Care Home: Beech Spinney

Similar services:

• Polesworth Group Friary Road
• Polesworth Group Pooley Heights
• Polesworth Group 32 Station Road
• Polesworth Group 70 Long Street
• Breme
• Polesworth Group 64 Long Street
• Polesworth Group 68 Long Street
• 10 Whitfield Avenue

What the care home does well The service has worked hard to improve its service. Management and staff have cooperated with us and with other professionals to ensure that improvements have been made. Staff know the people who live at Beech Spinney well. They understand their needs and how to meet these needs. They are working well with a range of professionals and relatives to ensure that people`s changing and often complex needs continue to be met. Peoples` changing swallowing needs have been identified and followed up with medical diagnosis. Advice on how to manage these changes whilst supporting people to safely eat has been implemented. New dishes are prepared by the cook to provide dietary interest and variety. The cook seeks feedback about whether people enjoyed the meal before putting it on the menu. The environment is well maintained and resourced and continues to meet people`s needs. There are good systems in place for the management of infection control. Staff feel well trained, supported and directed. New staff are recruited safely ensuring vulnerable people are protected. What has improved since the last inspection? The home is now being well managed. Much has been done to improve the safety of people living at Beech Spinney. There have been fewer incidents and accidents and no mistakes with the administration of medication. The service is now working very cooperatively with partner agencies and people`s complex changing needs are being managed well. The service is considering providing a respite service to a young person with complex individual needs and considerable time is being spent in advance to ensure the service can meet her unique needs before a decision is made. There have been a number of safeguarding investigations over recent months. However all have now been resolved. No allegations against the service have been upheld. Steps have been taken to identify and meet people`s spiritual needs. A pastor is now regularly visiting the home to meet and talk to the people who live there. People are accessing the community. A policy is now in place to ensure that the service contributes towards the cost when people eat out instead of eating at home. What the care home could do better: The service has provided contracts of residence to people who live permanently at Beech Spinney. Some omissions in the contracts have been identified. Also contracts should be issued to people who have respite at Beech Spinney. People have started to be involved in grocery shopping. This is very positive but should be reviewed to ensure it is meaningful for those who take part.The manager is aware of the need to personalise the communal areas of the home to detract from its hospital feel. More training should be provided in the use and maintenance of the suction machine. Complaint and training records need to improve to provide greater accountability. Confidential records about people who live in the home must always be stored appropriately. Since pointing this out to the manager at inspection, remedial action has been taken. The organisation needs a policy to guide managers and staff in the implementation of new deprivation of liberty legislation. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Beech Spinney Beech Spinney Ironbridge Telford Shropshire TF8 7NE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Deborah Sharman     Date: 2 3 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Beech Spinney Beech Spinney Ironbridge Telford Shropshire TF8 7NE 01952432065 01952432209 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Self Unlimited care home 7 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 7 The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 7 Date of last inspection Brief description of the care home Beech Spinney is managed by Cottage and Rural Enterprises Ironbridge. The responsible individual is Mr Erik Whitehouse. The Registered Managers post is vacant and is being covered by an acting manager. Beech Spinney is registered with the Care Quality Commission as a residential Care Home for a maximum of seven adults with learning disabilities and additional complex needs. The registration consists of a five single bedroom permanent home known as Honeysuckle House and an adjoining two-bedroom respite facility. The respite home (Thistle Lodge) has a dedicated staff team and runs independently from Honeysuckle House. All bedrooms have spacious en suite bathrooms and have access (via a tracking Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home hoist if required) to large assisted bathing and showering facilities. Communal space at Honeysuckle House comprises of a large kitchen, dining room and lounge. The gardens are landscaped and easily accessible. Beech Spinney also has use of a resource centre that boasts an indoor pool and a fully equipped sensory room. The service is block purchased by Telford and Wrekin. Weekly fees equate to 2539.73 pounds. People contribute towards this based on an assessment of their individual financial circumstances. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We carried out this key unannounced inspection on Tuesday, 23 June 2009. The inspection started at 9.45 am and finished at 6. 15 pm. Because of previous concerns we have had about medication, our pharmacy inspector carried out an inspection of medication management the following day on 24 June 2009. As the inspection was unannounced nobody knew that we were coming and they were therefore unable to prepare. As this was a key inspection, the plan was to assess all national minimum standards defined by us, the Care Quality Commission as key. These are national standards, which significantly affect the experiences of care for people living at the home. Care Homes for Adults (18-65 years) Page 6 of 30 Before the inspection, we prepared for it in a number of ways. We sent for the services Annual Quality Assurance Assessment or AQAA. This is a legal document that was returned to us in time and told us what the service feels it does well, what it needs to improve and how it intends to do this. We also sent out surveys to people living and working at the home as well as to people who visit the home in a professional capacity. We included surveys for relatives with those that we sent to the service. As part of the planning prior to inspection, we also looked at information we hold about the services history. This included reviewing information obtained at our last visit which was a random inspection in March 2009. At that inspection we had focused on safety issues connected with moving and handling and medication guidance. During the course of the inspection we used a variety of methods to make a judgement about how people are cared for. People living at Beech Spinney are unable to verbally tell us about their experiences living there. Therefore we observed care, interviewed the manager, talked with two assistant managers, the senior on duty as well as five other staff who work in care and non care roles. In addition, we looked in detail at the care provided to two people by using documentation and discussion with staff and managers. Furthermore, we looked at what steps were being taken to ensure the home can meet the needs of someone who has applied to have respite care there. We sampled a variety of other documentation related to the management of the care home such as staff training, recruitment, accidents, complaints and equipment maintenance. We also toured the premises to see how the environment is meeting the needs of people who live and stay there. As the manager was in a meeting at the end of the day, we telephoned her the following day to provide her with feedback. All this information helped to determine a judgement about the quality of care the home provides. What the care home does well: What has improved since the last inspection? What they could do better: The service has provided contracts of residence to people who live permanently at Beech Spinney. Some omissions in the contracts have been identified. Also contracts should be issued to people who have respite at Beech Spinney. People have started to be involved in grocery shopping. This is very positive but should be reviewed to ensure it is meaningful for those who take part. Care Homes for Adults (18-65 years) Page 8 of 30 The manager is aware of the need to personalise the communal areas of the home to detract from its hospital feel. More training should be provided in the use and maintenance of the suction machine. Complaint and training records need to improve to provide greater accountability. Confidential records about people who live in the home must always be stored appropriately. Since pointing this out to the manager at inspection, remedial action has been taken. The organisation needs a policy to guide managers and staff in the implementation of new deprivation of liberty legislation. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. Evidence: Brochures with information about the service have been recently reviewed and are up to date. They were easily located for us in the office but they would be useful if on display in the entrance for people to freely access. People who live permanently in Honeysuckle House are a stable group and there have been no discharges or new admissions. Thistle Lodge which provides respite care has also not had anyone new admitted but are in the process of assessing someone with a view to providing respite if they feel they can meet this persons needs. This person has very unique and complex needs Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: and we could see that everything possible is being done by the service to ensure they can safely meet the assessed needs before the first stay takes place. Alot of information has been gathered from a wide range of sources and managers have participated in multi agency meetings. The young person has visited on three occasions to date and it was positive to see steps staff had taken to help her to feel welcome and settled. Time is being taken to source appropriate equipment and an application has been appropriately made to the Local Authority in relation to the use of this equipment, under new Deprivation of Liberty safeguards. At the last inspection we found that people receiving a service had not been provided with contracts of residence. Some steps to address this have been taken although there is more to do. The organisation should ensure that all required contractual information is included and that where possible formats are accessible and steps taken to help people to understand their contracts as far as is possible. People who receive respite care have not been provided with contracts. Also peoples rights and responsibilities in relation to breach of contract or termination of placement are not included for people to know about and understand. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life with support if they need it. This is because the staff promote their rights and choices. Evidence: Written information is in place to help staff know how to support peoples care needs and minimise risks. This information is detailed and up to date and is written respectfully and positively and considers peoples individual preferences and needs. Staff that we spoke to are aware of the guidance. For example they could tell us how people communicate when they cannot do so verbally and how these people make choices. One persons care plan we looked at listed the birthdays of people significant to him. We could see from this that it was his Moms birthday on the day we were inspecting. We could see the effort being made by staff to support him to mark the occasion of his moms birthday. A manager had come in on a day off to drive him to Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: his moms and to transport a large and special present to her at home. Another staff member was preparing to support him to spend that day in Shrewsbury with his mom on her birthday. At the last inspection we asked the home to develop ways of communicating with people. We can see that staff know people very well and can interpret signs and signals they make. For example distress indicated by one person was promptly recognised and medical advice sought leading to a diagnosis of a medical problem and a positive outcome for the person. Additional steps are being taken to develop individuals communication tools further and the service is working with speech and language therapists currently. There is a proactive response to the management of risk and people are safer as a result. We found that confidential medical information relating to an appointment about one resident was not appropriately stored. We did not become aware of any further similar matters but as the manager had not been aware of this, we have asked her to conduct a review with all staff members to ensure that confidential information is stored appropriately at all times. Since inspection action taken to resolve this has been provided to us. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. Their dignity and rights are respected in their daily life. People have healthy, well presented meals that meet their individual needs. Evidence: When we arrived everybody who lives in Honeysuckle House was at home although everyone had plans for the day. As referred to earlier, one person was being supported to spend the day out with his Mom on her birthday. Other people were having pamper sessions and enjoying the garden under the gazebo, which staff put up for them. We can see that people are engaged in meaningful activities daily, enjoy regular Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: contact with family and go out to do things they enjoy. In the space of ten days we could see that someone had been into the countryside to watch the sunset, had been to the Severn Valley Railway, out shopping and for lunch, had been for a walk locally and had spent the day at the coast. In addition they had had telephone contact with a parent in addition to enjoying three visits. In this time period, the person whose care we were looking at in detail had also been to a night club. All the activities he had taken part in complied with what his care plan told us about the things he enjoys doing. Last year a holiday was organised in haste and people had little input into choosing their holiday. Everyone went together. This year two separate holidays have been organised and this will ensure that two people who do not enjoy each others company, can holiday separately. The service has positively responded to our feedback about identifying and meeting peoples spiritual needs. Everyones faith has been defined and a local pastor has begun to visit regularly. This is because the local church is not accessible to people who use wheelchairs. The acting manager told us that there are plans to hold services in a local school and that if this happens, people who want to will be supported to attend. If not alternative options should be considered. Meal times are flexible. We could see that one person had her breakfast after other people because she had had a lie in on the morning of our visit. The service has started to take on board the need for people to be more involved in food shopping. People are tentatively beginning to accompany the cook to the supermarket. This is a positive development. It is not clear that this is currently a meaningful activity in which people are fully engaged but as a new project needs review and improvement. Pictorial menus are not available for people yet but we were told that a meeting has been held about how to implement this. People are not actively making choices about the meals they eat, but we learned that the cook asks care staff if people enjoyed new recipes before she includes them on the menu. In addition, since we last visited two people have been assessed as having difficulties swallowing, with one person being at severe risk. Staff we spoke to are aware of this and how to minimise this risk. We spoke to the cook who is also aware of how to meet these changes in dietary need. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. People are safely supported to receive their medication in accordance with prescribing direction which promotes peoples health and welfare. Evidence: Peoples personal care needs are being met as they are receiving regular support with this and present as clean and well groomed. Documentation supports this to ensure that such care is monitored. The number of incidents and accidents has reduced. Since we last inspected there have not been any moving and handling incidents and neither have there been any errors in the administration of medication. The service is liaising with a wide range of health professionals to meet peoples health needs. People are being supported to attend specialist appointments which are pertinent to them and are also receiving routine health screening. The person whose Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: care we looked at had had an optician and dental appointment recently. Two people had had tests at the hospital to determine the level of risk to them from swallowing and advice has been acted upon. Another person is being supported to reduce his medication under medical authorisation and is being closely monitored. We could see that where another persons health changed, staff were quick to notice this by recognising signs of distress. Medical assessment and treatment were obtained without delay. The manager told us that she intends to further develop and improve health provision by working with health partners to use a new health assessment tool which will be completed for each individual to help to identify emerging health needs and trends. She said health action plans will be developed from the results of these new assessments. We found that the receipt, administration and disposal of medicines for the people who are using the service are being recorded accurately and showed that people are taking their medicines as their doctor had instructed. We found that there is some confusion as to how the carry forward of medicines should be recorded on the Medicine Administration Record or MAR charts. This was explained by the inspector during the inspection. We also found that at every handover the appearance of the Monitored Dosage System (MDS) and the quantity of the regular non MDS medicines are being checked to see that the medication had been administered to the person concerned. It was reported that this process was taking a long time to complete. A discussion took place about streamlining the process and it was proposed that the medication check is done daily. The home was advised to do the check in the afternoon so that if there are any problems then there will be medical staff on hand to give advice. We also found that the home is accurately maintaining a record of when medicines leave and return to the premises. We found when examining the care files of people who live at Honeysuckle House that the home has protocols for the administration of all when required medicines. These protocols had been verified by the persons doctor and the community learning disabilities nurse. These protocols, where appropriate, specified actions to try before resorting to the administration of medicines. We found at Thistle Lodge that the when required protocols are not in place. The production of these protocols were more difficult because the people who use the service are not permantly in the home and the issue of mental capacity differed from one person to the next. The inspector, after seeing the examples at Honeysuckle House, is confident that overtime these protocol will be put in place for all people using this service. We also found in Honeysuckle House that the care plans contain information about all of the medicines prescribed and include why the medicines had been prescribed and what the likely side effects Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: are. This sort of information is not available in Thistle Lodge but again the inspector is confident that as people visit the home over time this information will be provided. We found that the home is assessing the competency of those staff administering the medicines to the people who use the service every three months. We found that at both Honeysuckle and Thistle, the Controlled Drugs cabinets had been properly installed. At the time of the inspection there were no Controlled Drugs being held by the home. We found that the home is monitoring the maximum and minimum temperatures of the medication fridge on a daily basis. We found that the temperature of the fridge is not being kept at between 2 and 8 degrees centigrade but was not a concern at the inspection because the fridge was empty. The manager was asked to remind staff of the correct temperatures so that when a medicine is required to be kept at between 2 and 8 degrees centigrade the fridge is ready to accommodate this. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. Complaints have been resolved to the satisfaction of complainants, although a more robust approach to the administration of complaints records is required to provide greater accountability and assurance that complaints are managed well. Evidence: In the previous 12 months there have been three complaints. The third complaint was a repeat of a complaint referred to in an earlier two part complaint which had not been addressed. All matters have now been resolved to the satisfaction of the complainants. Complaints have referred to lack of dental care and lack of access to transport. More recently complainants have acknowledged improvements in the quality of care provided. Complaints records do not always evidence best practice. Complaints records should demonstrate greater transparency and a clearer audit process is still required. There have also been five safeguarding investigations undertaken by the local authority although only three of these directly related to the service at Beech Spinney. Following investigation by Social Services, none of the allegations were upheld and all safeguarding matters are now closed. We spoke to staff who have had safeguarding training. They understand what abuse is Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: and their role should they have any concerns. Staff we spoke to did not have any concerns about peoples protection and felt very strongly that people living and staying there are safe. Physical intervention or restraint is not used. Staff that we spoke to have a clear understanding that this method is not needed at Beech Spinney to support peoples behaviours. Staff were clear that behaviour is a form of communication and that distraction is sufficient. Advice of a behavioural nurse has been sought and written guidance about how to manage peoples behaviour is very detailed and clear. We looked at financial records and can see that systems are in place to safeguard peoples money and possessions. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are clean, tidy and well maintained. Premises are well equipped to meet peoples needs and provide spacious and safe accomodation. Evidence: The environment and equipment within it continues to meet peoples needs and steps have been taken to address an issue we identified last time. An additional grab rail has been fitted to a toilet to reduce the risk of falls and there has not been a repeat incident of this nature. The advice of an occupational therapist has also been sought who made a further visit to the home on the day we inspected to discuss a number of equipment options to ensure the toilet can be used safely. The manager agreed that although bedrooms have been decorated in colours of peoples choice, more still needs to be done to make communal areas of the home more stimulating and less like a hospital. The garden however is pleasant and colourful with wind chimes for stimulation. People had been enjoying the nice weather by sitting under a gazebo in the garden. Since we last visited people have had their photographs taken and these are displayed in the lounge, which has helped to personalise this room making it feel like a home to the people who live there Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: Much thought has gone into how the service can provide equipment needed for someone being considered for respite care. A plan has been agreed in partnership with the local authority as equipment will need to be moved in and out for each and every stay. The premises are clean and fresh and free from evident hazards. Copious protective equipment is available in each persons ensuite so staff can minimise the risk of cross infection when providing personal care. Clinical waste is managed well. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by an effective staff team who understand and do what is expected of them. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. Evidence: We spoke to a number of staff working in different roles. Everyone is very happy with how the service is developing. They feel that they are being well trained and supported and feel that they are now providing a good service to the people who live there. One staff member told us that she feels enriched working at Beech Spinney. Another staff member said based on outcomes for the people living there, the service should be rated as excellent given the level of staff committment and that in her words, it is all about the service users. We noticed that staff understand peoples needs well and interpret these well. An example being when they recognised a persons distress and called for medical assistance. A representative of the service when carrying out a monthly visit to the service reported that, it was very clear from their interaction that service users felt very comfortable in the presence of the staff on duty, who were sensitive in how they responded to peoples views. We could see that as a staff member has left, the service is shorter of permanent staff Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: than when we last visited. However our observations, discussions and random samples of the rota showed that staffing levels are being maintained. It is positive that to meet one persons changing needs additional staff have been provided. Also we reported at the last key inspection that the manager was concerned that night staffing levels were potentially unsafe. This has been reviewed and an additional waking night staff member is being provided until a permanent decision is made about this. Agency staff are being used frequently to ensure sufficient staff are provided. A new agency is supplying temporary staff and permanent staff spoke highly of the quality of staff provided by this agency. This agency is providing a written profile of each staff member it supplies and this is a positive development as it assures the home that these temporary staff have been suitably checked and trained to work with vulnerable people. Staff told us about the training they have received and they have been supported to attend a wide range of training in a short time. Training records continue to not always accurately relect this. At the time of our random inspection in March 09, we found some people including the manager had not done moving and handling training. This has been completed now. We looked at whether training in the use and maintenance of a suction machine has been provided. We did this as twelve months ago a complaint was made about its use. We could see that most staff have not received this training and those that have, did so in 2007. It is important that this is addressed. We looked at how two staff had been recruited and were assured that all steps necessary had been taken to meet regulation and to protect vulnerable people from the risk of new staff who may be unsuitable. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the care home because it is run and managed appropriately. The environment is safe for people and staff because health and safety practices are carried out. Evidence: Since the last inspection, the acting manager has submitted an application to us to be considered for registration. The acting manager reported feeling well supported by her managers and staff team. Likewise, everybody we spoke to, reported feeling well supported and directed by the acting manager. Staff told us that they appreciate the manager working alongside them and that every morning on arrival, she first checks the welfare of all the people who live there, and then enquires about the wellbeing of the staff on duty. Since the last inspection, the manager has completed training in moving and handling and the deprivation of liberty safeguards. She demonstrated a good understanding of her Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: responsibilities for safeguarding peoples liberties under the new legislation. Moreover, she has had early experience of referring a potential deprivation to the managing authority to request authorisation to implement safeguards which may have implications for the persons liberty. It is important, that the organisation now develops a deprivation of liberty policy to support the service. However, in the meantime it was positive to see that managers had downloaded Department of Health guidance. Quality assurance systems have not been fully developed to support the service to assess and monitor its own performance and quality. Currently, there is a piecemeal approach to this. However, it was positive to see that some questionnaires had been sent out to some people who use the service. Nine had been returned to the home and all nine showed a good level of satisfaction with all nine respite customers saying that they had enjoyed their stay. Feedback questionnaires should be developed to include people and relatives using Honeysuckle House. In addition we sent surveys to people who receive care and accommodation. Staff ensured that people were supported to complete these by independent advocates. This is good practice. In addition, it is positive to see references to service improvements acknowledged within communication from complainants. A staff member worked with us to show us that sufficient steps are taken to ensure that equipment and facilities are appropriately maintained. We looked at service records for fire equipment, moving and handling equipment, gas and electricity as well as water and cold food storage temperature management. Everything that we sampled was appropriately maintained with up to date service records. The only exception to this was gas certification. However, since inspection and prior to writing, action has been taken to remedy this. When we were looking at care documentation, we found records of one medical appointment for one person missing from the premises. Enquiries showed that for a number of reasons including lack of access to a computer, the record had been completed and stored away from the premises. The manager had not been aware of this. Since inspection and prior to writing, she has demonstrated to us that she has taken steps to ensure that this does not happen again. This will ensure that confidential information about people is always handled appropriately. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 22 A complaints log should be available and should be maintained. This should record the date the complaint was received, the name of the complainant, the nature of the complaint in brief, the date of any correspondence, the date the complaint was resolved and whether the complaint was upheld, unresolved, partially upheld or not upheld. Staff should receive training in the use and maintenance of the suction machine New recommendation from this inspection. 2 35 3 39 A holistic quality assurance tool should be developed to support the service to assess, monitor and respond to the quality of service it provides. This will ensure ongoing service development and improvement. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!