CARE HOMES FOR OLDER PEOPLE
Begbrook House Sterncourt Road Frenchay South Glos BS16 1LD Lead Inspector
Savio Toson Key Unannounced Inspection 24th October 2007 08:00 X10015.doc Version 1.40 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 Begbrook House DS0000020227.V350378.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 Older People. 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. Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Begbrook House Address Sterncourt Road Frenchay South Glos BS16 1LD 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) 0117 9568800 0117 9569900 begbrook.house@fshc.co.uk Grandcross Limited(wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Erma Benedicto Fernandez Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. May accommodate 32 Patients aged 50 years and over requiring nursing care Staffing Notice dated 3 December 2001 applies Manager must be a RN on parts 1 or 12 of the NMC register Brief Description of the Service: Begbrook House is a purpose built nursing home with the accommodation on the ground floor, which gives level access throughout the Home. The home is off the main road, has ample car parking space and is surrounded by garden. There is access to local shops, amenities and bus routes. The cost per week to live in the home is £580.00. Fees are reviewed annually and when care needs increase. This weekly fee does not include provision for items such as hairdressing, chiropody, dental, ophthalmic, or audiology services. Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over 6 hours and was completed in one day. I worked with evidence from a whole range of different sources, including: • Information provided by the manager in the pre-inspection questionnaire • Information taken from resident survey forms • Information from the resident’s relatives who filled out a survey form. • Information from professionals who visit the home • Speaking with residents • Case tracking a number of residents • Speaking with care staff • Walking round the home • Looking at some of the homes records • Watching how the staff worked with residents. The overall analysis is that the home has improved its service since the previous inspection and is a good place for people who use the service. What the service does well: What has improved since the last inspection?
Residents are now better assessed before moving into the home, to help ensure the residents care needs can be met by the home. The residents are involved in planning and agreeing their care. Residents now receive medicines from staff who are following their medicine procedure more closely. Residents are feeling their dignity and privacy is respected by the staff. Residents can feel able and understand how to make a concern or complaint known to the manager. Residents live in a safe, well maintained environment where a lot of the worn, stained, smelly carpets had been replaced. Residents can now expect to use clean wheelchairs as they are now regularly cleaned. Residents live in a home where the manager is committed to making improvements to the service being provided. Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 6 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. Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We considered standards 1, 3, 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their relatives may find it difficult to get sufficient information when they are considering moving into the home. Residents can assume that the home can meet their care needs because of the range if information collected on them before entering the home. EVIDENCE: Residents and their relatives may find it difficult to get sufficient information when they are considering moving into the home. The statement of purpose folder is difficult to read because of the 15 pages on the organisational structure of the registered owner and the 16 different types of job descriptions in the folder. The folder does not have information on the experience and qualifications of the manager. The home has attractive brochures to give to prospective residents. The manager explained the brochure as being the service user guide. The guide had the experience and qualifications of the owner’s representative and manger missing. The views of the service user’s of life in the home were also missing.
Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 9 Residents would find it hard to decide whether they can afford moving into the home because the fees and additional costs were missing from the service user guide. Residents who come from diverse ethnic backgrounds should feel welcome because the staff also came from a variety of ethnic backgrounds. The manager said that her staff came from 10 different countries. Residents can assume that the home can meet their care needs because of the range if information collected on them before entering the home. The care staff have now completed the new assessment documentation which gives them sufficient information to decide whether the service can give the resident the care they need. The assessment documentation I viewed contained health dependency ratings, assessment of the condition of the resident’s skin and their social and mental state. Half of the residents or relatives we surveyed said the home always meet the resident’s needs the other half said usually. The home does not have any intermediate care beds. Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10 were considered. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to have their needs met by staff using the paperwork, which sets how the staff provides the care. Residents are involved in planning their own care. The residents can expect to be given medicines by staff who follow safe practices. Residents can feel their privacy and dignity is respected by the staff. EVIDENCE: Residents can expect to have their needs met by staff using the paperwork which sets how the staff will be providing care. I viewed four care plans and all contained enough information to help provide residents with individualised care. Some of the phrases used in the records to provide care, were clearly based on what the resident had said to staff. The majority of response in the surveys filled in by residents or their relative said that their needs were either met or usually met. The care plans were detailed, showing the care that had to be given and how it was given.
Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 11 The records showed that the personal preferences, likes and dislikes of residents had been recorded. The care records had also been signed by the resident or their representative. The care records also showed that consideration had been given to the health risks to residents and the action taken to reduce the risks. The residents can expect to be given medicines by staff who follow safe practices. The home had a medicine procedure, the medicine administration sheets which were checked, were being correctly filled in. The controlled drugs book was checked and the number of medicines was equal to the number recorded in the book. The medicines which were checked were within their expiry date and therefore safe to give to residents. Residents can feel their privacy and dignity is respected. Staff were observed talking with residents in a natural respectful way. All six residents that I spent time with were positive about the staff. None of the residents shared any concerns. One resident said, “I have no complaints” another said ”they look after you here” and a third said “ the staff treat me well”. One relatives survey said “ I think the staff do their best for the residents”. As one professional said “the residents privacy and dignity is respected as I have not seen anything to think otherwise”. Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14.15 were considered. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are offered recreational activities. The residents have choice in their daily living. Residents have a choice of meals. EVIDENCE: Residents are offered recreational activities and the opportunity to socialise with the other residents because of the high number of communal areas in the home. The home has an activities organiser. The activities timetable for the week included: bingo, sing a longs, board games and a visiting musician. As I went round I could see that residents had a copy of the weeks recreational activities. One resident said that she was aware activities were available but preferred her own company and wanted to stay in her own room. Another resident said she thought the activities were “ok” but did not want to participate. One of the resident’s surveys said “I always participate in activities. .excellent”. The rest of the resident’s surveys gave the activities a high score. Resident’s relatives are welcomed to the home. There is literature for residents to read in the foyer. There is a comments book in the signing in area.
Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 13 Residents have been out on two trips into the community this year and another one is being planned. The photographs of the trip and a garden party in the home’s gardens were on display in the corridors. The residents have choice in their daily living. Each of the residents care records which I viewed has their preferences, residents can choose their meals, when to get up or go to bed. One resident told me “it feels like living in a hotel”. Residents have a choice of meals. The menus viewed offered the residents alternative meals to choose from. The cook explained how he collected the residents individual preferences. He gave the example of how he worked out in getting the fruit which the residents enjoyed at teatime. The dining room was clean and tidy. The kitchen had a recent environmental health inspection and received a reasonable report. The kitchen was clean on the day I visited and the deep cleaning had just been carried out. Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16, 18, were considered. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can feel able to make a complaint if they wish to do so. Residents can feel safe and protected from abuse. EVIDENCE: Residents can feel able to make a complaint if they wish to do so. The complaints procedure is easy to follow and is also on display in the foyer. The manager had dealt with two complaints which were recorded in the complaints book. There is also a comments book for relatives to share their views on any concerns. All the residents and relatives(apart from one) who returned their surveys said they knew how to make a complaint. Residents can feel safe and protected from abuse. The home had a protection of vulnerable adults policy. A staff member who was asked about the actions to protect residents from abuse was clear about the procedure to be followed. Training for staff on protecting service users was on going and I was told the date of the next session. Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,20,21,23, 25,26 were considered. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well maintained environment. Residents are protected from infections by a team who have an understanding of infection control. EVIDENCE: Residents live in a safe, well maintained environment. On the day I inspected the home, the maintenance man was redecorating the lounge. Several of the carpets which concerned us at the last inspection, had been cleaned or replaced. The atmosphere was free from offensive smells and all the sampled bedrooms had clean, odour free. Some of the carpets had debris from the day before but they were the ones due to be cleaned and none were found with major stains. Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 16 One relative’s survey said, “The home is always clean” whilst another said, “ the carpet is filthy”. There were two further adverse comments made about cleanliness. However several carpets were randomly checked and were found clean and free from odour. Also several carpets had recently been replaced. Four residents I spoke with said their room was kept clean. The home has a maintenance programme which is explained in the quality assessment form returned to us by the manager. Residents are protected from infections by a team who have access to the homes infection control policy and are attending infection control training. The home manager informed me that none of the residents had pressure ulcers which can be a reflection of good skin care and nutrition. The laundry service for the home is covered by 3 different staff. I found the clothing in the laundry, clean and free from stains. On the day of inspection the industrial iron had broken down, the fault had been reported, an engineer was coming out to repair the iron and staff had made alternative arrangements for ironing the resident’s clothing. I found the kitchen, laundry, toilet and bathroom floors, clean and free from odour. Wheelchairs are now cleaned on a regular basis and the ones checked were found to be clean and in good working order. Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29,30 were considered. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive care from a home which employs a range of staff with different skills. Residents receive care from staff who are keeping up to date by attending the relevant courses. Residents receive a service from care staff who have been recruited using the correct employment checks. EVIDENCE: Residents receive care from a home which employs a range of staff with different skills. On the day of inspection, the home had care staff, catering, laundry, domestic, administrative and maintenance staff available to provide services to the residents. Residents receive care from staff who are keeping up to date. The employment records which were viewed showed staff had attended a range of training. This was confirmed by the staff I spoke with. Three said they had attended recent training. The training programme for the next few months was viewed and it showed that a range of relevant courses was on offer. Training included, understanding dementia, health and safety, infection control, care of the dead and dying. Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 18 Residents receive care from a staff team who are going through their National Vocational training in care. The manger could explain the National vocational Qualification (NVQ) training for staff and the way it was going to be achieved to make sure most of the team have the qualification. Residents receive a service from care staff who have been recruited using the correct employment checks. The personnel records viewed contained completed application form, two references (one being from the most recent employer) and the relevant criminal records check. Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,32,33,35,36,37,38 were considered. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a manager in the home who having been made aware of the home’s failures in the past has worked very hard at complying with the regulations. EVIDENCE: Residents have a manager in the home who, having been made aware of the home’s failures to meet the regulations at the previous inspection, has worked very hard at complying with the regulations. The improvements are reflected in this report. The manager believes she maintains an open door policy. All the relative surveys returned to us said they were kept up to date and all the resident surveys knew who to speak to if they wanted to comment.
Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 20 The care records showed that the resident’s needs included their preferences, likes and dislikes. Four residents said that they felt they could exercise choice in how they lived in the home. Residents receive a service from care staff whose work is supervised. The home had supervision records but some were not meeting the target of six per year. Resident’s monies is kept in individual bank accounts, whilst the cash balances kept in the home are stored in one account. The records of residents cash kept in the home are clear and have the relevant receipts. The records show the resident’s cash available for them to spend is recorded in individual cash balances. The quality self assessment audit filled in by the home showed that health and safety generic checks had been carried out, equipment had been serviced and the fire procedure records were up to date. Staff were scheduled to have fire training in November 2007. The service invoices checked in the home showed that maintenance and other safety checks were up to date. Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 x 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 3 Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 22 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 2 Standard OP1 OP1 Regulation 4(1)(c) 5(1)(a)(b) Requirement The statement of purpose needs to have the registered managers experience and qualifications The statement of purpose needs:a) to have the registered provider’s representative and the registered manager’s experience and qualifications. b) the fees written in. c) a survey of the residents view of the home. Timescale for action 01/12/07 01/12/07 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 OP1 OP36 Good Practice Recommendations Residents would find the statement of purpose easier to use if the 15 pages of organisational structure and 16 pages of job descriptions were removed. Staff should have 6 supervision sessions each year. Begbrook House DS0000020227.V350378.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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
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