Inspection on 07/05/08 for Belgrave Court Residential Care Home

This is the latest available inspection report for this service, carried out on 7th May 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Belgrave Court Residential Care Home 12-16 Belgrave Road Bridlington East Yorkshire YO15 3JR Lead Inspector Eileen Engelmann Key Unannounced Inspection 7th May 2008 09:30 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 Belgrave Court Residential Care Home DS0000069850.V363176.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. Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Belgrave Court Residential Care Home Address 12-16 Belgrave Road Bridlington East Yorkshire YO15 3JR 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) 01262 673072 01262 609655 belgravecourt@aol.com R E Richmond & Co Ltd Mrs Brenda Elizabeth Netherwood Care Home 30 Category(ies) of Dementia (30), Old age, not falling within any registration, with number other category (30) of places Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category 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: Dementia - Code DE and Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 30 New Service 2. Date of last inspection Brief Description of the Service: Belgrave Court provides a service for people who meet the following criteria of need – older people and older people with dementia. There are currently twenty-nine people in residence, both male and female. The home is situated on the south side of Bridlington. It is within walking distance of local community amenities and facilities including the public transport network. Unrestricted on-road parking is available. The premises consist of three properties, combined and refurbished to meet the needs of the people who live there. The building has three floors with a passenger lift, three stair lifts and stairs providing access to the upper floors. There is a choice of lounges, a dining room and a conservatory. There is a patio area used by people in the summer months. Single and shared bedrooms all have en suite toilet facilities and five rooms have en-suite baths or showers. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager, and copies are given to people on admission to the home. Information given by the manager on 7 May 2008 indicates the home charges fees of £375.00 per week. People will pay additional costs for optional extras such as hairdressing, private chiropody treatment and newspapers/magazines. Information on the specific charges for these is available from the manager. Belgrave Court Residential Care Home DS0000069850.V363176.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 that the people who use this service experience Good quality outcomes. In April 2007 the home was re-registered with the Commission for Social Care Inspection, due to the business becoming a limited company. This means that we look upon the home as a new service and this is the first visit since its reregistration. Information has been gathered from a number of different sources over the past 12 months. This has been analysed and used with information from this visit to reach the outcomes of this report. This unannounced visit was carried out with the manager, staff and people using the service. The visit took place over 1 day and included a tour of the premises, examination of staff and people’s files, and records relating to the service. Informal chats with a people living in the home and one relative took place during this visit; their comments have been included in this report. Questionnaires were sent out to a selection of relatives, people living in the home and staff. Their written response to these was good. We received 10 back from relatives (100 ), 7 from staff (70 ) and 10 from people using the service (100 ). During this visit we carried out a thematic probe into Safeguarding practices within the home. A thematic probe is how we gather additional information on a particular theme during a key visit and includes asking specific questions of the manager, staff and people living in the home, looking at specific standards, records and policies. In the past year we have received one formal complaint from a relative, about care within the home, which was passed onto the Local authority Social Service team to investigate. Outcomes from the investigation were that there was no evidence of poor care, but the team recommended that recording in the accident books improved and more detailed information in people’s care plans about the care received was needed. Evidence from this visit shows the home has taken action to improve its recording practise. What the service does well: All of the people living in the home were positive about the home and like living there. Individuals told us that ‘the home excels at making people feel as Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 6 though they are in their own home. They make visitors very welcome and the staff are very patient and kind to us’. Staff are hard working and do their best to meet the needs of those people living in the home. People and relatives who spoke to us said ‘the staff make sure everyone is cared for according to their needs. They offer people help and support if they need assistance, but respect the wishes of people who like to be more independent’. People being cared for have good access to professional medical staff and are able to access external services such as dentists, opticians, physiotherapists, chiropody and dieticians, so their health is looked after and they are kept well. People living in the home said they are offered a good choice of meals and they enjoyed the quality of food. Specific wishes are catered for and they have plenty to eat and drink throughout the day. One person told us ‘ the food is excellent, we are offered plenty of choice and the quality of the meals is fantastic’. What has improved since the last inspection? What they could do better: Staff in the home must improve the quality of the information in the care plans to include details of the care being given on a daily basis and include up to date assessments of risk. This will help people in the home receive consistent care to a high standard and protect them from risk of harm. People who are working in the home have to be given training around keeping people safe from harm, this helps them understand how to look after individuals and speak up if they think anything is wrong. People who are working in the home have to attend more training around safe working practices to make sure they look after their health and safety and that of the people living in the home. Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 7 The manager must make sure that employment checks are carried out for all people working in the home before they start work to make sure the people using the service are protected from risk of harm. The inspector would like to thank everyone who completed a questionnaire and/or took the time to talk to her during this visit. Your comments and input have been a valuable source of information, which has helped create this report. 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. Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 8 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 Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 9 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): 3, 4 and 6. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wanting to use the service undergo a needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met. EVIDENCE: The people and relatives we spoke to said they received sufficient information to make an informed choice about the service before accepting the placement offer. These individuals have also received a contract/statement of terms and conditions from the home. Each person has his or her own individual file and the funding authority or the home, before a placement is offered to the individual, completes a need assessment. The three files looked at during this visit were for one funded individual and two self-funding people, and all were living in the home at the time of its re-registration by the owners. Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 10 The home develops a care plan from the assessments, identifying the individual’s problems, needs and abilities using the information gathered from each person and their family. Information is gathered during the assessment around issues of equality and diversity, such as age, disability, gender, sexuality, race and religion/beliefs and this is put into the care plan. Discussion with the manager indicated she goes out to assess individuals who have expressed an interest in coming into the home, and each person is given information about the service and life in the home. At present the manager said she gives a verbal offer of placements, and it was discussed that she should make this a more formal written practice. People using the service and relatives are very pleased with the care and support given by the staff, they said ‘the staff are caring and friendly and everyone is well looked after’ and ‘the home provides an excellent service’. Discussion with the manager, staff and people living in the home indicates that all of the people are of white/British nationality, and there are a number of people with different faiths and religions. One relative commented that ‘My mother is a catholic and receives communion from the priest each week’. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. The manager told us that the home looks after a number of people from the local community, although placements are open to individuals from all areas. Checks of the staffing rotas and observation of the service showed that the home employs all white/British, female staff, except for the handyman. Discussion with the manager indicates that this is due to a lack of suitable applicants and that an equal opportunities policy is used when employing staff. Staff members on duty were knowledgeable about the needs of each person they looked after and had a good understanding of the care given on a daily basis. Discussion with three people showed that they were satisfied with the care they receive and have a good relationship with the staff. One person said ‘these girls are great, nothing is too much trouble for them and they take the time to see you are okay and have a laugh with you’. The staff training files and the training matrix show that new staff go through an induction before starting work and that the home has a training programme in place. Information from the manager indicates that the home has concentrated in the past few years on ensuring staff complete a National Vocational Qualification in care. A member of staff is delivering the in-house training programme, and the manager has recognised the need to support this with more outside training from qualified sources. Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 11 The home is registered with us to accept placements for people with dementia and the manager is aware of the need to introduce more robust staff training around dementia and challenging behaviour to ensure the staff are able to meet people’s needs. Discussion with the staff indicated that some individuals have completed a distance-learning course on Dementia Awareness, and have found this beneficial to their work. The home does not have any intermediate care beds and therefore standard six does not apply to this service. Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 12 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): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of people living in the home are being met by the service and staff. EVIDENCE: Information from this visit indicates that the people who spoke to us are satisfied that the staff give appropriate support and care to those living in the home. People said they are able to make their own decisions about their daily lives most of the time; that staff treat them well and listen and act on what they say. One individual said ‘the care we get is excellent, there is no waiting for attention if you need help and my own health has improved tremendously since coming into the home’. The care of three people was looked at in depth during this visit and included checking of their personal care plans. The content of the plans is basic, easy to follow and on the whole completed to an acceptable standard. It was discussed with the manager that there are a few areas in the care plans that staff need to take more time over and these include Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 13 • • • • Risk assessments must be completed for all people around moving and handling, nutrition, falls and pressure area care. These must be completed on admission and reviewed on a regular basis, good practice would be for this to take place every month when the plan is evaluated by the staff. Changes to a person’s care must be dated and signed by the person altering the care plan. Where individuals have challenging behaviour such as verbal or physical outbursts of aggression, a management plan detailing how staff are to handle the situation must be in the person’s care plan. The daily notes completed by the staff must include information about the care given. This was a recommendation in the complaint investigation completed by social services (see standard 16). Two areas of good practice within the care plans are: • The staff take care to ensure their writing is legible and factual • The meticulous recording of professional visits, reasons for the visits and the outcomes The relatives spoken to have told us that the staff are extremely conscientious about letting them know how their relatives are doing and inform them immediately of anything that affects their wellbeing. Comments from the surveys said ‘I live some distance from the home, but visit quite frequently; if there is a problem I am always contacted. My relative has his/her own phone and I speak to her regularly’ and ‘ the staff are excellent at communicating with us. They treat us with respect and are very understanding of my needs, as I am currently going through bad health problems’. People said that they have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Comments from the people and relatives indicate they are satisfied with the level of medical support given to the people living at the home. One person said ‘Medically my relative is well looked after’ and another commented that ‘The staff are excellent, they could not give more care if it was their own mother’. The staff weigh everyone on a regular basis and evidence in the plans show that dieticians are called out if the home has particular concerns about an individual. It was noted by us that there were no pressure sore risk assessments in the care plans we looked at, but there is a good relationship between the home Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 14 and the District Nurse team who provide staff with advice and help around this area of care. Pressure care mattresses and other equipment are in use within the home. The manager assured us that she would update all the care plans to include risk assessments around pressure areas. All of the people spoken to prefer to have staff administer their medication and the manager confirmed that at the moment there is no one in the home who self-medicates. Checks of the medication records show that overall these are well maintained and kept up to date and the controlled drugs and register are monitored carefully, medication is stored correctly and records are accurate. Staff informed us that any medication that requires refrigeration is kept in the kitchen fridge in a compartment at the top. This area requires a label to show that only medication is to be stored in this area. Best practise would be that a lockable container is obtained and used for refrigerated medication storage. Due to recent changes in legislation the home requires a controlled drugs cabinet, which complies with the Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007 (9.4, 20.6). The manager assured us that advice would be sought from the Pharmacist, and a suitable cabinet purchased. Discussion with the staff and checks of the homes training programme indicates that everyone who administers medication to people in the home, has undergone training on the system in use. Some individuals have completed a distance learning course in medication, but not all. All staff who handle medication should attend accredited medication training, which includes • Basic knowledge of how medicines are used and how to recognise and deal with problems in use; • The principles behind all aspects of the home’s policy on medicines handling and records. People and relative comments show they are very satisfied with the care and support offered by the staff. Chats with people using the service revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Individual comments were that ‘my relative is happy and well cared for’ and ‘staff are friendly and helpful’. Observation of the service showed there is good interaction between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 15 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): 12, 13, 14 and 15. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with choice and diversity in the meals and activities provided by the home. Individual wishes and needs are catered for and people have the option of where, when and how they participate in both eating and leisure activities. EVIDENCE: The home employs an activities organiser for 15 hours a week and she works Tuesdays to Saturdays from 9.00am to 12.00 noon. Discussion indicated that she does not have a fixed programme of events for each week; daily walks out are a regular event, but the people who want to take part choose the morning activities. We were told that the most popular things to do included bingo, quizzes, dominoes and a wide variety of board games. On the day of this visit the weather was glorious and we observed a number of people going out into the town, walking to the sea front and some just enjoying sitting on the patio at the front of the home with friends and relatives. Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 16 One person told us that they were perfectly happy with reading the newspaper, watching television and going out for a walk, they did not wish to join in with the group activities and the staff respected their wishes. People living in the home remain a part of the community and are able to attend various clubs within the town. On a Tuesday and Thursday people are picked up by bus to go to a social club and Fridays is fish and chips with the Blind Society and this is also with arranged transport. The mobile library visits regularly, there is an organist who plays at the home every Sunday and the activity organiser gives 1-1 time to those who cannot join in with group events or who like time to themselves. Comments from relatives and people using the service are extremely positive about the social side of life within the home. Individuals told us ‘At 96 years old, my relative is well supported and has a good quality of life for her age. She still goes to three clubs during the week’ and ‘ people are encouraged to participate and staff appreciate each individual’s needs’. Evidence seen at this visit indicates that people are encouraged to celebrate Christian events such as Birthdays, Easter and Christmas. People have access to the local churches and visits by the Church of England minister and Catholic priest are arranged on an individual basis. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. Relatives and visitors to the home are very positive about the service and the staff. Comments made to us on the day of this visit showed a high level of satisfaction. Individuals said ‘they have created a friendly, kind and clean establishment. The level of care is exceptional. The food is good, nourishing as well as appetising. There is a family atmosphere’ and ‘there is always a welcome and very pleasant feeling when you visit. Everything is very clean – no unpleasant odours and I feel it is well run. My relative is very happy there and I have peace of mind’. The home acts positively to promote people’s independence and will offer individuals support to achieve this aim. One person who spoke to us looks after his/her own finances and they take pride in the fact they are still able to control their own affairs. Other people spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. There is some information and advice on advocacy and this is on display within the home. Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 17 Meetings for people using the service and their relatives are held every month; these are used as an opportunity for individuals to express their ideas of what activities they want and to give their feedback on events that have taken place. The manager has obtained information about the Mental Capacity Act and Disability Discrimination Act, but there is no evidence that staff have received training around current legislation in equality, diversity and disability matters. The registered person should ensure that staff are able to promote and protect the rights of people using the service through up to date knowledge and awareness of current legislation. Comments from the people living in the home and their relatives are on the whole very positive about the meals and kitchen service provided. Individuals said ‘the dining room is very clean and the food is excellent’, ‘I love the meals and have a good appetite’ and ‘we get three good meals a day and there are drinks available whenever we want one’. The lunchtime meals were well presented and offered a good choice of food. Staff were organised when serving the meal and they understood the preferences and dislikes of each individual so the meals served suited individuals regarding size of portions and addition of sauces. The home has one large dining room, which offers people a comfortable environment with suitable table and chairs for their dining experience. Mealtimes are a social occasion within the home, with staff offering people prelunch beverages such as juice, sherry or beer. One person told us ‘the meals are very good, I have put on weight since coming into the home and I am well looked after’. No menus were seen on display although the cook told us that she kept a copy in her kitchen. People told us the staff took round a tea list and they could choose their meal options, but few could remember what they had ordered for lunch. Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 18 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): 16 and 18. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that peoples’ views are listened to and acted upon. EVIDENCE: The home has a complaints policy and procedure that is included in the statement of purpose and service user guide. It is also on display within the home and all of the survey responses from people using the service showed individuals have a clear understanding about how to make their views and opinions heard. People told us that ‘we would talk to the staff if we had any problems’. Checks of the complaints records in the home showed that the manager has dealt with two formal complaints in 2007/08. Both were to do with laundry issues and were dealt with quickly and resolved. Ten relatives who completed a survey said that they felt the home responded appropriately if they raised a concern and minor issues were dealt with quickly. One individual told us ‘I would complain to the owners if I had any concerns and if it was something crucial I would ask them who I should contact’. In the past year we have received one formal complaint from a relative, about care within the home, which was passed onto the Local authority Social Service Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 19 team to investigate. Outcomes from the investigation were that there was no evidence of poor care, but the team recommended that recording in the accident books improved and more detailed information in people’s care plans about the care received was needed. Evidence from this visit shows the home has taken action to improve its recording practise. During this visit we carried out a thematic probe into Safeguarding practices within the home. A thematic probe is how we gather additional information on a particular theme during a key visit and includes asking specific questions of the manager, staff and people living in the home, looking at specific standards, records and policies. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of people’s money and financial affairs. The staff we spoke to are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. One individual is currently doing a distance-learning course in safeguarding. The manager understands how to make a safeguarding referral to the appropriate authorities and has a copy of the local policies and procedures to follow in the event of an allegation of abuse being made. The home has some in-house training for staff around safeguarding of adults, but this should be supported with specific training for the manager and senior care staff within the home. It is recommended that the manager take advantage of the training offered by the Local Safeguarding Team and ensure the skills and information gained from this is cascaded down to other staff members through staff meetings, supervision and training sessions. It would be good practice for all staff to attend the safeguarding training offered by outside professionals to ensure the safety and welfare of people in the home is promoted and protected in a robust manner. Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 20 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): 19 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of environment within the home is good, providing people with a comfortable and homely place to live. EVIDENCE: We walked around the building and found it satisfactory and suitable to meet the needs of the people using the service. The home has an ongoing maintenance and refurbishment programme and the environment is clean, comfortable and homely. The domestic staff do an excellent job of keeping the premises clean and odour free and visitors told us that ‘the environment is wonderful, and absolutely spotless’. People were seen to be using the two lounges and the dining room during this visit and individuals were sat out in the conservatory and on the patio to the front of the building. The home is built on three floors, and people can access Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 21 the upper levels using the passenger lift, stairs or one of the three stair lifts. There is a ramp to the front entrance to enable people with mobility problems easy access to and from the home and walkways inside are kept clear of any obstacles. There are a number of single and shared rooms located on the three floors. Each room has an en suite facility, some with either bath or shower. Those bedrooms seen were comfortable and well personalised. Discussions during this visit indicate that people using the service are satisfied with the laundry service provided by the home. When problems occur the housekeeper is quick to resolve the issues. Infection control policies and procedures are in place, and staff have access to good supplies of aprons and gloves for use in personal care. Discussion with the staff indicates they understand the basics of infection control, but checks of the training programme shows that few people have received formal training in this area of care. The registered person should promote this aspect of staff training and ensure more staff are given the opportunity to attend appropriate courses. Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 22 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): 27, 28, 29 & 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment practises are inadequate and do not promote or protect the health, safety and well being of those people using the service. EVIDENCE: Comments from the people using the service and relatives are on the whole very positive about the staffing levels within the home, and individuals feel that there is a good standard of care being given to the people living in the home. Survey responses said ‘the care home staff are friendly, helpful and supportive. Anything raised with them is dealt with immediately’, ‘the staff are pleasant and patient’ and ‘the staff make sure everyone is cared for according to their needs. They always have a cheery word for anyone who is feeling down and always seem to know when and how to comfort people’. At the time of this visit there were 29 people in residence and the staffing rota showed that the following staffing levels are in use 7:00am 8:00am 1:30pm 9:00pm to to to to 8:00am 1:30pm 9:00pm 7:00am – 5 care staff on duty – 4 care staff on duty – 3 care staff on duty – 2 care staff on duty Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 23 Information from the manager and the staffing rota about the number of care hours was used with the Residential Staffing Forum Guidance, and showed that the home is meeting the minimum hours asked for in the recommended guidelines. 50 of care staff at the home have an NVQ 2 or above in care and four more staff are in the process of completing this training, plus another two waiting to enrol. The manager told us that they have concentrated on getting sufficient staff through their NVQ training and these individuals have covered a number of mandatory training subjects as part of this process. The home’s own training programme is mainly in-house and at the moment one member of staff is cascading information down to others in the home. We were concerned about the robustness of this training and discussion with the manager indicated she is looking at introducing more outside training from qualified providers. Staff are booked onto a moving and handling course later on in 2008, one member of staff is doing a distance learning course in safeguarding of adults and the manager told us that she will look into the local councils training programme to see what courses are available for her staff. The manager is aware of the need to expand the range of training to include sessions on conditions relating to old age, dementia and challenging behaviour. During this visit we checked three staff files, two were found to only have one reference and one reference was obtained after the individual started work. All three staff members started work before their CRB checks were completed. Discussion with the manager indicated that the home had obtained POVA First checks for these people and they did not work unsupervised until the CRB was returned. The registered person must ensure that when POVA First checks are done a copy of the e-mail response is kept on file to evidence when it was completed. Two references must be obtained for all new members of staff, one from their last employer and if another professional one is not available then a character reference. The references must be obtained before an individual starts work. Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 24 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): 31, 33 & 38 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home reviews aspects of its performance through a programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. EVIDENCE: The registered manager, one of the two registered providers, has been in post since they opened the home in 1998. She has a background in customer services and experience in the care sector including work in residential homes and hospitals. She is aware of the need to complete a National Vocational Qualification in care and management to level 4. Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 25 Staff told us they feel supported by the manager and there is an open door policy so they can go to her at any time if they need advice or help. Comments from the people using the service and their relatives are also positive about the management approach within the home saying ‘The home appears to be well run and supportive to the people who live here’ and ‘I feel it is well run’. The home has achieved the local Council’s Quality award part 1 (QDS) in October 2007. The service is now working towards QDS part 2. Feedback is sought from the people living in the home and relatives through regular satisfaction questionnaires and meetings for people using the service are held on a regular basis and minutes are circulated to people living in the home. Staff have meetings with the manager and everyone is encouraged to join in with discussions and voice their opinions. People and staff agreed that they are able to express ideas; criticisms and concerns without prejudice and the management team will take action where necessary to bring about positive change. The home has a policy of not handling personal allowances for people who use the service. Instead individuals either manage their own finances or have a representative who does so. Discussion with the manager indicated where an individual builds up an outstanding balance, such as for the hairdresser or papers, then a bill is sent to the person responsible for their finances at the end of each month. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and staff are aware that regulation 37 reports must be completed and sent on to the Commission where appropriate. The home has an up to date fire risk assessment in place and the handyman and staff are undertaking regular checks of the systems. It is unclear from the staff training files how up to date individuals are with safe working practices, however work is ongoing to improve this aspect of care and we did not observe anything that indicates staff do not have the necessary skills to meet the needs of people living in the home. Belgrave Court Residential Care Home DS0000069850.V363176.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 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 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A x x 3 Belgrave Court Residential Care Home DS0000069850.V363176.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 OP7 Regulation 15 Requirement The registered person must ensure the individual care plans include risk assessments around moving and handling, falls, pressure sores and nutrition. Changes to a person’s care must be dated and signed by the person altering the plan and staff must complete daily notes with information about the care being given. This will make sure that staff have access to information that will help them to provide person centred care and support, and promote people’s health, safety and wellbeing. The registered person must ensure that two references are obtained before appointing a member of staff and that POVA First checks are completed and recorded before a person starts employment. This will make sure that the people using the service are protected from risk of harm. Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 28 Timescale for action 01/08/08 2. OP29 19(4)(c) 01/08/08 3. OP30 OP38 18 The registered person must ensure that there is a training programme in place that ensures staff fulfil the aims of the home and meet the changing needs of the people using the service. Specialist training on the elderly and diseases relating to old age, management of challenging behaviour and dementia must be included in the training programme. The registered person must make sure that staff have an individual training and development assessment and profile in place. So the health, safety and welfare of the people in the home is protected and promoted, and staff have the skills and knowledge to provide a high standard of care. 01/12/08 18(1)(c) 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 OP3 Good Practice Recommendations The registered person should ensure that people using the service or their representatives receive formal written confirmation that the home, taking into consideration the needs assessment, is able to meet their needs. This must be given to people prior to their admission. The manager should ensure that refrigerated medication is kept in a specifically labelled area of the kitchen fridge. Good practise would be for the medication to be kept in a lockable container. DS0000069850.V363176.R01.S.doc Version 5.2 Page 29 2. OP9 Belgrave Court Residential Care Home 3. OP9 4. OP9 5. OP14 6. OP18 The registered person should ensure that all staff who handle medication attend accredited medication training, which includes • Basic knowledge of how medicines are used and how to recognise and deal with problems in use; • The principles behind all aspects of the home’s policy on medicines handling and records. The registered person should ensure that a controlled drugs cabinet is obtained, which complies with the Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007 (9.4, 20.6). The manager should enable staff to access training around current legislation in equality, diversity and disability matters, to improve the staffs knowledge and understanding of a person’s individual rights within the care home and out in the community. The manager should take advantage of the training offered by the Local Safeguarding Team and ensure the skills and information gained from this is cascaded down to other staff members through staff meetings, supervision and training sessions. It would be good practice for all staff to attend the safeguarding training offered by outside professionals to ensure the safety and welfare of people in the home is promoted and protected in a robust manner. The registered person should promote infection control training and ensure more staff are given the opportunity to attend appropriate courses. The registered manager should complete an NVQ 4 in care and management (or equivalent) before the end of April 2009. 7. OP26 8. OP31 Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Belgrave Court Residential Care Home DS0000069850.V363176.R01.S.doc Version 5.2 Page 31 - 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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