Care Home: Bethany

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What the care home does well Surveys received from people who use the service evidenced that they make decisions about their lifestyle and are supported in daily lifestyle choices. There are regular meetings for people who use the service facilitated by a care assistant and this process feeds change in the home. There is a varied activities programme with opportunities for people who use the service to go to college, workshops or to do gardening. The gardening programme is well developed with a large greenhouse growing tomatoes, onions, courgettes, herbs and flowers. In addition people who use the service can have their own individual beds to grow produce of their choice. What has improved since the last inspection? The requirements of the last inspection have been met. Radiator covers are in place Some bedrooms have been redecorated and have new flooring. All staff have Criminal Records Clearance and a check against the Protection of Vulnerable Adult prior to commencing employment. There is an improved training programme and all staff undertake induction. What the care home could do better: There was some staining to the hallway carpet, this is to be cleaned. There was also some fraying to the stair carpet, which is also to be addressed. A counter edge, which is lifting in the kitchen, is to be addressed. CARE HOME ADULTS 18-65 Bethany 190 Hawthorn Road Bognor Regis West Sussex PO21 2UX Lead Inspector Sheila Gawley Unannounced Inspection 15th August 2008 10:00 Bethany DS0000014397.V369016.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 Bethany DS0000014397.V369016.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. Bethany DS0000014397.V369016.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bethany Address 190 Hawthorn Road Bognor Regis West Sussex PO21 2UX 01243 866260 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) bethanyleader@yahoo.co.uk L`Arche Manager post vacant Care Home 5 Category(ies) of Learning disability (0) registration, with number of places Bethany DS0000014397.V369016.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 5. Date of last inspection 21st September 2007 Brief Description of the Service: Bethany is registered as a care home providing personal care for a maximum of five adults with learning disabilities. The property is a detached house situated in a residential area on the outskirts of Bognor Regis. The accommodation for people who use the service is arranged on two floors and includes five single bedrooms two on the ground floor and three on the first floor. The lounge, kitchen, quiet area, conservatory and laundry are located on the ground floor. The third floor of the house is used for living-in staff. Bethany is one of three homes operated locally by LArche, a voluntary organisation. The Responsible Individual is Mr. Chris Bemrose and the manager is to apply to the Commission for Regulation. Current fees are from £823 to £876 per week. Bethany DS0000014397.V369016.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 site visit as part of the inspection process took place on 15/08/08. Prior to the visit all files held by The Commission for Social Care Inspection (We) were examined. We were in receipt of the Annual Quality Assurance Assessment (AQAA), which contained all of the information we asked for. A care assistant and the acting manager facilitated the inspection and any documents required on the day were made available. The manager is in the process of applying to the Commission for registration. Two people who use the service were case tracked and care plans, medicine administration charts, some policies, procedures and staff files were inspected. We were in receipt of four surveys from people who use the service and two from members of staff. All comments in the surveys were positive. During the visit, where possible, people who use the service were spoken to and their opinions sought. All indicated satisfaction with the care and support offered. The atmosphere in the home was very homely, relaxed and sociable. People who use this service experience good outcomes because they receive care from a well-trained and motivated staff in safe and comfortable surroundings. What the service does well: Surveys received from people who use the service evidenced that they make decisions about their lifestyle and are supported in daily lifestyle choices. There are regular meetings for people who use the service facilitated by a care assistant and this process feeds change in the home. There is a varied activities programme with opportunities for people who use the service to go to college, workshops or to do gardening. The gardening Bethany DS0000014397.V369016.R01.S.doc Version 5.2 Page 6 programme is well developed with a large greenhouse growing tomatoes, onions, courgettes, herbs and flowers. In addition people who use the service can have their own individual beds to grow produce of their choice. 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. Bethany DS0000014397.V369016.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 Bethany DS0000014397.V369016.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): 2 People who use the service experience good quality in this outcome area because needs would be assessed prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have not been any admissions to the home for many years. There are procedures and documentation in place to ensure any prospective admission to the home is fully assessed. There have been no new admissions since the previous inspection. All of the people living in the home had comprehensive assessments carried out before they moved in. Bethany DS0000014397.V369016.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 People using this service experience good outcomes in this area because they make decisions about their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans were examined. Surveys received from people who use the service evidenced that they make decisions about their lifestyle and are supported in daily lifestyle choices. These decisions were seen recorded in their care plans, as were wants, aspirations, future goals and plans to achieve these. Risk assessment is in place and people who use the service are allowed to take risks. There are not any people who use the service who self medicate at present. If anyone asks to do this they would be risk assessed. Needs are Bethany DS0000014397.V369016.R01.S.doc Version 5.2 Page 10 addressed in a person centred way, those able to take care of personal needs are allowed to do so. Risks associated with needs or behaviours are clearly documented, as are management strategies. There are regular meetings for people who use the service facilitated by a care assistant and this process feeds change in the home. Autonomy is always promoted and service users are provided with information so they can make an informed decision such as what activities to be involved in. Advocacy is encouraged. Bethany DS0000014397.V369016.R01.S.doc Version 5.2 Page 11 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): 12-16,17 People using this service experience excellent outcomes in this area because they can participate and contribute to the local community and they can be involved in varied activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home produces a “mandate” every two years in conjunction with the people who use the service, which identifies areas of development and sets out a philosophy. Areas of development and interest are identified in care plans and people who use the service are encouraged to achieve this. They are actively encouraged to go out into the community, they go on shopping trips and all have holidays away. The home has access to two minibuses and two cars. These can be used for transport and outings as requires. One person who uses the service can use public transport. A survey received from a person who uses the service commented that he works at a place that he had chosen Bethany DS0000014397.V369016.R01.S.doc Version 5.2 Page 12 at the beginning of the year. Privacy and dignity is respected and staff ask permission before entering the bedrooms and all bedrooms can be locked but the people who use the service choose not to do so at present. There is a varied activities programme with opportunities for people who use the service to go to college, workshops or to do gardening. Certificates were seen in the room of one person case tracked. The gardening programme is well developed with a large greenhouse growing tomatoes, onions, courgettes, herbs and flowers. In addition people who use the service can have their own individual beds to grow produce of their choice. A new community room is being built which the home and its two nearby sister homes are planning to hold a retirement group for the people who use the service who are getting older and may be less able than others. There is a canvas marquee in the garden where multi denominational prayer/share groups are held twice a week with participants from all three homes in the organisation. There are frequent trips to pubs and meals out. All have been away on a retreat this year and all have an annual holiday. People who use the service are encouraged and facilitated to maintain links with families and friends, either by having them to visit the home for meals or by being taken out to see them. The communal areas of the home are bright and comfortable and the only two people who use the service in the home were watching television. There was evidence of hobbies in bedrooms such as puzzles and music. The kitchen is domestic in style. There is a varied menu in place and people who use the service are consulted on this. Mealtimes are relaxed and flexible and people who use the service can choose when and where to take their meal. They can also help in the preparation of the meals and a rota was seen for this. The provision of meals takes into account the diverse dietary needs and choices of individuals. Bethany DS0000014397.V369016.R01.S.doc Version 5.2 Page 13 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 People using this service experience good outcomes in this area because they receive the personal and health care support that they need. The medication policies and procedures protect the health and well-being of people who live in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The needs preferences of people who use the service regarding personal care are noted in the care plans. Staff are provided with guidance about how meet these needs and preferences. The care plans of the two people case tracked seen showed that health care needs are assessed and monitored and changes are responded to. The manager stated the home has a good relationship with the GPs and staff in the local surgery to ensure that people receive the health care support that they need. Evidence was seen of the management of diabetes and liaison with the diabetes team. Evidence was seen of a person who was very afraid of many interventions being facilitated to attend the dentist and to also have foot care. Bethany DS0000014397.V369016.R01.S.doc Version 5.2 Page 14 None of the people living in the home are able to safely administer their own medication. Should there be a new admission they would be risk assessed in relation to this. Medicines are appropriately received, stored and administered in the home. Medicine Administration Charts were up to date. All staff who administer medication have attended training and staff who administer insulin have attended specialist training. There are not any controlled drugs in the home at present. Bethany DS0000014397.V369016.R01.S.doc Version 5.2 Page 15 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 because complaints would be listened to and taken seriously and they are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints policy that is provided in symbol and picture format to help people to understand the procedure for making complaints. All those who returned surveys said they know how to make a complaint if necessary. There is a communication group every week where people are encouraged to bring any concerns or to talk to the manager on a one-to-one basis if they prefer. There is a book for recording complaints; the service has not received any complaints since the last inspection. Policies and procedures are in place prevent people who use the service suffering harm. The manager has attended the Safeguarding training provided by the local training consortium aimed at managers. There is training in place for safeguarding adults and records of this training is seen. Staff spoken to demonstrated awareness on safeguarding issues and referral pathways. Bethany DS0000014397.V369016.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,30 People who use the service experience good outcomes in this area because they live in a clean and homely environment This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home and grounds are well maintained so that people have a comfortable environment. There is a large well-maintained garden for people who use the service to enjoy. The hallway and stairs carpets have some stains and some frayed areas. This was discussed with the acting manager who stated that she would get this dealt with. The lounge and dining area are clean well decorated and homely. Some bedrooms have been redecorated and have had new flooring more appropriate to the need of the person occupying the room. The rooms were clean and were personalised. The requirement that radiators be covered has been met. Bethany DS0000014397.V369016.R01.S.doc Version 5.2 Page 17 The home is clean and hygienic however the edge of the kitchen counter is lifting and the acting manager stated that she would address this. This has been reported to the organisation in July. There are appropriate laundry facilities and people who use the service are supported to manage their laundry. There is a rota in place to facilitate this. The home was free from offensive odours Bethany DS0000014397.V369016.R01.S.doc Version 5.2 Page 18 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 People who use the service experience good outcomes in this area because they are supported by well motivated and trained staff This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff team are motivated and support the people who use the service in an empathic way. The staff were seen communicating with people who use the service as equals. The AQAA states that care assistants are encouraged to establish good, mutual relationships with residents, seeing people with learning disabilities more as people than clients. Staff are well informed about individuals needs and are committed to achieving the best outcomes for people who use the service. There is a trainiing programme in place and all staff receive induction. National Vocational Qualifications are undertaken, the AQAA states thet the home has achieved 66 of staff trained to NVQ Level 2. Both the acting manager and the deputy manager are undertaking NVQ Level 4 and the acting manager is also doing the Registered Managers Award. There has been training on dementia and continence. Bethany DS0000014397.V369016.R01.S.doc Version 5.2 Page 19 There is a robust recruitment procedure in place. Staff files inspected contained a Criminal Records Bureau Clearance and POVA check, two references, application form with employment history. The recruitment is undertaken by head office however the home staff and the people who use the service have the final say with the people who use the service completing a questionnaire on staff following a probationary period of work. All staff receive a job description and full terms and conditions. A probationary period applies and monthly supervision is in place. Regular staff meetings are held to discuss client need, home management and general practice. Bethany DS0000014397.V369016.R01.S.doc Version 5.2 Page 20 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 People who use the service experience good outcomes in this area because they are protected by the management systems of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager is applying to the Commission for registration. She has been awaiting her crinminal records bureau clearance which has now been returned therefore she is in a position to submit her forms to the Commission. She is completing the National Vocational Qualification Level 4 in Care and the RMA. She ensures that policies and procedres are implemented and updated with changes in practice and legislation. She demonstarated leadership skills during the inspection and she supports staff to develop and make the most of their skills and abilities. There is a two year mandate in place which is a plan Bethany DS0000014397.V369016.R01.S.doc Version 5.2 Page 21 for development in the home . This is available in easy read format for people who use the service. There is an annual quality assurance system which is now due to be completed. Views on the quality of the service are sought from people who use the service, their families and those who have professional contact with the home. This self-monitoring allows the management to identify where procdures can be adapted to meet the changing needs of people who use the service. Some comments seen from these surveys included “ Staff very thoughtful and aware of needs”, Very open and honest, open to different ways of working”. Health and safety matters are addressed as they arise and regular checks are made to ensure the health and safety of all people who use the service and staff. Staff are trained in COSHH, Health and Safety, Fire, Food Hygiene, Moving and Handling, and First Aid. This is monitored by the manager. The home is maintained and areas which relate to electrical safety, boiler maintenanace, equipment servicing are documented. Risk assesssments relating to equipment and safe home management are in place and updated. Bethany DS0000014397.V369016.R01.S.doc Version 5.2 Page 22 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 X 2 3 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 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 4 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X Bethany DS0000014397.V369016.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bethany DS0000014397.V369016.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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