Care Home: The Beeches

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What the care home does well This home had a relaxed, friendly and comfortable atmosphere, and was light, bright and airy. The decoration and furnishings were of a good standard. Staff on duty were knowledgeable about service users care needs and the staff team worked together well and were enthusiastic about their work. Service users are involved, as appropriate, in the day-to-day planning of their own care and in the way the home is managed on a daily basis.Care plans are informative and help staff to understand the level of assistance service users want and need. The staff team enables service users to enjoy a wide variety of leisure and social activities, both local and farther afield. Comments made in surveys received from relatives of service users included: ` they (the staff) give my relative all the care & support he needs, they give ...... a very good social life and they keep the family informed of all that goes on regarding my relative `. What has improved since the last inspection? Requirements made by the fire authority had been responded to promptly, and full details of staff recruitment checks are now available for inspection. Regulation 26 reports (monthly visits by the registered provider) have now taken place and reports of these were available for inspection. The above issues were identified for action in the last inspection report, and the registered provider had responded positively to our requirements. There was a new dining table in the kitchen/diner. The lounge and kitchen/diner had been repainted. There was new furniture in the lounge, and in one bedroom. What the care home could do better: Training provided to all staff needs to include guidance on infection control good practice and the flooring in the dining area of the kitchen/diner was marked and would benefit from further cleaning or renewal.-------------------------- CARE HOME ADULTS 18-65 The Beeches 28 Shell Beach Road Canvey Island Essex SS8 7NU Lead Inspector A Thompson Unannounced Inspection 19th June 2008 09:30 The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Beeches Address 28 Shell Beach Road Canvey Island Essex SS8 7NU 01268 515441 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) kingswood@donna-higby.freeserve.co.uk Kingswood Care Services Limited Michael Frederick Bedford Care Home 4 Category(ies) of Learning disability (4) registration, with number of places The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Personal care to be provided to not more than 4 adults with a learning disability. Mr Michael Frederick Bedford to complete an approved course in Protection of Vulnerable Adults (POVA) within three months of registration. 12th June 2007 Date of last inspection Brief Description of the Service: The Beeches is a two storey detached property set in a quiet residential area on Canvey Island. The home is situated close to the beach, a bus route, pubs and clubs and within a mile of the town centre. The home offers one lounge with an open plan dining room and kitchen, and four single bedrooms. Three bedrooms had en suite facilities, including private bath or shower, and one a designated bathroom adjacent. There is a communal wc downstairs. The grounds and garden are compact and were well maintained and accessible offering both lawn and decking area for service users. Service users within the home access a range of day care and participate in a range of leisure pursuits/work based programmes within the local community. The weekly fees range between £1190 to £1948. Fees need to be discussed on an individual basis with the home as the exact amount will depend on assessed individual care needs. Additional charges are made for toiletries and evening and weekend transport, including taxis CSCI inspection reports can be obtained from the home, or via the CSCI internet website: www.csci.org.uk. The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 2 stars. This means the people who use this service experience good quality outcomes. This unannounced key inspection took place on Thursday 19th June 2008. The content of this report reflects the inspector’s findings on the day of the inspection along with information provided by the service and feedback by service users, staff and other parties. The registered manager of the home was off duty on the day of the inspection and the process was dealt with by the deputy manager, who made himself available for the entire day. The manager had completed and returned their Annual Quality Assurance Assessment (AQAA) to us prior to the inspection. This document gives homes the opportunity of recording what they do well, what they could do better, what has improved in the previous twelve months as well as their future plans for improving the service. Some of the information and detail provided within the AQAA has been included in this report. Discussions were entered into with service users, the deputy manager, service manager and staff on duty. CSCI survey questionnaires were also provided to service users, staff and stakeholders. We received eight completed surveys and reference to feedback from these has been made within this report. Random samples of records, policies and procedures were inspected and a tour of parts of the premises and grounds took place. All matters relating to the outcome of the inspection were discussed with the deputy manager of the home, with full opportunity for discussion given and/or clarification where necessary. What the service does well: This home had a relaxed, friendly and comfortable atmosphere, and was light, bright and airy. The decoration and furnishings were of a good standard. Staff on duty were knowledgeable about service users care needs and the staff team worked together well and were enthusiastic about their work. Service users are involved, as appropriate, in the day-to-day planning of their own care and in the way the home is managed on a daily basis. The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 6 Care plans are informative and help staff to understand the level of assistance service users want and need. The staff team enables service users to enjoy a wide variety of leisure and social activities, both local and farther afield. Comments made in surveys received from relatives of service users included: ‘ they (the staff) give my relative all the care & support he needs, they give …… a very good social life and they keep the family informed of all that goes on regarding my relative ‘. What has improved since the last inspection? What they could do better: Training provided to all staff needs to include guidance on infection control good practice and the flooring in the dining area of the kitchen/diner was marked and would benefit from further cleaning or renewal. -------------------------- Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, & 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering moving into the home can be confident that the admission processes ensures that the home can meet their needs. EVIDENCE: The home’s Statement of Purpose and service users guide were seen, and included the information needed to help new services users make an informed choice when considering moving into The Beeches. Information was easy to read and includes pictures, makaton and photographs. The current service users are placed and funded by local authorities. Records confirmed that these organisations had provided a full assessment of needs to the home before admission. In addition to this the manager at The Beeches undertakes a written assessment of needs for all prospective service users prior to admission. No new service users had moved into the home since the last inspection and so a file was looked at for a person admitted prior to 2007. The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 9 Included was information on the individual’s background, with assessed needs under headings of: social skills, self help, leisure interest/needs, communication, behaviours, family & professional involvement, physical, daily living, medical and health. Comments in service user surveys returned to us confirmed that they were asked if they wanted to move into this home. Information relating to admission provided by the manager in the home’s AQAA states: ‘A comprehensive and detailed pre admissions service users assessment is completed by the home prior to admission. The programme including pre visits to prospective sevice users homes and schools.This is filed in the clients personal file. From the initial assessment the information is then carried forward in the day-to day care planning. Service user guide demonstrates services on offer’. The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, & 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users had a plan of care which included their current needs. Service users were supported in making decisions and improving independence, this is because staff promote their rights and choices whilst taking account of perceived and identified risks. EVIDENCE: Four individual support/care plan files were inspected. These had comprehensive risk assessments with guidelines for staff on methods to minimise risk. Risk assessments had been reviewed regularly. There were also behaviour plans with detailed guidance for staff on how to mange incidents and aggression. Staff had received training on responding too and managing aggression. Staff spoken with confirmed this. The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 11 Daily assessed needs were listed under individual headings including: personal care, cycling, money, personal hygiene, reading, diet, communication, independent cleaning and household chores. Each area of need showed an aim and course of action relating to the daily care provided. All care plans had been regularly reviewed with a daily record completed by staff. Care reviews included recorded notes of the service user’s views. Healthcare issues were seen to be recorded including visits to medical professionals, social workers, hospital visits, GP consultations, dentists, opticians and chiropodists. Also seen recorded were notes of full reviews of placement undertaken with the placing authority and the service user. The deputy manager confirmed that service user meetings take place regularly. Minutes of a meeting that took place in March 2008 included evidence of discussion on interests, daily routines and community access. Service users views and opinions were included. Service users spoken with who were willing or able to express an opinion, (some did not engage in conversation with the inspector), confirmed that they thought they are fully included in day to day decision making within the home, with staff offering choices around routines and events. Information given by the manager in the AQAA when asked what the home does well regarding individual needs and choices includes: ‘The Beeches encourage all service users to participate in all aspects of life including meetings, menu planning, activities and daily living skills. Service users have the right to have their care reviewed regularly.The Beeches offers service users questionnaire following review to seek veiws and opinions regarding decisions made. Care Plans and goal plans are completed by the keyworker after discussing needs at meetings and with individual staff members. Person centred approaches are used to gather information regarding need and wishes’. The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of activities within the community mean that service users have various options to participate in social, educational and leisure opportunities. Meals and mealtimes are flexible and meet with the lifestyle of service users living at the home. EVIDENCE: The deputy manager confirmed that none of the service users living in The Beeches is currently in any form of paid or voluntary employment. Past work experience had included a service user working in a fast food outlet, however the service user stopped doing this. College courses are available at two further education facilities. All service users attend on a part time basis. Staff support service users to attend these classes on a 1-1 or 2-1 basis. The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 13 Staff also support most service users in accessing the local and wider community and its facilities. Records had been kept of daily activities offered and all service users had a monthly activity plan they participated in. Activities were recorded on individuals daily sheets and included: bike riding, trips to Colchester, cleaning rooms, painting at college, walks, pub, clubs, cinema, ice skating, bingo, swimming, bowling, arts & crafts, theatre, outings, cooking and eating out. Service users spoken with confirmed that they regularly attend many of these activities, usually with staff support. They also spoke about holidays they have taken, these included holiday camps, camping and holidays with family. The company owning The Beeches provides two vehicles based at the home for the benefit of service users, enabling ease of community access with full staff support. Service users see their families and friends regularly with staff offering to drive the service user home to ensure regular contact is supported. Contact includes regular visits home, including overnight stays. Records had been kept of family contact. The deputy manager said that staff enter bedrooms only with the individual’s permission, unless the welfare or well being of the service user is in question. All service users have keys to their rooms. Throughout this inspection staff were observed to interact appropriately with service users and appeared to always use the individual’s preferred form of address. Discussions were seen to take place and the atmosphere in the home was supportive and friendly. Nutrition records were inspected and evidenced a varied and balanced diet. The deputy manager said that service users usually eat at the large table in the lounge but sometimes may choose to eat in the kitchen/diner or in their room. Breakfast and lunch are taken at times according to service users choices and their daily routines. The main daily meal is in the evening, when generally everyone eats together. Menus are on a four week rotation. Service user meetings included discussion on the food and the deputy manager confirmed that service users food preferences and likes/dislikes form the basis of menu planning. Service users sometimes accompany staff on food shopping trips and will take part in meal preparation as part of a planned activity. The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at The Beeches can expect to receive support in an appropriate and dignified way that meets their needs. EVIDENCE: Care records and discussion with service users and staff confirm that service users are fully supported in making their own choices around clothing styles, hairstyles and general appearance. Assessment records included preferences around rising and retiring times and full details of the levels of personal; care support required was also seen to be documented. Service users spoken with, who were willing, when asked to fully express a view as to the support provided them by staff, did confirm that they liked the staff and were satisfied with the care provided them in the home. Care plans contained assessment of healthcare needs. The current service user group are offered staff support and guidance in recognition of their individual healthcare needs and to access community healthcare facilities. The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 15 Service users regularly visit community based healthcare services including consultant psychiatrists and dentists (with staff support). Service users healthcare needs were recorded within individual care plans and updated in the daily care notes. All service users accommodated were receiving full staff support with their medication needs. Service user files included a signed form consenting to staff providing this support. Some of the current service users, in the opinion of the inspector, did not appear to have a full understanding or awareness of the medical reasons for medication regimes prescribed to them. The deputy manager confirmed that if service users refused medication then advice and encouragement is offered to them to understand the reason for the prescribed dosage. The home’s written medication procedure/policy clarified policies on homely remedies, side effects of the medicines prescribed, the storage of medicines and of administering prescribed dosages. Records were seen relating to the reordering and returns of unused medication. A random sample of medication administration records and stocks of current medication were inspected. No errors were noted. Training records seen included evidence that the pharmacist had provided medication training to staff who deal with residents medication. Certificates of this were seen. Staff who handle medication had also been put through an inhouse medication competency assessment, records of this were also seen. Information stated in the AQAA under ‘what the home does well’ on personal & healthcare support includes: ‘Staff encourage and promote dignity, respect and privacy for each service user. Staff treat service users with respect and actively support service users to control of their care and health needs whenever possible. The service user are escorted to appointments by an appropriate staff member who has a good relationship with the service user and who has knowledge about their condition, disability, symptoms and medical history. Where a service user has reqiured emergency medical aid family were involved from the onset and best out comes were achieved for the service user under these circumstances. Medication is stored and administered to a high standard. There are robust policies and procedures in place with supplimentary information and guideance. This includes the latest guidance from the pharmaceutical society. Service users are able to self administer topical applications and homely remedies after a risk assessment and in line with policy, procedure and guidance. All service users have a keyworker, who has in depth knowledge of the service user. All service users have their own rooms where personal care is provided. The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 16 All health appointments are attended to with the service user and away from the home where necessary to promote presence. All appointments are recorded. Visiting professionals are given privacy to perform consultations. Service users are activeley encouraged to attend regular health checks, these include; primary health checks, hearing, vision and dental’. The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Practices in the home safeguard service users and ensure that concerns are listened to and addressed. EVIDENCE: The manager had a complaints procedure in place, which clarified the complaints process and the timescales that the manager should respond to the complainant. There was a pictorial style complaints procedure in the home. Some service users would not have the ability to follow any written procedure, but the document displayed clearly indicates to service users that they have a right to ‘feel sad’ or ‘feel unhappy’ and that they should tell somebody. Comments in service user surveys confirmed that if they were unhappy they would tell their key worker or somebody else. All service users have active involvement with their respective families and/or regular contact with external health/social care professionals. The home has active links with the local advocacy service and was able to demonstrate that this service is used as appropriate to ensure that service users wellbeing is paramount to any given situation. There was a set template form for recoding complaints and a complaints record book. There had not been any formal complaints recorded since the last inspection. The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 18 Also seen in the home was a copy of the safeguarding adults policy and procedure produced by the registered provider, and a copy of the latest joint safeguarding procedural guidelines issued by the Essex joint authorities on abuse issues. These documents included detailed guidance for staff on the adult protection procedures and on types of abuse that may occur. Staff have safeguarding adult abuse training during their induction and following this undertake external POVA training. Certificates were seen for this. Staff spoken with understood what was meant by ‘safeguarding adults from harm’ and said that if they suspected an issue then they would contact the manager or ‘on call’ manager. Also seen was a ‘whistleblowing’ policy which clarified staffs responsibility to report any suspected abuse. Comments from the manager in the AQAA under complaints included: ‘The home has an appropriate complaints policy procedures. In the last twelve months there has been no complaints. The home has a safeguarding adults policy procedure in place (including whistle blowing). All staff receive basic training in safeguarding adults. All agency staff records of training on protection of vulnerable adults are filed at the Beeches in agency file. Improved physical Intervention training has been sourced in line with Department of Health guidance’. The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users could be confident they will be provided with a comfortable, clean and homely environment. EVIDENCE: During the inspection a partial tour of the home was made accompanied by the deputy manager. The home was clean, bright, homely and was well maintained, furnished and decorated. All of the rooms at The Beeches are spacious and have their own or adjacent en-suite bath or shower and WC. There is one bedroom on the ground floor that leads off of the main lounge area. Private rooms had a range of fitted wardrobes and adequate storage facilities. Service users spoken with showed the inspector around their rooms and said how comfortable and homely the home is. The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 20 One recommendation concerning the private rooms is for the registered provider to arrange for repairs to be made to the broken light fitting in the first floor bedroom above the dining area. The deputy manager confirmed that service users are provided full opportunities to personalise their rooms to their own tastes and requirements, and rooms inspected included various items of personal possessions according to individual choices. The lounge was very well furnished and looked comfortable. The dining area of the kitchen/diner was well furnished but the floor covering was discoloured. The new laundry room was accessed off the dining area and had sufficient space and equipment for the size of this home. The garden is compact but is secluded and well laid out, and has decking area with seating which can be accessed through either the lounge patio doors or the office door. The home’s vehicles are parked on the drive and although the street outside the home is narrow there is still sufficient parking for visitors. Service users work together with staff to ensure that their home is kept clean and tidy and on the day of the inspection the home was bright, cheerful, clean and hygienic. The Beeches has a pay phone and the deputy manager said that some service users have their own mobile telephones. The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from being supported by an experienced staff team who had received training. The recruitment procedure in the home provides the safeguards to ensure that appropriate staff are employed. EVIDENCE: A clear organised staff rota was available for inspection. On the day of the inspection four service users were living at The Beeches. Daytime staffing was a minimum of four staff on duty on AM shifts with three on PM shifts. At night there is one waking member of staff with someone on-call as support. Daytime staffing levels reflect agreed support packages for service users who require 1:1 or 2:1 staff ratios. The deputy manager, and staff spoken with confirmed that staff meetings take place. Minutes of a meeting held on 1/5/08 were seen. Discussion had included service user issues, training, menus, team work, responsibilities and health & safety. The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 22 Staff records seen for new employees taken on since the last inspection included an application form, proof of ID, photo, a CRB check, two references, job description and contract of employment. New staff are subject to a probationary period during which time they receive in-house induction training covering safety, medication, COSHH, food hygiene, health & safety, risks, fire and challenging behaviours. After completing this they move on to the Skills for Care Common Induction standards for social care workers. Evidence of this was seen. New workers are encouraged to commence NVQ training (level 2). Staff training records had been kept in files, with an overall record of training provided and certificates of attendance on various courses. These included: induction, conflict management, key worker role, abuse, food hygiene, NVQ, health & safety, fire safety, use of fire equipment, communication, first aid, epilepsy, learning disability framework, medication, continence, restraint (Scape) and challenging behaviours. Evidence was not available to confirm that sufficient numbers of staff had received training on infection control. Staff spoken with confirmed they were well supported by the management team. They also said that they had been offered good training opportunities appropriate to their roles. Staff were open, friendly and demonstrated sound care values. All had a good understanding of work practices and routines and the observed rapport between staff and service users was relaxed and friendly. Staff supervision meetings had taken place, with records kept of the agenda discussions and actions. Areas included had been work role, responsibilities, key worker role, performance and training needs. The home’s written supervision policy provided clear guidance to staff on the reasons for regular 1-1 meetings. The frequency of supervision meetings had increased since the last inspection but still did not meet the recommended six times a year. The acting manager said that group supervision meetings may be used as an additional support tool, which would provide further opportunities for staff to discuss work issues. Comments from the manager in the AQAA under staffing included: ‘All staff have clear job descriptions. all staff are issued with GSCC code of practise. Skill scans are used to identify skill gaps within individual staff members.All staff achieve minimum training requirements. Staff are encouraged and supported to obtain NVQ in social care at level 2/3. Staff receive quality training in specific needs of service users. This includes inclusive communication, conflict and risk management( challenging behaviours) and physical intervention. The home manager has RMA. Recruitment is carried out by either: senior managers and staff from the beeches, or onother home when there are service wide vacancies. The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 23 All staff must receive 2 references and a clear acceptable CRB check prior to commencing duty. In exceptional circumstances where there are drastic staff shortages POVA firsts will be sought. All interviewers ask candidates the same questions’. The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, & 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at The Beeches can be confident that the home is managed effectively and that their opinions are central to how the home is run. The environment appeared safe. EVIDENCE: The registered manager has completed the NVQ4 Registered Managers Award. He was off duty on the day of this inspection and the deputy manager dealt with the inspection process in a professional and helpful manner. Comments in surveys received from staff about the management of the home included ‘I feel confident in my management that if I have any problems with my work I can go to them for advice’, and ‘we are lucky that we have a good The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 25 house manager’. Other comments made indicated that the writer thought management have to spend too much time on administration duties. The registered provider’s ‘annual quality assurance audit and development plan’ was sent ot us in April 2008. This evidenced that good quality management had taken place with service users and stakeholders views sought by sending them survey questionairre forms for completion, and that a development plan had been devised covering 2008-2009. Random samples of records required to be kept by regulation were inspected. These included: the statement of purpose and service users guide, regulation 26 reports (monthly registered person report), staff rota, visitor book, nutrition records, assessments, care plans, staff recruitment, complaints, medication records, regulation 37 notifications, service user monies held for safekeeping, fire procedures and fire drills. Staff had received training in first aid, fire safety, health & safety and food safety. Service records were seen to show that the home’s fire alarms, fire equipment, emergency lights, gas systems, the electrical installation supply and portable electrical appliances had all been tested/serviced within recommended timescales. The deputy manager confirmed that hot water supply is regulated at or near 43 degress celcuis, and that weekly checks on this take place. Records of this was seen. The home’s premises and safe working practices risk assessment formats were seen. These were regarded as a comprehensively compiled documents The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA35 Regulation 18 Requirement Evidence needs to be available for inspection to confirm that all staff are trained in infection control good practice to ensure they are trained for the duties they perform. Timescale for action 30/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA24 Good Practice Recommendations The floor covering in the dining area of the kitchen/diner should be cleaned or renewed to provide service users a pleasant environment to eat in. The broken light fitting in the first floor front bedroom should be repaired or renewed to provide the service user who lives in that room an environment he is satisfied with. All staff should receive supervision at least six times each year to ensure they are supported in their roles. 2 YA24 3 YA36 The Beeches DS0000047171.V366861.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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