Care Home: Beachfield

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What the care home does well People that live at Beachfield and staff that work there say that it is already a well run home having been open only a couple of months. There is an inclusive atmosphere, in which people are encouraged to live their lives to the full. They are well supported by staff that always work 1:1 or sometimes 2:1 with them. People say that they make decisions about what they want to do day to day and are helped to plan for the future. An example we saw was someone planning a trip to London to see a West End show. There is a good choice of appetising and well-balanced meals at Beachfield. People say that they are listened to and their choices are respected. The activities, events and work that people do are tailored to their likes and dislikes. People tell us, "I like going to see musicals" and "I go to dance class". Family and friends are made welcome. People can invite friends and family to stay if they want to, as there is a bedroom for visitors to use. There are policies and procedures that protect people, including dealing with complaints. People know how to make complaints and tell us that they can voice their concerns. They also feel that staff listens to them. Appropriate checks are done before staff are allowed to work with the people that live at the home. People tell us that all of the staff is kind. The manager encourages staff to do training. This means that they all keep up to date and understand how to care for people that live at the home. People tell us that they feel "safe". Staff also tell us this, which reassures us that health and safety is a priority. The home is clean, comfortable and well maintained. What has improved since the last inspection? This was the first inspection of Beachfield, which has just opened. What the care home could do better: We have made five recommendations that would improve the service people receive. The team had not written up an individual`s assessment until the second day of the inspection. People`s needs should be documented at the point of movinginto the home, so that the staff knows what they are and how to care for them. Some of the people that live in the home use a variety of methods to communicate such as makaton or have difficulty reading. People should have a copy of their care plan that is in a total communication format that they can understand. This would also ensure that they are asked about it. It was not easy to check what initials meant in medication records. A summary of signatures/initials for staff responsible for giving medication should be kept. This ensures that it is clear who has given a particular medicine to a person. Some people were unsure whether they had information about the complaint procedure. People should have a copy of this in a total communication format that they understand. None of the ensuite toilets had doors fitted. Therefore, if they had friends or family visiting them in their room they would not be able to use the toilet in private. Fitting doors to ensuite toilets should improve people`s privacy. CARE HOME ADULTS 18-65 Beachfield The Chantry 42 Nelson Road Westward Ho! Devon EX39 1LQ Lead Inspector Susan Taylor Unannounced Inspection 11 & 13th June 2008 10:00 th Beachfield DS0000070513.V362986.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 Beachfield DS0000070513.V362986.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. Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beachfield Address The Chantry 42 Nelson Road Westward Ho! Devon EX39 1LQ 01237 420777 01237 423623 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) Ark Care Homes Ltd Mr Bruce Ashley Martin Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is 6. Date of last inspection N/A Brief Description of the Service: Beachfield is registered to accommodate 6 residents who have a learning disability and are within the age range of 18 - 65 years. The home comprises of a three storey detached double fronted property situated in the seaside village of Westward Ho! The house is situated on the main street in the village. There is a level walk to the beach and other amenities in Westward Ho! The house has a pleasant private garden to the rear that is enclosed and secure. The home has it’s own transport for people living in the home, but they also use local transport services. The cost of care ranges from £1875 to £2237 per week depending on individual needs. Additional costs, not covered in the fees, include chiropody, hairdressing, and personal items such as toiletries and magazines. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk The inspection report is available upon request from the home. There is also an easy read format for prospective residents. Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is Two stars. This means the people who use this service experience Good quality outcomes. This was the first key inspection of Beachfield under the ‘Inspecting for better lives’ arrangements as a newly registered service. We were at the home with people for 10.5 hours over two days on 11th and 13th June 2008. The purpose for the inspection was to look at key standards covering: choice of home; individual needs and choices; lifestyle; personal and healthcare support; concerns, complaints and protection; environment; staffing and conduct and management of the home. We looked at records, policies and procedures in the office. A tour of the home took place. We tracked the care outcomes for two people. We also spoke to people alone in private, with their key workers and in groups about their experiences living at the home. We sent surveys to all of the people living in the home and received 2 back. The comments of people that did fill in the surveys are in the report. Information was also received from this service before the inspection, as asked for by the Commission for Social Care Inspection. This was in the form of an Annual Quality Assurance Assessment (referred to in the inspection report as an AQAA). The completed assessment provided us with important information that helped us to focus what we did. As at May 2008, the fees ranged between were £1875 and £2237 per week for personal care. Extra charges are made for chiropody, hairdressing, newspapers and magazines and toiletries and these vary. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk People living at Beachfield tell us that they “like it here” and feel “happy”. Staff we spoke to told us that they enjoy working at the home and that the provider is very “supportive” and offers them “plenty of opportunities to do training”. Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: We have made five recommendations that would improve the service people receive. The team had not written up an individual’s assessment until the second day of the inspection. People’s needs should be documented at the point of moving Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 7 into the home, so that the staff knows what they are and how to care for them. Some of the people that live in the home use a variety of methods to communicate such as makaton or have difficulty reading. People should have a copy of their care plan that is in a total communication format that they can understand. This would also ensure that they are asked about it. It was not easy to check what initials meant in medication records. A summary of signatures/initials for staff responsible for giving medication should be kept. This ensures that it is clear who has given a particular medicine to a person. Some people were unsure whether they had information about the complaint procedure. People should have a copy of this in a total communication format that they understand. None of the ensuite toilets had doors fitted. Therefore, if they had friends or family visiting them in their room they would not be able to use the toilet in private. Fitting doors to ensuite toilets should improve people’s privacy. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Beachfield DS0000070513.V362986.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 Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Quality in this outcome area is good People are supported to be fully involved in the assessment process. Information is gathered from a range of sources including other relevant professionals, and with the individuals agreement, carer’s interests are taken into account thus ensuring that people’s needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We read the document that is the statement of purpose, which briefly outlines the philosophy behind the service as being 100 of the people responding to our survey verified that they were given sufficient information enabling them to make a decision about whether to live at the home or not. Since opening at the end of April 2008, three out of five people living in the home had moved from either Acorn House or Acorn Manor owned by the same company. One person told us that they had specifically asked to move to Beachfield because they wanted a bigger room with more facilities. The manager told us that they had faciliated this for the person who now lives in a large room and has their own kitchenette and conservatory. Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 10 The provider and manager told us that people are assessed by themselves and that they go to visit the person in their current setting to do this. We looked at two care files. One out of the two files, had a thorough assessment of needs that had been completed with the person before and after they had moved into the home. Assessments established what risks there might be for an individual about their behaviours and mental health and highlighted triggers that might cause this. There was a clear strategy in place to minimise the risks for people. Additionally, information had also been obtained from social services about individuals, where appropriate. The second file for a person that had moved into the home 3 weeks previously only had limited information about the person that their relatives had provided. We asked the manager about this and was told that the assessment process was underway and these would be written over the course of the next few days. The manager did, however locate other information including a detailed letter that demonstrated that the individual was known to the organisation and staff having been supported previously at his family home. On day two of the inspection, we were shown this person’s file again. Like the other file, a detailed assessment had been written including risks and strategies for minimising these for the individual. We met all of the people living in the home over the course of two days. We observed them to be content, well cared for and valued as individuals. People we spoke to told us “I am happy here” and “I like going out and do this all the time”. We looked at contracts from the placing authorities for the two people whose needs we case tracked. The manager had sent a detailed written breakdown of costs to the placing authority, which was then easy to audit against outcomes for people living in the home. This demonstrates that the organisation is clear and transparent about what they propose to put in place in order to meet an individual’s care needs. We looked at duty rosters, from which we were able to establish that the people whose care we tracked had 1:1 and at particular times (as per contract) had 2:1 care from their key worker and other support staff. Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is good Care planning at Beachfield is person centred. This might be improved further by ensuring that the diverse needs of people are accounted for by using total communication formats. Financial systems protect the interests of people who need help to manage their money. The home manages to balance risks to promote the safety of people; whilst at the same time encourages people to be as independent as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at two care files on 11th June 2008. One out of the two files, had detailed care plans about their behaviours and mental health and highlighted triggers that might cause this with strategies for minimising this. The manager verified that care plans were in the process of being written for the second person. We looked at this person’s file again on 13th June 2008. Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 12 Detailed care plans had been written with input from the individual and their advocate. Plans of care gave clear details about individuals preferred routines and ways they should be supported, for example with learning and maintaining daily living skills. Where possible the plan had been drawn up with the individual and their advocate. In surveys people told us that they have a plan of care and they are aware of the content. We spoke to the individual’s concerned and they did not have a copy of the care plan in a total communication format. The manager verified that there are plans to do this. In a survey 100 of people responding verified that they make their own decisions about what they do during the day, during the evenings and at weekends. We observed this to be the case whilst we were at the home. All of the people living at the home have one to one and sometimes two to one care support from staff. This means that people get the support they need at all times and staff have the time to completely focus on the needs and wishes of that person. At the same time, we observed that people living in the home are treated as individuals and given respect by the staff looking after them. Two people’s financial records were examined. The provider and manager told us that fees are paid into ‘Ark Care Homes Ltd. – clients money account’ from which money is transferred into individual’s accounts. We were shown statements for this account. Both people had their own savings accounts and we were shown statements for these. Balance sheets had been completed and were audited and found to be in order. Two signatures were seen on balance sheets denoting withdrawals. Receipts for purchases tallied with entries seen in the records. The provider told us that a qualified accountant audits the accounts. Additionally, records demonstrated that transactions are regularly audited as part of the organisation’s quality assurance processes. The provider and manager told us that they do not expect people living in the home to pay for meals for staff whilst they are out. We were shown records demonstrating that a meal allowance is provided and how this is managed week by week. We saw receipts that tallied with the entries and in turn, corresponded with outings that people living in the home had gone out on. The home had policies or procedures about risk assessment and management. In practice comprehensive risk assessments had been completed and were detailed. For example, one person whose file we looked at had no safety awareness and has epileptic seizures. Each one clearly laid down ways to minimise identified risks and hazards, whilst at the same time encouraged the individual to be as independent as possible. We observed that staff followed the measures set out. People were kept safe; whilst at the same time had freedom to do what they wanted to do. Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is excellent The high staffing ratio means that people living at Beachfield lead full and meaningful lives. Meals are well balanced, varied and take account of individual preferences and choices. This judgement has been made using available evidence including a visit to this service. Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 14 EVIDENCE: Varying amounts of time was spent with the five people living in the home. In particular, we spoke at length to the two people whose needs were tracked. We also observed what they and the others living in the home did during the day to keep themselves occupied. In surveys 100 of people tell us that they can do what they want to during the day, evening and at weekends. Information that the provider sent us tells us that the home has it’s own 9seater minibus and a car. The number of staff on duty meant that people had 1:1 or sometimes 2:1 support at particular times of the day. This enabled them to do what they wanted to do during the day. One person said they had been to a dance class and then went on to a café for an ice cream. Their interests included musical theatre and they said they were going to Plymouth’s Theatre Royal the following week to see a show. We observed the person talking to their key worker about going to London and then choosing a West End show to book from a brochure. Their room was decorated with posters and memorabilia showing their interest in music and shows. Every person had an activity program. A wide range of local resources was used and people verified that these reflected their individual interest such as swimming, tap dancing or attending clubs like ‘Breakaway’. People were coming and going from the home all day having been involved in activities in the community. A member of staff and another person living in the home was watching a film that they had chosen and was clearly enjoying it. People made comments such as “I like going to skittles and ice-cream” and “I like my music”. Activity and behavioural programs for individual’s whose needs we tracked demonstrated that considerable support is being given to help them learn important skills like road safety, domestic chores and budgeting. We read assessments that demonstrated that risks had been assessed and were being managed around these tasks. Additionally, we observed this being put into practice with the individuals concerned over the course of the inspection. For example, we observed one person being prompted, by a member of staff, to look left and right before crossing the road in front of the home as they set out for a walk to get an ice cream. In records we saw that people have a lot of contact with friends and relatives. One person said that they sometimes stay with their family overnight. People said they “liked” the food. We observed lunch and evening meals being served over the course of two days. It was a relaxed atmosphere on both occasions. Staff preparing the meal said that they knew people’s likes and Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 15 dislikes because this information is written down in their care files. We observed individual preferences being catered for. The provider said that they have made provision in the budget so that every person has money set aside for staff to use to pay for their meals whilst out with them. The provider went on to say that they “do not like the concept of client’s having to pay” for staff meals whilst out. Other people stayed out at lunchtime and we saw records that demonstrated they had been to a café for a meal instead so that they could enjoy a full day out with the staff supporting them. Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good People are treated with dignity and respect. Beachfield has good systems for capturing medical information, which means that healthcare is individualised and takes account of people’s needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In a survey 100 of people felt that staff listened and responded to their needs. All of the people that were at home. From information that the manager sent us, the gender balance of people living at the home is well matched to that in the staff team. We observed staff to be respectful towards every person that we met. We looked at two care files. We examined incident reports between 1/6/08 and 9/6/08, highlighting episodes of aggression by two people living at the home. We asked whether the service used an ‘Antecedent, Behaviour and Consequence’ [ABC] assessment framework to establish underlying causes for Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 17 this behaviour. Staff told us that they felt that the incidents had occurred during the settling in period immediately after the individual’s had moved in. Admission dates seen in care files also concurred with this. We were told that the ‘ABC’ assessment framework was a tool that they used in the other homes owned by the same provider and would be used as standard at Beachfield. Additionally, the staff all verified that they had received training about the ‘Long bone holding technique’ that was a non-abusive measure that could be used but felt that this was “rarely needed”. The reports we saw were detailed and contained information about what had happened and the action staff had taken to diffuse difficult situations with a good outcome achieved. In all instances the person involved had quickly settled down and had been reassured by staff caring for them. One person told the inspector “I have regular checks at the doctor’s and the staff keep a close eye on me”. Similarly, daily records seen for the two people whose care we tracked demonstrated that they had visited the GP, dentist and optician since moving into the home. Medication Administration Record charts were in use and no gaps in the records were seen. We looked at the outcomes of care for two people, one of whom had epilepsy. Records demonstrated that medicines had been administered as prescribed and the individual concerned had not experienced an epileptic seizure since moving into Beachfield. The manager told us that they had developed a safe system for when people are out and medication is due. In such instances, we observed that the individual’s key worker had dispensed the medication. The procedure covering this stated that the key worker doing this was responsible for safekeeping and giving the medication to the person whilst out with them. The MAR sheet was not filled in until the individual and their key worker returned to the home. We did not see a summary of signatures/initials for staff giving out medication and the manager verified there was not one. The team had developed a medication profile for individuals that included an assessment of risks. This highlighted whether the individual would be able administer his or her own medication or not. This had been completed when the person moved into the home and had comprehensive medical and allergy information for staff to refer to. All medicines were seen to be stored in a new locked cupboard, which was securely affixed to the wall. Training records demonstrated that key staff involved in administering medication had received appropriate training. Additionally, the manager said that all new staff was supervised and their competency assessed before being able to administer medication on their own. Staff also verified this. Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good People living at Beachfield are protected and understand that they can voice their concerns, if they have any, safe in the knowledge that these will be dealt with. People have diverse communication needs and this need to be addressed by ensuring that procedures, such as complaints, are in a format they can understand. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 50 of people responding in a survey verified that they knew how to complain and who to speak to if they were unhappy. One person told us that they would tell a carer or XXX [the manager] if they were unhappy. We read the procedure and asked if there is a version in ‘total communication’ format. The manager told us that this still needed to be done. No complaints had been received since the home opened. 100 of people responding in a survey felt that the staff always treated them well and listened to them. The home had a written policy and procedure for dealing with suspected allegations of abuse. We spent sometime observing interactions between staff and people living at Beachfield. Staff engaged with people continuously at the right speed and demonstrated genuine warmth and attention, which people appeared to respond to and enjoy. Training records demonstrated that all of the staff had attended a course covering the Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 19 protection of vulnerable adults. Two staff that the inspector spoke to individually during the inspection also verified this. Staff had a clear understanding of the whistle blowing and safeguarding procedures within the home. The care records for one person demonstrated that a behaviour plan had been agreed between the home in collaboration with healthcare professionals and the individual themselves. Positive reinforcement was being used, and we observed staff encouraging them to talk about their feelings rather than becoming angry and frustrated. Information sent to us by the provider told us that staff is trained in nonabusive techniques to diffuse potential aggression. Additionally, no Pova referrals or safeguarding referrals have been made since the home opened Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 & 30 Quality in this outcome area is good People live in a comfortable, well-maintained home that is clean. Ensuite facilities do not provide sufficient privacy for people using them and needs to be addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information sent to us prior to the inspection told us that the building has undergone considerable refurbishment, including a new roof and kitchen. New windows had been fitted and have restrictors in place. Radiators had been covered where a risk assessment had indicated that they needed to be done. The home has a guest bedroom for the use of anyone visiting, good staff facilities and a bathroom, which people can use if they do not wish to have a shower. Staff told us that hot water is regulated so that it does not exceed 43 °C apart from hot water in the kitchen for washing up purposes. Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 21 People showed us their bedrooms, which reflected their individual tastes. One person said that they liked ‘ABBA’ and their room was full of memorabilia reflecting this interest. Another person liked listening to music and hifi, DVDs and had this and other electrical equipment in their room. One person’s comments demonstrated their level of involvement in choosing new furniture for their room in that they liked their ‘new bed’. None of the ensuite facilities had a door fitted. Whilst these facilities are within single bedrooms, there should be a door that people can close for privacy, in particular when they invite visitors into their room. The home was clean and very well maintained. 100 of people responding in a survey verified that their home was kept clean and fresh. Information that the provider sent to us verified that an audit using the department of health guidance had been carried out. Staff verified that they had attended training covering infection control management as part of the induction course. The laundry was clean. Safe systems were observed being followed with regard to separation of bed linen and clothing to maintain good infection control, whilst at the same time did not detract from some people being supported to participate in the process of doing their washing. Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good A team of highly skilled and experienced staff cares for people at Beachfield. Recruitment procedures are followed and ensure that staff that have been properly vetted ensuring that people are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff told us that they “enjoy working at Beachfield”. The duty roster for the week of the inspection was examined and accurately recorded the names of staff, and duties that had been worked. As discussed under previous sections, the number of staff on duty means that people always had 1:1 and sometimes 2:1 support at particular times of the day. This enabled them to do what they wanted to do during the day and during the evening. We observed that staff were attentive and supported people in an unhurried way that was totally person centred. Their comments also highlighted the philosophy as being about “everybody’s still an individual”. Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 23 Four personnel records were examined. Pre-employment checks had been done and the organisation had obtained satisfactory references including CRB and POVA entries. One new member of staff told us they were on ‘probation’ and felt well supported. All of the staff that we met verified that they had an individual portfolio and that their training needs are discussed through the supervision process. Staff said that the management team are “very approachable”. Additionally, they said that they feel “valued and respected” and that an ‘open door’ approach to management exists. An example of why people feel respected is that the home operates a self-directed rostering system that is consistent with work life balance principles. This means that staff know what care needs people have that live in the home and at the same time have the flexibility to plan their own time outside of work. Individual records demonstrated that training is ongoing and linked to the specific needs of people living in the home. For example, epilepsy awareness. All of the staff verified that the organization provides funding and time to receive training. Most recent training that staff had undertaken included fire awareness, safe handling of medicines and NAPPI. Advanced NAPPI training had been booked for August 2008. In discussion with staff and the manager, one of the people living at the home used ‘makaton’ to communicate with. The manager recognized that sufficient training had not been done on makaton and there are plans for staff to do this. All of the staff we spoke to hold the NVQ in care at levels 2 or 3. Additionally, one of the staff was a qualified nurse – RMNH. Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good The registered manager is experienced and qualified to run the home and does so effectively for the people who live there. Quality assurance systems are evident and ensure that people’s views are respected in this home. Health and safety is paramount and is effectively managed, which ensures that the people living there are safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager is experienced and has set up two other similar services owned by Ark Care Homes Ltd. He holds the Registered Managers Award but does not hold the NVQ Level 4 in Care. We saw the certificate for Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 25 this recently during the registration process. The manager and provider told us that they considered this to be a temporary arrangement and in the long term would be recruiting a manager for the service to take over from Bruce Martin. In discussion with the manager, he told us that he used the Internet extensively, in particular the Commission’s professional website, to keep up to date thus ensuring that the care delivered is best practice. Throughout the inspection we found him to be competent at his role and he demonstrated this by having an excellent overview of all the areas of the home to meet its aims and objectives. We observed that there are clear lines of accountability within the home. The Commission asked for, and promptly received, the AQAA (Annual Quality Assurance Assessment) document. The information provided was detailed and enabled us to know what to focus on during the inspection. Additionally, it was clear that the manager and provider fully embrace quality assurance and put the people living in the home at the centre of everything they do. At the same time, they were open about what they could do better and able to demonstrate continous improvement in various areas throughout the course of the inspection. Information sent to us by the provider told us that monthly audit; consultation with commissioners, and the people that live at the home and staff takes place. Similarly, there is an annual development plan. The atmosphere in the home is inclusive. Minutes of meetings held with people that live demonstrated that they are consulted about all aspects of their life there and that their views are listened to. 100 of people responding in a survey verified that the staff listened to them. Other communication systems were in place, which included regular staff handovers and meetings; minutes of the first meeting since the home opened were seen and contained positive reassuring messages for the staff team. A number of gaps in relation to policies and procedures were seen in the information sent to us: moving and handling; first aid; communicable diseases and infection control; aggression towards staff and dealing with violence and aggression. However, there were policies covering these issues at the home. Information that the provider sent us verified that internal audits of health and safety are carried out. We saw records that demonstrated this is regularly done. Maintenance of electrical systems, PAT, fire detection equipment, heating system and appliances had all been done in the last 12 months before the home opened. Additionally, an external risk management consultant had been employed to highlight areas needing improvement and an action plan had been produced and was being followed. Staff told us that health and safety is well managed. Additionally people living at Beachfield told us they feel “safe”. Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 26 Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 27 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 3 2 3 3 3 4 4 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 2 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 4 13 4 14 x 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 x 3 x 3 x 3 x x 3 x Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NA 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. 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. 2. 3. 4. 5. Refer to Standard YA2 YA6 YA20 YA22 YA27 Good Practice Recommendations People’s needs should be documented at the point of moving into the home, so that the staff know what they are and how to care for them. People should have a copy of their care plan that is in a total communication format that they understand. A summary of signatures/initials for staff repsonsible for giving medication should be kept so that it is clearly known who has given a particular medicine to a person. People should have a copy of the complaint procedure in a total communication format that they understand. The dignity of people using their own ensuite should be improved further by fitting doors. Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beachfield DS0000070513.V362986.R01.S.doc Version 5.2 Page 30 - 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. 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