Inspection on 19/04/07 for George Beal House

This inspection was carried out on 19th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 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 Vanessa Rumball Unannounced Inspection 19th April 2007 07:00 George Beal House DS0000033055.V336952.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.V336952.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.V336952.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 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.V336952.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 10th April 2006 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). The home also has 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. Fees are currently £654 per week. Additional charges are made for transport, some activities, holidays, outing, clothing, toiletries, hair care and magazines and newspapers. George Beal House DS0000033055.V336952.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, and took place from 07:00 to 15:30hrs. The inspector met service users, spoke to manager and staff on duty, looked at records, and had a tour of the premises. In addition views were sought from service users and their representatives via surveys. All service users surveys were completed with the help of support workers who work at the home. Service users had little or no verbal communication skills, and could only provide limited information about the care they received. Because of this, the inspector spent the majority of the inspection in ‘A’ bungalow, which is one of the long stay bungalows, to observe the care being provided. The inspector was grateful for the help of all those who participated in this inspection. This inspection report should be read in conjunction with the National Minimum Standards for Care Homes for Adults (18 – 65). What the service does well: What has improved since the last inspection? There had been a number of improvements in this service since the last inspection including the following: • • • Further work has been done on care planning and related paperwork. A mobile phone had been purchased so that service users could make calls in private. Service users were involved in menu planning and a picture menu was available if required. George Beal House DS0000033055.V336952.R01.S.doc Version 5.2 Page 6 • • • • Kitchenette areas and bathrooms had been refurbished. The manager checked all staff properly, and had copies of all the required information, before staff started work. Staff were well supervised and, on the whole, well trained to meet the needs of the people living at this home. Although a number of agency staff worked in this home, the manager had recently interviewed and recommended 3 support workers and a cook. What they could do better: There remained a few things the agency could do better. These included: • Care plans and related paperwork, still need further work to provide sufficient accurate information for staff to meet the needs of all the people who use the service. Risk assessments must be reviewed regularly and state whether a risk is acceptable or not. As previously reported, despite the limitations of the current environment, consideration must be given to improving service users’ opportunities to develop their individual skills, and enjoy more sensory experiences associated with every day home life and ordinary living principals. A record must be kept of the exact dose of all medicines administered on each occasion, and guidance must be provided to staff for where medication is to be administered that is prescribed to be given ‘when required’. • • • 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.V336952.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection George Beal House DS0000033055.V336952.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has developed useful information to enable prospective service users and their representatives to make an informed decision about the services offered at the home. Service users are assessed prior to the home providing care. EVIDENCE: Information regarding the home’s assessment procedure is included in the Statement of Purpose. In addition, there was evidence that appropriate and detailed information was generally being obtained prior to admission. In one instance, not all information had been obtained, but a risk assessment had been carried out and additional staff, with specialist training, were provided while the assessment was carried out. As stated previously, the home had developed a Service User Guide, and a Service User Contract. Both documents were illustrated with pictures to help service users to understand them. Service users and their families had signed copies of their contract and these were held on file. George Beal House DS0000033055.V336952.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The views of the people who use the service had been increasingly sought and their care needs were generally met. However, care plans contained some inconsistencies and could result in needs not being met properly. EVIDENCE: During the last two visits to the home, we have been told that service users files were being updated. Again at this inspection, some good examples of service user planning and related paperwork were seen. However, we did note some minor inconsistencies on individual files during this visit. These included one staff member describing a goal that a service user had, and was being worked towards, but this was not recorded on the service users care plan; additions and deletions to care plans being made, but not dated or signed and; information about medication had not been updated on individuals care plans. George Beal House DS0000033055.V336952.R01.S.doc Version 5.2 Page 10 The manager told us that all respite service users files and care planning paperwork had been reviewed. We did not verify this on this occasion. As it is evident that the home has continued to work to meet the requirement of the previous inspection, this requirement has now been removed. However, the home should continue this work and ensure that inconsistencies are eliminated. Risk assessments were in place, but, for one service user whose care we tracked, there was no evidence that these assessments had been reviewed since April 2005. A risk assessment was seen that stated ‘stop this practice immediately’ and referred the reader to other guidance for the situation. However, some risk assessments stated that the likelihood of a risk had a ‘high risk of occurring’ but did not state whether the risk was acceptable of not. We saw some records of discussions with service users that showed how they were consulted and their opinions sought. In the main the survey responses we received were positive regarding service users views of the home. Support workers from the service had helped service users to complete these, but the manager stated that advocates will be approached to do this in future. A service users representative commented that he/she felt that the service user was mostly happy to let others choose on his/her behalf and was often ‘carried along by the routine.’ George Beal House DS0000033055.V336952.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15,16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is limited evidence that all service users have regular access to a variety of meaningful activities. Participation arrangements for service users with regard to meals, although improved, continue to be poor. EVIDENCE: Again during this visit, files showed limited community presence achieved by service users. However, it clear from talking to staff that this had increased and further information was being sought regarding the use of public transport and in regard to access. Both service users, whose care we tracked, took part in a structured day care programme four days each week. The fifth week-day was spent at the home, or out, with a support worker. One of the service users took part in cooking in the main kitchen on occasion and light housework e.g dusting. George Beal House DS0000033055.V336952.R01.S.doc Version 5.2 Page 12 Service users were encouraged and enabled to maintain contact with family members and friends. Although service users do not have telephone points in their bedroom, the home had a mobile phone that service users could use in private. Each bungalow within the home had a kitchenette area, but these did not have sufficient equipment for meals to be prepared on a regular basis. Therefore meals were prepared in the main kitchen. Service user involvement with menu planning had increased significantly over the last year and a picture menu was now available. A service user who was able to move independently was seen collecting his/her breakfast things from the kitchenette and clearing up after the meal and some service users had been shopping for food. However, actual opportunities for service users to be involved with meal preparation were still very limited and could only take place, on occasion, in the main kitchen of the home. Appropriate support was provided to service users who required help at meal times. George Beal House DS0000033055.V336952.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ personal and health care needs are adequately met. However, some aspects regarding medication need to be improved to ensure the safety and well-being of the service users. EVIDENCE: Staff were observed to deliver support in a respectful and unhurried manner. On the whole, staff spoke with service users while assisting them with their care. However, we did see staff entering the dining area, where service users were sitting, without acknowledging them. Records indicated that service users’ health care needs were generally addressed within care plans, and other related documentation. Staff had a good understanding of service users needs and knew about the care plans and guidance to be followed. The instructions for administering and storing medication was reviewed in December 2006. George Beal House DS0000033055.V336952.R01.S.doc Version 5.2 Page 14 We saw medication records for two service users. In both cases there were some shortfalls, These included: • Medication prescribed to be given ‘one or two spoonfuls,’ although the medication record was signed that this had been administered, it did not state how many spoonfuls had been administered • Two medications were prescribed to be given ‘when required’ but were not in the home • No guidance for the administration of two medications to be administered ‘when required’ • Two medicines were in the cupboard, but were not recorded on the administration record, staff stated that these were no longer administered to the service user. Where an error in administering medication had been made, appropriate guidance had been sought, investigation and actions recorded, and notifications made. George Beal House DS0000033055.V336952.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has satisfactory systems in place to protect service users from harm and abuse, and to deal with any complaints or concerns about the service. EVIDENCE: Records showed that there were satisfactory arrangements in place to deal with complaints and any potential POVA (Protection of Vulnerable Adults) incidents. Three complaints / concerns had been investigated since the last inspection. Records were seen of the complaints, investigation, and the outcome letters to the complainants. These were of a satisfactory standard. George Beal House DS0000033055.V336952.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment does not adequately meet the requirements of the National Minimum Standards for Younger Adults, and is institutional in a number of aspects. Despite the opportunity to create better access and facilities for service users, recent environmental improvements suggest that this has not actually happened. EVIDENCE: As previously reported, a number of aspects regarding the organisation of the home and building were dated, and institutional. It is understood that the long-term plan for this service is reprovision, but the timescale for this to take place was still not known at the time of this inspection. George Beal House DS0000033055.V336952.R01.S.doc Version 5.2 Page 17 Since the last inspection, works to refurbish the bathrooms and kitchenettes in all three bungalows been completed. The décor in these areas was homely and a great improvement. However, the finished works did not adequately meet the specific needs of some service users, or promote better access and choice. For example, the new kitchenettes did not provide any more access for service users, or equipment to allow service users to participate in preparing food within their own living bungalows. As stated in the last inspection report, the décor in ‘A’ bungalow needed some attention, and cracks were still visible in the living room walls. The manager stated that further tests were to be carried out, but there were no dates for this. At the time of our visit the home was clean and tidy although the sensory room appeared to be used for storage of furniture and was not easily accessed. George Beal House DS0000033055.V336952.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 35 & 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected by the homes recruitment processes and staff work hard to make sure that service users are well cared for. EVIDENCE: As on our last visit to this home, there were two members of staff supporting four service users within ‘A’ bungalow. One member of staff had worked at the home for a number of years. The other member of staff was employed by an agency, and had worked at the home on a regular basis. Since the last inspection, rotas had been changed so that night staff came on duty at 10pm, one hour later than at when we visited last. Staff stated that service users were usually in bed when the night staff came on duty. Although staff records are all stored centrally at County Hall, a system had been set up, and agreed with us, that showed that the required information had been sought and verified prior to the worker starting employment. We sampled these records and they were satisfactory. George Beal House DS0000033055.V336952.R01.S.doc Version 5.2 Page 19 28 of staff had completed an NVQ in care and a further 16 were working towards this. The home had developed a training plan and a system for ensuring that refresher training in moving and handling etc was addressed. Training records for staff were seen. Some shortfalls had been identified, but plans were in place to rectify these. The manager said that interviews for staff had recently been held, and a cook and support workers had been recommended. However, there remained a vacancy for a member of the senior team which continued to put extra pressure on the remaining team members. George Beal House DS0000033055.V336952.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear line management structure in place, and there is evidence to show that managers are committed to making improvements for the service users at George Beal House. EVIDENCE: The manager had achieved NVQ level 4 in Management and was working towards an NVQ level 4 in Care. George Beal House DS0000033055.V336952.R01.S.doc Version 5.2 Page 21 Staff, who were spoken to, were generally positively about each other and the management of the home. Once again, it was observed that the team worked well together and, as a result, a relaxed and friendly atmosphere was noted. The resource manager for this home, as required by regulation 26 of the Care Homes Regulations 2001, had carried out monthly visits to the home to monitor the service. Reports of this were shown to the inspector. The manager was very good at notifying us of any issues we needed to be aware of. The manager confirmed quality assurance procedures included the resource manager’s monthly visits to the home, meetings with staff, service users and their representatives, and spot checks carried out by managers. However, no review of the previous years development plan was seen. The manager stated that the resource manager had a business plan for the service, but this was not available in the home. We saw one bottle of unmarked liquid in a bathroom. This was assumed to be hand-wash. This was removed during the inspection. No other concerns relating to health and safety were noted during this inspection. George Beal House DS0000033055.V336952.R01.S.doc Version 5.2 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 Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 X 12 2 13 1 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 X 2 X X 3 X George Beal House DS0000033055.V336952.R01.S.doc Version 5.2 Page 23 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. 2. Standard YA9 YA13 Regulation 13 12 and 16 Requirement Risk assessments must show whether the risk is acceptable and be regularly reviewed. All service users must have the opportunity to access the local community, and to engage in appropriate activities both in and out of the home. Previous timescale of 15/01/06 not fully met. 3. YA20 13 A record must be made of the dose of medication administered to each service user on each occasion, and guidance for administering medications prescribed to be taken ‘when required’ must be available to all staff who administer medication. 30/06/07 Timescale for action 30/06/07 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. George Beal House DS0000033055.V336952.R01.S.doc Version 5.2 Page 24 No. Refer to Standard Good Practice Recommendations George Beal House DS0000033055.V336952.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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.V336952.R01.S.doc Version 5.2 Page 26 - 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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