Care Home: Belamacanda

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What the care home does well The home actively encourages residents to be involved in the running of the home, and making decisions about their daily lives (e.g. through involvement with care plans, key workers, residents` meetings, quality assurance processes, etc.). A particularly good example of this was that a resident representative attended staff meetings. The home encourages contact with family and friends. Residents reported that they could receive visitors at any time. Relationships within the home are supported by staff, and one resident described the home as feeling like being in a "big family, it has changed my life". Another stated "This home never chose me , I chose it!" The home provides a good range of activities, social, leisure and educational, both inside and outside of the home. Several residents spoken to were particularly positive about a recent holiday to Euro Disney in France that some residents had gone on, and a computer (with internet facility) is available for residents` use in one of the lounge areas.On the day of this inspection, the home was maintained in a good condition. Residents were receiving good care and support, and those spoken to enjoyed living at Belamacanda and were positive about the staff team. What has improved since the last inspection? Recruitment processes have improved and all checks are undertaken in an ordered manner and staff only start work once all relevant checks are completed. The home has implemented the use of the Skills for Care Common Induction Standards for new staff. This enables the home to assess and evidence that a new carer has the knowledge and skills (i.e. competence) to meet the needs of residents. Since the last inspection, the home has continued to progress staff NVQ training. Most staff have achieved or are working towards NVQ level 3. At the last inspection the registered provider had implemented a new monthly audit form for the manager to use on a regular basis in the home. This enabled them to review how they were meeting various aspects of the National Minimum Standards, and should assist the home in developing their selfmonitoring processes. This has been maintained and shows a proactive approach to monitoring and developing the home for the benefit of residents. What the care home could do better: Some aspects of the recording of medication details were not satisfactory. It is important that medication administration details are clear in order to protect residents` health and welfare, and also because medication records constitute a legal document that must be accurately maintained. Clear records also protect staff in carrying out of their responsibilities. CARE HOME ADULTS 18-65 Belamacanda 172/174 The Street Little Clacton Clacton on Sea Essex CO16 9LX Lead Inspector Helen Laker Unannounced Inspection 4th September 2008 09:30 Belamacanda DS0000017766.V371161.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 Belamacanda DS0000017766.V371161.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. Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Belamacanda Address 172/174 The Street Little Clacton Clacton on Sea Essex CO16 9LX 01255 862238 01255 861837 belamacanda@blackswan.co.uk www.blackswan.co.uk Black Swan International Limited 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) Michael Ralph Melton Care Home 22 Category(ies) of Physical disability (22), Physical disability over registration, with number 65 years of age (22) of places Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, under the age of 65 years, who require care by reason of a physical disability (not to exceed 22 persons) Persons of either sex, aged 65 years and over, who require care by reason of a physical disability (not to exceed 22 persons) The total number of service users accommodated in the home must not exceed 22 persons 27th July 2006 Date of last inspection Brief Description of the Service: Belamacanda is a large detached property in Little Clacton in the County of Essex. The home offers accommodation for up to 22 service users of either sex who have physical disabilities. Up to 20 service users can be accommodated on the ground floor of the property 12 in single rooms and 8 in double rooms, with 2 further bedrooms on the first floor accessed by means of a stair lift. The communal areas on the ground floor include assisted bathing facilities, a lounge, a sitting room and a dining area. There is a small, enclosed courtyard area, and a garden to the rear of the property contains five sheds that are used for storage and includes a purpose built smoking shelter. There is ample parking to the front of Belamacanda and there is a bus stop right outside the home enabling access to the local community (the home also has its own minibus). The data AQAA submitted by the provider indicated that the fees at the home ranged between £675.00 and £750 per week, with additional costs for personal items (hairdressing, toiletries, contribution towards some leisure activities, etc.). Information on the home is available to residents and prospective residents through the service user guide, a copy of which is available on request and is provided to all residents. Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was carried out as part of the annual inspection programme for this home. The proprietor and manager were available on the day of the inspection. The inspection focused on all of the key standards. A tour of the premises was undertaken. Evidence was also taken from the Annual Quality Assurance Assessment (AQAA) completed by the management of the home and submitted to the CSCI. The AQAA provides an opportunity for the service to tell us what they do well and areas they are looking to improve and/or develop. It is anticipated that improvements or changes be noted as this contributes to the inspection process and indicates the home’s understanding of current requirements, legislation changes and own audited compliance. Ten residents and five staff were spoken with during the inspection. Three staff and one service user completed CSCI’s feedback survey sheets. All comments were taken into account when writing the report. Due to the care needs of the residents at the home it was not possible to fully obtain all their views specifically but from observations, residents’ looked happy, relaxed, well groomed and comfortable. What the service does well: The home actively encourages residents to be involved in the running of the home, and making decisions about their daily lives (e.g. through involvement with care plans, key workers, residents’ meetings, quality assurance processes, etc.). A particularly good example of this was that a resident representative attended staff meetings. The home encourages contact with family and friends. Residents reported that they could receive visitors at any time. Relationships within the home are supported by staff, and one resident described the home as feeling like being in a “big family, it has changed my life”. Another stated “This home never chose me , I chose it!” The home provides a good range of activities, social, leisure and educational, both inside and outside of the home. Several residents spoken to were particularly positive about a recent holiday to Euro Disney in France that some residents had gone on, and a computer (with internet facility) is available for residents’ use in one of the lounge areas. Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 6 On the day of this inspection, the home was maintained in a good condition. Residents were receiving good care and support, and those spoken to enjoyed living at Belamacanda and were positive about the staff team. 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. Belamacanda DS0000017766.V371161.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 Belamacanda DS0000017766.V371161.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 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are supported by the transition arrangements for admission into the home and can be confident they will receive information to enable them to make a positive and informed choice about where they wish to live. EVIDENCE: A copy of the home’s ‘statement of purpose’ had previously been provided to the CSCI and met regulatory requirements. The home also has a comprehensive ‘service user guide’ that was not reviewed as part of this inspection. The director confirmed that a copy of the service user guide would be made available to any interested party, and stated that a copy was provided in each bedroom. This was confirmed when viewing rooms on the inspection and we are informed that this document is regularly reviewed and has just been updated. This enables current and prospective residents to have access to information about the home. Assessment details for three admissions to the home since the last key announced inspection, in July 2006 were reviewed. The manager confirmed Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 9 that the home visits prospective new residents to carry out their own preadmission assessment prior to agreeing any admission, to ensure they can meet the person’s needs. The home records this on a set form, with scope to record brief information on all key areas of need. An example of this was seen on one of the files inspected. It was noted that on each of the three files examined the date of assessment matched that of the day of admission, although in discussion the manager confirmed that visits and consultations had taken place prior to each service users’s admission. Signatures on the assessment confirmed this and the manager also stated that prospective residents are encouraged to visit the home, and can have an overnight stay, in order to check whether they feel the home has the facilities to meet their needs. The home obtains a local authority care management assessment for each new resident however the home voiced concern regarding the quality of these. One local authority care management assessment for a recent admission to the home stated under the heading on the form ‘State all tasks to be undertaken by provider and the degree to which service user needs assistance’, “To have respite and all his care needs attended to”. This is very brief and the home finds this creates some barriers and is unhelpful when determining an accurate picture of the prospective service user and care tasks required to meet their needs. The home provides facilities and staff training appropriate to the needs that the home aims to meet. Residents spoken to were satisfied that the home had the skills and resources to meet their needs. One service user stated “They know exactly how I like things” A staff survey returned also stated that they “understand the person’s needs and provide appropriate care and support.” Belamacanda DS0000017766.V371161.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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to be supported by their care plan arrangements because they are consulted about the things that affect their lives. Residents are protected by the arrangements for the assessment of risk. EVIDENCE: The home has care plans for each resident, covering personal and health care needs, social/emotional and behavioural needs, and needs relating to financial management and restrictions of choice. In part this had not changed since the home’s last inspection where in some instances details of the action required by staff to support a specific need was fairly brief, but this was supplemented by further information recorded on a risk assessment form. This covered a good range of relevant risks (including medication, falls, bedsides, pressure areas, scalding, diabetes, smoking, going out on one’s own, challenging behaviour, gender sensitivity and any areas of risk of abuse). Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 11 In one case an additional separate care plan was seen with good guidance on addressing a person’s behavioural needs; in another instance it was good to see a care plan addressing short-term respite goals. The home now has a more detailed moving and handling risk assessment form and these were appropriately completed. There was evidence that residents and relatives had been involved in the development of their care plans and risk assessments, and also that these were being regularly reviewed. Service users spoken to confirmed they were involved in all steps of their care planning. Daily recordings were seen to vary in some cases, and in one instance where a service user had sustained an accident to their toe, there was no follow up mentioned, and an accident form had not been completed. This was discussed with the manager who agreed that variations in care planning and documentation would be monitored and training offered for staff where inconsistencies occurred. The AQAA tells us that “Care plans are reviewed on an ongoing basis, incorporating being formally checked every month and fully reviewed every 6 months” Signatures evidenced this on the day of inspection when care plans were inspected. From discussion with residents and staff, it was clear that residents were encouraged to be involved in decision-making about their lives, both on an individual level and as a group. One service user commented “This home didn’t choose me I chose it, and I can discuss anything about my care.” Each resident has a key worker, and those spoken with confirmed that they had a choice as to who their key worker was. From observations on the day of inspection, residents were making choices (e.g. how and where to spend their day, attending day centres, college courses.) and were provided with information and support to make these. The manager stated that advocacy support would be obtained through social services if required, one resident did have support from an advocate but now chooses to make their own decisions. Risk assessments identified any risks relating to a person’s daily activities, including their ability to manage their finances, and care plans had space to record any limitations of choice. One service user who smoked had a risk assessment in place that detailed that their cigarettes were kept by the office and given to them upon request. Residents’ meetings provided a forum for group decisions about outings, and holidays. The home had arranged for four groups of residents to go on holiday to Euro Disney in France was a good example of the home supporting residents to take risks as part of an independent lifestyle. The home had completed risk assessment forms in relation to this, and residents spoken with had thoroughly enjoyed these holidays. The manager confirmed that the home had a missing person’s procedure which was seen to be appropriate. Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were supported to take part in meaningful appropriate activities, both within the home and in the wider community, and to maintain family and personal relationships. Residents can experience a relaxed environment and feel their rights are respected and recognised in their daily lives and receive an adequate range of food at times to suit their lifestyle. EVIDENCE: The home supports and enables residents to access a range of appropriate social, developmental and educational activities. Although no current residents engage in paid or voluntary work, three attend a workshop for people with disabilities, and several attend (or have attended) various classes including computing, cookery, music, arts and crafts (including some adult literacy/numeric input), and a Stroke Club. Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 13 Another club offers discos’s every Friday night and drama classes. The home liaises with local colleges to access appropriate courses. The home uses local community resources for leisure activities (e.g. meals out, bowling, beach, local circus, carnival, and swimming at a hydro pool.), and obtains information about local events. The home has its own transport (a minibus), as most residents require a wheelchair accessible vehicle. There was good evidence of a wide range of social and leisure activities taking place both inside and outside of the home: there were regular social events (e.g. barbecues), and recently with the consent of relatives and service users, a stripper act was arranged for a 50th birthday party. This was done tastefully and we are informed that no one was offended. Some activities were brought into the home (e.g. fortnightly ‘keep fit’ session, and visits by Zoolab.), and a wide range of trips take place (e.g. local meals and bowling, day trips to London and France, and recent holidays to Euro Disney, Park Lodge in Sandringham and Jubilee Lodge in Chingford). The home has helped residents to obtain large TV’s for their rooms, as they enjoyed watching films. The manager stated that most excursions were financially supported by the home, with some small contribution being made for things like trips to France, which is commended. Four small groups of residents had recently been on holidays to Euro Disney, and those spoken to had very much enjoyed these. It was good to see care plans also reflecting short-term goals relating to individual interests and aspirations that the home aimed to support (e.g. one person aimed to attend a Madonna concert and had done that and one service user is due to be in a play at Christmas and it is to be filmed). The home encourages contact with family and friends. Residents reported that they could receive visitors at any time. Relationships within the home are supported by staff, and one resident described the home as feeling like being in a “big family, it has changed my life”. Daily routines appeared flexible, with residents seen to have the freedom to move around the home and grounds, and to choose how and where to spend their day. On the day of the inspection residents appeared content and relaxed, and were seen spending their time around the home engaged in their own interests (e.g. TV, jigsaws, spending time with others.). Staff were observed to knock on residents’ bedroom doors before entering, and residents were able to have keys to their doors. Residents spoken to were very positive about staff, with one reporting that “the staff are lovely” and another said “Give them a pay rise”. There was no cook on the date of inspection as the one who was rostered also undertook some care duties and had accompanied a resident to hospital the night before. On the day of inspection a mid day takeaway was arranged for that reason. Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 14 However we are informed that the timing of the main cooked meal (whether at midday or early evening) was flexible depending on the residents’ activities: menus reflected this, and also showed that meal times were flexible (e.g. showed ‘high tea’ as between 5.30 and 7pm). Menus showed that a choice of food was provided at each meal, and residents spoken to confirmed this and stated that they could also request an alternative. At the last inspection the cook had shown good knowledge of individuals’ likes and dislikes and of how he met this (e.g. one person particularly liked rabbit, and the cook said that this was provided for them on a regular basis), and also showed an understanding of special dietary needs (e.g. vegetarian, diabetics, soft diets, etc.). The cook also previously reported that two vegetables were generally served with each meal, and that primarily fresh vegetables were used in the home. Menus showed that snacks were available in the evenings, and it was noted that hot and cold drinks were regularly available during the day, and that (where able) residents could serve themselves to these. Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect good support and assistance with health and personal care enabling appropriate consultation and respect of individual choice. Some aspects of the home’s medication recording procedures were not satisfactory at the time of this inspection and could place service users at risk. EVIDENCE: Residents spoken with were happy with the way staff supported them in their personal care, and care plans/risk assessments reflected key information on how this should be done (reference standard 6). Residents spoken to confirmed that they had been involved in choosing their key worker, and risk assessments identified any sensitive gender issues or needs. For example one care plan identified that a resident preferred female carers purely because his wife usually undertook his care. Residents’ appearance reflected their personal choices of clothing, and times for getting up and going to bed appeared flexible and a matter of individual choice. Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 16 The home had appropriate equipment available to support independence (e.g. most rooms were equipped with overhead tracking hoists, special crockery was available, there were facilities for recharging electric wheelchairs, etc.) and where residents were at risk of pressure sores, pressure relief mattresses or cushions were in situ and the manager maintained a clear record of all pressure relief equipment in use in care plan documentation. A portable hoist is also available and taken on holidays with disposable slings. Healthcare needs were identified and supported by the home, and records were maintained of contact with healthcare professionals. Where residents suffered with diabetes, staff assisted in the monitoring and treatment of this condition and there was evidence that healthcare services had provided staff with comprehensive training in this, and had assessed their competency to provide the assistance needed. The home generally recorded all accidents and incidents (apart from one which was missed ref standard 6), and there were systems in place to monitor these, to ensure that any patterns could be addressed. Arrangements for routine healthcare appointments are in place and the AQAA highlights that the home would like to further develop their monitoring of nutrition needs. The home had a medicine policy that described the procedure for receipt, storage, administration, and disposal of medicines (including any controlled drugs), and promoted self-administration where appropriate. Secure medication storage facilities were available, and stocks viewed were stored in an orderly manner and a sample, inspected were in-date. The home was monitoring the temperature of the storage area, and a medicine fridge was available if required. Most medication was dispensed to the home in a monitored dosage system, and the pharmacist supplied medication administration records (MAR) that were pre-printed with the medication name, dosage and administration instructions. Staff recorded the date and quantity medication received by the home onto this form. There were a number of occasions when additional medication details had been transcribed/entered by hand by staff: these records showed several instances where staff had not fully entered the administration details (dose, frequency and times), mis-spelt the drug and/or the quantity of medication received or carried over from a previous month, and had not signed or dated the entry with two signatures which is considered best practice. This needed to be addressed at the last inspection also. The MAR sheets viewed had only recently been started: from the records available, staff appeared to consistently record when administration took place, and also the reasons for any non-administration. Systems were in place to record medication returned to the pharmacist. Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can feel confident about how to complain and can expect to be listened to and their complaints acted upon. Residents can also be assured that all carers are adequately trained to safeguard their welfare. EVIDENCE: The home has an appropriate complaints policy and procedure, which promotes complaints are taken seriously and responses to them handled efficiently. Residents spoken to felt able to raise concerns, and were clear that they would speak to the manager if they had any complaints. One service user stated “I don’t have any but if I do I just ask and they deal with it” Another who had some ongoing issues stated “I can speak to my keyworker so that helps”. The home maintained records of complaints received: these records showed that any complaints had been responded to. One resident had complained about clean laundry, and another dealt with a situation whereby a medication change had resolved the issue. The provision of the complaints procedure in alternative formats was discussed on this visit. However service users spoken with did display an awareness and understanding of the current policy. Staff training records showed that all staff had attended training in abuse awareness over the last two years; the manager also reported that most staff had attended a Protection of Vulnerable Adults (POVA) workshop in January 2008. Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 18 At the previous inspection it was noted that the director had recently obtained a POVA training pack (DVD and workbook) produced by Essex County Council, and planned to use this to update staff training. The home has a policy relating to the protection of service users, which included a statement on the protection of service users’ monies, referred to the home’s Whistle Blowing policy, and clearly identified social services as the lead agency to which any concerns would be referred. A concern raised previously had been appropriately investigated, and it was confirmed on this inspection that no further concerns had been raised. The AQAA does not outline any plans for improvement, however does state “We have an open policy of welcoming suggestions and any complaints, and these will be acted upon. All staff are trained in protection of vulnerable adults” Conversations with staff both new and existing, confirmed they had an awareness of the whistle blowing policy and the actions required to safeguard residents. Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 19 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, 26, and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is homely, clean and safe. Individual rooms were personalised promoting service users independence. EVIDENCE: The premises are in keeping with the local community. On the day of this inspection the home was clean and tidy, and no odours present, showing effective cleaning processes. Rooms viewed were in a satisfactory state of decoration, contained sufficient furnishings and fittings, and were homely and well personalised. Radiator covers are currently being fitted in all rooms. It was good to see the wide range of personal items in people’s rooms, including equipment to pursue individual interests (e.g. watching SKY, TV/films, music, jigsaws, etc.). Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 20 The organisation have also where required installed additional electric sockets in rooms, to ensure that the residents have sufficient sockets to run all their equipment, and two people have their own telephone. The home has two communal lounge areas (one which is used as a quiet room), and a separate dining area. There is a small internal courtyard area with seating facilities and a fishpond, which the manager reported was well used. The home has a maintenance person and additional assistance in the garden area; systems for identifying, planning and recording routine maintenance and decoration are in place. The premises were accessible throughout, and most rooms were fitted with overhead tracking hoists. The home has two bathrooms (both with assisted baths) and two shower rooms. The home has a laundry that is sited away from areas where food is stored or prepared. It was equipped with a sink that was used for hand washing of linen and also as a hand washbasin, and there were supplies of liquid soap, paper towels, and disposable protective gloves. The laundry contained one commercial and one domestic washing machine and two drying machines also one commercial and one domestic. The manager described appropriate practices for dealing with any soiled linen, and also confirmed that the home has little soiled linen as most body waste was contained and disposed of via disposable products (e.g. incontinence sheets and pads, cleaning wipes.) Appropriate arrangements were in place for the disposal of clinical waste. Infection control policies and procedures were not specifically inspected on this occasion but storage of COSHH substances was noted to be appropriate; training records provided showed that all apart from three new carers had attended infection control training over the last two years and this is planned for them. An inspection of the water systems was also being undertaken on the day of inspection. Feedback from the inspector highlighted only small areas requiring attention via verbal feedback to the manager. Since the last inspection, the removal of some trees in the front garden has made it more user friendly and a new rear patio area enabling easy access has been laid. The AQAA also confirms that “The smoking shelter has been completed and the home intends to ensure the garden is maintained to a high standard”. Some domestic rubbish was noted in the garden behind the sheds, such as old TV sets and the disposal of some cigarette ends were noted at the side of the building where one service user refuses to use to shelter and disposal bins. The manager confirmed that the rubbish would be removed and the cigarette end disposal, managed appropriately in future. Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home overall provides staff who were appropriately trained and qualified, in sufficient numbers to meet residents’ needs. Recruitment practices meet regulatory requirements set out to protect residents. EVIDENCE: The staff rota for the week of the inspection was viewed and showed overall four staff per daytime shift, and two waking night staff. Copies of rotas from previous weeks provided following the inspection showed that these staffing levels were usually maintained, although there were some occasions when a shift was one person short due to last minute sickness. On a few occasions when staff had volunteered to cover last minute absences, this had resulted in staff working an afternoon shift followed by a night shift. This was noted at the home’s last inspection and is not considered best practice and the manager should monitor this closely and avoid it wherever possible due to the length of the hours involved. Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 22 Feedback during the inspection suggested that the current level of staffing generally met residents’ needs, however some service users stated that “They felt more staff were needed at times as they are so busy and sometimes do not have time to do everything they need to do”. One service user said “More staff would create some calm, especially in the mornings but that they had no complaints regarding their care needs being met”. Staff spoken with confirmed that at times “they were short but they coped” There was not evidence that staffing levels are assessed to ensure they meet resident need. A discussion with the manager was held regarding more staff time being provided flexibly if required. The staff team reflected the gender composition of the residents. The home has regular staff meetings and a resident representative attends these meetings. This is good practice The manager confirmed that of the twenty care staff currently employed at the home, twelve had completed NVQ level 2; a further two staff had started NVQ level 2, and six have completed NVQ level 3. This is a good level of qualification amongst the staff team. Residents spoken to were positive about the staff, finding both the staff and manager approachable, and stating that they felt staff had the skills to meet their needs. The home maintains a clear database showing training completed by staff: this showed that the majority of staff had attended all core training, and also that a good range of training in additional specialist subjects had been attended by many staff (e.g. in specific medical conditions). The home therefore provided appropriate training to ensure that staff had the knowledge and skills to meet residents’ needs. The AQAA tells us the home is using the Skills for Care Common Induction Standards for new staff. This enables the home to assess and evidence that a new carer has the knowledge and skills (i.e. competence) to meet the needs of residents, and evidence of inductions and supervision sessions were seen on staff files inspected. One new staff member spoken to stated “Although they had a lot of experience they found the induction helpful and felt it relevant to the work they undertake” Recruitment documentation inspected for one staff member included an application form, employment history, a criminal record declaration, evidence of identity and a photo, two written references, and a CRB and a POVAfirst check The manager demonstrated a considered and responsible approach to recruitment issues discussed, and detailed some examples of when previously prompt and appropriate action was taken when alerted to a recruitment concern. This reflected a recruitment practice that aimed to protect service users. The AQAA also confirms that recruitment checks are now undertaken centrally by head office and no one starts work until all relevant checks have been completed. Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 23 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, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from a well-run home. Systems were in place to ensure that residents’ views form part of the monitoring and review of the home. Health and safety practices promote the health, safety and welfare of residents. EVIDENCE: The home has a registered manager who is suitably experienced to run the home. The AQAA informs us that he is currently undertaking the Registered Managers’ Award (NVQ level 4 in management). He demonstrated good knowledge and understanding of the service and of care and management practices, and training records showed that he regularly attended training to update his skills and knowledge. Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 24 Residents and staff spoken with reported that the manager was supportive and approachable, and it was noted that he spent a lot of time working alongside staff in the home, and therefore provided a good level of support and was able to monitor practices. The home has a quality assurance policy statement that promotes a positive approach to reviewing the quality of service. Quality assurance processes included an annual development plan (covering premises, staff training, and with reference to items identified from the service user survey), a monthly audit done by the manager reviewing how the home meets the national Minimum Standards, reports of monthly monitoring visits is carried out by the registered provider, minutes of service user meetings, and a service user survey using a feedback questionnaire (carried out twice yearly, with the responses summarised). Action taken by the home, in relation to responses, from the last service user survey was not specifically discussed on this occasion. The manager stated that most of the current residents are able to indicate their views, and that staff assist with completing the questionnaire if help is required. It was noted that the home had a range of appropriate policies and procedures, which are updated systematically and which include 17 core policies that staff had to sign to confirm they have read them. The home had systems in place to maintain the health and safety of the home, and a clear policy statement of the arrangements to maintain health and safety in the home, including employer and employee responsibilities. Staff training records showed that staff had received training in relevant health and safety topics, including the moving and handling of people. The home maintains records to show that equipment and utilities are regularly serviced, and that appropriate internal checks are carried out (e.g. routine testing of fire alarms and emergency lighting, fire drills, checking of bath and shower hot tap temperatures, checks on central hot water temperatures re risk of legionella, etc.). The home has a range of risk assessments on safe working practices, including fire risk assessments and the use/storage of chemicals (with hazard sheets available for the chemicals used). Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 25 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 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13 Requirement The registered person must ensure that any details of medication transcribed or entered onto the MAR sheet by staff include:Full administration details (i.e. dose and frequency/ times); The quantity of medication received or carried over from a previous month; The date of the entry and the signature of two persons making the record. This is a repeat requirement, previous timescale of 14/08/06 not met Timescale for action 31/10/08 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 Good Practice Recommendations DS0000017766.V371161.R01.S.doc Version 5.2 Page 27 Belamacanda 1. Standard YA6 It is recommended that staff ensure that care plans contain sufficient detail and follow up of any action required by staff to support each person’s assessed needs. Belamacanda DS0000017766.V371161.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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