Inspection on 15/11/07 for Lee Beck Mount

This inspection was carried out on 15th November 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lee Beck Mount 27/11/06

Lee Beck Mount 26/01/06

Lee Beck Mount 06/09/05

Lee Beck Mount 31/01/05

Lee Beck Mount 29/09/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 Lee Beck Mount 108 Leeds Road Lofthouse Wakefield West Yorkshire WF3 3LP Lead Inspector Dawn Navesey Key Unannounced Inspection 15th November 2007 10:30 Lee Beck Mount DS0000001529.V347998.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 Lee Beck Mount DS0000001529.V347998.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. Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lee Beck Mount Address 108 Leeds Road Lofthouse Wakefield West Yorkshire WF3 3LP 01924 824065 01924 823 787 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) Advitam Limited Mr Richard Smith Mr Neil Robinson Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th November 2006 Brief Description of the Service: Advitam is a Limited company, which operates one residential care home, Lee Beck Mount. Lee Beck Mount is situated on the A61 in the Lofthouse district of Wakefield. It is a large detached residence originally constructed in 1890 but has undergone extensive refurbishment to provide care for twelve people with learning disabilities, who may also have physical disabilities. It is accessible for people who use wheelchairs. The home does not provide nursing care. Lee Beck Mount is within walking distance of all local amenities; there is a range of public houses and restaurants that are welcoming to the people who live at Lee Beck Mount. Leeds and Wakefield City Centres are accessible by public transport. The home has two multi-passenger vehicles, which are used throughout the week. All bedrooms are spacious and provide en-suite facilities. There is a large communal lounge area, a dining room and a kitchen area. There is a covered patio area outside. Current information about services provided at Mayfield House in the form of a statement of purpose, service user guide and the most recent inspection report published by the Commission for Social Care Inspection are available by contacting the home. The current weekly fees for the home range between £675 and £141. additional charges are made for toiletries, hairdressing and some activities. This information was given by the managers of the home on 15 November 2007. Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.csci.org.uk This visit was unannounced and was carried out by one inspector who was at the home from 10.30am to 6pm on 15 November 2007. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people living there. And also to monitor progress on the requirements and recommendations made at the last inspection. Before the inspection evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the visit. An AQAA (Annual Quality Assurance Assessment) was completed by the home before the visit to provide additional information. Survey forms were sent out to people living at the home, their relatives and health and social care professionals. Three of these have been returned and the information used in writing this report. During the visit a number of documents and records were looked at and some areas of the home used by the people living there were visited. Some time was spent with the people who live at the home, talking to them and interacting with them. Time was also spent talking to staff and the managers. Feedback at the end of the visit was given to the home managers. I would like to thank everyone who contributed to the inspection process and to the home for their hospitality. What the service does well: People using the service said they were very happy with the home. One said, “I like it here”, another said, “It’s nice here”. A relative who returned a survey said, “Our son is very happy at Lee Beck”. The atmosphere in the home is friendly and welcoming. Staff have good knowledge on some of the care and support needs of the people who use the service. In a returned survey, a relative said, “ Staff are well trained and understand the needs of residents”. In another survey, a relative, in answer to what does the home do well, said, “Identify the needs of each resident”. Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 6 Staff interact well and communicate well with people who use the service. They show warmth and a positive approach. Staff are good at encouraging people who use the service to be more independent. One staff member said, “Being independent makes people feel good”. A person who uses the service said, “I am my own boss”. A good variety of food is available and staff make sure there is plenty of fresh produce such as fruit and vegetables. People who use the service said they enjoyed the food. Comments included, “It’s lovely”, “What I don’t like I don’t get” and “We have all sorts of different things”. What has improved since the last inspection? What they could do better: People who use the service must have a detailed and up to date care plan, which includes their specific health needs. This will make sure they receive person centred, safe support that meets their needs properly. All identified risks for people who use the service must have a detailed, up to date action plan in place in order to minimise or prevent the risk. The current practice of “potting up” the medication prior to its administration must be stopped as this could lead to errors in the administration of medication. Guidelines for ‘as and when required’ medication must clearly state the circumstances in which the medication is required. This will make sure staff’s practice is safe. A number of staff training issues must be addressed. The managers must review the training needs of staff and provide a suitable training programme to meet the needs of the people who use the service. This must include safeguarding adults and fire safety training. Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 7 The practice of hand sluicing soiled linen must stop as this increases the risk of cross infection. The managers must obtain written references for staff and should make sure they get one from the last employers of staff. This will make sure recruitment procedures are robust and protect people who use the service from any potential abuse. The managers of the home must both complete training to gain the Registered Managers Award. This will make sure they are suitably qualified to manage the home. The managers must make sure there is a quality assurance system in place so that people who use the service can express their views on the quality of the service. The managers must make sure that hazards in the home are risk assessed to make sure of safe working practices. They should also make sure that health and safety records are well maintained. Consideration should be given to producing information such as the service user guide and complaints procedure in an easy read format. This will make them more accessible to people who use the service. The managers should consider giving kitchen keys to people who are not at risk from hazards in the kitchen. This would give people more independence to use the kitchen freely. The managers should make sure that all staff receive regular supervision so that they are clear on their responsibilities and are properly supported. 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. Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service can be sure that the home will meet their needs following assessment. Also written and verbal information provides enough information for them to decide whether the home will meet their needs. EVIDENCE: The Statement Of Purpose, which provides information on the services provided by the home, is available from the managers of the home. A brochure and a philosophy statement has also been produced. The information would benefit people who use the service and any people thinking of using the service if it was produced in an easy read format. People using the service said they were very happy with the home. One said, “I like it here”, another said, “It’s nice here”. A relative who returned a survey said, “Our son is very happy at Lee Beck”. The needs of people who use the service have been assessed before they moved in to the home. The assessment used covers all aspects of daily living. Care plans are then drawn up from any needs that are identified. People who use the service had also had a re-assessment carried out, if their needs had Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 10 changed. However, some of the assessments looked at did not have any dates on them so it was difficult to see if this information was current. Also, the case records for one person showed that an assessment had not been completed by the home and that the information was from another placement. This could lead to important care needs being overlooked. In the AQAA, the managers said that they individualise any assessment to suit individuals. They said, “one service user visited around four times per week for around nine months prior to an overnight stay”. The managers have now produced contracts for people who use the service. This shows the current costs for the placement at the home. Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 11 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are, in the main, aware of the individual needs of people who use the service. The lack of detail in some care plans and risk management plans could however, lead to the needs of the people who use the service not being properly met. EVIDENCE: Each person who uses the service has a ‘pen picture’, which gives some good information on the person as an individual. It includes some person centred information on people’s history, background and some of the things that are important to them. Some people who use the service have support plans that have been developed from the assessment of their needs. The plans tend to focus on people’s needs and do not highlight people’s individual strengths or Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 12 aspirations. Some of the plans gave reasonably clear, detailed instruction on how needs are met. However, some care plans need more explanation and more detailed and specific information for staff to make sure that important care needs are not missed. For example, a plan to support someone with shaving said, ‘needs assistance’. A plan for encouraging continence said, ‘toilet regularly’. A good support plan should give clear and detailed information on how and when care is given, taking particular notice of the people’s preferences and choices. Care plans have now been reviewed at regular intervals. However, the care plan documentation does not give room for staff to write how a plan has been evaluated. The care plan is just dated as reviewed. It is not clear who has carried out the review and what has been considered during the review. This system does not show how the home is adapting to meet people’s needs as they change or if people who use the service are developing skills or working towards meeting their aspirations. Risks to people who use the service have been identified and assessed. The risk management plans for some people do not have enough detail, which again, could lead to needs being overlooked. Some risks to people do not have a management plan in place. For example, a person who is at risk from choking and has risks associated with smoking has no plans in place to show how these risks are managed. Another person has a management plan that said ‘sanctions are imposed’ when referring to behaviour that challenges others. This could be seen as punitive and needs further explanation so that staff are clear on how this behaviour is managed. Despite the gaps in care planning and risk assessment documentation, staff have good knowledge on some of the care and support needs of the people who use the service. Most were able to accurately describe the care they give and talk about the detail of how people like to be supported in their daily routines. In a returned survey, a relative said, “ Staff are well trained and understand the needs of residents”. In another survey, a relative, in answer to what does the home do well, said, “Identify the needs of each resident”. People who use the service have been involved in the drawing up of care plans. One person said that staff had talked to them about their care plan. This person had also signed the care plan. It would be good practice to also show how families of people who use the service are involved in care planning, especially for those, who due to the complexity of their needs may not be able to do this themselves. People who use the service were offered choices throughout the day, around what to do or what to eat. People who use the service also have meetings a few times per year. Issues discussed are holidays, activities, menus and any dissatisfaction people may be feeling. Staff interactions with people were very good. Staff showed warmth and a positive approach to people who use the Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 13 service. Staff gave good examples of what they do to make sure people who use the service are encouraged with their independence. One staff said, “Being independent makes people feel good”. A person who uses the service said, “I am my own boss”. Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 14 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): 11,12,13, 15 16 and 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home offers opportunities to people who use the service for personal development in addition to a range of leisure activities. People who use the service are able to make choices about their lifestyle. They also benefit from a good, healthy and varied diet. EVIDENCE: Staff said that people who use the service have a variety of activities that they are involved in within their local community. This includes day centres, shopping, meals out, going out to the pub, going to the garden centre and going to shows. On looking through activity records for people who use the service, it is clear that some people do not get out very often. Two people who use the service had left the house only once in a two week time period. The managers said that these people were sometimes difficult to motivate and preferred activity in the home. It was suggested that this is written in the Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 15 individuals’ care plans. In the main, staff said they felt there were enough staff to make sure people who use the service get a good level of activity. Some staff said it could be more difficult to get people out on occasions when there is staff sickness or vacancies. Activity is also provided and encouraged within the home. Staff said they try to meet the diversity of people’s needs by providing a varied programme of activity such as baking, karaoke nights, bingo and board games. The home has also now got a dog. People who use the service are involved in caring for the dog and seemed to gain a lot of pleasure from their interaction with her. Staff were respectful of people who use the service when they wanted to ‘do their own thing’. People who use the service said they were looking forward to Christmas and all the celebrations. One person said they were excited about putting the tree and decorations up. In returned surveys, in answer to, ‘does the care service support people to live the life they choose’ relatives said, ‘always’. A relative also said, “Since my relative has been at Lee Beck we have seen a vast improvement in his social skills as well as his speech and behaviour” Staff said that some people who use the service are able to practice their independence skills in the home’s kitchen. In order to do this, people have to ask staff to unlock the kitchen for them. It is kept locked due to hazards and risks to other people who use the service. The managers should consider giving some people their own key for the kitchen so that they can use it freely whenever they want. People who use the service are supported to keep in touch with family and friends. Some people who use the service have regular visitors to the home. Others are supported to keep in touch by making phone calls or sending letters and cards. In a returned survey, a relative said, in answer to ‘does the care home help your relative to keep in touch with you’, “Lee Beck are a good care home in this respect because we have regular contacts with our son and he comes home for visits”. Menus are developed based on the likes and dislikes of people who use the service. They are well balanced and nutritious. A good variety of food is available and staff make sure there is plenty of fresh produce such as fruit and vegetables. People who use the service said they enjoyed the food. Comments included, “It’s lovely”, “What I don’t like I don’t get” and “We have all sorts of different things”. The lunchtime meal was cheese and tomatoes on toast followed by a choice of fruit, yoghurt or chocolate. People who use the service said they could always have something different if they didn’t like what was on the menu. Staff said they always make sure they have favourite foods in stock for people. Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 16 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The lack of some written documentation could lead to personal and health care support needs being overlooked. Some practices regarding medication administration are unsafe and could lead to errors being made. EVIDENCE: Care plans have details of the personal and health care needs of the people who use the service. As already mentioned in the Individual Needs and Choices section of this report, the level of detail in some support plans on how personal care and health related tasks are to be carried out is not always detailed enough and could lead to important needs being overlooked. One person’s plan said they required ‘full intervention’ with personal care. It is not clear what this means. It is not detailed, person centred or individual to the person. Someone who is at risk from pressure sores had a plan that said to apply a cream. It did not say where the cream was to be applied. People who Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 17 use the service who are nutritionally at risk had charts in place for monthly weight records. Some people had not had their weight recorded for over nine months. Despite the gaps in care planning documentation, staff have a good awareness of the personal care, and likes and dislikes of the people who use the service. They were able to talk about the way in which people liked to be supported. Staff were seen to offer support to people with their personal care needs in private and with dignity. In a returned survey, a relative said, “I am relaxed with the care my son receives”. The support plans have details of any health professionals that people who use the service see. These include the General Practitioner (GP), chiropodist, dentist, specialist nurse, and optician. Good records are kept of any health appointments and their outcome. A health professional, in a returned survey, indicated they were happy with the health care of people at the home. Staff said they had received some training in the specialist health needs of people who use the service. This included, dementia and continence promotion. In the AQAA, the managers said, that they are planning to evaluate and budget for specific training on personal and health care support. Some staff said they felt there was a lack of training around health care needs. Staff said they have not received any first aid training or moving and handling training. A number of people who use the service have needs relating to their mental health. Staff said they had not received any training on mental health issues. The managers must identify what training is required, specific to the needs of the people who use the service and make sure staff are provided with this. This will make sure that staff are better equipped to meet peoples’ needs properly. The home uses a monitored dosage pre-packed system for medicines. Some of the senior staff take responsibility for the administration of medication and have been deemed competent to do so by the managers. No specific training in the safe handling and administration of medication has been undertaken by the managers or any of the staff team. During the visit, poor practice in medication administration was seen. Medication was dispensed from the prepacked blister pack into an unmarked pot and left in the medication cupboard to be dispensed later in the day. This is unsafe practice and could lead to errors in administration. The managers agreed to stop this practice and to make sure medication is dispensed straight from the blister pack to the person in future. Medication record sheets were also looked at. There were no errors in the recording of medicines that had been administered. However, the numbers of tablets received into the home was not being checked and signed off. This means there is not a clear audit trail of medication kept in the home and it Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 18 would be difficult to check if any went missing. Again, the managers agreed to do this in future. Some people who use the service have guidance in place for the use of ‘as and when required’ medication. Some guidance was not clear and stated ‘as required’. This does not accurately describe the circumstances in which the medication is to be given and could lead to errors or misinterpretation. Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 19 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service and their relatives have their views listened to, taken seriously and acted upon. The systems in place to protect people from abuse are not robust enough. EVIDENCE: The home has a complaints procedure. This would benefit people who use the service more if it was produced in an easy read format. However, people who use the service, who were spoken to, said they would tell staff if they were unhappy. The complaints procedure also needs to be updated to give current contact details for people to make complaints to organisations other than the home. The home has not received any complaints since the last inspection. Returned surveys showed that relatives of people who use the service know how to use the complaints procedure. There is an adult protection policy and a whistle blowing policy in the home. The adult protection policy has been reviewed, as requested at the last inspection, to include information on what staff must do in the event of an incident or allegation of abuse being made. Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 20 Most staff have not received training in the protection of vulnerable adults. This was a requirement at the last inspection of the home. The managers said they were trying to access training in the local area but had not found any as yet. This training must be provided for all staff at the home to make sure people who use the service are properly protected from abuse. Despite the lack of training, most staff spoken to were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. They were also able to describe some of the different types of abuse. The home also has a policy on restraint. This policy covers restraint in general terms and does not give information on how this may be carried out for individuals. Staff said they had not received any formal training on the safe use of restraint. Some staff said they had been trained by the managers of the home and were able to assist in carrying out restraint procedures. Other staff said they had not been trained and would not attempt to restrain anyone. All staff said the use of restraint is extremely infrequent. However, the managers must make sure that restraint management plans are in place for individuals who may need this type of intervention. They must also make sure that staff are trained in the safe use of restraint to make sure practice is safe. Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 21 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 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment in the home is homely, clean, safe and hygienic. Staff’s practices, in the main, control the spread of infection. EVIDENCE: The home is very spacious, clean and homely, providing sufficient space for people. Bedrooms have been decorated and furnished to suit individuals and their interests and personality. All bedrooms have an en-suite bathroom. People who use the service said they had been able to choose the colour schemes for their rooms. One said, “I am the boss in here”. The home is nicely decorated and has furniture and furnishings of a good standard. A maintenance officer is employed by the home. He makes sure any maintenance work is attended to promptly and has a programme of Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 22 regular re-decoration for the home. Communal areas were clean and there were no odours noted. The home employs part-time domestic assistants too. The home is set in large gardens and there is ample parking space. There is a covered patio area that is well used by people who use the service. Some people who use the service like to help out with some planting in the garden. In the main, clinical waste is properly managed and staff wear protective clothing when attending to the personal care needs of people who use the service. However, staff talked of the practice of hand sluicing soiled linen. This increases the risk of cross infection and must cease. The washing machine in the home has a sluice programme and therefore there is no need for staff to hand sluice. Some staff have received training in infection control as part of their NVQ (National Vocational Training) and are able to say what infection control measures are in place. This training must be given as part of staff’s induction to make sure all staff’s practices are safe. Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are sufficient staff numbers in the home. However, they are not always trained or supervised to fully meet the needs of the people who use the service. EVIDENCE: There are staff on duty throughout the day and night. There are usually three or four staff on each shift through the day. There is also one staff on waking night shift with another staff sleeping in to be called upon in emergency. The managers of the home provide an on-call back up service too. In returned surveys, relatives spoke highly of the staff. Comments included, “Staff are well trained” and “They are very caring staff”. Recruitment is, in the main, properly managed; interviews are held, references and CRB (Criminal Record Bureau) checks are obtained before staff start work and checks are made to make sure staff are eligible for work. However, one staff file showed that references had been obtained from a family member and Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 24 not the person’s last employer and some references had been taken verbally rather than in writing. This practice could lead to unsuitable people being employed to work with vulnerable people. When staff start work at the home, they are provided with a home induction. One of the managers works alongside them so that they become familiar with their role. The managers of the home have developed the induction. Staff said they did not attend any training courses as part of this induction. Training records showed that most staff have only undertaken food hygiene training as essential training. Comments were mixed from staff regarding their training. Some staff felt they had received enough training to carry out their role, others didn’t. Some said they felt they should receive training on first aid, moving and handling techniques and infection control. As already mentioned in other sections of this report, training is lacking in several areas. The managers do not have a training plan in place for staff and do not keep records of when training is due for staff. Some training has been booked for two staff to attend moving and handling training. The managers must make sure that training is provided so that staff are properly trained to meet the needs of people who use the service. In the AQAA, the managers said “ We ensure workers are trained appropriately in accordance with relevant legislation and guidelines”. They must carry out a review of staff’s training needs to make sure that staff fulfil the aims of the home and meet the needs of the people who use the service. Well over half of the staff team have achieved an NVQ (National Vocational Qualification) in care at level 2 or above. Some staff said that this training had covered some of their training needs. Others felt more was needed. Staff said they had not received training specific to people who have a learning disability. They said they would welcome this. At the last inspection of the home it was recommended that Learning Disability Award Framework training should be considered for new workers. The managers have not introduced this as yet. Staff said they felt they had a good team and the managers are very supportive. Some staff have had supervision from the managers in the form of one to one meetings. Records showed that this was fairly infrequently. The managers said they are in daily contact with staff and encourage good communication by maintaining this presence in the home. The managers should make sure that staff have more regular supervision meetings to give them the support to carry out their jobs properly. Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 25 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, 38, 39, 41 and 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is adequately managed. The interests of the people who use the service are seen as important by the manager and staff. However, the lack of quality assurance and health and safety systems means they are not properly safeguarded. EVIDENCE: The home has two registered managers. One of these, Neil Robinson has now completed NVQ level 4 in care and is working towards the Registered Managers Award. The other registered manager, Richard Smith has a nursing qualification. As a registered manager, he must also gain a suitable management qualification. In the AQAA, the managers said that they wanted Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 26 both managers to have gained the Registered Managers Award in the next twelve months. Both managers share the management tasks in the home. Some of the time they are supernumerary, other times they work on shift alongside staff. Staff spoke highly of the support they receive from the managers. They said they are approachable. Staff said they were good leaders and deal well with any matters in the home. In a returned survey, a relative said, “Very well managed care home”. In the AQAA, the managers said, “The management welcomes comments from all parties involved with the home”. The managers have not, however, introduced any quality assurance systems to seek the views of people who use the service or their relatives. The managers must do this to make sure that people are given the opportunity to express their views about the service. In returned CSCI surveys, when asked how the home could improve a relative said, “Just to continue with the high standards they already adopt”. Another said, “I don’t think they can improve because they are doing a good job now”. As already mentioned in the Individual Needs and Choices and Personal and Healthcare Support sections of this report, care plans and risk assessment records must improve. This will make sure they are of a good standard and give staff detailed and specific instruction on care and support needs for people who use the service. There are a number of health and safety issues to be addressed. Staff have still not received any fire safety training. This was a requirement made at the last inspection of the home. The managers said they would consider finding a training course which would enable them to train to deliver this training themselves. Staff have however, participated in fire drills. Hazards in the environment have not been risk assessed to make sure of safe working practices. Most staff have not had training to ensure safe working practices. Training must be provided to include, moving and handling, first aid and basic health and safety. The home has some health and safety policies and procedures in place. Staff sign these to say they have read them. In the AQAA, the managers said the gas and electrical wiring certificates are up to date. They also said that the portable electrical equipment had not been tested for three years but they were in the process of arranging for this to be done. The home employs a maintenance officer who does regular health and safety checks around the home. This involves identifying any hazards and testing water temperatures to see they are safe. This information should be recorded to show how health and safety is managed. Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 27 Accident and incident records were well recorded. Fridge and freezer temperatures are being recorded to make sure that food is stored at the correct temperature. Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 3 2 X 2 2 X Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 29 Yes. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 YA19 Regulation 15.1 Requirement People who use the service must have an up to date detailed care plan, which includes their specific health needs. This will ensure that they receive person centred support that meets their needs. (Previously agreed timescales 3/04/05, 16/11/05, 30/03/06 and 28/02/07 have not been met in full). 2. YA9 13.4 All identified risks for people who use the service must have a detailed up to date action plan in place in order to minimise or prevent the risk. (Previously agreed timescales of 30/03/06 and 28/02/07 have not been met in full). 3. YA20 13.2 The manager must make sure that current practice of “potting up” the medication prior to its administration is stopped as this could lead to errors in the DS0000001529.V347998.R01.S.doc Timescale for action 31/01/08 31/01/08 16/11/07 Lee Beck Mount Version 5.2 Page 30 administration of medication. Guidelines for as and when required medication must clearly state the circumstances in which the medication is required. This will make sure staff’s practice is safe. The managers must make sure that all staff are trained in safeguarding adults, to make sure their practice is safe. (Previously agreed timescales of 30/03/06 and 28/02/07 have not been met). Training must also be provided in the safe use of restraint. To make sure all staff’s practice is safe. The practice of hand sluicing 16/11/07 soiled linen must stop as this increases the risk of cross infection. The managers must obtain written references for staff. One should be from the last employer of staff. This will make sure recruitment procedures are robust and protect people who use the service from any potential abuse. The managers must review the training needs of staff and provide a suitable training programme to meet the needs of the people who use the service. The registered managers of the home must both complete training to gain the Registered Managers Award or an equivalent management DS0000001529.V347998.R01.S.doc 4. YA23 18 31/03/08 5. YA30 13.3 6. YA34 19 30/11/07 7. YA35 18 30/06/08 8. YA37 9 30/06/08 Lee Beck Mount Version 5.2 Page 31 qualification. This will make sure they are suitably qualified to manage the home. (Previously agreed timescales 3/04/05, 16/11/05, 30/03/06 and 30/06/07 have not been met in full). 9. YA39 24 The managers must make sure there is a quality assurance system in place so that people who use the service can express their views on the quality of the service. 31/03/08 10. YA42 23.4 All staff must receive fire training 31/03/08 to make sure their practice is safe and up to date. (Previously agreed timescale of 30/06/07 has not been met). 11. YA42 13.4 The managers must make sure 31/03/08 that hazards in the home are risk assessed to make sure of safe working practices. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 YA22 Good Practice Recommendations Consideration should be given to producing information such as the service user guide and complaints procedure in an easy read format. This will make them more accessible to people who use the service. The managers should consider giving kitchen keys to DS0000001529.V347998.R01.S.doc Version 5.2 Page 32 2. YA16 Lee Beck Mount 3. 4. 5. 6. YA20 YA35 YA36 YA41 people who are not at risk from hazards in the kitchen. This would give people more independence to use the kitchen freely. Accredited medication training should be given to all staff to ensure good, safe practice. Learning Disability Award Framework training should be considered for new workers. The managers should make sure that all staff receives regular supervision so that they are clear on their responsibilities and are properly supported. The managers should make sure that health and safety records are well maintained. Lee Beck Mount DS0000001529.V347998.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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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