Care Home: Beeches (The) (Seven Kings)

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What the care home does well What has improved since the last inspection? Since the last inspection a number of staff working in the home have either achieved National Vocational Qualification Level 2 or 3 in Care or they were working towards it as well as completing mental health awareness training. All staff are also registered on the City and Guilds mental health training course. There is a good recruitment procedure that clearly defines the process to be followed. The manager has ensured that records of all medication received into the care home was now maintained. What the care home could do better: The registered person must ensure that external grounds which are suitable and safe for use by service users are provided and appropriately maintained. The registered person must ensure that monthly unannounced visits to the home take place in order to form an opinion of the standard of care provided in the care home. A written report must be prepared and made available for inspection at the home at any time. CARE HOME ADULTS 18-65 Beeches (The) (Seven Kings) 45 Norfolk Road Seven kings Ilford Essex IG3 8LH Lead Inspector Ms Harina Morzeria Unannounced Inspection 23rd April 2008 11:30 Beeches (The) (Seven Kings) DS0000068828.V362171.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 Beeches (The) (Seven Kings) DS0000068828.V362171.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. Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beeches (The) (Seven Kings) Address 45 Norfolk Road Seven kings Ilford Essex IG3 8LH 020 8590 4340 020 8590 4340 thebeeches_7kings@yahoo.co.uk 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) Tealk Services Ltd vacant post Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 10 adults (MD) Mental Disorder with associated Mild Learning Disabilities. 1st November 2007 Date of last inspection Brief Description of the Service: The Beeches (Seven Kings) is a care home registered to provide personal care and accommodation for individuals between ages 18-65 with a history of mental illness, who need support in order to live in the community. The home is located on a residential street in Ilford and is close to all community facilities. These include a wide range of shops, pubs, the post office, town centre and parks. The Beeches consists of ten single bedrooms, three of which are located on the ground floor. Access to the first floor is via stairs. There are two reception rooms on the ground floor, one of which is used as a dining/lounge area, for relaxation and viewing television. The second room is mainly used by service users who smoke. A rear garden with a patio area is being constructed with a large room at the back of the garden for service users to use as an activities area when it is completed. It is easily accessible from the kitchen and smoking area. A group of staff are on hand to provide twenty-four hour care and support to service users. A statement of purpose is made available to all service users and/or their relatives in the home and each individual is provided with a service user guide. Fees are charged at £650.00 - £1000.00 per week. Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means that people who use the service experience good quality outcomes. This inspection was unannounced and was carried out as part of the inspection programme for 2008/09. The inspector spoke to the manager and staff as well as service users present at the time of the inspection. A tour of the downstairs part of the premises was undertaken as the whole premises had been checked during an inspection carried out in November 2007. A number of records were checked including staff records and service users’ files. The manager was also asked to complete the Annual Quality Assurance Assessment. Some of the information provided in the assessment has been incorporated into this inspection report. Although effort was made to seek feedback from the Redbridge Assertive Outreach Team, who have two service users placed at the home a response was not received. The Local Authority stated that they did not have any comments to make. What the service does well: Staff continued to work closely with service users to ensure that their needs are met – including their specialist needs. This is so, despite the levels of variance amongst the motivation levels of service users. Feedback from staff when asked what the service does well was, “ supporting and helping service users to maintain their mutual health and be stable and to provide for their primary care”. Service users strengths are developed in achieving an improved standard of life. It is recognised that outcomes for individual service users were based on their individual strengths and choices made. As far as possible all service users are supported to contribute towards the daily running of the home, primarily through informal discussions and key worker sessions. There was evidence that the management and staff continue to provide for the diverse needs of service users, particularly in relation to their cultural, nutritional and religious needs. Staff continue to work at exploring options with service users in motivating them to use community facilities as far as possible. There was evidence of consistency and valuing the achievements of individuals. Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 6 Service users therefore felt at home with the staff and this was evidenced from the service user feedback received. Appropriate care planning systems were in place. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have information, which they could rely on in making a decision to live at The Beeches (Seven Kings). The process of assessment is robust so that people who use the service are assured that their needs would be thoroughly assessed and know that the home they enter will be able to meet their needs. Service users have a statement of terms and conditions/contract which details the obligations of the registered persons in meeting their needs. EVIDENCE: There were no admissions to the home since the last visit. At the time of inspection only three service users were accomodated in the home. As at the last inspection, service users have access to information through the home’s Statement of Purpose and Service User Guide. The Service User Guide details what the prospective service user can expect and gives a clear account of the services provided, quality of the accomodation, qualifications and experience of the staff and how to make a complaint. It is in a format that is suitable to the service user group and provides an option for conversion to larger prints or alternative languages upon request. The home provides long-term placements to people with serious and enduring mental health problems, who are subject to the care programme Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 9 approach(CPA). Hence, mental health professionals, such as community psychiatric nurses and specialist social workers continue to remain involved. A preliminary assessment of a prospective service user is undertaken prior to admission. The assessment is conducted professionally and sensitively and involves the individual and their family or representative where appropriate. The findings from these assessments feed into a transitional service user plan. As part of the admission process assessment information is also gathered from the referring agency as required by Regulation. A thorough sharing and examination of information of the person’s past history is undertaken and the impact of this person’s admission into the home and on the other service users is considered. The inspector was informed that a clinical consultant is employed and will be involved in the initial assessment process for each new service user and guide the team when any information is required or any issues arise with any service user. Each service user has a signed contract setting out the obligations of the provider and the service user and this included details of a trial stay. This document outlines the obligations of the registered provider as well some of the key rights of the service user. Service users sign their statement of terms and conditions, along with the registered manager and this confirms acceptance of the document by both parties. Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each service user has a care plan which is detailed and tailored to meet individual needs. Service users are consulted and involved in decisions affecting their lives and are reassured that information held on them is handled in line with the home’s policy on confidentiality. Service users are involved in negotiating their daily routines and objectives and are encouraged to live life to their full potential subject to a risk assessment. EVIDENCE: At the time of the inspection, three service users were accomodated in the home and there have been no new admissions to the home since the last inspection. Although all service user plans were examined, one service user plan was checked in detail as this was incomplete(transitional) at the time of Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 11 the last inspection. The service involves the individuals in the planning of care which affects their lifestyle and quality of life. The staff encourage individuals to make their own decisions and choices. They use methods that enable the person to lead a full life that promotes independence and choice. The file examined showed that an initial assessment was carried out by the manager following a referral and another assessment of need was undertaken during the introductory period. The findings from these assessments feed into a transitional service user plan which is transformed in to a detailed care plan once the trial period for each individual is over. All the service users are subject to the Care Programme Approach and have appropriate professionals involved in their future care. The care plans examined were individualised and person centred and based on each person’s specific needs, outlining how these will be met by staff. The care plans give details of how each person likes and needs to be supported. There was evidence to show that the service users are involved in the development of their care plans. Evidence was seen of one to one discussions held with the service users showing that staff work consistently with the service users to achieve their goals. Evidence was seen that for the most recently admitted service user, the care plan describes the person’s behaviours, why they may exhibit these behaviours and what to do if they have a mental health breakdown. This will ensure that all staff have correct and full information about individuals and how to work with them. The manager and key worker review service user plans monthly, three monthly and six monthly. Evidence of initial reviews taking place was seen during case tracking. A key worker system allows staff to work on a one to one basis and contribute to the care plan for the individual. From observation on the day of inspection, it was clear that the service users are given good support from the staff in making decisions about their daily routines and lives. The service users are involved and consulted on various aspects of life in the home. Evidence was seen of service user meetings planned, however only some meetings are attended but others do not take place as service users are not always willing to attend the meetings. Informal ways of seeking people’s views are used such as during outings or when undertaking activities in the home. Suggestions are sought about activities, furnishings, menus and health and safety. Service users also express their views informally and in key-worker sessions. On the day of the inspection, the inspector noted that one person really enjoyed the one to one interaction with the staff members whilst knitting together and staff were seen undertaking this activity with her. They were also very supportive and reassuring her as she had an appointment with the hospital consultant and was therefore very anxious. Each plan includes a comprehensive risk assessment, which is reviewed regularly. These are carried out in discussion with service users and relevant Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 12 specialists. These identify risks for the service users and indicate ways in which the risks can be reduced. The inspector was informed that all known risks have been risk assessed and evidence was seen on file that risk assessments are in place. This would ensure that staff are fully aware of the risks posed by individuals living in the home and what action will be required to minimise identified risks and hazards, enabling all service users to lead independent and safe lives. There is a policy in place in the event of a person going missing from the home and staff are made aware of it. Service users’ records and other information is stored in a lockable cabinet in the office and staff are aware of issues of confidentiality. Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities for social and leisure pursuits and personal development are actively promoted and supported by staff for all service users to enable them to participate in the wider community in which they live. Service users are provided with varied and nutritional meals, staff promote healthy eating and individual preferences are catered for. Visitors are made to feel welcome in the home and service users are supported to maintain and establish family links and friendships. EVIDENCE: Service users have access to a range of leisure activities and staff were seen to work hard to motivate people to become involved in their chosen activities. An activities room is being built at the back of the garden area and when ready, will be used for in house activities. Currently all the service users are independent, choosing to carry out their own activities. They all have leisure passes which they can use to access recreational and fitness facilities. One of Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 14 the service users spoken to stated that she enjoyed attending the day centre and on the day of the inspection was going to a local church to work in the kitchen preparing meals. She proudly pointed out the she had completed food hygiene training which meant she can now work in an area she enjoys. Photographs were seen of her receiving her award on the wall as well as of other trips undertaken by the service users. All the service users’ have individual activity plans and individuals are supported to identify their goals and work to achieve them. This was evident with one service user who completed food hygiene training which enables her to work voluntarily. One other service user goes to an Asian day centre where she has an opportunity to meet other people from a similar background and participate in a variety of activities such as reflexology, yoga and arts and crafts. Staff also support her to pursue activities in the home such as knitting and crochet as well as cooking Asian food and listening to Asian music. Hence, the routines for daily living are flexible and the service users can make choices in major areas of their life. The routines, activities and plans are individually focused and can be quickly changed to meet the individuals changing moods, needs, choices and wishes. The manager and staff are aware of and actively promote the rights of the service users to make informed choices, providing links to specialist support when needed. This includes developing and maintaining family and personal relationships. Family and friends are welcomed and their involvement in daily routines and activities is encouraged with the service users’ agreement. The service users are offered a key to their own bedroom which can be locked from inside and outside. The key to the front door of the home is offered subject to a risk assessment. At the time of inspection none of the service users had the front door key but did have the keys to their own rooms. A community risk assessment is in place and staff interact with service users constantly so that they are aware of the risks to service users when out in the community and are aware of the company they keep so that they can be given appropriate advice when going out. Service users are also involved in the domestic routines of the home. They take responsibility for their own room, planning and cooking meals, making sure they are able to enjoy the food they prefer and like. Menus are planned in advance. Staff prepare and cook meals with involvement from the service users and the menu for the week ahead is discussed at the weekend. However, the menu is very flexible as most of the service users change their minds on the day and are therefore offered alternatives. One of the service users is vegetarian and is supported to shop for Asian vegetarian food items and encouraged to prepare it by the manager and the staff so that her dietary needs can be met appropriately. The kitchen is accessible to the service users at all times and appropriate food stocks are purchased with the involvement of the service users. They accompany staff to do the shopping. Service users can choose when and where to eat but usually eat in the dining area. Most of the staff now involved Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 15 in handling food have completed food hygiene training to promote the health and safety of the service users. Advice was given the manager to ensure that all staff whether full or part-time or agency to complete the basic training including food hygiene. As part of promoting their rights, service users have access to advocacy services, and they are given advice about how to access these services. The service users also have social workers and families who can advocate on their behalf. They are also aware that they can have access to independent advocacy services if they wish to contact them. Visitors are encouraged to visit at any reasonable time and are encouraged to see their relative/friend in the lounge or another room in privacy. There was evidence that one service user’s son visits her daily and he takes her out at the weekend, she also receives visits from her extended family. One other service user has begun to see her mother and sister on a regular basis and evidence of regular visits taking place was seen. Beeches (The) (Seven Kings) DS0000068828.V362171.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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are prompted and encouraged to take responsibility for their own personal care. The service users’ physical and emotional health care needs are monitored and this ensures that service users’ needs are recognised and met. The medication policies and procedures are clear. Staff have undertaken medication training in order to ensure the safety of the service users. EVIDENCE: The service user plans examined show that the physical and emotional needs of the service users are identified and strategies were in place to provide support for each individual. Service users receive personal support in a way they prefer, with encouragement provided to enable them to carry out their own personal support tasks in a way that maintains their independence, privacy and dignity. Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 17 There was evidence that service users’ needs, based on assessments, were recorded and they were carried out to promote their health, safety and welfare. Staff have completed training in working with people with mental health issues and are therefore able to observe changes in the general and specific healthcare needs of service users and make interventions as appropriate to ensure their health and safety needs are met appropriately. Staff have now received specific mental health training in order to recognise and deal with mental health breakdown. The service users were all registered with a GP and records seen indicated that they had input from other health professionals such as the dentist, chiropodist and the opticians. On the day of the inspection the inspector was informed that one of the service users became unwell and has been admitted to hospital. Staff attend weekly ward rounds and reviews to discuss his progress and possible discharge on a phased basis. The manager stated that as far as possible service users are given the opportunity to independently attend their appointments, as part of taking responsibility for their own healthcare. At the time of the inspection all three service users required support from staff to attend any health care appointments. Records were maintained where service users attended health related and professional appointments. Service users may see professionals privately in their rooms or in one of the offices at The Beeches. A medication policy and procedure are in place. Medication records are completed, contain required entries and are signed by appropriate staff. Staff handling medication, have had training in the handling and administration of medication, with further training specifically targeted to deal with service users with mental health needs and includes specific training regarding medication interactions and reactions as well as side effects of many of the anti psychotic drugs taken by service users with mental health needs. Medication storage was satisfactory as was the recording of drugs administered by staff. Accurate records are kept of all medicines received, administered and leaving the home or disposed of in order to ensure that there is no mishandling. Evidence was seen that all staff received in house updated medication administration training in March 2008. Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 18 Beeches (The) (Seven Kings) DS0000068828.V362171.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): 22,23 People who use the 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 manager and staff make every effort to sort out any problems or concerns and make sure that the service users feel confident that their complaints and concerns are listened to and will be acted upon. Staff working in the home have received training in safeguarding adults in order to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has policies and procedures for dealing with complaints. The complaints log was examined and no complaints have been recorded since the last inspection. The complaints procedure is that all complaints verbal and written, would be recorded with details of investigation, any action taken and the outcome for the complainant. The service users know what to do if they were unhappy about anything in the home and said that they would speak to the manager or their key worker. The complaints policy is displayed in each room and the corridors, with information about how to contact the Commission, if the complainant remains dissatisfied with the outcome of any investigation. There is a written policy and procedure for dealing with allegations of abuse and whistle blowing. Staff, as part of their induction are taken through the Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 20 adult protection guidelines of the home and a copy of all the relevant Local Authority Adult Protection protocols is kept in the home for the guidance of staff. All staff working in the home have now received training in safeguarding adults and staff were aware of the action to be taken if there were concerns about the welfare and safety of service users in order to ensure that there is a correct response to any suspicion or allegation of abuse. The training provided includes discussions with the staff team about their duty to balance the rights and choices of people living in the home, with a legal duty to safeguard and protect service users. Beeches (The) (Seven Kings) DS0000068828.V362171.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): 24,25,26,27,28,29,30 People who use the 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 home provides a comfortable environment for service users, with wellmaintained communal spaces. Service users bedrooms are suited to individual tastes/preferences and promote their independence. The décor, furnishings and fittings in the home are of a good standard and the home is clean and hygienic. EVIDENCE: The home was newly registered in January 2007 and has been altered to provide spacious facilities with all furnishings and fittings in place. On the day of the visit the home was clean, tidy and in good decorative order. Service users contribute to the maintenance of some aspects of the communal areas as well as their private spaces. Only three service users were accommodated at the time of this inspection. The inspector noted that eight rooms have en-suite facilities and two service Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 22 users will share a bathroom/toilet which is located upstairs between two rooms. All bedrooms are lockable and have lockable space for the storage of valuables. A good standard of cleanliness was found in all parts of the home. Laundry facilities were satisfactory and policies for the control of infection were in place. Service users are involved in doing their laundry as part of maintaining their independent living skills and most were quite happy with this. Hand washing facilities were appropriately placed throughout the home and the services and facilities complied with the Water Supply Regulations. In order for the home to be registered the premises underwent a thorough check from all relevant authorities and met the requirements of the local fire service and environmental health department, health and safety and building Regulations. None of the service users currently accomodated need any specialist equipment at present. An exterior building has been built to provide additional space for leisure facilities. The building was almost ready at the time of this inspection however it is yet to be decorated and equipped before it can be used for its stated purpose. This area must be ready for service users to enjoy during the summer as building works have been on going there for over a year and need now to be completed. A requirement has been made. A large decking area has also been converted for the service users which can be used during fine weather. Beeches (The) (Seven Kings) DS0000068828.V362171.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): 32,33,34,35,36 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive care and support from a committed and motivated staff team. The staff team are receiving training that is appropriate to the needs of service users. Staffing levels are adequate to meet the individual needs of the service users at all times. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. EVIDENCE: Staff observed during the course of the inspection demonstrated good commitment to supporting each service user in the home. They understood the needs of the service user group and were skilled listeners and work well in motivating them. Service users spoken to said they were happy with the efforts of staff stating that the carers listen and act on what they say. Ninety per cent of the staff had achieved at least an NVQ level 2 in care and three staff are in the process of completing NVQ level 3. The staff team is Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 24 mixed in terms of ethnicity and this provides a solid platform for meeting the diverse needs of the service user group. Records assessed indicated that staff maintained positive relationships with professionals in the best interests of individual service users. Feedback forms received from staff confirms that they were provided with training that was specific to meet the needs of the service user group they are looking after e.g. managing challenging behaviour and mental health awareness. Hence, they have an understanding of mental health issues in relation to the diagnosis and the needs of service users currently accommodated in the home. The manager stated that as part of the home’s development plan they have now appointed a clinical consultant to provide support and guidance to the staff group when dealing with specific mental health issues. It is envisaged that this person will also be involved in the initial assessment process as and when needed. Staff have also received training regarding drug use and its effects and interactions, particularly with prescribed medication so that they can better understand the needs of service users. Staff have been making contacts with external professionals as and when the need arose in order to ensure that service users get specific support when they most need it. The manager is aware that this level of training must be maintained for all staff including newly recruited staff. The AQAA(annual quality assurance audit) states that the registered person aims to provide more relevant training to the staff as well as recruit gender specific staff to balance the staff team. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and the changing needs of the people who use the service. The normal pattern of cover is for two people on both the early and late shifts, including the manager on the early shift. The manager informed the inspector that when she is out at meetings or doing assessments, a second member of staff is scheduled to cover the shift, ensuring that there are always two people on duty at any time. At the time of inspection night cover was provided by one person doing waking nights, and one person sleeping in as the number of people accommodated has been reduced to nine, to allow for one bedroom to be used for staff accommodation. The manager is aware that staffing levels must be kept under review and increased as the number of service users accomodated in the home increases. A lone person working risk assessment has been carried out and staff are aware of actions to take in an emergency when working alone. This must always be kept under review as differing situations may arise needing different reactions from the staff team. Staff have now completed food hygiene and safeguarding adults training as well as medication administration training. There is a programme of individual supervision. Staff records seen and feedback forms received confirm that they receive regular supervision from the Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 25 manager. Supervision covers philosophy of care, care practice and training & development. This meets the minimum requirements of this standard, and staff are able to informally meet with the manager as she makes herself accessible to them. They also use the team meetings which are held regularly as another way gaining support. The manager demonstrated a good understanding of equality and diversity issues throughout the recruitment, induction and training process. The daily records are now reflective of discussions held with service users and how staff are progressing with the individual care plans. Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 26 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): 37,38,39,40,41,42 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a home which is well-run and are supported by a manager who is experienced but not yet registered with the Commission. Service users’ rights and best interests are safeguarded by the home’s recordkeeping policies and procedures. Service users’ and staff health, safety and welfare are adequately promoted and protected. EVIDENCE: Since the last inspection in November 2007, an experienced new manager has been employed. The manager has yet to be registered with the CSCI by the Commission’s Registration team and has a ‘fit person interview’ booked. She has experience of working as a manager in a care home for over ten years and Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 27 has worked in the care field for over twenty years. The manager informed the inspector that she is undertaking the Registered Managers Award and VRQ 3 qualification in Mental Health. A deputy manager is also employed who has completed the RMA and NVQ4 course and the NCFE 2 in health and nutrition. The manager leads and supports the staff in all areas of running the home. The manager is aware of current developments both nationally and by CSCI and plans the service accordingly. The AQAA contains clear, relevant information that is supported by a wide range of evidence. The AQAA lets us know about changes they have made and where they still need to make improvements. The manager is supported by the operations manager and the provider to run the home. Service users and staff commented that the manager and operations manager always make themselves available and deal with any issues to the best of their ability. The following feedback was received from staff, “ excellent manager who works hard and tirelessly to achieve excellence, support, guidance to staff and service users”. “Manager is approachable, works as part of the team.” The manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. There is a business and annual development plan in place. There is a quality assurance policy and procedure in place, which would include seeking the views of the service users regularly via holding the service user meetings and feedback questionnaires. The operations manager checks the quality of care in the home through monthly Regulation 26 monitoring visits. However, the inspector noted that the last report available at the home was dated in January 2008. The registered provider must ensure that unannounced visits as required by Regulation 26 take place at least once a month and a written report on the conduct of the care home is prepared and made available to the CSCI upon request. A requirement has been made. The home works to a clear health and safety policy, all staff are fully aware of the policy and are trained to put theory in to practice. The home’s standardised policy and procedures files is available and staff are required to read and sign these on a regular basis. There is a clear organisational structure that is available to staff, service users and their relatives. The operations manager supervises the registered manager and this is in line with Regulation. Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 28 Checks show that the home’s records were found to be up to date and secure with confidential files stored in locked cabinets. A range of records were looked at including fire safety. There was evidence that actions were taken to promote the health and safety of service users and this included staff training in health and safety and individual training records reflect this, safety signage, fire drills and procedures, risk assessments on safe working practice topics, fire training for staff and the maintenance of updated gas and electrical certificates. COSHH risk assessments are carried out. People are supported to manage their own money where possible. Where this is not possible there is a clear reason why. Individuals can have access to their records whenever they wish. Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 2 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 2 3 3 3 x Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA28 Regulation 23(O) Requirement Timescale for action 31/07/08 2. YA39 26 30/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection London Regional Contact Team 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Beeches (The) (Seven Kings) DS0000068828.V362171.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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