Inspection on 18/04/08 for George Beal House

This inspection was carried out on 18th April 2008.

CSCI found this care home to be providing an Adequate service.

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 19/04/07

George Beal House 10/04/06

George Beal House 29/11/05

George Beal House 16/04/05

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 Bedford MK42 7HL Lead Inspector Nicky Hone Unannounced Inspection 18th April 2008 12:45 George Beal House DS0000033055.V362600.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 George Beal House DS0000033055.V362600.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. George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service George Beal House Address Off Williamson Road Kempston Bedford MK42 7HL 01234 857300 01234 843225 georgebealhouse@bedscc.gov.uk 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) Bedfordshire County Council Mrs Violet Ntombizodwa Masters Care Home 16 Category(ies) of Learning disability (16) registration, with number of places George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. Care Home Category: LD - Learning Disablilty (Longstay) (10) Category: LD - Learning Disability (Respite) (6) Period of stay for respite service users - maximum six weeks Gender: Male and Female Age: over 18 years Service Users may also have additional physical disabilities Date of last inspection 19th April 2007 Brief Description of the Service: George Beal House is a local authority care home, situated in a residential area close to the centre of Kempston. Local amenities are close by, and Bedford, with its range of shops, restaurants and leisure facilities is a short drive by car or bus. The building is made up of three interlinked bungalows, each of which has its own lounge, dining/kitchen, bathrooms and single bedrooms. There is also a large shared lounge near the front door, a laundry, main kitchen, staff facilities and offices. George Beal House offers a permanent home to ten adults with profound multiple disabilities (learning and physical), in two of the bungalows. The third bungalow offers respite care to six people with disabilities. Gardens surround the home and there are parking spaces at the front. Fees are currently £1686 per week. Additional charges are made for transport, some activities, holidays, outings, magazines and newspapers, and personal items such as clothing, toiletries, and hair care. George Beal House DS0000033055.V362600.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 1 star. This means the people who use this service experience adequate quality outcomes. For this inspection we (the Commission for Social Care Inspection) looked at all the information that we have received, or asked for, since the last key inspection of George Beal House. This included: • The AQAA (Annual Quality Assurance Assessment) that the manager completed and sent to us in March 2008. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living at the home. It gives the manager the opportunity to say what the home is doing to meet the standards and regulations, and how the home can improve to make life even better for the people who live there. The AQAA also gives us some numerical information about the service; Surveys which we sent to people who use the service, to their relatives/carers, and to staff. We received 5 replies. Some of the comments from the surveys, and some of the results are quoted in the summary and in the body of the report; What the service has told us about things that have happened in the service, these are called ‘notifications’ and are a legal requirement; and Information we asked the home to send us following our visit. • • • This inspection of George Beal House included an unannounced visit to the home on 18/04/08, when we met several of the people who live here and spoke with one of the people who was having a respite stay. We spent time with the manager and assistant manager, and some of the staff. The resources manager was present during our feedback session. Most of the people who live here do not use words to communicate, so were unable to tell us about their home, so we spent some time observing the support being given. We also looked at some of the paperwork the home has to keep. This included care plans, risk assessments, medication charts, and records such as staff personnel files, staff rotas, menus and fire alarm test records. George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: In their response to our survey, one member of staff wrote “With more staff, service users could go out more and mix in the community better”. We found a number of things the home could do better, which means we have made fifteen requirements. Two of the requirements were immediate requirements which we told the home about on the day of the inspection. Some of the things the home could do better include: • • Test the fire alarms weekly and keep a record of the tests Make sure fire doors are not wedged open DS0000033055.V362600.R01.S.doc Version 5.2 Page 7 George Beal House • • • • • • • Produce support plans which give staff clear guidance on the way each person wants their needs to be met Keep personal records securely Make sure people’s healthcare needs are met Improve the environment by doing some repairs and decorating Give staff enough training, especially in safeguarding, and health and safety topics, so they can do the best job possible Employ enough staff to meet people’s needs, and offer staff regular supervision Develop a quality assurance system so that people who live and stay at the home know their views are taken into account 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. George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 People who use this service experience good quality outcomes in this area. People can be confident that their care will be based on good information the home has collected about them. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has a Statement of Purpose, and a Service User Guide. The statement of purpose was updated in early 2008. The manager updated the service user guide on the day of the inspection to include a change in contact details for the CSCI. The information is in pictures as well as words. Everyone who comes to live, or stay, at George Beal House, has their needs fully assessed before they move in, both by their social worker and by staff from the home. There have been no permanent admissions since our last inspection. We saw assessments on file for people who have respite stays. These contained sufficient detail about the person so that staff could then develop a care plan. George Beal House DS0000033055.V362600.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, 9, 10 People who use this service experience adequate quality outcomes in this area. Support plans have improved but still did not contain sufficient information and guidance for staff so that each person can be sure their individual needs will be fully met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We looked at the support (care) plans for five people. We also spent some time with the assistant manager talking about the support plans. She explained that the home is in the process of changing all the plans to a new format which is designed to include more detail. This is more person-centred and is being written with each person being involved as much as possible. It includes sections such as “Important people and things about me”, “Communication”, How I stay Healthy”, “Things I like / like to do / make me George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 11 happy / don’t like”, as well as routines and guidance for staff about personal care. This is the fourth inspection where we have been told that the files were being updated. The plans we saw did not include enough detail or adequate guidance for staff in all areas of the care needed. One of the new plans showed that staff still need further training on understanding what a support plan is for, and how to complete one so that it is a useful working document. For one person, the new format care plan had been started but was nowhere near to completion. The ‘old’ care plan was still in place: this had not been reviewed since December 2006. There was little evidence to show that people are involved in decisions about their lives. The manager told us that communication passports are in place for each person. These have been devised with the Speech and Language Therapist. The manager said they could be improved further, for example in a more relevant format for the person who is blind. The assistant manager also spoke with us about risk assessments which were all being updated and personalised. There are 35 areas of risk which have been identified, so up to 35 assessments are being carried out for each person. This is still a ‘work in progress’, but is an improvement on the risk assessments that were in place at our previous inspection. We found some files containing personal information about some of the people who live and stay at the home on top of a cabinet in one of the dining rooms. Personal information must be stored securely. George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 People who use this service experience adequate quality outcomes in this area. There are not enough opportunities for people to take part in leisure activities and outings so that they can lead full and stimulating lives. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: All the people who live at George Beal House attend day services away from the home. Each person has one day off a week, when they have time with their keyworker to go shopping or carry out household chores such as helping to clean their room or do their laundry. Several people spend time away from the home with their families. One person whose records we looked at goes home to her parents most weekends. There was no evidence that this person had been offered any activities in the George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 13 evenings. We were told that spontaneous activities are almost impossible because of staffing limitations. We were also told that the “weakest staff points are at weekends”, and that little activity is possible. Staff can plan activities and then extra staff are asked to work. One staff member said there is always something going on. However, these activities only involve a few people at a time, with little for everyone else to do. One person told us that he likes to go out and would like to go out more. On the files we looked at we saw little evidence of any activities or outings taking place. One person’s file in particular had no evidence of any community access. One person had booked a holiday with another person when they will be supported by three staff. Staff said all the people who want to go on holiday will be given the opportunity. There are 2 cooks who prepare the meals in the main kitchen at George Beal House. People have their main meal in the evening during the week, and at lunchtime at weekends. The main meal is 2 courses. There is a meat dish and a meat-free dish for people to choose from each day, plus alternatives if people do not like what is on the menu. There is a choice of either a hot or a cold pudding. People choose each day what they would like to eat in the evening: this record is kept as the home’s record of food provided. The cook told us that lunch for the few people at home during the week is usually prepared in the bungalows. There are plans for more meals to be cooked in the new kitchenettes in the future, with assistance from people who live here. The cook has had advanced food hygiene training. According to the information in the AQAA, only two care staff have had basic food hygiene training. All staff who prepare food must have this training. George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People who use this service experience adequate quality outcomes in this area. There is not an adequate system in place to make sure that people’s healthcare needs are addressed in the best way to make sure they remain as healthy as possible. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We observed staff and people who live here together and they seemed comfortable in each other’s company. Staff showed respect and warmth towards people and gave support in a friendly, relaxed way. On the whole the staff we spoke with had a good understanding of people’s needs. We discussed healthcare with the manager and the resource manager. We were shown minutes of a management meeting held in April when it had been agreed that a Health Action Plan would be introduced for each of the people who live here permanently. We did not see a system in place currently to George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 15 make sure that each person has regular health checks. The manager told us that most people attend a mobile dentist when it visits the day service and people are referred to the health team if a need to see an optician is identified. Two staff (including the manager) have done training in cutting nails. If people need to see a chiropodist, the doctor has to refer them to the clinic. One person’s support plan showed that he had not been weighed since April 2005. There was no reason recorded as to why his weight had not been checked more regularly. The manager said the staff would link with the dietician if they had any concerns about anyone’s weight or appetite. Healthcare for the people on respite stays remains the responsibility of their main carer, unless there is an emergency or a booked appointment during the person’s stay. None of the people who live at George Beal House would be able to look after their own medication safely. Each person has a form on their file, signed by their representative, giving consent for staff to administer their medication. We looked briefly at the medicines in two of the bungalows: all were in date and stored in a satisfactory way. The Medication Administration Records had been signed correctly. George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People who use this service experience adequate quality outcomes in this area. People can be confident their concerns will be listened to, however staff have not received adequate training to know best practice in keeping people safe. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager showed us the compliments and complaints log. One complaint had been recorded since our last inspection, and we saw that an appropriate response had been made. The log contained a lot more compliments than complaints, from people clearly very pleased with the service their relatives had received. The home has a complaints procedure which is part of the Service User Guide. It included details of how people can contact the CSCI: the manager changed the contact telephone number during the visit. We saw that the manager has completed a safeguarding/Protection Of Vulnerable Adults (POVA) risk assessment, which had been signed by staff to say they had read and understood it. The most recent POVA policy from Bedfordshire County Council was on the file, and staff have signed that as well. George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 17 The new support plans include a statement which highlights any areas relating to safeguarding that staff need to be aware of. Staff have not had training in safeguarding adults. The manager said that although the number of courses arranged by Bedfordshire County Council has increased, the home has not been able to access any of the places. George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 18 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, 26, 27, 30 People who use this service experience adequate quality outcomes in this area. Although some areas of the home have been refurbished, there are parts of the home which are poorly maintained and which do not offer the people who live and stay here a comfortable and homely place to live. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: When she completed the AQAA the manager told us about the work that has been done to make the home more comfortable for the people who live here. During our walk round the building we saw that in bungalow A and bungalow B large, open kitchen/dining areas have replaced the small kitchenettes. These look bright, airy and modern and are more accessible to the people who live George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 19 here, but still do not adequately meet the specific needs of some people. All bedroom doors now have magnetic catches to hold the doors open. In bungalow B the lounge has been decorated and the carpet replaced. We were told that decoration in bungalow A has been “put on hold” because there is still a problem with subsidence. This has been a problem for some time now (we reported on this following our inspection in April 2007), so must be rectified without further delay so that the people who live here have a safe, comfortable place to live in. Everyone has his or her own bedroom, which has a washbasin. None of the bedrooms have ensuite facilities. We saw that work has started to personalise the bedrooms, and some people have decided to buy their own furniture. There are bathrooms and shower rooms throughout the building, with a variety of specialised baths, and there is overhead tracking in several of the bedrooms and bathrooms to assist people who need the use of a hoist. All three bathrooms have been refurbished and look fresh and clean. Paintwork in the corridors and on door frames in most areas of the home is badly scuffed from wheelchairs and hoists and needs to be decorated, and we saw that the carpets in some of the bedrooms need to be replaced. The ‘link corridor’ could be a pleasant area for people to sit as it looks out onto gardens both sides, but on the day of the inspection this area was being used to store spare tables. The shared lounge near the front door is large, bright and reasonably decorated. This lounge was being used by people who had arrived for their respite stay. The kitchenette/dining area/lounge in bungalow C (the respite unit) looks as though it has not been decorated for a long time. The whole area is shabby and looks dirty with black marks on the walls, especially above the radiators and where pictures have been moved. We noted that there are two handles on many of the bedroom doors. Although we were told that these have all been “de-activated” by a small switch, staff still used both handles to open the doors, indicating that perhaps they are sometimes still used. The majority of people who use this service would not be able to operate both handles, and would therefore be ‘locked’ in their bedroom. This is not acceptable and we have made a requirement that they should be removed. The staff team keep the home very clean, and all areas we visited smelt clean and fresh. However, there was a lot of ‘clutter’ around, including items such as underwear on the side in the dining room, numerous files and untidy paperwork on a side table, chairs shoved in corners and so on which made some areas look untidy and not homely. George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 20 In the report following our inspection in April 2007 we wrote “the sensory room appeared to be used for storage of furniture and was not easily accessed”. We were very disappointed during this visit to note that the room was still not being used as a sensory room. George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 People who use this service experience adequate quality outcomes in this area. There are not always enough staff on duty to meet people’s needs, and staff have not received sufficient training and supervision to make sure they know the best way to support each person. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We looked at the staff rota which showed that the number of staff on duty during the day changes depending on how many people are at home. The rota showed that a large number of agency staff are used, although the manager explained that some of the agency staff have been working at George Beal House for a long time. Each bungalow has a team of staff, led by a team leader, who work most of their shifts in that bungalow. We were told that the staff team in the respite bungalow has been “severely depleted” for some time. Although the shifts have been covered, by relief and agency staff, the team leader has found it George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 22 more difficult to get things done, such as updating the support plans. The manager told us the home is now trying to recruit permanent staff. Evidence from people’s files, and discussion with staff, showed that there are not always enough staff for the people who live at George Beal House to be offered an adequate number of activities and/or outings (see Lifestyle section of this report). Two staff who responded to our survey wrote “….there are staff shortages and budget issues” and “Often there is not enough staff”. An agreement was reached between Bedfordshire County Council and CSCI that staff files can be kept at County Hall. A sample of these will be inspected later in the year. However, a pro-forma is kept at the home, which details information about each staff member, including whether references were obtained, and the date a Criminal Record Bureau check was carried out. All the pro-formas we saw had a photograph of the staff member and included all the relevant information. In the AQAA the manager wrote that 16 out of the 34 care staff have achieved a National Vocational Qualification (NVQ) in care at level 2 or above, and 6 more staff are working towards this qualification. The manager told us that training records are kept on the computer but that these were not up to date. She said some training has taken place which has not been added to the record. From the records we saw, and from our discussions with staff, it was clear that staff have not received adequate opportunities for training, even in the ‘mandatory’ topics (moving and handling; fire safety; food hygiene; infection control; first aid). In the AQAA the manager wrote that only 2 of permanent care staff have had training in safe food handling. One staff member said they had fire training “about 18 months ago”: fire safety awareness training should be done twice every twelve months. Staff have not had sufficient training in safeguarding adults (POVA): (see Complaints, Concerns and Protection section of this report). Staff said they have not had regular supervision but the office door is always open and they felt confident they could talk about whatever they needed to. The manager confirmed that the management team have “struggled” with finding time for supervision, and that she is currently working out a plan so that staff will receive regular supervision. In their response to our survey, one staff member wrote “Would make you feel a lot more confident in your abilities if you were reassured by staff, especially the manager”. George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 People who use this service experience adequate quality outcomes in this area. This home is not managed well enough for the people who live here to have good quality, safe lives. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager, Violet Masters, has worked at this home for several years and is currently completing NVQ level 4 in care/management. In our report following the inspection in April 2007 we wrote “there is evidence to show that managers are committed to making improvements for the service users at George Beal House”. Although the manager and assistant manager we met are still George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 24 committed to making improvements, little improvement has actually taken place, and this inspection has resulted in a greater number of requirements. The minutes of the ‘strategy meeting’ held in April with the new resource manager show that the management team is aware of a number of areas that must improve, and are putting plans in place to address them. Most of the people who live and stay at George Beal House do not use words to communicate, therefore it is even more important that the home has systems in place to make sure people’s views about the service are sought and taken into account. In one of the bungalows we saw that some work has been started using ‘objects of reference’, and some work around choice of meals is done with people, using photographs of food. We were told that meetings take place in each bungalow – the last one in the respite bungalow was in January 2008 and we saw the minutes of that meeting. The manager told us that no other meetings have taken place this year. The manager said that there will be a meeting in May 2008 to introduce the new home’s advocate to the people who live here. Further work is needed to make sure people’s views are sought and acted on. We checked some of the records the home has to keep. The record of tests of the fire alarm system showed that the fire alarms had not been tested weekly as required. In the 68 weeks from 04/01/07, only 24 tests had been carried out. The last recorded test was done on 12/03/08, more than 5 weeks before our visit. We required the manager to make sure a test was done within 24 hours, and to put a system in place to ensure that tests are done weekly as required. We also noted that although faults were recorded, there was no evidence that any action had been taken to rectify them. Following our inspection the manager wrote and told us she had carried out a test of the alarms that same evening. We noted that the door to the laundry room was wedged open with a wooden wedge. We removed this during our visit. Fire doors must only be held open by a means approved by the fire authority. We gave the manager an immediate requirement regarding this, to make sure that fire doors are not wedged open. Staff have not received adequate opportunities for training in the topics related to health and safety, that is moving and handling; fire safety; food hygiene; infection control; and first aid. (See Staffing section of this report). George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X 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 2 25 2 26 2 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 2 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 X 2 X 2 2 X George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 YA6 Regulation 15 Requirement Each person who lives or stays at this home must have a full and detailed support plan which gives clear guidance to staff on the way they want their needs to be met, and which is regularly reviewed and updated. All personal information must be stored securely, so that people’s privacy and dignity are respected. Timescale for action 30/06/08 2 YA10 17(1)(b) 18/04/08 3 YA13 16(2)(m) and (n) All the people who live and stay at George Beal House must have the opportunity to access the local community, and to engage in appropriate activities both in and out of the home, so that they have a good quality of life. Previous timescales of 15/01/06 and 30/06/07 not fully met. 30/06/08 George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 27 4 YA19 13(1)(b) Healthcare needs of all the people who live at this home must be assessed and a system put in place to make sure any health needs are addressed, so that people are as healthy as possible. All staff must receive adequate training in safeguarding so that people are safeguarded from harm and abuse. The issue regarding the subsidence affecting bungalow A must be addressed to make sure the bungalow is safe and well maintained for the people who live there. A plan of redecoration must be drawn up, giving timescales for when decoration in the areas identified on the day of the inspection as being in need of decorating will be completed. The plan must be submitted to CSCI within the timescale. The decorating must be completed before the end of 2008, so that the people who live at and visit George Beal House have a pleasant place to be in. The carpets identified as being stained and worn must be cleaned or replaced. The double handles on the bedroom doors must be removed, so that people cannot be ‘locked’ in their rooms. 30/06/08 5 YA23 13(6) 30/06/08 6 YA24 23(2)(b) 31/07/08 7 YA24 23(2)(d) 30/06/08 8 YA24 16(2)(c) 31/07/08 9 YA26 13(7) 30/06/08 George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 28 10 YA33 18(1)(a) There must be sufficient numbers of staff on duty to meet the needs of the people who live and stay here, including their needs for activity and stimulation. 30/06/08 11 YA35 18(1)(c) Staff must receive training in a range of topics relevant to the care of the people who live and stay here, including the five topics relating to health and safety, so that they can do their job well. A plan of training must be submitted to CSCI within the timescale, and all staff must receive training in at least the five topics above, by 30/09/08. 30/06/08 12 YA36 18(2) Staff must receive adequate supervision so that they can do their job well. All staff must receive one session within the timescale, and at regular intervals after that. 30/06/08 13 YA39 24 There must be an effective quality assurance system in place to make sure the best quality of service is offered to the people who live or stay at George Beal House. The system must be based on the views of the people who live and stay at the home, and must show how these views are taken into account. 30/09/08 George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 29 14 YA42 23(4)(c) Health and safety of the people who live and stay at this home must be given greater priority. Records must show that the fire alarm system has been tested weekly as required, and any faults rectified. We gave the home an immediate requirement on the day of the inspection, to test the fire alarm system within 24 hours. 19/04/08 15 YA42 23(4)(a) Fire doors must not be held in the open position with anything other than a device approved by the fire authority. We gave the home an immediate requirement regarding this on the day of the inspection. 18/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Regional Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 George Beal House DS0000033055.V362600.R01.S.doc Version 5.2 Page 31 - 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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