Care Home: George Beal House

What the care home does well The two people who responded to our survey were very positive about the service that is offered at George Beal House (see quotes in the paragraph above). The staff member also wrote that positive comments are now often received from parents/carers. Staff we spoke with were very enthusiastic about the way the home is moving forward and all the improvements that have been made. Information about the home is available in different formats, including on CD, so that most people who want to use the service will be able to know what it offers. Assessments of people`s needs are carried out, and support plans are written in a person-centred way and give staff good, detailed guidance on how each person wishes to be supported. People attend day services most days in the week, and are offered opportunities for leisure activities on their `day off` and at weekends. Menus show that varied, nutritious meals, chosen by the people who live and stay at the home, are produced with plenty of alternatives. People know their complaints will be listened to, and that staff have been trained in safeguarding so that they will be kept safe from harm.The redecoration of almost the whole home is nearly completed, and George Beal House is now a bright, clean, comfortable, and homely place for people to live/stay in. People have personal items in their bedrooms. Staff are recruited and trained well, and a high percentage of the staff have been awarded a National Vocational Qualification (NVQ) in care. All staff are starting to receive regular supervision and will have an annual appraisal. Tests of the fire alarm and emergency lighting systems are done regularly as required, and the provider visits monthly and writes a report of the visit. What has improved since the last inspection? There have been major improvements in all aspects of the service offered at George Beal House since our last inspection, which means that the management of the home has improved considerably. The atmosphere in the home has changed, helped by the cleaner, brighter, fresher feel of the building following all the redecoration and refurbishment. Staff morale seemed higher, and people who live and stay here appeared happy. The relatives who wrote to us said "The redecoration of the whole premises has been welcomed by residents, staff and visitors. Staff in particular comment how they appreciate their improved working environment". Following the inspection in April 2008 we made 15 requirements. These covered almost all areas, including care/support plans, confidentiality, activities, healthcare, staff training, the environment, quality assurance, the number of staff on duty, staff supervision and health and safety. At this inspection (April 2009) we judged that all of these requirements had been met, or were well on the way to being met. We have confidence that the acting manager will continue to lead the staff team to continue making the improvements. In the AQAA the acting manager summarised some of the improvements made in the past year. She included: having a permanent, experienced staff team in place; personcentred support plans; communication passports; health action plans; and key worker meetings. What the care home could do better: We have not made any requirements following this inspection, which means we did not find any failures to meet the regulations. We have made a few recommendations. During the months before our visit, the home had told us about a number of errors in the way medicines were administered. The acting manager has successfully worked with staff to reduce the number of errors, and we have recommended she continues to monitor this closely. We also found that staff do not always record the administration of `when needed` medicines as consistently as we would expect, so we have recommended improvements to this. Better records should be kept to show that people`s money is not `pooled`, and people should be more involved in preparing and cooking meals, by making better use of the kitchens in the bungalows. We know that the acting manager is aware of areas that can continue to improve so that the service offered to the people who live and stay at George Beal House continues to get better. Key inspection report Care homes for adults (18-65 years) Name: Address: George Beal House Off Williamson Road Kempston Bedford MK42 7HL The quality rating for this care home is: 2 star good A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Nicky Hone Date: 0 6 0 4 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement They reflect the We review the quality of the service against outcomes from the National Minimum Care Homes for Adults (18-65 years) Page 2 of 30 Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for Adults (18-65) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: George Beal House Off Williamson Road Kempston Bedford MK42 7HL Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 16 Additional conditions: Care Home Category: LD - Learning Disablilty (Longstay) (10) Category: LD - Learning Disability (Respite) (6) Period of stay for respite service users - maximum six weeks Gender: Male and Female Age: over 18 years Service Users may also have additional physical disabilities Date of last inspection: Brief description of the care home: George Beal House is a local authority care home, situated in a residential area close to the centre of Kempston. Local amenities are close by, and Bedford, with its range of shops, restaurants and leisure facilities is a short drive by car or bus. The building is made up of three interlinked bungalows, each of which has its own lounge, Care Homes for Adults (18-65 years) Page 4 of 30 01234 857 300 01234 843 225 Bedford Borough Council Mrs Violet Ntombizodwa Masters Care Home 16 Over 65 0 1 8 0 4 2 0 0 8 dining/kitchen, bathrooms and single bedrooms. There is also a large shared lounge near the front door, a laundry, main kitchen, staff facilities and offices. George Beal House offers a permanent home to ten adults with profound multiple disabilities (learning and physical), in two of the bungalows. The third bungalow offers respite care to six people with disabilities. Gardens surround the home and there are parking spaces at the front. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: 2 star good Our judgement for each outcome: Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Good Good Good Good Good Good Good Good How we did our inspection: For this inspection we (the Care Quality Commission) looked at all the information that we have received, or asked for, since the last key inspection of George Beal House. This included: - The AQAA (Annual Quality Assurance Assessment) that the acting manager completed and sent to us in February 2009. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living at the home. It gives the manager the opportunity to say what the home is doing to meet the standards and regulations, and how the home can improve to make life even better for the people who live and stay here. The AQAA also gives us some numerical information about the service; - Surveys which we sent to the home to give to people who live and stay there, their relatives/carers and to staff. We received 1 reply from relatives/carers; and 1 from a member of staff. - What the service has told us about things that have happened in the home. These are called notifications and are a legal requirement; - Any safeguarding issues that have arisen; and - Information we asked the home to send us following our visit. This inspection of George Beal House also included a visit to the home on 06/04/09. No-one who lives or works at the home knew we were going to visit on this day. We Care Homes for Adults (18-65 years) Page 6 of 30 spent time talking to the acting manager, resource manager and other staff. We looked round the home and spent time in the bungalows, observing what happens. We also looked at some of the paperwork the home has to keep including care plans, risk assessments, medication charts, and records such as staff personnel files, staff rotas, menus and fire alarm test records. Since our last inspection, the registered manager has been absent from the home for several months. She had a long period of sick leave and, although she has returned to work, she has been undergoing a phased return in another service so has not returned to George Beal House. The acting manager, Sheena Archer, who was present for the inspection, started work at the home in September 2008 to undertake some specific pieces of work. She was asked to take on the acting manager role when the manager went off sick in November 2008. In the report following our inspection in April 2008 we made the judgement that This home is not managed well enough to make sure that the people who live here have good quality, safe lives. We commented that little improvement had taken place since our inspection in 2007, and the inspection resulted in 15 requirements being made. Both of the surveys that were returned to us, and some of the people we spoke with during this inspection made it clear that most of the improvements have taken place since the acting manager started at the home. One person said Sheena is well thought of by all staff, as she has boosted staffs confidence in their work and continues to do so. If the previous manager returns, I hope that this will continue, as staff say that GBH is now a better place to work. The relatives who wrote to us, when answering questions about communication, information, meeting needs, environment, staffing and general improvements, wrote several times that this has improved since the introduction of new management. They wrote We feel that strong leadership is necessary in the home and this is now being given, and The biggest challenge will be to maintain and build on the considerable improvements made in the last few months. What the care home does well: The two people who responded to our survey were very positive about the service that is offered at George Beal House (see quotes in the paragraph above). The staff member also wrote that positive comments are now often received from parents/carers. Staff we spoke with were very enthusiastic about the way the home is moving forward and all the improvements that have been made. Information about the home is available in different formats, including on CD, so that most people who want to use the service will be able to know what it offers. Assessments of peoples needs are carried out, and support plans are written in a person-centred way and give staff good, detailed guidance on how each person wishes to be supported. People attend day services most days in the week, and are offered opportunities for leisure activities on their day off and at weekends. Menus show that varied, nutritious meals, chosen by the people who live and stay at the home, are produced with plenty of alternatives. People know their complaints will be listened to, and that staff have been trained in safeguarding so that they will be kept safe from harm. Care Homes for Adults (18-65 years) Page 7 of 30 The redecoration of almost the whole home is nearly completed, and George Beal House is now a bright, clean, comfortable, and homely place for people to live/stay in. People have personal items in their bedrooms. Staff are recruited and trained well, and a high percentage of the staff have been awarded a National Vocational Qualification (NVQ) in care. All staff are starting to receive regular supervision and will have an annual appraisal. Tests of the fire alarm and emergency lighting systems are done regularly as required, and the provider visits monthly and writes a report of the visit. What has improved since the last inspection? What they could do better: We have not made any requirements following this inspection, which means we did not find any failures to meet the regulations. We have made a few recommendations. During the months before our visit, the home had told us about a number of errors in the way medicines were administered. The acting manager has successfully worked with staff to reduce the number of errors, and we have recommended she continues to monitor this closely. We also found that staff do not always record the administration of when needed medicines as consistently as we would expect, so we have recommended improvements to this. Better records should be kept to show that peoples money is not pooled, and people should be more involved in preparing and cooking meals, by making better use of the kitchens in the bungalows. We know that the acting manager is aware of areas that can continue to improve so that the service offered to the people who live and stay at George Beal House continues to get better. Care Homes for Adults (18-65 years) Page 8 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 – 5)........................................................................ 11 Individual needs and choices (standards 6 – 10) ................................................... 13 Lifestyle (standards 11 – 17) .............................................................................. 15 Personal and healthcare support (standards 18 – 21) ............................................. 18 Concerns, complaints and protection (standards 22 – 23) ....................................... 20 Environment (standards 24 – 30) ........................................................................ 22 Staffing (standards 31 – 36)............................................................................... 24 Conduct and management of the home (standards 37 – 43) ................................... 26 Outstanding statutory requirements..................................................................... 28 Requirements and recommendations from this inspection ....................................... 29 Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: 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. Good information is available about the home and people know their care will be based on a thorough assessment of their needs. Evidence: George Beal House has a Service User Guide and Statement of Purpose, which describe what people can expect from the home. These are in large print, with lots of pictures and are easy to read. The Service User Guide is also available on CD for people who would prefer to listen to the information. All the documents had been updated (other than the changes to the Council, which had only taken place a few days before our visit). Copies of the Service User Guide are available in the entrance hall, along with the previous inspection report and lots of other useful information for people living/staying at the home, their relatives and other visitors. Each person has a contract with the home. Again, these are written in a way which is easy to read, and include a lot of pictures and photographs. The contract explains what the person can expect from the home, and what is expected of them. Full assessments of peoples needs are carried out before people are offered a place at the home, whether its a permanent place, or a respite stay, and each person is supported through a transition period which meets their individual needs. The care manager from the social services team carries out a review every year on each person Care Homes for Adults (18-65 years) Page 11 of 30 who lives permanently or stays at George Beal House, which is an assessment of the persons current needs, and reviews how well the home is meeting those needs. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: 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. Support plans are based on each persons assessed needs and give good guidance to staff on the way each person prefers their needs to be met. People are supported to make decisions about their lives, and risk assessments enable people to be as independent as possible. Evidence: The information about each person who lives at George Beal House has been divided into 3 folders: support plan, social and health. The support plan folders we looked at are all written in the first person (that is, using I). We saw that each contains a pen picture of the person, giving brief details of who the person is and what support they need. The support plans are also written in a very person-centred way (using I), and, where possible, contain photographs of the person. Support plan folders also contain risk assessments and risk management guidelines. Any risks that a person could be involved in are assessed: one of the files we looked at had 19 risks assessed. These are indexed so each one is easy to find, and the management guidelines give staff good information on how to support the person so that the risks are minimised, but the person is still able to do whatever the activity involves. Care Homes for Adults (18-65 years) Page 13 of 30 The staff team have helped each person to develop a communication passport. Each persons communication passport is in a small folder, with each page laminated, so that they can take it with them wherever they go (college, day services and so on). We looked at one of these: the passport uses photographs, symbols and pictures to show how the person communicates, how they express their feelings, their likes and dislikes and contains some useful personal information. This is excellent, especially as a number of people at George Beal House do not use words to communicate. Staff write daily notes which give a clear picture of how each person has spent their day. Each person has a keyworker (and a co-keyworker) who gathers information each month about the progress the person has made, ready for the annual review. The acting manager told us that an annual review has been carried out for all except one of the 10 people who live here, and for almost all the people who come here for respite. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: 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. People are offered a wide range of opportunities to lead full, satisfying and interesting lives. Evidence: Most people who live here go to a day service or college for 4 days a week. They have one day at home, plus the weekends and evenings. People who stay here for respite carry on going to whatever services they usually go to when they are at home. Each persons social file contains a weekly activity planner. This includes pictures/photographs and shows that people lead busy lives at the times they are not at day services. The acting manager told us that they are planning to put an activity board in each persons bedroom. An activities book is filled in which gives lots of detail about what people do on their days off and at weekends. The home also uses an activity planning diary, so that activities can be planned in advance, to ensure that there are enough staff on duty, tickets are bought, transport organised and so on. In the respite bungalow we saw that a lot of art work is done. At the time of our visit there were things in the lounge/dining area, including a big painting on the wall, lots of pictures, mobiles and other items that people had made to celebrate special events, such as Mothers Day, St Patricks Day, Easter and so on. Staff showed us a folder which is full of photographs of people doing Care Homes for Adults (18-65 years) Page 15 of 30 things, such as painting, card-making, out on walks and so on. Staff told us about their plans for a May day party, and that people are currently involved in painting pictures to go in their bedrooms. One person said he does lots of things when he stays at the home, and he would be going to the cinema on Saturday morning. A Wii games system has been bought for people to use, which has proved to be very popular. One member of staff who started working at the home in the autumn of 2008 told us that there has been an improvement in activities, both in-house and in the community. Everyone has a holiday. The provider pays a contribution toward the cost of the holiday, and pays for staff to support each person to have a 7-day holiday of their choice each year. People can have more than one holiday if they want to, but they then pay all the costs. The acting manager told us that a pack has been put together so that staff know everything they have to do when supporting someone to arrange their holiday. Monthly keyworker meetings are held: there is a set agenda and minutes are taken. In the folders we looked at we saw that decision making is described, so that it is clear how each person has been supported, if they need support, to make a decision. There is plenty of evidence in peoples files to show that diversity has been considered, and peoples specific needs are clearly recorded. The acting manager said they are planning to do formal diversity mapping with each person so they have an even clearer picture of each persons needs. Families of the people who live and stay at George Beal House are encouraged to be involved in their relatives lives as much as they want to be. Several people spend weekends, or days with their families. If needed, staff support people to keep in contact with their families. An advocacy service is available for anyone who needs additional support. George Beal House still has one main kitchen where most of the food is ordered and cooked. We spoke to the cook who told us she goes round the home every week, using pictures to plan the menu with the people who live here. The menu includes a wide range of meals, and people are encouraged to try new things. There are always 3 choices for the main course: a meat dish, a vegetarian or fish dish, and salads. Pictures of meals are used so that people can make choices about what they would like to eat. The cook keeps a list of peoples likes and dislikes in the kitchen, which is reviewed every 3 months. The main meals are delivered to the bungalows in heated trolleys. If anyone needs a pureed diet, the support workers do that in the bungalow. During the week, breakfast is whatever each person wants: a choice of cereals, porridge, toast, baked beans, scrambled eggs and so on. Lunch is provided by the day services and people who are at home during the day make their own arrangements for lunch (either out or making a snack lunch in their bungalow). The main meal is in the evening. At the weekends the main meal is at lunchtime, and people also get a choice of something cooked for tea. Stores of foods are kept in each bungalow so that snacks are available at any time and there is always a range of other options for people who dont want what is on the menu. Each bungalow can also choose to have a take-away of their choice. On the day Care Homes for Adults (18-65 years) Page 16 of 30 we visited the cook and kitchen assistant were giving the kitchen a thorough clean, so people were choosing what take-away meal they wanted that evening. Although we acknowledge that the home is providing a good, healthy diet and catering to individual needs, more could be done to involve people in meal preparation and cooking, by making better use of the kitchen facilities in each bungalow. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience Judgement: 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. People are supported with their personal care in the way they prefer, and their health needs are met. The safe administration of medicines is improving. Evidence: The folders we looked at contained detailed support plans for all aspects of the care and support the person needs, for example, with personal care, dressing, using the toilet, gastrostomy and so on. It was clear from these that staff had spent a lot of time working out the ways in which each person prefers to be supported, and the detail of the guidelines makes sure that the person gets consistent staff support. Everyone who lives at George Beal House has a Health Action Plan in place. The ones we looked at are written in a very person-centred way, with lots of detail about the ways in which each person wants to be supported to maintain their health. Cultural needs are also considered, for example, one persons plan includes details about specific products needed for her hair, and how to use them. For the people in the respite unit, their main carers are responsible for making sure their health needs are met, although the home will arrange for medical treatment if it is needed during the persons stay. We looked at the way the home deals with medication for the people who need it. Since our last inspection we had received a number of notifications about mistakes in medication administration. None of the people involved had been badly affected by the mistakes, but nevertheless mistakes are not acceptable. We were satisfied that these were dealt with appropriately each time and that the acting manager is doing Care Homes for Adults (18-65 years) Page 18 of 30 everything possible to make sure staff are properly trained and carry out their responsibility to administer medication safely and well. The acting manager explained that medication training is in 3 parts. Training records showed that all staff have had the training in administration of medication and the pharmacy talk. The new staff are currently undergoing in-house assessments to make sure they are competent before they are allowed to administer medication on their own. Medicines are kept in locked cabinets in each of the bungalows. Each person has information on file about which medicines they are currently using, what their purpose is and how they should be administered. We checked the Medication Administration Record (MAR) charts for one person. We noted that there were some inconsistencies in recording the way the when needed medicines are administered. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: 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. People know that their concerns will be listened to and acted on, and that staff are trained to keep them safe from harm. Evidence: George Beal House has a complaints procedure which is displayed so that people know who they can complain to. This is available in pictures so is suitable for most people who live and stay here. A complaints log is kept: no complaints had been received in 2009. There were 2 complaints in 2008 (before the acting manager started working at the home). One was about some confusion over a holiday booking, and one about various issues during someones short stay. Both had been investigated (the second involved the SOVA team) and dealt with satisfactorily. As a result of the complaint about the holiday, a pack is now in place so that staff have a checklist of everything that needs to be done to ensure holiday bookings go smoothly. The acting manager said the staff team work hard to deal with concerns quickly so that they dont become formal complaints. We looked at the arrangements the home has in place for dealing with finances, as none of the people who live here are able to manage their own money. The assistant manager explained that most people have a bank account, which needs two signatures for any withdrawals. 2 people have building society passbooks. A money request system is operated: keyworkers have to plan what money a person will need, for example if they are going shopping, or on an outing, so that the money is available. Receipts and bank statements are kept for each person. We checked one persons records which were accurate. A small amount of cash is also kept for each person. Any transactions are entered into one book for everyone, and the total in the book is for all the residents. This way of dealing with the money looks as though the money is pooled, which is not acceptable. We discussed alternative ways of keeping records so that each persons money is clearly held separately. Care Homes for Adults (18-65 years) Page 20 of 30 Bedfordshire County Council has produced a leaflet for people with learning disabilities, which is about red-carding the bullies. The manager said this had been discussed in the monthly meetings which are held in each bungalow, and keyworkers are trying to make sure that each person understands what bullying is, and what to do about it. Training records showed us that almost all the staff have attended a training course on safeguarding vulnerable adults (SOVA). Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: 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. Evidence: We were very pleased to see, as soon as we entered the front door, that a lot of decorating and refurbishment has been done at George Beal House since our last inspection. On the day of our visit the home felt light, airy, clean and fresh, and the whole atmosphere felt lifted compared to the last time we visited. The acting manager and other staff all told us what a difference it has made to everyones morale, residents and staff alike, and how good it is now to work in much more pleasant surroundings. All shared areas of the home, including lounges, corridors, bathrooms and so on have been painted, and the majority of carpets have been replaced. Most of the bedrooms have also been redecorated, and carpets replaced or cleaned. The huge cracks in the walls that were so unsightly in one bungalow have been filled and decorated, and the dark room (which was not used) has been turned into a quiet area where people can watch a different TV programme, listen to music, meet with their families or whatever they want to do. Overhead tracking for hoists to assist people who need it to transfer to/from their wheelchairs and so on has been fitted into 15 of the 16 bedrooms. Some parts were still being waited for before most of these could be used, but the acting manager said it would make a huge difference to people who needed this assistance as it is safer and more comfortable than using a mobile hoist. The clutter around the building has mostly been removed, including in the link corridor which is now a pleasant place to sit in, and the gardens have been tidied up. The acting manager said the staff and residents are buying and/or painting pictures to make the building more homely. Staff clearly work hard to make sure peoples Care Homes for Adults (18-65 years) Page 22 of 30 continence needs are met so that there are no unpleasant odours. Staff said they are hopeful that funding will be found in this years budget so that the kitchenette in the respite bungalow can be replaced in the way the other 2 kitchenettes have been so that it is easier and safer for people to use to help prepare drinks and meals. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: 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 people who live here benefit from staff that are recruited well, and who have sufficient training, supervision and support so that they can do their jobs properly. Evidence: The acting manager told us that 8 new staff had been appointed since August 2008, including 3 team leaders. One of these had recently left, and interviews were to be held, which would involve some of the people who use the service. Other than the team leader, and one part-time member of staff who had just handed in her notice, the acting manager said the home was fully staffed. Some agency staff are still being used, to cover for holiday and sick leave, but this number of agency staff is a lot less than previously. 3 of the permanent staff are on secondment (to training or other posts) so their hours are covered by 3 agency staff who work all their hours at this home. One person who wrote to us said the agency staff appear more integrated since efforts have been made over the past few months to try to ensure the same people are used. There are usually 8 staff on duty for all the daytime hours, but the actual number depends somewhat on what the people who live at the home are doing. There are always 2 night staff awake during the night and a senior person sleeps in the building in case of emergencies. One of the people who wrote to us felt that it would be better if the assistant managers worked at least 1-2 shifts a week on the floor, supporting staff and service users. One person said that even more staff would give even greater opportunities for more one-to-one activities with people. We looked at the records the home keeps about two of the staff. There was a proCare Homes for Adults (18-65 years) Page 24 of 30 forma in place, showing that all the necessary documentation is in place in their personnel files, which are held centrally at County Hall. These had been verified by a senior manager. We spent a morning in June 2008 checking a random selection of files of staff who work across the County Councils registered services. Generally all the required information was available on the files we looked at. Some staff have been employed for many years, and started long before the current requirements were in place. The Council has worked hard to get as much information as possible, and has ensured, for example, that Criminal Record Bureau (CRB) checks have been done, and are renewed every three years. The home has a detailed induction checklist which is worked through step by step with all new staff until it is complete and signed off. Before the acting manager was in post, supervision was not taking place as often as it should. However, since she started, the acting manager has met with all the staff individually and supervision is now cascaded down: the manager supervises the assistant managers, they supervise the team leaders, who supervise the rest of the staff team. Supervisions are done regularly and annual reviews will take place for all staff. One (fairly new) staff member said My supervision has been regular and informative. I am always told how I am working and given copies of my supervision notes. New records have been put in place, showing the training that each staff member has undertaken. The records show very clearly which training is needed, when courses have been booked, and when they are due for renewal. The records showed that almost all the staff are up to date with all 5 topics related to health and safety: first aid; moving/handling; food hygiene; infection control and fire safety, as well as SOVA and medication (discussed in previous sections of this report). Staff have also been given the opportunity to undertake a range of other training, such as autism, mental capacity act, person centred planning, peg feeding, and epilepsy. 7 staff are currently being trained to drive the house vehicle. One survey said Regular staff are well trained and the mix of skills seems appropriate. There is a high percentage of qualified staff at George Beal House; 23 staff have been awarded a National Vocational Qualification (NVQ) level 3 in care, and 1 has NVQ level 4. 3 staff are working toward NVQ level 4, and another has registered and will start this imminently. The 3 new staff are undergoing the LDQ (Learning Disability Qualification). Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: 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. This home is managed much better than it was, so that the quality of life for the people who live here is improving. Evidence: The registered manager has been absent from the home for several months (see Summary of this report). The acting manager, Sheena Archer, who was present for the inspection, had started work at the home in September 2008 to undertake some specific pieces of work. She had been asked to take on the acting manager role when the manager went off sick in November 2008. Sheena has a degree and has been awarded NVQ level 4 in care, and the Registered Manager Award. She has also undertaken a range of other relevant training during her career in care. There are a number of ways that the quality of the service offered at George Beal House is checked. A survey was sent to parent/carers in June 2008: there were 10 responses which were put together into a report. A lot more positive comments were made than negative ones, including praising the friendly and approachable staff for their kindness and doing an excellent job, and general satisfaction with the respite service. Some of the ways parents/carers felt the home could improve included laundry, communication, and a lack of permanent staff. A survey was also completed by an advocate with each of the people who live here. This concentrated on the activities that people do, and a number of improvements were introduced as a result. A newsletter is now sent regularly to anyone with an interest in the home, to improve communication. The newsletter which went out in Care Homes for Adults (18-65 years) Page 26 of 30 February 2009 included photographs of the new staff with a brief description of their role, as well as news about what was happening in the home such as the redecoration, activities, and the next parent/carer meeting. People who live and stay at the home have lots of ways of making their views known, including bungalow meetings, one-to-one meetings, reviews and so on. Parent/carer meetings are held regularly and the newsletter confirmed that people are welcome to contact any of the management team if they have anything they would like to discuss. A representative of the provider carries out regular visits to the home and writes a report of the visit, which includes any actions the manager must take. In December 2008 this was extended to a thorough inspection of the home. 5 staff are trained as fire wardens, and the team is putting together a power-point presentation on fire safety that can be delivered regularly to all staff. We looked at the records of the tests of the fire alarm and emergency lighting systems. The fire alarms had been tested every week, and the emergency lights almost monthly, which meets the requirements. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes No Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 17 More should be done to involve people in preparing and cooking meals, by making better use of the kitchen facilities in each bungalow. The manager should continue to monitor the administration of medicines closely so that mistakes are not made. The recording of the administration of when needed medicines should be clarified so that there is consistent practice from staff. Records of each persons money should be kept differently so that it is clear the money is not pooled. 2 3 20 20 4 23 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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