Inspection on 27/04/05 for The Beeches

This inspection was carried out on 27th April 2005.

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

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

Other inspections for this house

The Beeches 26/02/10

The Beeches 19/10/07

The Beeches 06/07/06

The Beeches 28/02/06

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 09/07/2008.

CARE HOME ADULTS 18-65 The Beeches Fairfield Bungalows Blandford Dorset DT11 7HX Lead Inspector Sophie Barton Unannounced 27 April 2005 & 09 May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Beeches Version 1.10 Page 3 SERVICE INFORMATION Name of service The Beeches Address Fairfield Bungalows, Blandford, Dorset, DT11 7HX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01258 453436 01258 451540 Dorset County Council Susan Joy Tuck CRH 25 Category(ies) of LD - 25 registration, with number of places The Beeches Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Staffing levels must be those determined in accordance with guidance recommended by the Department of Health. The home can accommodate one named service user, who has a sensory impairment in the bungalow at The Beeches. The home must meet the staffing levels as agreed in their action plan to the commission dated 12th November 2003. Date of last inspection 21 December 2004 Brief Description of the Service: The Beeches provides accommodation for adults who have a learning disability, providing long-term care and 2 respite beds. The Beeches is within walking distance of the town centre. The Beeches has a bungalow attached to the home, and three service users are currently living in the bungalow. These three service users are supported by two members of staff while in the bungalow during the waking day, and one waking night staff. The bungalow has its own kitchen, dining room, lounge and bathroom. The main part of the home is also staffed 24 hours a day. The majority of the service users attend local day centres during the weekdays. A high level of personal care is provided by staff, with staff supporting residents with bathing, dressing and personal hygiene. Staff are employed to cook all meals for the service users, with the main home having a non-domestic kitchen for the use of staff only. The home was purpose built in the 1970’s. Accommodation is arranged over two floors, with the lounges and dining room being on the ground floor. There is no lift to the first floor. There is a large garden to the rear of the property The Beeches Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspection was carried out over two days. The first day was unannounced and took place between the hours of 2.00pm and 6.00pm by two inspectors. This part of the inspection involved examining in detail five care files of randomly selected service users. An inspector also spoke to some parents of a service user recently admitted to the home, and informally spoke with three other service users. The second day was announced, with just one inspector, between the hours of 11.30am and 6.00pm. This day involved examining a range of documentation (e.g. complaints log, fire log, rotas, medication administration records, staff personnel files), speaking with service users, staff and having a tour of the premises. What the service does well: What has improved since the last inspection? Service users are now given the opportunity to spend a day at home occasionally and not attend the Day Centre (named an “activity day”) to complete independent tasks such as collecting their benefits and going The Beeches Version 1.10 Page 6 shopping. Staffing has also increased slightly to allow for more time to be spent supporting individual service users away from the home. The assessments of service users needs are more up to date and accurate with the staff team working hard to improve the assessment documentation. Individual Service Plans have also become more user-friendly, again showing commitment and interest from staff to develop practice. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Beeches Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Beeches Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 and 4. The home ensures service users’ specialist needs are assessed fully, but there remain gaps in the assessments of holistic needs and aspirations, with assessments lacking a person-centred focus. The home allows service users to visit and become familiar with the home prior to having to make a decision. EVIDENCE: There has been one new service user admitted since the last inspection. The Inspector spoke to this service user and their relatives. The service user was having a slow (user focused) transition into the home, spending weekdays at the Beeches and returning to the care of his parents at weekends. The service user was still in the transition stage, but stated that he was happy to remain living in the home. The relatives stated they had been involved in the home’s assessment of the service user’s needs and the service user had signed the written document. There remain gaps in the assessment documentation. The areas in relation to meaningful education, occupation, family contact, income/finances, cultural needs, health needs and compatibility with others, and agreed restrictions are absent from the current assessment pro-formas. There was also no clear indication of the service users’ aspirations. An examination of another service user’s file, evidenced that the Manager had supported a service user in accessing Advocacy support where there has been issues relating to whether this service user should continue living at The Beeches or not. The Beeches Version 1.10 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 8 and 9. The home’s care planning procedures are not sufficient to show how the home is going to meet the everyday and changing needs of the service users. The home’s risk assessment management strategies have improved, but risk assessments continue to need more clarity to ensure staff have the information they need to minimise risks identified for service users. Some improvement is noted in ensuring service users participate more fully in the running of the home, but service users full control over decision-making and independent living is limited. EVIDENCE: As stated above there are gaps in the assessment of some needs, and therefore this leads to gaps in the documentation of how the home is to meet the range of needs for each service user. There is not one clear care plan document, but instead the home records needs and action on three different documents. None of these documents clearly identify how the day-to-day holistic needs of service users are to be met. For instance one file stated that the service user liked going to church, but it did not state how the home will support the service user with attending church. Another example included a The Beeches Version 1.10 Page 10 service user needing support with collecting benefits but not stating what support. It is beneficial to see some of the service users’ goals and aspirations recorded on the ISP, but it was unfortunate to note that on three of the files seen some of the goals listed were not recorded as being met (social activities, holidays, befriender). The lack of clear direction with the care planning documentation, is also reflected with the risk assessment forms. Two forms are being used, and staff are not always completing them effectively or covering the necessary area of what action needs to be taken to prevent risks. This was seen for a risk assessment in relation to falling and mobility difficulties. In relation to participation and service users control over decision making the home arranges regular Residents Meetings, where service users are given the opportunity to comment on group activities, or raise concerns about the running of the home, and the Manager has arranged for service users to take part in staff recruitment and staff meetings. However full participation and consultation is limited. Service users continue to not be able to access the kitchen (the Manager states its because of health and safety reasons as it is an industrial furnished kitchen), and they do not have a key to the front door. Policies are agreed at Directorate level rather than consulted and agreed with service users. A service user has continue to request changes to the disabled shower for over a year now, due to her not being able to shower independently, but this has still not been actioned by the Directorate, however the Manager has confirmed that the works has now been ordered. The Beeches Version 1.10 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 16 and 17. Opportunities for community activities have increased slightly although these remain limited in variety. The home has made attempts to increase service user participation and consultation although some individual practices continue to undermine the autonomy of service users. Service users are offered a varied and healthy diet, but service users are not encouraged to be independent with preparing their meals. EVIDENCE: There has been a slight increase in service users accessing the local community, going for walks, collecting benefits, going to the local shops and to the pub. Service users went and voted in the recent elections. In discussion with service users they did state that they would like more of an opportunity to go into town but that “staff are too busy” or “not enough staff”. One file showed that in 6 weeks the only activity the service user had partaken in was attending a specialist club disco. Another file showed that in a six week period the service user had been to the Post Office and shops twice, one pub lunch, The Beeches Version 1.10 Page 12 and visited friends twice. Staff had recorded that service users had made a sandwich etc as part of an activity day. This should not be seen as a specific “activity” as it is part of everyday living, and should be an activity made available to him daily. No evidence was seen of service users being supported to undertake outside hobbies or adult education classes / college and in discussion with service users they did not think these options were available to them outside of the activities arranged by the Day Centres. Staff have however been proactive in arranging for groups of service users to attend shows and musicals. Following the inspection it was confirmed by the Council that residents do attend adult education classes, however these are arranged through the day centre and in partnership with a residential home. The Inspector noted that service users sat down waiting for the meal an hour before it was to be served, a member of staff stated this was the service users choice, although the Inspector did see a member of staff bringing service users to the dinner tables early. Service users can however choose where to eat the meal. The service users stated that meals were at a set time, but the Manager has since stated that meals can be given at a flexible time. Service users do have a choice of two or three meals in the evening. One service user stated that he enjoyed cooking at the Day Centre but could not do any cooking at The Beeches, but that he would “love to”. Service users have unrestricted access to the communal living areas of the home and to the rear garden, however do not have access to the laundry or kitchen. The Inspector has been informed that this is due to health and safety reasons and indeed the kitchen is of a non-domestic scale. No service users have a front door key, and service users have the ring the bell to access the home. Service users do have keys to their bedrooms and are encouraged to lock their doors. The Beeches Version 1.10 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20. Personal care needs are documented thoroughly ensuring staff have clear information about how to guide and support the service users. Insufficient recording of health needs has the potential for causing some needs to be missed by staff. Service users are potentially being placed at risk of under and over administration of medication due to inadequate medication recording systems being maintained. EVIDENCE: The ‘Help Lists’ completed for each service user detail the personal care needs of service users. Files seen showed that service users had been referred to specialists (e.g. Occupational Therapy, Psychologist), and that staff liaise closely with these professionals. However, on two files seen the service users had specific health needs that were not recorded on their assessments, and there was no evidence seen that service users have been supported to have a hearing test. However the five files seen showed that the service users had all had check ups at the dentist and opticians. The Inspector noted an error in the home’s administering of medication, and the Medication Administration Record has not been completed appropriately. Also of concern was that twice in one week medication for epilepsy had been found on the floor in the Bungalow, and no evidence seen that any action had been taken following this. The Beeches Version 1.10 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23. The home has a satisfactory complaints system, with service users views and complaints being sought, listened to, recorded and acted upon. The home is not adequately protecting service users from assaults from other service users. EVIDENCE: There have been four adult protection investigations in the home during the last 12 months, two of which were substantiated, and one member of staff referred to the Department of Health protection of Vulnerable Adults List. On two occasions the appropriate procedures were not immediately followed following the identification of the adult protection concerns. There have been no formal complaints made about the home in the last 12 months. The manager is now recording service users ‘grumbles’ / minor complaints. These were checked by the Inspector and they involved service users making minor complaints about other service users. The staff had taken appropriate action following these ‘grumbles’. The Inspectors noted that recently there had been incidents involving service users hitting / kicking other service users. The incident forms completed did not indicate that appropriate action had been taken following these incidents. As the victims representatives were not informed and they did not see anyone independent about the incident. The perpetrator of the assault had been asked to apologise. No other action recorded how the risks of this happening were to be minimised. However the Manager has confirmed that a risk assessment and behaviour management plan has been completed for one of the instigators of these assaults. The Beeches Version 1.10 Page 15 The majority of staff have received training in managing service users’ challenging and aggressive behaviour. Staff have not received training in physical intervention or restraint. The Beeches Version 1.10 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, and 28. The home is clean, safe and comfortable but it does not provide a homely or domesticated environment for service users, and not all individual needs are met. Service users have single bedrooms, with appropriate individual furniture and furnishings, which meet their needs and personal tastes. EVIDENCE: The home is a purpose built home. The main house has an institutional feel, with an industrial style kitchen, and keypad locks on the front, office and kitchen doors. The home is not unitised which makes it difficult for staff to create a homely feel, and difficult for service users to undertake more independent living (cooking, cleaning, laundry, independent access). There are three communal areas, which are of a good size and can easily accommodate the 25 service users in a comfortable way. However the Inspector noted that electric wheelchairs are being stored in one of the lounges and a commode and hoist were being kept in the telephone/quiet room. The Beeches Version 1.10 Page 17 The Inspector was shown three bedrooms by service users. All service users have single bedrooms. The bedrooms seen were individual in style and included personal possessions. The Inspector noted that the bathrooms were not made comfortable or homely. They were void of any colour, ornaments, pictures, towels or rugs, but instead looked sterile, cold and bare. The shower for use by service users who have a physical disability continues to not meet the needs of the service users, as they cannot access it independently. The home continues to accommodate two service users at a time for respite care. They share the same living accommodation as the permanent residents, although this is clearly not recommended in the National Minimum Standards. It does not aid consistency or privacy for the long-term service users. An Occupational Therapist and a Rehabilitation Officer have been involved in assessing the premises. The Beeches Version 1.10 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35, and 36. Only limited progress has been made in addressing staffing shortages and as a result service users do not receive consistent or appropriate care and support. The home has not followed safe recruitment practices and has therefore placed service users at risk. The staff are trained to meet the service users’ basic needs, however they do not have the knowledge or trained sufficiently to meet the specialist needs of service users who have a learning disability and associated difficulties. EVIDENCE: There remains a shortfall of approximately 275 hours per week as the Department of Health recommends 900 care hours per week but the home’s rota shows that approximately 625 hours are provided. The home’s rota aims for 6 staff on the morning shift (7am – 9:30am / 10.30am) and afternoon/evening shifts (4.15pm – 9:30pm). Two of these staff work in the bungalow, which leaves 4 staff to work in the main house with up to 22 service users. During the day on Mondays, Tuesdays and Wednesdays there are two members of staff working in the home, and three staff on Thursdays and Fridays. There continues to be seven vacant care posts. The Beeches Version 1.10 Page 19 Service users themselves stated that staff were too busy, or not available to help them access the community. The opportunity for staff to spend uninterrupted time with service users is limited. There has been a consistent senior team working in the home, and there are regular staff meetings. All staff are over 18 years of age. The service users stated they had no concerns about any staff, and that they are friendly. Relatives were also positive about the home confirming that the service users are well looked after, and that the staff are “lovely”. However the Inspector observed some concerns about the staffs approach to everyday activities for service users, in that independence and ‘normalisation’ is not being promoted by staff e.g. service users not being enabled to visit a pub due to having a “learning disability”, and a service user making a sandwich being a ‘special’ activity rather than a daily living task. Training for staff specific to the needs of service users is limited. The evidence seen showed that only 2 people had been on a training course in relation to old age, only one on dementia, and two on total communication, and still no staff have attended autism training. The home is also not meeting the target of new staff receiving induction training within 6 weeks or foundation training within 6 months. Only approximately 25 of staff have an NVQ 2 qualification. Eight staff files were checked, which included recently appointed staff. Appropriate references were obtained, although there was no evidence that gaps in employment had been explored and verified. All new staff had started work in the home prior to their Criminal Record Bureau certificate being received by the home, and there was no evidence that a POVAFirst check had been requested. A risk assessment for one of the new members of staff seen stated that he could do personal care unsupervised with service users, but just needed to ‘check in’ with the Team leader every 30 minutes. This is not acceptable and is a serious breach in regulation. The Inspector also noted that three different complaints had been raised about a member of staff’s competence over the last 10 months. This member of staff however had only had two supervision sessions in this time. However, the Manager has since confirmed that other meetings had taken place with this member of staff but evidence was not available at the time of the inspection to show this due to the manager being on leave. Supervision of other staff is adequate, with staff having approximately 6 sessions per year. The Beeches Version 1.10 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 41, and 42 The records kept by the home are up to date and accurate, but in areas of case recording and care planning there is a lack of direction and effectiveness. Health and safety is addressed satisfactorily by the home through procedures and staff training. EVIDENCE: The Inspectors considered that all the information required by regulation was present in the service users’ care files, however the files were full of old information which is potentially confusing for staff. The Inspectors felt that there was no real content to the daily recording, and comments were judgemental and non-factual “happy”, “no problems today”. Entries, assessments and guidelines written by staff were not always dated and signed. Some of these entries in the staff communication book needed immediate action i.e. relating to found medication on the floor, or service users being ill, or service users requiring external services, but there was no indication The Beeches Version 1.10 Page 21 whether these requests from service users or staff had been actioned by the senior team. In relation to health and safety, the fire equipment and alarms are checked regularly. However, the Inspector noted that there had been a fault on the emergency lighting since February 2005, and a fault with the lounge door closing mechanism since January 2005. There was no evidence recorded to show that these faults had been addressed, but the Manager has since confirmed that they had been addressed stringently. There are water temperature regulators on the baths and sinks. There was no evidence maintained that the water temperatures are taken regularly and recorded, and indeed when checked the hot water temperatures were low (max 38 degree centigrade). The majority of staff have had training in moving and handling and food hygiene, and there is a system set up to notify the manager for when staff need to update this training. The senior staff members are appointed person first aid qualified. Risk assessments for safe working practices have been carried out (although these were not reviewed by the Inspector). The most recent Regulation 26 report (undertaken on 26 April 2005) stated that fire training for staff needed to be updated. The Beeches Version 1.10 Page 22 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x 3 x Standard No 22 23 ENVIRONMENT Score 3 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x 2 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 1 2 x x Standard No 11 12 13 14 15 16 17 2 2 1 2 x 2 1 Standard No 31 32 33 34 35 36 Score x 1 1 1 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 x Standard No 37 38 39 40 41 42 43 Score x x x x 2 3 x The Beeches Version 1.10 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 13 Regulation 16 Requirement There must be evidence that the staff have consulted with service users about their social interests, and make arrangements to enable them to engage in local, social and community activities) Service users must be provided with facilities to prepare and cook their own food. The Registered Manager must ensure that staff record the administration of medication accurately and ensure that any gaps or errors in administration are investigated. The home must ensure that the medication administered to service users is correct as per the prescription. Case recording made by staff of concerns or abuse must be accurate, factual and contemporaneous. (Previous timescale of 1 March 2005 not met) The home must ensure that appropriate action is taken following any assaults on a service user from another service. Action must be taken to modify Version 1.10 Timescale for action 1 August 2005 2. 3. 17 20 16 13 1 September 2005 10 June 2005 4. 23 13 1 July 2005 5. 27 23 1 August Page 24 The Beeches 6. 32 18 7. 32 18 8. 33 18 9. 34 19 the ground floor shower in the home to enable service users to be as independent as possible when using it. (Previous timescale of 30 August 2004 not met) The Registered Person must ensure that all workers are competent. Where concerns to competence is raised these must be investigated fully and action taken to protect service users. The home must provide training to staff on autistic spectrum disorder. (Previous timescale of 30 August 2004 not met) 50 of care staff must have at least an NVQ 2 qualification in care. Care staff must receive training in communicating with service users who have a learning disability. The Registered Provider must continue the programme of investment into The Beeches so that the staffing levels allow for increased opportunities and needs to be met for individuals. (Previous timescale of 30 June 2003 not met) Staffing hours must be increased to ensure that service users needs can be met. The Registered Provider must take action to reduce the number of vacant posts within the home. No person must start work in the care home until a POVAFirst check has been received. Persons working in the home without a full CRB check must be supervised at all times by a designated person/s. 2005 1 June 2005 1 September 2005 1 August 2005 1 June 2005 The Beeches Version 1.10 Page 25 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. 2. Refer to Standard 2 2 Good Practice Recommendations The homes assessment of service users needs should cover a wider range of needs, and more meaningful detail. There should be clearer detail on potential restrictions placed on service users right to freedom and choice (and agreed by the service user and representative) on the service users care file. Each service user should have a clear care plan that details how the home is to meet their day to day needs. The care plan should cover the areas detailed in Standard 2.2. The service users care plan should be reviewed every 6 months and up dated where necessary. (This recommendation has not been actioned appropriately since the inspection dated May 2004) Where goals for service users have not been met, there should be clear reasons documented for this. Service users should be given the opportunity to particpate in all aspects of life in the home and consulted about the homes procedures and services (using advocates and representatives where needed). Services users wishes and feedback should be acted upon where necessary. Risk assessments should be individualised, clearly detail the nature of the risk and record the action to be taken to minimise the risk. The home should ensure that each service user is given the opportunity to develop independent living skills in a meaningful and regular way. Care plans should detail how service users are to be encouraged to be as independent as possible. There should be evidence of full consultation with each service user about the training, employment or further education opportunities they would like to take part in. Service users should be encouraged and given the opportunity to engage in a range of appropriate leisure activities. Service users should have as part of the basic contract price the option of a seven day annual holiday outside of the home. Service users should have unrestricted access to the front Version 1.10 Page 26 3. 6 4. 8 5. 6. 9 11 7. 8. 12 14 9. 16 The Beeches 10. 11. 17 19 12. 13. 14. 15. 23 24 27 28 16. 35 17. 41 18. 42 door of the home and kitchens. Consideration should be given to ensuring mealtimes are more flexible. Health needs should be more clearly documented on the service users assessment and care plans. The record of health appointments should clearly detail the outcome of these appointments. Service users should be enabled to have a hearing tests. Staff should receive accredited training in restraint. The Registered Manager / Provider should forward an action plan to the Commission detailing the plans for untising the Beeches into smaller more living units. The bathrooms should be made more comfortable, welcoming and homely. Mobility equipment and aids should not be stored in the communal areas. The home should not continue to offer a short term care service as the communal areas cannot be separated from the living areas of the permanent residents. Care staff should complete the Learning Disbaility Award Framework induction training within 6 weeks of appointment and the foundation training within 6 months. (This recommendation is brought forward from the inspection dated Sept 2004). Training opportunities for staff should be linked to service users needs, to ensure that staff have the skills and competence to meet the range of sevrice users specialist needs. Service users should be encouraged to be involved in the maintaining of their personal records. Daily recording should be factual and non-judgemental. Consideration should be given to archiving old assessments and care plans. Staff should ensure that when completing written documentation about service users this is dated and signed. Hot water temperatures should be maintained at a temperature close to 43 degree centigrade. The Beeches Version 1.10 Page 27 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Beeches Version 1.10 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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