Care Home: Bellever

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What the care home does well When asked this, a relative said cleanliness, and having a `friendly family atmosphere`. People living at the home benefit from being cared for by staff who know them well, and from management systems aimed at promoting their best interests, upholding their wellbeing, health and safety. Peoples` health and personal needs are well met, partly because the home involves community-based professionals to achieve this. People are treated with dignity, and their rights are generally respected. There are procedures for trying to ensure their concerns are heard, and that they are protected from abuse. Their views and the views of other people who have contact with the service are used in plans for improving the service. They live in a well maintained home that is homely, adapted for their needs and clean. They enjoy a balanced diet that caters for their needs or preferences, as well as enjoying various activities in the local community and beyond. What has improved since the last inspection? This is the first inspection of the home as a new service. CARE HOME ADULTS 18-65 Bellever Bellever 2 Queen Elizabeth Drive Chapple Down Crediton Devon EX17 2EJ Lead Inspector Ms Rachel Fleet Unannounced Inspection 24 April 2008 9 am Bellever DS0000071063.V362353.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 Bellever DS0000071063.V362353.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. Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bellever Address 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) Bellever 2 Queen Elizabeth Drive Chapple Down Crediton Devon EX17 2EJ 01363 776170 bellever@dchs.org.uk Guinness Care and Support Ltd Mr William John Saulsbury Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 6. Date of last inspection N/A Brief Description of the Service: Bellever is a single storey, purpose-built care home that has existed for several years under different ownership. Guinness Care and Support Ltd. now owns the building and employs most of the staff. A very small number of staff are employed by the Devon NHS Partnership Trust. The service is registered to provide residential care for up to six adults with Learning Disabilities. A service is offered to both men and women, over 25 years of age. At the time of this inspection, there was no-one under 40 years of age living at the home. Nursing care is not offered, apart from that which the local community nursing service can provide. The home is on the outskirts of Crediton, in a residential area near the local hospital. It has level access, including to the enclosed back garden with a small patio area. There are six spacious single bedrooms (not en suite), a bathroom, a shower room/wet room, an open plan kitchen/dining/lounge area and a separate lounge. There is also a laundry area and a staff office. Care fees were £590 – 1026.45 per week at the time of inspection. Additional costs not covered in the fees include aromatherapy, hairdressing, private chiropody, toiletries, clothes, dry cleaning, make-up, family gifts or presents, newspapers and magazines, taxis, fuel costs for other transport, meals out, entrance fees, holidays, and alcohol for personal use. Current information about the service, including Commission for Social Care Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 5 inspection (CSCI) reports, is available from the home’s office on request. A copy of CSCI’s latest report can be provided by the home, if people want their own copy Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 6 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 took place as part of our usual inspection programme. There were six people living at the home on this unannounced site visit, which lasted eight hours. John Saulsbury, the manager, had previously returned a CSCI questionnaire about the home (the Annual Quality Assurance Assessment, or ‘AQAA’), which included an assessment of what they do well, and their plans for improving the service. We had also sent surveys to the home to be given to each of the six people living there and to their next-of-kin or supporters. We received surveys back from all the people living at the home, all of whom were helped to complete them by care staff from the home. Four surveys were returned from peoples’ relatives/supporters. Of six surveys sent to health and social care professionals linked with people at the home, none were returned. We spoke with two social care professionals, however. The inspection included ‘case-tracking’ of three people living at the home – the sample including people new to the home, and people with more diverse or more complex needs. This involved looking into their care in more detail by meeting with them, checking their care records and other documentation relating to them (pre-admission assessments, medication sheets, etc.), talking with staff, and observation of care they received. Everyone living at the home went out to different places during our visit, for part or most of the time. However, we were able to have lunch with five people who lived at the home. Two spoke with us in more depth. Others were unable to give their views in detail, because of communication difficulties, but we observed general care and interactions with staff during our visit. We also spoke with four care staff, as well as the manager. Other records we looked at included those relating to staff, peoples’ personal monies, the kitchen, and health and safety. We looked around the home. We ended the visit by discussing our findings with the manager. Information gained from all these sources and from communication about the home since it was registered under new ownership (in December 2007) is included in this report. What the service does well: Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 7 When asked this, a relative said cleanliness, and having a ‘friendly family atmosphere’. People living at the home benefit from being cared for by staff who know them well, and from management systems aimed at promoting their best interests, upholding their wellbeing, health and safety. Peoples’ health and personal needs are well met, partly because the home involves community-based professionals to achieve this. People are treated with dignity, and their rights are generally respected. There are procedures for trying to ensure their concerns are heard, and that they are protected from abuse. Their views and the views of other people who have contact with the service are used in plans for improving the service. They live in a well maintained home that is homely, adapted for their needs and clean. They enjoy a balanced diet that caters for their needs or preferences, as well as enjoying various activities in the local community and beyond. What has improved since the last inspection? What they could do better: In response to this question, relatives suggested more activities, more appropriately qualified staff to facilitate outings and holidays (including regular exercise/activity), and transport to facilitate these. People can find out about the home in various ways, although some information could be better, to help them make a properly informed choice about where to live. A proper assessment of individuals’ needs and wishes must be obtained before they are admitted, to ensure that they move into a home that is suitable for them. Two improvements in medication procedures must be made to ensure peoples’ needs for medication are met safely. More person-centred care planning with more proactive support would ensure peoples’ individual needs and goals are identified and met, promoting peoples’ personal development and fulfilment. Timely action should be taken so people get the assistance they need to make decisions or to take appropriate risks, to improve the quality of their lives. Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 8 Improvements in some aspects of staffing and management – including training, and development - would ensure people will have appropriate support to meet all their current or changing needs, and that they and their best interests are fully safeguarded. 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. Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 9 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 Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 10 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. Quality in this outcome area is adequate. People can find out about the home in various ways, although written information could be improved so people can be clear about the service being offered, when choosing somewhere to live. Peoples’ needs and aspirations are not fully assessed before they are admitted, creating a risk that they may move into a home that is not suitable for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is comprehensive written information available about the home. This has been updated to reflect the new ownership, but still requires a small number of amendments to give correct and required information (about the accommodation, for example). Much of the information can, on request, be produced in a format more suited to the needs of people who might use the service. Prospective residents are usually invited to visit the home so they can find out more about the home. They are offered an initial ‘trial stay’ period if they move in. Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 11 We asked to look at the pre-admission information obtained about one person who had moved into the home since it was newly registered. We were told the person had been admitted at very short notice. There was no evidence that anyone from the home had carried out an assessment of their needs prior to their arrival, which the manager confirmed. There was no record of any assessment or information being provided by any other suitably qualified person, such as a care manager, before the person was admitted. Staff told us they knew little about the person’s needs on their admission. We saw they had requested information from the person’s care manager after the person’s admission - about the person’s usual routine, preferences, etc. They told us that the care manager visited the day after the person was admitted, and had told them more about the person. They also said they had asked the person’s relatives. We saw an assessment had been completed by the home the day after their admission. There was no written pre-admission assessment regarding another person previously admitted, although in that case, the manager had met with them before they moved in, to discuss their care needs. Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 12 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 & 9. Quality in this outcome area is adequate. Staff know well the people they care for, but care planning is not yet personcentred enough to ensure peoples’ individual needs or goals will be identified and met. Action is not always taken to enable people to get the assistance they need to make decisions or to take appropriate risks, which may affect the quality of their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at care records for three people. Care plans gave staff information on how to meet peoples’ needs as individuals, with peoples’ likes and dislikes recorded. However, it was not clear that the individual’s views had been included or considered more fully. Words such as ‘encourage’ or ‘regularly’ were used sometimes, without information as to any agreed goals, timescales, etc. The manager had begun re-writing the care plans, intending to make them more person-centred. Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 13 There were care plans with separate risk assessments. A full assessment by an occupational therapist was also kept separately. We suggested these all might be cross-referenced, so staff were alerted to other relevant information when reading care plans. A risk of absconding had been noted in one person’s care records, but there was no photo of them in their records for use if they did go missing. The care plans and risk assessments had been reviewed within the last six months. However, we noted risk assessments for one person had not been reviewed in the light of recent changes in their health. There was no body map or record of bruises for one person we were told had a history of bruising. One person living at the home had an independent advocate, whilst others relied on relatives to support them in this way. Staff had helped people complete our pre-inspection surveys. The home’s quality assurance systems had identified a need to improve advocacy for people at the home. Staff described how people made their feelings known if they couldn’t communicate well verbally. They explained how people were enabled to make choices daily, adding that for some, this relied on staff who knew them well and who could interpret their body language or behaviour. One person had said they wanted to move from the home. We were told the person’s care manager was aware, and staff were waiting for them to take further action. This had not been followed up recently, however. Staff said one person wanted to go walking in the woods and to go paddling, but couldn’t give a reason as to why this hadn’t been possible. The manager was appointee for two people, who could not manage their own finances, because no-one else wished to take on this role. Relatives or Devon County Council staff supported the other people living at the home. Personal monies records for three people were checked and found to tally with cash balances held. Two staff signatures were recorded to verify the transactions shown, with receipts available where sought at random. (See also the section on ‘Complaints & Protection’). Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 14 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): 11 - 13 & 15 – 17. Quality in this outcome area is adequate. People are treated as individuals to an extent, with their dignity and rights generally respected. They enjoy a balanced diet that caters for their needs or preferences, as well as various activities in the local community and beyond. However, they are not always proactively supported in person-centred ways, limiting their personal development and fulfilment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One community-based professional felt activities for people at the home had improved in recent months, although they thought further improvement was hampered by funding, staffing and transport issues. They hoped that advice from an occupational therapist was still being used - sensory cookery, for example. Staff told us baking was not a planned activity, although it was done about once a week. They said some people decorated cakes or watched while Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 15 staff made scones, and one person who had one-to-one cookery sessions went out more often now (as seen in their care records), so did less baking. Care notes for one person showed they spent time knitting and doing puzzles, which they told us they enjoyed. The information compiled by the occupational therapist was kept separately to the rest of individuals’ care records, with some staff indicating it wasn’t referred to often. We did not see structured programmes of in-house activities in peoples’ care plans. During our visit, everyone went out for part of the day - to a chat group run by Social Services, to the shops with staff, to college or to a day centre. Two people were able to tell us they had enjoyed themselves. On other days, some attended a new social group in Exeter started by the provider, which staff escorted them to. Care records showed one person declined to the shops one day, but later the same day accepted an invitation to go out to a garden centre. Outings were being recorded separately, for better monitoring. This showed people had been out less in recent months than in preceding months. Staff said this was partly because staff had been on leave. For one person, outings were usually to a day centre, weekly. Two other people had been out about four times a month - to garden centres, shops, coffee mornings, for drives or to feed some local donkeys. Two people went out more often, with relatives or church friends. One person who was particularly interested in music had been taken to musical events in nearby towns. Two staff told us they had recently taken one person out for the day without their peers, so they could have some individual attention. Staff told us most people at the home needed a wheelchair for distances, which had to be considered when planning outings. Staff sometimes pushed people to the town centre, with some difficulty; although there was a bus-stop near the home, buses were not wheelchair-accessible. Staff said they were told that when one person was admitted some months ago, they were to have a motorised chair, but this still had not been organised. The manager said the home would soon have transport that would be shared with two other local homes, purchased by the current service users. We were told peoples’ relatives and care managers had agreed to this. When asked how staff encouraged people to get enough exercise, they said they got people to play skittles, darts or parachute games. And spoke about advice from a physiotherapist, who had assessed each person. Care notes had occasional references to such activities. Relatives’ responses were mixed when they were asked if they got enough information from the home and if the home helped the person there to keep in touch. Regarding the latter, relatives’ responses varied from ‘Never - it is one Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 16 sided’ and ‘Sometimes – if X requests a phonecall, X is assisted with this’, to ‘Usually’ and ‘Always’. Staff described arrangements for people at the home to keep in touch with their relatives, which did often rely on the relative contacting the home. Staff were not sure if this had come about through agreement with relatives, reflecting some people living at the home did not speak much. The statement of purpose said fees included use of the telephone. Staff engaged with people when in their company, assisting when requested or through knowing peoples’ usual routines. They acknowledged that people had the right to make choices, and staff should not force them to do anything against their wishes. People sat in the lounge of their choice during our visit. One went to rest on their bed rather than go on an outing. A weekly planner on display showed people living at the home attended some events on their own, and went with their peers to other events or activities. There was little in care plans to show people were encouraged to develop living skills, take on responsibilities for sharing housekeeping, etc. We saw a range of breakfast cereals, and one person was able to make hot drinks for themselves. The main meal of the day was usually at lunchtime unless most people were out for the day – as during our visit - in which case it was eaten in the evening. We joined people living at the home for lunch, which was a variety of sandwiches that they appeared to enjoy. Staff also ate with them at the dining table, and it was a calm, unhurried, sociable occasion. The weekly menu had mainly traditional English dishes on it – roast dinners, shepherds pie, fish and chips, etc., with fresh vegetables regularly, and fresh fruit was included for dessert. Where pizza was on the menu, staff said some people currently at the home couldn’t eat these very well, so softer alternatives were provided. They were also mindful that one person had certain food intolerances, needing an alternative choice at times. A record of meals provided was kept in a kitchen diary. Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 17 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 – 20. Quality in this outcome area is good. Peoples’ health and personal needs are well met, partly because the home involves other professionals appropriately to achieve this. Two improvements in medication management would ensure peoples’ needs for medication are met safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans we saw had good detail about how individuals’ personal care needs were to be met. Staff clearly knew people well, and felt this was very important if they were to support people who couldn’t easily express choices or preferences verbally. They showed awareness of the need to balance peoples’ preferences with encouraging healthier options in some instances. One person’s daily notes showed staff had used diversion strategies to reduce their agitation, and helped them with activities included in their care plan. We saw staff using appropriate manual handling practices (as also described in peoples’ care plans). Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 18 Staff described different communication methods used by the people at the home – their own version of Makaton, etc. People seemed at ease with staff, and staff were observant, interpreting their body language or actively listening to them, checking their understanding with individuals. Staff felt people living at the home had the aids and adaptations they needed, adding they could easily get advice from an Occupational Therapist about aids, etc. if peoples’ needs changed. Care plans also had good detail about how peoples’ health needs were to be met. One person was having their eyes checked soon, and told us they had seen their GP recently. Conversations with staff and care notes showed staff acted in a timely way when people had developed dental problems or increased sleepiness, for example. Someone had been seen by a relevant specialist about their eating difficulties. Letters in care records showed medical staff or specialists reviewed people regularly, for their physical and mental health, or needs related to their learning disabilities. A multidisciplinary risk assessment for someone included their weight should be monitored. We discussed with the manager that this was still to be implemented. Staff said sit-on weighing scales would be helpful, for better monitoring of peoples’ weights; at present, they took people elsewhere for weight checks. We saw staff using safe procedures when giving out medication. However, variable doses for one medicine were not being recorded on administration records, so it was not clear how much the person had been given. We discussed this with the manager. There were records of medication received by the home and returned to the supplying pharmacy for disposal. Records were kept of medication supplies taken away when people went to stay with relatives; the home had arranged for the supplying pharmacy to package such medication separately. Stocks were at appropriate levels, but some were out of date as were some disposable medical supplies obtained when the home was a nursing home. There were some skin creams in a toilet area that were prescribed for someone who no longer lived at the home. The manager had obtained a training pack on medication for updating staff routinely or if a problem with their practice was identified. He said he intended to observe staff, and would record this as part of their formal supervision. Bellever DS0000071063.V362353.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. Quality in this outcome area is good. There are procedures for trying to ensure peoples’ concerns are heard and that they are protected from abuse, although some improvement is needed to assure people that they and their best interests are safeguarded as fully as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose included the complaints procedure, with required details such as who could be contacted and timescales for dealing with complaints. It said the complaints procedure was available in symbol form. Individual copies of the new complaints procedure were awaited, to be given to people living there and to their relatives. The manager said he would look at providing this to people in the alternative format as appropriate. One person living at the home said they could tell staff or their relative if something were wrong. Of four surveys from relatives, two said the service always or usually responded appropriately if they raised concerns about care; a third said the service never responded appropriately, and though they usually got a written response, it was not in plain English. A fourth did not answer this question. CSCI has not received any complaints about the service. Staff said they would report any complaints to senior staff verbally or in writing, or could contact the Responsible Individual. They said the written procedure was usually kept in peoples’ bedrooms. Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 20 The manager said staff were asked at formal supervision sessions if they had any concerns about the care provided at the home. There was appropriate basic guidance available to staff on reporting suspected abuse, etc., although contact details in the home’s policy needed updating. Staff were clear about what constituted abuse and that they should report any suspicion of abuse to senior staff; some were less clear about outside agencies that could also be contacted if necessary. The manager was not fully aware of current local authority safeguarding procedures, although would have sought advice from his manager. Training records we saw for one support worker suggested they had not had updating on safeguarding for over two years. We saw a risk assessment for the use of bedrails, which are a potential form of restraint or harm. This had been done appropriately with multidisciplinary input. Peoples’ care records included inventories of their property. Care plans we saw included what help people needed to manage their finances or personal monies. It appeared from two receipts and personal monies records we saw that people living at the home had paid for refreshments for staff on two occasions, which is not in line with the home’s policy. The manager spoke with staff concerned, clarifying correct procedures, and said this would be monitored in future. If cash was left with staff by relatives, etc., for peoples’ accounts, no receipt was given. The manager said receipts would be provided in future, after we discussed this, to ensure there was clarity about what money had been handed over. Bellever DS0000071063.V362353.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 & 30. Quality in this outcome area is good. People live in a well maintained home that is homely, pleasant, clean and adapted for their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People we asked told us they liked their bedrooms. These were colourful and personalised with peoples’ possessions, reflecting their interests, important relationships, etc. Staff had decorated areas in recent months, so much of the home looked fresh and bright, although they pointed out the dining/lounge area was now in need of attention. The manager said the fire detection system had been upgraded in the last year. There were privacy locks on toilet and bathroom doors. These areas had grab rails, and low level facilities for people with mobility problems or who used Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 22 wheelchairs. There was a bath with an electrically operated chair, and a separate shower room with level access, to also help them. Staff suggested a more suitable shower seat/chair would be helpful. All beds but one were adjustable height beds and mobile, which assisted individuals, and staff helping them, to get in and out of the bed more easily. There was ramp access between the dining area and the garden, which was looking tidy, with garden furniture and shade available on a paved area. The home looked clean, and there were no malodours. People said this was usually the case, one survey including this as something the home does well. The laundry area was well kept, with handwashing facilities, and sound floors and wall coverings. The washing machine had suitable programmes for cleaning and disinfecting laundry properly. Staff confirmed suitable procedures for handling soiled washing and disposal of clinical waste. We saw disposable protective clothing was available for staff. Bellever DS0000071063.V362353.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, 34 & 35. Quality in this outcome area is adequate. People living at the home benefit from the stable staff team, but some aspects of staffing do not ensure people will have appropriate support to meet all their current and changing needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were three support workers and the manager on duty when we arrived, to care for six people. Care staff were also responsible for cooking and cleaning (as well as for redecorating the home if necessary). One person we spoke with said they got on with the staff, and we saw they communicated happily with them. Staff confirmed no-one had left the staff team for several months, only one person has joined the team, and that agency staff are rarely used (as indicated on the AQAA). They also said all but one staff member worked both night and day shifts, which would also help to promote appropriate, consistent care for people living at the home. We found there was good communication within the Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 24 team – staff told us about peoples’ changing needs and subsequent input from community-based professionals, as reflected in their care records, for example. There was one less care staff member on duty in the evening, and one person on duty overnight from 10pm, with the manager as well as staff at a near-by home on call. The relatively late finish for day staff helped ensure that a female carer was available to assist people getting ready for bed with their personal care, when a male carer was on duty overnight. There was evidence that this was revised when necessary – if someone’s needs changed, etc. Staff thought this was a satisfactory arrangement. Staff said there were usually two staff on duty at the weekends, instead of three as in the week. They said occasionally there were three staff on duty so that outings could take place, and confirmed the usual staffing arrangements restricted outings at weekends. The manager said staff working patterns were being reviewed, so that they would not affect people living at the home in this way. We looked at recruitment information obtained for a new staff member. Required information had generally been obtained, in a timely way, including police checks. The job application form did not specify how much employment history was required. Related regulations ask for a full employment history. The applicant had given their last seven years of employment. There was a four-month gap in the employment history, but no evidence that this had been accounted for. They were undertaking an induction programme, which met nationally recognised standards, although their progress had not been recorded yet. The manager said he would ensure this was begun. The AQAA said five of the 13 care staff had a recognised care qualification (National Vocational Qualifications). The statement of purpose said new staff would be expected to undertake this qualification. Training records that we saw for three staff showed that they had had updating on health and safety topics in recent months. The statement of purpose said staff receive training on care of the elderly, and that they will be highly trained in line with the latest developments in care practice and legislation. This was not reflected in the training records we saw. One staff said they had learnt something of legislation about mental capacity and decision-making. Another indicated there had been training about epilepsy, although they themselves had missed it. One person said they were booked to attend training about dementia, and the manager said there was going to be learning about person-centred care planning. We saw that two of the staff on duty had had supervision sessions with the manager in recent months. It was an opportunity to discuss any training Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 25 needs, with staff telling us these were particularly linked to the needs of those people they were keyworkers for. Staff said there had been a staff meeting recently, and also that the manager was readily available to them if they wished to discuss anything. Bellever DS0000071063.V362353.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, 39 & 42. Quality in this outcome area is good. People living at the home benefit from management systems aimed at promotion of their best interests, upholding their wellbeing, health and safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager had many years of experience in care settings, and had been the home’s registered manager for almost a year. He told us he had commenced a care management qualification, hoping to achieve it by January 2009, and was receiving weekly support from another registered manager. He attended the Company’s managers’ meetings when they were held. Staff said he was always available to them if they wanted advice, etc. Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 27 Whilst action was being taken to ensure the manager has the skills necessary to ensure the home is run well, and not many requirements were made as a result of this inspection, there were a number of recommendations – which relate to ‘good practice’ issues. The need for a more proactive management approach has also been noted in other sections of this report. The manager was planning a residents’ meeting, since there had not been any recently. Service users, relatives, visiting professionals and staff had recently completed ‘quality of care’ surveys, with the findings used to develop an action plan for improving the service. This included improving activities, transport, advocacy for people living at the home, and person-centred care planning. Care plans we saw included safety checks to be carried out on equipment used by individuals, such as wheelchairs. People living at the home told us there were fire drills, and that they heard the fire alarms being tested. Current food safety guidance was in use. Fridge and freezer temperatures records showed they were kept within recommended ranges for food safety. Radiators were covered, to prevent burns. The bath hot water temperature was within safe limits; the manager said a new thermostat had been fitted recently. We noted there was an electric hob in the kitchen area, with plates that can remain very hot after they are switched off. We were told one person who lived at the home used the area. The manager agreed to record a risk assessment for this and take steps to manage any risks. Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 28 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 2 2 1 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 X 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 3 X Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? N/A 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 YA2 Regulation 14 (1)(a&b) Requirement You must not provide accommodation to people unless, so far as it shall have been practicable to do so, (a) The person’s needs have been assessed by a suitably qualified or suitably trained person; (b) The registered person has obtained a copy of the assessment -So that you have a full & comprehensive assessment of each person’s needs, so as to ensure the home is suitable for them and their needs will be met if they live there. You must make arrangements for the recording, safe administration and disposal of medicines received into the care home Including that a) Where variable doses are prescribed, the actual dose given is recorded each time on the medication administration record, and b) There is prompt disposal of medication no longer Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 30 Timescale for action 31/05/08 2 YA20 13(2) 31/05/08 needed by the person for whom it was prescribed and of out-of-date items -To ensure the safety of people receiving medication at the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA1 YA6 Good Practice Recommendations It is recommended you ensure the statement of purpose has accurate, up-to-date information in it, so people have good quality information about the home. It is recommended a) You develop and agree (as much as possible) a care plan with each person, which includes advice from other professionals, on how the service will meet their current and changing needs as well as their aspirations and help them achieve goals; b) The plan is in a language or format the person can understand e.g. visual, simple printed English, explanation. So people know their various needs and personal goals are reflected in their care plan in a person-centered way. It is recommended staff ensure people are given the assistance and communication support they need, so they are able make decisions about their own lives in a timely way. It is recommended risk management strategies are recorded in or cross-referenced with the individual’s care plan, being reviewed both regularly and when their needs change, so that people are supported safely to take appropriate risks. It is recommended people living at the home have more opportunities to maintain and develop social, emotional, communication and independent living skills, promoting their personal development. DS0000071063.V362353.R01.S.doc Version 5.2 Page 31 3 YA7 4 YA9 5 YA11 Bellever 6 YA15 7 8 YA16 YA23 9 YA32 It is recommended that support for people to maintain family links is reviewed, to ensure people are getting the support they need or want to keep in touch with their relatives. It is recommended that people living at the home are encouraged to take on responsibilities in their daily lives, promoting their personal development. It is recommended you ensure all staff are aware of current local safeguarding procedures, including external agencies to be contacted if necessary, to ensure there are robust procedures for ensuring the safety and protection of people living at the home. It is recommended that a) Staff have the skills and knowledge necessary for the work they are expected to do, including up-to-date knowledge of the disabilities or specific conditions of people living at the home; b) 50 of care staff achieve a care NVQ 2 So that staff can meet the current & changing needs of the people they support. It is recommended that you ensure you obtain a satisfactory written explanation for any gaps in the employment history of prospective staff -To ensure there is a thorough recruitment procedure, which protects people living at the home from unsuitable staff. It is recommended that the registered manager establish more proactive management of the home, to meet its stated purpose, aims and objectives as well as to meet the National Minimum Standards. 10 YA34 11 YA37 Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Bellever DS0000071063.V362353.R01.S.doc Version 5.2 Page 33 - 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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