CARE HOMES FOR OLDER PEOPLE
Benbow House at Admirals Reach Residential & Nursing Home Ridgewell Avenue Chelmsford Essex CM1 2GA Lead Inspector
Francesca Halliday Unannounced 10 - 27 May 2005 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. 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. Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Benbow House at Admirals Reach Residential & Nursing Home Ridgewell Avenue Chelmsford Essex CM1 2GA 01245 266567 01245 280469 Address 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) BUPA Care Homes (CRHCare) Limited No. 2741070 Mrs Chipema Chitambala Care Home 30 Category(ies) of Dementia - over 65 years of age (DE(E)), 30 registration, with number places. of places Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Persons of either sex, aged 65 years and over, who require nursing care by reason of dementia (not to exceed 30 persons). Date of last inspection 19/10/2004 Brief Description of the Service: The Admirals Reach site consists of four single storey, purpose built houses each accommodating 30 residents. Each house is staffed on an individual basis and the central services include administration, laundry and the kitchen. There is a spacious car park. The home is situated approximately one mile from Chelmsford and within walking distance of the bus service. Benbow House is registered to provide nursing care for up to 30 residents over the age of 65 years with dementia. All residents on Benbow House are accommodated in single bedrooms with en-suite facilities. The majority of rooms overlook the landscaped gardens. Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 10th May 2005. The inspection lasted 6 hours 25 minutes. The inspection process included: discussions with 10 residents (although advanced dementia made communication difficult with some residents), 5 relatives, one visiting health professional and 6 members of staff (including a manager covering the home in the absence of the registered manager). The premises and a sample of records were inspected. Further information was requested on 23rd May, and this arrived on 27th May, and this concluded the inspection process. 16 of the 38 standards were inspected: 10 met the standard, 4 standards had minor shortfalls and 2 standards were not met. The judgements made within the report are based on the observations and evidence gathered during this inspection. What the service does well: What has improved since the last inspection?
One relative spoken with considered that the overall standards of care had improved. A visiting GP considered that the overall management and standards of care had improved over the past year, that the management of challenging behaviour was better and that less sedatives were now being used. Staff training was more resident focused and a demonstrable improvement in overall standards of care and service was noted. Relatives and staff both considered that the cleanliness on Benbow House had improved. The standard of food and range of choices available had improved, as had the cleanliness in the kitchen. Residents who could express a view said that the food was “very good”. Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 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. Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3 (standard 6 is not applicable) The information provided by the home enables prospective residents and their representatives to make informed choices about the suitability of the home. The pre-admission assessment process ensures that residents are only admitted to Benbow House if the home can meet their needs. EVIDENCE: The home has a range of information for prospective residents and their representatives. Staff use BASOLL (Behaviour Assessment Scale of Later Life) as a pre-admission assessment tool. The sample of assessments seen demonstrated that thorough needs assessment had been carried out to ensure that the home could meet the prospective resident’s needs. Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 8 Residents’ health and care needs were met. However, the standard of care documentation was variable and this could potentially impact on the quality of care, staff communication and communication with relatives. EVIDENCE: Care plans were generally of a good standard, with regular evaluations of care and care needs. However, in one of the records sampled there had been no care plan developed for a month after a resident returned from hospital with a pressure sore. On a number of occasions staff recorded that they had changed a dressing without giving any further information about the wound or wounds. It was therefore very difficult to establish the progress of healing and how many sores the resident was suffering from. Some of the progress records were of an excellent standard, but others were less informative. A communications book had care details about a number of residents in it, and did not meet the requirements of the Data Protection Act 1998. Benbow House had a range of risk assessments in place, and the sample seen were generally up to date. Staff reported that they had good access to local health services and very good support from their GP. Residents on Benbow House had access to hospital
Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 Page 10 consultants if advice on symptom control was needed. A visiting GP said that the standards of care had “improved over the past year”, the style of care was “less rigid”, “the management of challenging behaviour was better and less requests had been made for sedation”. Staff confirmed that there had been a reduction in the use of sedatives on Benbow House. Residents who could express an opinion said that the staff were very good, one resident said “it’s very nice here”. Relatives spoken with confirmed that the standard of care was good. One relative considered that staff paid attention to all the small details of care such as nail care. Two relatives considered that the care had improved, and another relative said “there is a very caring attitude here”. The majority of relatives spoken with said staff kept them informed of any changes in health care needs or any accidents that occurred. One said “they called to tell me about an accident immediately, and let me know if he needs any clothes”. However, one relative felt that communication could sometimes be “a problem”. They said that they had not been given the name of a keyworker and were not always told if there was a change in health, an injury occurred or more clothes were needed. They said that they had discovered an injury (with bruising and broken skin) when visiting, which they had not been contacted about. There was no record that the relative brought this to the attention of staff. The relative’s concerns had not been recorded in the daily progress records and the injury had not been recorded in the accident records. A member of staff said that keyworkers had recently been allocated to all residents and that relatives would be informed of the name of their keyworker and named nurse. Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 Social activities are limited and do not provide sufficient stimulation for residents at all stages of dementia. Staff promote residents’ independence and autonomy and offer them regular choices. Visiting arrangements are open and relaxed. Meals are nutritious, provide a balanced diet and cater for individual dietary needs. EVIDENCE: Benbow House has input from an activity coordinator for three sessions each week. One resident who could express a view said, “they don’t really have activities”, another said that they sometimes went to a “sing-along on another house”. Staff said that they did try to provide some extra activities, but confirmed that these were not provided in a systematic way. There was no record of which residents had been involved in activities or how they had responded to the activities. There was a sensory room on Benbow House, however, staff said that it was rarely used more than once a week. Staff were not aware of any guidelines on the use of the sensory room or the assessment of residents as to their suitability for activities in the sensory room. A number of staff said that they wished that there were more activities, and wished that they were held on a daily basis. Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 Page 12 Benbow House does not have any restriction on visiting, and relatives spoken with said that they were made to feel very welcome at any time. There was evidence in a number of records seen that staff were trying to maintain residents’ independence and autonomy for as long as possible. A number of staff spoken with confirmed that they offered residents choices about the clothes they wore, the food they wished to eat and when they got up and went to bed. Residents who could express a view indicated that staff did offer them choices. One resident asked about the choices available at mealtimes said, “they get you something else if you don’t like it”. There was evidence that alternative meals to the menu were available and had been requested. Staff considered that the standard of food had improved and said that a greater choice was now offered. The chef said that three choices were now offered at lunchtime, and that this included a vegetarian dish and a soft dish such as cottage pie. The choices for the evening meal included a hot dish, salads, soup and sandwiches. A range of diets was also offered. Residents who could express a view said that the food was very good. One resident said “they give me what I want”. There was evidence that alternative dishes had been prepared for some residents who did not want what was on the menu. The meals seen looked nutritious and there was evidence of a good range of fresh produce in the kitchen. The chef said that individual staff were now responsible for cleaning designated parts of the kitchen. The kitchen was noted to be cleaner than at the last inspection. Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Some ancillary staff who visit Benbow had insufficient knowledge of protection of vulnerable adults issues to enable them to protect vulnerable residents. EVIDENCE: The home has policies and procedures concerning the protection of vulnerable adults and whistle blowing. All staff on Benbow House had undertaken training in the protection of vulnerable adults (POVA). The majority were able to demonstrate an awareness of the different types of abuse that can occur, and the actions to take if abuse was suspected. Catering staff spoken with had not received formal POVA training and did not have an understanding of all the different types of abuse that can occur. Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20, 24 and 26 Overall cleanliness of Benbow House had improved and staff demonstrated commitment to raising standards still further. The condition of some furniture and inadequately stored equipment posed a potential risk to residents. EVIDENCE: All residents are accommodated in single rooms, with an en-suite toilet and hand basin. Rooms were generally personalised with residents’ belongings and photographs. There was a range of communal rooms to meet different needs. These included a reminiscence room, with old artefacts, pictures and photographs, and a sensory room. Benbow House was cleaned to a high standard on the day of this unannounced inspection. A number of staff and relatives considered that the standard of cleaning had improved. One relative said “it never smells”. There was some odour in a couple of rooms that were inspected. The domestic on duty considered that Benbow House would benefit from an additional session of carpet cleaning each week in a few problem areas. Some armchairs were extremely stained, and some of the chair
Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 Page 15 cushions had lost much of their padding increasing the potential risk of pressure sores developing. On the day of inspection the small sitting room (used by residents who smoked) was full of equipment, which posed a potential hazard to residents. Two residents were using the room whilst it contained eight Zimmer frames, four wheelchairs, a hoist, a broken stool and a number of tables. Staff said that the dishwasher in the Benbow House kitchen had leaked and “flooded the kitchen” on a number of occasions, and that mopping up the water took them away from caring duties. Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30 Staff training is directly focused on improving the care and services for residents. EVIDENCE: Staff spoken with were enthusiastic about the training opportunities in the home and were keen to do more training. One member of staff considered that the dementia care course had helped staff improve care standards and provide more “person centred care”. Another member of staff said that following the dementia course staff were able to support residents better and that communication with residents had improved, resulting in less challenging behaviour. Another said that they had found the personal best course very useful. Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 The home is well run in the interests of residents. EVIDENCE: The registered manager is an experienced registered nurse, who holds additional qualifications in care of the elderly and management. The manager was off sick at the time of this inspection, and two managers from other BUPA care homes had provided appropriate management cover and support in her absence. Staff spoken with considered that there was good communication and good staff support on Benbow House. They said that they felt happy to approach the head of care or the home manager if they had any concerns. One member of staff described the manager as “open and accessible”. The home has a quality assurance programme, which includes personal best training. A number of staff had completed the personal best and the dementia care training. There was evidence that both courses had influenced staff to
Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 Page 18 improve standards, and that the care and services were now being provided in a more resident centred way. Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3
COMPLAINTS AND PROTECTION x 1 x x x 3 x 2 STAFFING Standard No Score 27 x 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 3 3 3 x x x x x Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 Page 20 no 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. Standard 7 Regulation 15(2) Requirement The registered person must ensure that the care plans cover all care needs and are updated following changes in needs. Informed at the time of inspection. The registered person must ensure that the progress records provide sufficient details of the care given, the residents health and welfare and how they have spent their day. Informed at the time of inspection. The registered person must ensure that staff communications books do not contain personal information about residents. Informed at the time of inspection. The registered person must ensure that all bruising or injuries are recorded both in the daily care records and in the accident records, that relatives are notified and that a record is made of this discussion. Informed at the time of inspection. The registered person must ensure that there is a range of therapeutic activities for Timescale for action 10.05.05 2. 7 15(2) 10.05.05 3. 7 15(2) 10.05.05 4. 8 17(2) 10.05.05 5. 12 16(2)(m) (n) 10.05.05 Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 Page 21 6. 12 16(2)(m) (n) 7. 18 13(6) 8. 20 13(4) 9. 20 13(4) 23(2)(g) 16(2)(k) 23(2)(d) 10. 26 11. 26 23(2)(c) residents at all stages of dementia, that there are activities on a daily basis and that a record is made of individual response to activities. Informed at the time of inspection. The registered person must ensure that there are clear guidelines on the use of the sensory room and that individual residents are assessed as to whether the sensory room would be suitable for their needs. The registered person must ensure that all ancillary staff have protection of vulnerable adults training. The registered person must ensure that an appropriate and safe area for equipment storage is developed. The registered person must ensure that worn out armchairs that have lost cushion padding are refurbished or replaced. The registered person must ensure that the frequency of cleaning armchairs and carpets is reviewed, and that they are kept clean and odour free. The registered person must ensure that the dishwasher on Benbow House is repaired or replaced. 1.07.05 1.07.05 1.07.05 1.08.05 1.08.05 1.07.05 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 Good Practice Recommendations Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 Page 22 Commission for Social Care Inspection 1st Floor, Fairfax House Causton Road Colchester, Essex CM1 1RJ 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 Benbow House at Admirals Reach Residential & Nursing Home I56-I05 S15345 Benbow House V226256 100505 Stage 1.doc Version 1.30 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
