Inspection on 26/01/05 for Homebeech

Care Home For Older PeopleHomebeech19/21 Stocker Road Bognor Regis West Sussex P021 2QHUnannounced Inspection26 January 2005 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: · Promote improvement in social care · Inspect all social care - for adults and children - in the public, private and voluntary sectors · Publish annual reports to Parliament on the performance of social care and on the state of the social care market · Inspect and assess `Value for Money of council social services · Hold performance statistics on social care · Publish the `star ratings for council social services · Register and inspect services against national standards · Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment Homebeech Address 19/21 Stocker Road, Bognor Regis, West Sussex, P021 2QH Email address Name of registered provider(s)/company (if applicable) Homebeech Limited Name of registered manager (if applicable) Miss Marie-Claire Vallerich Type of registration Care Home No. of places registered (if applicable) 66 Tel No: 01243 823389 Fax No: 01243 841295Category(ies) of registration, with (number of places) Old age, not falling within any other category (50), Physical disability (16), Physical disability over 65 years of age (16) Registration number H110000294 Date first registered Date of latest registration certificate 30th July 2002 Was the home registered under the Registered Homes Act 1984? Do additional conditions of registration apply ? Date of last inspection 7th December 2004 YES YES 01/06/04 If Yes refer to Part CHomebeechPage 1 Date of inspection visit Time of inspection visit Name of inspector Name of inspector Name of inspector 1 2 326 January 2005 08:15 am Mrs L RiddleID Code076694Name of inspector 4 Name of specialist (e.g. Interpreter/Signer) (if applicable) Name of establishment representative at the time of inspectionMiss M-C Vallerich and Mr A R Marchant.HomebeechPage 2 CONTENTSIntroduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspectors Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Methods & Findings National Minimum Standards For Older People: Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management & Administration Part C: Part D: D.1. D.2. D.3. Compliance with Conditions (if applicable) Providers Response Providers Comments Action Plan Providers AgreementHomebeechPage 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the Commission for Social Care Inspection (CSCI), is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000. This document summarises the inspection findings of the CSCI in respect of Homebeech. The inspection findings relate to the National Minimum Standards (NMS) for Care Homes for Older People published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the CSCI regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the Standards. The report will show the following: · Inspection methods used · Key findings and evidence · Overall ratings in relation to the standards · Compliance with the Regulations · Required actions on the part of the provider · Recommended good practice · Summary of the findings · Providers response and proposed action plan to address findings This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The report is based on the findings of the specified inspection dates.HomebeechPage 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. Homebeech is a care establishment providing accommodation and nursing care for 50 older people and for 16 people between 18-65 years of age who have physical disabilities. The service is privately owned by Homebeech Limited. The Responsible individual on behalf of the company is Mrs Sandra Ellis. The registered manager in charge of the day to day running of the establishment is Miss Marie-Claire Vallerich. Homebeech has been awarded a contract with West Sussex County Council to provide a number of nursing beds in the home. The establishment is located in Bognor Regis, close to the sea front, shops and other amenities. It was opened in 1998 and consists of a large extended property, which was originally four houses. The majority of the rooms are single with en-suite facilities. A passenger lift is available. A unit called The Daffodil Suite, for younger physically disabled people was built more recently. This unit is part of the overall premises of Homebeech care home for older people, but has its own separate communal space, living accommodation and staff. Catering and laundry facilities are shared with the main establishment .HomebeechPage 5 PART A SUMMARY OF INSPECTION FINDINGSINSPECTORS SUMMARY (This is an overview of the inspectors findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.) This inspection was carried out over one day in February 2005. In view of the two registration categories which apply in the establishment, both the National Minimum Standards for Older People (OP) and the National Minimum Standards for Adults (18-65) (YA) were reviewed during the inspection process. The majority of standards assessed were fully met or partially met, those not met were relevant to both sets of standards. Those standards not assessed on this occasion had been found to be met in full when the previous inspection was carried out in June 2004. This inspection generated one requirement which had also been made in the previous report. recommendations for good practice and to fully meet the relevant standards, are made in the report. The inspector was assisted with her enquiries by the registered manager and the care manager. She examined records and documents, made a tour of the premises and spoke with 10 service users, 2 visiting relatives, several members of staff and briefly with the registered provider. Service users and relatives expressed much satisfaction with the care, facilities and services provided. Policies and procedures were in place to support the delivery of care and records were well maintained. The building was in a good state of repair and decorative order and provided a very comfortable and pleasant environment for service users. Attention to fire safety precautions needed to be more strictly observed and an immediate requirement in respect of this was made. Appropriate staffing levels were being maintained.HomebeechPage 6 Choice of Home OP (Standards 1-6) YA (standards 1-5) All service users had been provided with clear statements of terms and conditions at the point of moving into the establishment. Documentation examined by the inspector showed that no service users are admitted to the establishment without a full assessment of their needs having been undertaken. Health and Personal Care OP (Standards 7-11) Individual needs and choices YA (standards 6-10) Suitable arrangements were in place for meeting the health and personal care needs of the service users. Care plans were very well developed, informative and met clinical guidelines. Procedures were in place and observed to be followed for the safe receipt, handling, recording, storage and disposal of medications. The privacy and dignity of service users was seen to be upheld by staff. Daily Life and Social Activities OP (Standards 12-15) Lifestyle YA (standards 11-17) Service users were able to choose from a range of activities or to follow their own interests and had opportunities to go out into the community, independently if able or with staff members. Staff in the Daffodil suite were able to provide some one to one attention during the quieter periods of the day. Routines were suitably flexible to suit service users individual lifestyles. Complaints and Protection OP (Standards 16-18) The establishment has a complaints procedure which is made available to service users and their representatives in the Service User Guide. Copies are also displayed in the establishment. The more able service users told the inspector that should they need to complain they felt able to do so and could follow the procedure. One complaint had been made direct to the Commission for Social Care Inspection. This had been appropriately investigated by the registered person and the Commission kept informed. It was found to be unsubstantiated. Personal and Healthcare Support YA (standards 18-21) Staff were observed to be sensitive and flexible to the needs of service users. Records indicated that service users have access to other health professionals. Concerns, Complaints and Protection YA (standards 22-23) Policies and procedures were in place to protect service users from all forms of abuse. Staff were given training in the procedures to follow and in relation to their responsibilities in respect of `whistle blowing. Environment OP (Standards 19-26) YA (standards 24-30) The location and layout of the establishment is suitable for its stated purpose and was seen to be well maintained externally and internally. The accommodation was furnished and equipped to a high standard and contained many aids and adaptations to assist service users with daily living. Communal space was light and airy. The report requires early action be taken to stop the practice of fire doors being wedged open. It is understood that many doors to private rooms will have new more suitable locks fitted to replace those which are currently too stiff for service users to operate them. Work to provide covers for all radiators is continuing. The premises throughout were clean, tidy and fresh and policies and procedures were in place and followed by staff, to prevent the spread of infection.HomebeechPage 7 Staffing OP (Standards 27-30) YA (standards 31-36) The staffing levels in both the main house and the Daffodil unit were considered to be suitable to meet the assessed needs of the service users accommodated. The establishment employs a high percentage of overseas staff and has put a training programme in place which is task orientated and assesses the individuals ability on each task performed. This has been put in place to assist with the initial language difficulties which might arise if training was more theory and orally based. National Vocational Qualification training is on going in the establishment and further development of this is expected. Management and Administration OP (Standards 31-38) Conduct and Management of the Home YA (standards 37-43) A quality assurance/monitoring system had been put in place and a recommendation has been made in the report to expand this to fully meet the standard. All staff are supervised in the course of carrying out their duties but a formal documented system of providing the required bi-monthly supervision/support sessions to care staff had not yet been implemented. Training for staff in topics relating to health and safety had been arranged and there were policies and procedures in place in relation to health and safety in the workplace. A recommendation has been made in the report in respect of the width opening of some windows above ground floor level where the restrictors did not appear to be operating to the specified limits.HomebeechPage 8 Requirements from last Inspection visit fully actioned? If No please list belowNOSTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard Required actions Timescale for action 1 23(4)(c) YA42 The registered person shall make adequate arrangements for detecting, containing and extinguishing fires. Immediate action was required.Action is being taken by the Commission for Social Care Inspection to ensure compliance in regard to the above requirements. RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented No. Refer to Good Practice Recommendations Standard 1 YA26 Locks on service users room doors should be maintained to ensure that they could be locked.CONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS).Met (Yes / No)HomebeechPage 9 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report, which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001 and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard * Requirement Timescale for action 1 23(4)(c) OP38YA42 The registered person shall make adequate OP19 arrangements for containing fires. Further to the immediate requirement for all fire doors to be kept closed the registered person by agreement, is to be installing approved appliances to doors which need to be kept open. Immediate31st March 2005RECOMMENDATIONS Identified below are areas addressed in the main body of the report, which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s). The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Refer to Good Practice Recommendations Standard * 1 2 YA24 YA39OP33 Locks fitted to the private rooms of service users should be of a type which can be easily managed by persons with a disability. An annual development plan should form part of the quality assurance/monitoring system.3Staff should have regular, recorded supervision meetings at least six YA36OP36 times a year with their senior/manager in addition to regular contact on a day to day basis.HomebeechPage 10 4OP38Arrangements should be made for the maintenance of window restrictors, based on assessment of vulnerability and risk to service users.* Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. OP10 refers to Standard 10.HomebeechPage 11 PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Direct observation Indirect observation Sampling · Pre-inspection questionnaire · Records · Care plans / Care pathways · Meals · Activities · Other (Specify) `Tracking care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting professionals survey / feedback Tour of premises Formal interviews Document reading Additional inspection information: Number of service users spoken to at time of inspection Number of relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the responsible individual seen CRB check for the manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total number of care staff employed (excluding managers) Total number of staff with nursing qualifications employed Date of inspection Time of inspection Duration of inspection (hrs) YES YES NO YES YES NO YES NO YES YES YES YES YES YES NO YES NO YES NO YES 10 2 0 YES YES YES YES 30 12 01/02/05 08:15 7.75HomebeechPage 12 The following pages summarise the key findings and evidence from this inspection, together with the CSCI assessment of the extent to which the National Minimum Standards for Care homes for older people have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No shortfalls) (Minor shortfalls) (Major shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.HomebeechPage 13 Choice of HomeThe intended outcomes for the following set of standards are: · · · · · · Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home.Standard 1 (1.1 ­ 1.3) The registered person produces and makes available to service users an up to date statement of purpose setting out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the home; and provides a service users guide to the home for current and prospective residents. The statement of purpose clearly sets out the physical environmental standards met by a home in relation to standards 20.1, 20.4, 21.3, 21.4, 22.2, 22.5, 23.3 and 23.10: a summary of this information appears in the homes service users guide. Range of fees charged From (£) X To (£) XAny charges for extras If yes, please state what the extras are: Key findings/Evidence Standard not assessed.YES X Standard met? 0HomebeechPage 14 Standard 2 (2.1 ­ 2.2) Each service user is provided with a statement of terms and conditions at the point of moving into the home (or contract if purchasing their care privately). 3 Key findings/Evidence Standard met? All service users are provided with contracts at the point of moving into the establishment which clearly state the terms and conditions of residency. The contract allows for a trial period of stay. A specimen contract examined included all points as specified in this standard. Standard 3 (3.1 ­ 3.5) New service users are admitted only on the basis of a full assessment undertaken by people trained to do so, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party. 3 Key findings/Evidence Standard met? Files examined showed that thorough assessments are undertaken prior to admission by a qualified nurse to ensure that the establishment is able to meet the needs of each person. These were well documented and formed the basis upon which the care plans were developed.Standard 4 (4.1 - 4.4) The registered person is able to demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 0 Key findings/Evidence Standard met? Standard not assessed.Standard 5 (5.1 ­ 5.3) The registered person ensures that prospective service users are invited to visit the home and to move in on a trial basis, before they and / or their representatives make a decision to stay; unplanned admissions are avoided where possible. 0 Key findings/Evidence Standard met? Standard not assessed.HomebeechPage 15 Standard 6 (6.1 - 6.5) Where service users are admitted only for intermediate care, dedicated accommodation is provided together with specialised facilities, equipment and staff, to deliver short term intensive rehabilitation and enable service users to return home. 9 Key findings/Evidence Standard met? Intermediate care not provided.HomebeechPage 16 Health and Personal CareThe intended outcomes for the following set of standards are: · · · · · The service users health, personal and social care needs are set out in an individual plan of care. Service users make decisions about their lives with assistance as needed. Service users, where appropriate, are responsible for their own medication, and are protected by the homes policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect.Standard 7 (7.1 ­ 7.6) A service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. 3 Key findings/Evidence Standard met? Random care plans examined were found to be well developed and set out in detail the action needed to be taken by the nursing and care staff to ensure that all aspects of the health, personal and social care needs of the service users are met. The plans met relevant clinical guidelines and included risk assessments. It was noted that the risk assessments did not all include key scales to determine whether the assessed scores were high or low and the care manager agreed to remedy this.HomebeechPage 17 Standard 8 (8.1 ­ 8.13) The registered person promotes and maintains service users health and ensures access to health care services to meet assessed needs. No. of incidents where service users have been taken to Accident and Emergency during last 12 months No. of service users with pressure sores at time of inspection (from information taken from care notes) Key findings/Evidence 1 1 Standard met? 3Service users all presented as being well groomed and well cared for. Those being cared for in bed were seen to be comfortable and well attended and had appropriate pressure relieving equipment in place. Service users in the Daffodil suite who have more complex needs and are more dependent, appeared equally well attended. Staff appeared to be very conversant with the individual needs of service users and were seen to be prompt in responding to those who required help. It was noted that a great deal of equipment had been provided in communal areas, bathrooms, WCs and bedrooms to assist service users following OT assessments. Service users had opportunities for appropriate exercise both through organised activity within the establishment and by walks outside or in the locality, independently (if able) or with staff or relatives. Nutritional screening is undertaken in the initial assessment process and subsequently, as needs change, through the care plan. Appropriate arrangements were in place to facilitate service users in obtaining chiropody, optical, dental and physiotherapy treatment as needed. All service users were registered with a GP.HomebeechPage 18 Standard 9 (9.1 ­ 9.11) The registered person ensures that there is a policy and staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework. 3 Key findings/Evidence Standard Met? No service users were managing their own medications at the time of inspection. Policies were in place and staff were following the procedures to ensure safe receipt, storage, handling, administration and disposal of medications. This is only undertaken by trained nursing staff. Medications are stored in locked facilities within a clinical room which is also kept locked Appropriate arrangements were also in place for the storage, administration and recording of controlled drugs. The temperature in the clinical room is monitored and a fridge is provided for those medications and preparations which are required to be kept the same. 3.Standard 10 (10.1 ­ 10.7) The arrangements for health and personal care ensure that service users privacy and dignity are respected at all times, and with particular regard to: personal care giving, including nursing, bathing, washing, using the toilet or commode, consultation with, and examination by, health and social care professionals, consultation with legal and financial advisors, maintaining social contacts with relatives and friends, entering bedrooms, toilets and bathrooms, and following death. 3 Key findings/Evidence Standard met? Staff were seen to respect the privacy of service users by knocking on doors before entering and service users asked, told the inspector that they felt staff respected them and upheld their dignity, especially when carrying out very personal tasks for them. The registered manager told the inspector that the rights of residents and the core values of care are being focused on as part of the new form of induction training which they have introduced.HomebeechPage 19 Standard 11 (11.1 ­ 11.12). Care and comfort are given to service users who are dying, their death is handled with dignity and propriety, and their spiritual needs, rites and functions observed. 0 Key findings/Evidence Standard met? Standard not assessed.HomebeechPage 20 Daily Life and Social ActivitiesThe intended outcomes for the following set of standards are: · · · · Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them.Standard 12 (12.1 ­ 12.4) The routines of daily living and activities made available are flexible and varied to suit service users expectations, preferences and capacities. 3 Key findings/Evidence Standard met? Routines in both units of the establishment appeared to be suitably flexible to take into account the individual needs and wishes of service users. The inspector observed some service users having a `lie in and there were a number who liked varying arrangements for the timing and venue of breakfast and other meals. The establishment has an activities programme and the inspector observed service users in the main house enjoying a musical afternoon led by an outside organiser who attends regularly. This involved service users in playing a number of different musical instruments and any visitors present were able to join in. Service users in the Daffodil suite who are more dependent and less able to participate in communal activities benefit from some one to one attention from staff during the quieter times of the day. Staff offer manicures and massages and spend time chatting with them and if they are able and wish to go out in their wheelchairs and cannot go independently, staff will accompany them.Standard 13 (13.1 ­ 13.6) Service users are able to have visitors at any reasonable time and links with the local community are developed and/or maintained in accordance with service users preferences. 0 Key findings/Evidence Standard met? Standard not assessed.HomebeechPage 21 Standard 14 (14.1 ­ 14.5) The registered person conducts the home so as to maximise service users capacity to exercise personal autonomy and choice. 0 Key findings/Evidence Standard met? Standard not assessed.Standard 15 (15.1 ­ 15.9) The registered person ensures that service users receive a varied, appealing, wholesome and nutritious diet, which is suited to individual, assessed and recorded requirements, and that meals are taken in a congenial setting and at flexible times. 0 Key findings/Evidence Standard met? Standard not assessed.HomebeechPage 22 Complaints and ProtectionThe intended outcomes for the following set of standards are: · · · Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users legal rights are protected. Service users are protected from abuse.Standard 16 (16.1 ­ 16.4) The registered person ensures that there is a simple, clear and accessible complaints procedure which includes the stages and time-scales for the process, and that complaints are dealt with promptly and effectively. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to CSCI Percentage of complaints responded to within 28 days Key findings/Evidence 1 0 0 1 0 1 100 3Standard met?A complaints procedure was displayed in the main hall of the home. It is also included in the pack given to new service users or their representatives. Some of the more able service users spoken with during the inspection said that they felt able to complain if the need arose and knew who to complain to. All complaints received are recorded and investigated and any relevant correspondence is maintained.HomebeechPage 23 Standard 17 (17.1 ­ 17.3) Service users have their legal rights protected, are enabled to exercise their legal rights directly and participate in the civic process if they wish. 0 Key findings/Evidence Standard met? Standard not assessed.Standard 18 (18.1 ­ 18.6) The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policies. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the Department of Health Guidance No Secrets No. of staff referred for inclusion on POVA lists Key findings/Evidence Standard met? YES 0 3Training for staff in the adult protection procedures is being addressed and the registered manager confirmed that this is also included in the training which has been designed for the overseas staff.HomebeechPage 24 EnvironmentThe intended outcomes for the following set of standards are: · · · · · · · · Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic.Standard 19 (19.1 ­ 19.6) The location and layout of the home is suitable for its stated purpose; it is accessible, safe and well maintained; meets service users individual and collective needs in a comfortable and homely way and has been designed with reference to relevant guidance. 1 Key findings/Evidence Standard met? Homebeech is very conveniently situated on level ground close to local shops and the seafront. It is easily accessible for those in wheelchairs and there is some parking space provided. The establishment has a programme of routine maintenance and renewal of the fabric and decoration of the premises and it was evident that this is on going. The garden is accessible to service users and there is also a large roof garden with extensive sea views. Whilst the premises generally meet the requirements of the local fire service, the inspector again witnessed many fire doors to service users bedrooms being wedged or held open by a variety of means. This was also observed during the previous inspection and generated an immediate requirement both then and again at this inspection. (See requirement 1 and previous requirement) The inspector spoke about this matter with the registered manager and with the registered provider and agreement was reached after the provider contacted the senior fire officer, that approved devices would be fitted to all of those doors where the occupants wish the doors to be kept open. The inspector specified that priority should be given to those rooms where the occupants are smokers. Until such time as these approved fixtures are installed, all fire doors should be kept closed.HomebeechPage 25 Standard 20. (20.1 ­ 20.7) In all newly built homes and first time registrations the home provides sitting, recreational and dining space (referred to collectively as communal space) apart from service users private accommodation and excluding corridors and entrance hall amounting to at least 4.1 sq. metres for each service user. 0 Key findings/Evidence Standard met? Standard not assessed.Standard 21 (21.1 ­ 21.8) Toilet, washing and bathing facilities are provided to meet the needs of service users. 0 Key findings/Evidence Standard met? Standard not assessed.Standard 22 (22.1 ­ 22.8) The registered person demonstrates that an assessment of the premises and facilities has been made by suitably qualified persons, including a qualified occupational therapist, with specialist knowledge of the client groups catered for, and provides evidence that the recommended disability equipment has been secured or provided and environmental adaptations made to meet the needs of service users. 3 Key findings/Evidence Standard met? Appropriate aids and adaptations are provided throughout the main accommodation such as grab rails, hoists, assisted baths, passenger lift and raised WC seats. The Daffodil Suite has been purpose built to meet the standards for the category of persons accommodated and disability equipment was in place including overhead hoists in bedrooms. The matter of any doors held open to accommodate the needs of service users has been addressed in Standard 19.HomebeechPage 26 Standard 23 (23.1 ­ 23.11) The home provides accommodation for each service user which meets minimum space as prescribed Total number of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1 April 2003) - single bedrooms below 10 sq.m usable space or additional compensatory space Total number of wheelchair users accommodated for in rooms at least 12sq.m Total number of wheelchair users accommodated for in rooms at less than 12sq.m Total number of shared rooms at least 16 sq.m Total number shared rooms less than 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total number of single bedrooms Total number of single rooms with en suite Total number of double rooms Total number of double rooms with en suite Key findings/Evidence Standard not assessed. NO YES NO X X X X Standard met? 0 X XX X X XHomebeechPage 27 Standard 24 (24.1 ­ 24.8) The home provides private accommodation for each service user which is furnished and equipped to assure comfort and privacy, and meets the assessed needs of the service user. 2 Key findings/Evidence Standard met? The accommodation meets the majority of elements in this standard. Bedrooms in both units were attractively decorated and furnished to a high standard. It was evident that service users were able to bring in items of furniture and other personal belongings to make them more homely. Doors to service users rooms are not routinely fitted with locks in the older peoples unit, however Mrs Ellis informed the inspector during a previous inspection that if service users wish it they can have a lock fitted. The inspector was told that the current locks on the doors in the Daffodil Suite are to be changed for a type which will be easier for service users to operate and a further recommendation in relation to this is made. (See recommendation 1 and previous recommendation)Standard 25 (25.1 ­ 25 8) The heating, lighting, water supply and ventilation of service users accommodation meet the relevant environmental health and safety requirements and the needs of individual service users. 0 Key findings/Evidence Standard met? Standard not assessed.HomebeechPage 28 Standard 26 (26.1 ­ 26.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation and published professional guidance. 3 Key findings/Evidence Standard met? All parts of the premises were clean, tidy and free from unpleasant odours. Pedal bins had been provided to replace the previous bags which were in use in accordance with recommendations made following an infection control audit carried out by an external agency. The macerator had been disposed of. Since the previous inspection a new sluice had been fitted well away from the clinical room. The inspector noted that there were good supplies of protective equipment such as disposable aprons, gloves, etc. Policies and procedures in respect of inspection control were in place. The laundry room is sited outside the main building and dedicated laundry staff are employed. The laundry floor finishes are impermeable and the walls easily cleanable. Industrial equipment is provided and the washing machines have the specified programming ability to reach disinfection standards.HomebeechPage 29 StaffingThe intended outcomes for the following set of standards are: · · · · Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the homes recruitment policy and practices. Staff are trained and competent to do their jobs.Standard 27 (27.1 ­ 27.7) Staffing numbers and skill mix of qualified/unqualified staff are appropriate to the assessed need of the service users, the size, the layout and purpose of the home, at all times. Number of staff /hours in respect of service user needs based on guidance recommended by Department of Health. Personal Nursing Care No. service users High No. staff hours 7 X X needs allocated No. service users Medium needs No. service users Low needs No. of staff hours required No. of full time equivalent first level registered nurses No. of care staff No. of ancillary staff Key findings/Evidence 24 29 1289 No. staff hours allocated No. staff hours allocated No. of staff hours provided X X X X X 17969 43 27 Standard met? 3HomebeechPage 30 Duty rotas for all grades of staff were provided for examination by the inspector. The above numbers relate to the combined hours and staffing for Homebeech and Daffodil Suite and the requirements are based on The Residential Forum Guidelines for older people and for people with physical disabilities. The staff team has a good skill mix of qualified nurses and care staff. The registered managers hours of work are not included in the above. Domestic staff are employed in sufficient numbers to ensure that standards relating to food, meals and nutrition are fully met, and that the establishment is maintained in a clean and hygienic state. Four administrative staff are also employed.Standard 28 (28.1 ­ 28.3) A minimum ratio of 50 trained members of care staff (NVQ Level 2 or equivalent) is achieved by 2005, excluding the registered manager and/or care manager, and in care homes providing nursing, excluding those members of the care staff who are registered nurses. No. care staff (excluding registered nurses) with NVQ level 2 or equivalent of care staff with NVQ level 2 Key findings/Evidence 7 16.3 Standard met? 3National Vocational Qualification training is on-going at levels 2 and 3 however, overseas staff are unable to undertake this until they have been in this country for three years. As the establishment relies heavily upon care staff from overseas, the percentage of staff with level 2 or above remains low at this stage. The registered manager and deputy care manager are currently undertaking level 4/Registered Managers Award and the care manager who has joined the staff in recent months, is about to commence this training.HomebeechPage 31 Standard 29 (29.1 ­ 29.6) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 3 Key findings/Evidence Standard met? Since the previous inspection the administrator had ensured that copies of all recruitment documentation for each member of staff employed in the establishment are held in their individual files. The inspector examined six files which confirmed that thorough recruitment procedures are being followed. The inspector was told that there are still problems relating to the length of time some CRB checks are taking. All staff receive statements of the terms and conditions of their employment. The organisation is an equal opportunities employer.Standard 30 (30.1 ­ 30.4) The registered person ensures that there is a staff training and development programme which meets the National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 3 Key findings/Evidence Standard met? An induction training programme is now in place and non-overseas staff undertake B-Tec induction training before progressing to National Vocational Qualification training. The induction programme for overseas staff has been adapted as described in Standard 10.HomebeechPage 32 Management and AdministrationThe intended outcomes for the following set of standards are: · · · · · · · · Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users financial interests are safeguarded. Staff are appropriately supervised. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. The health, safety and welfare of service users and staff are promoted and protected.Standard 31 (31.1 ­ 31.8) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. 0 Key findings/Evidence Standard met? Standard not assessed.Standard 32 (32.1 ­ 32.7) The registered manager ensures that the management approach of the home creates an open, positive and inclusive atmosphere. 0 Key findings/Evidence Standard met? Standard not assessed.HomebeechPage 33 Standard 33 (33.1 ­ 33.10) Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in meeting the aims, objectives and the statement of purpose of the home. 2 Key findings/Evidence Standard met? There was documentation to show that a quality assurance/quality monitoring system is in place in relation to catering, maintenance and service user satisfaction. Policies and procedures are reviewed on a regular basis in light of changing legislation and good practice advice from the Department of health and other specialist/professional organisations. The system, however, remains in need of expansion as discussed during the previous inspection to include an annual development plan based on a systematic cycle of planningaction-review, reflecting aims and outcomes for service users. (See recommendation 2).Standard 34 (34.1 ­ 34.5) Suitable accounting and financial procedures are adopted to demonstrate current financial viability and to ensure there is effective and efficient management of the business. 0 Key findings/Evidence Standard met? Standard not assessed.HomebeechPage 34 Standard 35 (35.1 ­ 35.6) The registered manager ensures that service users control their own money except where they state that they do not wish to or they lack capacity and that safeguards are in place to protect the interests of the service user. Number of service users subject to Power of Attorney processes Number of service users subject to Enduring Power of Attorney processes Number of service users subject to Guardianship Orders Key findings/Evidence Standard not assessed. Standard met? 0 X X XStandard 36 (36.1 ­ 36.5) The registered person ensures that the employment policies and procedures adopted by the home and its induction, training and supervision arrangements are put into practice. 2 Key findings/Evidence Standard met? Whilst it was clear from discussion with the registered manager and various staff members that Miss Vallerich and the other senior staff do provide good support and informal supervision to all care staff, a formal (documented) system of bi-monthly supervision/support/personal development sessions has still not been implemented. This should be set up without delay. (See recommendation 3).HomebeechPage 35 Standard 37 (37.1 ­ 37.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 3 Key findings/Evidence Standard met? All records required in accordance with Schedules 3 and 4 under Regulation 17 were available for examination and found to be accurate and up to date. A policy is in place indicating that service users have access to their records and personal information held about them. Individual records are kept safe and secure.Standard 38 (38.1 ­ 38.9) The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 1 Key findings/Evidence Standard met? By the end of February all staff will have received four fire safety training sessions in the last 12 months. All kitchen staff who handle food had undertaken appropriate food hygiene training. Courses in first aid were being arranged. 2 staff were undertaking skills apprenticeships-one as a chef and the other in administration. Some training in health and safety had taken place through Highbury College and staff had received training in infection control and manual handling. As previously stated, many fire doors were seen to be wedged open at the time of inspection which is a very dangerous practice. (See requirement 1 and previous requirement) Individual risk assessments for service users had been undertaken as had a risk assessment of the premises. A fire risk assessment of the premises was in the process of being undertaken. A number of windows in the original building above ground floor level were found to open considerably wider than the recommended safety limit of 4 inches. (See recommendation 4) Arrangements for the safe storage of chemicals were being adhered to. All accidents, injuries and incidents of illness or communicable diseases are recorded and reported as necessary. There was documentary evidence to show that arrangements are in place for the maintenance and repairs of equipment and installations in the premises.HomebeechPage 36 PART C(where applicable)COMPLIANCE WITH CONDITIONSCondition Compliance Service users in the PD and PD (E) categories to reside only in the Daffodil Suite. CommentsCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceLead Inspector Second Inspector Regulation Manager Date Public reportsLinda RiddleSignature Signature SignatureIt should be noted that all CSCI inspection reports are public documents. Homebeech Page 37 PART DD.1PROVIDERS RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Persons comments/confirmation relating to the content and accuracy of the report for the above inspection.We would welcome comments on the content of this report relating to the Inspection conducted on 28 January 2005 and any factual inaccuracies: Please limit your comments to one side of A4 if possibleHomebeechPage 38 Action taken by the CSCI in response to provider comments: Amendments to the report were necessary YESComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection reportNOProvider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to be factually accurate Note: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. D.2 Please provide the Commission with a written Action Plan by 11 March 2005, which indicates how requirements are to be addressed and stating a clear timescale for completion. This will be kept on file and made available on request. You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. Status of the Providers Action Plan at time of publication of the final inspection report: Action plan was required YESAction plan was received at the point of publicationYESAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action planYESOther: enter details here HomebeechPage 39 D.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.D.3.1 I Sandra Denise Ellis of Homebeech confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or D.3.2 I of am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) for the following reasons: Sandra Denise Ellis Signed 03/03/05 Managing Director Homebeech Ltd 03/03/05Print Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.HomebeechPage 40 Homebeech / 26 January 2005Commission for Social Care Inspection 33 Greycoat Street London SW1P 2QF Telephone: 020 7979 2000 Fax: 020 7979 2111 National Enquiry Line: 0845 015 0120 www.csci.org.ukS0000024153.V202017.R01© This report may only be used in its entirety. 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