Care Home: Bevan House

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What the care home does well All the written and verbal comments received from the two people who live at Bevan House were in the main very positive about their experiences. Typical comments included, "I`ve lived here a long time and like it most of the time", "I like (the deputy manager) she helps me out and we go shopping", and "I go to work and write about things in my book". We saw that the one member of staff (deputy manager) who was on duty at the time of this site visit had clearly built up a very good working relationship with the one service user who remained at home during the morning. The deputy was observed throughout the inspection actively encouraging and supporting this individual to make informed choices about their life and do more things for themselves (so far as reasonably practicable). E.g. we saw the deputy prompting this individual to make hot drinks for themselves and choose what they ate for their lunch that day. What has improved since the last inspection? The departure of the homes registered manager in January 2008 has been the single most significant change that has occurred in the home since it was last inspected. We were told in writing by the proprietor in January 2008 that he would be the homes new temporary acting manager, but all the evidence gathered indicates that the homes deputy manager has been in fulltime dayto-day control of Bevan House ever since. Nonetheless, the deputy manager demonstrated a good understanding of her new role and responsibilities as the new acting manager, is evidently focused on the needs and strengths of the people who use the service, and had made a number of significant improvements to the home, including addressing the vast majority of requirements identified in the homes last inspection report (see below): The home`s Guide has been reviewed and up dated accordingly to include all the information people who use the service and their representatives need to know about all the facilities and services they can expect to receive and how much they would be charged for them. This has made the home far more open and transparent enabling anyone who uses it to determine whether or not they are getting value for money. As previously mentioned in this summary the deputy/acting manager has improved the support the two people who currently use the service receive to help them develop their independent living skills. For example, new supervisory arrangements developed by the deputy are now in place to enable the people who use the service to take greater control of their own medication. It was also evident from comments made during the visit that the deputy manager in particular is taking more of a proactive approach in supporting one individual who uses the service to write their ideas down in a note book in order to help them improve their communication and writing skills. This innovative idea has clearly taken into account this individuals needs, strengths, and interests. The way in which the home plans for and monitors the health of the people who use the service has improved with evidence produced to show the two people who live at the home have attended a number of appointments with various health care professionals in the past six months. The outcomes of these meetings were also clearly recorded in peoples care plans. All the outstanding environmental issues identified at the last inspection have also been addressed. This includes, the hanging of more suitable curtains in bedrooms, the fitting of more appropriate locks on toilet doors, the replacing of faulty showers with safer thermatically controlled models to minimise the risk of scalding, the securing of a trap door and the dry brick barbeque in the garden, removal of unnecessary CCTV equipment in the lounge, and the fitting of a wash hand basin and impermeable flooring in the laundry room. As a result Bevan house is a far safer and more homely place for the people who use the service to live. Duty rosters now accurately reflect the number of hours each member of staff has worked in the home, and in line with National Minimum training standards for support worker the homes entire staff team have either achieved an National Vocational Qualification level 2 or above in care or are enrolled on a suitable course. Finally, the deputy manager has carried out a fire safety risk assessment of the building and the names of all the staff who participate in regular fire drills at Bevan House are now recorded in the homes fire book. CARE HOME ADULTS 18-65 Bevan House 104-106 Coldharbour Road Croydon Surrey CR0 4DW Lead Inspector Lee Willis Key Unannounced Inspection 18th June 2008 09:30 Bevan House DS0000025865.V365710.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 Bevan House DS0000025865.V365710.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. Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bevan House Address 104-106 Coldharbour Road Croydon Surrey CR0 4DW 020 8726 7811 020 8686 0135 unicornprojects@hotmail.com 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) Mr Maharajah Madhewoo Manager post vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning Disability - Code LD The maximum number of service users who can be accommodated is: 6 8th January 2008 Date of last inspection Brief Description of the Service: Bevan House is a privately run service that can provide accommodation and personal support for up to six adults with learning disabilities. Following the resignation of the homes former registered manager on 11th January 2008, Mr Madhewoo (the homes proprietor) informed us that he would once again be the temporary acting manager of Bevan House while a suitable candidate was found. The home is situated near several mainline bus routes and Waddon train station ensuring the people who use the service have good transport links to central Croydon and the surrounding areas. A number of good leisure and community facilities are also within walking distance of the home, including a wide variety of local shops, cafes, restaurants, takeaways, pubs, and banks. Having been extended in 2007 the property now consists of six single occupancy bedrooms. All three of the bedrooms located in the newly converted neighbouring terrace house (formerly 106 Coldharbour Road) have been provided with en-suite toilet and shower facilities. Communal space now consists of a new main lounge area, a dinning room, kitchen, office, ground floor bathroom, and a separate laundry room and workshop facilities located in outhouses in the rear garden. The garden is relatively well maintained. There is able space for parking vehicles at the front. Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 5 Information about what facilities and services are provided and how much people who use the service can expect to be charged for them are available via the homes Guide and individual terms and conditions of occupancy. The service currently charges £1,186.06 to £1,202.81 a week for each placement. Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This homes overall performance has improved since it was last inspected in January 2008 and consequently we now rate it as a 2 star service. This increase from zero to two stars now means we consider the people who use the service as experiencing good quality outcomes. From all the available evidence gathered during the inspection process the Commission for Social Care Inspection (CSCI) has judged the service as having a number of strengths as well as areas of particular weakness that the service needs to take action to improve. This inspection was carried out over three hours on a Wednesday morning by Regulatory inspectors Lee Willis (lead) and James O’Hara. During this unannounced site visit we spoke at length to one person who currently resides at Bevan House, the proprietor (temporary acting manager), and the home’s deputy manager. We also looked at a variety of records and documents, including the care plans for the two people who currently live at Bevan House. The remainder of this site visit was spent touring the premises. We received two ‘have your say’ comment cards about the home. The two people who use the service with the support of staff completed both these surveys. The proprietor also completed an Annual Quality Assurance Assessment (AQAA) for the home. What the service does well: All the written and verbal comments received from the two people who live at Bevan House were in the main very positive about their experiences. Typical comments included, “I’ve lived here a long time and like it most of the time”, “I like (the deputy manager) she helps me out and we go shopping”, and “I go to work and write about things in my book”. We saw that the one member of staff (deputy manager) who was on duty at the time of this site visit had clearly built up a very good working relationship with the one service user who remained at home during the morning. The deputy was observed throughout the inspection actively encouraging and supporting this individual to make informed choices about their life and do more things for themselves (so far as reasonably practicable). E.g. we saw the deputy prompting this individual to make hot drinks for themselves and choose what they ate for their lunch that day. Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? The departure of the homes registered manager in January 2008 has been the single most significant change that has occurred in the home since it was last inspected. We were told in writing by the proprietor in January 2008 that he would be the homes new temporary acting manager, but all the evidence gathered indicates that the homes deputy manager has been in fulltime dayto-day control of Bevan House ever since. Nonetheless, the deputy manager demonstrated a good understanding of her new role and responsibilities as the new acting manager, is evidently focused on the needs and strengths of the people who use the service, and had made a number of significant improvements to the home, including addressing the vast majority of requirements identified in the homes last inspection report (see below): The home’s Guide has been reviewed and up dated accordingly to include all the information people who use the service and their representatives need to know about all the facilities and services they can expect to receive and how much they would be charged for them. This has made the home far more open and transparent enabling anyone who uses it to determine whether or not they are getting value for money. As previously mentioned in this summary the deputy/acting manager has improved the support the two people who currently use the service receive to help them develop their independent living skills. For example, new supervisory arrangements developed by the deputy are now in place to enable the people who use the service to take greater control of their own medication. It was also evident from comments made during the visit that the deputy manager in particular is taking more of a proactive approach in supporting one individual who uses the service to write their ideas down in a note book in order to help them improve their communication and writing skills. This innovative idea has clearly taken into account this individuals needs, strengths, and interests. The way in which the home plans for and monitors the health of the people who use the service has improved with evidence produced to show the two people who live at the home have attended a number of appointments with various health care professionals in the past six months. The outcomes of these meetings were also clearly recorded in peoples care plans. All the outstanding environmental issues identified at the last inspection have also been addressed. This includes, the hanging of more suitable curtains in bedrooms, the fitting of more appropriate locks on toilet doors, the replacing of faulty showers with safer thermatically controlled models to minimise the risk of scalding, the securing of a trap door and the dry brick barbeque in the garden, removal of unnecessary CCTV equipment in the lounge, and the fitting of a wash hand basin and impermeable flooring in the laundry room. As a result Bevan house is a far safer and more homely place for the people who use the service to live. Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 8 Duty rosters now accurately reflect the number of hours each member of staff has worked in the home, and in line with National Minimum training standards for support worker the homes entire staff team have either achieved an National Vocational Qualification level 2 or above in care or are enrolled on a suitable course. Finally, the deputy manager has carried out a fire safety risk assessment of the building and the names of all the staff who participate in regular fire drills at Bevan House are now recorded in the homes fire book. What they could do better: All the positive comments made above notwithstanding their remains a lot for the proprietor, the incoming manager, and deputy to do in order to improve the lives of the people who use the service, as well as keep them safe: A Statutory Requirement Notice was served on the home in 2007 because the registered provider had failed to ensure that reasonable notice of their intention to terminate a person’s placement was given to the individual’s next of kin and the relevant placing authority. The Commission is very conscious that the home currently has four vacancies and will continue to closely monitor how the service deals with any new referrals. The proprietor was also issued with a warning letter in January 2008 because of the homes repeated failure to carry out all the necessary recruitment checks on new members of staff. We are conscious that no new members of staff have commenced working at the home since it was last inspected, but are aware the home has staff vacancies and is in the process of actively recruiting a new manager. We will therefore continue to closely monitor how the service goes about recruiting new staff. The service needs to keep detailed records of risk assessments carried out to determine whether or not the people who use the service who choose to self medicate are capable of performing this task. The home’s complaints procedure could be amended further to ensure it is made much easier to read and understand by the people for whom the service is intended. This will ensure people who use the service and their representatives know how to make their views known about the homes operation if they are dissatisfied. There must be at least one first aid trained member of staff on duty in the home at all times. This will ensure the people who use the service will receive appropriate and timely treatment in the event of an accident occurring. Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 9 All staff who work at the home must be provided with a written copy of their job description, which can be produced on request. This will enable anyone authorised to inspect these documents to determine what work each member of staff is expected to perform that included their job roles and responsibilities. An Annual Quality Assurance Assessment for the service must be completed in the form and manner required by the Commission, which also contains details of the measures, the proprietor considers it necessary in order to improve the quality and delivery of the service provided in the home. This will enable us to make more informed judgements about the service, especially within regards to how it ensures good outcomes for the people using it. Finally, as previously mentioned in this report there has been some concern that the proprietor failed to make it explicitly clear to us who would be in fulltime day-to-day control of the home following the departure of the former registered manager in January 2008. As a consequence the Commission is now considering taking enforcement action in relation to this matter to ensure future compliance and secure the safety of the people who use the service. A requirement has not been made in this report regarding this issue. 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. Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 10 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 Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 11 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 5. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their representatives know about their rights and responsibilities, what facilities and services they are offered, and how much they can expect to be charged for them because the home has reviewed its Guide and produced costed contracts for everyone. This has made the service more open and transparent making it easier for any major stakeholders to determine whether or not they or the people they represent are getting value for money. People who use the service cannot be certain that the home will meet their needs and aspirations as there have been weaknesses in this area in the past. EVIDENCE: As recommended in the homes last two inspection reports the service users Guide was reviewed in 2008 and up dated accordingly to reflect all the information people who who the service and their representatives need to Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 12 know about the facilities and services provided. The document now includes information about all the staffs’ qualifications and the range of fees charged for facilities and services provided. The service user met told us they had been given a copy of the new Guide, which they kept in their bedroom. As required at the homes last inspection all the people who use the service have now been supplied with costed contracts regarding their terms and conditions of occupancy. Contracts that had been signed by all the relevant people were produced on request in respect of the two people currently living at the home, which set out what was and was not covered by the basic price of each placement. The proprietor told us the service had not received any new referrals for well over a year. The last admission to Bevan House was on the 31st of March 2007 which brought into question whether those responsible for the admissions process were putting those who are in need of services at the centre of all their activities. The admission had been made involving an individual who had elements of their needs that the staff in the home had not been trained or sufficiently experienced to immediately provide the care. The new service user was subsequently moved to Unicorn House another of the registered providers care homes despite the placing authority advising the home to wait for a formal review to be held before taking any further action. Due to this historical failing and the high number of vacancies the service has (i.e. Two-thirds of all bedrooms remain unoccupied) we will continue to closely monitor how the service manages any new referrals it receives in the future. The deputy manager told us she would work very close with the homes manager to determine whether or not the home was capable of meeting a new referrals needs and what impact accepting it would have on the people already residing at Bevan House. The deputy also told us she would ensure any new referral would be encouraged to visit the home and meet the other service users before any decisions about moving in were taken. Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 13 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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are sufficiently detailed and person centred to allow anyone authorised to read them to determine what is important to the individual for whom the plan is intended, what their strengths are, and what support they require to achieve their personal goals. The homes arrangements for assessing and managing identified risks ensures the people who use the service are protected and supported to live their lives as independently as they can (so far as reasonably practical). Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 14 EVIDENCE: The files of the two people who use the service were both inspected. The files included a missing persons profile, a recent photograph, details of their next of kin, General Practitioner, letters about health care appointments, risk assessments and support guidelines for epilepsy and challenging behaviours, service user satisfaction comment forms, and finance records. The person centred plans were very detailed and included sections such as my likes, my dislikes, a relationship circle, personal care, finance and social and spiritual needs. These had been kept under regular review and signed and agreed with each person who users the service. One person who uses the service told us the deputy manager had helped them “write stuff in their care plan” and “given them a new book to write things in”. The deputy told us she had introduced the ‘jotting pad’ to help this individual improve their numerical and writing skills. This personal goal was included in the individuals care plan. The person who uses the service told us they enjoyed “writing about cars and road signs”, which was reflected throughout the book. This approach to enabling this individual improve their communication skills is innovative and takes into account the persons strengths and interests, for which the deputy is commended. Both the people who used the service had care plans that had been kept under regular review by the home and care managers from their placing authority. The deputy manager told us that a care manager was coming the following week to review one individual’s placement. Individual risk assessments for both the people who use the service and more general risk assessments had all been kept under regular review. The deputy manager produced evidence that residents meetings had taken place in March, April, and June this year. Items on the agenda at the last meeting included planning for summer activities, food and the menu and organisational issues. Minutes of the last meeting revealed the people who use the service and staff had all been involved in discussions about the appointment of a new home manager. Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 15 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, 12, 13, 14, 15, 16, and 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The variety of in-house and community based social, leisure and recreational activities the people who use the service have the chance to participate in on a regular basis is adequate, although there remains scope to improve the number of variety of games and literature available to residents in communal areas. The opportunities people who use the service have to maintain and develop their independent living skills has improved since the last inspection ensuring their rights to greater freedom of choice and independence are promoted. Dietary needs and preferences are well catered ensuring the people who use the service are provided with daily variation, choice, and nutritionally wellbalanced meals. Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 16 EVIDENCE: The two people who use the service wrote on our comment cards that they can ‘always’ do what they want during the day, evening and at weekends. On arrival at the home one person who uses the service had gone out while the other was due to attend the Unicorn day centre later that afternoon. The deputy manager produced individual weekly activities charts for both the people who use the service. These charts had been agreed and signed by the people for whom they were intended. The charts indicated that these individuals attend the Unicorn day centre on a regular basis. The one person who remained at the home throughout the course of the morning told us they “liked going to ‘work’ to write and was looking forward to going out after lunch”. They went onto to say “there’s always lots of things to do at the home and they go out with staff sometimes”. The deputy manager told us the shed in the rear garden was recently converted to accommodate one person’s interest in woodwork. A person who uses the service told us the other individual they share their home with likes using the shed to make things, especially at weekends. During a tour of the premises a number of carpentry tools were found stored in the shed. During a tour of the main lounge and dinning room we observed a number of magazines and books were available, although a large proportion were aimed at staff. Some games were also noted in these communal areas, although supplies were limited. Care plans indicated staff actively encourage people who use the service to prepare some of their meals, wash up, and clean their bedroom. It was evident from comments made by the deputy manager and some practices observed that the service is now more committed to actively encouraging and supporting the people who use the service to maintain and develop their independent living skills as recommended in its last inspection report. During this site visit the deputy manager was witnessed prompting one person who uses the service to put away their breakfast things after they had finished, make a number of hot drinks, and choose what they wanted for their lunch time meal from food stocks kept in the kitchen. One person who uses the service told us “the kitchen is never locked and I can get a drink whenever I want”. This individual also told us they had been given keys to the front door and their bedroom, which they kept on the mantle piece in the dinning room. Both people who currently reside at Bevan House have regular contact with their families. The proprietor told us their next of kin visits one person on a regular basis now that they no longer stay over night at their mothers. We were told visiting arrangements were changed to meet the wishes of the person who uses the service who recently indicated that they no longer wanted Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 17 to continue staying over night at their mothers place each week. They also keep in regular contact with their mother by telephone. The other person who uses the service contacts their relatives by telephone. The proprietor told us that this individual’s sister has recently made contact and has started visited the home on a regular basis. The deputy manager politely invited us to sign the homes visitors book on arrival as a permanent record of who had entered Bevan House that day. Food menus were examined and found to be appropriate. The deputy manager produced two menus, these include fresh fruit and vegetables, pasta, chicken curry, home made soups and a variety of meals such as plantain that reflected the cultural needs and preferences of the people who use the service. One person who uses the service told us they “liked to eat plantain, thought the food they were given was ‘ok”’, and “usually went shopping with staff for food”. Food stored in the fridge and freezer and kitchen cupboards reflected what was on the menus. Staff maintain an accurate record of all the food consumed by the poepele wh use the service, which revealled the meals provided were relativley varied and nutritionally well-balnced. As previoulsy mentioned in this report the deputy was observed being actively encouraging one person who uses the service to choose between hot dogs, baked beans on toast, a meat pie, or cheese sandwiches for their lunch. A bowl of fresh fruit was noted on top of a worksurface in the kitchen during a tour. Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, & 20 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has suitable arrangements in place to ensure the people who use the service receive personal support in the way they prefer and require. Improvements made to the planning and monitoring of appointments the people who use the service attend with various health care professionals ensures their health care needs are continuously met. The home’s policies and procedures for handling medication are sufficiently robust to keep the people who use the service safe. Since the last inspection more is being done to actively encourage and support the people who use the service to take a greater degree of control of their medication. EVIDENCE: A person who uses the service told us they regularly go clothes shopping with staff and had recently purchased some new trainers they were wearing at the time of this inspection. This individual also told us they had picked their new trainers out themselves and always wore what they liked. The deputy manager Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 19 confirmed that as required in the homes last inspection the restrictive practice of allowing others to buy clothes on behalf of the people who use the service without gaining their informed consent had now ceased. Since the last inspection the deputy manager has reviewed peoples health care plans and introduced new shaving and washing routines and monitoring records to ensure people who use the service receive all the personal care support in the way they prefer and require. As required in the homes last report the deputy manager was able to produce detailed records of all the health care appointments both the people who currently reside at the home had attended in the past six months. Records sampled, including care plans and the homes visitors book, indicated that the two people who use the service had seen their GP’s, a psychiatrist, a dentist, and chiropodist. The deputy told us as recommended in the homes previous report arrangements had been made for the people who use the service to regularly attend the local well-man clinic. Staff maintain detailed records of all the accidents and incidents involving the people who use the service. These records showed that no accidents or significant incidents had occurred in the home since January 2008. No recording errors were noted on medication administration records (MAR) sheets sampled at random. These records reflected current medication stocks held by the home on service users behalves. As recommended in the home previous report medication is now more securely stored in a purpose built lockable medication cabinet fixed to the wall in the office. The deputy manager told us that as recommended in the homes last report arrangements were already in place to enable one person who uses the service to dispense their own medication under staff supervision, while discussions about how best to support the other service user take far greater control over their medication were on going. The deputy told us the issue of allowing people who use the service to have greater control over their medication had been discussed with all the relevant parties, although as yet no risk management strategies had been drawn up. The deputy manager told us the service does not currently hold any Controlled Drugs, but ‘as required’ (PRN) medication is still administered from time to time. Medication records showed as required PRN medication had been used twice in the past six months, which compared very favourably with previous years when this type of medication had been used more frequently. It was also clear from the written explanations given by the members of staff who had recently administered PRN medication why they had done so, in line with best practice. Furthermore, the deputy manager had recently up dated protocols for the use of as required PRN to ensure they accurately reflected any change in need/provision. The deputy manager was also very clear when and how to Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 20 administer this type of medication, stating “PRN medication should only ever be given as a ‘last resort’ when all other methods had failed to deal with an incident”. The home has still not obtained a copy of the Royal Pharmaceutical Society of Great Britain’s guidance on best practice regarding the handling of medication in a residential care setting, despite it being recommended in its last report. The deputy manager told us she would purchase a copy. This recommendation is therefore repeated in this report. Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes arrangements for dealing with complaints and allegations of abuse are sufficiently robust to ensure the people who use the service feel listened to and safe. However, information about the complaints procedure is not available in ‘easy’ to read formats, therefore not everyone who lives at the home may know how to complain if they are dissatisfied with the care they receive. People who use the service cannot yet be certain that the home’s recruitment practices are safe. EVIDENCE: The two people who use the service wrote on our comment cards that they knew how to make a complaint if they were unhappy. The home has a book for recording complaints. The deputy manager told us that there have been no complaints about the homes operation since it was last inspected. Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 22 As required in the homes previous inspection report the complaints policy has been reviewed in an attempt to make it more accessible to the people for whom the service is intended. We believe more could still be done to make the policy easier to read and therefore understand. We advised the deputy manager to seek advice from the new manager of another Unicorn project in the area about how to go about illustrating policies to make them more service user friendly. None of the people currently residing at Bevan House have been subject to a safeguarding adults referral in the past year. The deputy manager demonstrated a good understanding of the local authorities vulnerable adult protection protocols and was fully aware which external agencies would need to notify without delay if abuse was witnessed or suspected in the home. The proprietor told us no new support workers had recently been employed since the homes last inspection, but he had recruited a new acting manager. However, the new manager had not yet commenced working at the home because the proprietor was still awaiting his Criminal Record Check. The proprietor went onto confirm that the recently appointed manager had already completed two days induction at the home and that his personnel file contained two references, a POVA clearance and other employment details. The new acting home manager’s personnel file was not examined at this visit, but will be looked at in some depth at the homes next inspection. Staff duty rosters examined revealed the new acting manager had commenced his induction training at the home. As a result of all the requirements set at the homes previous inspection relating to poor recruitment practices we will continue to closely monitor what checks the home carries out in respect of any new employees, specifically in relation to references, Criminal Record Bureau and Protection of Vulnerable Adults checks, and employment histories, especially if they previously worked with vulnerable adults. We issued a warning letter on 25th January 2008 reminding the proprietor about his recruitment responsibilities in relation to obtaining all the relevant information and documents in respect of all persons managing or working at a care home. The Commission will consider taking enforcement action against the service if a similar breach of the Regulations occurs in the future. The recommendation made at the homes last inspection that recruitment policies for Bevan House should be reviewed in order to comply with best practice in relation to equal opportunities employer (see CSCI publication Safe and Sound) was not assessed on this occasion. The recommendation is therefore merely repeated in this report and is not considered unmet (See good practice recommendation No.4); Advertise vacancies widely and in a manner that ensures equal opportunities to all prospective candidates. Develop a standard interview template. Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 23 Keep evidence of short-listing and those invited for an interview. It is good practice to keep evidence of decision making even where there are a small number of applicants. Ensure that two or more senior members of staff are present at interviews to reduce bias. Record answers given by the candidate to questions. As recommended at the homes last inspection copies of bank account statements held in the name of the people who use the service are now kept on their personal files. Financial records show that one person who uses the service has access to their own money on a daily basis, which is topped up by their relative on a regular basis as and when required. Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 24 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, 27, 28, and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The overall décor, furnishings, and fittings in the home are of a ‘reasonable’ quality, which means the people using the service live in a relatively homely and comfortable environment, although communal areas should be supplied with more soft furnishings. Recent improvements made to the homes environment means the home is a lot safer place for people who use the service to live. Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 25 EVIDENCE: The overall impression of the home is that it is relatively well decorated, clean, and suitable for the needs of the people who currently reside there, although there is a distinct lack of soft furnishings in communal areas (e.g. cushions, throws ect…). The deputy manager told us she acknowledged this point and would endeavour to improve things in respect of the homes soft furnishings. As recommended in the homes last inspection report the damaged fax machine has now been replaced. One person who uses the service invited us to view their bedroom with them. The room was decorated to a reasonable standard and the current occupant told us they “liked the colour it was painted and that they had all the things they needed in the room”. The garden is well tended however the garden furniture is old and worn. It is recommended that new garden furniture be purchased for the garden. The homes washing machine located in a separate building in the rear garden is capable of cleaning laundry at appropriate temperatures. There is a small office just off the lounge for administration purposes. A number of requirements were set at the last key inspection in relation to the environment, which have all been met. As required at the last key inspection new curtains have been hung in bedrooms large enough to cover the full width of the window they are intended to cover. As required at the last key inspection the deadlocks fitted to ensuite shower and toilet doors have been replaced with more suitable devices that can be overridden by staff from the outside in the event of an emergency. A requirement was set at the last key inspection that the shower units in the home must be assessed for the risk they present the people who might use the service in future and what action is to be taken to minimise the likelihood of scalding. The home has replaced the shower units with new thermostatically controlled units. As required at the last key inspection the homes shower facilities are being kept in good working order. As required at the last key inspection the dry brick barbeque in the rear garden has been made safe, the disused CCTV equipment in the main lounge has been Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 26 removed and the trap door on the stairwell ceiling in the new extension has been made secure. As required at the last key inspection new hand washing facilities have been installed in the laundry room and the carpet has been replaced with more suitable flooring that is readily cleanable. Staff have cleaned the plastic shade of the fluorescent tube lighting in the main lounge, although the proprietor has yet to consider replacing this ceiling light with a more suitable fitting that is more domestic in style, as recommended at the homes last inspection. Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main people who use the service receive safe and appropriate support because there are enough competent staff on duty at all times, although there is scope to improve the homes arrangements for identify staffs training needs and the number of people trained to administer first aid. Suitable arrangements are now in place to ensure staff are supervised at regular intervals, which ensures they have the necessary knowledge and skills to meet the needs and wishes of the people who use the service. EVIDENCE: The two people who use the service wrote on our comment cards that staff ‘always’ treat them well. We observed the deputy manager speaking and interacting with the one person who uses the service in an extremely caring, polite, and dignified manner throughout the course of this morning site visit. The person who uses Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 28 the service told us they “got on well with this deputy and would miss her next week when she was on holiday”. Other comments made by this individual about staff included, “I like most of the staff that work here”, and “I can speak to the deputy/keyworker if I’m unhappy”. The deputy manager produced training records for the homes entire staff team on request. These records indicated that all staff had either achieved a National Vocational Qualification level 2 or above in care or were enrolled on a suitable NVQ training course in line with National Minimum training Standards for residential support workers. Since the homes last inspection the deputy manager has carried out a thorough assessment of the training needs and strengths of the current staff team, which revealed that overall most staff are suitably trained to perform their duties. The deputy told us that she was in the process of arranging dates for training shortfalls identified in respect of fire safety, and supporting people with epilepsy. The deputy also agreed that more robust arrangements would need to be developed to ensure any shortfalls in staff training are identified in a more timely fashion (i.e. before the training people have already received has expired). Documentary evidence revealed that more staff would need to receive first aid training to ensure a suitably qualified person is on each shift. The duty roster examined on the day of this site visit indicated the name of the staff member who was on duty that morning. As previously mentioned in this report the proprietor has not employed any new support workers since the home was last inspected, although a new manager has been appointed who has yet to commence working unsupervised at Bevan House because their Criminal Record Check is still be processed. The deputy manager told us all staff are now supervised at regular intervals. The deputy was able to produce written evidence to show she had ensured the three other permanent members of Bevan Houses staff team had each received between two and three supervision sessions in the past five months. Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 29 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40 & 42 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Deputy Manager has effectively run the service on a day-to-day basis since January 2008 ensuring the needs of the people who live there have been met. However, the lack of clarity about who was actually in full time day-today control of the service in the absence of a registered manager has meant those who use the service cannot be sure that there is an accountable management of the service. we have not had access to all the information we require to determine whether or not the service has being ‘properly’ managed in the past five months. Overall, adequate quality assurance and monitoring systems are in place that allow the views of the people who use the service to influence homes operation and development. However, the services annual quality assurance assessment lacks detail and could be improved significantly. Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 30 The people who use the service are kept safe because the homes fire and health and safety measures are sufficiently robust to promote and protect their welfare. EVIDENCE: The proprietor gave us notice in writing that from 11th January 2008 , following the resignation of the home’s registered manager, that he would be the interim manager of Bevan House. However, it was quite evident from information included on staff duty rosters worked since January 2008 that the proprietor was not based on site at Bevan House and was therefore clearly not in ‘fulltime’ day-to-day control as manager of the service. Furthermore, it was evident from comments made by the homes deputy manager and the proprietor during this inspection that the deputy had effectively been in operational day-to-day control of Bevan House since 11th January 2008. The Commission requires that accurate information is provided to it about who is in day to day control of a service. The Commission also needs clear and concise records kept in the home of when staff are carrying out their designated duties. This enables those in receipt of a service to know that there are competent and accountable management arrangements in the home. The proprietor has failed to pay due diligence to these important responsibilities, as a result the Commission may consider taking enforcement action. As previously mentioned in this report the proprietor also told us he had recently recruited a new manager for the home who had been unable to start because he was still awaiting for their Criminal Records Check to be processed. The temporary acting manager, (Deputy) demonstrated a good understanding of her new managerial role and from all the evidence gathered during this inspection had ensured the home had been well run since the departure of the former registered manager. The proprietor told us that the deputy manager is currently completing the City and Guilds Community Care Mental Health qualification and was able to demonstrate throughout this inspection that she had knowledge and was highly competent in a range of areas, including being responsive to the needs of the people who use the service, prompting their independence where practicable, having good people skills, and maintaining good monitoring and record keeping systems. The deputy manager told us she was promoted to this position in January 2007, but was unable to produce a job description that set out what her roles and responsibilities where as a deputy manager. Regulation 26 visits have been carried out at the home on a regular monthly basis. The reports were available in the home for inspection, reports indicated that the registered provider had sought the opinions of the people who use the Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 31 service about the home and referred to the requirements set by the Commission at the last key inspection. Both the people who use the service had completed the homes satisfaction questionnaires, which indicated that they were satisfied with the service provided by the home. It was suggested to the registered provider that questions such as, what does the service do well. And what could we do to improve the service? Could be included in the questionnaires so that the registered provider could use the answers to inform how the service could be improved. Residents meetings had taken place in March, April, and June this year. Items on the agenda at the last meeting included planning for summer activities, food and the menu and organisational issues. The residents and staff had discussed that a new home manager had been appointed to work at the home. A required at the homes last key inspection the proprietor completed an Annual Quality Assurance Assessment. He told us that this had been filled in at the last minute because he expected that the new home manager would have been in post by now (see above). In the AQAA under “what we could do better” and “our plans for improvement in the next 12 months” these sections had not been completed. The registered provider was advised that these were important area’s that should be completed so as indicate how the home will develop and progress the service for the benefit of the people who use the service and staff working at the home. The registered provider must ensure that all parts of the Annual Quality Assurance Assessment are completed in full in the future. Failure to do may result in the Commission taking enforcement action. The AQAA indicated that the home did not have policies on aggression towards staff, admissions, discharge including planned discharge, death of a service user, food safety, hygiene and food safety, first aid, record keeping and recruitment and employment. However on examination of the homes policies and procedures it was evident that the majority of these were in place but recorded under different titles. The registered provider told us that he would review the homes policies and procedures file, rename the policies, and procedures in line with and in the order laid out the AQAA. It is recommended that the homes policies and procedures be reviewed. As required in the homes previous inspection report the deputy/temporary acting manager has reviewed the fire risk assessment for the building. The deputy told us the London Fire and Emergency Planning Authority had arranged to visit the home the following day 19th June 2008. We recommend the home seek advice from the LFEPA about the suitability of its recently Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 32 revised fire risk assessment and not having the boiler in the main lounge encased. Fire records revealed that the homes fire alarm system continues to be tested on a weekly basis and that as recommended in the homes last report the names of everyone who participate in regular fire drills at the home are now included in the appropriate record. During a tour of the premises all the fire resistant doors tested at random automatically closed into their frames in line with good fire containing measures. Chemicals and other substances hazardous to health were found locked away in suitably secure places within the home. Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 33 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 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 3 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 3 12 3 13 X 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 3 2 3 X 3 X Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 34 Yes 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. 1. Standard YA20 Regulation 13(2) (4) Requirement Risk assessments must be undertaken to determine whether or not people who use the service are capable of selfadministering their own medication and copies kept in care plans. This will ensure that people who use the service receive the correct levels of medication safely. The people who use the service and their representatives must have access to easier read versions of the home’s complaints procedures. This will ensure people who use the service and their representatives know how to make their views known about the homes operation if they are dissatisfied. Previous timescale for action to be taken to comply with this outstanding requirement by 8th February 2008 has been partially met. Timescale for action 15/08/08 2. YA22 22(2) 15/08/08 Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 35 3. YA35 13(4)(c) & There must be at least one first 29/08/08 18(1) aid trained member of staff on duty in the home at all times. This will ensure the people who use the service will receive appropriate and timely treatment in the event of an accident occurring. 17(2), Sch 4.6(e) (f) All staff, including the deputy manager, must be provided with a written copy of their job description, which can be produced on request. This will enable anyone authorised to inspect these documents to determine what work each member of staff is expected to perform that included their job roles and responsibilities. An Annual Quality Assurance Assessment for the service must be completed in the form and manner required by the Commission, which also contains details of the measures, the proprietor considers it necessary in order to improve the quality and delivery of the service provided in the home. This will enable us to make more informed judgements about the service, especially within regards to how it ensures good outcomes for the people using it. Previous timescale for action to be taken to comply with this outstanding requirement by 8th February 2008 has been partially met. 01/08/08 4. YA37 5. YA39 24(1 to 5) 29/08/08 Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 36 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. Refer to Standard YA12 Good Practice Recommendations People who use the service should be able to access more meaningful and ‘age’ appropriate’ social resources within the home (e.g. Books, games, puzzles ect…). This will enable the people who use the service to live more interesting lives. People who use the service should have access to easy to read versions of the published menus. This will enable everyone who uses the service to make an informed choice about what they would like to eat at mealtimes. The people who work at the home should have access to the latest version of the Royal Pharmaceutical Society’s guidance on handling medication in a residential care setting. This will ensure they have all the information they require to handle medication safely in the home in order to protect the people who use the service from harm. This recommendation was made at the homes last inspection, but has not been implemented. The way in which the service recruits people to work at the home should be reviewed to make these arrangements more transparent and to promote equal opportunities. This will minimise the risk of the people who use the service being placed at unnecessary risk of harm or abuse from staff who are ‘unfit’ to work with vulnerable adults. This recommendation was made at the homes last inspection, but was not assessed on this occasion. It is therefore merely repeated in this report and therefore not considered unmet. All the homes communal areas should be provided with some cushions and other soft furnishings. This will ensure the people who use the service live in a more comfortable and homely environment. 2. YA17 3. YA20 4. YA23 5. YA24 Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 37 6. YA28 The home should consider replacing all its fluorescent tube lighting with more suitable light fittings that are more domestic in style. This recommendation was made at the homes last inspection, but has not been implemented. The home should consider purchasing some new garden furniture for the people who use the service and their guests to sit out and enjoy the garden. The way in which the service assesses the training needs of its staff team should be reviewed to ensure any gaps in their knowledge and skills are identified in a more timely fashion. This will ensure all staff are suitably trained to perform their duties and meet the needs of the people who use the service. The way in which the service up dates its policies and procedures should be reviewed to ensure they always reflect any changes in best practice. The service should seek the views and advice of the London Fire and Emergency Planning Authority about changes made to its recently revised fire risk assessment of the building and its decision not to encase the boiler in the lounge. 7. YA28 8. YA35 9. YA40 10. YA42 Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bevan House DS0000025865.V365710.R01.S.doc Version 5.2 Page 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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