Inspection on 26/09/07 for James Burns House

This inspection was carried out on 26th September 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

James Burns House 10/10/06

James Burns House 19/12/05

James Burns House 23/05/05

James Burns House 27/01/05

James Burns House 21/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 James Burns House Greenways Avenue Bournemouth Dorset BH8 0AS Lead Inspector Heidi Banks Key Announced Inspection 26th September 2007 10:30 Beeches (The) (Seven Kings) DS0000004006.V351060.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 Beeches (The) (Seven Kings) DS0000004006.V351060.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. Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service James Burns House Address Greenways Avenue Bournemouth Dorset BH8 0AS 01202 523182 01202 533058 claire.hough@lc-uk.org www.leonard-cheshire.org.uk Leonard Cheshire 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) Claire Hough Care Home 21 Category(ies) of Physical disability (21), Physical disability over registration, with number 65 years of age (21) of places Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th October 2006 Brief Description of the Service: James Burns House was purpose built in 1977 to accommodate up to twentyone younger adults with varying physical needs and abilities. It is one of a number of services run in the south west region by the Leonard Cheshire Foundation. The home is situated in a small complex which includes sheltered housing. It is close to all local facilities, including a post office, library and a shopping centre. The home has a fleet of vehicles to support people in accessing their community. Accommodation is in single rooms. There are two communal lounges / dining areas and shared toilet and bathroom facilities for people. James Burns House is well equipped with specialist aids and adaptations to meet the assessed needs of people who use the service. There is level access into all parts of the building and surrounding gardens and ample car parking facilities. There is a large annexe for the storing and recharging of electric wheelchairs. Based on information given at the time of the inspection, the current fees for residents at James Burns House range from £650 to £850 per week according to assessment of individual needs. This does not include transport costs for which people are invoiced separately. Further information on fair terms of contracts and care home fees can be found on the Office of Fair Trading’s website: www.oft.gov.uk. Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key announced inspection of the service. The purpose of this inspection was to assess the home’s progress in meeting the key National Minimum Standards since the last key inspection of the service in October 2006. The on-site inspection took place over approximately sixteen hours on 26th September, 3rd October and 8th October. On 26th September the lead inspector was joined by an ‘Expert by Experience’ from the Southampton Centre for Independent Living for approximately two hours. ‘Experts by Experience’ is a project that involves people who use services in the inspection of those services. Their role is to join inspectors to help them get a good picture of the service from the viewpoint of the people who use it. The Expert by Experience, who was accompanied by her Personal Assistant, met with a group of six people who use the service. People’s views have been reflected throughout this report. At the time of this inspection there were seventeen people living at James Burns House. During the inspection we were able to take a tour of the home and talk to some people who use the service. Discussion took place with the Registered Manager, Claire Hough and some members of the staff team. We were also able to meet with a Facilitator from the Leonard Cheshire Service User Support Team who has regular contact with the home in her role. A sample of records was examined including some policies and procedures, medication administration records, health and safety records and service user and staff files. Prior to the inspection, an Annual Quality Assurance Assessment (AQAA) was completed by the Registered Manager and submitted to the Commission. Surveys were distributed by the home to people who use the service, their relatives, care workers in the home, care managers and health care professionals on behalf of the Commission. Seventeen surveys were received from service users, all of whom had been supported to complete their surveys by a senior member of the staff team at the home. Twenty completed surveys were received from care workers employed at the home, six from people’s relatives, two from care managers, three from health care professionals and three from general medical practitioners who have contact with the home. A total of twenty-four standards were assessed at this inspection. What the service does well: Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 6 The home ensures that they have enough information about prospective service users to ensure their needs can be met. Support plans are drawn up with the involvement of people who use the service and it was clear that the home is being creative in finding ways of consulting with them about the service they want. The home welcomes visitors at any time and people who use the service told us that they have contact with their family and friends. The home has consulted with service users about meal-times and food provision and it is clear that their views have been central to development in this area. People’s health care needs are met with good liaison and communication happening between the home and health care professionals. Where people have been at risk of harm there is evidence that the home has taken appropriate action to manage this. Care workers are recruited safely and training provided to care workers is of a high standard which means that they are aware of good practice and can respond to people’s individual needs. The home has an experienced manager who is well-qualified for her role. There is a clear management structure in the home which means that people know who to go to if they need advice or wish to discuss concerns. Quality assurance processes are in place and there was ample evidence at this inspection of people being invited to have their say about issues that are important to them. Health and safety practices are well-managed with checks being carried out as appropriate to keep people safe in the home. What has improved since the last inspection? Since the last inspection of the home, progress has been made in many areas in response to requirements and recommendations made. There was evidence to demonstrate that people’s needs are being kept under review and that relevant people are involved in this. This helps ensure that people’s needs are continuing to be met by the service. Care plan paperwork was better organised and had been kept up-to-date so that it contained relevant information about people’s needs. The home has consulted with people who use the service about what they want from activities and has developed a programme based on what they said. Goal planning has been introduced to ensure that people have the opportunity to discuss their aspirations and put together an action plan to meet them. Records of the food eaten by individuals are in place to provide an account of people’s intake on a daily basis although these were not always very clear. The home is promoting the complaints procedure among service users and their relatives to ensure people have the information they need to be able to raise concerns should they need to. Relatives who responded to the survey Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 7 generally felt that they were kept informed of matters affecting their family member. Fire training provision has been reviewed and there was evidence to indicate that regular updates and drills are taking place. This ensures that staff have the knowledge and skills to promote people’s safety in the event of an emergency. What they could do better: As a result of this inspection, one requirement has been made which is repeated from the last inspection of the service. Feedback from people who use the service, their care workers, some relatives and a care manager indicated that there are not always enough staff on duty at any one time to meet people’s individual needs. The home must provide evidence to demonstrate that staffing levels are sufficient to be able to meet the assessed needs of people who use the service on a daily basis. This includes the capacity for care workers to attend to people’s personal care needs without delay. Six recommendations have also been made where room for further development has been identified. The home should continue to promote people’s ownership and control over their support plans and risk assessments to ensure that their views and preferences are central to the care process. Further consideration should also be given to the key working role to ensure that people benefit from the one-toone support they need to meet their goals and aspirations and have control, choice and spontaneity in their everyday lives. Where concerns are raised by relatives, the home should ensure that positive outcomes are achieved and people who use the service have the information they need to make contact with independent advocacy organisations if they so wish. Plans for the continued refurbishment of the home are being given consideration by the provider. These should include plans to ensure that all facilities in the home are fully accessible to service users and that their ability to be independent is promoted. Although procedures to manage infection control are in place it is recommended that the home uses the latest Department of Health guidance to assess their current systems against the national benchmark. Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 8 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. Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 9 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 Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 10 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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admission to the service is based on a comprehensive assessment of people’s needs which means that plans can be put in place by the home to promote a smooth transition. EVIDENCE: Discussion with the manager and people who use the service indicated that people’s needs are assessed prior to them moving into the home. Contact with the care manager for one service user also indicated that she had carried out a full assessment of the person’s needs on behalf of the local authority and that the service user had been enabled to visit the home prior to the admission. The home’s pre-admission process provides an opportunity for the home itself to obtain information about individuals’ needs and paperwork to this effect was seen during the inspection. During the inspection, the manager received telephone calls from care managers and relatives of prospective service users evidencing that communication was taking place to promote a smooth transition. The manager told us about the needs of someone who was due to be admitted to the home in the near future and it was clear that consideration had been given to their personal circumstances and the support that would Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 11 need to be in place to help the person adjust to a placement in residential care. Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 12 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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is making progress in developing the care planning process in a way that takes greater account of people’s needs and choices. EVIDENCE: A sample of individual support plans were seen. These were well-organised and gave some clear information on people’s needs and preferences with regards to their care provision and people’s level of independence in activities of daily living. Plans showed evidence of regular review. Information supplied by the Registered Manager following the last inspection of the service showed that the home is making progress in ensuring that people’s needs are reviewed with the involvement of their placing authority. A chart on one of the office walls in the home also indicated where people’s reviews are due and a senior member of staff told us that a system is in place to send out reminders prior to reviews to ensure that significant professionals are able to attend. Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 13 It was evident that where one person wanted more autonomy over their care a plan had been developed which aimed to strike a balance between respecting their need for independence and offering enough support to ensure that their health and well-being is maintained. People had also been given the opportunity to write their own ‘Personal Profile’ which gave a summary about who they are, their history and what is important to them, these giving a very real and positive insight into their lives. Two care workers responding to the survey commented that encouraging people to write in their own support plans was an area that could be expanded by the service. Support plans showed evidence of consultation with people using the service about the care they receive with service users signing to indicate their agreement. However, one person told us that they did not agree with all aspects of their support plan and risk assessments but had signed them in order to comply with what their key worker was asking of them. It is suggested that the provider looks at this issue to ensure that people’s rights are being fully respected in this area by all staff and everyone is enabled to work in partnership with their key workers to have real control and ownership over the content of their support plans. This is an area for development that the home has already noted in its Annual Quality Assurance Assessment document. People’s involvement in decision-making is an area that the home is working hard to promote. Focus groups are being set up to look at specific issues in the home. At the time of the inspection, a ‘Food Focus Group’ was in operation to increase service user involvement in meal-time arrangements and a senior member of staff spoken with told us that a further focus group would be arranged to get people’s input into what they want from the key working role. The member of staff told us that all service users are invited to attend although not everyone wishes to be involved. Residents’ meetings are also held on a regular basis in the home as a means to promote their involvement in decision-making and records of these showed that people were being consulted about things they wanted to do and in compiling a ‘wish list’ for the home. Evidence of goal planning was seen in people’s support plans. This is a system that has been recently introduced in the home and therefore is still in its infancy. Goals set ranged from issues around personal and health care, communication and advocacy needs and goals in relation to people’s social, educational and work aspirations. Actions to be taken by the home and the individual to meet these goals had been clearly documented. Progress records were also in place to show actions taken to date to enable people to work towards them. Plans showed documentation around specific risk factors for individuals. Where individuals are able to be independent in activities of daily living and Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 14 accessing their community there was evidence that this is given consideration with positive outcomes. Discussion with one person indicated that there had been some improvements in the attitudes of staff towards their wish to achieve greater independence and they felt they were being enabled to take appropriate risks. Another person commented that they did not feel empowered to make some choices, this causing them to feel restricted from enjoying an independent lifestyle in the home. The home has noted in their Annual Quality Assurance Assessment ways in which the risk assessment process could be developed including increased involvement from service users. Discussion with a member of staff and a tour of the premises showed that the home is giving people opportunities to do things for themselves, for example, access to facilities for preparing hot drinks and snacks and laundry facilities. Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 15 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 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home consults with people who use the service about what they want and is being creative in finding ways to achieve some positive outcomes. However, staffing levels and issues around transport may restrict people’s opportunities in this area. EVIDENCE: At the last inspection of the service a statutory requirement was made that the provider must consult service users about the programme of activities arranged by the care home and provide facilities for entertainment. In addition, a further requirement was made for the provider to consult with service users about their social interests and make arrangements to enable them to engage in local, social and community activities. Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 16 The system of goal planning in place for individual service users showed evidence of their preferred social and leisure activities being given consideration. A programme of in-house entertainment is in place which includes a weekly visit from a ‘Canine Companion’, bingo, card making, film nights and visits by an entertainer. The manager confirmed that people had been involved in the consultation process and this was echoed by some care workers in surveys who told us ‘A variety of trips and activities is offered to those who wish to go out and participate’; ‘The service does well in providing a variety of activities and is open for suggestions of what they’d like to do’. The home has told us in their Annual Quality Assurance Assessment that they support people in accessing external activities including day centres, social clubs, church and attendance at adult education centres and they are aiming to develop this further in the next twelve months. Discussion around lifestyle and activities took place between six people who use the service and the Expert by Experience. One person reported that they go to a pottery class every week and another stated that they attend a Multiple Sclerosis Group in the local area. One group member informed the Expert by Experience that they loved doing craft activities and were able to do artwork at the home. The same person also commented that they enjoyed gardening and had been able to go to the garden centre to choose plants. Another person said that ‘if you can’t get out and about there are always crosswords, television and video nights’. It was felt by the group that the home needed a larger vehicle to accommodate more than two wheelchairs as they would like to go out more frequently in small groups. The manager of the home told us that the home had previously had a larger minibus but it was rarely used by service users and therefore not cost-effective to maintain. It was noted by the Expert by Experience from her discussion with people who use the service that holidays seemed non-existent for some of the residents which with careful planning and preparation could be overcome. People’s goal plans seen during the inspection showed some evidence of holidays being given consideration. People told the Expert by Experience that staffing levels sometimes restricted their opportunities. They told us that activities had to be organised in advance and it was difficult for them to be spontaneous. They also said that they could arrange time with a key worker once a week and at times it was possible to have three hours of one-to-one time if staffing levels permitted. They also commented that it could be very disappointing if staff did not turn up at their allocated time. The Expert by Experience felt that there is a need for the home to think about how they can positively change the quality of people’s one-toone time to enable real choice, control and spontaneity. Although the home has recruited some volunteers to support people with social activities both inside and outside the home, care workers told us that this is an area where the service could do better. Comments received included ‘Provide Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 17 more access to transport. Provide more staff to go on outings and encourage more individuality’; ‘They should provide more information, for example, to access college facilities and social events. Put some money towards developing activities and using the skills and interests of staff and residents to do so’; ‘More staff for activities’; ‘Have more money to do more things’; ‘A larger van for taking residents out’; ‘I don’t believe social needs are given enough priority’. Similar issues were also highlighted in responses to surveys from relatives; ‘People do not seem to be able to participate in activities, get out or get jobs….seems to be due to lack of care staff and lack of drivers’; ‘The home could be more proactive in activities with residents’; ‘My relative needs more brain stimulation and be taken out more’. The home is currently taking steps to promote people’s access to public transport and so, enable their independence. It was evident that five people who use the service were keen to be part of this initiative and had put their names down for a ‘wheelchair skills day’ to practice manoeuvres that would help them access local buses. Other service users had not shown interest in this. Residents spoken with told us that they have contact with friends and family as they wish. This was echoed in the home’s Annual Quality Assurance Assessment which states that there are no restrictions on visitors and visiting times and that they are promoting people’s access to internet and Skype facilities to enable them to communicate with their friends and families. People also told the Expert by Experience that in the summer they can have a barbeque in the garden and they are able to invite friends and family to socialise. Support plans seen detailed people’s significant relationships and contact with them. The majority of relatives responding to the survey indicated that the home always keeps them up to date with important issues affecting their family member. The manager reported that she now works some evening shifts in the home to make herself more available to visitors who wish to speak to her. Observation during the inspection indicated that people have access to their own bedrooms and communal areas in the home as they wish. They can also choose when they wish to be on their own and in the company of others. The manager has told us in the Annual Quality Assurance Assessment that all service users have been provided with keys to their doors. One person told us in a survey that they liked to have a rest in the afternoons and that this was respected by staff. Another person commented that they had the choice to join in activities if they wanted to. One service user told us that they felt staff had a better understanding of their rights than previously and gave examples of where they had worked in partnership to come to an agreement about their individual plan. However, a visitor to the home commented in a survey that there seemed to be ‘a lack of awareness that James Burns House is the home Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 18 for the residents’ and discussion with one person indicated some concerns about policies and attitudes of some staff in the home not promoting ordinary life principles. During her discussion with people who use the service, the Expert by Experience felt that it was difficult for people to focus on their rights as individuals to have goals and aspirations other than mentioning holidays and outings. The home has a cook who prepares lunch on a daily basis. Choices were seen to be offered and meals were based on preferences expressed by people who use the service. One person reported in a survey that they felt the food was ‘exceedingly acceptable’ and another person told us in discussion that they were quite happy with meal-time arrangements and the flexibility offered. A Senior Team Leader in the home facilitates a ‘Food Focus Group’ to promote consultation with people who use the service and minutes of meetings indicated that this was working to good effect with ample evidence that people who are using the service are steering change. Although the main kitchen is not used by service users, there are kitchen facilities that are accessible to them with each communal lounge area having facilities for people to prepare snacks and drinks for themselves. Records of food eaten by individual service users were in place. These were quite difficult to understand in places as records are kept for each ‘room’ rather than each person. Also there were some gaps in recording and occasions where meals had been declined and the reasons for this were not always clear. Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 19 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 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some aspects of personal and health care provision are good and achieve some positive outcomes for people who use the service. However, delivery of personal care is compromised at times by staffing levels which means that people do not always benefit from a person-centred and responsive approach to their needs. EVIDENCE: All but one person responding to the survey indicated that staff always treated them well with the remaining service user stating this was usually the case. Comments received in surveys and through discussion included ‘They take into consideration my disability and the care is according to what I need’; ‘The staff are excellent and do as I tell them’; ‘Some staff are better then others but on the whole I can’t complain’; ‘Sometimes staff do something for me which I could have done myself as I am capable, so although trying to help I feel it is a little interfering. If I need help I will ask them for it.’ Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 20 Some people told the Expert by Experience that they were happy with the level of control they had over the way their personal care was managed and they felt the staff were generally sensitive. People have call-bells in their rooms to be able to summon assistance when they need it. However, some people told us that it can be as long as 15-20 minutes before their call-bell is answered although at other times it can be answered in 5-10 minutes. Some of the residents reported that this delay had meant they had been incontinent while waiting for assistance. The Expert by Experience commented that while meeting with people who use the service she rang the call-bell twice for a group member and the response from staff was very quick. A key worker system is in place in the home and individual support plans seen showed some good examples of key workers developing a plan of care with the service user to ensure their needs and preferences are met. However, one person told the Expert by Experience that their key worker worked nights and as a result they did not get much opportunity to discuss issues with them. All seventeen people who use the service at the present time require some support with their personal care. At the time the home’s Annual Quality Assurance Assessment was submitted, nine people required two or more staff to help with their care during the day and at night. Eleven of the twenty care workers responding to the survey indicated that there were usually enough staff to meet the individual needs of all the people who use the service with six care workers stating that this was ‘sometimes’ the case and three people giving no answer. Comments received from staff indicated that there were periods of staff shortages due to holidays and sickness when it was more difficult for them to meet people’s needs. One care worker commented that ‘They seem to run on minimal staff quite often….we may still be getting residents out of bed at 11.30am – 12 noon…this happens rarely but it does happen.’ Comments from a service user echoed this in that they were aware it was sometimes difficult for staff to meet their personal care needs at their preferred times – they felt that staff ‘do their best’ and tried hard to accommodate their preferences but that staffing levels did not always promote the provision of a person-centred service. This was echoed by comments from a care manager who noted that while the home is ‘trying to use limited resources to full potential, staff shortages do have an impact on services offered’. A visitor to the home indicated that they had observed ‘tasks done speedily or not to the required standard when people would like’ which they believed was due to lack of staff. Other relatives indicated their satisfaction with the level of care received by their relative; ‘Good care’; ‘All aspects of care are carried out to the family’s satisfaction’. People’s health care needs have been clearly documented in their individual support plans, for example, the need for service users to have regular eye checks, weight monitoring, dental checks, continence needs, chiropody Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 21 treatment, support around behavioural needs or pressure area care. It was evident from one plan that one service user had expressed a desire to take control of making their own health appointments. An agreement had been reached for staff to give support only when requested by the service user although they would document appointments in the unit diary. For another service user, the date of an appointment with their general practitioner had been documented incorrectly so that it did not correspond with information in the daily record. This was clarified at the time of the inspection and amended promptly. Moving and handling needs for each person are also clearly documented. The home has two care workers who are trained moving and handling assessors and therefore are able to undertake assessments as required to ensure safe practice is promoted. Three comment cards from general medical practitioners who have contact with the home all indicated that the home communicates well with them and that staff demonstrate a clear understanding of the care needs of service users. Health care professionals also told us in surveys that they felt the home did well in meeting people’s health care needs although one person felt that service users’ positioning in chairs could be improved at times. A professional who has contact with one individual in the home told us that they had been impressed with the relationship between service user and staff and they felt the person had been treated with respect and dignity during their appointments. It was noted by the Expert by Experience that people talked positively about the sensitive way their care workers had informed them of deaths of other residents in the home due to illness. A Senior Team Leader, who is a Registered General Nurse, takes responsibility for medication systems in the home. Medication is supplied by a local pharmacy who also produces Medication Administration Record (MAR) charts for use in the home. A monitored dosage system is used for the majority of medicines. Medication is stored in people’s rooms in a lockable cabinet fixed to the wall. Both service users and staff told us that this system generally works well as it means that medication can be administered at the same time as personal care is given and the Senior Team Leader felt that the system reduces the risk of errors occurring. The Senior Team Leader reported that there are no service users administering their own medication at the present time although it was clear from discussion and from individual support plans that if people expressed a wish to do so then this would be risk assessed. This has been identified as an area for development in the home’s Annual Quality Assurance Assessment. One service user’s controlled drug is stored centrally. The controlled drugs book was seen and records kept corresponded with the number of tablets in the box. One person’s medication was seen with their MAR chart. Where they were meant to have eye drops administered five times a day for a short period there Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 22 were five gaps on the MAR chart indicating that they had not been given as prescribed. There was no evidence on the MAR chart to indicate why the eye drops had not been given. All other medicines had been appropriately signed for. It is suggested that the home does regular audits on medication systems and if gaps are noted this is recorded as an incident and followed up in accordance with the home’s policy on medication errors. Medication training for all care workers is facilitated by the Senior Team Leader following the pharmacy’s ‘Medication Handling System’ training pack which includes completion of a workbook. The Senior Team Leader confirmed that no member of staff is permitted to administer medication until they have completed both the training and been observed a minimum of three times administering medication to people who use the service. It is recommended that the home looks at the latest guidance published by the Commission to ensure that the training provided to care workers meets current guidelines. Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 23 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service generally feel that their views are listened to and acted on. Systems are in place to protect people from abuse. EVIDENCE: Eleven out of seventeen people responding to the survey felt that their care workers always listened and acted on what they said with the remaining six people saying that this was usually or sometimes the case. All but two service users said they knew how to make a complaint, the majority of people telling us they would go to the manager or a Senior Team Leader to raise concerns. Minutes of service user meetings indicated that people are reminded of the home’s complaints procedure on a regular basis. One service user told the Expert by Experience that they had made a complaint and was satisfied with the way it had been dealt with. People who met with the Expert by Experience were, however, confused about how they would access an independent advocacy service if they wanted help expressing their views although they said they would approach staff for information in the first instance. Two care managers also commented that when concerns had been raised with staff they had been responded to positively; ‘I have always found that discussing the issues with James Burns’ managers and key working staff has been productive. This has meant that I have visited very often to discuss care. Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 24 Issues raised have been addressed and steps taken to prevent them happening again.’ A copy of the organisation’s ‘Have Your Say’ leaflet was on display in the home at the time of the inspection. The home’s complaints record was seen. There is a system in place to track the progress of complaints and quarterly updates on this are sent to the organisation’s regional headquarters. Since the last inspection, six complaints have been recorded as received. A letter of complaint from a service user was found in their individual service plan although this had not been acknowledged. Discussion with the manager indicated that she did not know this complaint had been made but as soon as this was highlighted, appropriate action was taken to respond to it in line with the home’s complaints procedure. Although all but one member of staff told us in surveys that they knew what to do if a service user has concerns about the service, it is suggested that the home continues to remind people of the procedure so that the manager is made aware of all complaints that are made and these can be responded to appropriately. Five out of six relatives responding to the survey indicated that they knew how to make a complaint about the service if necessary. One reported that they could not remember but confirmed that they had been given a leaflet and would refer to this. Half of the relatives indicated that they had raised concerns in the past, one telling us that the home had always responded appropriately with two people telling us that this was usually or sometimes the case. Two reported that they had never had cause to complain. The home has a system in track issues of a safeguarding nature, this information going to the organisation’s regional headquarters on a quarterly basis. One whistle-blowing incident was discussed with the manager. It was clear that appropriate action had been taken by the home in response to this. The Commission had also been notified. During the inspection concerns of a safeguarding nature were disclosed by a service user. A safeguarding adults referral was made and the issues raised are currently being investigated by the local authority. It has been noted by the local authority that the home has been very co-operative with all aspects of the investigation. All care workers employed by the service receive training in abuse awareness during their induction programme and through updates. Discussion with the manager indicated that staff have recently attended training in neglect and that she is a trained trainer in this area. A care worker who had attended this training commented that it had been very positive and had they had learnt a lot. Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 25 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, 26 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service live in a safe and well-maintained environment that generally meets their physical needs. However the layout of the building does not create a homely environment. Systems are in place to prevent crossinfection in the home and promote appropriate hygiene practice. EVIDENCE: James Burns House is a single-storey building with level access for wheelchair users. The building is divided into two ‘ends’ – ‘Hudson’s Walk’ and ‘Sunnymead’. Each ‘end’ has its own lounge and dining area and shared bathroom / toilet facilities. There are no en-suite facilities at the home. All bedrooms have wash basins although, as identified at both this and the last inspection, these are not always easily accessible to people who use wheelchairs. There is a main laundry area which is equipped with washing machines and tumble dryers. A tour of the premises showed that domestic Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 26 scale washing machines have been installed in the kitchen area of each lounge to enable people to do their own personal laundry if this is their choice. Consideration has also been given to providing outside drying facilities that service users can use. The home employs a person to take responsibility for maintenance of the building. One care worker commented in a survey that the home needs modernising so that it is more appealing to prospective service users. Discussion with the manager indicated that the organisation is looking at plans for a total refurbishment of the home to create a more homely environment for people to live in. It was not clear at the time of the inspection that this would definitely go ahead but serious consideration should be given to this so that ‘small group living’ is promoted. In the meantime various improvements are being made which has recently included the delivery and installation of new bathing facilities and improved storage for equipment. Service users who met with the Expert by Experience stated that they could choose how their room was decorated and how often. A tour of the home showed that people had been able to personalise their bedrooms as they wish. The Annual Quality Assurance Assessment supplied by the home indicated that they involve service users in the maintenance programme through discussions on a sixmonthly basis although they have identified that documentation regarding these discussions should be put on display. Some positive comments were received from visitors about the atmosphere in the home; ‘ Friendly, nice atmosphere’; ‘Relaxed, friendly atmosphere for residents’; ‘Provides a generally pleasant place to live for residents’. The home employs domestic staff to take responsibility for maintaining a clean home environment although service users are also involved in keeping their own bedrooms clean if this is their choice. Ten out of seventeen people responding to the surveys indicated that the home is always fresh and clean with seven people saying that this is usually or sometimes the case. One visitor to the home reported in a survey that they felt the cleanliness of the home could sometimes be improved. The home have identified in their Annual Quality Assurance Assessment that they will make improvements in the next twelve months by improving documentation of domestic cleaning that takes place and instigating a rolling programme for a ‘deep clean’ of the home. The home has told us in their Annual Quality Assurance Assessment that they have a policy for preventing infection and managing infection control. They have also indicated that they have not used the Department of Health guidance ‘Essential Steps’ to assess their infection control management. It is recommended that the home consults this guidance to ensure that the procedures they have in place meet the current national recommendations. Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 27 The home has also told us that training in infection control is in place for all care workers as part of their induction programme, this being confirmed at the inspection by the service’s Training and Development Officer. Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 28 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 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service benefit from care workers who are recruited through robust practices and are well trained and competent. Care workers work well as a team but when there are staff shortages this impacts on the delivery of a person-centred service for the people who live in the home. EVIDENCE: The service has a Training and Development Officer who works across the county co-ordinating training for all staff and implementing the organisation’s training plan. A comprehensive induction programme is in place which covers all aspects of mandatory training. Staff responding to the survey told us ‘There were a lot of training sessions which were very useful and enabled me to learn basic care needs and more’; ‘Found it very interesting’. Discussion with the Training and Development Officer indicated that the service has a comprehensive computer system for identifying when people require update training and to book people onto specialist training to meet the individual needs of people who use the service. Again, staff told us that this was Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 29 something the service does well; ‘The training here is excellent and the best I have had within my employment history’; ‘A service user came to the home and has a stoma so they placed me onto a stoma care course so that I was confident to deal with it which was brilliant’; ‘Challenging behaviour training was the best one – good and interesting’; ‘I attend a lot of training that is relevant to my role and helps me focus on service users’. Some staff indicated that they felt they did not always have the experience and knowledge to understand diversity issues, for example, age, gender, race, ethnicity, sexual orientation and faith. The manager confirmed that training in these areas is being rolled out by the organisation and they are putting together an action plan to address diversity issues. One service user spoken with told us that they felt new staff would benefit from more experiential training to improve their understanding of disability and experience using a wheelchair. This was relayed to the service’s Training and Development Officer at the time of inspection who responded enthusiastically to this and agreed that this could be incorporated into the induction programme. The home has told us in their Annual Quality Assurance Assessment that out of twenty-seven care staff, eighteen have a National Vocational Qualification at Level 2 or above and nine are working towards this qualification. On the day of the inspection, there were seven care workers on the morning shift and four on the afternoon shift providing care for a total of seventeen people. Staffing levels have recently been reviewed to reflect current vacancies. Care workers told us in surveys that they felt they worked well as a team; ‘… a great team of staff who work hard and well together’; ‘As a service everyone pulls together when needed’. The majority of care workers told us in surveys that there were usually enough staff to meet the needs of people who use the service but people also commented that at times when staff were on holiday or off sick things became more difficult; ‘We do have times of staff shortages especially when residents need a high amount of care. Care then comes first, activities come second’. Several care workers commented that this was an area which the home could improve on. One person told us that they thought ‘separate staff could be employed to carry out tasks such as laundry and ironing….a kitchen assistant to do residents’ suppers to allow carers to do what they do best which is to spend all their time looking after the residents and perhaps get them out more.’ One service user spoken with told us that staff ‘are very, very busy…when they come to me the care is good but I do have to wait’ and another told the Expert by Experience ‘Staff do not have time to sit and talk to us’. This was echoed by three relatives of service users who told us that they felt the care home could improve by resolving ‘apparent staffing level issues’ and ‘care workers spending more time doing care work rather than domestic tasks.’ One visitor to the home reported that they felt staff ‘operate in rather a disorganised way’ and require better direction to use their time effectively. Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 30 Inspection of documentation in the home and discussion with the manager indicated that agency workers are used to fill in gaps in staffing levels. During July 2007, 182.5 care hours were done by agency workers. This was noted by a care manager who stated in a survey that the care service could improve by increasing staffing levels and using ‘less agency staff’. A sample of recruitment records were seen. There was evidence that a structured interview process was in place and that checks with the Criminal Records Bureau and satisfactory references had been obtained prior to people commencing work in the home. Proof of identity was on file and staff had signed to confirm receipt of relevant codes of conduct and the home’s whistleblowing policy. The home has told us in their Annual Quality Assurance assessment that they plan for more service users to be involved in the recruitment, selection and induction of new staff in the next twelve months. Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 31 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 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home consults people who use the service about various aspects of their care to promote their participation in its development. Health and safety is well-managed in the home with regular checks being in place to promote people’s safety. EVIDENCE: The Registered Manager, Claire Hough, was appointed as the Service Manager for James Burns House in September 1999. She has since completed her NVQ Level 4 in Care and Registered Manager’s Award and has continued to study for a range of other qualifications which show evidence of further professional development including a Masters degree in Disability Studies. Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 32 Claire Hough is supported by a team that includes two Senior Team Leaders and three Team Leaders, all of whom have delegated supervisory responsibilities for a team of care workers. Systems such as regular staff meetings and a supervision structure are in place to promote communication within the staff team but some care workers commented that they felt more direct communication from management would be beneficial. Staff training in the home is co-ordinated by a Training and Development Officer who works across a number of Leonard Cheshire services in Dorset. An Office Assistant is in post to support the manager with some general administrative responsibilities. Leonard Cheshire carries out an annual survey of service users and staff to gain feedback on the running of the home and quality of care. A copy of the report from the service user survey carried out in November 2006 was seen. It was evident that the survey was based on outcomes for service users and the aim of the organisation to provide a service that promotes flexibility, choice and respect. One of the Senior Team Leaders takes responsibility for internal quality assurance processes. It was clear from discussion with her that she is positive about consulting service users about the care they receive and enabling them to contribute to the development of the service. The home has already put in place a focus group to look at food provision in the home and the Senior Team Leader discussed some ideas about other areas of support where service users’ contributions would be beneficial. The home has stated in their Annual Quality Assurance Assessment that they are committed to continue to promote people’s participation in this process. Inspection of documentation in the home showed ample evidence of selfassessment, audits and monitoring systems being in place in relation to all aspects of service provision. Information is provided to the Regional Head Office on accidents, incidents, environmental health issues, control of substances hazardous to health on a monthly basis. A system of fire safety checks, water temperature checks, equipment checks and servicing were seen to be in place. Regular audits of health and safety practices in the home are carried out by the organisation’s Regional Health and Safety Officer and there was evidence that where the home had identified risks they had consulted him for advice. The Registered Manager communicates well with the Commission and notifies us of incidents that occur in the home in line with the regulations. At the time of the inspection, work was being carried out on fire doors in the home in response to recommendations made at a recent inspection by the Dorset Fire and Rescue Service. Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 33 The home has stated in their Annual Quality Assurance Assessment that they have increased the frequency of fire training and drills in the last twelve months. A sample of fire safety records was seen to provide evidence of this. There are five appointed ‘Fire Marshals’ in the home who have received training from the organisation’s Regional Health and Safety Officer to undertake their role and provide training for staff. The home has now put in place individual training records for staff, these evidencing that new staff to the home had received fire safety training and other staff were also receiving regular training updates. One of the Senior Team Leaders had completed the home’s fire risk assessment although it was reported that an external company has now been appointed to undertake this task, a representative from which was visiting the home on the day of the inspection to commence this process. Fire drill records showed that practices are carried out at various times of the day and this was confirmed by the Senior Team Leader. There was clear documentation of dates and times of drills, staff and service users present and any issues identified at the drill. Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 34 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 X 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 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 2 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 3 X 3 X X 3 X Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 35 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 YA18 Regulation 18(1) Requirement The home must provide suitable evidence that there are sufficient numbers of suitably qualified, competent and experienced staff to support service users’ assessed needs at all times. This includes responding to service users’ personal support needs promptly to maximise their privacy, dignity, independence and control over their lives. This requirement is repeated from the last inspection of the service as the previous timescale of 16/12/06 has not been fully met. Timescale for action 31/01/08 Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 36 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA6 YA13 YA16 YA22 Good Practice Recommendations The home should continue to promote people’s ownership and control over their support plans and their participation in the risk assessment process. The home should think about how they can positively change the quality of people’s one-to-one time to enable real choice, control and spontaneity. Further work should be done to promote awareness of people’s rights in the home and their goals and aspirations to ensure that the care provided is fully person-centred. The home should review the way concerns raised by relatives are responded to in order to ensure that positive outcomes for people who use the service are achieved. People who use the service should be given information about how to access an independent advocate should they wish to. The provider should ensure that all fixtures and fittings in the home are fully accessible to people who use the service. The home should assess their infection control procedures in accordance with Department of Health guidance to ensure they are following best practice. 5. 6. YA26 YA30 Beeches (The) (Seven Kings) DS0000004006.V351060.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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. 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