CARE HOME ADULTS 18-65
The Beeches 7 Crescent Rise Luton Bedfordshire LU2 0AT Lead Inspector
Carol Mitchell Unannounced 04 September 2005 10:00 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 I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Beeches Address 7 Cresecent Rise Luton Bedforshire LU2 0AT 01582 425792 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) jonathan1971@91lineone.net Mr G Plane and Miss D Newman Mr J Plane Care Home Only 12 Category(ies) of Mental Disoder (MD) 12 registration, with number of places The Beeches I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12/03/05 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 stations. The shopping centre and other amenities in the town centre are also within walking distance of the home. The Beeches I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 4.25 hours on 4th September 2005. Three residents were spoken to at some length, and their records were checked. The inspector looked around some parts of the building, and also spoke to a visitor, and four members of staff including the deputy manager. Three staff files were checked. The inspector is very grateful to everyone who helped with the inspection. What the service does well:
The staff are friendly and make sure that people living at the home get the right care. A resident said, “The staff are very good, and work very hard”. Another commented, “You can choose what you do, there is plenty of freedom”. People living at the home are listened to, and can be involved in the running of the home if they wish. A resident said, “We have resident meetings.” Relatives are encouraged to visit when they like. A resident said, “My nephew comes any time, we go to my room, or use the coffee room.” A visitor confirmed that she is made welcome, and said, “The staff are really nice, and it’s a hard job.” The staff at the home like working there, and they know what to do if someone living at the home becomes ill and needs extra help. The staff are trained and supported well by the managers. The staff know how to handle medicines, and how to support people who take their own medicine. The manager keeps a close check to make sure that staff are dealing with the medicines correctly. Any new staff are checked out properly, to try to make sure they are right for the job. New staff are given special training and lots of useful information to help them settle in, and learn how to support the residents. The Beeches I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Beeches I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 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 I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 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, 5 The needs of people living at the home are assessed, and staff at the home are knowledgeable. Therefore people living at the home can be confident that they are being looked after in the right place. EVIDENCE: No residents have been admitted to the home during the last few weeks or months. The most recently admitted resident has been living at the home for two years. Residents spoken to said that they are supported to do what they want and need to do, and assessments had been done. Different levels of care and support are in place according to individual and sometimes challenging need. The staff are knowledgeable, and familiar with the residents needs. Since the last inspection, work has been done and is continuing, to improve the content of contracts for residents. The Beeches I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 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, 7, 8, 9 People living in the home can be confident that their personal needs will be met because care planning is in place, residents are involved in the running of the home if they wish to be, and their views are respected by a staff group who care about them. EVIDENCE: Each resident has an assigned key worker to provide continuity of care, and attention to individual needs. Key workers complete and review care plans, which were in place for the three residents checked. Details of assessed needs and risks had been recorded and were being reviewed at the time of inspection. The care required for specific behaviours was included. A daily record of events is maintained. All entries within the care records should be timed. Smoking in bedrooms needs to be risk assessed for any resident doing this, and the Deputy Manager said that written assessments would be done. Residents have opportunity to have input into care planning at any time, and formally at the time of six monthly reviews, when family members can contribute if the resident wishes.
The Beeches I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 Page 10 Staff hand over to each other at the beginning and end of shifts. Residents spoken to said that they have freedom and control over their lives, and spontaneously gave examples such as when they retire to bed, and how they spend their time. One resident said that he wanted to start helping with the cooking again, and was advised by staff that he will be supported to do this. Residents are respected and taken seriously by staff. Residents are able to speak freely, and confidently express their opinions regarding aspects of life in the home on a day to day basis, and during meetings. The Beeches I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 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, 13,15,16,17 People living at the home can be sure that they will be encouraged to develop personally because they have choice and are respected, and suitable opportunities for them are available. EVIDENCE: Residents referred to two local organisations providing places to meet, and in one case opportunities for personal development. Residents listed activities there such as computer skills, maths, English, cooking, art, bingo, and other games. One resident talked warmly about his involvement in the community through the local church, and how this has increased his circle of friends. Residents said that their family members can visit when they wish, and they also enjoy trips home when possible, and like visiting their friends. The mother of one resident was present during the inspection, and she confirmed that she is able to visit the home as and when she wishes, or is able. The Beeches I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 Page 12 Residents said that they are sometimes taken out to lunch, or to the cinema, and that they choose what they want to do. One resident said that he listens to music a lot. Staff encourage residents to take responsibility in their day to day lives. For example, one resident explained that he tries to keep his room clean, and residents are supported by staff to do their washing. There is a four weekly rotating menu, and flexibility within this to cater for individual requirements. The staff on duty said that they do the cooking as part of their duties without problem, and that they have received food hygiene training. Residents give feedback about the meals provided when they wish, and also by filling in questionnaires from time to time. Alterations are made to the menu in response to any feedback received. Staff try hard to meet the changing wishes of residents, and also have to keep in mind the need for healthy eating. Therefore, staff and residents may find advice from a dietician helpful. Food is available at all times, although the kitchen is locked at night for safety reasons. The Beeches I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 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, 20 People living at the home can be confident they will be looked after correctly, because their needs are met by caring and knowledgeable staff who obtain the right advice when they need to, and who know how to manage residents’ medication. EVIDENCE: Residents and a visitor spoke highly of the staff, and said that they are pleased with the way residents are looked after. Staff are sensitive to the needs of residents, some of whom may at times have challenging behaviour, and are patient and knowledgeable in their dealings with residents. Staff were able to discuss the detailed needs of specific residents, and were very aware of their emotional and physical needs. The staff have strong relationships with healthcare professionals such as the Community Psychiatric Nurse and Psychiatrist, and know when to call for help or advice. All residents have a family doctor, and a resident was awaiting a dental care appointment at the time of inspection. One resident explained that he has control over some of his medication, and staff detailed the monitoring systems in place. Staff also described safe
The Beeches I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 Page 14 systems for the administration of other medicines. Staff administering medicines attend a training course. Two members of experienced staff are awaiting this training, dates for which were being arranged at the time of inspection. Medicines and medicine sheets were stored safely. Staff working at the home receive infection control training. The Beeches I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 Page 15 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) 22,23 People living at the home are able to complain, and staff are being trained about abuse, so that residents can be sure they will be protected from harm. EVIDENCE: Residents said that their views are listened to, taken seriously, and acted on when appropriate. Residents said that they would speak to staff, and were able to give names of senior staff, if they wished to raise a concern, or make a complaint. Residents felt that they would be supported if they made a complaint, and staff described how they, or someone from an advocacy service used by the home, would help the resident. No recent written complaints have been received. The manager and deputy manager have received Protection of Vulnerable Adults training, and are in the process of training all staff within the home. Written policies for staff were in place including one for the prevention of abuse. The Beeches I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 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, 28, 30 People living in the home have enough space for their needs, and they are given privacy and their safety needs are considered. Cleaners are employed, and efforts are made to keep the home as clean as possible. Therefore residents live in as homely an environment as possible. EVIDENCE: Residents spoken to were happy with their rooms, and the communal areas. Residents hold keys to their rooms and keep their rooms locked if they wish. The kitchen is kept locked at night to ensure residents’ safety. One bedroom seen was kept very tidily by the occupant, and another was not so tidy, in line with the resident’s wishes. Residents have books and other belongings in their bedrooms. There were televisions with no mains aerial connection in the bedrooms seen. In one bedroom some maintenance was needed. The surround of the vanity unit and a drawer handle needed replacement, and the soap holder was not
The Beeches I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 Page 17 securely attached to the wall. These jobs were to be attended to on the Wednesday following inspection. Some of the carpets throughout the home were badly stained despite regular cleaning. There was particularly bad staining in one lounge and one bedroom seen. Carpet cleaning was due again during the week following inspection, and the lounge carpet had been replaced in recent months. Consideration should therefore be given to the type of floor covering used in the lounge, and whether there may be a more suitable alternative in the long term. Despite recent replacement and regular cleaning, the settee and other seating in the lounge seen were visibly dirty. Therefore it is suggested that alternatives such as the use of furniture with removable, machine washable covers should be considered for use in communal areas. Cleaning staff are employed on a daily basis, including weekends. Residents are also encouraged to take some responsibility for cleaning their rooms. On the day of inspection a resident had volunteered to scrub the path to the side of the house. The Beeches I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 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) 31, 32, 33, 34, 35, 36 Staff are given training, support, and supervision, and this in turn means that people living in the home are well supported by an effective staff team. EVIDENCE: The staff spoken knew the residents and were able to talk about their needs and overall safety in detail. Staff receive training in general areas such as food handling and manual handling, and more specialist areas such as mental health needs training, and personal safety. Staff are supported to undertake National Vocational Qualification training. Staff enjoy the work and there is a steady staff group. Staff members have a relaxed and confident rapport with residents who trust them. Staff meetings are held, and staff feel supported and prepared for their role. There is an on call system so that advice or help can be obtained if necessary, and induction training for new staff is properly organised and comprehensive. Formal appraisal and supervision systems are in place, and supervisors have received training. The Beeches I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 Page 19 Robust recruitment procedures are in place, and appropriate checks are made of criminal records and the protection of vulnerable adults list. Interviews are held, and members of staff are given job descriptions and contracts. Staff files are maintained in an organised way and to a high standard. Files are stored securely. The Beeches I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 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) 37, 38, 39 The home is run in an open way by managers who care about the residents. Therefore people living at the home will benefit. EVIDENCE: The manager and deputy manager are currently undertaking relevant management training, and both are experienced. The management style is open, and residents and staff are listened to, and encouraged to contribute to the running of the home. Training and support of staff are given high priority, staffing levels are kept under review, and a robust on call system is provided. The manager audits medicine sheets every week, and other quality monitoring tools include questionnaires for residents and relatives. Policies are kept under review, and some were being worked on at the time of inspection.
The Beeches I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 Page 21 The training staff receive includes fire training, and the deputy manager said that efforts are to be made to arrange fire training from a Fire Officer for residents. The Beeches I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 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. 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 3 x x 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 3 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 x x 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Beeches Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x x x I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 Page 23 no 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 Regulation Requirement Timescale for action 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 24 Good Practice Recommendations Alternative floor coverings and furniture/furniture coverings could be considered for use, especially in communal areas. The Beeches I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Bedford Office Clifton House 4A Goldington Road Bedford, MK40 3NF 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 I51 14881 The Beeches 213115 040905 Stage 4.doc Version 1.40 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
