Inspection on 06/07/06 for The Beeches

This inspection was carried out on 6th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Beeches 26/02/10

The Beeches 19/10/07

The Beeches 28/02/06

The Beeches 27/04/05

The Beeches 21/12/04

The Beeches 19/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Beeches (The) Fairfield Bungalows Blandford Dorset DT11 7HX Lead Inspector Maxine Martin Unannounced Inspection 6th July 2006 10:10 Beeches (The) DS0000032198.V302305.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 Beeches (The) DS0000032198.V302305.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. Beeches (The) DS0000032198.V302305.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beeches (The) Address Fairfield Bungalows Blandford Dorset DT11 7HX 01258 453436 01258 451540 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) Dorset County Council Susan Joy Tuck Care Home 25 Category(ies) of Learning disability (25) registration, with number of places Beeches (The) DS0000032198.V302305.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. To accommodate up to a maximum of 6 service users in the category of LD (E) at any one time. 28th February 2006 3. Date of last inspection 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 home was purpose built in the 1970’s. Accommodation is arranged over two floors, with the lounges, dining room and domestic kitchen being on the ground floor. There is a large garden to the rear of the property. The home has good access to the local community and is within walking distance of the town centre. The Beeches has a bungalow attached to the main home that currently accommodates three service users. These 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. Service users attend local day centres during the weekdays or have day activities arranged by the home. A high level of personal care is provided by staff, with staff supporting residents with bathing, dressing and personal hygiene. Beeches (The) DS0000032198.V302305.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over nine hours by Maxine Martin. The site inspection included attending a staff meeting, a tour of the building, consultation with residents, staff and inspection of files/related documentation. During the inspection the manager, Mrs Susan Tuck, made herself available and facilitated the process. Mrs Tuck said that the pre-inspection questionnaires had only been received a few days prior to the inspection and they were in the process of distribution. This report will take into account any received during completion. A letter from a resident’s relative had been received and the positive contents will be included in this report. The service has just completed a Satisfaction Survey of residents and staff. The Research Section of Dorset County Council collates the results independently – these will be reflected in the report. (Twelve resident and the service pre-inspection questionnaires have been received) Twenty-five regulation 37 notices had been submitted relating to eight residents, the contents of which informed the choice of resident’s files and were discussed with the manager. Three regulation 26 reports had been completed, all of which recorded positive visits and where any issues identified were dealt with immediately. Current fees at the Beeches are in the region of £480 dependent on assessed needs. The term resident and service user are inter-changeable for the purpose of this report. What the service does well: Service users are supported in an environment where their needs and rights are respected. They are involved in decision-making and are enabled to make choices about their lives. Observed interaction between the staff and residents was caring and reflected good values and respect of individual rights. Residents are involved in a range of activities outside as well as in the home. Quotes from pre-inspection questionnaires included: “ I like the Beeches” “Beeches is a very nice home” Residents’ rooms reflect their choice and style, privacy is respected. Improvements are being made in the environment and there is a long-term plan to build a purpose built home. Beeches (The) DS0000032198.V302305.R01.S.doc Version 5.2 Page 6 Residents say about the Beeches: “ “ “ “ I am happy” The staff are always nice to me” They do listen to me” I like all the staff “ Residents are involved in quality assurance to enable the service to develop with the residents as the central focus. The manager, Mrs Sue Tuck, is supported by a committed management team, which are working hard to achieve positive change and maintain current good standards. During the inspection professional interaction between the management team was observed, which showed flexibility and a commitment to work together. Staff and management relationships appeared very positive, with an open culture where staff are encouraged to raise issues that affect care practice. Staff interviewed showed a high level of commitment to the home and there has been consistency in the staff team. Staff spoke of: ‘positive relationships’ and ‘positive place to work’. Organised systems are in place and separate managers are given specific responsibilities to ensure these are maintained and developed to support good practice. The service is actively planning towards the future building developments and consulting residents and staff to ensure all needs are identified and considered. What has improved since the last inspection? A requirement at the last inspection related to the medication policy and procedure. The home has now produced a detailed medications policy with clear procedural guidance and recording tools. The home has developed an ‘Emergency file’ to ensure if any cover staff have to be used they have all necessary information to hand. Management responsibilities have been changed round which promotes standard practice and the development of management skills. Additional hours have enabled increased opportunities for activities for residents. Activity records have been developed and are used to support choice. Building work is underway to adapt the downstairs bathroom and should be completed in the near future. Beeches (The) DS0000032198.V302305.R01.S.doc Version 5.2 Page 7 The Satisfaction Survey has been revised to ensure that as far as possible it is user friendly and enables as many residents and staff as possible to inform current care practice and service development. Mrs Tuck said there has been progress in the area of training, which they hope to build on. Mrs Tuck also stated that supervision and Personal Development Reviews have been undertaken more frequently. 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. Beeches (The) DS0000032198.V302305.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 Beeches (The) DS0000032198.V302305.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 This standard was not inspected as there have been no new admissions to the home since October 2005 – prior to the last inspection. EVIDENCE: However it is worth noting that out of the twelve pre-inspection questionnaires, eleven residents said they had received information regarding the home and had been involved in the choice. The previous inspection on 28th February 2006 recorded that the home has a pre-inspection procedure in place. Beeches (The) DS0000032198.V302305.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this area is good. The judgement made is using available evidence including a visit to the service. Residents are involved in their Personal Care Plans and Essential Life Plans. This means that they are supported to identify their needs and be involved in the care planning process. The staff demonstrate a commitment to enabling residents to make decisions. This means residents feel they are involved in planning which affect’s them and promotes their choice. A risk management process is in place in the home, which means residents’ choices are taken into account and safety promoted. EVIDENCE: In the feedback questionnaires, under the area of choice and decision-making, residents all answered positively to being enabled to make decisions and do what they want. One resident said; ‘ have discussions with care staff and I am able to choose’. In the Satisfaction Survey undertaken by the home, but independently collated by Dorset County Council Research Group, 86 of Beeches (The) DS0000032198.V302305.R01.S.doc Version 5.2 Page 11 responses received were positive about staff being there when needed, getting the right amount of help. Other questions about choice were positively responded to with higher percentage outcomes. During the inspection, in the team meeting (where 18 staff were present), agenda items reflected service user choice “their choice”. Staff were requested to ask residents about decisions that were being considered. Discussions also took place about individuals whose needs were creating health and safety concerns and how the service may best meet these changing needs. Four care files were sampled on the inspection, all had ‘Individual service Plans’ and ‘Help lists’ completed in pictorial format to support effective communication. Files also contained references to things like ‘what name an individual prefers’, choice of bedroom furniture. Two residents were happy to show the inspector their bedrooms, which reflected individuality and their choice. The care files had clearly divided sections, which ensured a holistic approach to care planning and were well organised. Sections included a range of health professionals and other related services. Risk assessments were seen which had been reviewed and had future dates on. The home is part of Dorset County Council provision therefore documentation around risk is of a standard format. Other documentation had been adapted with use of pictures to promote service user involvement. Daily logs were read and positive language noted detailing choice. In the team meeting discussion around Essential Life Plans included how best to support people to express and achieve their ambitions. In the quality development audit service users said: ‘ They do listen to me’. Beeches (The) DS0000032198.V302305.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this area is good. The judgement made is using available evidence including a visit to the service. An increase in hours and staff in post is enabling service users to take part in regular activities appropriate to their needs. This enables residents to have a range of interests and experiences. Activities are planned in line with individual choice and accessing local resources to promote integration. Service users are supported to maintain relationships to ensure their needs are fully addressed. Residents’ independence is promoted in the home by the staff working to involve residents in the decision-making and to take part in everyday activities, which recognises individual responsibility. The home has continued to develop increased choice in meals and cooking activities, so that food and drink is a positive experience for residents. Beeches (The) DS0000032198.V302305.R01.S.doc Version 5.2 Page 13 EVIDENCE: The increase in staff has facilitated the opportunity for residents to take part in a range of activities. Files viewed had individual activity sheets, which referenced; horse riding, picnics, shopping, park walks, boat trips, cinema and seaside. The sheets recorded discussions with the resident on their choice and the outcome of the activity, which will support future planning. Language used included ‘I asked….’ indicating choice and involvement in the planning. This was also borne out in feedback questionnaires where residents said ‘I go to church every Sunday’, ‘I am able to choose’. A letter received from a relative said that generally…. ‘her relative seemed happier than before and staff were less rushed and that the resident had been shopping for clothes, cooked her own snack lunch and been for walks more often’. The satisfaction survey completed asked a question relating to ‘getting bored’ the results were: 2 people said yes they sometimes get bored, 6 – sometimes, 6 they did not get bored. The results of this survey were only received on the day of the inspection and the services response to it is to follow – please ask the provider for further information. The home is situated within a residential area with access to a range of local facilities. Many residents attend a range of day activities close by as well as using other community resources. Family members and friends are welcome and the home has an open access policy but ensures safety through a locked front door and signing in book. The home has now purchased time at a caravan to offer residents an opportunity to go on holiday. One manager is taking the lead in organising this. This provides limited choice for residents who do not have any other alternatives for a holiday, however it is an improvement since the last inspection. Other options detailed in the previous inspection are still considered in line with residents’ personal plans and choices. One resident was quoted as saying in the satisfaction survey :’ I like it at the Beeches, I do like my holidays in Cornwall.’ There is a residents committee , which was taking place on the evening of the inspection. At the staff meeting matters were identified for further discussion at the residents meeting. In relation to a summer fete residents were being asked if they wanted to be involved in planning this event and activities taking place. In previous inspections reference had been made that residents should have more choice around eating. The downstairs kitchen continues to be used for residents to prepare meals or do baking. From the quality development survey 93 said they enjoyed the food and 79 said they choose what they eat. In relation to accessing snacks 86 said they could get them when they want. Beeches (The) DS0000032198.V302305.R01.S.doc Version 5.2 Page 14 The cook produces menus, which provide choice and allow for individual needs. These are also assessed by the County’s dietary advisor section to ensure they provide healthy balanced diets. On the day of the inspection the cook, with the responsible manager, were making required amendments. Observation saw residents making drinks independently and going to make meals in the small kitchen. Beeches (The) DS0000032198.V302305.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 Quality in this area is good. The judgement made is using available evidence including a visit to the service. Residents are supported in personal care in a way that respects their choices, values individual’s privacy and meets their needs. Caring staff, supported by detailed planning and record keeping, meet the physical and emotional care needs of residents, all of which creates a relaxed but positive care setting for the residents to live in. A new medication policy, supported by clear procedural guidance and practice enable proper management of medication to meet residents’ needs so that they are protected. Residents’ ageing needs are assessed; practice is informed to ensure all their needs could be met appropriately to promote their health. EVIDENCE: Files viewed had up to date care plans and reviews for residents. Files are divided to ensure information is easily accessible. Medical sections detailed a range of health professionals involved including; physiotherapists, specialists, Beeches (The) DS0000032198.V302305.R01.S.doc Version 5.2 Page 16 chiropody, opticians. Individuals have Individual Service Plans and the home is just in the process of implementing Essential Life Plans for residents. Files also contain activity record sheets, which detail planning between the key workers and individuals on a range of individualised activities. These also record if a planned activity has not happened and why. Positive language was used in the files, statements like ‘helps to promote independence’; risk assessments were in place with review dates established. The home uses the Dorset County Council standard format. Individual choice was indicated in the files and resident feedback has confirmed this. Health needs are identified and records of appointments kept. Increasingly needs relating to age are detailed in the files and where necessary training and information has been provided over specific areas i.e. Parkinson’s, Mobility, Dementia. The Regulation 37 reports detailed areas such as mobility and falls, risk assessments and action plans to address changing needs. Mrs Tuck said that they will continue as long as possible to meet individual need but are aware of there limitations as a service. They currently have a resident group where a high proportion have increasing age related needs. On one file there was evidence of a fluid chart being used, Mrs Tuck said this had been at the request of the GP. Files also contained birthday details of relatives and friends. Files had records of residents’ wishes in the sad event of death. During the inspection a senior health professional who has frequent contact with the home spoke to the inspector and said that the home is “very friendly and welcoming”. That they are able to deal with complex issues very professionally and that she can rely on the staff to follow through guidance to support residents health needs. She also stated that the file system in place is good and easy for them to record health issues on. A requirement at the last inspection related to the medication policy and procedure. The home has now produced a detailed medications policy with clear procedural guidance and recording tools. The managers have just changed round responsibilities and the manager now responsible for medications is consolidating the work to date. There was a particular issue regarding GPs not always sending through written confirmation of changes. Advice was given on the day and agreement that the Pharmacy Inspector from CSCI would contact to discuss. On the day the medicines cabinet was seen, MAR charts inspected and two residents medications checked as correct. Eyedrops in the fridge were stored appropriately and dated. The home uses a major company’s medication dispensary system and had recently been inspected by the company’s advisor. A record of this visit was available and the suggested actions were in the process of implementation. Beeches (The) DS0000032198.V302305.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this area is adequate. The judgement made is using available evidence including a visit to the service. Service users feel that they are involved in decisions and that they can talk to staff, so that they can make their needs known. The home has established policies/procedures and work practices in place to protect residents from abuse . EVIDENCE: Positive feedback was received from residents in relation to being listened to and their views acted on. In the staff meeting positive reference was made to residents’ views and one resident joined the staff meeting part way through. The service has undertaken a Satisfaction Survey last year, in response to which they develop an action plan. Observed practice reinforced residents’ choices. In the feedback questionnaires nearly everyone said they knew how to complain and would know who to go to if they were not happy. One resident’s file evidenced the use of an advocate. In the manager’s pre-inspection questionnaire, Mrs Tuck detailed two residents as having independent advocates and that all service users have access to Dorset Advocacy if required. The home produces a Quality Assurance Framework to improve standards for residents and staff. A copy of the 2005/6 was provided with the pre-inspection information. Beeches (The) DS0000032198.V302305.R01.S.doc Version 5.2 Page 18 No formal complaints have been received since the last inspection, the home has developed a ‘Grumbles log’, seen during the inspection. This was also mentioned by one of the residents in feedback ‘I tell staff use grumbles book’. Mrs Tuck then follows up the grumbles and documents the outcome. The abuse policy and guidelines were seen. Some staff have completed training, ongoing training to ensure staff are updated has been identified in the training development plan compiled by the manager. Observed practice was of an ‘open’ culture which works to prevent abuse happening. The only area of concern was of the rights of individuals or staff who may be ‘injured’ by another resident and what action is taken. The home has risk assessments in place as they have several residents who can present challenging and aggressive behaviour. In discussions with Mrs Tuck options are discussed with the ‘victim’, so reference is made to these discussions on the Regulation 37 form but not in sufficient detail. The option of making a referral under POVA as an allegation of abuse needs to be considered to ensure the rights of all parties are addressed and individuals protected from repeated incidents. Mrs Tuck showed a form that had previously been used in the home to facilitate this process and advised she would implement this immediately. Financial records were viewed and two residents’ petty cash floats checked against records and found to be correct. Five residents’ finances are managed by County Hall, two by families and the rest manage their own, which includes their own saving accounts. In the letter received from the relative there was mention of the resident purchasing clothing, equally on files notes were made of purchases by individuals. Beeches (The) DS0000032198.V302305.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this area is good. The judgement made is using available evidence including a visit to the service. Within the limitations of the buildings structure, the home provides a comfortable and homely care service to meet the diverse needs of residents. Standards within the home are generally maintained to a high level to ensure a safe environment for service users. EVIDENCE: The building has continued to be changed in an effort to meet the needs of the resident. However the service is clear that to achieve this in full requires a purpose built accommodation. In the staff meeting MrsTuck advised that the local authority have just given this consideration and they are currently back at the top of the list for this to happen. Mrs Tuck felt that this was still at least three years away. Ongoing improvements in furnishing and decoration are still needed, as confirmed in the regulation 26 reports, and remain under the recommendation section of this report. Beeches (The) DS0000032198.V302305.R01.S.doc Version 5.2 Page 20 In previous reports a requirement had been the modification of the downstairs bathroom, work was actually underway at the time of the inspection. As the work was in progress the requirement has been removed but the finished work will need to be viewed at the next inspection. The home still provides regular respite care and as identified previously the premises do not allow separate living for the permanent residents. This was a recommendation at the last inspection and will remain in. Fire records were inspected and found to be up to date, however discussions were held about the need to ensure all night staff have fire training for night evacuation. The home has actively responded to this and has confirmed in writing that they are dealing with the matter. Regulation 37’s had been submitted in relation to all notifiable incidents. One requirement has been made in relation to food labelling. This was being addressed at the staff meeting, but on inspection of one fridge two items of food were out of date. The manager dealt with this immediately and it was accepted that the staff team were working to ensure safe practice in reviewing current procedures. During the staff meeting one particular issue of concern was being discussed in relation to a door that adjoins the bungalow to the kitchen. One service user is currently getting in through this door even though attempts had been made to prevent this. At the staff meeting various options were being considered to eliminate the risk. The manager was seeking further advice and was going to review the risk assessment. A requirement has been made in relation to this matter. As part of the inspection a tour of the premises was undertaken and good hygiene standards were noted. Residents’ rooms viewed were clean and reflected the resident’s individuality. Staff receive training in related areas and thorough procedures are in place to promote infection control. Staff were observed using plastic gloves when necessary and following good practices. This was verified by the Regulation 26 reports completed by independent managers who confirmed good standards of hygiene on their inspections. They also confirmed the need for alternative accommodation in the long-term. Beeches (The) DS0000032198.V302305.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this area is good. The judgement made is using available evidence including a visit to the service. Residents feel cared for and supported by appropriate staff. The home continues to fall short of the 50 NVQ2 requirement, which they are striving to achieve. Requirements processes are in place, which comply with requirements and promote the safety of residents. Training continues to be provided to meet the diverse needs of residents and promote their welfare. Residents benefit from a committed and caring staff who value working in the establishment and are supported by appropriate supervision and support systems. EVIDENCE: Observed interaction and discussions with residents was of positive care practice. This was confirmed by the regulation 26 reports: ‘service users were very positive about the staff and the care and support they receive in the home’…. ‘staff observed being patient and caring with all residents’. Beeches (The) DS0000032198.V302305.R01.S.doc Version 5.2 Page 22 Staffing levels have increased as detailed in the last report; rotas, activity records and discussions with Mrs Tuck confirmed this. Staff files were viewed and where staff had been newly recruited POVA checks were in place as a minimum with supervised working pending CRB clearance. Risk assessments had been completed for new workers where there was only a POVA. Files contained induction checklists and Personal Development Plans. One file had a picture missing and this was being dealt with by one of the assistant managers. Staff files viewed had supervision records and completed Personal Development Profiles. Generally staff files reflected the organised documentation systems found within the home. Although the service has identified the training needs of staff and Dorset County Council is prioritising these, achieving the 50 level of staff completing NVQ2 has not been achieved yet. Increase in staff hours has meant this target has changed and the service is aware of this and is actively working to meet this requirement. In the staff meeting eighteen staff were present and encouraged to raise any issues that they needed to. Positive feedback was also given to staff in this meeting and training awards given out. Staff were encouraged to put any ideas for the future service onto a wish list. Staff were encouraged to get residents involved in future planning through the residents’ meeting. Several staff spoken to said ‘positive staff relationships’ ‘find it very good’. The positive staff interaction means that an effective and enthusiastic staff team supports residents. Staff training records reflected the core courses like induction, POVA, LDAF and NVQ2. Enhanced training is also undertaken by staff in courses like; Visual impairment, Communication and listening skills, Dementia and Mental Disorder. Staff stated there is always lots of training available. For reference - Training Web Links: www.Picbdp.co.uk www.Skillsforcare.org.uk www.traintogain.gov.uk www.Isc.gov.uk/bdp/employer/eggt_intro.htm Beeches (The) DS0000032198.V302305.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this area is good. The judgement made is using available evidence including a visit to the service. The management team are led positively and work together so that the home runs effectively to meet the needs of residents. Service users views are valued and encouraged in the home to support development and to ensure their rights are respected. Health and safety practices are generally good and are reviewed regularly to promote a safe care environment. EVIDENCE: Organised documentation and general systems support a committed management team to manage the home effectively. An emergency file has been put together to ensure any cover staff are fully aware of all the information to enable the safe running of the home. Management roles are Beeches (The) DS0000032198.V302305.R01.S.doc Version 5.2 Page 24 changed to ensure overall competency. Mrs Tuck has considerable experience and appropriate training to lead the home effectively. Generally the feedback in the Satisfaction Survey was positive with some areas for action by the management team. The inspector has requested the home write confirming the results of their investigation into one residents feedback over staff. Staff are encouraged to participate in planning and there is an open culture to raise any matters for discussion. This was evidenced in the staff meeting, through discussions with staff and in the Satisfaction Survey for Staff – communication with colleagues and residents was felt to be excellent or good. Feedback from residents, discussions and observed practice was of a positive care environment where residents are happy and feel well cared for. Residents’ needs and views are central to the running of the home and the staff continue to work hard to maintain and develop the service to meet and exceed required standards. The Satisfaction Survey had just been completed and it was positive to see that they had consulted with Dorset People First to develop the document to be more user friendly. This continues to be one of the routes through which residents are encouraged to actively be involved in the running and development of the home. Overall the service continues to provide a positive care environment for residents where improvements are considered regularly to ensure improvements in care practice, which reflects residents needs and rights. Beeches (The) DS0000032198.V302305.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 x 2 x 3 x 4 x 5 x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 x 4 x x 3 x Beeches (The) DS0000032198.V302305.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 YA23 Regulation 12 (a) Requirement Timescale for action 07/07/06 2. YA24 23 (2) (a) 3. YA24 13 4. YA32 18 The provider must ensure the rights and needs of any ‘victims’ of an incident are met. Decisions must be recorded and consideration given to the adult protection procedure. Consultation must be undertaken with all appropriate parties. Frequency of incidents must be risked assessed in relation to the balance of resident’s needs. The service must consult with 31/08/06 the necessary individuals and fire services in relation to the door joining the bungalow to the kitchen. Also the service needs to ensure all night staff are up to date with training in night time evacuation procedures. To ensure the safety of residents and staff. The service must ensure all food 31/07/06 stored is labelled appropriately with full dates and when to use by. The registered provider must 31/03/07 achieve the target of at least 50 of care staff achieving a NVQ 2 qualification in care. Beeches (The) DS0000032198.V302305.R01.S.doc Version 5.2 Page 27 (Previous timescale of 01/09/05 and 30/06/06 not met.) 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 YA19 Good Practice Recommendations Fluid charts should include details of equivalent fluid measures and average daily amounts. They should also have clear information on why required, when started and finished. Training and practice information should regularly be undertaken/provided in relation to residents increasing age related needs. It is recommended that consideration be given to redecorating some areas of the home and replacing items of worn furniture. It is recommended that the home’s short term care service be reviewed, as the communal areas cannot be separated from the living areas of the permanent residents. It is recommended that staff’s previous qualifications be recorded so the home can effectively plan towards the 50 target of qualified staff that they need to meet. 2. 3. YA19 YA24 4. YA28 5. YA32 Beeches (The) DS0000032198.V302305.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Poole Office 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. 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