CARE HOME ADULTS 18-65
The Mews Main Street Bessingby Bridlington YO16 4UH Lead Inspector
John Trainor Unannounced 10 August 2005 09.45
th 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 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 Stationary 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. The Mews J53 JO4 S63609 The Mews V241627 120805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Mews Address Main Street Bessingby Bridlington East Yorkshire 01262 605340 01262 605340 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Franklin Homes Limited Care Home Only 5 Category(ies) of Learning disabilities mixed gender registration, with number of places The Mews J53 JO4 S63609 The Mews V241627 120805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10/03/05 Brief Description of the Service: The Mews Care Home is registered for service users with a learning disability and is situated on the outskirts of Bridlington in the small village of Bessingby. The home occupies a period cottage type property together with an annexe, which has been adapted for its purpose as a care home. The house has its own ample gardens and people living at the home have access to this pleasant space. Bridlington Town has a range of local amenities, however given the distance of these from the home; access to them is reliant on a long walk or the homes own transport, nearby public transport or taxis. The Mews J53 JO4 S63609 The Mews V241627 120805 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and conducted over seven hours. Three of the four people resident had their care provision inspected in detail including inspection of care plans, other records and observing practices of care staff as well as meeting the people resident in the home. The person representing the home was the manager Marianne Wardle. What the service does well: What has improved since the last inspection? What they could do better:
There had recently been changes to night staffing arrangements in the home when, following a risk assessment process a decision had been made to reduce night staffing by one waking member of staff, which would only leave staff on sleep in duty. This was thought to be not acceptable and an immediate
The Mews J53 JO4 S63609 The Mews V241627 120805 stage 4.doc Version 1.40 Page 6 requirement to re-instate waking night staff was issued on the day of inspection. Some parts of the environment had been damaged and found to be unsafe. A tile in the bathroom had sustained damage and had sharp edges and kitchen chairs were damaged and also found to have sharp edges. The home was required to take immediate action to rectify these issues and make them safe. The manager was not able to provide evidence that the gas and electrical installations had been tested and found to be safe and it was required these certificates be forwarded to the Commission for Social Care Inspection before 17th August 2005. The nature of the difficulties some people living at the home experience, means it is crucial all staff are adequately trained in breakaway techniques and safe methods of restraint, in order to ensure the safety of all of the people in the home. This training needs to be implemented as a matter of priority as restraint is currently being used in the home. Staff also needed training in Adult Abuse Awareness in order to reduce any risk to service users. Staff were not being supervised in line with recommendations in the standards and the outcome to this was crucial routines and interventions essential for managing peoples behaviour and maintaining a safe environment were recently not being adhered to by staff. Staff must be formally supervised six times a year to ensure their practice is up to date and consistent with providing a high quality of care. In the interests of safety and following risk assessment the kitchen areas are kept locked and people are always supervised in the kitchen. This should be made clear in the service user guide so people are aware of this prior to deciding to come to the home. The training programme and quality assurance methodology currently being developed by the company must be implemented in the home to improve things for both staff and people living there. Care plans would benefit from the addition of individualised task specific detail with regard to personal care provision so all staff meet peoples personal care needs consistently and in line with their expressed preference. 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 Mews J53 JO4 S63609 The Mews V241627 120805 stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Mews J53 JO4 S63609 The Mews V241627 120805 stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 and 5 Though people had their needs assessed prior to moving into the home and the inspection suggested those needs were being met, improvements to the statement of purpose/service user guide would ensure people had all the information they needed on the environment to make a decision before they moved in. EVIDENCE: Care files had detailed assessment and risk assessment documentation to enable care plans to be developed which would meet the needs of the individual they were reviewed regularly by key workers and there was evidence of revision People’s contracts were found to include a breakdown of fees and who was responsible for paying them. The statement of purpose had not been updated following a requirement from the previous inspection and needed modification to include detail of those areas kept locked and an explanation of the environment structure based on the risk assessed needs of the people in the home. The statement of purpose should also include the homes philosophy and policy on restraint. The statement of purpose and service user guide should accurately describe the service people can expect to receive as a way of assisting them in the decision making process when considering the home.
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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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 People’s individual needs and choices were respected and in the main provided for though care planning must be delivered consistently in the home to ensure all people have their needs documented and met. EVIDENCE: Three out of four of the plans were completed to a high standard though would benefit from the addition of task specific detail with regard to meeting personal care needs in a way which reflects individual need and preference and ensures consistency across all staff members. Risk Assessments and risk management plans were in place. One care plan identified on the day of inspection was not complete, current and up to date and the registered person must ensure this is rectified as a priority. Service user meetings are held, which are individually documented, where things are explained to people in simple language to aid understanding. Staff practices were observed which demonstrated respect for the choices of the individual.
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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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15, 16 and 17 People are supported to have a lifestyle which maximises independence and choice and encourages family relationships. EVIDENCE: People maintained regular contact with their family who were kept informed of the developments in care provision in the home. One service user likes to attend church and is supported to do so. Though the others do not regularly attend they are always offered the choice. Issues of preference had been addressed in service user meetings and with the families. Practice was observed which respected there is a choice at meal times and people can always have an alternative should they wish. People are supported and encouraged to assist with maintaining the domestic environment. People have use of a large garden, can go out for walks with staff, attend local facilities, one goes to a day centre.
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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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 Though people receive personal healthcare and support as needed more attention to detail in recording preference in personal care plans would ensure consistency to approach from staff and guarantee this is delivered in the way people prefer and require. EVIDENCE: Consultation with staff evidenced they were aware of how people liked their personal care needs met and descriptions of the approach suggested due respect for individual privacy and dignity were considered as well as safety factors. However care planning did not detail personal care interventions to account for individual preference and could be improved. People had their health care needs met by primary care interventions and access to secondary specialist services when required. The Mews J53 JO4 S63609 The Mews V241627 120805 stage 4.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 People cannot always be guaranteed a timely response to any complaint unless the home’s complaints policy is revised to include timescales. Failure to train staff in adult abuse issues leaves open the potential for abuse to occur without being picked up by staff. EVIDENCE: There is a complaints procedure but this requires some revision to ensure it will address the issues raised in any potential complaint in a timely fashion. This was a requirement from the previous inspection which has not yet been actioned. The home has an adult abuse policy and access to the multi agency agreed procedure however staff have not received training in Adult Abuse Awareness and this should be addressed. The Mews J53 JO4 S63609 The Mews V241627 120805 stage 4.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 Though the environment is fairly minimalist to assist in risk management it was clean and hygienic. However some areas were not maintained safely and required action to ensure safety could be guaranteed. EVIDENCE: The home was clean though some parts of the environment had been damaged and found to be unsafe. A tile in the bathroom had sustained damage and had sharp edges and kitchen chairs were damaged and also found to have sharp edges. The home was required to take immediate action to rectify these issues and make them safe. (See requirement number 7) The infection control policy was inspected and found to meet the standard. The manager was not able to provide evidence that the gas and electrical installations had been tested and found to be safe and it was required these certificates be forwarded to the Commission for Social Care Inspection before 17th August 2005. The Mews J53 JO4 S63609 The Mews V241627 120805 stage 4.doc Version 1.40 Page 14 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35 and 36 People were well looked after during the day with staff deployed in sufficient numbers to meet their needs. However recent changes to night staffing meant there was not sufficient supervision during the night and action was required to put this right immediately. Staff did not receive enough supervision to support them in caring for the people living in the home. EVIDENCE: Staff were deployed in sufficient numbers during the day to maintain at least a 1-1 ratio of staff to service users. However recent changes to the night rota meant there were no waking night staff and immediate action was required to ensure waking night staff were deployed. Staff practices observed suggested people were treated with respect and staff interviewed seemed knowledgeable about the care needs of the people resident. Staff supervision was not taking place as required to ensure good care delivery. Staff training had been reviewed and a plan to implement training had been developed this should be implemented to ensure staff receive the training they need to continue to meet the needs of the people in the home. Training is needed on breakaway and restraint techniques and adult abuse issues.
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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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 40, 42 and 43 Though the management at the home is improving because of more time for the manager, better support from the company and the development of management systems there was insufficient evidence to support the home being managed and maintained safely and competently. EVIDENCE: The manager has applied to become registered with the Commission for Social Care Inspection as required from previous inspections and is in the process of receiving training to NVQ level 4. The Manager has received line management supervision and feels better supported by the company. Staff were trained in food hygiene and first aid and there was an infection control policy.
The Mews J53 JO4 S63609 The Mews V241627 120805 stage 4.doc Version 1.40 Page 16 The general manager is completing regulation 26 visits and a quality assurance methodology is being developed. Recent problems with recruitment has meant the manager has been providing hands on care, however jobs are now advertised and one person is awaiting checks to enable them to commence work. This will enable the manager to get to grips with some of those areas which have been allowed to slip and ensure a management style, which provides clear leadership and supervision for staff and ensures health and safety within the home. Gas and electrical safety certificates were not available for inspection to guarantee the safety of the installations. The Mews J53 JO4 S63609 The Mews V241627 120805 stage 4.doc Version 1.40 Page 17 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 2 x 3 Standard No 22 23
ENVIRONMENT Score 1 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 1 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 1 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 1 1 x 2 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Mews Score 2 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 x 1 2 x 1 3 J53 JO4 S63609 The Mews V241627 120805 stage 4.doc Version 1.40 Page 18 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 Regulation 15 (1), Schedule 3 (1(b)) Requirement All people resident at the home must have a written care plan from the time of admission, based upon a comprehensive assessment, which includes task specific detail of all care needs and risk assessment/risk management strategies. The Care Plan for the person identified as not having one must be developed as a priority The registered person must ensure that the complaints policy is updated to give timescales for action. (Previous timescale of 10/04/05 not met.) All staff must receive training in breakaway techniques and physical restraint. (Previous timescale of 7.03.05 not met.) Staff must receive training in Adult Abuse Awareness. Waking night staff must be on duty to maintain the safety and supervision of the people resident in the home. Timescale for action Agust 31st 2005. 2. YA22 22 (4 & 7(a,b)) 30th September 2005. Training must be commence d before 31st December 2005. This must be implement ed from the 10th August and maintained therafter.
Page 19 3. YA 23, YA 32. 13(7), 18(1(c)) 4. YA33 18(1(a)) The Mews J53 JO4 S63609 The Mews V241627 120805 stage 4.doc Version 1.40 5. YA36 12(5(a&b) ), 13(6) The registered person must ensure staff receive formal supervision at least six times a year and that an annual appraisal of individual staff performance takes place. (Previous timescale of 01.05.04 not met) 6. YA39 24 7. YA24, YA42 13(4) The registered person must ensure an effective quality assurance and qualitymonitoring system is implemented for the home and that the results of service user and associated stakeholder surveys are published and made available to interested parties including the CSCI. (Previous timescale of 07.06.05 not met.) Gas Safety, Fixed Wiring Electrical Safety and PAT testing Certificates were not available for inspection though the Manager was certain testing had been completed. These certificates must be made available to the Commission for Social Care Inspection before the 17th August 2005 to evidence that the health and safety of people resident at the home is being maintained. All staff should have commence d a regular supervision programme before the 30th November 2005. 31st December 2005. 17th August 2005. Tiling in the upstairs bathroom is damaged and one tile by the shower is broken with sharp edges. This should be made safe 13th August before 13th August 2005. 2005. Chairs in the kitchen need replacing several have the struts in the chair back broken and some have sharp edges which could cause injury. A review of their safety must be conducted
The Mews J53 JO4 S63609 The Mews V241627 120805 stage 4.doc 13th
Page 20 Version 1.40 before 13th August and action taken to ensure they are safe. August 2005. 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 Good Practice Recommendations The Statement of Purpose and service user guide should be revised to ensure it includes arrangements for those areas of the home kept locked due to risk management and accurately reflects the environment and care philosophy of the home including use of restraint in order to be sure people have this information before making a choice to live at the home. The registered person should ensure that specialist training in autistic spectrum disorders is accessed for staff working in the home. The home should have a minimum of 50 of care staff achieve a NVQ 2 by 31st December 2005. The newly developed training programme for staff should be implemented as soon as possible. The Manager should review all policies and procedures in use at the home and ensure they are specific to the identified needs at The Mews and should sign and date them to evidence this review. 2. 3. 4. 5. YA3 YA32 YA35 YA40 The Mews J53 JO4 S63609 The Mews V241627 120805 stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection York Area Office Unit 4 Triune Way Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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