Inspection on 22/02/08 for The Beeches

This inspection was carried out on 22nd February 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Beeches 13/02/09

The Beeches 16/03/07

The Beeches 15/11/05

The Beeches 16/05/05

The Beeches 31/08/04

The Beeches 19/04/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 The Beeches 35 Ethelbert Road Canterbury Kent CT1 3NF Lead Inspector Jenny McGookin Unannounced Inspection 22 February 2008 11:30 nd The Beeches DS0000023597.V359480.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 DS0000023597.V359480.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 DS0000023597.V359480.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Beeches Address 35 Ethelbert Road Canterbury Kent CT1 3NF 01227 769654 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) canterbury.thebeeches@virgin.net Mr David John Barzotelli Post Vacant Care Home 18 Category(ies) of Learning disability (14), Learning disability over registration, with number 65 years of age (4) of places The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. LD (E) is restricted to those residents whose dates of birth are 26/07/1930 02/04/1935 16/11/1927 and 08/01/1931 Date of last inspection Brief Description of the Service: The Beeches is a care home, which has been registered to provide personal care, support and accommodation to 18 people with learning disabilities – hereafter referred to as “clients” as this is said to be their preferred term of address. Clients at this home should all be over 18 years of age. The home is located in a residential part of Canterbury, not far from the city centre and close to public transport. There is parking space for up to eight vehicles at the front of the house and also some on road parking, though this is subject to restrictions. The home consists of a large detached building with an extension to the rear. All bedrooms are single. At the rear of the house is a garden area, with seating, greenhouse and shed, which is well maintained and accessible. The owner is Mr David John Barzotelli, who also owns another home in the area and domiciliary care services. Mr Christopher Dives is currently the acting manager. The basic fee payable is £608.66 per week. Any extra care (e.g. for personal care, toileting, feeding, speech programmes or extra / specialist community integration) would be charged at a further £9 per hour. Transport costs and day centre sessions are also extra charges payable. Information on the home’s services and the CSCI reports for prospective clients should be detailed in the Statement of Purpose and Client Guide. There is currently no available e-mail address for the home. The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection site visit, which was intended to review findings on the last inspection (March 2007) in respect of the day-to day running of the home; and to check compliance with matters raised for attention on that occasion, given all the timeframes had run their course. The inspection process took eight and three quarter hours, and involved meeting with the registered proprietor, the manager from the other home in the group (who is currently overseeing the acting manager), the acting manager and a team leader, who is also the home’s cook. The inspector also met with a group of three clients over lunch and interactions between staff and clients were observed during the day. Feedback questionnaires were taken to the inspection for distribution among clients, their relatives or representatives, including social and healthcare professionals. It was not judged likely that responses would be submitted in time for inclusion in this report. But account was, in the meantime, taken of the home’s own feedback exercise over the New Year. Account was also taken of the home’s annual quality assurance assessment (AQAA), which was submitted by its due date. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. The inspection involved an assessment of five bedrooms (one of which was vacant and undergoing refurbishment) and most communal areas. Three clients’ files were examined in detail along with three personnel files and a range of maintenance records. What the service does well: The location of this home is generally suitable for its stated purpose, convenient for visitors and offers ready access to community resources. Property maintenance checks were in good order, and the home was tidy, clean and odour free when inspected. Most key standards are being met and there are positive outcomes for people using the services. The introduction of person-centred care plans is judged promising. The staff team is committed, and supported on a day-to-day basis. The rapport between the proprietor, manager, staff team and clients is appropriately familiar, relaxed and respectful. The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 6 Compliance was found with most aspects of the National Minimum Standards inspected. Record keeping is systematic and open to inspection. 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 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 2, 3, 4 The home needs to better evidence that prospective clients and their representatives have all the information needed to choose a home, so that they can judge for themselves that the home will meet their needs. Prospective clients have their needs and some aspirations assessed by the home so that it can demonstrate it can meet their needs. EVIDENCE: The home has revised its Statement of Purpose, Client Guide and contract, and reports that the Service User Guide is available in pictorial form, small and large print to meet individual needs. But copies were not submitted for assessment against the National Minimum Standards in time for inclusion in this report. The records do not evidence whether copies of the Statement of Purpose or Client Guide have been shared with, or issued to, the prospective clients or other interested parties and whether other formats were warranted. This is required, or their non-provision will need to be justified by properly documented assessments. The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 9 Many of the current clients were admitted before the provisions of the National Minimum Standards (hereafter referred to NMS) became applicable (April 2002) and their admissions were, therefore, not assessed against the NMS on this occasion. Information indicates that more recent admissions had in practice been managed effectively and that the clients had in most cases settled down together well. The home has its own preadmission assessment form, and also takes into account assessments carried out by funding authorities, where these are available – this is not reliably the case. Some attempt is being made at this early stage to identify the prospective client’s aspirations (matter raised for attention by the last inspection). The acting manager reports that prospective clients are encouraged to visit several times, including overnight stays, to assess the home’s suitability and their compatibility with other clients. But there were no records on file to evidence this. The acting manager was, therefore, advised that the home needs to document any preadmission visits or activities as evidence of a careful admission process. Information would indicate that the last inspection’s quality rating of “adequate” should still stand. The Beeches DS0000023597.V359480.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 6, 7, 9, 10 Individuals benefit from being involved in decisions about their lives and in planning the care and support they receive. EVIDENCE: The format of this home’s care planning processes already enables most aspects of each client’s personal and health care needs to be addressed. These are underpinned by day-to-day checks (general care issues, dependency, seizures etc), communication issues and risk assessments. The home has a key worker arrangement, so that staff can build up a rapport with individual clients and can give continuity of care. See, however, comments below in respect of the scope of care plans, and the section on “Personal and Healthcare” for feedback on staff attitudes. Less clear, however, has been the sense of “person” in care plans, to distinguish one client from another – matter raised for attention at the last The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 11 inspection. But the format currently being introduced is designed to make more conspicuous reference to each client’s background, relationships, skills and hobbies, as well as their views, to make this more evident. This is judged promising, as long as there is more pointed cross-referencing between all relevant documents – e.g. daily reports, incident/accident reports, risk assessments, complaints, care plan objectives etc (matter also raised for attention at the last inspection), so that care can be tracked and to ensure a fully rounded approach. The elements of each care plan are currently being reviewed every month, though often without change. This is judged surprising, given the likely scope for skills development and aspirations of clients in comparable residential care home settings. The new care planning format promises to be more personcentred and proactive in terms of setting objectives. Records of the home’s own informal reviews already include the signature (where able) and comments or non-verbal responses of the clients as evidence of their involvement in this process. This is judged a good start, but the home will need to better evidence that it invites all stakeholders to participate in the decision making (most notably the clients, as well as relatives, community nurses, care managers and the home’s own staff), to ensure an inclusive approach. Clients were observed being supported to make choices during the day, but the extent to which they are involved in the day-to-day life of the home was not pursued any further on this occasion. The home uses computer-generated and hard copy documents. Its arrangements for keeping confidential information secure against unauthorized access were judged satisfactory. Each client has the option of locking their bedroom door and each has a secured, lockable facility for storing items of any value to them. This home’s plans to redevelop its care plans are judged promising, but it is still too soon to judge how effective they will be. This would indicate that the last inspection’s quality rating of “adequate” should still stand. The Beeches DS0000023597.V359480.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 11, 12, 13, 14, 15, 16, 17 Clients benefit from the support they receive to make choices about their dayto-day lives, but more could be done to develop their skills and interests. Social and recreational activities meet individual’s assessed needs but the home could do more to raise expectations in terms of their educational or employment potential. Clients benefit from the provision of a nutritious and varied diet. EVIDENCE: Abilities, activities and personal preferences are identified in this home’s care planning processes and promoted by day-to-day consultation or interpretation (where clients do not have sufficient verbal skills) thereon. Each client has The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 13 their own activities sheet, though this is applied flexibly, and there are laminated cue cards to help clients make choices. Where funding is available clients attend day centres arranged by their care managers - for developmental and recreational courses. Clients are also supported to access cinemas, theatre, pubs, shops etc. i.e. ordinary community facilities not restricted to, or readily associated with, their learning or physical disabilities. No one currently has a job Activities on site include lively exercise sessions to music (one such session was overheard during this inspection visit – it was clearly a source of enjoyment, judging by the peals of laughter) and domestic sessions like cooking and gardening. One client spoke enthusiastically about the way she tended the garden, and how another client there liked to do the jobs around the garden that she didn’t enjoy as much. Clearly the partnership was working well for her! A recent feedback exercise carried out by this home indicated that clients were generally quite happy with their lives at this home, and in some cases wanted to do more of what they were already doing (see list above). But they also had lots of ideas about other activities they would like to pursue, both on and off site. Suggestions included: bowling, modelling clay; garden centres; swimming; walking; horse riding and outings both small-scale (in the car, to garden centres, London or Margate) and further a-field (e.g. involving bus or train trips, even an airplane, to Disneyland, to Scotland). One wanted to be supported to visit their home more often, and another wanted to obtain employment. The registered proprietor and acting manager have undertaken to follow some of these suggestions up, which is judged promising. The clients observed during this visit appeared to have a reasonable understanding of the spoken word, simply put, but some sign language and cue cards are used to help staff communicate with one or two clients. And previous inspections have confirmed that there are some individualised behaviour management techniques. There are open visiting arrangements. There is a communal phone on the ground floor by the front door (this is scheduled for conversion into a payphone) and clients can also use the office phone. One client has his own mobile phone. Feedback from relatives over the New Year asked the home’s staff to support one client to phone home more. Regular newsletters keep relatives informed of events in the home and they are routinely invited to seasonal celebrations such as Christmas, Easter as well as individual birthday parties and the home’s summer fete. Dietary needs and preferences are identified as part of the care planning process, and confirmed by day-to-day consultation. A picture-assisted menu is usually on display every day (though it had slipped off the wall on the day of The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 14 this visit and required reinstatement). Some clients require a special diet (diabetic, Gluten-free, wheat-free) and their needs and preferences are being catered for. The home takes the Government’s recommendations on five fruit and vegetables a day seriously. The main kitchen is accessible to clients and clients take it in turns to assist the cook with the preparation of meals. There is also a separate training kitchen, for clients to prepare drinks and small snacks in, but its location (en route to the laundry) is not suitable for more ambitious meal preparation. The dining room facility provides a congenial setting, and a choice of three dining room suites, though two are scheduled for replacement, so that clients have a choice. The clients were joined for lunch, which was a fish or pie and chips takeaway. The pace of the meal was unhurried and staff support was judged sensitive and supportive. The three clients all said they thought the food was “brilliant” and said they enjoyed helping with the cooking. The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 18, 19, 20 Clients’ health and personal care are properly based on an assessment of their individual needs, but their scope for self managing some aspects of their care should be further explored, to give them more choice and control. The principles of respect, dignity and privacy are generally put into practice, but some interpersonal relationships may require further attention. EVIDENCE: The care planning process assesses, in the first instance, the extent to which each client can manage their own personal care, and their choice and control is in most cases being actively promoted by staff (most notably their key workers) thereon. Observed practice was judged appropriately familiar and respectful. A recent feedback exercise carried out by the home confirmed that clients were generally happy with their key worker and that staff were kind to them (13 out The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 16 of 14 surveyed). However, when asked whether they were spoken to in a polite way, 11 agreed, but three said “sometimes”, and one said, “sometimes staff don’t, but most do”. This indicates the need for closer attention to some interpersonal relationships. Each client has their own Health Action Plan (matter raised for attention at the last inspection), which is written in the 1st person (“things I like to do”, “my health conditions”) to keep the client’s perspective central. And records are maintained to monitor their healthcare needs, healthcare appointments etc. Weight and exercise are monitored closely. The home routinely accesses a range of standard and specialist healthcare professionals e.g. GP, district nurses, podiatrist, optician, physiotherapist, occupational therapists, speech therapists. All clients are registered with one GP practice, though one or two GPs there tend to cover their care between them, so that clients have some continuity of care. Records also confirm that the home also accesses care managers, and other social care professionals as appropriate. The bedrooms are single occupancy to offer privacy and each client’s ability to manage a key (to the bedroom door and a lockable facility) is risk assessed in each case. There are enough toilet and personal care facilities (baths and wash hand basins) within reasonable distance of bedrooms and communal facilities, and although one bath has a shower attachment, shower facilities are planned, to enable the clients to exercise more choice. Staff are available on a 24-hour basis to assist the clients if required. The home uses the monitored dosage system (MDS) and medication administration record (MAR) sheets. Recording standards were judged satisfactory, although the question of allergies needs to be more routinely recorded in each case. The deputy manager is responsible for monitoring standards, and the home has a copy of the Royal Pharmaceutical Society Guidance to ensure its practice is compliant with best practice. It also has a copy of The British National Formulary (directory of medication and its purpose and side effects) but this was in need of updating. The home keeps its medication properly secured in a lockable wall-mounted cabinet, and is monitoring the temperature of the fridge used to store medication. The acting manager was advised to remove one product, which was out of date, and to take a pharmacist’s advice on optimum fridge temperatures and whether to use the fridge to store one other product. Some matters were raised for attention to improve the medication room. Client’s files show that their consent to staff administering their medication is recorded in each case. But as the last inspection reported, the criteria for The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 17 managing their own medication are very exacting if not off-putting – they require an understanding of timekeeping, an ability to read and administer the correct dose; an ability to understand medication and its side effects; as well as an understanding of the effects of not following GP instructions and how to store medication safely. It is accepted that clients are being supported to complete medication booklets to help them understand some of these elements. The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 22, 23 People who use the service are supported to express their concerns. There is a complaints procedure in place and it is being used. Clients are generally well protected from abuse, and have their rights protected. EVIDENCE: The home has a complaints procedure, as required, and has it on display throughout the home and in the Service User Guide. It is also available in more user-friendly format for the clients, though they do not have their own copies. Regular group meetings with clients and periodic feedback exercises are used to refresh their memory. Staff also receive a copy of the home’s complaints procedure as part of their induction. In short, the home has been quite proactive about their take-up and registering complaints, so that the register becomes a realistic reflection of communal living. There was no evidence of independent advocacy services being used to support any clients, though contact information is available. The home relies on the clients’ relatives and friends to provide this. The acting manager reports that clients are supported to vote where they wish to do so. The acting manager reports that the homer has a range of policies to safeguard the clients, including a policy on abuse and a whistle-blowing policy. The home also has a copy of the local multi-agency protocols for addressing The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 19 abuse, to ensure a timely and co-ordinated approach. And this is all underpinned by a range of staff training (including ‘understanding challenging behaviour’ training and ‘Non aggressive physical and psychological intervention’ training) as well as periodic feedback questionnaires. One recent feedback exercise, however, has indicated that some clients may feel they are being bullied (it was not clear by whom) and may not have enough confidence in staff to tell them. This has been reported back to the acting manager for further attention. The home does not act as Appointee or agent for any client’s financial affairs, but it does look after clients’ pocket monies and keeps individual records and receipts. The acting manager and deputy manager maintain records for the clients’ care managers and also carry out monthly audits of the home’s own accounts. This element of the home’s operation was not assessed on this occasion. The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 24, 25, 26, 27, 28, 29, 30 Clients benefit from a reasonably clean, safe, and comfortable environment – though some matters are raised for attention. The physical design and layout of the home encourages some freedom of movement and independence. EVIDENCE: This home is judged generally suitable for its registered purpose, and the level of cleanliness is judged satisfactory. The furniture tends to be domestic in style, which is judged generally appropriate for the current clients, and there were homely touches throughout. One or two clients use wheelchairs and there are ramps and handrails. There is a stair-lift, which is kept maintained, but it is not in practice being used. The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 21 The home has a “No Smoking” policy – smokers would need to use a designated smoking area outside. The communal areas are all on the ground floor and are all scheduled for redecoration, though there was no short-term timeframe for this. There is a formal TV lounge where armchairs need to be lined up in 2-3 rows to accommodate all the clients in one sitting. And next to it is a dining area, spread over two open plan rooms, which has an activities section (exercise equipment) to one side. Some dining room furniture is scheduled for replacement. There is a main kitchen, and there is a second adjoining kitchen used by the clients for training and storage e.g. the dishwasher. Both were having their flooring replaced during this site visit, and a new cooker is planned. Both kitchens were judged reasonably light, airy, and clean, but the training kitchen is also the only means of access to the laundry facilities so its use as a kitchen is restricted (e.g. to light snacks) and subject to infection control measures, to keep people safe. The home’s bath and WC facilities are reasonably accessible to bedrooms and communal areas; and some are scheduled for refurbishment. Only one bath has a shower attachment though. The plan is to install shower rooms, so that clients have more choice, but there was no timeframe for this. All the bedrooms are single occupancy, so that clients can be assured of privacy when they want it, and staff are under instruction to knock on bedroom doors and ask the clients’ consent to enter. Clients are assessed for their ability to manage their bedroom door keys and two were found to have been locked during the site visit, according to personal choice. All the bedrooms inspected were found to be personalised and reasonably well maintained, accepting they are scheduled for redecoration as part of a rolling programme. Clients choose their own décor. In terms of their furniture and fittings, however, they were not fully compliant with the provisions of the National Minimum Standards. The inspector was assured that non-provision was being justified by properly documented risk assessment or consultation. The siting of the laundry facilities (in an outbuilding) is far from ideal, as access requires carrying laundry through a kitchen area, down two steep steps and through an external, albeit covered, walkway and over another threshold. This will require periodic review and resolution. All the home’s maintenance records inspected were up to date and systematically arranged. Two matters raised for attention by the last Environmental Health inspection (may 2007) had been addressed. Some matters were raised for attention (see schedule), though it is accepted that they may already be within the home’s refurbishment plans. The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 32, 33, 34, 35 Clients generally benefit by a staff team, which has the training, skills and numbers to support them and the smooth running of the service. Some recruitment checks require review so as to ensure clients stay safe. EVIDENCE: The waking / working day has been interpreted as 8am till 8pm at this home, (though a 15 hour day is the recommended standard as it would enable the evenings to be put to more active use). Visitors should expect to find 3-4 carers (including a senior) on duty. The acting manager is on duty from 8am till 4pm (five days a week) and there are also 2 ancillary staff – a cook and cleaner – who work from 8am till 2pm. In their absence, cooking and cleaning tasks are covered by care staff, and clients are supported with some domestic tasks. The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 23 At night there is invariably one member of staff on waking duty, and a second sleeping but on call. And there are wider on-call arrangements to keep people safe. Three personnel files were selected at random for assessment against the provisions of the National Minimum Standards, and were found to be systematically arranged. Important recruitment checks (e.g. application forms, job descriptions, references and CRB checks) were in place. However, there were some gaps in the recruitment records (e.g. two did not have signed contracts, one did not have interview records, another did not have a completed record of induction). The acting manager said that each new member of staff is required to read key policies, and is given a copy of the General Social Council Code of Practice (though there is no system to certify this) - all of which is intended to set their practice standards. And this is followed up by the completion of workbooks to demonstrate competency, staff meetings and training. The home’s recent feedback exercise included staff, who confirmed in part (the checklist was not exhaustive) information provided by the acting manager about the range of mandatory training opportunities available to them, such as food safety, 1st Aid, fire safety, manual handling, health and safety, infection control and COSHH (control of substances hazardous to health). Something like 45 of the current staff group is reported to have NVQ Level 2 accreditation or above, which is just short of the National Minimum Standard, though more investment is planned. The home also arranges more specialist training such as diabetes awareness, managing challenging behaviour and Makaton as well as specialist input (see section on personal and healthcare) to meet the clients’ special needs. The plan is to arrange training from the Tizzard Centre in communication and person-centred planning over the next 12 months (matter raised for attention at the last inspection). Less clear, however, was evidence of formal supervision contracts (to secure the rights and responsibilities of both parties), documented supervision sessions to comply with all the provisions of the National Minimum Standards (including frequency - matter raised by the last inspection), or periodic performance appraisals - though the latest feedback exercise indicates this is happening in some form, and the manager was said to be accessible and supportive. In terms of this home’s commitment to equal opportunities and diversity, the acting manager reports that the current client group is all white British and that both genders are represented. The staff group is predominantly female (only two males) but shows more ethnic diversity – Asian, African and Chinese as well as white British. No diversity issues are raised for attention. The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. 37, 38, 39, 40, 41, 42, 43 The acting manager needs to obtain the accreditation required for the role of manager so that the business is not compromised by shortfalls in overall management. The quality of service provided is being assessed and monitored but there needs to formal business planning to demonstrate how feedback can influence the way the service is delivered. The health, safety and welfare of both staff and clients are protected by current procedures. EVIDENCE: The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 25 The current acting manager has seven years’ experience working with this client group, including two opportunities to act up as manager, but will need to be registered for NVQ level 4 (Registered Manager’s Award) training and accreditation to be eligible for the Commission’s own formal registration as manager of this home. The registered proprietor (who visits daily) has, in the meantime, arranged for another registered manager in the group to visit regularly to oversee the operation and give guidance. This is judged supportive. This is a home, which has been able to demonstrate evidence of its inclusive approach to its clients. Many of its clients have benefited from access to a range of activities on and off site as well as to mainstream community resources not immediately identifiable with or confined to their special needs. The home has its own Quality Assurance process and organised a feedback exercise over the New Year for clients, their relatives and staff. Most clients said they were generally quite happy with their lives at this home but were able to list a number of suggestions for further activities. The registered proprietor and acting manager have undertaken to ensure a number of their suggestions are taken forward, to enhance their quality of life and skills development. Feedback from relatives also indicated a generally sound level of satisfaction with the services provided. Suggestions were made about improving the outside of the building, and about the communication of messages and skills development. The acting manager explained how these were being addressed. The feedback exercise was also useful as a measure of the staff team’s morale and commitment. They clearly feel valued, able to approach management and to contribute to meetings. There was, however, no evidence of a business development plan or statement of audited accounts available for inspection. These are required. The views of all stakeholders should be central to these processes, to properly measure the home’s success in meeting its aims, objectives and statement of purpose. There was good evidence on site of the proprietor’s regulatory duty to carry out his own documented inspection visits at least monthly. Property maintenance records were judged in good order and maintained in the best interests of the clients. The home has the required public liability insurance cover. The acting manager said that the home does not act as any client’s appointee or agent, and there is a monthly internal audit of finances by the manager and deputy manager. Financial records are made available to relevant client’s financial officers. But this aspect of the home’s operation was not assessed. The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 26 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 3 4 2 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 2 25 3 26 3 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 2 32 3 33 3 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 3 LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 3 2 X X 3 X The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 27 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 YA1 Regulation 4& Schedule 1 Requirement The registered person must ensure the revised Statement of Purpose and Client Guide is fully compliant with the National Minimum Standard and regulations. Copies must be submitted to the Commission for assessment and future reference 2 YA37 8&9 The registered person must ensure there are arrangements to provide this home with a registered manager. 31/03/08 Timescale for action 31/03/08 3 YA39 Action plan to be provided. 24(1)(a)(b), There needs to be an annual (2)(3) business development plan, based on a systematic cycle of planning, action and review reflecting aims and outcomes for clients. 31/03/08 The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 28 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 YA6 Good Practice Recommendations Care plans should be person centred, and should: • Identify who participates in the decision-making • Cross reference with other relevant documentation e.g. daily reports, incident/accident reports, and risk assessments, complaints – so that care can be tracked. • Identify personal goals and aspirations and how they are in practical terms to be supported. Feedback from relatives over the New Year asked the home’s staff to support one client to phone home more. Clients have identified a range of skills development activities, which the home should look for opportunities to pursue Clients have identified a range of recreational activities, which the home should look for opportunities to pursue The acting manager should take a pharmacist’s advice on optimum medication fridge temperatures and whether to use the fridge to store supermarket products. Some matters were raised for attention to improve the medication cupboard room: • Floor needs to be smooth, impervious and carpet free. Edges should be coved. And no items should be stored at floor level. • The surfaces of walls and ceiling should be washable • The ceiling light should have a diffuser. • Worktops should not be used for storage, and should be free of clutter • Sink should be free of overflow aperture • Sharps bins should be dated, labelled and wall mounted, not stored on floor • There should be a Sharps injury poster on display • Disposable aprons should be readily accessible and wall mounted Medication arrangements. The following matters are raised for attention. • The home should continue to look for opportunities to support clients to self medicate within a carefully managed risk assessed arrangement • The question of allergies should be more routinely recorded on each MAR chart. DS0000023597.V359480.R01.S.doc Version 5.2 Page 29 2 3 4 5 6 YA11 YA12 YA14 YA20 YA20 7 YA20 The Beeches 8 YA23 9 YA24 10 YA31 11 12 YA33 YA36 The home’s copy of The British National Formulary was in need of updating. One recent feedback exercise has indicated that some clients may feel they are being bullied (it was not clear by whom) and may not have enough confidence in staff to tell them. This requires further attention Building. The following matters are raised for attention. • Exterior paintwork requires refreshing • Forecourt requires redressing with gravel to obtain a level surface • All chemicals need to be stored away from kitchen / food stuffs in a lockable cupboard – it is accepted that this is already planned. • Recommend a sample selection of 1st Aid products in the kitchen for ready access by catering staff • There should be a dedicated WC for kitchen staff close to kitchen with wash basin, soap dispenser, paper towels or air dryer • WC (1st Floor - Next to Room 2) should have a wash hand basin, soap dispenser, paper towels or air dryer • External bathroom or WC windows should all have blinds or curtains over obscure glass, to guarantee privacy. • All bedrooms should be furnished according to the elements listed by the National Minimum Standards. Non-provision must be justified by documented risk assessments or consultation. Electrical sockets should be fully accessible, and clients should be able to reach their cash tins. • The home’s washing machine should have a sluice / disinfecting cycle. • One rust stained section of the laundry floor requires making good. There should be a system to certify the issue of copies of the General Social Council Code of Practice (though there is no system to certify this) - to set their practice standards A 15 hour waking / working day is the recommended standard as it would enable the evenings to be put to more active use Staff Supervision. There should be formal supervision contracts, to secure the rights and responsibilities of both parties. And records should demonstrate compliance with all the provisions of the NMS, including frequency. There should be a financial plan for the home and the service, reviewed annually DS0000023597.V359480.R01.S.doc Version 5.2 Page 30 • 13 YA43 The Beeches Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Beeches DS0000023597.V359480.R01.S.doc Version 5.2 Page 31 - 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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