Inspection on 27/11/07 for The Beeches

This inspection was carried out on 27th November 2007.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Beeches 21/11/06

The Beeches 19/12/05

The Beeches 04/09/05

The Beeches 27/07/04

The Beeches 25/03/04

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

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

CARE HOME ADULTS 18-65 The Beeches 7 Crescent Rise Luton LU2 0AT Lead Inspector Sally Snelson Key Unannounced Inspection 27th November 2007 12:00 The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Beeches Address 7 Crescent Rise Luton LU2 0AT Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01582 425792 01582 418126 jonplane@hotmail.com Mr Geoffrey Plane Miss D Newman Mr Jonathon Plane Care Home 12 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (12) of places The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st November 2006 Brief Description of the Service: The Beeches is a care home for younger adults who have mental health needs. The home opened in 1987, and some of the residents have been at the home since then. The home is registered for a maximum of 12 residents. All residents are offered single bedrooms, and four of the rooms have en-suite facilities. There are two lounges on the first floor, and the kitchen and the dining room are located in the basement. The home has a garden at the rear of the house, which is mainly grassed and has trees, flowerbeds, and a water feature. There is a small parking area at the front of the house. The home is within walking distance of the local bus and train station in Luton. The shopping centre and other amenities in the town centre are also within walking distance of the home. The fees for this home vary from £468.00 per week, to £800.00 per week, depending on the funding source and assessed need of the resident. The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out in accordance with the Commission for Social Care Inspection’s (CSCI) policy and methodologies, which requires review of the key standards for the provision of a care home for younger adults that takes account of residents’ views and information received about the service since the last inspection. Information from the home, through written evidence in the form of an Annual Quality Assurance Assessment (AQAA) has also been used to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. The inspection of The Beeches was a key inspection, was unannounced and took place from 12 midday on 27th November 2007. The registered manager, Jonathan Plane, was present throughout. Feedback was given throughout the inspection. During the inspection the care of three people who used the service (residents) was case tracked. This involved reading their records and comparing what was documented to what was provided. In addition to sampling files, people who lived at the home, and staff were spoken to and their opinions sought. Any comments received from staff or residents about their views of the home, plus all the information gathered on the day was used to form a judgement about the service. Prior to the inspection no service user comment cards had been received. The inspector would like to thank all those involved in the inspection for their input and support. What the service does well: The home is well located close to local amenities and within easy reach of the centre of Luton. Each of the residents has their own bedroom and has free access to come and go as they wish. Should a resident require the support of a staff member to attend an appointment this can be arranged. The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 6 On the whole the manager ensures that the requirements made at previous inspections are met, but this may mean other standards slip. What has improved since the last inspection? What they could do better: There are a number of areas in which improvements need to be made, including: • All health and safety checks must be completed and recorded at the required intervals • All staff must be regularly supervised by someone who is suitably qualified to do so. • The home must have a robust quality assurance programme that is used to influence the annual business plan. • There must be sufficient staff on duty to provide the necessary care and support for the residents. The staff team must have the necessary qualifications and experience to provide the required care. • New staff must not start work until all the information and documentation outlined in schedule 2 of the National Minimum Standards has been obtained. • All of the residents must have a signed contract that sets out the terms and conditions of their tenancy. • All new residents must be assessed prior to a placement being offered. • The homes medication policy must be accurate and followed at all times. • All staff must be aware of how to protect residents from any form of abuse and what to do if a situation arises. The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4,5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Information provided to people before moving into, and during their stay, at The Beeches was not complete and could leave them vulnerable. EVIDENCE: By attending a meeting as a representative for the sister home of the Beeches, the manager had been made aware of the need for the Statement of Purpose to be more specific about the conditions that the staff team had the training and experience to care for. Some work had started on reviewing the Statement of Purpose, however still more needed to be done to ensure that the Statement of Purpose and the Service Users Guide included all the information required by Regulation 4 and 5 and schedule 1 of the National Minimum Standards and was in a format suitable for those living at the home. Only one of the three residents whose care was tracked had moved into the home since the last inspection. It was clearly documented that this person had wanted to move to be near his family and had had a number of trial visits before moving in fully. However there was no documentation to support that a member of staff had made a visit to this person to make the initial The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 10 assessment. There was information on file from he previous placement and staff were aware that an assessment visit, by the manager had taken place but there was no documentation to support it. Evidence throughout this report demonstrates that the home is not ensuring that service users needs and aspirations are met. The files sampled included tenancy agreement between the home and the residents. The agreement, for the person that had been accommodated since April 2007, had not been signed and had blank spaces that had not been completed. It also included false information. For example it suggested that his bedroom provided him with a shower, wash hand basin and toilet when not all these facilities had been provided. Another tenancy agreement had been signed in 2001 and not updated to reflect changing terms. The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans that were not kept-up-to-date and reviewed with the residents could mean that residents were provided with poor care, or care that they had not agreed to. EVIDENCE: All of the files sampled included some care plans, but they were not always completed in sufficient detail or kept-up-date. This was despite a requirement being made following the last inspection that ‘care plans and care documentation must be accurate and clear in their guidance to staff on the care and support needed by all residents’. Of the three files sampled, the file that belonged to a resident who had recently been the subject of a safeguarding allegation had been updated and The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 12 additional useful information included. The manager stated that staff had worked hard to ensure this plan was correct. However the other two sampled did not have the same detail. One was relying on some information provided from his last placement. The manager thought this omission might be because the plans had not been typed up, however he was not able to find a more current example during the inspection. The third file included some care plans that had been written 03.03.05 and reviewed 23.6.05 but not altered since then. It was clear from tracking this person that the behaviours referred to in 2005 had altered considerably. Because of the nature of their illness, many of the residents found it hard to make decisions for themselves, for example how to spend their money or how many cigarettes to smoke. Documentation did not support how residents might be supported to make more informed decision, although the manager reported that some of the residents had been supported to consider reducing or cutting down on smoking and others were given support to make their money last by being given small amounts daily. Many of the resident’s living at the home had their personal money managed on their behalf by the commissioners of their care or family members. Staff checked the monies held by the home, daily at handover. During the inspection a small (2 pence) and a larger discrepancy (£10.00) were noted in the balances of two residents. These discrepancies were not new, despite staff confirming, by signing, that they had been checked daily. The manager agreed to look into these discrepancies but saw the solution as him providing the money that was missing. We did not see documentation to support the practice of residents benefit cheques being cashed by a staff member. It was also noted that the rent was taken out before the money was given to the resident, with no indication as to why they could not handle their own money. There was some evidence that residents were encouraged to take risks, but again documentation did not suggest how residents were being supported to move forward. For example many of the residents would go out and do a range of activities on their own, but it was unclear how this was moving them towards independence. Two of the three files included the paperwork to be used if a resident had to be reported as a missing person. The inclusion of the paperwork in the files suggested that this may be necessary, but it was noted that this paperwork had not been completed. The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There was little to indicate that living at the Beeches provided any stimulation for the residents or encouraged socialisation. EVIDENCE: None of the residents had any type of employment or attended any educational establishments. Some of the residents did go out, but many choose to stay in the home and watch TV and smoke. During a random inspection on 17th August 2006 it was noted that residents had few opportunities for leisure pursuits. By the next inspection this had The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 14 improved, however it had tailed off again. The activity book that staff completed when they went out with a resident had few entries until the last month when it had again improved slightly. It was apparent that at times there was only one member of staff on duty and therefore impossible for staff to accompany residents out of the home. On the day of the inspection the manager put off taking a resident out, even though it was made clear that the manager did not have to be present during the whole of the inspection. From 1pm there were two staff on duty, in addition to the manager who was conducting a staff interview, however the staff members sat together in the office and had very little contact with the residents and did not suggest any activities. When this was mentioned to the manager a member of staff joined the residents in the lounge, but it was clear residents were not used to this. Whilst tracking care it was noted, that during a residents care review held on 15.10.07, the Local Authority required the manager to source appropriate activities for a resident. There was nothing (more than six weeks later) to update this, or suggest it had been done. At the last inspection it had been recorded and residents had reported, that much of the food provided was bland, pre-prepared frozen food. This inspection covered both lunch and dinner. Lunch was served soon after 12 o’clock and dinner at 5.15pm. The inspector was concerned that this left a long gap, from dinner to breakfast the next day as food in the kitchen was locked up and accessed by staff only. Both members of the care staff went to the kitchen (in the basement) to prepare the meals and shouted up to the residents when it was ready. One resident, who was not hungry at lunchtime, was given a milk drink when he became hungry later in the day. There was little evidence in his care plan as to how his weight loss and refusal of meals was being managed. Staff reported that residents were consulted about the menu, however it was noted that staff changed the evening meal from meat pie and mashed potatoes to meat pie and chips because they had had mash the day before. One resident ordered a take away because he did not like what was offered. The resident paid for this meal. The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were supported by staff to attend healthcare appointments. EVIDENCE: All but one of the residents were able to provide their own personal care, but many of them needed a reminder to do this. Many of the residents wore grubby ill-fitting clothes. However staff stated that they would smarten up if they were going out. Staff reported that each of the residents had a set day in which they were supported to do their personal washing. Residents were supported by staff to attend appointments with health care professionals both inside and outside the home. On the day following the inspection three different residents needed to attend appointments and staff were planning how this could be achieved with the available staff. The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 16 The inspector was concerned that a resident who had a stroke and was advised to have a low cholesterol diet was offered chicken Kiev, coleslaw and bread and butter for lunch, and meat pie and chips at dinner. It is believed that each of these foods had a high fat content. There were male and female carers employed to care for a pre-dominantly male client group. On the whole medications were signed into the home and administered correctly. One of the residents was able to self medicate and another handled his own medication to take home. In some cases it was noted that odd doses of medication had been taken from the blister for the end of the month because the medication was needed before the official start date as it had run out early the previous month. This practice makes it impossible to carry out a true audit trail. The newly appointed deputy stated that she was ensuring that individual doses of the missing medications were ordered so that this was not necessary in the future. The medication policy referred to staff checking the resident’s photograph that was part of the medication chart, when administering medication. No photographs were seen. The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staff, including the manager, did not appear to have a working knowledge of the correct process to ensure that vulnerable adults were protected from all forms of abuse. EVIDENCE: There had been a recent incident in the home that involved a resident alleging that a member of staff had abused them. The manager had not taken the appropriate actions in a timely fashion. At the subsequent strategy meeting the manager had stated that the home did not have a restraint policy and that the carer involved had used some form of restraint. It was also apparent that the home did not have a de-escalation policy and that this resident was known to sometimes become agitated during personal care. When the incident occurred the staff member was working alone, despite documentation to support the need for two carers at times. It was a concern that it was as a result of the strategy meeting that the manager agreed to increase the staffing levels to two from 8am to 9pm, and not as a result of the incident confirming the need for additional staff. The need for additional staff in the home had been a concern raised at previous inspections. Only the manager and two care staff had attended training on safeguarding adults and this had been delivered in-house almost two years ago. It was The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 18 concerning that this training was delivered in-house as there appeared to be gaps in the managers knowledge of the subject. The policy and procedure file provided during the inspection stated that document 15 referred to the disclosure of abuse. This policy was missing from the file. As already stated in this report the checking of residents personal money highlighted a discrepancy and it was unclear that residents were in agreement with their benefit cheques being cashed by a member of staff and the rent taken at source. The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,27,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There had been some improvements to the decoration of the of the home since the last inspection, but it was not a homely environment for people to live in. EVIDENCE: Since the last inspection the TV in the lounge had been replaced with a digital TV, and there had been some redecorating and replacing of furniture. The layout of the home was becoming unsuitable for the resident who had mobility problems, as although her bedroom was on the ground floor the kitchen and dining room were in the basement. Communal facilities included two lounges, one designated as a non-smoking area, however it was noted a resident, who preferred to be quiet, but smoked, The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 20 used it. Where floor coverings had been replaced with wooden floors these were in good condition and appeared appropriate, but others, particularly the dining room and office, were in need of replacement. One resident offered to show the inspector their bedroom. This was appropriate and had some personal touches. There was a toilet but not a bath or shower on each floor. A rail had been positioned at the steps leading to the front door. However this had not been adequately secured and was very wobbly. A cleaner was employed to keep the home clean and tidy and the residents appreciated what she did. During the inspection it was noted that there was no heat to an area of the home. The manager thought this was because the electricity was shorting, as when the inspector took him to show him how cold it was the lights went out. As a result an electrician was called but it was found that the lights were on a system that senses when there is someone around and go on and off accordingly. Staff reported that they did not like this and felt residents could trip because of it. The manager appeared unaware that this system was in place. The day after the inspection the manager reported that a plumber had been called to check the heating. The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Staffing levels were not kept under review to ensure that the staff team was sufficient, or had the necessary skills and qualifications, to meet the needs of the residents. EVIDENCE: The record of statutory training provided as part of the inspection had been completed in 2006 and had not been updated, so there was no documentation to support that appropriate training was provided or had been taken up by staff. The training plan provided was also outdated and did not reflect the needs of the residents. On the day of the inspection there were two care staff, the manager and a cleaner on duty. Since the beginning of the week the manager had made a commitment to the local Authority to ensure that there was always a minimum of two care staff on duty. However the night continued to be covered by one The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 22 member of staff who slept-in. Staff reported that they went to the staff flat (within the building) at 9.00pm and unless they were awaken by someone or something they did not appear downstairs until 07.30 hrs the next day. There was a record in the notes of a person who sometimes stayed out late with his family that he was to knock on the door of the flat to alert staff to his return. We were however concerned that missing persons paperwork had been included in this file, to be used in the event of him not returning, but had not been completed, also his care file did not include a photograph. One of the residents, with frailer health, had an alarm system that alerted staff to her needs but others would have to climb one or two flights of stairs to the flat. We were also concerned that the carer sleeping-in on the night of the inspection had worked at the home for less than a week and although she had previous experience of working in care settings and with clients with mental disorders was still undergoing a period of induction, but was to do her first sleep-in alone At the last inspection when checking recruitment practices it had been reported that not all the staff had a current Criminal Record Bureau check. This inspection indicated that the newest recruit had been started with only one returned reference. The manager was in the process of employing new staff and increasing the hours of two exsisting staff members to ensure that the home had two staff on duty at all times. When asked about staff supervision the manager reported that it was happening but had not been documented. The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39.42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. In many outcome areas the manager was unable to provide sufficient evidence that the home was run to the required minimum standards, which could put staff and residents at risk. EVIDENCE: The manager had still not completed the Registered managers Award (RMA) and had not undertaken many training updates. For example, despite administering medication he had not attended any medication update training and relied on the fact that he had had many years experience . The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 24 There had been no recent quality assurance survey undertaken by the management. The last one seen was dated 2006, although a previous action plan had suggested it would be repeated six monthly. Documented staff meetings and residents meeting were not routinely taking place. The inspector was not confident that fire procedures were being routinely carried out and checked, as documentation was not correctly completed. For example, the last recorded fire evacuation was not dated and the one previously was 18.9.06. Also records did not indicate how long it had taken to evacuate the building. Weekly fire alarm tests were recorded every seven days until 30/10/07 but nothing at all for the month of November at the time of the inspection. It was also noted that for the day of the inspection there had been no entries in the visitor’s book, despite the inspector meeting a prospective staff member and three visiting health professionals. The inspector was not asked to sign into the home. A requirement about guarding radiators had not been met. The manager reported that the owners had not responded to this because only one resident was at risk of burning himself or herself and they could not reach the radiator. We were not aware as to how this risk had been assessed or documented. The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 1 3 X 4 3 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 2 28 X 29 2 30 2 STAFFING Standard No Score 31 x 32 1 33 1 34 2 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 2 x LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 x 1 x x 1 2 The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 26 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 YA1 Regulation 4,5, Schedule 1 Requirement There must be a Statement of Purpose and Service Users Guide that includes all the required information and ensures that the residents are able to make an informed choice about where to live. There must be written evidence that a representative from the home has carried out an assessment on a prospective resident as part of the admission process. All of the residents must have a signed contract which sets out the terms and conditions of their tenancy. Care plans and care documentation must be accurate and clear in their guidance to staff on the care and support needed by all residents. This was not met from the last inspection although some work had been started. The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 27 Timescale for action 01/02/08 2 YA2 14 (1) 01/02/08 3 YA5 5(b) 01/02/08 4 YA6 15(1) 01/02/08 5 YA6 15(1) 6 YA7 16(2)(1) 7 YA9 13 (4)(b) 8 YA17 16(2)(h) Schedule 2 9 YA19 12 10 YA20 13(2) 11 YA23 13(6) 12 YA32 18(1) 13 YA33 18(1) 14 YA34 19 Care plans must be regularly reviewed and updated as care needs alter. Where possible the resident should be part of the review process. Staff must keep accurate records to show how residents have reached decisions to ensure that the support provided is in the residents best interest. Any risks that residents take should be assessed and it must be clearly documented how the risk is to be managed. A record of the diet taken by a resident must be kept and where a special diet is indicated this must be encouraged. Where a special diet is indicated this must be encouraged and any deviation recorded. The homes medication policy must be accurate. It must be possible to check what medication has been given. Staff must have access to a robust abuse policy that is followed by all staff involved in any incident. The must be evidence that the staff team have sufficient training and experience to care for the assessed needs of the residents. There must be sufficient staff on duty to provide the necessary care and support for the residents. All new employers must have all the information and documentation outlined in DS0000014881.V355496.R01.S.doc 01/02/08 01/01/08 01/02/08 01/01/08 01/01/08 01/02/08 01/01/08 01/02/08 01/01/08 01/01/08 The Beeches Version 5.2 Page 28 15 YA35 18(1) 16 YA36 18(2) 17 YA39 24 (1)(a)(b) 18 YA42 12,37 19. YA42 12(1)(a) & 23 schedule 2 of the National Minimum Standards, before starting work. The home must have a training plan that indicates the training completed and needed to be undertaken or revisited, by staff. All staff must have 5 paid days training in any year. All staff must be supervised at least six times a year by someone who is suitably qualified to do so. The home must have a robust quality assurance programme that is used to influence the annual business plan. All health and safety checks must be completed and recorded at the required intervals Radiator guards must be in place in all areas with exposed radiators to prevent the risk of burns. (Previous requirement timescale of 31/03/06,30/10/06,31/01/07 not met. If it is believed this is not necessary appropriate risk assessments must be in place. 01/02/08 01/04/08 01/04/08 01/04/08 01/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA12 Good Practice Recommendations There should be more evidence of the type of interest a resident has and how these are to be continued while DS0000014881.V355496.R01.S.doc Version 5.2 Page 29 The Beeches 2 3 4 YA24 YA29 YA37 living at the Beeches. The should be evidence that the layout of the home is suitable for the resident’s living at the Beeches Any adaptations fitted should be secure The manager should complete, as agreed following previous inspections, the RMA The Beeches DS0000014881.V355496.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Inspection Team Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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