CARE HOMES FOR OLDER PEOPLE
Belamie Gables 210 Hyde End Road Spencers Wood Reading Berkshire RG7 1DG Lead Inspector
Stewart Mynott Unannounced Inspection 2nd February 2006 10:10 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 Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 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. Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Belamie Gables Address 210 Hyde End Road Spencers Wood Reading Berkshire RG7 1DG 0118 988 3417 / 4648 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) Mr J Parry Mr D L White Belinda Vickery Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th July 2005 Brief Description of the Service: Belamie Gables is a privately owned care home. The service is registered to provide personal care and accommodation for up to 20 persons who are over the age of 65. It is situated in a quiet residential area to the south of Reading. The property is a large detached house set back from the main road. There are large front and rear gardens with car parking spaces at the front of the property. There is a passenger lift in the building and accommodation is provided on two floors. Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection occurring during the weekday lasting for 5½ hours. The purpose of this inspection was to look at how residents choose to move into the home, the daily lifestyle and routines of residents and the management and administration arrangements at the home. Most of this inspection was spent with service users and staff in the communal lounge observing the daily life at the home. All but two residents were met during this inspection with more detailed discussions occurring with over half of the residents to gain their views and perspectives about the home. All staff on duty were also spoken to gain their views. During the day lunchtime for residents was also observed. Time was spent with the registered manager in discussion to assist in assessing some of the standards. During this time records relating to the care of residents and records relating to the running of the home were examined to cross reference observations and discussions during the course of the inspection. Residents preferred the term “resident” to “service user” and hence this term is used throughout this report What the service does well:
Belamie Gables provides a homely and warm atmosphere for residents. Resident’s confirmed their satisfaction with the daily life, services and facilities at the home. The registered manager leads the home in an inclusive manner and all staff were seen to treat residents with the utmost respect and dignity. Staff always included residents in conversations and resident’s choices were respected at all times. Residents confirmed that they are “well cared for” and two residents described the feeling akin to “belonging” and “its like one big family here”. The staff on duty worked in a cohesive manner demonstrating commitment and good teamwork. Residents were particularly complimentary about the registered manager describing her as “caring” and “always approachable”, all residents spoken to felt the manager listened to their views and was accessible. During lunch the registered manager and staff at various intervals took their lunch with residents and joined in conversations. Residents clearly enjoyed this time with the staff further demonstrating the inclusive ethos of the home. Resident’s who had recently moved in described the experience as positive and felt the home delivered exactly what they expected. They confirmed that they were encouraged to bring in personal items to make them fell at home.
Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 Page 6 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. Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 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 the following standard(s): 3 and 5 Prospective residents have their needs assessed prior to admission to ensure the home can meet all the assessed needs. It recommended that additional visits conducted by the manager should be recorded as part of the assessment and admission process. Prospective residents and their representatives are encouraged to visit the home before admission. EVIDENCE: Two residents that had very recently been admitted to the home discussed their experiences. Both confirmed that they had visited the home and seen their bedroom prior to admission with the support of their family. Both residents felt they were settling in and were positive about the home and staff team. A third resident who recently moved in has some memory impairment and was unable to fully discuss their experiences. The admission records for the three residents spoken to were examined. All three residents had care managers and their needs had been assessed through the care management process prior to admission. Two of these reports were on file and for one resident the registered manager had advised that the care
Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 Page 9 manager had not forwarded this document. The manager confirmed that she also undertakes assessment visits to confirm that the home can meet prospective residents needs and to check that information has not changed since the care manager’s report. It recommended that such visits should be recorded as part of the assessment and admission process. The manager confirms that she undertakes full assessments for “private” prospective residents. Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6 to 11 were not assessed during this inspection. EVIDENCE: Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14 and 15 The routines and daily life at the home are flexible and meet the needs and expectations of the residents. Residents are free to receive their visitors without restriction in private as they wish. The home assists residents to exercise and maintain choice and control over their lives. The home provides a varied home cooked menu with scope for additional personal choice. The diet is wholesome and appealing. EVIDENCE: Most residents choose to spend their time in the homely communal lounge / dining area where most of the inspection was spent with residents and staff on duty. The daily life and routines observed during the inspection were flexible according to resident’s wishes and abilities. Residents confirmed that staff observe their individual choices throughout the day to include the timing of personal support and participation in social activities. Residents spoken to described feeling in control on how they spent their day. The relationship between the staff on duty and residents was observed to be warm, friendly and inclusive. Two residents described the feeling akin to “belonging” and “its like one big family here”. Residents confirmed that they are free to see their visitors without restriction either in the lounge or their personal bedroom for privacy.
Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 Page 12 Residents confirmed that they are able to choose their own individual activity and pursuits of hobbies during the day and whether to join in with any organised activities provided at the home. During the inspection one resident spent time in their room completing a large jigsaw and listening to their own music and other residents in the communal area were reading their daily newspapers, chatting in small groups and knitting. A care assistant was providing nail care and manicures for some of the ladies. Staff and residents also discussed the general activities that are organised to include bingo, art and crafts and trips to the local garden centre. A church group visits the home on a regular basis for those who wish to participate in religious observance. Several residents discussed photos of activities displayed on the wall. Residents confirmed that each year a trip is arranged for all residents to participate in. Last year most residents had gone to “Longleat” for the day on a coach hired by the home. Three residents confirmed that they chose the location of this outing with the staff team during residents meetings held before hand. Residents new to the home confirmed that they are encouraged to bring personal items with them. One resident had their own artwork on display in the lounge. The same resident showed the inspector their room, which contained many personal items making the room individual to them. Another resident had many personal items and confirmed that this was encouraged and also confirmed that they retained control of their own finances further evidencing the commitment to residents exercising personal autonomy. The cook described that menus are varied over a period of time. Each day the staff on duty asks residents which choice of main meal they would prefer and this is then cooked to order. Residents confirmed that this occurs and that they always get their preferred choice. Residents and staff also confirmed that breakfasts are available when requested depending on the times each resident rises. The home keeps a record in a diary of all meals prepared for residents. This diary also contained evidence of resident’s own individual choices for meals in addition to the main menu choices. The staff served lunch and residents chose where to sit to eat their meals. The lunch served was presented attractively and residents confirmed that they were enjoying the meal. Staff offered help to those residents that required assistance in a discreet and sensitive manner. Staff were observed to sit and eat their meal with residents at various times during the meal and participate in the general conversation. This further demonstrated the inclusive atmosphere within the home and residents clearly stated they enjoyed this routine. Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 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 the following standard(s): Standards 16 to 18 were not assessed during this inspection. EVIDENCE: Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 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 the following standard(s): 19 and 23 Work is in progress to rectify the deficiencies noted in the recent Fire Safety Inspecting Officer’s inspection of the premises. The CSCI require notification when this work is complete. The Proprietors are planning to increase the sizes of the two smallest bedrooms to meet the minimum advised standards. EVIDENCE: The Berkshire Fire Safety Inspecting Officer had made an inspection of the premises in December 2005 and noted a number of safety deficiencies at the premises in meeting the current safety regulations. The Proprietors have acted swiftly to remedy this and the contractor responsible for the majority of this work was met during the inspection. The contractor felt that work would be completed within timescale and the registered manager and Proprietors were liaising with the fire safety office. It is a requirement that the CSCI are notified on completion of this work. Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 Page 15 On previous inspections it was noted that two bedrooms provided a very limited amount of usable floor space, below that of the minimum advised standard. On previous visits these rooms had been occupied and the home was able to demonstrate that residents occupying these rooms were satisfied and their needs were being met. Since the last inspection these bedrooms have become vacant and the registered manager advised that a planning application had been made to extend these rooms. This is a positive step forward to meet the advised minimum standards in relation to bedroom sizes. Progress in relation to this will be followed up during the next inspection. Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27 to 30 were not assessed during this inspection. EVIDENCE: Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 The registered manager is qualified and provides an open and inclusive approach to leading and managing the home. Resident’s views are collected informally by the staff team and the registered manager. A further review of service as part of a quality assurance system is required to ensure the home is achieving its aims and objectives for residents and contribute to any further development plans for the service. An improvement to the recording of the use of resident’s personal allowances is required to include appropriate receipts and invoices for each transaction. The home operates a good system to ensure the continued health, safety and welfare of residents. The home is required to follow its own procedures and maintain records in relation to the temperature of hot water in resident’s bedrooms and the daily recording of fridge/freezer temperatures. EVIDENCE: The manager has been registered in post since 2001 and has gained the necessary qualifications to run the home. The assistant manager is currently
Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 Page 18 on maternity leave and an experienced senior carer is now acting up to ensure continuity in the management of the home. The registered manager describes herself as “very hands on” within the home. Residents spoken to made very positive and complimentary comments in relation to the manager and describe her as “kind”, “approachable” and “always has time and listens to me”. During the inspection this approach to the residents and staff was clearly demonstrated. The ethos in the home is one of inclusion, observation and general discussion revealed a warm atmosphere with a “homely, family like approach” for residents and staff. The registered manager described the current arrangements for quality assurance and monitoring systems within the home. Residents are enabled to express their views informally as revealed during lunch when the manager and several service users discussed the home in an open manner with the inspector. Formal residents meeting have also been held as confirmed by residents spoken to. The last recorded minutes shown to the inspector were in February 2005 and the manager was going to arrange the next meeting. The registered manager confirmed that resident’s representative’s views had been gained collectively via a questionnaire sent out approximately 18 months ago and further development of the questionnaire was planned to make the process easier next time. It is a requirement that the next review of the quality of the service is planned and the CSCI notified when this will occur. The review must include resident’s views and their representatives particularly for those residents who have a degree of memory impairment and should include other professionals involved in resident’s welfare. This will ensure a measure on how the home is achieving its aims and objectives for residents and contribute to any further development plans for the service. The home provides a facility for safe holding residents personal allowances to allow for payment of services or purchases not included in the fees. Each resident has monies stored appropriately in individual envelopes in the safe. There is a separate individual record of transactions recorded on a “personal allowance record” sheet. Several of these records were examined. It was noted that each transaction for monies deposited or withdrawn for payment of services was recorded with clear dates and signatures of senior staff. It was noted that many transactions particularly for the payment of hairdressing and podiatry that no invoices or receipts had been collected to accompany the records. On four occasions the reason for the deduction of monies had been noted without the exact amount. It is a requirement that records in relation to personal allowances follow good practise to include invoices and receipts with each entry onto the “personal allowance record” and amounts deducted recorded clearly for each transaction. The arrangements for the health, safety and welfare of residents and staff were examined. Staff spoken to had a clear understanding of their responsibility and knowledge of safe working practises. Staff also confirmed
Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 Page 19 that they had received appropriate training in this area. Observations revealed safe working practises were followed in relation to the care of residents particularly in relation to the control of the spread of infection and moving and handling. Records kept to monitor the health safety and welfare of residents and staff were examined to include, fire safety records, electrical testing, gas and boiler servicing and safety records, food hygiene records, regulation of hot water temperatures, risk assessments for safe working practises and equipment and maintenance of equipment. The majority of these records have been appropriately reviewed and maintained to a good standard. It was noted that hot water temperatures to the bedrooms had not been randomly tested since June 2005 and records in relation the daily monitoring of the fridge and freezer temperatures had several gaps in January. It is a requirement that these records are maintained to the required frequency identified by the home. The recording of accidents to residents and staff follow good practise and all incidents are clearly recorded in resident’s daily records with an appropriate accident form. Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 Page 20 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 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 X 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 X 17 X 18 X 2 X X X 3 X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 2 X X 2 Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 Page 21 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 OP19 Regulation Requirement Timescale for action 30/04/06 2 OP33 3. OP35 4 OP38 23(4)(a-c) The registered manager must notify the CSCI in writing on satisfactory completion of the deficiencies noted in fire safety officers report 24 It is a requirement that the next 31/07/06 review of the quality of the service is planned and the CSCI notified when this will occur. This review must include resident’s views and their representatives particularly for those residents who have a degree of memory impairment. 17(2) The registered manager must 15/03/06 ensure that records in relation to personal allowances follow good practise to include invoices and receipts with each entry onto the “personal allowance record” and the amounts deducted recorded clearly for each transaction. 12(1)(a) The registered manager must 28/02/06 & 13(4) ensure the records are appropriately maintained in line with the homes recognised procedures for • Daily fridge and freezer temperatures
DS0000011398.V281478.R01.S.doc Version 5.1 Belamie Gables Page 22 • Monitoring of the temperature of hot water in residents bedrooms. 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 manager is advised to record any additional assessment carried out with prospective residents when confirming the home can meet their needs following an assessment through the care management process to complete the account of the admission process. It is essential that the care manager report be obtained before the planned admission of any prospective resident. Belamie Gables DS0000011398.V281478.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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