Inspection on 30/08/06 for Robert Bean Lodge

This inspection was carried out on 30th August 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Robert Bean Lodge 08/05/08

Robert Bean Lodge 30/05/07

Robert Bean Lodge 22/02/06

Robert Bean Lodge 06/09/05

Robert Bean Lodge 06/09/04

Robert Bean Lodge 28/07/04

Robert Bean Lodge 04/03/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Robert Bean Lodge Pattens Lane Rochester Kent ME1 2QT Lead Inspector Andrea Leverett Key Unannounced Inspection 30th August 2006 09:30 X10029.doc Version 1.40 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 Robert Bean Lodge DS0000036756.V311557.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 Older People and 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. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Robert Bean Lodge Address Pattens Lane Rochester Kent ME1 2QT 01634 831122 01634 531113 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) Medway Council Mrs Vivianne May Simmons Care Home 44 Category(ies) of Learning disability (4), Old age, not falling registration, with number within any other category (40) of places Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The 4 beds registered for Learning Disability are for Respite use only. Date of last inspection 22nd February 2006 Brief Description of the Service: Robert Bean Lodge is a purpose built home which includes a community day centre. All of the accommodation is on the ground floor in single rooms. The accommodation is divided into four units, each containing ten bedrooms and separate day space. Medway council runs the establishment, which is registered for forty older people. The home is on a bus route and has off road parking available. The home employs care staff, working a roster, which gives 24-hour cover. The home also employs other staff for catering and domestic duties. In addition the home is temporarily accommodating a Learning Disability respite care service. This is registered for 4 persons and is selfcontained with its own staff team. The elderly residential home charges are £367.50 per week, which is dependent on an individual financial assessment. The younger adults’ respite service financially assesses each service user. Charges are dependent on level of benefit being paid and range from £1.00 to £10.77 per night. The service is subsidised by Medway Council. Robert Bean Lodge DS0000036756.V311557.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 unannounced inspection and took place on the 30th of August 2006 between 9.30 and 6.30 and the 4th of September between 4pm and 7pm. The focus of the inspection was around the key standards for both the elderly residential Home and the younger adults respite service. During the inspection documentation and records were read, including care plans. A tour of the building was undertaken and many of the residents and some visiting family members/friends were spoken to. Time was also spent talking to staff and members of the management team from both the elderly care home and the younger adults respite care unit. Overall the home has made good progress towards meeting requirements made at previous inspections and feedback from service users across both services was, on the whole, positive. Some shortfalls were noted around care planning and supervision in the elderly service and the appropriateness of the environment in the younger adults respite unit. The inspector is concerned that after 18 months the respite unit has still not been re-sited, even though it was agreed that its temporary move to Robert Bean Lodge would only be for 6 months, whilst more suitable premises were identified. The findings from the inspection have confirmed that this is an inappropriate site for this service both in terms of the Care Standards Regulations and what is considered general good practice for this service user group. The inspector was made aware of several options that Medway Council are looking at to resolve this issue, but to date no firm plans are in place. A requirement has been made regarding this. What the service does well: Elderly residents benefit from living in a well maintained and spacious home, which is clean and free from offensive odours throughout. Generally residents benefit from staff that have the skills and training to meet their needs. The home has a day centre onsite and offers temporary respite care as part of its linked service provision. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 6 During the inspection the vast majority of the residents confirmed that they were well looked after and that staff supported them well. Comments on the food were very positive. Both elderly and younger adult service users benefit from having a well managed medication administration, recording and storage system. The Younger Adults Respite service benefits from good communication between the unit and parents and carers of service users using the service. Service users from the respite unit benefit from staff who are sensitive to their needs and interact with them in a respectful manner. What has improved since the last inspection? What they could do better: The recording and undertaking of supervision and in particular, staff induction, across both elderly and younger adults services could be improved. Service users’ rights and their understanding of what they can expect from the service would be improved if appropriate service user contracts were in place for both elderly and younger adults. Service users’ access to a more consistent staff team could be improved by filling staff vacancies and using less agency staff for both the elderly and younger adult service users. Elderly residents would benefit from having access to more regular activities both inside and outside the home. Elderly residents would benefit from improvements in the assessment, care planning and monitoring of their needs. The management of the elderly residential service could be improved if the manager was not also undertaking a direct management role in the day centre. Younger adult service users would benefit from having access to their own transport at evenings and weekends. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 7 Younger adults respite service would be improved if it were re-sited. Apart from the inappropriate sharing of premises and facilities with elderly people, the environment is cramped, the garden area is not secure and is not used and the bath is not appropriately adapted to meet all service users’ needs. It does not have unrestricted access to a kitchen or kitchen sink. The younger adults service would also be improved if it could plan its own menu’s appropriate to younger people and have the facilities for them to be involved in shopping, cooking and preparing their own food. 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. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 (older people) and 2 (adults 18-65) The quality of service in this outcome group as been judged as poor. Both older people and younger adults do not benefit from having appropriate service user contracts. Older people do not always benefit from having their needs assessed prior to moving into the Home. Younger persons prospective service users know that their individual aspirations and needs will be assessed. EVIDENCE: Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 10 Older Persons Residential home A sample of residents’ files were inspected including two of the most recently admitted service users. The inspector was concerned to note in both these cases that neither care manager assessments or the home’s own assessment were undertaken at the point of admission. It is acknowledged that in both cases the residents had transferred from another local authority home. However, a full inspection of care plans and daily monitoring records showed in both cases that lack of information had undermined the quality and safety of their care. For example concerns raised about the health of one service user was not noted and followed up after transferring to Robert Bean Lodge and risk assessments were inadequate and incomplete. It was also noted that some residents that have transferred are showing signs of confusion/possible dementia and lack of assessments have meant that staffing levels and staff training needs have also been overlooked in this respect. A requirement has been made that the home review staffing levels particularly at night and ensure that basic dementia awareness training is provided for all care staff. Files inspected did not have service user contracts and a requirement has also been made regarding this. Younger Adults Respite Service Files seen did not have service user contracts and the manager confirmed that the respite service does not have them. A requirement has been made regarding this. A sample of service users’ files were inspected and all contained appropriate comprehensive assessments and care plans. The manager explained that service users are assessed in their own homes if needed and a good relationship promoted between the respite and day service, which most service users attend. As well as care manager assessments the service seeks information and feedback directly from parents and carers regarding the needs and wishes of prospective service users. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10(older persons) and 6,9,16,18,19 and 20 (adult 18-65) Older persons The quality of service in this outcome group as been judged as adequate. Service users’ health, personal and social care needs are not adequately set out in their care plans and met. Service users benefit from the home’s well managed medication administration, storage and recording systems. Service users know that they will be treated respectfully and their right to privacy will be upheld. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 12 Younger Persons Service users know that they are assessed and their changing needs are reflected in their care plan and will be met, including support to take risks as part of an independent life style. Service user’s rights are respected and they know that they will be given support in a way that they choose and require. Service users benefit from having their medication administered, stored and recorded in an appropriate manner. EVIDENCE: Older Persons Care plans and monitoring records seen were not comprehensive enough to ensure that service users’ health, personal and social cares needs are being met. Assessment and care plans, including risk assessments, lacked detail and some sections were not filled in at all. Lack of assessment and poor monitoring was noted to have undermined the health care of several service users. For example one lady had been losing weight and her care plan stated that her food and fluid intake should be monitored. Care records showed that these were not being monitored in sufficient detail or in some cases not at all. As stated previously the health needs of one service user had not been followed up after being transferred from another Home. The risk assessments and care plans of one service user who had frequent falls did not reflect how this was to be managed and the guidelines for referring service users to the falls clinic was not clear. It was also noted that some service users with diabetes had to pay for their chiropody service, which should be free on the NHS. Several requirements have been made regarding all of the above issues. An inspection of the home’s medication administration and storage system was undertaken. The home has its own dedicated medication room, which is kept locked. In addition, medication cabinets and a medication fridge are in place with appropriate temperature controls. The home uses the Boots monitored Dosage System and medication storage and records were sampled from all three units. On the whole medication was well kept and recorded accurately. Files contained service user photos and a sample of staff signatures. Controlled drugs storage and records was managed appropriately and the home’s medication returns book and system was well organised. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 13 The team leader confirmed that only senior staff administer medication and have received medication administration training before they undertake this role. Training records sampled and discussion with staff confirmed this although Medway Council provides the training, certificates seen did not show what the training covered. In order to ensure that the training is accredited a requirement has been made that the manager evidences that the trainer is appropriately qualified to undertake this role and that the course content includes all aspects of medication administration and includes a competency test. The manager must also demonstrate how staff competency is demonstrated within the home, for example, on the job monitoring during a planned induction period. Observation during the site visit and discussion with service users demonstrated that staff treated service users with the upmost respect and their right to privacy was upheld. Service users spoken to could not praise the staff enough, many service users said that staff were marvellous and couldn’t be better. Several confirmed that they could go to bed and get up when they liked. Relatives also confirmed that were always kind and helpful. Younger adults A sample of service user files seen showed that care plans reflected service users’ needs and were comprehensive and detailed and included risk assessments. These were reviewed regularly and detailed daily monitoring of care was recorded. Service users spoken to and observation during the site visit showed that staff respected service users’ right to make choices. Service users said that staff were nice and that they could go to bed when they liked. Service users were observed moving freely around the unit, making choices regarding activities and having options presented to them in a respectful manner. The unit’s medication administration, storage and recording system was inspected. The unit currently shares its medication facilities with the elderly service but the manager informed the inspector that it has placed an order for its own medication storage facilities inside the unit. The inspector was impressed with the unit’s medication administration and recording systems. Appropriate guidelines and safety checks were in place to take account of the medication routinely being received from and returned to service users’ homes. Medication was counted in and out and properly recorded. Guidelines were in place to ensure that only appropriately labelled medication was received into the unit and administered and staff training records showed that staff had received medication administration training. As for the elderly service, it was not clear what the medication training course consisted of or if a competency test was included and a requirement has been made regarding this. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 (older persons) 12,13, and 17(younger adults) Older persons The quality of service in this outcome group as been judged as adequate. Service users do not always find the lifestyle experienced in the home matches their expectations and preferences. Service users are supported to maintain contact with family and friends as they wish. Service users receive a wholesome, appealing and balanced diet in pleasing surroundings at times convenient to them. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 15 Younger adults More could be done to ensure that service users are part of their local community. Service users are denied some opportunities to develop their independence skills in that they are not able to take part in planning shopping and cooking their meals. Service users do not have the benefit of eating their meals in a congenial setting. EVIDENCE: Activity levels were generally considered low, with several service users expressing a wish to undertake more activities including being able to go out more. The home does not currently have an activities co coordinator and social needs were not adequately reflected in service users’ assessments and care plans. The home does not have its own transport or enough drivers to use the day centre buses. The home does have a weekly exercise class, although this only consists of armchair exercises. It was clear that some service users would benefit from more varied exercise options. Service users also confirmed that they had music twice a week. Activities that service users said they would like to do included cards, dominos, bingo, going out, quizzes and the option of a large screen DVD or video in the evenings. It was also noted that the home has a portable loop system for service users who are hearing impaired although it was not evident that this was used or that its use was promoted. Feedback from relatives and a family member spoken to during the site visit was positive about the service. They felt able to visit at any reasonable time and without warning. They spoke highly of the staff team and thought that they communicated appropriately with them in the best interests of their relative. All service users spoken to could not praise the food enough. Comments such as, “it is fantastic and brilliant” was made about the food. An inspection of the home’s kitchens was undertaken. It was clear that food was stored, prepared and cooked to a high standard. Food stocks were of good quality and were varied, using ample fresh fruit and vegetables. Younger Adults The inappropriate building that houses this respite service does not aid integration of the younger people into the local community and is not in line with younger adults’ preferences for small family scale homes. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 16 The service does not have access to its own transport and so community outings are limited to when buses can be loaned from the day service. An over reliance on agency staff also has an impact on community activity levels. It is acknowledged that all service users attend day services during the day and undertake a range of activities there. Communication between service users relatives and staff is given a high priority in this respite service. The inspector was impressed with the systems in place to ensure proper feedback to and from relatives regarding service users’ stays. It was also clear that the service was very flexible when relatives needed to change dates or were having to manage emergencies. Although service users were happy with the quality of food provided it does not allow for service users’ involvement in the planning and cooking of meals. The elderly services main kitchen prepares all food and the menu is essentially planned around their needs, although special dietary needs of the respite service are catered for. The respite unit does not have its own kitchen or food preparation facilities and does not even have its own sink. The unit’s dining room is too small to accommodate 4 service users and staff to support them to eat at the same time. Service users have to use the lounge area, which is also small. The way that food is provided is institutional in style and totally inappropriate for this younger adults service. The unit does have its own fridge and can store and prepare small snacks if needed. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18(older persons) 22,23(younger adults) Older Persons. Service users and their relatives can be confident that their complaints will be listened to and acted upon and that they will be protected from abuse. Younger Adults Service users and their relatives feel their views are listened to and acted upon and that they will be protected from abuse, neglect and self-harm. EVIDENCE: Older Persons. Records seen and discussion with service users and relatives showed that complaints are listened to and acted upon. A relative informed the inspector of a recent complaint she had made and discussion with the manager and records seen showed that this was being addressed. The home has an Adult Protection Policy and procedure in place, which includes whistle blowing. Discussion with staff and training records seen showed that adult protection training was undertaken. Younger Adults Records seen and discussion with service users and staff showed that complaints are listened to and acted upon. The unit has an Adult Protection Policy and procedure in place, which includes whistle Blowing and discussion with staff and an examination of training records showed that adult protection training was undertaken. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 18 Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26(older persons) 29,28,24 and 30(younger adults) The quality of service in this outcome group as been judged as poor Older Persons. Service users benefit from living in a safe comfortable well-maintained environment that is clean and free from offensive odours. Younger Adults Service users do not live in a homely, spacious environment with the appropriate specialist facilities and equipment to meet their needs. EVIDENCE: Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 20 Older Persons. A tour of the premises was undertaken and it was clear that the home was well maintained, nicely decorated with good quality furniture and fittings. The bathrooms have been recently upgraded and all radiators in rooms used by service users have appropriate covers for the safety of service users. Service users spoken to were happy with their environment although some bedrooms were in need of decoration. The home was clean and free from offensive odours throughout. Younger Adults The unit inappropriately shares some key facilities such as kitchen and laundry facilities with the elderly unit. It was also noted that staff shouting on the elderly services side in the early hours of the morning sometimes disturbs service users. Altogether this has a very institutionalised feel to it and is not appropriate for this younger adults respite service. The kitchen and lounge areas are too small and the garden area is not presently safe to be used by service users. The bath is not appropriately adapted to meet all service users’ needs, which means that some service users cannot have a bath while using the respite service. Service users’ bedrooms were all single occupancy and had appropriate moving and handling equipment and en suite facilities. The unit was nicely furnished and decorated and was clean and free from offensive odours. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30(older persons) 32,34and 35(younger adults service) The quality of service in this outcome group as been judged as adequate. Older Persons. Whilst service users needs are largely met by the numbers and mix of staff working in the home during the day, the care of service users is comprimised by inadequate staffing levels at night. Service users are protected by the home’s recruitment policies and procedures. The quality of care offered to service users is comprimised because new members of staff are not properly inducted and other staff have not all received appropriate training in key areas relating to the care of the service users. Younger Adults The quality of care offered to the service users may be comprimised because of the home’s over reliance on the use of agency staff. Service users may be put at risk because of some shortfalls in the home’s recruitment policies and procedures. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 22 The quality of care offered to service users may be compromised because new members of staff are not properly inducted EVIDENCE: Older Persons. Service users and staff had mixed feelings about staff levels in the home. Some felt that there were sufficient staff and others noted that staff seemed very busy and rushed off their feet, especially in the mornings. The inspector is concerned that there may not be enough staff, especially at night, given that more than one new service user has high needs at night such as waking up and being confused and disorientated. It was also noted that the younger adults had occasionally being woken in the early hours of the morning by staff talking loudly to each other on the elderly unit. The manager is being asked to review staffing levels and staff practices especially at night with regard to these issues. On the whole training records and discussion with staff showed that training was comprehensive and consistent. However it was noted that the home did not carry out an appropriate induction procedure with records kept. A requirement has been made regarding this. A requirement has also been made that staff should have dementia awareness training. A sample of staff files were inspected including the most recently employed staff members. Files included application form, interview records, Contracts, two written references and Criminal Record Bureau checks. Younger Adults Service users and staff spoken to felt that staffing levels were good, although a large proportion of agency staff are currently being used. Although it is acknowledged that several of these agency staff are regular and know the service users well, the ratio of one permanent staff member to two agency per shift is not appropriate and is undermining consistency and quality of service, specially around access to the community. The manager is asked to review the staffing arrangements in this regard. Training records on the whole were very good and it was clear from feedback from staff that they are encouraged by the manager to undertake personal development and training. Medway council’s comprehensive training programmes support this. It was noted however that the service did not operate an appropriate staff induction procedure with records kept and a requirement has been made regarding this. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 23 A sample of staff files were inspected including the most recently employed staff members. Files included application form, and Criminal Record Bureau checks. There were no copies of, or evidence that two written references had been undertaken in the files seen and a requirement has been made that this is addressed. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38(older persons) and 37, and 42(younger adults) The quality of service in this outcome group as been judged as poor. Older Persons. The management of the service is compromised because the manager does not give sufficient time to the running of the home because of her involvement in the day-to-day running of the day centre. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 25 Because of the identified shortfalls management time, the health, safety and welfare of service users and staff are not always fully promoted and protected. Younger Adults Service users and staff benefit from a well-managed service, which ensures that the health, safety and welfare of service users and staff are promoted and protected. The care of service users may be compromised because new staff are not subject to a formal induction procedure. EVIDENCE: Older Persons. On the whole staff and service users spoken to felt that the manager was approachable and felt supported by her. General feedback about the home was largely positive. Records showed that the home was being maintained appropriately and the health and safety of service users in this respect was being upheld. As stated previously service user assessments and care planning was not appropriately maintained and consequently health, personal and social care needs were not adequately met. Records also showed that regular staff supervision was not being undertaken and the home did not have an appropriate induction procedure in place. The manager explained that she is also the manager for the day centre and on the first day of the site visit was busy reviewing day centre files. Although the inspector was aware that residential managers in Medway Linked services homes also line manage the day centre management team, it is not her understanding that this role includes hands on day to day management such as reviewing service user files. Given the shortfalls noted at this inspection the registered person is required to review the manager’s role and give feedback to the commission. Younger Adults Staff and service users spoken to felt supported by the manager and found her approachable. It was clear that she had a good understanding of service users needs and her relationship with relatives in the best interests of service users was observed to be excellent. Although staff confirmed that supervision was taking place staff records did not support this and the recording of the staff induction process was poor. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 26 Service user risk assessments were in place and the unit was maintained to ensure service users safety. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 1 3 1 4 X 5 X 6 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 2 34 X 35 2 36 X 37 X 38 2 Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 28 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 OP2 Regulation 5(1)(c) Requirement The registered person must ensure that service user contracts are in place in both the elderly residential Home and the younger adults respite unit. Action plan by: The registered person shall not pay money belonging to a service user into an account unless the account is in the name of the service user or any of the service users to which the money belongs. This requirement has been carried over from the last inspection. Action plan required Timescale for action 20/10/06 2. OP35 20(1a) 20/10/06 3 OP36 18.1(c) (I) & 18.2 The registered person must 20/10/06 ensure that the recording and undertaking of supervision and in particular, staff induction, across both elderly and younger adults services is carried out. The registered person is required to ensure that they produce an action plan detailing how it plans to meet the recommendations DS0000036756.V311557.R01.S.doc 4. OP22 23(2a) 20/10/06 Robert Bean Lodge Version 5.2 Page 29 made in the Kent Association for the Blinds assessment of the premises and facilities. This requirement has been carried over from the last inspection. Action plan required. Not inspected. 5 OP27 18.1(a) and (b) The registered person is required 20/10/06 to review its staffing levels in the elderly residential Home and review the use of high numbers of agency staff for both the elderly and younger adult service users. Action plan by: The registered person must 20/10/06 review the day to day role the manager plays in the day centre and ensure that her responsibilities as registered manager of the elderly residential service is not compromised. Action plan by: The registered person must 20/10/06 ensure that the younger adult service users have access to a safe secure garden area that is appropriately maintained. Action plan by: The registered person must provide the Commission with an action plan detailing when the Younger Adults Respite Service will be re located including time scales. Action plan by: The registered person must ensure that the younger adults service has appropriate facilities for them to be involved in shopping, cooking and preparing their own food. Action plan by: DS0000036756.V311557.R01.S.doc 6 OP31 10.1 7 OP23 23.2(o) 8 YA24 23.1 (a) (b)&2(a) 20/10/06 9 YA17 16.2 (h) 20/10/06 Robert Bean Lodge Version 5.2 Page 30 10 YA27 23.2 (n) 11 OP27 18.2 12 OP3 14.1& 2 and 15.1 The registered person must 20/10/06 ensure that the younger adults service has a bath with appropriate adaptations to meet service users needs. Action plan by: The registered person must 20/10/06 ensure that the elderly service reviews its staffing practices to ensure that staff do not shout inappropriately and disturb service users. Action plan by: The registered person must 20/10/06 ensure that the elderly residents health, personal and social cares needs are appropriately assessed and met. Action plan: 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 OP35 Good Practice Recommendations The following is recommended: Southampton City Council have managed to find a good solution to the issue around Reg 20, and the need to avoid pooling service user monies. The system theyre adopting is called Clients Monies Service (CMS) from Nat West. It involves one account, with separate sub-accounts within it. The subaccounts carry their own number and are interest bearing, therefore ensuring interest is calculated on the amount in each account etc. Monies can be managed in relation to each sub-account by the authoritys finance department through a modem link to the bank. It is recommended that the home employ an activities co- coordinator who is trained to undertake exercise groups and other activities that she may be required to facilitate. DS0000036756.V311557.R01.S.doc Version 5.2 Page 31 2. OP12 Robert Bean Lodge 3. 4 OP12 OP12 It is recommended that the home provides organised activities. It is recommended that both services have access to their own transport. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Robert Bean Lodge DS0000036756.V311557.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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