Care Home: Beech Lodge

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What the care home does well Each of the homes are overseen by an experienced and competent Manager. She ensures that the service is managed effectively and in the best interests of residents. Residents are supported by a consistent, knowledgeable and dedicated team of staff who provide a high standard of personal care to people with complex physical and learning disabilities. Residents are supported to lead varied and fulfilling lifestyles and take part in a range of meaningful and stimulating activities. Residents play an active role in their community and are supported to maintain positive relationships with family and friends. Residents and their relatives can be assured that the home will listen to and respond to any concerns or complaints they may have. Relatives commented: "The atmosphere is very homely, friendly and welcoming. The staff are always cheerful and nothing is too much trouble for them. We always feel a part of the Beech Lodge family. We feel fortunate to have had the opportunity for our son to live at this specialist place" "The home really looks after people. It`s a wonderful place. The home is peaceful and staff are dedicated in their job" What has improved since the last inspection? There were no requirements made at the last inspection. What the care home could do better: Residents and staff would benefit from a person centred approach to care planning. Care plans could be simpler and more user-friendly. The Manager needs to ensure that all residents with epilepsy have clear guidelines within plans of care for staff to follow. At present, some areas of Redwood House are inaccessible to residents. The Manager needs to determine whether or not this is in their best interests.The Manager must ensure that medication practices are robust. All medicines must be checked against the medication administration record on delivery to the home. Staff require additional guidance in respect of medicines that are prescribed on an as and when required basis. CARE HOME ADULTS 18-65 Beech Lodge Guildford Road Broadbridge Heath Horsham West Sussex RH12 3PW Lead Inspector Niki Palmer Key Unannounced Inspection 13th December 2007 09:30 Beech Lodge DS0000043443.V347596.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 Lodge DS0000043443.V347596.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 Lodge DS0000043443.V347596.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech Lodge Address Guildford Road Broadbridge Heath Horsham West Sussex RH12 3PW 01403 791725 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) beechlodge@sussexhealthcare.org sussexhealthcare.org Dr Shafik Hussien Sachedina Mr Shiraz Boghani Mrs Corinne Alison Nikolova Care Home 40 Category(ies) of Learning disability (40), Learning disability over registration, with number 65 years of age (1) of places Beech Lodge DS0000043443.V347596.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users accommodated in Beech Lodge One, Two and Three may also have a physical disability. Service users accommodated in Redwood House are in the category Learning Disability (LD) requiring personal care only. One named service user in Redwood House is in the category Learning Disability over 65 LD(E). 25th September 2006 Date of last inspection Brief Description of the Service: Beech Lodge is a single registration for three care homes for adults with learning disabilities; Beech Lodge, Redwood House and Oak Lodge. The three homes are located on the same site in a small village five miles from Horsham town centre. Corinne Niklova is the Registered Manager for all three homes. Beech Lodge and Oak Lodge are purpose built homes for people with complex learning and physical disabilities. Beech Lodge accommodates up to twenty people, whilst Oak Lodge, 10. Redwood House supports up to 10 more physically able people. There are separate communal areas in each of the three buildings, which are mostly used for activities, although designated activities areas are available. Spa pools and sensory rooms are available in both Beech Lodge and Oak Lodge. Attractive gardens and grounds surround the properties. Sussex Health Care owns these homes and a number of others. Dr S Sachedina and Mr S Boghani are the Registered Providers. Weekly fees range from £764.00 to £2604.00 dependant upon individual needs. People who use the service are expected to purchase their own toiletries and pay for hairdressing, chiropody and some holidays. This information was provided to the CSCI on the day of the inspection. Written information regarding the services and facilities provided at the home are available in the form of a Statement of Purpose and Service Users’ Guide. A copy of the home’s most recent inspection report is available on request from the home. Additional information can be found on the Provider’s web address. Beech Lodge DS0000043443.V347596.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 use the term ‘service user’ to describe those living in care home settings. The Registered Manager of the home confirmed that they use the term ‘residents’. For the purpose of this report people living in each of the homes will be referred to as residents. This key unannounced inspection took place over six hours on Thursday 13th December 2007. This enabled the Inspector to visit each of the homes, meet and talk with a number of residents and staff and inspect a number of the home’s records and documentation. 33 residents in total were accommodated on the day of the inspection. A number of feedback survey forms were sent to the home prior to the inspection. 19 completed forms were received by the Inspector at the time of writing the report. Five had been completed by relatives/representatives, whilst care staff had taken the time to try to seek the views of 14 residents; although it must be noted that due to the capabilities of residents accommodated, it was not possible to gain their views and opinions. Three individual plans of care from each of the homes were looked at for the purpose of monitoring care. Other records and documentation seen included: the home’s medication procedures, complaints procedure and the systems in place to safeguard people from harm, staff recruitment records and the provision of training and the home’s quality assurance systems. Much of the inspection was facilitated by the Registered Manager, although individual and group discussions were had with staff. An Annual Quality Assurance Assessment (AQAA) was completed by the Registered Manager and returned to the CSCI prior to the inspection. This gave the service the opportunity to tell the CSCI about how they are performing including: how they ensure that the views of people using the service are upheld and incorporated into what they do, what the service does well, identify any barriers to improvements that have been faced over the past 12 months and how the service plans to make improvements within the next 12 months. A number of their comments have been reflected throughout this report. Beech Lodge DS0000043443.V347596.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: Residents and staff would benefit from a person centred approach to care planning. Care plans could be simpler and more user-friendly. The Manager needs to ensure that all residents with epilepsy have clear guidelines within plans of care for staff to follow. At present, some areas of Redwood House are inaccessible to residents. The Manager needs to determine whether or not this is in their best interests. Beech Lodge DS0000043443.V347596.R01.S.doc Version 5.2 Page 7 The Manager must ensure that medication practices are robust. All medicines must be checked against the medication administration record on delivery to the home. Staff require additional guidance in respect of medicines that are prescribed on an as and when required basis. 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 Lodge DS0000043443.V347596.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 Lodge DS0000043443.V347596.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 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives are provided with sufficient information prior to admission in order to support their decision of whether the home can meet their needs and expectations. Good systems are in place to ensure that only people whose needs can be met are admitted to the home. EVIDENCE: There is a Statement of Purpose in place, which covers all three homes, whilst individual Service Users’ Guides have been written for each of the homes. These were seen on the day of inspection, but the content of each was not read in detail. The Manager wrote in the AQAA and commented on the day of inspection that she is keen to update the Service Users’ Guide in a different format in order to make it easier for prospective residents and their relatives to understand; this was discussed in some detail. The home’s progress with this will be followed up at the next inspection. The Manager wrote that the home’s website has been updated since the last inspection in order to provide better information to Care Managers and relatives. The Manager commented that this enabled them to provide urgent respite care for a person who lived a long distance away, as the Care Manager was able to obtain all the information required about the services offered at the home directly from the website. Beech Lodge DS0000043443.V347596.R01.S.doc Version 5.2 Page 10 The care records for one newly admitted person were viewed on the day of inspection. Evidence showed that The Deputy Manager had completed an assessment of this person’s needs prior to them moving in. This covered most activities of daily living. The resident and staff talked about the introductory visits that were facilitated prior to moving in. Staff talked about the good level of information that was given directly to them by the person’s relatives. Beech Lodge DS0000043443.V347596.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, 8 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have a good understanding of residents’ needs, however both residents and staff would benefit from a clearer, person centred approach to care planning. EVIDENCE: Three care plans were viewed on the day of inspection, one from each of the homes. Each of the homes use a template plan of care, which are written by the team leader of that house. Whilst they were mostly found to contain information is respect of how a person’s personal and healthcare needs are to be met, they were noted to be quite disorganised and difficult to read, understand and follow. E.g. at the front of one person’s care plan a great deal of previous correspondence was found; there was no personal profile in place in respect of that person. Therefore it took a great deal of time to read through each person’s plan of care in order to determine what level of care and support is required. Beech Lodge DS0000043443.V347596.R01.S.doc Version 5.2 Page 12 It was also noted that the home uses a number of different recording methods and tools; care plans, Health Action Plans, separate daily records and additional files for guidelines and risk assessments. Not withstanding that all care staff spoken with demonstrated a clear understanding of individuals’ needs and daily records are being maintained in respect of residents’ health and well-being, it is recommended that the Manager review the current care planning format in order to make them more user-friendly for residents and staff and in line with Person Centred Planning as outlined in Valuing People. Most of the residents have complex physical and learning disabilities and are therefore reliant on care staff, their relatives and other health and social care professionals to make decisions on their behalf about many aspects of their lives. Comments received from relatives/others confirmed that they are consulted and involved in these decisions as they arise by the Manager and care staff. Albeit that residents’ verbal communication is limited, staff working in the home were observed to interpret individuals’ subtle level of communication and include residents in the daily routines of the home wherever possible. Some residents have individualised communication tools in place, which staff were observed to use and understand well. This was echoed by a relative: “Every effort is made to understand and respond to his non-verbal signs” Due to the complex disabilities of the residents, limited risk taking can be initiated, however risk assessments are in place for most activities of daily living and personal health care needs. Beech Lodge DS0000043443.V347596.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, 14, 15, 16 and 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are supported to take part in a wide range of activities to lead fulfilling lives, meet their needs and ensure their personal development. Residents play an active role in their community and are supported to maintain positive relationships with family and friends. EVIDENCE: The AQAA, observations made on the day of inspection and discussions with staff confirmed that there is a varied and structured programme of activities in place for residents. These are planned around individuals’ needs and preferences as much as possible. Additional activities staff are employed to support activities on a daily basis, including weekends. Some residents have enrolled in local college courses or receive ‘outreach’ from these at the home some weekdays. Courses include: cooking, drama and developing communication and independence skills. Beech Lodge DS0000043443.V347596.R01.S.doc Version 5.2 Page 14 Some residents attend nearby day services, which are also owned by Sussex Healthcare. In-house activities include arts and crafts, games, relaxation and massage, reflexology, aromatherapy and hydrotherapy. A local school were performing a carol service for residents on the day of inspection. Residents from each of the homes gathered in Beech Lodge to watch and listen to this. Staff were observed to give hand massages whilst waiting for the carol service to begin. A number of trips to local pantomimes in the lead up to Christmas and over the festive period had also been organised for residents. They are supported to and from events and activities outside of the home in wheelchair friendly transport and/or smaller cars owned by the home. Many of the residents were looking forward to spending Christmas with their relatives at the family home. Residents and staff talked about different leisure activities such as shopping in Horsham, Crawley and Brighton, ice-skating, the cinema, theatres, local pubs and holidays. Some residents are supported to maintain links with local churches and/or meet with the Clergy during one of his visits to the home. Residents are supported to maintain a good level of contact with relatives. One relative commented: “The home always supports my son to phone home if he is feeling anxious” Staff talked about regular social events that are organised and attended well by relatives such as coffee mornings, parties and fundraising events. Advocacy services are sought on a needs-led basis for residents that do not have families or representatives to act on their behalf. It was noted in one of the homes (Redwood House) that kitchen and bathroom doors are kept locked at all times. It was explained that this is to prevent one person from gaining access to hot and cold water taps. This matter was further discussed and explored with staff and appears to have been reached based on historical reasons rather than on an assessment of need. As all hot water outlets are regulated (in order to prevent residents and staff from burning themselves) and that in keeping these areas locked restricts access for all other residents, it is required that a risk assessment is undertaken in order to determine whether or not this restriction is necessary. All meals are prepared in Beech Lodge by a chef and his small team of cooks. All meals are transferred between homes in a heated trolley. The chef was Beech Lodge DS0000043443.V347596.R01.S.doc Version 5.2 Page 15 spoken with on the day of inspection who confirmed that all produce is sourced and supplied locally. A weekly menu including alternatives was seen, whilst the Inspector had the opportunity to observe the lunchtime meal in Oak Lodge. The meals were noted to be wholesome, nutritious and prepared to individuals’ needs. A Speech and Language Therapist has provided guidelines for many of the residents who experience some level of difficulty with swallowing, which were being followed by care staff. Beech Lodge DS0000043443.V347596.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 and 21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff provide sensitive and dignified support to meet individual needs. Good arrangements are in place to meet the emotional and physical healthcare needs of residents. Residents are mostly protected by the home’s procedures for the safe handling of medicines. EVIDENCE: All residents are registered with a local GP and dentist and are supported to all healthcare appointments as necessary. The home has developed close working relationships with the local Community Learning Disability Team (CLDT) comprising of Community Nurses, Psychiatry, Clinical Psychologists and Speech and Language Therapist. In addition the home employs it’s own Physiotherapist and Physiotherapy Assistant. Relatives commented: “I am always contacted if my son needs to see the doctor. The home always contacts me after the visit to tell me what was said” Beech Lodge DS0000043443.V347596.R01.S.doc Version 5.2 Page 17 “The standard of care is very good” All personal care is carried out in the privacy of one of the communal bathrooms/shower rooms or in residents’ own bedrooms. Due to the complex physical healthcare needs of residents, all personal care for residents living in Beech Lodge and Oak Lodge is undertaken by two care staff. This is to ensure that safe moving and handling procedures are followed at all times. Whilst care plans in some instances were noted to be quite difficult to read, understand and follow, individual wishes and needs regarding the way that personal care should be provided was in place. Some of the residents living at the home have epilepsy and whilst it was pleasing to note that the majority of staff have received training in this area including the administration of emergency medication and were observed to respond well to one person having a seizure on the day of inspection, two out of the three guidelines seen within care plans were noted to be unclear. The home is required to ensure that all residents with epilepsy have clear guidelines in place for staff to follow. This should include a brief history of the person’s seizures, a description of what form the seizure takes and instructions for staff to follow in the event of a seizure occurring. The Manager explained that she has recently purchased a telemetry device in order to support care staff to monitor one person’s seizures particularly at night. The Manager was reminded of her responsibility to ensure that clear and transparent guidelines are in place for its use in order to make sure that it does not compromise the person’s privacy and dignity. This has not been reflected as a requirement or recommendation of this inspection report, but will be followed up at the next inspection. The home’s medication systems and records were viewed in Oak Lodge and Redwood House. All medicines are delivered to the home on a monthly basis from the GP surgery in pre-packed blister packs, which are easy to use and monitor. All medicines are stored in locked trolleys that are taken around the home(s) when medicines are administered. No residents are able to selfadminister. Whilst medication procedures were mostly found to be sufficient, some concerns were raised in respect of prescribed medicines that are to be given on an as and when required basis (PRN): - One person was prescribed a topical cream, but the medication administration record (MAR) stated that it should be given orally. Whilst this is not directly an error on behalf of the home, it should have been noticed and rectified at the time of receiving and checking the medicines into the home. Beech Lodge DS0000043443.V347596.R01.S.doc Version 5.2 Page 18 - Many residents are prescribed PRN pain relief and medicines used in the short-term relief of anxiety and agitation, yet there were no clear guidelines to support staff as to when these should be given. - On some occasions e.g. when residents are prescribed short-term prescriptions such as antibiotics or topical creams, care staff handwrite these onto the MARS. In order to reduce the risk of human error, it is recommended that all handwritten entries be countersigned. This will help to ensure that the correct medication, time and dose are recorded. The AQAA confirmed that the home has joined the Gold Standards Framework (GSF) initiative to provide quality End of Life care for residents. The Manager said that additional support from the Palliative Care Team is being provided on a twice weekly basis. Beech Lodge DS0000043443.V347596.R01.S.doc Version 5.2 Page 19 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives can be assured that the home will listen to and act upon any concerns or complaints that may arise. The home has good systems in place to protect individuals from potential harm, neglect and abuse. EVIDENCE: There is a clear and accessible complaints procedure in place, which has been simplified for residents. It details how a complaint can be made by and the timescale within which it will be dealt with. Records showed that a parent who wished to complain about the out of hours GP service was supported well by the Manager in doing so (although it must be noted that this was not a complaint on behalf of the standard of care at the care home) and that a complaint made by a care worker was fully investigated and resolved. This complaint was not upheld. No complaints have been received by the CSCI about the home since the last inspection. Relatives said: “I have never had to raise concerns concerning the standard of care” “I have complained on several occasions. They have been dealt with mostly to my satisfaction” The home has a detailed Safeguarding Vulnerable Adults policy and procedure in place in accordance with newly revised multi-agency guidelines. The Beech Lodge DS0000043443.V347596.R01.S.doc Version 5.2 Page 20 Manager has recently attended a Safeguarding Adults workshop facilitated by West Sussex County Council. The AQAA confirmed that the new procedures have been communicated to staff through regular staff meeetings and supervision and that policies are being reviewed to update and incorporate the new changes. One Safeguarding Vulnerable Adults alert has been raised since the last inspection. This was thoroughly investigated by the appropriate agency. This was discussed in detail on the day of inspection and a number of care records looked at. The CSCI concludes that the appropriate action has since been taken on behalf of the home in order to safeguard the well-being of residents. Staff training records showed that a number of care staff have not received refresher Safeguarding Adults training; some since 2005. In order to promote good practice in relation to Safeguarding Adults, it is recommended that annual refresher training be provided to all staff. Beech Lodge DS0000043443.V347596.R01.S.doc Version 5.2 Page 21 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 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Beech Lodge, Oak Lodge and Redwood House offer a friendly and relaxed environment that is kept in good decorative order. All homes present as a clean, well-maintained and homely place to live. EVIDENCE: Beech Lodge and Oak Lodge are purpose built homes on ground level, whilst Redwood House is an older style building which is located over two floors, although it does have a lift. Bedrooms in each of the homes were viewed. It was evident that residents and their relatives have been involved in choosing their own furniture, accessories and décor. They all have their own TV, video, stereo equipment and some specialist equipment in their rooms. There are a number of photographs displayed throughout the home of each of the residents, all of which have been nicely framed and presented. Beech Lodge DS0000043443.V347596.R01.S.doc Version 5.2 Page 22 All three of the homes had been nicely decorated for Christmas. There are separate communal areas in each of the three buildings and suitable bathing and other specialist equipment provided throughout. Separate sensory rooms are available in both Beech Lodge and Oak Lodge, whilst Beech Lodge also has a heated spa pool, which can be used by residents in all three homes. Overhead tracking for residents with reduced mobility is provided in Beech Lodge and Oak Lodge in individual bedrooms and bathrooms. All areas were noted to be clean and well-maintained on the day of inspection. Additional cleaning and laundry staff are employed. Staff commented that all repairs and maintenance issues are promptly dealt with. Clear fire procedures are displayed throughout each of the homes. Beech Lodge DS0000043443.V347596.R01.S.doc Version 5.2 Page 23 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 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s robust recruitment policies and practices and are supported by a consistent, well trained and dedicated staff team. EVIDENCE: The AQAA confirmed that a total of 44 care staff are employed to work across all three homes. Over 50 of care staff have achieved at least NVQ Level 2 in Care. Each home has it’s own designated staff team. Discussions with staff confirmed that staff turnover is relatively small. A number of staff have worked at the home for many years and have therefore got to know the residents well. Staff confirmed that they have clear job descriptions and fully understand their roles and responsibilities. The Registered Manager is a qualified Learning Disability Nurse. Whilst other nursing staff are employed, they do not undertake nursing tasks. All are Beech Lodge DS0000043443.V347596.R01.S.doc Version 5.2 Page 24 Registered General Nurses, whom have completed their adaptation training at the home from overseas through a local University. Staffing rotas confirmed that there is always sufficient numbers of staff on duty in each of the homes day and night. This was also confirmed by care staff and relatives: “There are always plenty of staff available when I visit, including nurses” The Manager confirmed that all job advertisements and recruitment checks are organised through Sussex Healthcare’s head office. The recruitment files for three newly employed carers were viewed. Two of these had been recruited via an overseas agency based in London. There was evidence to show that all satisfactory pre-employment checks were undertaken for all three persons prior to them starting work including: the submission of a written application form, two written references, photo identification, permits to work and police checks. Staff also confirmed that they did not start working prior to all checks being obtained. All staff are expected to undertake a two day induction programme at the organisation’s head office. This comprises of a number of health and safety aspects including policies and procedures. After this point, all staff are required to complete an induction booklet, based on Skills for Care. It is recommended that the Manager explore the option of introducing the Learning Disability Induction Award that covers the Common Induction Standards. This replaces the Learning Disability Award Framework (LDAF). Staff commented that the organisation is good at providing relevant training courses such as moving and handling, first aid, continence, working with challenging behaviour and Makaton. Beech Lodge DS0000043443.V347596.R01.S.doc Version 5.2 Page 25 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A skilled and experienced Manager provides clear direction and support to enable the staff to provide a high standard of care to residents. Both residents and staff benefit from a well managed and organised home. EVIDENCE: The Registered Manager is a Registered Nurse with over 20 years experience of working with people with learning disabilities, both in the UK and overseas. She is responsible for overseeing the general management of all three homes and is mostly available Monday to Friday, although she does work some weekends. Without exception, all of the staff spoken with said that they feel the home is managed well. Beech Lodge DS0000043443.V347596.R01.S.doc Version 5.2 Page 26 The Manager is supported in her role by an experienced Deputy Manager, who is working towards a Registered Manager’s Award (RMA). She commented that she is finding this additional training to be relevant and informative in her practice. Each of the homes are overseen by team leaders, who are directly supervised and line managed by either the Registered or Deputy Manager. It is recognised that seeking feedback from residents is a challenging role for the home due to individuals’ complex care needs and limited verbal communication skills. The AQAA and discussions with the Manager confirmed that postal quality audits (questionnaires) are sent from head office to relatives on a regular basis, although the Manager did comment that regular feedback is sought from relatives on an informal basis, during their visits to the home. One relative commented: “The staff are always responsive to suggestions” The Manager said that she is keen to develop the service’s quality assurance systems and begin to seek feedback from others such as GP’s, Care Managers and members of the CLDT. The home’s progress with this will be followed up at the next inspection. The Manager wrote in the AQAA that health, safety and protection issues are of paramount importance in order to ensure that residents’ welfare and safety is maintained and that regular checks are made on services to the home as well as fire fighting equipment. Whilst individual health and safety records were not viewed during the inspection process, the home appeared safe and well-maintained on the day of inspection. Beech Lodge DS0000043443.V347596.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 X 4 3 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 2 25 4 26 4 27 4 28 3 29 4 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 3 3 3 3 X X 3 X Beech Lodge DS0000043443.V347596.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Not applicable 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 YA16YA24 Regulation 12(1)(a) 13(4)(a) Requirement That a risk assessment is undertaken in Redwood in order to determine whether or not it is appropriate for all bathroom and kitchen doors to be locked. Timescale for action 29/02/08 2. YA6 YA19 12(1)(a)(b) That all residents with epilepsy have clear guidelines in place for staff to follow. This should include a brief history of the person’s seizures, a description of what form the seizure takes and instructions for staff to follow in the event of a seizure occurring. 29/02/08 3. YA20 13(2) 17(1)(a) That all prescribed medicines are checked thoroughly against the medication administration records (MARS) at the time of receiving them into the home. That clear guidelines are in place for all medicines that are prescribed on an as and when required basis (PRN). 29/02/08 Beech Lodge DS0000043443.V347596.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 YA6 Good Practice Recommendations That the Manager reviews the current care planning format in order to make them more user-friendly for residents and staff and in line with Person Centred Planning as outlined in Valuing People. That all handwritten entries on medication administration records (MARS) are countersigned by a second person. This will help to reduce the risk of human error and ensure that the correct medication, time and dose are recorded. That Safeguarding Adults from potential harm, neglect and abuse training be provided to all staff on an annual basis. That the Manager explores the option of introducing the Learning Disability Induction Award that covers the Common Induction Standards; which replaces the Learning Disability Award Framework (LDAF). 2. YA20 3. 4. YA23 YA35 YA35 Beech Lodge DS0000043443.V347596.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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. 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