Inspection on 05/08/05 for 32 Bentinck Road

This inspection was carried out on 5th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

32 Bentinck Road 02/11/06

32 Bentinck Road 08/02/06

32 Bentinck Road 21/02/05

32 Bentinck Road 09/09/04

32 Bentinck Road 02/03/04

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Thornham Grove

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Thistle Hill Hall

Conifer Lodge

Westwood Lodge

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Alfred Minto House Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE 32 Bentinck Road, Hyson Green Nottingham NG7 4AF Lead Inspector Meryl Bailey Unannounced 5 August 2005 th 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 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 and 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. 32 Bentinck Road, C53 C03 S2229 32 Bentinck Rd V242077 050805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 32 Bentinck Road, Address Hyson Green, Nottingham, NG7 4AF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0115 841 7730 0115 841 7731 Mr Michael Leng Mr David Milburn Care Home (CRH) 17 Category(ies) of 1. Mental Disorder (MD), excluding learning registration, with number disability or dementia 17 of places 2. Mental Disorder over 65 years (MD(E)) 17 3. Past or present alcohol dependence (A) 17 4. Past or present alcohol dependence over 65 years of age (A(E)) 17 32 Bentinck Road, C53 C03 S2229 32 Bentinck Rd V242077 050805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None other than categories of registration as above. Date of last inspection 21/02/05 Brief Description of the Service: 32 Bentinck Road is an extended detached house within easy access to various community facilities, public transport and Nottingham City centre. The service is provided for people aged 49 years and above who have been homeless and may be mentally ill or have an alcohol problem. Alcohol is allowed in part of the premises. Single bedrooms are provided for service users on the ground and first floors. The first floor is accessible only by stairs and there are steps at the main entrance, but the ground floor is accessible at the rear of the building, where the ground is level. 32 Bentinck Road, C53 C03 S2229 32 Bentinck Rd V242077 050805 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and conducted by two inspectors during one day. 16 current residents were at home and conditions of registration were met. The registered manager was not present due to long-term illness, but an assistant manager was present in the home during most of the inspection and a service manager from Framework HA (providers) visited during the day. Some residents and staff gave their views about the care provided. The communal areas of the home were inspected and one bedroom was also seen. What the service does well: What has improved since the last inspection? 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. 32 Bentinck Road, C53 C03 S2229 32 Bentinck Rd V242077 050805 stage 4.doc Version 1.40 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) 32 Bentinck Road, C53 C03 S2229 32 Bentinck Rd V242077 050805 stage 4.doc Version 1.40 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The needs of service users have been appropriately assessed prior to admission. EVIDENCE: The files of three service users were examined and pre-admission and initial assessments were found. The most recently admitted service user had been appropriately assessed, but had no current written plan to meet the assessed needs. For others there was a link between assessment and some care planning (see under standard 7). 32 Bentinck Road, C53 C03 S2229 32 Bentinck Rd V242077 050805 stage 4.doc Version 1.40 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9 Individual support plans are in use, but are not consistently developed for all service users and some important areas of need are omitted, which may lead to needs not being met. Support is given to enable health care needs to be met by external healthcare services. Medication is well organised, but records need attention to detail. 32 Bentinck Road, C53 C03 S2229 32 Bentinck Rd V242077 050805 stage 4.doc Version 1.40 Page 9 EVIDENCE: Of the three service users’ files inspected, there was only one appropriate individual support plan. One plan was incomplete, with needs identified, such as mobility, but no corresponding action planned. The other file contained no appropriate plan at all. On this latter file there were records and a plan relating to a placement two years ago in another service. These records should be archived, as they are no longer relevant and could be misleading. The support plan format that has been used showed the involvement of service users, but plans around support with personal care still need to be developed. However, there was a strong focus on alcohol and finance, both in risk assessment and action planned. Service users spoken with felt their needs in those areas were well met. Daily records of events were comprehensively written and up to date, but regular reviewing and updating of plans has not taken place. For service users over 65 years and others whose needs frequently change, care plans should be reviewed and amended at least monthly. A staff member explained that one service user’s personal care needs were met only in part from staff at the home, but supplemented by external domiciliary care services. This unusual arrangement appears to have enabled a return to the home from hospital, as the service, reportedly, could not provide sufficient staff to meet the increased need for support with personal care. There was evidence in the support plans and records that assistance has been given to support service users to attend medical appointments. Accidents and other incidents resulting in health concerns were recorded by staff in a format that clarifies action needed to prevent a recurrence. There were a high number of alcohol related incidents. One service user reported that he has received considerable support from staff in reducing his alcohol intake following a series of incidents. Medication was well organised and stored securely. Records of medication administered were mostly clear, but reason codes have not always been entered when medication has not been taken. 32 Bentinck Road, C53 C03 S2229 32 Bentinck Rd V242077 050805 stage 4.doc Version 1.40 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with asssistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 A range of activities is available and encouraged. Service users are satisfied with the balanced diet provided. EVIDENCE: The cook is also employed as an activities worker and has developed a choice of activities for those service users who are interested. One service user went out into the City with the activities worker during this inspection. Others were either in their own rooms or drinking in one of the lounges. Another staff member was preparing a painting activity for the afternoon. A darts board was 32 Bentinck Road, C53 C03 S2229 32 Bentinck Rd V242077 050805 stage 4.doc Version 1.40 Page 11 available in one lounge and other activities planned on a chart included: audio book club; carpentry; and cycle club. Some service users have joined with another service in regular visits to an allotment and encouragement has been given with this with some planting and growing initiated in the grounds of the home. Some service users reported a 3-day holiday to Skegness in May 2005 and a day trip was advertised. The kitchen was well organised and menus showed two choices for each day’s main meal. A four-week rolling menu provided variation and choices were always available for other meals. The Community Dietetic Department has given advice and meals were well balanced and suited to specific needs. Service users said that they enjoyed the food provided and a cooked breakfast was available until 9.30am. Assorted sandwiches were prepared for lunch and the main meal was cooked in the late afternoon. The cook said that some service users have been involved in cooking for themselves with supervision as part of their individual programmes. There were also tea and coffee making facilities in each of the two lounges for service users to make their hot own drinks, though some prefer their alcohol. 32 Bentinck Road, C53 C03 S2229 32 Bentinck Rd V242077 050805 stage 4.doc Version 1.40 Page 12 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 An appropriate complaints procedure is in place. EVIDENCE: The complaints procedure was displayed within the home and information about how to contact the Commission has been added since the last inspection. A file was available for inspection that showed complaints appropriately dealt with and recorded. Regular meetings were held and service users were encouraged to give their views. 32 Bentinck Road, C53 C03 S2229 32 Bentinck Rd V242077 050805 stage 4.doc Version 1.40 Page 13 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 A clean and well-maintained environment is provided. EVIDENCE: Communal areas and one individual room were seen during this inspection. No structural changes have been made since the last inspection. The two lounge rooms, a dining room and an activities room, all on the ground floor, were found clean. Bathrooms were being cleaned during the inspection. The bedroom seen was suited to the needs of the individual and communal rooms contained sufficient and appropriate seating. The two lounges were comfortable with homely furnishings. All areas appeared well maintained. Further seating was provided on the patio. 32 Bentinck Road, C53 C03 S2229 32 Bentinck Rd V242077 050805 stage 4.doc Version 1.40 Page 14 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 A fixed staffing level is provided and alternative arrangements have had to be made to meet specific needs. Appropriate recruitment practices are in place. EVIDENCE: The staffing rota showed that there was always a minimum of two support staff on duty in addition to the assistant managers. Two wakeful staff were provided each night. Shifts overlapped and handover meetings were held. It was not clear how staffing levels were established and no evidence was available to link levels with individual needs. The needs of one service user, as reported under standard 7, could not be met by the level of staffing provided and external services have been arranged. Staffing records were checked at random and more relevant documents were found than on the previous inspection. The outcomes of Criminal Records Bureau checks have been filed, but there was only one reference for the most recently appointed staff member. The assistant manager stated that the main Framework office had not forwarded the other reference. 32 Bentinck Road, C53 C03 S2229 32 Bentinck Rd V242077 050805 stage 4.doc Version 1.40 Page 15 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s polies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 33, 35 and 38 (Older People) and Standards 23, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 The registered manager is not currently fit due to long-term ill health. 32 Bentinck Road, C53 C03 S2229 32 Bentinck Rd V242077 050805 stage 4.doc Version 1.40 Page 16 EVIDENCE: The registered manager was not present and has not been working at the home since April 2005. Management duties have been shared between the two assistant managers. Staff spoken with were positive about the smooth running of the service in the manager’s absence. Staff said they have had regular supervision meetings with the assistant managers. However, should the absence continue more than for a further month, an application must be submitted to the Commission to register another manager even if the arrangement is temporary. 32 Bentinck Road, C53 C03 S2229 32 Bentinck Rd V242077 050805 stage 4.doc Version 1.40 Page 17 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 x 2 x 3 3 4 x 5 x 6 x HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 3 x x x x x x x Score Standard No 7 8 9 10 11 Score 2 3 2 x x Standard No 27 28 29 30 x x x x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 4 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 3 x x MANAGEMENT AND ADMINISTRATION Standard No Score 31 x 32 x 33 x 34 x 35 x 36 x 37 x 38 x 32 Bentinck Road, C53 C03 S2229 32 Bentinck Rd V242077 050805 stage 4.doc Version 1.40 Page 18 Yes 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 OP 7 YA 6 OP 7 YA 6 Regulation 15 15 Requirement Ensure a Support Plan is in place for every service user. Ensure all Support Plans include arrangements for personal care and that all plans are kept under review. The target date for this was 31st May 2005 and has not been met. An application must be submitted to the Commission to register another manager should the registered managers absence continue more than one further month. Timescale for action 30th September 2005 30th September 2005 3. OP 31 YA 37 8 5th September 2005 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 OP 9 YA 20 OP 27 YA 33 Good Practice Recommendations Enter a reason code on the record whenever a prescribed medication is not administered. Demonstrate how staffing levels are calculated to meet needs of service users. 32 Bentinck Road, C53 C03 S2229 32 Bentinck Rd V242077 050805 stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection Edegley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 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. 32 Bentinck Road, C53 C03 S2229 32 Bentinck Rd V242077 050805 stage 4.doc Version 1.40 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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