pm. George Beal House Version 1.10 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 and 19. Service users’ personal and health care needs are adequately met. EVIDENCE: Staff were observed to be delivering support and personal care in an appropriate and respectful manner. Service users’ health care needs were being addressed within care plans and related documentation. Appropriate equipment and measures were in place with regard to pressure care for service users. George Beal House Version 1.10 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 standard(s) 22 The home had a satisfactory complaints system. EVIDENCE: Information regarding the home’s complaints procedure was available within the Service User Guide. George Beal House Version 1.10 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 standard(s) 24, 27, 29 and 30 The environment does not adequately meet the requirements of the NMS for Younger Adults, and is institutional in a number of aspects. EVIDENCE: The inspector noted the environment to be clean, tidy and free from offensive odours. The organisation of the home and the building was institutional in a number of aspects. The management had previously explained that the long-term plan for the home was re provision, but no known timescales had been set. See also ‘conduct and management’ of the home section of this report. A mobile hoist was being shared between ‘A’ and ‘B’ bungalow. Staff indicated that this caused difficulties at times, but that the installation of overhead hoists would alleviate this somewhat. George Beal House Version 1.10 Page 17 It was noted that specialist equipment required at meal times such as tabards and spoons appeared to be in short supply by lunchtime. The local Fire Authority had inspected the premises on 9th March 2005 and found the existing fire safety measures to be satisfactory. George Beal House Version 1.10 Page 18 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) 32 and 33. The staff have a good understanding of the service users’ support needs. EVIDENCE: On the morning of this inspection 3 members of staff were supporting 5 services within ‘B’ bungalow. This appeared to be adequate to meet the complex needs of these individuals. Staff commented on the fact that the manager was organising rotas in such a way to ensure that appropriately skilled staff (i.e. medication trained or bus drivers) were available as required. Staff felt that external opportunities for service users had increased because of this. Staff on duty had all worked at the home on a relief or permanent basis for an adequate period of time to be able to provide individual and consistent support to service users. Staff demonstrated a good awareness of individual service user’s needs, and the needs of the service. They were observed to be attentive and respectful, and all spoke to service users as they supported them. Comments made to the inspector were delivered in a constructive manner, and are reflected throughout this report. Staff who were not working within ‘B’ bungalow were observed to knock before entering. George Beal House Version 1.10 Page 19 George Beal House Version 1.10 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) 38. After a period of considerable change and instability, staff are now receiving clear management guidance and direction. EVIDENCE: George Beal House Version 1.10 Page 21 Since the last inspection, the home had had another change in management, and an agency manager, Stuart Tripcony, had been appointed on a temporary basis. A number of staff spoke positively about Mr Tripcony and his input since coming to the home. Staff said that the manager was taking the service forward, and that he was an open and listening manager. One person said that the manager included staff and gave them the autonomy to carry out their roles. Previous experiences of a ‘them and us’ style management structure appeared to be fading. The inspector also observed a positive rapport between staff and an agency assistant manager. Kate Walker, operations manager, was in the process of applying to the CSCI to become the ‘Responsible Individual’ for this service. Reports in accordance with regulation 26 of the Care Homes Regulations 2001 were now being received by the CSCI. There was evidence of progress having being made since the last inspection of this service. The assistant manager summarised these as an increase in external activities for service users, the provision of overhead hoists in 3 bedrooms, plans to refit 2 bathrooms to include overhead hoists (in line with advice from relevant external assessors), the introduction of a secondary care planning system, the completion of reviews for all service users, arranging holidays for all but one service user (days out were to be arranged for this person as an alternative), securing funding for a new intercom system, an increased number of referrals to local advocacy services, and training for staff (including LDAF, mandatory, medication and NVQs). In addition, a number of requirements made as a result of the last inspection, had been addressed. SCORING OF OUTCOMES George Beal House Version 1.10 Page 22 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x x x 3 Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x 1 x 2 3 Standard No 11 12 13 14 15 16 17 x 2 x 3 2 x 1 Standard No 31 32 33 34 35 36 Score x 3 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score x 3 x x x x x George Beal House Version 1.10 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4 Requirement The registered person must ensure that the Statement of Purpose is completed and made available. Please forward a copy to the CSCI on completion. (Timescale of 1.4.04 not met0. The registered person must provide toilet and bathroom facilities that are in good decorative order. (Timescale of 1.4.05 not met). The registered person must ensure that an effective quality assurance programme is developed. (Not assessed on this occasion). The registered person must ensure that records of all accidents/incidents are clear, legible and comply with data protection legislation. Please also ensure that the home manager acknowledges all accidents and incidents, and that there is evidence of follow up action as required. (Not assessed on this occasion). The registered person must ensure that all information (inc notices), and individual records with regard to service users, are Version 1.10 Timescale for action 15.5.05 2. YA27 23 30.6.05 3. YA39 24 31.5.05 4. YA41 17 31.5.05 5. YA40 17 31.5.05 George Beal House Page 24 6. YA17 16 7. YA6 15 8. YA34 19 9. YA39 7, 26 10. YA26 and YA15 16 11. YA35 18 kept secure and confidential. (Timescale of 7.5.04 not met) The registered person must evidence that service users are actively supported to help plan, prepare and serve meals in the home. (Timescale of 31.5.04 not met). The registered person must ensure that care plans are completed for all service users which fully meet the requirements of NMS 6 for Younger Adults. This must include any restrictions on choice and freedom, and identify clear goals with regard to the individuals development of skills and abilities. In addition, plans should be produced in a language and format that the service user can understand. (Timescale of 1.7.04 not met). The registered person must maintain evidence in the home to demonstrate that satisfactory recruitment procedures (for all staff) have been followed. *Please note that from 26/7/04 Schedule 2 has been updated within the amended Care Standards Act 2000 (Establishments and Agencies) (Miscellaneous Amendments) Regulations 2004. (Not assessed on this occasion). The registered provider must submit an application for Responsible Individual. (Timescale of 30.10.04 not met). The registered person must provide a telephone point (in service users bedrooms) or access to a cordless phone handset for use in rooms. (Timescale of 30.10.04 not met). The registered person must introduce a training and Version 1.10 30.6.05 30.6.05 30.4.05 31.5.05 30.6.05 31.5.05 George Beal House Page 25 development plan for all staff that incoporates induction, LDAF, mandatory, specialist and NVQ training. The plan must also identify how 50 of the care staff will hold an NVQ award in care by 2005. Individual staff training records must be maintained with copies of training course certificates (Not assessed on this occasion). The registered person must ensure that the homes policies and procedures are specific to the home, up to date, signed and regularly reviewed. Policies and procedures should cover the topics set out in Appendix 2 of the NMS for Younger Adults. (Not assessed on this occasion). Service users must be offered a varied choice of meals which meet their dietary and cultural needs. All meals must be attractively presented including soft and pureed options. Ensure that specialist equipment is provided in adequate quantities to ensure the needs of service users are met at all times. 12. YA40 17 30.6.05 13. YA17 12,16 15.5.05 14. YA29 16 31.5.05 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. Refer to Standard YA6 Good Practice Recommendations Consideration should be given to maintaining all current information regarding individual service users within just Version 1.10 Page 26 George Beal House 2. 3. YA12 YA14 one file per person. Review the current day time opportunities for the individual outlined in the lifestyle section of this report. Provide entertainment equipment within communal areas that is in good working order, and that meets the needs and preferences of the service users. George Beal House Version 1.10 Page 27 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI George Beal House Version 1.10 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!