CARE HOME ADULTS 18-65
The Bay 29 Dymchurch Road St Marys Bay Kent TN29 0HF Lead Inspector
Wendy Mills Unannounced 3 May 2005 13.15 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 Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Bay Address 29 Dymchurch Road, St Marys Bay, Kent, TN29 0HF 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) 01679 67538 Parkcare Homes (No 2) Ltd Care Home only 19 Category(ies) of Learning Disability x 16; Physical Disability x 3 registration, with number of places The Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: There are special conditions to allow for three of nineteen residents with a learning disability to also have an associated physical disability Date of last inspection Brief Description of the Service: The Bay is part of Craegmoor Group and is a Home for up to nineteen people with a learning disability. It has special conditions of registration to allow for three of the nineteen residents to also have a physical disability. It is situated in a small close just off main Dymchurch Road at St Marys Bay. The sea and local shops are nearby and larger shopping areas, educational units and leisure facilities are available in nearby towns of Ashford and Folkestone. The Home consists of three separate modern houses that are situated next door to each other and have a communual garden. each house has spacious and comfortable communual space and all the residents have own rooms. Prior to 2005 the three houses were registered as three separate care homes but a decision to register the homes as one was made in April 2005. The manager, Miss Janey Beaney, has recently been appointed and is not yet registered with CSCI. Designated staff are allocated to each house and the residents in each house tend to live as a small group. The Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and began at 1.15pm. The inspection lasted five and a half hours. The inspector spoke to seven residents during the course of the inspection. Three residents spoke with the inspector in the privacy of their own rooms. They were able to clearly express their views about the Home. The inspector also spoke to six members of staff and the manager, Ms Janey Beaney. Four staff members were interviewed in the privacy of the manager’s office. A tour of the home was undertaken during which the inspector was also able to indirectly observe staff and their interactions with the residents. An inspection was made of the storage, recording and administration of medicines. Documentation, including a thirtypercent sample of care plans, was inspected The inspector thanks the residents, the manager and her staff for their assistance during this inspection. What the service does well: What has improved since the last inspection?
Pre-admission procedures have improved and the most recently admitted resident said that he is very happy with his placement and his room. He told the inspector that the staff at the Home had helped him settle in and that he had all his possessions around him. Activity programmes at the Home continue to improve and the residents told the inspector that they like to go out. Some residents now have the confidence to leave the Home and are spending more time in the local community.
The Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 Page 6 Radiator covers have now been fitted to all radiators. Care plans have been reviewed and are now clearer. What they could do better: 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 Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 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 Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 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 There has been an improvement in the admissions procedure since the last inspection but it is unclear as to how the stated needs of all the residents can be met. EVIDENCE: A newly admitted resident told the inspector that he was very happy with his room and that the staff had helped him settle into the Home. Appropriate preadmission procedures had been followed and the Statement of Purpose for the Home now describes the Home more adequately. Staffing levels in the Home have improved slightly since the last inspection but are still low. It is unclear how all the needs of the residents can be met when there are so few staff on duty. The Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8&9 The Home has worked hard to update care plans and ensure that they are clear and accessible. However, it does not appear that the residents are consulted adequately as to their wishes, nor do they do not seem to be encouraged to participate in the day-to-day running of the Home. EVIDENCE: Care plans were up-to-date and contain risk assessments but rosters show barely adequate staffing levels. In addition, high levels of sickness have been exacerbated staffing shortages. Residents are frequently taken out in the minibus as a group, rather than as individuals. The manager said that, because of lack of staff, this is the only way in which the Home can ensure the residents get an outing each week. Some residents had a great many “Happy Meal” toys in their rooms. The inspector was told that they collected these when they went on outings. Further investigation suggested that the residents are taken out in the minibus but do not get off. A member of staff apparently buys the “Happy Meals” and these are eaten on the bus. This suggests that there is little encouragement of individual choice and preference. The inspector arrived at the same time as the weekly shopping was being unloaded. It appeared that the residents had little involvement in this. It is
The Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 Page 10 likely that one large shop is carried out weekly despite many of the residents being capable of visiting the shops with support and making their own choices. The Home must find ways of offering informed choice. It must also support residents to carry out meaningful activities and participate in the day-to-day running of the Home. It must also ensure that these activities are recorded. The Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,16&17 Progress has been made in supporting the residents to take part in social, leisure and work activities but there is room for improvement. Residents, for the most part, have a healthy and varied diet and enjoy their meals. EVIDENCE: Some of the residents have part-time jobs and were proud to talk about their work. Another resident hopes to be able to have some part-time work soon. Efforts are made to take the residents out but the inspector was told that lack of resources, particularly in staffing, means that activities are not always tailored to individual needs. The quality of food is generally good and the inspector spoke to some of the residents during their evening meal. This is the main meal of the day and there were there were plentiful quantities of home cooked food, including fresh vegetables. The dining areas of the Home are spacious, light and comfortable. The Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19&20 Residents generally receive adequate personal support and their healthcare is promoted, however, there are areas where improvement needs to be made. The systems for the storage, administration and disposal of medicines have improved but there are still concerns about the way in which procedures are followed. EVIDENCE: Staff, for the most part, offered personal care in a discrete manner, however, some residents lacked attention to detail in their personal care. For example, some had food around their faces, poor nail care, and unkempt hair. Staff said that they believed that they should provide good role models for personal hygiene and dress. There is a dress code for staff but some staff members ignored this and came to work inappropriately dressed. Consequently the dignity of the residents was compromised. Some residents had been sunburned over the weekend previous to the inspection. This was apparently because staff had failed to ensure that the residents were wearing appropriate clothing or that sun cream had been applied. It was also stated that there was no sun cream available. The policies and procedures, storage, and records for the administration were inspected. The policies for medication still contain inappropriate policies, for example, one policy explains how to give an injection despite this being a care home where no member of staff is qualified to give injections. Storage has improved and each of the three houses now has its own medicine cabinet.
The Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 Page 13 However, the cabinet in one house was not adequately locked. The records for administration of medicines have been improved and updated. The record of each resident now contains a photograph. The record of controlled drugs had a significant number of corrections that were not countersigned. When questioned about medication errors staff were unclear as to whether all errors had been reported to the manager. The Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 Page 14 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&23 The Home is improving in the way it listens to the concerns of the residents and has reported serious concerns appropriately. However, there is a need for better systems for the prevention of abuse within the Home. EVIDENCE: Residents said that they know who to talk to if they are worried and that they feel happy to talk to most of the staff. A resident recently had cause to tell staff of concerns and they listened appropriately. However, lack of full understanding of adult protection measures meant that the investigation of the complaint was hampered. In addition, despite the area manager for the Craegmoor Company assuring the adult protection team that measures to prevent further potential abuse would be put in place, no additional measures were found to have been taken by the time of this inspection. The Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 Page 15 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) 24,25,27,28&30 Improvements have been made to the environment but there a number of health and safety hazards and outstanding maintenance needs EVIDENCE: The interiors of all three houses were clean and free from offensive odours. The communual areas are bright and well carpeted and decorated, however, the fire safety devise on one kitchen door was not working. There were items of dilapidated and broken furniture in three of the bedrooms and a drawer in one kitchen was broken. Sinks in four bedrooms and one bathroom have cracks in them and the backsplashes behind some wash hand basins are in poor condition and a door handle was loose. There are adequate numbers of toilets and bathing facilities in each of the houses, however, there was staining in some of the toilet bowls. The Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 Page 16 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) 31,32,33,34,35&36 Staffing levels are too low to meet the identified needs of the residents. Some members of staff have low morale. There are systems in place to promote better team working but communication could be improved. Recruitment practices have now improved but the Company is still addressing issues caused by previous poor recruitment practice. Staff supervision has improved but more attention must be given to obtaining staff views. EVIDENCE: There is a great deal of commitment on the part of many of the staff however rosters show low staffing levels. For the most part there is only one member of staff on duty at any one time in each house. An extra member of staff is now allocated to whichever house requires additional assistance. Only one house has a wake night member of staff. In the other two houses there are residents in ground floor rooms but the sleep night room is on the floor above. Two incidences of problems with main doors to the houses either being locked when they should have been unlocked or locked when they should have been locked, have occurred. The adult protection alert can be directly linked to low staffing levels. Staff said that, although they know that additional staffing has been rostered, this is still not enough. In addition, high levels of levels of sick leave and difficulty in obtaining cover have meant that they do not yet notice any
The Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 Page 17 difference. This has also led to low morale. Some staff suggested that high levels of overtime being undertaken are a possible cause of errors. The Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 Page 18 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 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) 37,38,39 The management team is now making some progress in achieving the National Minimum Standards. However, there appears to be a lack of adequate financial investment in the Home and as a consequence, the wellbeing and health and safety are being put at risk EVIDENCE: The Company has made efforts to address the problems identified in the inspection report of June 2004 although some requirements and recommendations remain outstanding. The new manager, Ms Beaney, is currently preparing her application for registration with the CSCI. She is also in the undertaking the NVQ level IV in management and care. She is open to constructive criticism and willing to address identified concerns. She said that she feels well supported by her manager. She has already made significant improvements in the Home but feels constrained by lack of resources for staffing. Ms Beaney has plans to spend time working alongside the support workers in order to get to know the staff better and to better understand their concerns. A tour of the Home
The Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 Page 19 identified several health and safety hazards, including broken furniture and cracked wash hand basins. Representatives of the Company say that there is a lack the resources to provide appropriate staffing levels and the necessary support for the residents. The Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 Page 20 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 3 2 2 x x Standard No 22 23
ENVIRONMENT Score 2 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 2 2 x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 2 x 3 3 x 2 Standard No 11 12 13 14 15 16 17 2 2 2 2 x 2 3 Standard No 31 32 33 34 35 36 Score 2 2 1 2 1 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Bay Score 2 2 1 x Standard No 37 38 39 40 41 42 43 Score 3 2 1 1 x 2 2 H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 Page 21 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 Regulation Requirement The Home must ensure that adequate numbers of suitably qualified members of staff are on duty at all times in order to meet the standards for personal care, leisure and educational activity and the health and safety requirements The Home must review its policies and procedures for the management and administration of medicines to ensure that errors are prevented The Home must ensure that the residents are protected from harm at all times. There must be adequate numbers of staff on duty at all times and all appropriate checks must be carried out on all staff.. The Home must ensure that a health and safety audit is carried out and that all health and safety deficiencies are rectified. The Company must ensure that the Home is adequately funded for the numbers of staff required and not use lack of finance as an excuse for not meeting the National Minimum Standards. Timescale for action 31/05/05 7,8,9,11,13 18(1)(a) ,16,33 2. 20 13(2) 30/08/05 3. 23 19,20,22 06/05/05 4. 39,40 23 30/08/04 5. 43 25 31/05/05 The Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 Page 22 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 16 Good Practice Recommendations The Home should undertake a review of the way the residents make choices about how they spend their leisure time. Staff should record all activities., particulalry those taking place in evenings to ensure that residents are not becoming isolated in their rooms. More attention to detail should be given when supporting personal care. For example, residents should be encouraged to wash their faces and clean their teeth after meals; nail care should be more frequent and thorough. 2. 18 The Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent TN23 1HU 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 The Bay H56-H05 S23319 The Bay V224540 030505 Stage 4.doc Version 1.30 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
