Care Home: The Beach House

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What the care home does well The Beach House is a well managed service that provides a good standard of care to the people it supports. There is evidence to show that the ethos of the service is open and transparent with the views of service users listened to and valued. Some of the service users and their carers commented: `I like going on outings, shopping, doing art work, meeting with my friends and watching TV`. `I enjoy outings, going for a drink and going to Sea World`. `Our son is happy and says he likes the staff and enjoys it`. `We find the care wonderful and would not have kept our daughter living at home for 28 years without this support`. `Staff are always helpful and professional`. Service users have good opportunities to take part in social and leisure opportunities as the location of the service is very central with good links to public transport. Service users are supported well by a strong and consistent staff team who have developed positive relationships with all of the people who use the service (and their carers). The Beach House is well maintained and comfortable and service users have been involved in the decoration of the service and their views and opinions were listened to in respect of how they would like the garden and bedrooms to look. What has improved since the last inspection? This was The Beach House`s first inspection. What the care home could do better: The Manager has a good understanding other areas where further developments are either planned or would benefit the people who use the service; for example improving the current care planning documents in line with person centred planning. One requirement has been made as a result of this inspection and in this in relation to how the service manages individuals` as and when required medication (PRN). In order to make sure that all staff are clear on when to give some medicines and how much, all guidelines need to be clearer. Key inspection report Care homes for adults (18-65 years) Name: Address: The Beach House 29 Westbourne Villas Hove East Sussex BN3 4GQ     The quality rating for this care home is:   two star good service 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: Niki Rayner     Date: 1 2 0 5 2 0 1 0 This is a review of 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 2 1 0 stars - excellent stars - good star - adequate 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. that people have said are important to them: They reflect the things 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. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum 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 years) 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: The Beach House 29 Westbourne Villas Hove East Sussex BN3 4GQ 01273295288 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): justin.nuttall@brighton-hove.gov.uk www.brighton-hove.gov.uk Brighton & Hove City Council Name of registered manager (if applicable) Mr Justin Nuttall Type of registration: Number of places registered: care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is: 14 The registered person may provide the following categories of care only: Care home only (PC) to service users of the following gender: either whose primary care needs on admission to the home are within the following categories: Learning Disability (LD), Physical Disability (PD) Date of last inspection Brief description of the care home The Beach House was formerly known as Pioneer House in Brighton, but it relocated to its current premises, changed its name and re-registered with the Care Quality Commission in December 2009. It is a purpose built establishment located in a residential area of Hove, East Sussex. It offers regular short-term breaks to people with learning disabilities and their carers. Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 0 14 14 Brief description of the care home The accommodation is arranged over three floors; there is a lift, two staircases and 14 single bedrooms all with ensuite facilities. There is a good sized garden to the rear of the property. Two beds are set aside for people with physical disabilities, whilst two are reserved for emergency admissions. There is no parking available at the service, although paid on street parking is available. More detailed information about the services provided at The Beach House can be found in the services Statement of Purpose and service Users Guide. Copies of these documents can be obtained directly from the Provider. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This report reflects a key inspection based on the collation of information received since December 2009, a review of the information contained within The Beach Houses written Annual Quality Assurance Assessment (AQAA) and an unannounced site visit, which took place over one day and lasted a total of four hours between 10.00am and 2.00pm. There were no service users at The Beach House at the time of the inspection as they were attending day services and/or college, however their views and opinions were given in the form of completed service users surveys, which were received by the Commission prior to the inspection. The site visit included a tour of the premises and some care records, medication and staff records were looked at. In addition, discussions were had with staff on duty and the Manager of the service. Care Homes for Adults (18-65 years) Page 6 of 29 Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 8 of 29 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 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 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 using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users individual needs are fully assessed with the involvement of the individual and their carers. This helps to make sure that The Beach House can offer them the support they need. Evidence: The services AQAA states that its aim is to offer regular short-term breaks to people with learning disabilities and their carers. Two beds are set aside for people with physical disabilities, whilst two are reserved for emergency admissions. The services referrals process procedure was seen on the day of inspection, which clearly states that no referrals are accepted without a current Adult Social Care Assessment. The Manager explained that most referrals are made by the Community Learning Disability Team (CLDT) Care Management Team. All referrals are assessed and reviewed by either the Manager of the service or one of the Senior Care Officers who after meeting with the potential service user and their carers will decide whether the service is appropriate to meet their individual needs. Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: The AQAA states that all new service users are given a copy of the Statement of Purpose, Service Users Guide and terms and conditions of contract which includes the cost of an overnight stay. The Manager said that all potential service users are given the opportunity to test drive The Beach House for an overnight stay. The Manager explained that emergency referrals to the service are frequent and that in this instance (where limited information is available) a copy of the most recent Adult Social Care Assessment is obtained at the earliest opportunity, whilst liaising with a number of health and social care staff who have a good understanding of the persons needs. The Manager said that all staff working at the service are very good at helping people to settle in, especially those who may be frightened or concerned after being admitted to the service on an emergency basis. The Manager said that the staff team are mindful of individual needs and preferences when booking in service users for respite care e.g. they will try to make sure that people are staying at the same time as their friends (as much as is possible). The care records for two service users were seen on the day of inspection, which confirmed that a good deal of information is obtained by the service prior to admission (including on an emergency basis) to ensure that their individual needs can be met. Care Homes for Adults (18-65 years) Page 12 of 29 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 using this 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 well by the services care planning procedures. They are consulted about all aspects of the service and are supported to make decisions in all aspects of their lives to the best of their abilities. Clearly assessed and managed risks enable service users to undertake a wide range of activities in order to promote their independence. Evidence: The Manager and care staff said that all service users have a working care plan in place, that have been developed from the Adult Social Care Assessment and with the individual themselves. We looked at three of these on the day of inspection. Each contained all aspects of service users lives including a pen portrait, their likes and dislikes, health and personal care needs, self-care, diet, mobility, community participation, relationships, consultation and advocacy support. Whilst there was some evidence to show that care plans are reviewed to reflect any changes in individuals needs or wishes, some were quite difficult to read and follow as Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: handwritten entries had been written over the top of typed words. The Manager said that he was aware of this issue and is currently looking at ways in which all care plans can be revised and updated in line with person centred planning. This has not been reflected as a requirement at this time but will be followed up at the next inspection. Risk assessments were seen in each of the care records we looked at. These showed that service users are encouraged to take responsible risks to increase their skills and independence. This is done in a measured way to minimise risk without limiting opportunity. The AQAA states: The team have always been ahead where personal choice and active support is concerned.. we have some service users that may do chores at home or support their carer and when they come to The Beach House, they themselves need a rest. They may not want to be involved in cooking etc. and are not expected to do so. Meanwhile those who are eager to maintain/enhance skills are encouraged by staff at the choice of service users. All care staff spoken with had a good understanding of individuals needs, whilst feedback received from service user surveys showed that people feel their needs and choices are respected well by the staff at The Beach House. Evidence seen on the day of inspection showed that service users are supported to make decisions about their lives. One example of this was whereby the care staff asked the General Practitioner (GP) to change the timing of one persons medication in order to fit in with their daily routine. From the evidence seen and comments received, we consider that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Care Homes for Adults (18-65 years) Page 14 of 29 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 using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported to take part in a wide range of activities to lead fulfilling lives and meet their individual needs. They play an active and fulfilling role in their community and are supported to maintain positive relationships with family and friends. Evidence: The services AQAA states: Service users are encouraged to develop and maintain their friendships and relationships with others and we are flexible in ensuring that people can attend their short breaks with friends or people they know. Trips out into the community happen on a daily basis. Some people like to be involved in local learning disability events such as clubs/discos etc. On the day of the inspection all service users were out. During the week this is mostly at a local day centre, college or work. Staff said that during the evenings, weekends Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: and college half-terms, routines are flexible. They explained that a number of social activities are chosen by service users at these times. Records showed that these include shopping, going to the pub, going for a walk, cinema and going out for meals. Feedback from service users in the returned surveys showed that people are happy with the different activities available during their stay at The Beach House. Some of their comments include: I like going on outings, shopping, doing art work, meeting with my friends and watching TV. I enjoy outings, going for a drink and going to Sea World. The Manager commented that since The Beach House has opened, service users have had more opportunities to take part in their local community as the location of the service is very central to Hove and Brighton with good links to public transport, although the service does have a large people carrier that has been adapted for people with physical disabilities. All food is prepared by a full-time cook who has worked at The Beach House (formerly Pioneer House) for over eight years. On the day of the inspection she explained that she encourages service users to help with preparing seasonal menus and over the years has learnt what individuals like and dislike. She said that she is planning to devise pictorial menus, which will be available on display within the service each day. Menus looked at showed that nutritious and healthy meals are provided. In addition, service users can ask for alternatives such as jacket potatoes, omelettes, pizza or pasta if they do not want the main meal on offer. The AQAA states that service users are routinely offered the choice of helping with cooking, although the Manager explained that due to the current layout of the main kitchen, at present this is not practical. An architect was at the service on the day of the inspection looking at ways in which this area can be improved. The Beach House was awarded five Scores on the door by Brighton and Hove Environmental Health Agency in January 2010. Care Homes for Adults (18-65 years) Page 16 of 29 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 using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive the personal, physical and emotional support to the level they need. They are supported to access healthcare services as needed, so that they stay healthy and well. Evidence: The Beach House uses a key worker system. The key worker is responsible for ensuring that service users support plans are kept up to date and ensures that all staff are aware of service users particular likes and needs and are aware of any changes. All aspects of personal care and support and health needs are incorporated into the support plan. This ensures that each individual is able to receive support in the way they wish. As already mentioned under Individual needs and choices, the Manager intends to review the current care planning format in line with person centred planning. We looked at three support plans, which showed that service users health and personal care needs are identified and met. There was evidence to show that the service has input from the local Community Learning Disability Team (CLDT) including Community Nurses, Speech and Language Therapists, Psychologists and a Consultant Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: Psychiatrist. In addition, all staff have recently had epilepsy training provided by the Joint Epilepsy Council with particular emphasis on the administration of buccal midazolam (medicine used in the management of epilepsy). Detailed epilepsy guidelines were seen in individual care plans, although in one persons plan none were available. The Manager explained that this was an oversight on their behalf and would action this immediately. This has therefore not been reflected as a requirement at this time. Staff said that they regularly support service users to healthcare appointments, including GP, dentist and opticians. Staff said that the daily routines within the service are flexible. For example service users can choose what time they would like to have a shower or bath and in most instances who they would like to support them (if necessary). Staff said that as The Beach House is a respite service, service users bring their medicines with them from home. The Manager said that this can sometimes be problematic e.g. some medicines may be sent in with wrong labelling or insufficient numbers, but the AQAA states that the service has robust systems and checks in place to make sure that any errors or discrepancies are kept to a minimum. The services medication room(s) and a sample of records were looked at. Whilst no major concerns were raised, it was noted that the guidelines for the administration of as and when required medicines (PRN) were insufficient. For example in one instance the reason for administration was agitation without any further information or guidance for staff to follow. Whilst in another persons records it was written that the dose could either be 0.5mg or 1gram, but there was no guidance for staff to follow in order to determine what the most appropriate dose should be. The Manager is required to make sure that clear and detailed PRN guidelines are in place for all service users to ensure that staff are able to meet individual needs in a consistent manner. Care Homes for Adults (18-65 years) Page 18 of 29 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 using this 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 Beach House has good systems in place to ensure that all complaints are investigated and responded to appropriately. Service users are protected from potential harm, neglect and abuse through the homes robust policies and procedures and through staff receiving the appropriate training. Evidence: Service users have regular meetings and are encouraged to say when things are not right or they have any concerns. The Manager said that the services complaints procedure is included within the Statement of Purpose and Service Users Guide, which gives clear guidance with regards to how a complaint can be made and how the person can expect it to be dealt with. All of the returned service users surveys confirmed that individuals would talk to their keyworker or Manager in the first instance. The AQAA identified that six informal complaints have been made by service users in the past 12 months, whilst no formal complaints have been made in over two years. The range of reported complaints showed that service users are confident in raising concerns and that these are fully investigated. In addition to complaints, the Manager also keeps a record of any positive comments received from service users and/or their relatives. These were seen on the day of inspection and included comments such as: Thank you for your support. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: Thanks for taking [service user] at such short notice. The whole family expressed their gratitude. The AQAA states that Brighton and Hove City Council has a multi-agency Safeguarding Vulnerable Adults policy and procedure in place and that staff receive regular training in adult safeguarding issues. This was verified from the sample of staff training records looked at and discussions with staff during the inspection. In addition, staff said that they have recently attended Mental Capacity Act and Deprivation of Liberty training, which has helped them feel more confident in understanding peoples rights. One alert has been appropriately raised and investigated by the service since the last inspection. Care Homes for Adults (18-65 years) Page 20 of 29 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 using this 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 Beach House offers a friendly and relaxed environment that has been built and decorated to a high standard throughout. It presents as a clean, well-maintained and homely place to be. Evidence: Accommodation is arranged over three floors. The ground floor comprises of a staff office, a locker room for service users and staff, the main kitchen, a dining area, two bedrooms with a shared bathroom and a large lounge area. The first floor has four bedrooms with ensuite facilities, a kitchen and lounge area, laundry, a games room, two medication rooms and a sensory room. Whilst the second floor has two selfcontained flats and four bedrooms with ensuite facilities. All areas have been tastefully decorated and lighting and flooring is varied and suitable to each area (carpets in bedrooms and lounges, wood effect linoleum in dining areas and linoleum type flooring in bathrooms and ensuites). The Manager advised that service users helped to choose colour schemes and stated they wanted a TV and DVD player in each of the bedrooms. All rooms have required furniture; bed (some height adjustable), chest of drawers, bedside table with lockable drawer, wardrobe, chair, lamp, mirror and TV. Overhead tracking is provided in a small number of the rooms for people with physical disabilities. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: Underfloor heating is provided throughout, therefore there are no radiators. There are heating controls in each room in order that the temperature can be individualised. Whilst most rooms have ensuite facilities, the Manager explained that these are not suitable to meet the needs of service users with physical disabilities (they are raised shower trays in an enclosed area) therefore it is difficult for staff to assist with personal care needs. The Manager is working closely with the Housing Association and building team to look at alternatives. The AQAA states that The Beach House has two members of domestic staff who work opposite each other. All areas of the home were found to be clean, safe and wellmaintained on the day of inspection. The Manager said that there have been a few snagging problems with the new build but they working hard alongside the Housing Association and building team to rectify these as a matter of priority. There is a good sized garden to the rear of the property, which service users have said they would like to spend their £5000 donation (from the building contractors) on a mosaic, which will be built along the boundary wall across the length of the garden. The Manager explained that a local learning disability day service has been commissioned to undertake this project. The Manager said that feedback from service users and their carers about the new build has generally been very positive with one person saying: This is just a brief note to express our delight and admiration of the building and its furnishings. Care Homes for Adults (18-65 years) Page 22 of 29 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 using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by a skilled and dedicated staff team who continue to work hard to meet individual needs. Service users are supported and protected by the services robust recruitment procedures. The staff team are supported to provide consistent care and meet the needs of service users through regular supervision and staff meetings. Evidence: In addition to the Registered Manager, the service employs a total of 20 care staff, over half of whom have obtained at least NVQ level 2 in Care. In addition, one administrative person, two cleaning staff and 1 cook are employed. On the day of the inspection the service had two carers vacancies. Brighton and Hove City Council supply regular relief staff to cover any staff shortages. Staff and duty rotas confirmed that there are usually between three to four carers on duty each shift, although these numbers are increased depending on the assessed needs of service users. The services shift pattern is generally divided into two shifts 7.30am to 3pm and 2.30pm to 10pm. There is always one waking night carer on duty and one sleeping-in staff. The Manager and staff spoken with said that there is a relatively low turnover of staff. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: Many have worked at the service (formerly Pioneer House) for number of years and have therefore developed positive relationships with each of the service users and each other. The comments received from staff in the surveys and on the day of inspection were all very positive: We work as a team and take initiative. The Beach House supplies an excellent respite service and meets well the different needs of service users. The whole team are very service user focused. All staff spoke positively of the number of different training courses available to them. In addition to mandatory training they said that recent training has included epilepsy, Mental Capacity Act, positive behaviour support, restrictive practices and in-house Makaton training. Staff confirmed that a supervision structure is in place and that generally this works well, although due to the recent move to The Beach House, this has on occasions had to be postponed. The Manager and Senior Care Officers are aware of this issue and are taking steps to get this back on track. Staff said that regular staff meetings are held. All staff are asked to contribute to the agenda. Staff said that these meetings are a useful source of sharing information and keeping up to date. All staff said that these meetings are service user focused. The Manager confirmed that all new staff have an induction pack that meets the Skills for Care (national approved training body) standards. Each staff member has an individual training plan that is developed and monitored through supervision and annual appraisal system. We looked at the recruitment records for one long-term member of staff and one newly appointed person. Whilst all checks were in place and available for inspection for the first person, including a completed application form, photo identification, written references and a current police check, a current copy of the newest member of staffs police check was not available. The Manager explained that this was still at the Councils Human Resources office. The Manager confirmed in writing following the inspection that he has since obtained a copy of this which is now kept on their personnel file. Care Homes for Adults (18-65 years) Page 24 of 29 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 using this 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 Beach House is well managed by a competent person and a staff team who listen and act on the views of service users and their carers. Evidence: The Registered Manager has worked in the care sector since 1997, including both day and residential care services. He was appointed to manage Pioneer House in 2007 and holds both NVQ Level 4 in Management and a Registered Managers Award qualification. He has sound knowledge of working with people with learning disabilities and is visionary in his approach to the service. The Manager is supported in his role by two Senior Care Officers. Without exception, all staff and feedback from service users confirmed that The Beach House is a well managed service. It was stated in the AQAA and confirmed on the day of inspection that service users views are important to everyone working at The Beach House. Service Users forums are held every two months, which are then fed back to senior staff. Minutes are taken at each meeting and then fed back in person at weekly service user meetings at The Beach House. There is also a comments and suggestions box, regular key worker Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: meetings and six weekly telephone contact with carers. The AQAA states that as a result of listening to service users views, they are now involved in the recruitment of staff (showing candidates around the service and telling them about The Beach House in their own words and from their own perspectives). In addition, service users have been involved in the decoration of The Beach House and have put forward their ideas about how they would like to spend their £5000 donation (as mentioned under Environment). Feedback from carers is also important to the staff at The Beach House. The most recent carers survey (July 2009) was positive. Some of their comments include: Our son is happy to go to Pioneer and says he likes the staff and enjoys it. We find the care wonderful and would not have kept our daughter living at home for 28 years without this support. Staff are always helpful and professional. Meetings with other members of staff and keyworkers would be helpful. Nothing will ever be 100 perfect, but Pioneer is as good as it gets. Carers meetings have been very informative. Also I know that I can pick up the phone and ask re anything. We miss the number of weekends we used to have. Evidence provided within the AQAA identified that all equipment is well-maintained and regularly serviced including: fire equipment and alarms, environmental health issues, electrical appliances and emergency lighting. We also looked at the services incident and accident records, which showed that working practices are safe and there have been no preventable accidents. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R 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 27 of 29 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 1 20 13 13(2): That clear and 16/07/2010 detailed PRN guidelines are in place for all service users who require medication on an as and when required basis. To ensure that staff are able to meet individual needs in a consistent manner. 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 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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