CARE HOME ADULTS 18-65
The Berkeley 1 & 2 Elysium Terrace Kingsthorpe Road Northampton NN2 6EN Lead Inspector
Moira Mosley Unannounced 24 June 2005 @ 14.00
th 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 Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Berkeley Address 1 & 2 Elysium Terrace Kingsthorpe Road Northampton NN2 6EN 01604 722033 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) Mentaur Limited Vacant Care Home 14 Category(ies) of LD Learning Disability (14) registration, with number LD(E) Learning Disability - Over 65 (2) of places The Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To include up to 2 people over the age of 65 years 2. It is a condition of this registration that the home is authorised to care for the two current named Service Users who have Learning Difficulties and additional Mental Health needs, and one named Service user who has Sensory Impairment in addition to her Learning Difficulties. Date of last inspection 25th February 2005 Brief Description of the Service: The Berkeley, is situated in a residential area in Northampton within approximately 1.5 kilometres of the town centre and local facilities including a town park, and is on a regular bus route. The Berkeley is one of three homes in the locality owned by Mentaur. There is a Day centre locally, run by the organization, which service users have a choice of attending. The house is a large town house of three storeys and a basement, service users have single or shared rooms, on three of the four floors. The ground floor is made up of communal rooms including a lounge, dining roomand the staff office. The home has an accessible rear garden for the use of the service users. Access is via steps to the front entrance however level access is available to the rear of the property. The Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a statutory unannounced inspection; 2 hours were spent gathering information and planning for the inspection and 4.5 hours were spent in the home. The care of two service users was reviewed to include their care plans and other records. Eight service users were in the home. Due to their learning disability some were unable to comment on their care however a period of observation and discussion with five of the service users was undertaken along with discussions with three staff members to ascertain how care is provided. Service user questionnaires were returned to the Commission for Social Care Inspection from the thirteen service users. What the service does well: What has improved since the last inspection?
The process for the recruitment of staff has improved with new staff spoken to confirming they were subject to a robust procedure including criminal record bureau checks and references being sought prior to commencing employment, this was confirmed within staff files. In addition an induction process is in place to train and support the staff team. Care plans have been written for assessed needs and there was evidence of regular reviews in light of any changes identified. The Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.doc Version 1.40 Page 6 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 Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.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 Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.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) 1 The lack of availability of the statement of purpose and service user guide restricts the staff and service users knowing fully what service is to be provided. EVIDENCE: The statement of purpose and service user guide was not available in the home and the staff and service users spoken to were unaware of the contents. At the last inspection in February 2005 a recommendation was made for the statement of purpose to be updated. The Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.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 and 9 Care plans and risk assessments identify service user needs and appropriate action is planned. Service user rights are not being met due to the lack of documented evidence about restrictions made. EVIDENCE: Care plans have been written for assessed needs with some evidence of service user or their representative’s agreement. There was evidence of detailed plans indicating what action was required by staff to meet needs and a useful overview of the service user within a service user profile document. One of the service users who was able to communicate knew about his care plans and had spoken to staff about what they meant. One service user had restricted access to cigarettes; the care plan in place did not clearly identify the reason for this restriction nor was there any documented agreement in place. In discussion with staff and the service user it was evident this was based on an identified need and risk. The Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.doc Version 1.40 Page 10 Risk assessments were cross referenced to care plans and for one service user who has frequent aggressive outbursts the risk assessment and accompanying care plan was very well written and clearly identified a scale for response. The Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.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) 12, 13, 14 15 and 16. The provision of day placement, activities and community access meet the social needs of the service users, however the large number of new staff is impacting on service user holidays. EVIDENCE: The service users spoke about their daily activities, some attend the day service run by the organisation that own the home, some attend other day care facilities or access college. Service users were seen to be supported to access local shops and one was taken to town to purchase an electrical item he wanted. The service users spoken to spoke about a trip to Legoland planned for the following day and were looking forward to this. One service user spoke about the range of activities, which included trips to the pub, swimming and a monthly pottery group. The Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.doc Version 1.40 Page 12 One service user was disappointed that there were no holidays planned for this year, on discussion with staff this was confirmed due to the lack of experienced staff although a number of day trips have been planned. This is further discussed within the national minimum standard 32 about staffing. Two of the service users spoke about home visits and said their families were welcomed when visiting. Staff were observed to interact positively with the service users, they all were able to access all areas of the home and gardens and were able to prepare themselves drinks and snacks. Three of the service users have their own key to their bedroom as agreed by a risk assessment, although the suitability of locks is further discussed within national minimum standard 26. The Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.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 and 19. The healthcare needs of the younger service users are being met however the lack of documented intervention for the elderly service user identified is putting her healthcare at risk. EVIDENCE: The service users spoken to confirmed they receive support for personal care and were able to make choices in regard to their level of need. They said they were able to make choices for example when they went to bed and got up in the morning. The service user questionnaires all stated they felt well cared for and they are treated well by staff. Service users have access to healthcare services including the GP, optical and podiatry services with specialist input from psychiatric services as identified. One service user was identified as having some problems with eating and the staff spoken to felt it was related to a constipation problem. However there was no care plan for constipation and the food care plan did not identify at what point medical intervention would be sought in relation to weight loss. This service user had lost 8 pounds over a period of tw months. The Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.doc Version 1.40 Page 14 There was no risk assessment for nutrition or to assess the risk of pressure ulcers in light of her reduced mobility, weight loss and medical needs. This same service user was diabetic and there was no detailed care plan, in addition staff were undertaking urine tests for her with no instruction as to action needed depending on result. The Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.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) 23 There are the necessary systems on place to ensure service users are protected from abuse. EVIDENCE: Staff spoken to were clear about the procedures for raising any concerns about service user welfare. The incidents of aggression by some of the service users are fully documented and appropriately responded to, with the protection of vulnerable adults procedures implemented where required. The Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.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, 26 and 30 The inappropriate door locks and the wedging open of fire doors could be a health and safety risk. EVIDENCE: The home was clean and tidy and provided a range of communal space including a safe garden area for the use of the service users. The staff spoken to stated a weekly maintenance schedule was submitted to head office and a tracking system was in place to monitor action taken, although these records were unavailable at the time of the inspection. The last fire officer’s visit identified some work on fire records and fire doors and these have been actioned. A number of doors in the home were propped open with door wedges and furniture, which the service manager for the home stated was agreed by the fire officer. Service user bedrooms have locks fitted however as they have a key hole on each side there is a potential that if a service user locked the door and left the key in the lock, staff could not access them in an emergency. In addition there
The Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.doc Version 1.40 Page 17 is the possibility of service users being locked in their rooms, the service manager agreed to review these and for suitable locks to be sought. The laundry area has a domestic style washing machine and tumble dryer and incontinence management is via a contracted disposal system. Staff confirmed they have access to equipment needed including gloves and aprons. The Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.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) 32, 33, 34 and 35. The needs of the service users are not being fully met due to the lack of suitably qualified and experienced staff. EVIDENCE: The staff rotas showed sufficient staff on duty throughout the day and night to meet service user needs. There have been five new staff out of the team of 11 care workers in the home and the retention of staff impacts on the service provided, for example the restriction in holidays this year. A detailed staff training package is implemented from induction and the staff spoken to confirmed the range of training available. However some had not yet received NAPPI training (training in the safe management of aggression) and on some shifts there would be insufficient qualified staff to deal with an incident. At present there home does not have 50 of the staff qualified at NVQ (National Vocational Training) level 2 however training is due to commence for 4 staff members. The Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.doc Version 1.40 Page 19 The recruitment of staff includes a detailed process including CRB checks and references being taken prior to commencement of employment, the staff spoken to and the staff files showed evidence of this process. The Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.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) 38, 42 and 43. Service users have the opportunity to be involved in the running of the home. Documentation relating to health and safety issues must be available to ensure service users are not at risk. EVIDENCE: Service users spoken to confirmed there are regular service user meetings where they discuss what is happening in the home and are involved in some decision making. There is a also a meeting between delegated service users from all the homes owned by Mentaur with one of the directors to discuss wider company issues and share experiences between the homes. There was evidence of statutory training including fire, health and safety and food hygiene. Fire records showed evidence of regular maintenance and checks on equipment. Maintenance records for utilities were also available. There has been a recent problem with rats in the home due to building works to the rear of the property, staff confirmed that pest control have been involved although there was no documentary evidence available.
The Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.doc Version 1.40 Page 21 The insurance certificate was not available at the time of the inspection. Although there was a memo from head office stating cover is provided and the new certificate will be sent. The Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.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 2 x x x x Standard No 22 23
ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 2 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x 2 x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 x Standard No 31 32 33 34 35 36 Score x 2 3 3 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Berkeley Score 3 1 x x Standard No 37 38 39 40 41 42 43 Score x 3 x x x 2 2 C51 C08 S12706 The Berkeley V235247 Stage 4 240605.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. 2. Standard 1 7 Regulation 4, 5 17(1)(a), schedule 3(3)(q) 12(1)(a)( b)13(1)(b ) Requirement The statement of purpose and service user guide must be available in the home. Any restrictions on service users must be fully documented and agreed by the service user and/or their representative. The service user identified must have a full healthcare assessment and plans agreed to meet her health needs. To include nutrition, diabetes, constipation and pressure ulcer assessments. Documented agreement from the fire officer about the wedging of doors must be submitted to the CSCI. Appropriate door locks must be fitted to Service user bedrooms. Evidence of pest control action regarding the problem with rats must be submitted to the CSCI. A copy of the insurance certificate for the home must be submitted to the CSCI Timescale for action 30/7/05 30/7/05 3. 19 30/7/05 4. 24 23(4)(a)1 2(1)(a)13 (4)(c) 13(4)12(1 )(a) 13(3)13(4 ) 25(2)(e) 30/7/05 5. 6. 7. 26 42 43 30/8/05 30/7/05 30/7/05 The Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.doc Version 1.40 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 24 32 35 Good Practice Recommendations Maintenance records should be available in the home. 50 of the staff team shoould have NVQ at level 2 or above by the end of 2005. The retention of staff should be explored to ensure there are sufficient suitably qualfied and experienced staff available to meet service user needs. The Berkeley C51 C08 S12706 The Berkeley V235247 Stage 4 240605.doc Version 1.40 Page 25 Commission for Social Care Inspection 1st Floor, Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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