Care Home: Bedford Road, 153

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What the care home does well People at Bedford Road live in a homely, clean and spacious environment. They can make choices about their own lives, with the support of family and staff and take part in a range of activities, both in Autism Initiatives own facilities and in the wider community. They are supported by a full staff team that is committed to providing a good service. What has improved since the last inspection? The level and consistency of staffing has been improved, so residents can take part in the activities they choose and will be able to go on holiday again next year. Regular management visits are taking place. Care plans have been updated and there was evidence that they are being properly implemented and monitored. Staff receive training and most have the appropriate qualification for support/care workers. What the care home could do better: Some elements of administration and recording could be improved. Complaints and safeguarding issues need to be recorded in more detail. Individual risk assessments need to be readily available on the individual`s file. Repairs and maintenance should be seen to promptly. An application to register a manager should be submitted as soon as an appointment is made. CARE HOME ADULTS 18-65 Bedford Road, 153 153 Bedford Road Bootle Liverpool Merseyside L20 2DR Lead Inspector Peter Cresswell Unannounced Inspection 15th December 2008 11:00 Bedford Road, 153 DS0000005236.V373479.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 Bedford Road, 153 DS0000005236.V373479.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. Bedford Road, 153 DS0000005236.V373479.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bedford Road, 153 Address 153 Bedford Road Bootle Liverpool Merseyside L20 2DR 0151 933 5397 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) bedford153@autisminitiatives.org www.peterhouseschool.org Autism Initiatives Manager post vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Bedford Road, 153 DS0000005236.V373479.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 3 LD Date of last inspection 30th January 2008 Brief Description of the Service: 153 Bedford Road is a four bedroom terraced house in a residential area of Bootle, close to community facilities and public transport to the centre of Bootle and Liverpool. It is home to three men who have learning disabilities and have lived there for many years. Bedford Road is owned by Autism Initiatives, a not for profit organisation that provides support for people with autism. The agency aims to promote the independence of the people for whom they provide support, both at home and in the community. Fees are negotiated on an individual basis with the authorities who fund the residents. Bedford Road, 153 DS0000005236.V373479.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 2 star. This means the people who use this service experience good quality outcomes. This inspection included a visit to the home. We did not tell anyone at the home that we were going to visit. We talked to the acting manager and the other member of staff on duty at the time as well as to two of the people who live there. We looked at records, including case files, care plans, safety records and information about staff. Some staff records are kept at the owner’s headquarters. The previous manager completed an Annual Quality Assurance Assessment (AQAA) for the Commission before the inspection. The AQAA provides us with information about the home as well as the provider’s own assessment of how the home is performing. The manager had left to take up a new job with Autism Initiatives shortly before the inspection and the inspection was dealt with by the acting manager. What the service does well: What has improved since the last inspection? The level and consistency of staffing has been improved, so residents can take part in the activities they choose and will be able to go on holiday again next year. Regular management visits are taking place. Care plans have been updated and there was evidence that they are being properly implemented and monitored. Staff receive training and most have the appropriate qualification for support/care workers. Bedford Road, 153 DS0000005236.V373479.R01.S.doc Version 5.2 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 summary of this inspection report can be made available in other formats on request. Bedford Road, 153 DS0000005236.V373479.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Bedford Road, 153 DS0000005236.V373479.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5. Quality in this outcome area is good. Appropriate information is available in the event of a new admission ever being considered. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The same people have lived at Bedford Road for many years so the question of how a new resident would be dealt with is largely academic for now. The owners, Autism Initiatives, have polices and procedures on how to deal with new admissions, including a full assessment of their needs and trial visits. Bedford Road, 153 DS0000005236.V373479.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10. Quality in this outcome area is good. People’s needs are identified and met. People who live in the home are supported in taking part in appropriate activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked in detail at the care plans for one of the people who live at Bedford Road. It included detailed daily write ups that were linked to the care plan. This system has started since the last time we inspected the service and makes it easier to assess how the care plan is being met. The care plan had been updated in June 2008 and plans are evaluated by the key worker every month. The acting manager said that major reviews are held each year, with all relevant people, including relatives, invited. The care plan included elements which are specific to the individual concerned, such as ‘Understanding future events’. There was a detailed pen picture and a schedule of daily activities, The acting manager told us that everything identified in the care plan was now being carried out as staffing has improved since the last time we inspected the home. This was also supported by evidence from the daily reports. Bedford Road, 153 DS0000005236.V373479.R01.S.doc Version 5.2 Page 10 There were risk assessments in place for this resident but we looked at the file for another resident and there were very few risk assessments, though this person is plainly at risk in various ways. Staff and the manager were well aware of the risks and how to manage them but it is important that the formal risk assessments are in place and available for reference. The acting manager said that the assessments had been completed but for some reason were missing. The people who live in the home are fully involved to the best of their ability in discussions about what goes on in the house. Information on the residents is securely stored in the office, which is kept locked. Bedford Road, 153 DS0000005236.V373479.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is good. People are supported in taking part in activities that they enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The activities and routines for the people who live in the home are mainly centred around Autism Initiatives own various day facilities, including a garden centre. This includes a work placement where one resident helps with office work (mainly photocopying) at headquarters, which he told us he enjoyed. Families are encouraged to become involved in the home and some of the people in the home go to their families’ homes regularly. Relatives visit the home regularly and are made welcome. The acting manager said that the home has good relations with neighbours and local residents. The home has been there for 17 years and most of the residents have lived there for all that time. They are now a well established part of the local community. In previous years people had gone on holiday and one of them told us about a holiday in Wales that he had greatly enjoyed. However, this year, because of staffing issues no holiday had been possible, though staff had taken people on ‘days out’. Bedford Road, 153 DS0000005236.V373479.R01.S.doc Version 5.2 Page 12 The acting manager assured us that next summer the residents would be able to go on holiday again as the staffing issues had been resolved. The residents jointly lease a car, using their benefits, and pay diesel and other costs as required. The acting manager said that this arrangement has worked well and they use the vehicle more or less equally. When we arrived one of the residents was helping to provide the evening meal, which he had chosen himself. He also decided what to have for lunch, with gentle guidance from the member of staff on duty to ensure he had a healthy diet. Staff said that a healthy diet is provided to make sure that none of the residents have to go on special weight reducing diets. On the morning when we called one of the residents had been to the shops with the member of staff to do some of the food shopping. Bedford Road, 153 DS0000005236.V373479.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is good. People’s health and personal care needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Arrangements for personal support are set out in the care plans and are based on the needs of the individuals and their own preferences. The plans deal with people’s emotional needs as well as physical ones. There was a minor emergency involving one of the residents whilst we were there and it was dealt with efficiently and effectively by the staff. There is also detailed information about the residents’ health care needs. One person had gone to hospital that morning with a member of staff for a specialist appointment. Medication is stored safely in a locked cupboard and was accurately recorded. However, a controlled drug is used and should be kept in an approved controlled drugs cabinet. It is always administered by two members of staff, both of whom sign the register. The controlled drugs register should be in a hard backed book. The controlled drug required a particular method of administration and staff had been trained in this. Where any medication is to be taken ‘as required’ (PRN) details of the circumstances in which it is to be given should be on the individual’s file. None of the people living at the home look after their own medicine. Bedford Road, 153 DS0000005236.V373479.R01.S.doc Version 5.2 Page 14 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 are protected by the home’s procedures for responding to concerns and complaints. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The owners have a complaints procedure and one (relatively minor) complaint had been received since the last inspection. The outcome was not well recorded, though the acting maanger told us it had been dealt with satisfactorily. One incident that had been reported to the Commission was not adequately recorded, though, again, it had been satisfactorily resolved. It is essential that incidents are fully recorded, both for future reference and in case there are further developments concerning incidents of the same nature. Bedford Road, 153 DS0000005236.V373479.R01.S.doc Version 5.2 Page 15 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, 25, 26, 27, 28, 29, 30. Quality in this outcome area is good. Bedford Road is a clean and comfortable environment for people to live in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This home is a four bedroom terrace house in a residential area of Bootle. It is close to bus routes, with the centre of Bootle being quite close. Liverpool city centre is further away but is also within easy reach by train or bus. In the immediate area there is a range of shops, pubs, cafes and other community facilities. The house is spacious and has a back yard that is used for barbecues in the summer. We looked at all parts of the home and it was clean and well decorated. Individuals’ bedrooms were personalised and decorated according to their tastes. The kitchen is spacious and there are two living rooms, one of which is mainly used as a dining room. The bath/shower room needed some minor maintenance - the vinyl floor covering needed repairing and tiling replaced. These repairs had been reported to the owners and should be acted on promptly. Bedford Road, 153 DS0000005236.V373479.R01.S.doc Version 5.2 Page 16 The house was ready for Christmas, with a tree in the front room. One of the residents told us that he had helped to decorate it. Two of the residents were going to be in the house for Christmas and a turkey dinner was planned. Bedford Road, 153 DS0000005236.V373479.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is good. The people living at Bedford Road are adequately supported by staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is normally staffed by two care workers. The acting manager and the other member of staff on duty told us that staffing is always kept at least at this level and that any staff who are used to fill temporary gaps are from other Autism Initiatives’ services and know the residents. The home no longer has to use agency workers. In addition to the normal staffing the owners provide an additional 35 care/support hours a week to allow all of the residents to go out with staff support. This is funded through one individual’s care package. The staff we saw had a very good relationship with the residents and understood their needs, talking to them as well as meeting practical needs. Training is recorded on individual staff files. Six of the eight staff have at least NVQ2 and another is due to start a programme. Recent training includes Epilepsy Awareness and Food Hygiene. It would be better if training was recorded on a matrix that makes it apparent what training has been done and when further training is required. The acting manager said that she was planning to record training progress on a whiteboard in the office. Bedford Road, 153 DS0000005236.V373479.R01.S.doc Version 5.2 Page 18 We looked at the records for a member of staff who had been recruited recently. The file contained an application form, references and evidence that a Criminal Records Bureau certificate had been received before employment though there was no date on this. The acting manager was clear that it was company policy that nobody could be employed until the organisation had obtained a CRB certificate. The actual CRB certificates are kept in the Human Resources department so we were not able to check them on this occasion. Staff receive one to one supervision from the manager every three months and a record is kept of the sessions. The staff at the home receive support from other parts of the organisation including the Practice Support team that is based at the owner’s Crosby headquarters. Bedford Road, 153 DS0000005236.V373479.R01.S.doc Version 5.2 Page 19 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, 38, 39, 42. Quality in this outcome area is good. The people who live at Bedford Road benefit from efficient management of the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The long serving registered manager left recently to take up another post in the organisation and the deputy is currently the acting manager. A permanent appointment will be made in January and the successful applicant will then apply for registration. The previous manager had properly completed the CSCI Annual Quality Assurance Assessment (AQAA) before the inspection. This is an important part of the inspection and also requires managers to assess the performance of the service. We only saw two members of staff but they worked well together and regular team meetings are held to discuss issues and develop teamwork further. Autism Initiatives holds the Investors In People award (a national quality assurance system). The organisation also has internal Quality Assurance Co-ordinators who visit the home. Bedford Road, 153 DS0000005236.V373479.R01.S.doc Version 5.2 Page 20 Senior staff visit the home at least every month and submit written reports, though the most recent on file was from September 2008. It may be that subsequent reports had been delayed but more recent reports should be in place. The acting manager had a copy of all of the organisation’s policies. A fax machine has been installed though it was not working when we visited. Personal allowances are held in the home and are paid to people on request. Receipts are kept if staff spend any money though these are only small amounts. A signed record is kept of how the personal allowance is spent and staff make regular checks on the amount kept to make sure that nothing is missing. We looked at the records for one person and they were kept correctly. Fire safety records were up to date and up to date electrical and gas safety certificates were in place. New fire doors and smoke alarms are due to be fitted following a safety assessment. Bedford Road, 153 DS0000005236.V373479.R01.S.doc Version 5.2 Page 21 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 3 3 x 4 x 5 3 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 3 3 x x 3 x Bedford Road, 153 DS0000005236.V373479.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 YA20 Regulation 13(2) Requirement The registered person must make arrangements for the safekeeping of all medicines received in the home, therefore controlled drugs must be kept in an approved controlled drugs cabinet and the controlled drugs register should be a hard backed book. The premises must be kept in a good state of repair and therefore the vinyl flooring and tiling in the bathroom must be repaired or replaced. Timescale for action 01/02/09 2. YA24 23(2) 01/02/09 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. Refer to Standard YA9 YA22 Good Practice Recommendations Personal risk assessments should be safely kept on individual files so that they are readily accessible to all staff. Complaints and safeguarding issues should be clearly and fully recorded. DS0000005236.V373479.R01.S.doc Version 5.2 Page 23 Bedford Road, 153 Commission for Social Care Inspection Unit 1 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Bedford Road, 153 DS0000005236.V373479.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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