Care Home: The Beeches

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What the care home does well The owner and the acting manager had worked really hard to create a staff team that met the needs of the people using the service and were committed to caring and supporting people with mental health problems. Because the improvements have been made since the last inspection the details will be recorded in the ` What has improved since the last inspection` section of this report. When we are sure that the improvements can be sustained they will be included in this section. What has improved since the last inspection? There have been many improvements to this service that have provided those people using the service with better outcomes. These include:An up-to date Statement of Purpose and Service Users Guide that includes all the required information and ensures that the residents are able to make an informed choice about where to live has been produced. All of the residents now have a signed contract that sets out the terms and conditions of their tenancy. Care plans and care documentation are accurate and clear in their guidance to staff on the care and support needed by all residents. Care plans are regularly reviewed and updated as care needs alter. Where possible the resident are part of the review process. Staff make records to show how residents have reached decisions. This is demonstrates that any support provided is in the residents best interest. Any risks that residents take are assessed and clearly documented, so it is clear how the risk is to be managed. Medication procedures in the home are robust and provide safe outcomes for the people using the service. Staff have had training on recognising and reporting abuse and a new policy has been instigated.Staff training has been expanded and the staff team have the collective skills to meet the needs of the residents. There are sufficient staff on duty to provide the necessary care and support for the residents. All new employers are correctly checked before starting work. The acting manager supervises all the staff. Service users, staff and other stakeholders are asked for their views of the home and the comments are used to make improvements. All health and safety checks are completed and recorded at the required intervals. CARE HOME ADULTS 18-65 The Beeches 7 Crescent Rise Luton LU2 0AT Lead Inspector Sally Snelson Unannounced Inspection 16th September 2008 10:15 The Beeches DS0000014881.V366318.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 DS0000014881.V366318.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 DS0000014881.V366318.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Beeches Address 7 Crescent Rise Luton LU2 0AT 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) 01582 425792 01582 418126 jonplane@hotmail.com Mr Geoffrey Plane Miss D Newman Mr Jonathon Plane Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 12 13th March 2008 Date of last inspection Brief Description of the Service: The Beeches is a care home for younger adults who have mental health needs. The home opened in 1987, and some of the residents have been at the home since then. The home is registered for a maximum of 12 residents. All residents are offered single bedrooms, and four of the rooms have en-suite facilities. There are two lounges on the first floor, and the kitchen and the dining room are located in the basement. The home has a garden at the rear of the house, which is mainly grassed and has trees, flowerbeds, and a water feature. There is a small parking area at the front of the house. Unfortunately there is very limited parking outside the home, but there is a car park near-by. The home is within walking distance of the local bus and train station in Luton. The shopping centre and other amenities in the town centre are also within walking distance. The fees for this home vary from £500.00 per week, to £886.00 per week, depending on the funding source and assessed need of the resident. The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection was carried out in accordance with the Commission for Social Care Inspection’s (CSCI) policy and methodologies, which requires review of the key standards for the provision of a care home for younger adults that takes account of residents’ views and information received about the service since the last inspection. Information from the home, through written evidence in the form of an Annual Quality Assurance Assessment (AQAA) has also been used to assess the outcomes within each standard. Evidence used and any judgement made within the main body of the report includes information from this visit. The inspection was a key inspection, was unannounced and took place from 10.15 am on 16th September 2008. At the last key inspection the home was considered to be providing poor outcomes for people. This resulted in us carrying out two random inspections, including pharmacy inspections. The Local Authority and the Primary Care Trust (PCT) also reviewed all their clients in the home. In April 2008 we took enforcement action with regard to medication practices which at the random inspection on 16th May 2008 had improved considerably with safe outcomes for the people living at The Beeches. The registered manager had been off sick for a while and the owners had employed someone to manage the home in his absence. He was now back at work, but in a different role, and was unavailable on the day of the inspection. Therefore the acting manager Jane Bozier supported the inspection and was available throughout to assist the process. The owners need to confirm their plans for the management of the home with our registration team. During the inspection the care of two people who used the service (residents) was case tracked. This involved reading their records and comparing what was documented to what was provided. We also looked at recruitment, training health and safety documentation, medication records and food planning as well as touring the building. Any comments received about the home, plus all the information gathered on the day was used to form a judgement about the service. Two service users had completed surveys, and the acting manager had completed an AQAA in advance. We would like to thank all those involved in the inspection for their input and support. The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? There have been many improvements to this service that have provided those people using the service with better outcomes. These include:An up-to date Statement of Purpose and Service Users Guide that includes all the required information and ensures that the residents are able to make an informed choice about where to live has been produced. All of the residents now have a signed contract that sets out the terms and conditions of their tenancy. Care plans and care documentation are accurate and clear in their guidance to staff on the care and support needed by all residents. Care plans are regularly reviewed and updated as care needs alter. Where possible the resident are part of the review process. Staff make records to show how residents have reached decisions. This is demonstrates that any support provided is in the residents best interest. Any risks that residents take are assessed and clearly documented, so it is clear how the risk is to be managed. Medication procedures in the home are robust and provide safe outcomes for the people using the service. Staff have had training on recognising and reporting abuse and a new policy has been instigated. The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 7 Staff training has been expanded and the staff team have the collective skills to meet the needs of the residents. There are sufficient staff on duty to provide the necessary care and support for the residents. All new employers are correctly checked before starting work. The acting manager supervises all the staff. Service users, staff and other stakeholders are asked for their views of the home and the comments are used to make improvements. All health and safety checks are completed and recorded at the required intervals. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 8 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 DS0000014881.V366318.R01.S.doc Version 5.2 Page 9 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): 1,2,3,5 People who use this service experience good quality outcomes in this area. Each resident was provided with a Statement of Purpose and Service Users Guide that gave information about what was provided at the Beeches. This also meant that residents, and prospective residents, knew and would know, what they could expect from living at The Beeches. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home now had a statement of purpose that was up-to-date and which the acting manager ensured was altered as staff, or other circumstances relating to the home, changed. Each of the people using the service had been provided with a copy of the Statement of Purpose and the Service Users Guide. The acting manager had plans to involve those using the service with preparing the information about the service. We look forward to viewing this at future inspections. Currently, staff and the residents reviewed different sections of the Service Users Guide during a residents meeting. There had been no new admissions to the Beeches since the last inspection so in order to assess this standard we looked at the policy and the paperwork that the manager intended to use. It was clear that admission procedures would be The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 10 robust and that an admission would not be made if the staff team did not have the experience and qualifications to provide the care required. There was a vacancy at the Beeches but the manager, with the owners approval agreed that during this period of change for the home it was better to consolidate what was being offered and not look to admitting new residents yet. Discussion with the acting manager indicated that staff continually assessed people living at The Beeches and would support them to move to alternative placements if this was in their best interest. All people living at The Beeches had a contract with the home that was signed by them and a senior member of staff. Since the last inspection all the contracts had been reviewed to ensure that the information in them was current and factual and included information about the fees and how these were broken down. Pictures had been used to ensure that people clearly understood areas of the contracts. The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9. People who use this service experience good quality outcomes in this area. Staff included the people living at The Beeches in the process of planning care to ensure that the care delivered was person centred. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: During the inspection we looked in detail at the care plans of two people living at the home and also looked at how the care described reflected the care delivered and met their needs. People using the service had new clear, wellwritten plans of care they clearly identified a need, a goal, and how staff were to support the need. Care plans were kept under review every month and were altered as care needs changed. The acting manager was aware that there was a requirement to review the plans six monthly, but felt it better to review them more frequently. She sated ‘ if a plan does not need altering regularly then the goal is wrong’. We considered this to be a good philosophy. The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 12 It was apparent from the way that care plans had been written that the people using the service had been involved in their care plans, and were supported by staff, and sometimes relatives, to make decisions about their lives. One service user had insisted that it was her plan and it should be written on pink paper, as this was what she would choose. Some files had been decorated by the person using the service as staff were working with them on the contents. Where people were making individual decisions this was well document and signed by the resident. For example where someone had agreed that their benefit should be collected on their behalf, or that they wanted money or cigarettes to be held on their behalf and given to them periodically throughout an agreed period this was recorded clearly. Wherever necessary staff identified risks and planned with the resident how these could be minimised. These risks usually centred on behaviours such as smoking, or staying in bed, and there was evidence that the person using the service was provided with sufficient information to make an informed decision about risk. The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 13 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 People who use this service experience good quality outcomes in this area. People who use the service were supported to make choices and to pursue the lifestyle that they wished. Staff respected people’s human rights and treated them as individuals. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Since the last inspection the people living at the Beeches have been involved in many more activities both inside and outside of the home. One of the residents was being supported by the staff to move towards independent living and was now doing some cooking, shopping, washing and cleaning for himself. This was recorded in his care plan. The cooking had extended to him cooking for some of the other people living at the home. It had also encouraged some of the other residents to cook, or want to try. Over the last few months the service had moved from having menu plans to now offering people a choice The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 14 from the provisions in the home. This often resulted in people having different meals according to their preferences. On the day of the inspection at lunchtime we noted that one person had ham rolls, another cheese, another a beef burger in a bun and another sausage and onion while someone else had scrambled egg. People had their meal when they wished and took it either in the dining room or in their bedroom. If someone did not appear for their meal staff went to check the reason and offer them whatever they wanted wherever they wanted it. This was very different from the practices seen during the last inspection. A record was kept of the food that had been consumed by each person rather than what it was anticipated that they would eat. The manager told us that she shopped regularly and would encourage residents to join in this activity, but that items such as bread and milk were not bought in bulk so that people using the service could go either on their own, or with staff, to the shops to run an errand. One person told us about the regular conversations he had with the owner of a local shop. The home was no longer relying on frozen and ready meals and was not having take-aways, instead for a treat people would eat out or have a coffee out in order to assist them to socialise and integrate in to the community. A person whose diet needed to include halal meat, was working with a member of staff to prepare halal meals rather than the home buying them in preprepared. This gave him much more choice and nutrition. There was the outline of an activity plan, and if outside agencies were involved then plans were made in advance, but the ethos of the home was for staff and residents to make decisions about how they wished to spend their time on the day. The staff had worked with the people living at the home to ascertain what they enjoyed doing and where they would like to go for day trips, and what they would like to do, so that activities arranged were what people wanted. As with the menus, activities were recoded after the event and included some information about the person’s enjoyment and participation in a certain activity. An activity record for one person from the 2nd to the 15th September included; a trip to the bank, cooking, shopping and a meal out, coffee out, bingo, a trip to town, singing, and a family visit. All of the people who wanted to go and as many staff as possible were treated by the providers, to a day trip to Brighton. Although it was a group outing people divided into small groups and pursued activities that interested them. One group told us they enjoyed the trip and the fish and trip lunch but then returned home, another group had taken advantage of a range of activities including shopping and walking on the pier, before returning home at 9pm. Since the last inspection the practice of ordering a taxi to take people out had been ceased and people had been supported to walk or use the bus. In the long-term this had offered the people using the service a greater amount of flexibility and socialisation. The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 People who use this service experience good quality outcomes in this area. The home had built good links with community health staff and would support people using the service to make healthy choices. Medications procedures were adhered to and provided good outcomes for people. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Each of the people living at the Beeches had been allocated a key-worker and were regular asked to confirm that this person was acceptable to them. People were now being given more opportunities to make choices and it was documented that these were ‘informed choices’. Instead of everyone having a specific day to do or have their laundry done this was now flexible and people could do washing when their washing bin was full or they had the time. Few of the people living at The Beeches needed assistance with care continually but many needed prompting and intermittent support with care. The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 16 At the time of the inspection none of the people using the service had nursing needs. In the past when people had nursing needs the community nurses had supported these. Community Psychiatric Nurses (CPN) were frequent visitors to the home and staff had good relationships with them and the GP’s and consultants involved in residents care. Staff encouraged people to regularly attend health screening and health appointments, including opticians and dentists. The acting manager ensured that there was sufficient staff on duty to support any health appointments, which was a big improvement from our last visit when appointments had to be cancelled and missed because there were not enough of staff on duty. Care plans indicated that staff were now supporting people to reduce their smoking and were, with agreement, withholding cigarettes or rationing them to help this process. People living and working at The Beeches were much more aware of diet and nutrition and staff were in the process of introducing a ‘five a day’ scheme to encourage people to eat more fruit and vegetables. Our pharmacy inspector had made two visits to the service since the last inspection and had made a number of requirements relating to the medication procedures in the home, which had progressed to enforcement action. An inspector and the pharmacy inspector visited the home 16/05/08 when it was recorded that all medication procedures were now satisfactory. We checked and reconciled medication at this inspection and found them to be correct. The service must now ensure that the required medication storage cabinet is put in place. Currently medication was being audited at every staff handover. The Beeches DS0000014881.V366318.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 People who use this service experience good quality outcomes in this area. The home had an ethos that allowed people living there to make complaints and to be protected from any form of abuse. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We had not received any complaints about the home since the last inspection, and neither had there been any complaints to the staff or management. There was an easy to read copy of the complaints file in the Service Users Guide and staff had all been given a copy of the policy. People who use the service that were spoken to, or completed a questionnaire, were aware of how they would complain if they thought it necessary. Many were keen to tell us that they did not need to complain. A copy of the local guidance in Safeguarding adults (SOVA) was noted to be in place alongside a procedure on abuse. This described the different types of abuse and what staff must do if they suspected any abuse of someone living at the home. Training records, and staff through discussion, confirmed that they had received training in this area. Because of concerns about past reporting and because the home was subject to a Local Authority serious concerns meeting the safeguarding co-ordinator for the Local Authority had attended a The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 18 staff meeting to update staff and ensure that they understood procedures and had all the paperwork in place. Staff were confident that because of the training and the relationship they had with the Local Authority safeguarding team they would know what to do and how to seek advice. We were now being correctly informed via Regulation 37 of any incidents affecting the lives of the people living at the Beeches. The Beeches DS0000014881.V366318.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 People who use this service experience adequate quality outcomes in this area. The home provided people with an environment that suited their need, although with an aging group meant that the layout of the home should be kept under review. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The communal areas of the home were clean and free from offensive odours at the time of inspection, as were individual rooms visited. Since the last inspection some areas of the home had been re-decorated and some of the furniture replaced. There was a needs to ensure that all areas were well maintained and that rooms that had old furniture had this replaced and the cause of the mould in a bedroom treated. However the people using the service spoken to were happy with their accommodation and although we The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 20 thought the flooring in one bedroom should be replaced the person whose room it was, was content with that was provided. The home employed cleaners to clean all areas of the home and the care staff were responsible for cleaning up as spillages happened and doing the cleaning in the absence of the cleaners. Resident s were encouraged to refrain from smoking in some areas of the home but this was not very successful. One of the people using the service was keen to garden and kept the back garden looking presentable. The layout of the home was such that some bedrooms, the dining room and the kitchen were in the basement At the time of the inspection all the people living at the Beeches could manage the stairs most of the time. Staff must keep this under review in case with an aging group of people living in the home this becomes a problem. The Beeches DS0000014881.V366318.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): 32,33,34,35,36 People who use this service experience good quality outcomes in this area. Robust recruitment procedures and a varied training programme ensured that people living at the home had their needs met by a skilled staff team. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The staff team had changed and few of the staff who were employed at the time of the last inspection were still employed. Those that were still in post had a commitment to the care and support people with mental health problems. Three staff files were looked at and it was apparent that staff had been recruited correctly and had not started work until all the appropriate checks and references had been undertaken. Staff commented that they wished to try and encourage more service users to become involved in the recruitment process. There were now at least three staff on duty during the main part of the day and extra staff could be called upon to cover busy times or appointments. The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 22 The practices of having no staff on duty overnight but only a member of staff sleeping-in continued. We were confident that the acting manager and the owners were keeping this under review. We spoke to all the staff who worked the sleep-in shift and they were confident that they could get support from an on-call staff member if it was necessary. The acting manager wrote in the AQAA ‘Staff have a comprehensive induction training programme that covers the common induction and statutory training. The training is the skills for caring induction programme that links into the NVQs. This includes specialist training in mental health needs and protection of vulnerable adults. Recruited staff have a range of skills and qualifications to meet the specialist needs of the service users, including a registered mental health nurse who is currently undertaking the RMA, 3 carers with level 3 in Care. 1 with level 2 in care who is currently studying level 3 and 1 carer currently studying level 2 in care’. The manager had a robust system for ensuring that staff had the necessary training and that any training that was provided was updated as necessary. The training included mandatory training and also training specific to the needs of the people using the service such as diabetes awareness, suicide and self help, mental capacity and anger management. The acting manager was training staff about ways in which situations could be de-escalated. All staff had regular supervision that was recorded. The files looked at showed that supervision had taken place at least 2 monthly and sometimes more frequently. The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 23 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): 37,39,40,42 People who use this service experience good quality outcomes in this area. Despite only having an acting manager the home was being effectively run. The AQAA contained clear information that was supported by appropriate evidence. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Despite the fact that there had not been a registered manager in post for a number of months the home was being effectively run. The registered manager had been off sick for sometime and was returning to work in a different role. The acting manager had been appointed to manage the sister home to the service, but moved to The Beeches when it was apparent that the home was The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 24 failing to provide acceptable outcomes. She had worked hard with the owners to make all the necessary changes and it is commendable that all of the 18 requirements made at the last inspection had been met or worked towards. She had a nursing qualification and a degree in Health and Social care. Staff spoke highly of her management style. Quality assurance questionnaire had been sent out for the current year and notice had been taken of any points raised but as yet a report had not been produced. Staff were meticulous in checking that any monies held in the home were correct at all times. The home held petty cash for emergency shopping etc. and also some monies on behalf of the people living at the home. Some of the service users had an agreement between the home the placing social worker and themselves that their allowances would be given to them in divided amounts across the week. A receipt supported each transaction. Currently the staff team were checking the monies at each handover. It is expected that this could be reduced in the future. The acting manager stated that she was reviewing policies and procedures and had introduced a number of new policies, but this were still policies that needed to be reviewed. Staff were not only producing more comprehensive care pans but are also completing daily logs in detail, so that care and support was consistent. Health and safety checks were routinely carried out and recorded. The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 25 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 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 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 2 x 3 x 2 2 x 3 x The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA20 Regulation 13(2) 9(1) Requirement The home must purchase the correct storage for medication. The owners must inform us of their plans for who is to be registered as the manager of The Beeches and de-register the person currently registered. Timescale for action 01/12/08 30/11/08 YA37 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. 2. Refer to Standard YA24 YA39 Good Practice Recommendations The programme for redecoration should be on-going There should be report produced following analysis of the stakeholder questionnaires The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region 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. Extracts may not be used or reproduced without the express permission of CSCI The Beeches DS0000014881.V366318.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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