CARE HOME ADULTS 18-65
The Beeches 7 Crescent Rise Luton LU2 0AT Lead Inspector
Katrina Derbyshire Unannounced Inspection 21st November 2006 11:30 The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Beeches Address 7 Crescent Rise Luton LU2 0AT 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) 01582 425792 Mr Geoffrey Plane Miss D Newman Mr Jonathon Plane Care Home 12 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (12) of places The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th December 2005 Random inspection on 17th August 2006 Brief Description of the Service: The Beeches is a care home for younger adults who have mental health needs. The home opened in 1987, and some of the residents have been at the home since then. The home is registered for a maximum of 12 residents. All residents are offered single bedrooms, and four of the rooms have en-suite facilities. There are two lounges on the first floor, and the kitchen and the dining room are located in the basement. The home has a garden at the rear of the house, which is mainly grassed and has trees, flowerbeds, and a water feature. There is a small parking area at the front of the house. The home is within walking distance of the local bus and train station in Luton. The shopping centre and other amenities in the town centre are also within walking distance of the home. The fees for this home vary from £468.00 per week, to £800.00 per week, depending on the funding source and assessed need of the resident. The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The purpose of this visit was to undertake a key inspection. This unannounced visit was carried out on 21st November 2006. The Registered Manager Jonathan Plane was present throughout the inspection. During the inspection all areas of the home were visited and the inspector spent time with many of the residents’ in the main sitting area of the home. The care of two residents’ was examined by looking at their records and interviewing the residents’ and staff who look after them. The views of residents were have been used alongside information from the home through a pre inspection questionnaire to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit and the random inspection carried out on 17th August 2006. Observations of care practice and communication between the residents’ and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well:
Residents living at this home feel that the staff support them in making decisions about their own lives. Staff at the home make sure residents have access to help from advocacy services who are not connected to the home or management. This means residents can have guidance and assistance in their lives that maintains their independence and individual rights. If a resident is not happy with a part of the care they receive there is a good policy that the home has, this lets all the staff know how they should respond to the resident and improve the standard of care. The home takes the feelings and wishes of the residents very seriously and they make sure that the residents have an opportunity to let them know how they are feeling. The home is also good at helping residents feel part of the local community. Local facilities including shops, pubs and places of worship are all within walking distance and residents are encouraged to use all the town facilities. In addition staff always make sure that local events are shared with the residents so that they can always be involved with the local community in Luton. The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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
The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems in place to assess the needs of prospective residents are good, ensuring the home has sufficient information to ascertain that they are able to meet the resident’s needs. EVIDENCE: The homes policy regarding the admission of residents showed that a planned approach to all admissions to the home should be undertaken. Two residents through discussion confirmed that they had been involved in the decision to move into the home and had been given the opportunity to visit prior to making any decisions. Combined assessments by the home and placing authority are in place for more recent admissions to the home, these are comprehensive and make clear the needs that the home would need to meet. Social and cultural needs are assessed alongside the physical and social needs of the resident. The care plans in place were directly linked to the assessment of needs. The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffs approach to risk management for residents both reduces risks for the residents but allows them freedom to live their lives in an unrestricted way. EVIDENCE: Residents spoke of the choices available to them whilst living at the home. One resident said “ l go out when l want to, they don’t restrict me the only thing l have to do is let them know when l am going out, so they know l am safe”. Other choices available to residents were choice of meals, clothing and social activities, written evidence of these were seen in the care records. Care plans were seen to be in place for all assessed needs and showed that a review of their needs had been undertaken every six months. For one resident their care plans were comprehensive and gave clear guidance and instructions
The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 11 to staff on how to meet their needs. However another resident’s plan concerning their diabetes did not make clear the action staff should take if their blood sugar was to high or low. In addition there had been no nutritional risk assessment undertaken for this resident, this is required to identify any action required to reduce the risk associated with their nutrition. Many of the resident’s living at the home have their personal money managed on their behalf by the commissioners of their care or family members. Management of monies held by the home were noted to be satisfactory with a balance sheet maintained for each resident and receipts of all expenditure incurred. The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The provision of a high amount of frozen food does not meet the tastes of all residents at this home. EVIDENCE: All residents spoken with and a staff member confirmed that following recent changes to the menu, the staff at the home now mainly use frozen foodstuff for meals. Two residents felt that these meals “could be tasteless at times”. Residents felt that if one particular member of staff was on duty they would always prepare fresh vegetables and would not cook from frozen. Residents reported that they enjoyed these meals, however most of the time they felt that the meals were not satisfactory. On examination of the stores of provisions in the home, it was noted that a large amount was frozen goods. Within the care records of residents, entries were seen within the daily notes to show that residents participated in a variety of activities and occupation. Since
The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 13 the previous inspection the home now maintained further records to show activities that were available and that had taken place. Residents attended varying day care services where they were able to participate in a curriculum of activity and development. Staff confirmed that residents supported by themselves attended events within the local community. Residents had a good knowledge of the local area and all facilities available to them. Information provided by the home show that activities provided include, pictures, watching films, shopping and arts and crafts. The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal support given to residents is of a good standard so residents receive care that respects them as individual people and maintains their dignity. EVIDENCE: Through observations it was noted that staff approached all residents in a sensitive manner when addressing them. Residents were seen to be supported and encouraged by staff in maintaining their personal hygiene and making themselves refreshments. When a resident needed encouragement relating to their clothing, this was done discreetly by the staff member, who offered constant verbal reassurance to the resident. Care plans contained entries that gave clear guidance to staff in how to offer personal support to each resident. In addition the review of residents also ensured that the care provided was also changed when required by the resident.
The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 15 Within the individual care records of residents it was noted that there were documents from a variety of medical specialists. These documents showed that residents received regular support from speech Doctors and Nurses. Staff confirmed that they assisted residents to attend hospital appointments and the outcome of any medical intervention and subsequent guidance was recorded. Residents also spoke of visiting their Doctor; one resident said “if l am not well they always take me to my Doctor”. The storage, receipt and administration of medication was examined. The medication administration sheets were noted to be correct. The storage of medicines were seen to be in a locked facility. Records were seen to show returns of unused medication. Staff confirmed that they did receive regular updates in the administration of medicines and observations were made of medication and noted to be appropriate and follow safe practice guidelines. . The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems in place to protect vulnerable adults in the home is robust and reduces the risk of the residents from being at risk of harm. EVIDENCE: The homes policy on the protection of vulnerable adults had recently been updated to include the referral guidance in accordance with the local Protection of Vulnerable Adults policy. It includes varying types of abuse and examples including, physical, financial and sexual abuse. The home uses the local protection of vulnerable adults policy and this contains guidance to staff on how to report any allegation of abuse. Staff also confirmed that they had received training in this area. In addition the home also had in place a very clear complaints procedure. Reference is also made within the homes statement of purpose on how anyone may complain about the services in the home. One staff member said “ its not a bad thing getting a complaint, it just means we sometimes have to change and then things get even better”. The policy was noted to meet with this standard and did inform the reader how they would be responded to and within what timescale. Residents spoken with all confirmed that they knew their rights to complain and would feel comfortable doing so to the manager at the home.
The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some areas of the home have an unpleasant odour and is not clean; this is not nice for the residents living there. EVIDENCE: At the random inspection undertaken in August 2006 the following was reported. ‘The main lounge carpet was heavily soiled causing stickiest to peoples shoes when walking across it. Light fittings in this area were broken and there were no curtains at the window’. It was noted that some light fittings were still broken, there were no curtains at the window and the carpet remained stained, in addition the television was broken. These areas must now be addressed so that an acceptable level of comfort and privacy is in place for the residents at the home.
The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 18 It was observed at this visit that cleaning of the home was being undertaken, by a person employed by the home to specifically undertake this role. Residents reported that this staff member worked very hard in trying to keep the home clean. However some areas in the home despite this were not maintained to an acceptable level, the toilet based on the ground floor was stained and marked on the walls and floor. The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The procedures for the recruitment of staff are at times not sufficient to offer protection to the people living in the home. EVIDENCE: Examination of some staff records showed that a staff member had been employed at the home, using a Criminal Records Bureau check arranged by another home that had been the previous employer. This resulted in the home not following guidance in this area, and not having up to date information regarding this staff member to make a decision as to whether they would be suitable to work with vulnerable people. The remaining staff files contained the information listed in schedule 2 and 4. Training records and staff confirmed that alongside statutory training staff had undertaken further training in relation to their roles. The home had been active in commencing staff on a National Vocational Qualification programme and all staff had development and appraisal plans in place. Certificates of attendance were maintained for all courses undertaken.
The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 20 Staff spoke of the training available to them. Training undertaken by staff included fire safety training, understanding mental health, and assessment of need and Protection of Vulnerable Adults. Information through discussions with residents indicated that they felt well cared for, that staff treated them well, respected their privacy and that they felt safe at the home. The homes staff team had clearly defined roles and the observations on the day of inspection demonstrated staff were clear in their roles and were able to advise and explain their post and associated responsibilities. Examples were when a resident makes a complaint, staff were aware that they would need to seek guidance from senior staff at the home in certain instances, to provide the best outcome for the resident. Staff rotas show that there is a time period of one and a half hours a day when there is only one member of staff on duty. Although an on call system is in place where someone can be called in, this area needs to be reconsidered as there is a time delay from making the request until the on call person arrives. Care records contained entries that showed several residents living at the home can demonstrate both verbal and physical aggression towards others. The risk associated with this and there being only one staff member must now be reviewed by the management. The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and safety systems in this home need to improve to provide an environment for residents that reduces the risks associated with this area. EVIDENCE: Staff and training records showed that heath and safety training had taken place including fire safety and food hygiene. The most recent inspection by the Fire Service in 2006 showed that the home still are required to undertake risk assessments to meet all the requirements in this area. In addition the most recent inspection by environmental health required the home to have a clear system in place under HACCP to meet their requirements. A requirement to The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 22 have radiator guards in place to prevent the risks of burns remained unmet, two timescales for compliance have not been met. The home carries out consultation with the residents in different forms. Staff confirmed that on a day-to-day basis residents are asked for their views and these decisions are then integrated into the care plans of the resident, examples included a certain type of diet. More formal methods such as residents meetings had taken place in the past and minutes were available for inspection, but the home recognised that the views of all residents could not be sought in this way. Residents reported that they found the manager to be a very good listener and all felt that he was very easy to talk to and that they trusted him. Staff said that they found the manager to be both organised and approachable. Residents said that the manager was nice and their comments suggested that they felt confident in his abilities. The manager is undertaking his Registered managers’ award and is aiming to complete this in 2007. The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 3 32 3 33 2 34 1 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 1 X The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 24 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 12(1)(a) & 15(1) Requirement Care plans and care documentation must be accurate and clear in their guidance to staff on the care and support needed by all residents, including nutritional risk assessments. A balanced diet must be available to all residents at all times, including the use of fresh ingredients to meet the tastes of the residents. Repair or replacement of the sitting room lighting and television must take place. Curtains must be in place in the main sitting room. The home must ensure that it has sufficient numbers of staff on duty to maintain both residents and staff safety. The home must ensure they follow guidance in securing a criminal records bureau check on all staff prior to employment in the home. Radiator guards must be in place in all areas with exposed radiators to prevent the risk of burns. (Previous requirement
DS0000014881.V316612.R01.S.doc Timescale for action 15/01/07 2. YA17 12(4)(a) 16(2)(i) 31/12/06 3. YA24 23 & 13 31/12/06 4. 5. YA24 YA33 23 & 13 12 & 18 31/12/06 31/01/07 6. YA34 12 & 19 31/12/06 7. YA42 12(1)(a) & 23 31/01/07 The Beeches Version 5.2 Page 25 timescale of 31/03/06 and 30/10/06 not met) 8. YA30 16(2)(K) The home must ensure that all areas of the home are clean. (Previous requirement timescale of 30/10/06 not met) Fire risk assessments must be carried out to meet fire regulations as directed by the Fire service. A clear policy for HACCP must be in place to meet environmental regulations as directed by the environmental health department. 31/01/07 9. YA42 12, 13 & 23 31/12/06 10. YA42 12, 13 & 23 31/12/06 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 YA24 Good Practice Recommendations Alternative floor coverings and furniture/furniture coverings could be considered for use, especially in communal areas.(Previous recommendation from September 2005, December 2005 and August 2006) The Beeches DS0000014881.V316612.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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