Care Home: Beech House

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What the care home does well If people want to come and live in the home, the manager visits them where they live, invites them to the home and looks carefully at what they need to make sure that the staff can look after them properly. The home makes sure that it writes down what residents need and what they want so that staff can check that they are helping people properly (providing the assessed care.) The home try hard to make sure that people can choose things for themselves. The home has good risk assessments to make sure that people can do as much for themselves as possible, as safely as possible.The home writes down how people say what they want to even if they cannot talk very clearly, so that everyone knows what they want and think of things. Staff know what people like and don`t like and help them in the way they like best so that they feel comfortable. The house is nice and clean and comfortable to live in. What has improved since the last inspection? The home is trying hard to make sure that people have lots of different things to do and are encouraged to go out as much as they want to, so that their life is more interesting. The home has a plan that staff can follow to help people to feel happier and behave in a good way. These are written down so that everybody knows what they are and what to do to keep people safe. The manager is using lots of ways, such as regular staff meetings, meeting with individual staff and showing staff, to help them to get to know the best ways to give good care to the residents. The home makes sure that the medicine the Doctor gives people to help them behave in a good way is given at the right times. They have written this down so that it makes people feel better and stops them from being very unhappy or making other people unhappy. Staff are trying hard to make the home more `homely`, in a way that everyone likes and agrees with, so that everyone will feel more comfortable. Staff make sure that they write down what they do about any worries that people have about the home, so that everyone knows they are listened to and something is done about it. The manager is good at looking at everybody`s different needs and ways of doing things so that all the staff and residents can work together to make sure that the residents can enjoy their lives, as much as possible. What the care home could do better: The home could make sure that residents` appointments with Doctors and other people are written down so that everyone can see when they were and what happened. The manager must make sure that all staff know who to tell if they are worried about how residents are treated, so that they can make sure they are always safe and protected from bad things happening to them.Staff must get N.V.Q or other professional training to make sure that they are qualified to look after residents in the best way. The manager must be registered to make sure that she is not breaking the law by running the home and she can make sure that the residents get the best care and enjoy their lives. It would be good if the home made it clear what they are going to do about trying to stop accidents happening again and to make sure ensure that everyone is kept as safe as they can be. CARE HOME ADULTS 18-65 Beech House 49 Crockhamwell Road Woodley Reading Berkshire RG5 3JY Lead Inspector Kerry Kingston Key Unannounced Inspection 4th February 2008 11.00 Beech House DS0000011350.V357716.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 Beech House DS0000011350.V357716.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. Beech House DS0000011350.V357716.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech House Address 49 Crockhamwell Road Woodley Reading Berkshire RG5 3JY 0118 969 8373 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) milburycare.com/home.html Milbury Care Services Ltd Mrs Marina Diane May King Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Beech House DS0000011350.V357716.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th February 2007 Brief Description of the Service: Milbury Care Services Ltd. is registered to provide personal care in Beech House for up to six adults aged between 18-65 who have learning difficulties and associated behavioural problems. Beech House is a large two storey modern house that is situated in Woodley in a residential area, close to a local shopping centre and facilities. The shopping centre is within easy walking distance of the home. The home has its’ own transport and is on a frequent bus route to the large town centre of Reading. Accommodation is offered in single bedrooms, three are on the ground floor and three on the first floor. There is a car parking area at the front of the property and the residents have the use of a secluded garden at the rear. The fees range between £1,080.00 and £1,443.00 per week. Beech House DS0000011350.V357716.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 stars. This means that the people who use the service experience good outcomes. This is a report for the key inspection of the service, which included a routine unannounced site visit. This took place between the hours of 11.00 am and 5.00pm on the 4th February 2008. The information was collected from the Annual Quality Assurance Assessment, a document sent to the service by the Commission for Social care Inspection and completed by the manager of the service. The home is registered for six people and there are, currently six people in residence. Discussions with two staff members and the Manager took place. The people who use the service have no or limited verbal skills, therefore observation was used as a source of information throughout the visit. Residents have difficulty accepting new people in their environment and any change from their usual routine can cause distress, therefore observation was limited, advice on this matter was taken from the manager. A tour of the home and reviewing residents’ and other records were also used to collect information on the day of the visit. The home has complied with all the requirements made at the last inspection and has met the recommendations. What the service does well: If people want to come and live in the home, the manager visits them where they live, invites them to the home and looks carefully at what they need to make sure that the staff can look after them properly. The home makes sure that it writes down what residents need and what they want so that staff can check that they are helping people properly (providing the assessed care.) The home try hard to make sure that people can choose things for themselves. The home has good risk assessments to make sure that people can do as much for themselves as possible, as safely as possible. Beech House DS0000011350.V357716.R01.S.doc Version 5.2 Page 6 The home writes down how people say what they want to even if they cannot talk very clearly, so that everyone knows what they want and think of things. Staff know what people like and don’t like and help them in the way they like best so that they feel comfortable. The house is nice and clean and comfortable to live in. What has improved since the last inspection? What they could do better: The home could make sure that residents’ appointments with Doctors and other people are written down so that everyone can see when they were and what happened. The manager must make sure that all staff know who to tell if they are worried about how residents are treated, so that they can make sure they are always safe and protected from bad things happening to them. Beech House DS0000011350.V357716.R01.S.doc Version 5.2 Page 7 Staff must get N.V.Q or other professional training to make sure that they are qualified to look after residents in the best way. The manager must be registered to make sure that she is not breaking the law by running the home and she can make sure that the residents get the best care and enjoy their lives. It would be good if the home made it clear what they are going to do about trying to stop accidents happening again and to make sure ensure that everyone is kept as safe as they can be. 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. Beech House DS0000011350.V357716.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 Beech House DS0000011350.V357716.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): 2. People who use the service experience good quality outcomes in this area. The home makes sure that people are assessed thoroughly, are introduced to their prospective home appropriately and that they can meet the assessed needs. The home makes sure that the well being of the other people, in the home, is not compromised by the admission of the new resident. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new resident came to live in the home in July 2007. There was a full assessment by a community nurse, which includes an intensive behaviour report and risk assessment. It also includes a social history and reasons why the new placement was needed. The assessment notes how the home will meet each assessed need. As well as any behavioural and special needs the assessment includes cultural, religious needs and family contacts. The placement was reviewed after six weeks to ensure that the home was meeting the identified needs. The introduction to home included one short visit with current carers, one longer visit and the manager of the new home spending time at the previous Beech House DS0000011350.V357716.R01.S.doc Version 5.2 Page 10 home to see how staff interacted with the resident and to try to ascertain her preferences and views. A letter from community nurse noted that behaviour and seizure activity had reduced, which was likely to be due to the behaviour programmes put in place by the new home, it also noted that staff were being trained to meet the specific needs of the individual. There was evidence of timely referrals to the local Community Team for People with Learning Disabilities and to a consultant psychiatrist. A completed contract is on file and a care plan, which includes detailed behavioural guidelines, has been developed so that staff know how to best meet the needs of the individual. The new resident has limited verbal communication skills but indicated by their behaviour and some communication that they are happy in the new home. Improvement in behaviour such as going to bed at night and reduced aggression to others further evidenced that they were happy and settled in the new home. Beech House DS0000011350.V357716.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 and 9. People who use the service experience good quality outcomes in this area. Peoples’ care plans include all the necessary information to enable staff to support them in the best way, possible. Residents are being helped to make as many decisions and choices for themselves as possible. The availability of detailed risk assessments and using them in conjunction with care plans has resulted in increased independence for some residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four care plans were seen. All residents have a detailed care plan that ensures staff know how to support them with all aspects of their life. They include ‘Things I need support with’ and ‘how I would like you to support me.’ There is a six monthly review of the care plan by the home in some instances but some are not up-to-date. Beech House DS0000011350.V357716.R01.S.doc Version 5.2 Page 12 The formal reviews take place annually, two remain outstanding since 2005 but are planned imminently. Care plans include any equality and diversity issues such as same gender care, communication and behaviour. All residents needs are well documented, the manager advised that a new care planning process is underway, which will lead to a review of the content and layout of the care plans. Daily notes for individual residents clearly note what decisions and opportunities for choices residents have and how they are encouraged to make decisions, communication passports describe how people make decisions and make their choices known. Menus are chosen by residents under the direction of the staff, that is each individual is given an appropriate amount of choices and supported to choose what they want, by this method they choose every main meal. Pictures and photographs are used to aid choice. Residents are encouraged to attend house meetings, where staff discuss all aspects of the home, few take this opportunity at this time but the staff team are supporting people to become more involved. There are numerous risk assessments for individuals, as is necessary all have been reviewed within the last six months and include residents vulnerability to abuse, access to money and daily living such as accessing public transport and travelling in the vehicle aswell as challenging behaviours. The use of risk assessments combined with behavioural plans and care plans has lead to people participating in the community much more such as attendance at the Drs and dentist surgeries, rather than health professionals visiting the home and people having 1: 1 rather than 2:1 support in the community (this means that more staff are available to help people with their daily activities.) Beech House DS0000011350.V357716.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 and 17. People who use the service experience good quality outcomes in this area. The home has improving activity plans for individuals and they are able to enjoy a rewarding lifestyle, which includes opportunities to become involved in the community. People are supported to maintain and enhance relationships with families and friends. Residents are offered a healthy diet and good opportunities to choose what they eat. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has reviewed some activity programmes and there are a variety of activities available such as art, music, sensory activities, adventure playground, trampolining and community presence. Beech House DS0000011350.V357716.R01.S.doc Version 5.2 Page 14 Most residents have a planned activity everyday although those provided by residential staff are more flexible and can respond to the choices of the residents. Daily notes evidence that people are supported to access the local community and use the local Drs. and dentists surgery, access public transport and go shopping and out for meals. There has been a significant increase in these activities since the last inspection and the home are continuing to develop programmes for individuals. Residents were observed on the day of the inspection visit interacting with staff, being involved in household activities and doing ‘tabletop’ type activities that they enjoy. One person has been given extra 1:1 time during the week so that he can be supported to access more activities, particularly in the community. Staff said that residents are involved in many more activities and confirmed that there are plans to further improve activity opportunities. Two residents bedrooms were seen, neither had a Television, the manager advised that they had little interest in television programmes and chose to come to the main lounge if they wanted to watch, one person was seen to have her own Compact Disc player as she enjoys music. One person was observed making a telephone call, assisted by staff and there was open access to the office, when staff were present. The home is in the process of organising holidays for people, these will be long weekends, day trips or weeks away as is suitable for and chosen by individuals. Peoples relationships with families and friends, is noted on care plans and contacts are recorded in the daily notes. The home supports people to maintain contacts and enables them to visit family homes, as appropriate. The manager is aware of one person who has no family contact and is planning to try to establish a link with a sibling of the resident. One other person has no family contact, efforts at finding some contacts have not been successful, as yet. The menu seen was well balanced and healthy, the resident’s name is written next to the dish they have chosen. The manager described how people are given the amount of choices that is suitable to their current ability level and to enable staff to maintain a balanced diet. The home uses pictures, symbols and photographs to enable the residents to make choices and uses a simple meal planning system to ensure that meals are nutritionally balanced. Beech House DS0000011350.V357716.R01.S.doc Version 5.2 Page 15 Care plans include any necessary guidelines so that all the residents can enjoy their meals. Residents were seen requesting drinks, throughout the day and staff responded quickly to their requests. Records showed that staff support people to have meals or drinks in the community, if they choose to. Beech House DS0000011350.V357716.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 and 20. People who use the service experience good quality outcomes in this area. The home offers good support in the areas of health personal and emotional care, in a way that is preferred by the residents. The home makes sure that people receive their medication regularly and it is administered as safely as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans for four residents were seen they include ‘how I would like you to support me’, to describe how staff should approach offering them care. Care plans have details about peoples’ ethnicity, culture, faith, gender and disability and are individually ‘tailored’ to meet those needs. Which gender of staff are to offer personal care is clearly described in the personal care plans. There was evidence that people access health and emotional care as necessary. Several people had appointments with doctors, dentists, opticians and more specialist services. Beech House DS0000011350.V357716.R01.S.doc Version 5.2 Page 17 The manager met with the Doctor in January 2008 to review all the medication people had been prescribed. Residents now attend the local surgery rather than people coming into the home. This increases community presence and peoples’ opportunities for new and different experiences. This has taken thought from the staff team and working closely with the surgery. The manager is very clear about peoples’ rights and their equality with regard to access to healthcare. It was discussed with the manager that a health record may be useful so that it is easier to ‘track’ all health appointments and the results of them. The home has detailed guidelines to support those people who may display difficult or challenging behaviours and there was written evidence that some behaviours had improved with their use. One of the staff spoken to was knowledgeable about peoples’ behaviours and needs and how to support them with any difficulties. The home uses a monitored dosage system, provided by the local pharmacy, to administer medication. Drugs are kept in a locked metal cabinet in a locked office. Only staff who have been trained and assessed as competent to administer medication do so, their competence is re-assessed annually. The medication records seen on the day of the visit were accurate and the manager advised that there had only been one medication error since the last inspection, this was appropriately dealt with. The home has guidelines/protocols for the administration of medication prescribed, to be taken ‘when necessary’, one resident has ‘as necessary’ medication, prescribed to help control behaviour but it has not been used for over six months. The Primary Health care trust inspected the homes’ medication administration procedures in October 2007 and found that they had met the standard required. Beech House DS0000011350.V357716.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 and 23. People who use the service experience good quality outcomes in this area. The home acts upon the views of the residents, as far as possible and keeps them safe from all forms of abuse. It has developed behaviour guidelines to make sure that residents are protected, as far as is practicable form self harm or aggression. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has received two complaints since the last inspection, both from neighbours regarding fences and noise levels. Both complaints were dealt with effectively and quickly and the details were properly recorded. Complaints are written in a complaints book and include what action has been taken and when. Residents would be unable to access the complaints procedure without the support of staff or families, it is clearly recorded how people make it known if they are unhappy or distressed. All residents have detailed behavioural guidelines, as necessary to ensure their safety and the safety of the staff team. All staff receive non-violent crisis intervention training and have guidelines for individuals of when they need to use it. The manager confirmed that no restraint had been used since she has been managing the service (July 2007). Beech House DS0000011350.V357716.R01.S.doc Version 5.2 Page 19 The manager confirmed that there have been no safeguarding adults issues since the last inspection. All staff have received training in the protection of Vulnerable Adults and one staff member was clear about what they would do if they felt they need to protect a resident. Another staff member was not clear about what they would do but this may have been a communication issue. The manager undertook to clarify with the staff member the Safeguarding procedures and ensure that they had understood the training that they had completed in this area. Two residents financial records were checked, recording was accurate and detailed and receipts are kept for all significant expenditure. The provider acts as appointees for the residents, the manager has access to cash via two signatures. One resident has a P.I.N card but only the manager has access to the P.I.N number. The Commission for Social Care Inspection has received no information with regard to complaints or Safeguarding Adults issues since the last inspection. Beech House DS0000011350.V357716.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 and 30. People who use the service experience good quality outcomes in this area. The home is clean and hygienic and offers a comfortable and pleasant environment for the people who live there. The staff are working hard to add ‘homely’ touches that the residents will accept, to the environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is clean and hygienic and well decorated. It appears quite bare but the manager described her programme for introducing more ‘homely touches’ so that those residents resistant to change will accept them. A slow and sensitive approach is being used such as a picture board, with residents and staff photographs on one wall and one bathroom with a cheerful ‘bathroom tidy, toy’ decoration. One resident has been persuaded to tolerate an extra item of furniture and some cushions in their bedroom. Beech House DS0000011350.V357716.R01.S.doc Version 5.2 Page 21 The two bedrooms seen were comfortable and reflected individuals’ tastes and personalities. The Kitchen was very clean and tidy and the laundry was seen to be in good order. Most of the staff team have received infection control training and a red bag system is used, as necessary, to ensure the proper handling of ‘foul’ clothing/linen. Beech House DS0000011350.V357716.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): 32,24,35 and 36. The people who use the service experience adequate quality outcomes in this area. The staff team are not as well qualified as they should be but are improving their competence and effectiveness, through training and confidence building programmes, so that they are able to meet the needs of people with complex and diverse behaviours. Staff are supported to carry out their tasks and meet the needs of the people who live in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has 12 full time and two part time staff, there are the equivalent of three fulltime vacancies, including a deputy manager post that the manager is optimistic has been filled. There are a minimum of four staff on duty during waking hours, this sometimes drops to three in the late evening. Agency staff are used, but only those that are familiar with the residents, there are always permanent staff on duty and much of the shortfall in staff is covered by permanent staff doing overtime and bank staff. Beech House DS0000011350.V357716.R01.S.doc Version 5.2 Page 23 Most of the staff team have been working in the home for over a year and are familiar with the needs of the residents. Four staff have an N.V.Q. 2 or above qualification. All staff pursue an induction programme with written tests to check their understanding of the topics covered. Staff have a training plan and most of the health and safety courses are up-todate and complete. Training records are held and include the date for up –dating the training, as necessary. Some specialist training is completed, such as epilepsy and more is being arranged by the new manager. All staff have received training in dealing with people with challenging behaviour, medication and the Protection of Vulnerable Adults. The provider organisation has a designated training officer who is able to offer advice and arrange for the training needs of the staff team. One staff member spoken to said that they had plenty of opportunity for training and they felt that the new manager was giving more encouragement for people to access the professional training. One staff member spoken to was unable to communicate effectively, in English and there was a discussion with the manager about checking that all staff had sufficient language skills to understand all their roles and responsibilities. The staff member said that they had less difficulty communicating with the residents than with other staff. Supervision records for two staff were seen and showed that staff had received regular supervision since the new manager has been in post. Staff confirmed that they have regular supervision and they find it helpful. Staff meetings are held on a monthly basis and these include some training sessions, which focus on good practice, attitudes and the daily work in the home. The manager and staff team have a good awareness of culture and ethnicity issues among the multi cultural work force and openly deal with any issues that this might create, including language and attitude issues such as explaining the cultural significance, that is showing value and respect, of using please and thank-you. Recruitment records for two staff were seen, detailed information is kept at head office but the home has some information and a tick list completed by personnel to say that all the necessary documents are in place. Application forms are completed but contain little detail, however detailed records of interviews are kept. One of the staff members said that the staff team is developing and has become more stable. The manager is aware of staff effectiveness and training issues and is using a variety of methods to increase peoples’ competence and knowledge base. Beech House DS0000011350.V357716.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): 37,38,39 and 42. People who use the service experience good quality outcomes in this area. The home has a new manager who has made several improvements in the home, she has a sound idea about what needs to be done to develop the service, and how. The manager is developing the staff team to ensure they are able to improve the standard of care they offer the residents. The home has robust quality assurance systems and keeps the people who live in the home as safe as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a new manager, who has been in post since May 2007 (approximately 9 months). Beech House DS0000011350.V357716.R01.S.doc Version 5.2 Page 25 She has been in care work for approximately 10 years and an acting manager for one year in a day service setting. She has some management related training and has an N.V.Q.3 but does not hold a Registered Managers Award. An application to register her as the manager for this service has not been received by the Commission. She confirmed that she gets regular support and supervision from the provider. The new manager has developed many areas of the home notably ensuring residents have more access to the community, using behavioural plans to assist people to control their behaviours and improving the effectiveness of the staff team. Staff confirmed that they felt supported, now have regular supervisions and are encouraged to pursue training. Outcomes for residents in lifestyle and Personal Healthcare and support have improved since the last inspection. The Annual Quality Assurance Assessment was of good quality and accurately completed. It described what progress had been made and what further improvements are needed and how they will be actioned. The manager has a good awareness of equality and diversity issues for the staff team and the residents in the home and an awareness of the Mental Health Capacity act as it relates to the resident group such as medical consent pathways and the necessity of risk assessments for any restrictions that might have to be imposed on residents. Quality Assurance systems are in place such as regular regulation 26 visits, questionnaires sent annually to residents’ families, advocates and other professionals and an annual review report and action plan, which are developed from these (as at last inspection.) The organisation also has a designated Quality Assurance officer who completes annual quality visits and compiles a report from their findings (last visit in March 2007). Residents views are sought in imaginative ways as described by the manager and daily notes are used to gain and assess individuals’ views and choices. The Annual Quality Assurance Assessment and the homes’ own quality assurance systems confirmed that all the necessary Health and Safety checks and maintenance schedules were completed on time. Hazardous substances are stored in locked cupboards and information sheets are available, the manager is very aware of infection control. The home records accidents and incidents but there was a discussion with the manager about the value of cross referencing accidents that result from an incident, as the incident forms contain more information about what action is Beech House DS0000011350.V357716.R01.S.doc Version 5.2 Page 26 to be taken to minimise the risk of recurrence, particularly where the incidents are as a result of a challenging behaviour. Beech House DS0000011350.V357716.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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 3 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 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 3 3 X X 3 X Beech House DS0000011350.V357716.R01.S.doc Version 5.2 Page 28 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA23 Regulation 13.6 Requirement To ensure that all staff including those for who English is not their first language know who to approach if they have any concern about the safety or well-being of someone in their care, so that they are better able to protect them. To put a programme in place to ensure that the staff have suitable qualifications to enable them to meet the needs of the people who use the service. To apply for registration by the Commission to ensure that the manager is suitably qualified and experienced to run the service in the best interests of the people who live there and is not committing an offence by running the home whilst unregistered. Timescale for action 01/03/08 1. YA35 18.1(a) 01/05/08 2. YA37 11 (C.S.A. 2000) 01/04/08 Beech House DS0000011350.V357716.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA19 Good Practice Recommendations To develop a clear health recording system so that it is easy to ‘track’ peoples’ medical and health appointments and when check ups are due, to help to ensure that residents’ health needs are met at all times. To cross reference accidents resulting from incidents with the incident report forms to ensure there is enough detail recorded for people to see how they are to minimise the risk of recurrence and so improve the safety of residents and staff. 2. YA42 Beech House DS0000011350.V357716.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Beech House DS0000011350.V357716.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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