Inspection on 26/02/10 for The Beeches

This inspection was carried out on 26th February 2010.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Beeches 19/10/07

The Beeches 06/07/06

The Beeches 28/02/06

The Beeches 27/04/05

The Beeches 21/12/04

The Beeches 19/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: The Beeches Fairfield Bungalows Blandford Dorset DT11 7HX The quality rating for this care home is: zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Tracey Cockburn Date: 0 1 0 3 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 47 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 47 Information about the care home Name of care home: Address: The Beeches Fairfield Bungalows Blandford Dorset DT11 7HX 01258453436 01258451540 s.j.tuck@dorsetcc.gov.uk www.dorsetforyou.com Dorset County Council care home 25 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 25 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is 25 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 47 A bit about the care home The Beeches provides accommodation for adults who have a learning disability, providing long-term and short-term care. The home was purpose built in the 1970s. Accommodation is arranged over two floors, with the lounges, dining room and domestic kitchen being on the ground floor. There is a large garden to the rear of the property. The home has good access to the local community and is within walking distance of the town centre. The Beeches has a bungalow attached to the main home that currently accommodates three service users. The people who live in the bungalow, are supported by two members of staff during the waking day, and one waking night staff. The bungalow has its own kitchen, dining room, lounge and bathroom. The homes service users guide and a copy of the last inspection report is available on request. Details of charges are available on request. Care Homes for Adults (18-65 years) Page 5 of 47 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 47 How we did our inspection: This is what the inspector did when they were at the care home This was a key inspection the first since 2007. We decided to inspect the service because of information we received regarding safeguarding concerns that people in the home may not be safe. Two inspectors visited the home over two days, the first day was unannounced and we returned for a second day. We looked at information we received about the service including information from the safeguarding investigation as well as information sent to us by the service in the annual quality assurance assessment. We looked at information about the service sent to us in survey forms from people who use the service, staff and health care professionals. We looked at a variety of records relating to the running of the home as well as health and safety records, staff training, recruitment, care plans, activities and a tour of the building. We spoke to people who use the service, we observed life in the home, we spoke to staff and the manager. Care Homes for Adults (18-65 years) Page 7 of 47 What the care home does well What has got better from the last inspection What the care home could do better At the end of this inspection there are thirteen requirements and twenty five recommendations. It is important that information about the service is accurate and reflects the aims and objectives of the home this will ensure that people are choosing the service which can meet their needs and aspirations. Individual plans of care must reflect a persons changing needs and personal goals. Page 8 of 47 Care Homes for Adults (18-65 years) People who use the service must be able to make decisions about their own life. People who use the service must be supported to take risks as part of an independent lifestyle. Plans must be insufficient detail to ensure an individuals physical and emotional health needs are being met. People who use the service must be protected from, abuse, neglect and harm. Staff working in the home must be qualified and competent to support the needs of the people who use the service. Staff must be appropriately trained to meet the individual and collective needs of the people who use the service. People who use the service must be confident that self monitoring which takes place is robust enough to ensure they are safe from harm. Systems must be in place to ensure that the health, safety and welfare of people using the service is promoted and protected. It is important that information about the service and peoples rights are in a format which is accessible to them. It is important that people are involved in the development of their plans, that the plans are accessible and that personal Care Homes for Adults (18-65 years) Page 9 of 47 goals are developed and monitored with peoples aspirations in mind. People who use the service should be supported to develop life history books and keep a record of their life in the home. People who live in the home should be able to make decisions about their lives and be supported to participate fully in the life of the home. People who use the service should be confident that information about them is handled appropriately and their confidences about their personal health and emotional needs is maintained. Records need to be kept in a way that meets the requirements of the Data Protection Act 1998 and preserves peoples right to privacy. People who use the service should be supported to access activities locally either individually or with friends with the same interests. It is important that people who use the service have their preferred form of address recorded and used by staff at all times. People who use the service should be able to choose who supports them and they should be able to access information about annual health checks and health action plans, so they are able understand their health needs. Care Homes for Adults (18-65 years) Page 10 of 47 People should be supported to understand how to complain when they are sad or worried. People should have access to a pictorial or photographic guide about safeguarding so they understand who to speak to if they are worried or upset about abuse. It is important that access to the rear of the building is safe. Staff should be encouraged to work towards National Vocational Qualifications. It is important that people on the rota are clearly identified with their full name. It is important that there is a system in place to identify the person on each shift responsible for first aid. It is important that there are staff on duty at all times who can communicate with people using their preferred method of communication. It is important that the manager undertakes periodic training to keep up to date with current good practice. It is important the management of the home, communicate a clear sense of direction and leadership when the home is going through changes to ensure that staff and the people using the service understand what is happening and why. Care Homes for Adults (18-65 years) Page 11 of 47 Policies and procedures need to be reviewed and updated to make sure that they reflect current good practice advice to staff. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Tracey Cockburn Colston 33 33 Colston Avenue Bristol Avon BS1 4UA 01179307110 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order Care Homes for Adults (18-65 years) Page 12 of 47 line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 13 of 47 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 14 of 47 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At present people do not have access to information about the service in a format they can understand. Information about the service does not give an accurate picture of the provision. Evidence: The statement of purpose for the home says The Beeches offers personalised care, tailored to meet individual religious, cultural, spiritual, social and psychological needs. We can demonstrate through evidence in other outcome areas that this is not the case. The statement of purpose also says we now offer a day service which is designed to suit the individual alongside their person centred plans. We will also evidence in other outcome areas that this is not happening fully. The statement of purpose says: The home provides services to residents with a learning disability of both sexes from 18years of age to 65 years. This statement is incorrect as there are people living in the home who are much older in their eighties and nineties. Page 15 of 47 Care Homes for Adults (18-65 years) Evidence: The statement of purpose says: The Beeches will be offering a day service from October 2008, we asked the manager if this included people living in the community and we were told it was only for people living at The Beeches however the statement of purpose does not make that clear. The statement of purpose also says Both community and home based activities will be provided to work alongside personal centred plans, we will demonstrate in other outcome areas that there is no focused goal setting in person centred plans which are either measurable or reviewed. The service user guide has photographs in the document which would help some people understand the home under the heading arrangement for meeting special needs within the home. The guide says there is a total communication officer and team and that a variety of communication methods are offered such as communication passports, pictorial menu, staff photo board and makaton. We found that there are pictorial menus and a staff photo board, but very few communication passports and none of the staff have had any Makaton training. The service user guide and statement of purpose are not in an accessible format, the manager told us they are in the process of being updated. Neither document makes reference to respite care taking place in the home and neither document makes it clear the age range of people using the service. Both documents are not accessible, we were not shown any other accessible documents detailing the service. In the files we looked at there were care management assessments in place which were completed at the time of moving into the home. There has been no one new move into the home long term for some time except for one person who moved into the home in December 2009 for respite and is still there. There is no plan in place about this persons future or that the respite is indefinite. We could see in one assessment the cultural needs of the individual and we could see that some information had been translated into their preferred language however we could not see evidence that their cultural needs were being met in their daily life. We looked at several contracts and found they are not accessible for people. We could not find any evidence of how they have been supported to understand their contract and their rights. Care Homes for Adults (18-65 years) Page 16 of 47 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples changing needs and personal goals are not clearly reflected in their individual plans and it is unclear how they are supported to make decisions about their lives. People who use the service are not supported to take risks as part of an independent lifestyle. People who use the service cannot be confident that information about them is handled appropriately. Evidence: The annual quality assurance assessment says : Every service user has a person centred review PCR which is held at 6 monthly intervals. The PCR is all about giving an individual service, taking into account service users wishes, needs and goals. The information gathered at person centred reviews is used to create person centred plans. Person centred planning gives service users the opportunity to make autonomous decisions about their lives and promotes a more inclusive life within the community. The individuals day service is based on the information provided in their person centred plan. The Care Homes for Adults (18-65 years) Page 17 of 47 Evidence: annual quality assurance assessment also says: We adopt an effective person centred approach involving service users in all aspects of their life. The home generates an individual care plan and a help list for each service user, which covers all aspects of personal and social support and health care needs as set out in Standard 2. and We use risk assessment to facilitate rather than hinder a persons right to be as independent as possible within their own lives. Each person has a blue folder which contains the pre admission assessment, specialist assessment, community care plan and record sheet as well as incident and accidents forms, they also have a red folder which contains their person centred plan and reviews as well as the help list and risk assessment. A staff survey said under the heading what does the home do well?: Treats service users with individuality respect and dignity. Meets individuals needs and wishes. Looked at the care file for one person who is on short term care they were admitted in December and are still in the home early March with no plan about what happens next. This does not demonstrate a person centred approach in supporting the person to make decisions about their future. There is an eating, drinking and swallowing care plan from the speech and language therapist dated 25/01/10 assessment completed on 18/01/10. We looked at one of the files it is in nine sections, section one; case recording and activity sheet, section two; community care plan, disability assessment and pre admission assessment, section three; personal care programme, help list and ISP, section four; risk assessment, accidents and incidents form, section five; MAR, medical , SALT and OT, section six; finance, section seven; correspondence, section eight; contract, section nine; death and bereavement. There are another two files containing other information about the person. We found information and assessments dating back a number of years and not current to the persons needs now. The community care assessment for one person states: X prefers to be greeted in Hindi it also says opportunities for X to have Nepalese foods, residential staff have been provided with recipes and advice about food We did not see any evidence of this happening for the person. We could not find any information in care plans about how this person is supported to maintain his cultural links apart from regular visits from his family. The help list for this person ( which is the care plan) states under the heading help needed to talk to people complete sentences confuse me, I am usually very compliant. I like my routine and if its disrupted I can get frustrated and upset. We felt that the way the information is written is not respectful of the person as an individual especially the first sentence. Page 18 of 47 Care Homes for Adults (18-65 years) Evidence: We found twenty four separate risk assessments for one person including risk assessments covering the use of the smoothie maker, being left alone in the bungalow and making toast for breakfast; this risk assessment is dated 27/05/06 and although they are reviewed, reviews say no change and the original risk assessment has not been updated. We found this to be the case for other people we looked at. The use of the smoothie maker is a joint risk assessment with three people, not very person centred. The risk assessment in place since 27/05/06 for one person around the making of toast said due to his disabilities X would need total support if attempting to make his own toast. There was no information in the risk assessments around making noodles which is the persons preference at breakfast and there was no information on whether this activity could be considered as a personal goal. We looked in one persons all about me file ( black folder) it has a picture of the person on the front cover, inside on the first page is a photograph of an older man with a different ethnic background from the person concerned. The book is dated October 2009. On another page there is a photo of a man again with a different ethnic background, in a wheelchair again not an accurate reflection of the person concerned. Further in the file we found photographs of important people in the individuals life. This included photographs of friends and relatives, this was a demonstration of good practice and how the document could be very person centred. We were told that the speech and language therapist had written the book. We were unsure if the person was involved in the development of the book. We were also told that the book was a communication passport. We looked at the person centred file for another person and on the first page it says I am incontinent of urine and faeces we would expect the first page to have a pen picture or story of my life so far, we could not find any life history information even although this person has lived in the home for 30 years. The person concerned may have a view on whether that is the first piece of information they want written about themselves, it was unclear whether the person was involved in developing the plan. We were also concerned about the use of images in one persons person centred file, where the information is talking about the persons limited eye sight there is a cartoon of a man wearing joke glasses which come out on springs, this was not respectful of the individuals serious condition. We were told that seven people out of the fourteen living in the service do not lack capacity however it was difficult to find information in files on how these decisions had been made. We could not find any assessments of capacity. We were told they had not yet been completed. Throughout the visit we found that people who use the service are not always called by Care Homes for Adults (18-65 years) Page 19 of 47 Evidence: their names or preferred names but referred to as sweetheart or darling by staff we could not find any evidence that people have expressed a preference to be called these terms. Care Homes for Adults (18-65 years) Page 20 of 47 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further work is needed to ensure that people are supported to participate in activities, attain personal goals and develop their life skills. Evidence: The annual quality assurance assessment says: We have a total communication team who are implementing total communication methods. This ensures that everyone has an understanding of what is going on at The Beeches; What The Beeches can do for them and what they can do for The Beeches and each other. At the present time whilst some of the staff are training we have implemented the taped residents meetings, Picture menus, and a staff identification board. We have also been donated a sign and symbol pack for the computer; we are presently training staff in the use of this. We looked at how people are supported to have and achieve goals, one person had their goals last reviewed in 2008, goals included; continue with photo album, pictures to be taken when out on activities, to create communication passport, SALT ( speech and language therapy)assessment, none of the goals had been reviewed there was no Care Homes for Adults (18-65 years) Page 21 of 47 Evidence: evidence of progress and they were the same goals repeated each year. A staff survey said under the heading what could the home do better?: Provide more interesting things for service users to do during the day. There are not enough activities for the quiet and less able service users Another staff survey form said residents get to go out in the community and do the things they like to do We could see from the records we looked at that people using the service are supported to be out in the community, however with the lack of a dedicated day service officer, we could see little evidence of the development of people going to leisure activities in the local community. We could see from records that people are supported to exercise through walking and go to bingo in the day centre next door and go out for lunch in pubs and restaurants. We could see that some people attend a project being run in Dorchester for a couple of hours each week. The annual quality assurance assessment tells us: There is now a day service officer in post at The Beeches. The aim of this role is to research and co-ordinate activities that service users have expressed interest in. This allows us to provide a more person centred service based on what the service users wants. Service users who are provided with a day service at the Beeches have the opportunity to maintain and increase independent living skills, preparing them for the possibility of residing in supportive living in the future. Service users also have the opportunity to access the community promoting social inclusion and meeting personal goals on a 1:1 basis with the staff they wish to support them. During residents meetings, service users have asked to have more time to go on outings. The amount of 1:1 time service users have with their key carers has now increased according to their person centred needs. Of the fourteen people living in the service seven go to day centres and six are supported with day activities from The Beeches. We were told that each morning, the day activity officer meets with people as a group and they decide on the activities they wish to do that day. We looked at the record kept of each meeting. We were told by the manager that the activity budget is two thousand pounds for the year. During our visit people were supported to participate in activities. On the first day of our visit it was one persons birthday and they were out for lunch with a friend and other people living in the home, decorated the dining room for a party to celebrate. We were told that there is a day service officer however they are away on placement and support staff are covering this role. Each morning there is a meeting with people who have day activities from the home and everyone agrees what they want to do, this is recorded on a sheet. People also have activity schedules, for one person this included time learning and developing their total communication skills with the support of one member of staff. Care Homes for Adults (18-65 years) Page 22 of 47 Evidence: It was difficult to find evidence of activities as the information in peoples files is not archived consistently and there is information going back a number of years which is not current and not relevant to their care needs now. We looked at one persons care file, we noted that the original assessment states that the person who is from a different cultural background, has soup and noodles for breakfast we could see no other information about whether this happens, when we spoke to staff about this we were told that this person only likes noodles but they could not tell us if he has them for breakfast. We observed lunch, people are able to make choices with support, the food is served buffet style and each person makes their own choice. Some people need support when eating. During lunch, we observed one member of staff, who was walking around the room with a clip board on which she was recording each persons choice. We observed one member of staff supporting one person to eat slowly. Staff eat with the service users and there was lots of conversation round the tables, people chose where they want to sit, some people come in for lunch make their choice then eat in another room. Lunch was relaxed with people coming in to eat when they had finished day activities. One person can only eat their food in a pureed form because of a medical condition, this person made their choice and then the cook asked whether the person wanted her meal pureed all together or all the components separately they made the choice to have it all pureed together. The cook took time to do this and when the persons meal arrived in was very finely pureed which is how this person needs it to be. The annual quality assurance assessment says: We are also including Makaton into some of our staff meetings, this is lead by a service user who is, as are all the staff keen to use this method of communication. We found that none of the staff have received any training in makaton. We looked at the person centred plan for one person under the heading good things that have happened to X in the last year it says new experiences and opportunities, regular public transport outings, good and appropriate support This is not person centred, it is generalised and not detailed. It is not measurable. It is unclear what these new experiences have been, it is unclear if the outings have involved friends or in a group. The kitchen was clean, the fridges and freezers were well stocked there was evidence of fresh fruit and vegetables being used. The environmental health officer visited the previous week and no requirements were made. A record is kept of individual meals served. On both days of our visit there were a variety of choices on the menu. Care Homes for Adults (18-65 years) Page 23 of 47 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. Improvements need to be made to demonstrate that the principles of respect, dignity and privacy are put into practice. Evidence: We looked at peoples help lists which detail how they prefer to be supported and their preferred routines depending on the time of day. It was unclear if people can express a preference of which staff they would like to support them. The home uses a key and link worker system to give people continuity in their care and support. We could see from care files that people receive additional specialist support and advice as needed. We received a survey form from a health care professional which said under the heading what does the service do well: Staff (senior) know a lot about the residents. If staff have any concerns about someones communication or eating and drinking they contact me promptly. I have been invited to staff meetings to discuss issues with whole staff team Under the heading what could the service do better they wrote Be more organised. There was an occasion where mealtime guidelines for a resident were mislaid. Monitoring of peoples eating and drinking has not always occurred as requested with monitoring Care Homes for Adults (18-65 years) Page 24 of 47 Evidence: sheets not filled in or contradictory to notes. Daily recording sheet for one person said that they stated part of their body hurt while in the bath, the daily record states that a senior was notified, we could not find any further information on the action taken or whether the person saw a GP about it. We could see from recording in the health file for people that they are attending health care appointments and visiting the GP surgery when necessary. We could also see from the medication records that staff are understanding of peoples anxiety when it comes to health care appointments and advice has been sought about how best to support someone with anxiety to appointments. There are two people who live in the home who have epilepsy. There is no separate epilepsy care plan for either person. We were told that if either person has a seizure then a pressure mat on the bed rings an alarm and a member of staff comes over from the main building. The protocol for one person says that an ambulance must be called if the person is still having a seizure after 4 minutes. We are concerned about the system in place to support people with epilepsy especially at night when only two staff are on duty in the whole building and no one is specifically based in the bungalow. There was also some confusion about whether or not another person in the home had a diagnosis of epilepsy even although they were on medication which would indicate they have the condition. In one persons file, the care plan says what others need to know or do to support...( no name, it then says senior staff keep up to date with my seizure pattern and procedures. We could not find any. We were shown a protocol from the ambulance service but this is not the same as information about seizure patterns and guidance for staff in the support plan. It was unclear from records if people are facilitated to take control and manage their own healthcare we could see from records that people are supported to attend appointments. We looked at the system in place for managing medication. Medication is stored correctly, only staff who have completed the training are able to dispense medication and all medication is securely stored. We looked at medication stored in the controlled drugs cabinet and found it to be correct. However we did note that one person takes Diazepam before any medical appointments and it had not been used since August 2009. We were told that this was because the person was coping better with these appointments. We suggested seeking advice from the GP about whether it was necessary to continue with this medication. Care Homes for Adults (18-65 years) Page 25 of 47 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems in place have not been implemented correctly to ensure that people using the service are protected from harm. Evidence: We found there is a complaints policy and procedure, there have been no formal complaints recorded since 5/7/04. There is a book known as the grumbles book which has not been used since 2007. It has information on the same page about different people. There were two letters of compliment in 2008. The annual quality assurance assessment says: An accredited physical intervention course is now available for which all seniors have been nominated. A new system of recording and monitoring bullying has been put in place and is followed through by the manager, key worker and staff. This involves asking the victim what they wish to do, informing appropriate parties and taking appropriate action. We also have a crime reporting form to use should it become necessary. Risk assessments on bullying and being bullied are kept up to date and relevant. Behaviour charts are made up as and when necessary according to the specific behaviours. This enables us to explore and understand behaviours and make appropriate interventions. Specialist advice can also be sought from psychology and psychiatry services Dorset County Council commissioned a safeguarding audit of the home and found Care Homes for Adults (18-65 years) Page 26 of 47 Evidence: numerous issues of assault between service users which had not been properly reported under safeguarding protocols and not reported to the commission. There is an ongoing safeguarding investigation and until this has been concluded there are no new admissions to the home either longer term or for respite. We found that people are potentially at risk, safeguarding protocol has not been followed, risk assessments have not been updated although they have been reviewed. People are not being supported to live safely in their own home. We found evidence in the incidents being recorded of individuals targeting other more vulnerable people in the home repeatedly and no clear plan on how to actively stop this from happening. All twenty care staff working in the home have completed safeguarding training in either 2008 or 2009 which means they should understand how to protect people and keep them safe in their own home. Seven of the eleven senior staff have completed safeguarding training in either 2008 or 2009. Only two of the senior staff have completed training in Managing Challenging and aggressive behaviour one in 2000 and one in 2005. Fifteen of the twenty care staff have completed training in Managing Challenging and Aggressive behaviour. Risk assessments that we looked at for one person were reactive to the aggressive and behaviour rather than suggesting proactive strategies for intervention. We looked at a risk assessment for one person who has physically assaulted two people living in the home. The risk assessment document states that the person is verbally bullied and reacts later by physically assaulting one of the people who is more frail and vulnerable. The risk assessment makes no further reference to this targeting behaviour or to the action to be taken to support the other two service users into understanding why they should not bully someone. The information in the AQAA is not accurate. We made a safeguarding alert following our visit as we were concerned about the safety of one persons finances. We asked about the particular finances of one person who was using her own money to fund part of a relatives trip to visit. We were told that this information was held at County Hall, however when we asked for the information to be faxed from County Hall they knew nothing of the terms of this discretionary fund. We were told it had always been done this way, which is why we were concerned that money was not being used correctly for one person living in the home. The whistle blowing policy dated 4/12/01 did not have information on public concern at work and did not have the commissions details. Page 27 of 47 Care Homes for Adults (18-65 years) Care Homes for Adults (18-65 years) Page 28 of 47 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home does not enable people who use the service to live in a safe, well maintained environment which enhances independence. Evidence: The home is registered to accommodated 25 people and there are currently 14 people living in the home. It was purpose built. The lounge has comfortable seating and a large flat screen television, while we visited the home we noted that the television was on all the time even when no one was in the room. We noted that there were paper towels and liquid hand soap in all toilets and bathrooms. Most of the bins were open and not foot operated. Bedrooms were personalised and there were pictures on the walls of activities which people had been involved in including parties and trips out. A door from the conservatory leads into the garden, access is via a ramp. The railings on the ramp have flaking paint, the ramp itself at the top, has brick pavers, which have sheered off in the frost, the bits of brick which have broken off have not been swept up. This could be a potential tripping hazard. There is a smoking shelter in the garden which is not used as it does not meet the Care Homes for Adults (18-65 years) Page 29 of 47 Evidence: regulations, it is used as storage we questioned why it is there. A washing machine in the laundry room has been broken for a number of months. The home was clean and did not smell. Care Homes for Adults (18-65 years) Page 30 of 47 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are not receiving the training they need to support people. Evidence: We looked at how staff are recruited, we found the guidance says that they may choose to start people without police clearance if pressing operational need there is no mention of the ISA ( independent safeguarding authority). We looked at the recruitment files for two staff, we found application forms, health declaration, references, proof of identity letters offering job and CRB and Pova 1st disclosures. There are 11 senior staff on the Core Training matrix including the manager. Two staff in this group completed adult protection training in April 2009, one of whom was the manager. Two staff have completed Managing Challenging & Aggressive situations one in Dec 2000 and one in Feb 2005. One member of senior staff has completed NVQ level 3 Management and learning disability in July 2009. None of the 11 senior staff have completed the Approved first aider 4 day course. Four have completed the appointed first aider 1 day course In Oct 2008 and Jul 2009. Five senior staff have completed what I assume is refresher food hygiene training in Oct 2009, but it is unclear from the matrix if it is refresher training. Only two have completed moving and handling, the matrix is unclear if this is refresher Care Homes for Adults (18-65 years) Page 31 of 47 Evidence: training. On the enhanced training matrix for senior staff, two staff have completed Understanding Autistic Spectrum one in Nov 2007 and one in Dec 2005. Only one senior has completed Visual Impairment Awareness. None of the senior staff from looking at the training matrix which we were told was up to date have completed; communication and listening skills, makaton, deaf awareness, infection control, PCP approach, support profound and multiple disabilities. Only three senior staff have completed Epilepsy awareness only one has completed Total communication, nutritional care training, Learning disability and sexual health workshop, only one has completed mental capacity training, only two have done intensive interaction five have completed breakaway techniques, six have completed deprivation of liberty safeguards. None of the care staff have completed Epilepsy awareness. Six staff have completed total communication training and six are due to do it. One member of staff has completed nutritional care training. Two staff have completed social inclusion training and none are recorded as completing PCP approach. Five staff have completed learning disability and sexual health training. Six care staff have completed breakaway techniques, three staff have completed communication and listening skills training. Thirteen staff have left. Seven care staff have NVQ level 2 and four care staff are working towards the qualification and started in October 2009. Relief care staff have completed very little enhanced training. One has NVQ 2. One member of relief staff has not completed mandatory training since 2007. Core training for night staff, Moving and handling training for two night staff has not been done since 2007. One member of night staff has not completed basic first aid since 2004. Four night staff have completed Epilepsy awareness. A staff survey form said some staff do not pull their weight A number of staff surveys expressed concern about the closure of the Beeches and stated that very little information is filtering through to staff. Another member of staff thought there were far to many forms and writing to do. Staff rota; there are separate rotas depending on your role, so there is a night staff rota, a day staff rota and a domestic rota, only first names are used and there is no recording of job role or identification of who is the first aider on each shift. We were told that the Senior Care and Community Service Officer is always in charge of the shift. Care Homes for Adults (18-65 years) Page 32 of 47 Evidence: The annual quality assurance assessment says: Staff are now more up-to-date with personal centred thinking. It also tells us there are: 35 part time staff no full time staff The manager told us there is normally six support staff on shift and 2 night staff. We were told that seniors have the responsibility on shift regarding first aid however as we noted in the training matrix none of the eleven Senior staff have completed the four day first aider course. Care Homes for Adults (18-65 years) Page 33 of 47 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not well managed. Policies and procedures are not regularly updated to make sure they reflect current good practice advice and legislation. They system in place does not clearly show that staff are up to date with mandatory training in fire safety, moving and handling and first aid. Evidence: The management ethos of the home does not demonstrate a clear sense of direction and leadership, we found instances where we were told the responsibility for certain aspects of the service such as the development of the accessible service user guide lay with someone at County Hall. We were told the reason that person centred documents for individuals contain pictures of other people not the individual or their family or friends was because the document was provided by the speech and language therapist. We were told when asked about the finances of someone that was the responsibility of County Hall. We were concerned that the manager does not receive the support needed to move the home in the right direction and develop person centred approaches to care at the same Care Homes for Adults (18-65 years) Page 34 of 47 Evidence: time as giving strong leadership to a service which is closing and the anxiety that causes both for staff and the people living in the service. There is a quality assurance system in place. Satisfaction surveys were completed in June 2009 and December 2009 for staff and people who use the service, we looked at the document produced. In December the staff were asked questions such as how would you generally describe communication between yourselves and the following and a list of staff such as other professions, catering staff, housekeeping, county hall, residents. There were also questions about staff meetings, supervision, key worker scheme, training and equipment. We were told that survey forms are also sent out to people who use the service for respite but unusually they had not had any responses. The information from the surveys is collated into a report and short conclusions drawn. Many of the homes policies and procedures have not been updated for several years ( in some cases 2004). This means that they do not reflect current good practice advice and guidance may not provide the right information to staff. There is no evidence that staff and people who use the service are involved in the development of policies and procedures. Policies are not reviewed and amended. Individual records are not in good order and are maintained in a way which is not always in accordance with the Data Protection Act 1998. We found that although accident and incident records are being recorded properly a further record is kept if all accidents and incidents for the manager to audit but this is not kept in accordance with the act. The homes training programme includes mandatory training;fire safety, first aid, food hygiene and moving and handling. However, the training matrix supplied by the home showed that twenty three staff did not have current moving and handling qualifications and fifteen staff did not have an up to date first aid qualification although the certificate may have been relevant but the matrix does not record how long a certificate is valid for. and eight staff do not have current food hygiene qualifications, but again seven staff had not completed this training since 2008 and there was no information on how long the certificate is valid for. We were concerned about the fire system in the home as a number of fails were recorded in different parts of the building and the emergency lighting had failed. We discussed this both with the manager and with a member of staff who has the delegated responsibility. We looked at emails which show the communication between the home and the county councils own fire officer. We could also see that the company used to service the system had been involved. We asked a fire officer from Dorset Fire and Rescue service to inspect the building as we were unclear about the safety of the system. They visited later in the week and reported back that the system is safe. We were concerned that there are no personal evacuation plans in place for people who Care Homes for Adults (18-65 years) Page 35 of 47 Evidence: use the service, we were told that the fire officer had said they were not necessary however we were given a communication with the fire officer that advised a template for personal evacuation plans would be sent for completion for each person using the service. There is no demonstration of year on year development for each person using the service which is linked to implementation of their individual plan. We were concerned that monthly regulation 26 visits were not picking up issues in the home. A water hygiene assessment for legionella was last completed in July 2005, water outlets which are not frequently used are flushed twice a week, shower heads are cleaned monthly. We found that the water temperature was checked on 2/2/10 in room 14a and recorded at 50 degrees C, but we could not find any evidence of the action taken to address this. On the 18/01/10 the water temperature in the bungalow kitchen was recorded as 48 degrees C. We could find any evidence of the action taken. We could not see from the records if the temperatures then regulated downwards after a minute. We also note that when water temperatures are taken in individual bedrooms they are sometimes recorded as very cold 15 and 16 degrees C. Care Homes for Adults (18-65 years) Page 36 of 47 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 37 of 47 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 1 4 The registered provider shall 30/04/2010 compile in relation to the care home a written statement which shall consist of a statement as to the matters listed in Schedule 1. People who are considering using the home need to have accurate information about all aspect of the service being provided including the age range of people using the service. 2 3 12 The registered person shall 30/04/2010 make suitable arrangements to ensure that the care home is conducted with due regard to the sex, religious persuasion, racial origin and cultural and linguistic background and any disability of service users. Care Homes for Adults (18-65 years) Page 38 of 47 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action It is important that the home is able to demonstrate they are meeting the needs and preferences of individuals with diverse cultural backgrounds. 3 6 15 The registered person shall 30/04/2010 after consultation with the service user,or a representative of his, prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. It is important that peoples changing needs, aspirations and goals are clearly recorded and reviewed as part of their person centred plan. Goals must be specific, measurable and time specific. Plans must state who is responsible for for supporting the individual achieve their goals and how will it be monitored. 4 7 12 The registered person shall, for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings. 30/04/2010 Proper support plans must be in place when people are Care Homes for Adults (18-65 years) Page 39 of 47 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action being moved. There must be clear evidence of the action taken to prepare people. 5 9 13 The registered person shall, 28/05/2010 ensure that unnecessary risks to the health and safety fo service users are identified and so far as possible eliminated. It is importnat that people are supported to take risks in their daily life through robust risk management of situations and the development of positive action to facilitate this. 6 19 12 30/04/2010 The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service suers. where individual shave ongoing serious health conditions there must be detailed plans in place so that staff know exactly what to do and what to record. 7 23 13 The registered person shall make arrangements by training staff or by other measures to prevent service users being harmed or suffering abuse or being placed at risk of harm or 30/04/2010 Care Homes for Adults (18-65 years) Page 40 of 47 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action abuse. It is important that staff put their training into practice and ensure people who use the service are safe at all times. 8 32 18 The registered person shall, 31/05/2010 having regard to the size of the care home , the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. It is important that staff working in the home receive the training they need to understand the complex needs of people using the service. 9 35 18 30/04/2010 The registered person shall ensure that the persons employed to work at the care home receive training appropriate to the work they are to perform. It is important that there a training needs assessment is Care Homes for Adults (18-65 years) Page 41 of 47 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action carried out on the staff team linked to the services needs and the needs of individual living in the home. 10 39 26 Where the registered provider is an organisation the care home shall be visited in accordance with this regulation. 31/05/2010 It is important that the process of conducting monthly visits to the home are meaningful and ensure the people using the service are protected. 11 42 37 The registered person shall give notice to the commission without delay of the occurance of any areas detailed in the regulation. 30/04/2010 It is important the commission is aware of how people are supported when ill through accidents and when injured, in order to be clear how the home is protecting vulnerable people. 12 42 13 The registered person shall 30/04/2010 ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. Care Homes for Adults (18-65 years) Page 42 of 47 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action When hot water temperatures are recorded and they are higher than they should be it must be evidenced what action has been taken to ensure people are protected. 13 42 13 The registered person shall 30/06/2010 make suitable arrangements for the training of staff in first aid, moving and handling, infection control, food hygiene and fire safety. It is important that all staff receive training and refresher training in safe working practices to ensure people who use the service are safe at all times. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The registered manager should ensure that the service user guide and statement of purpose are available in a format suitable for the people for whom the home is intended. The registered manager should ensure that the contract is in a format and language appropriate to each individuals needs. People should be supported to develop life history books including details and photographs of their life, family, friends, where they grew up, who they know. This is especially important knowing the future of the service Page 43 of 47 2 5 3 6 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations where many people have lived for a number of years. 4 6 The registered person should ensure that the plans ( know as help lists) are available in langauge and format the individual can understand. Their plans should be held by them unless clear reasons not to are recorded. The registered person should ensure that plans establish individualised procedures for service users likely to be aggressive or cause harm, focusing on positive behaviour, ability and willingness. The registered person should ensure that people are involved in their reviews and if a person lacks capacity as defined in the Mental Capacity Act code of practice then the care plan should record how this decision has been reached. The registered person should be able to demonstrate how individual choices are made and clearly record where decisions have been made by others and why. The registered person should ensure that people who use the service are consulted about changes to the homes statement of purpose. The registered person should ensure that all information handled about people who use the service is in accordance with the homes written policies and procedures and the Data Protection Act 1998. The registered person should ensure that people are supported to make use of services, facilities and activities in the local community. The registered person should ensure that group trips are planned and chosen by people who share the same interests. The registered person ensures that staff use the individuals preferred form of address, which is recorded in the individual plan. The registered person should ensure that people who use the service have some choice of staff who work with them, such as staff from the same ethnic, religious or cultural 5 6 6 6 7 7 8 8 9 10 10 13 11 14 12 16 13 18 Care Homes for Adults (18-65 years) Page 44 of 47 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations background or the same gender. 14 15 16 19 19 22 The registered person should ensure that individuals are facilitated to have health action plans. People who use the service should be offered annual health checks The registered person should be proactive in ensuring that people who use the service know what a complaint is and how they can make one if they are unhappy or concerned. This should be considered a priority based on the future of the service. The registered person should develop a pictorial/ photographic guide so that people know who they can talk to if they dont feel safe or they are concerned about abuse. The registered provider should ensure that people who use the service have safe access to the home. The ramp at the back of the home should be made safe, as it is currently a tripping hazard. The registered provider should make significant effort to ensure increase the number of staff qualified to NVQ level 2 or above. The registered person should complete a first aid risk assessment to determine how many first aider should be on duty on each shift and the level of training they need. The assessment shoul include the needs of people who use the service, how likely first aid will be needed and what kind of first aid will be required. If provider do not carry out a risk assessment first aiders will need to be provided at all times by properly trained staff. The registered person should ensure that the rota includes the full names of staff. The registered person should ensure there are staff on duty at all times who can communicate with service users in their first language including sign and have skills in other communication methods relevant to service users needs. The registered manager should undertake periodic training 17 23 18 24 19 32 20 33 21 22 33 33 23 37 Care Homes for Adults (18-65 years) Page 45 of 47 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations to maintain and update her knowledge, skills and competence while managing the home. 24 38 The registered manager should communicate a clear sense of direction and leadership which staff and people who use the service understand and are able to relate to the aims and purpose of the home. The registered person should ensure that policies and procedures are regularly reviewed and updated to make sure they reflect current good practice advice and legislation. 25 40 Care Homes for Adults (18-65 years) Page 46 of 47 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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