CARE HOMES FOR OLDER PEOPLE
Belgarth Nursing Home Wheatley Lane Road Barrowford Nelson Lancashire BB9 6QP Lead Inspector
Mrs Marie Matthews Unannounced Inspection 21st November 2005 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 Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 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. Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Belgarth Nursing Home Address Wheatley Lane Road Barrowford Nelson Lancashire BB9 6QP 01282 699077 01282 619030 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) Bellgarth Care Home Limited Mrs Lynne Margaret Markham Care Home 47 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number disorder, excluding learning disability or of places dementia (2), Mental Disorder, excluding learning disability or dementia - over 65 years of age (22), Old age, not falling within any other category (44) Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Within the overall registration of 47, a maximum of 37 service users requiring nursing care who fall into the categories of either OP,DE(E), or MD(E) may be accommodated. Staffing must comply with the letter to the registered provider dated 11th February 2004. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The variation for the two younger service users with a mental disorder (MD) should apply only whilst accommodated in the home and under the age of 65 years. 21st June 2005 2. 3. 4. Date of last inspection Brief Description of the Service: Belgarth is a detached older building situated on the outskirts of Barrowford, near Nelson. The building has been extended over the years and is registered to provide both nursing care and personal care for older people. There is a passenger lift to access the first floor. The home has garden and patio areas for service users to sit out in and provides a parking area for visitors and staff. The home has a separate unit for people who are elderly and have dementia or a mental disorder. Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection was conducted at Belgarth Care Home on 21st November 2005. The inspection involved looking at records, talking to management, three staff, six residents and two visitors, a tour of the premises and generally looking at what was happening in the home. This inspection looked at things that should have been done since the last visit, in June 2005, and a number of areas that affect resident’s lives. There were forty-seven people living at the home on the day of the inspection visit. Residents said staff were ‘very friendly’ and ‘always helpful’. The home was assessed against the National Minimum Standards for Older People. This report should be read with the inspection report of 21st June 2005 for the reader to get a complete overview of the home. What the service does well: What has improved since the last inspection?
Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 Page 6 A training and development plan showed that staff had been given appropriate training to help them to meet the resident’s needs. Staff had a good understanding of residents needs. The home was using a new medication system and this had improved the safety of the system. Residents said they were given a choice about many aspects of their care; this included choices about meals, activities and how they spent their day. Repairs to the patio area had been done and the gardens were now safe for people to use. Photographs showed that staff, residents and their visitors had enjoyed the garden during the warmer months. Redecoration of the home was ongoing and a number of rooms looked cleaner and brighter. Residents said there was enough staff on duty; one said ‘there is always someone around to help’. Staff were provided in sufficient numbers to make sure the needs of the residents were met. The home had recruited permanent staff and the registered manager said this had improved staff morale. The home had improved the way it sought people’s views about the standard of the services given. Meetings for staff, residents and their relatives had been held and a satisfaction survey had been done in June 2005; the results of this had been made available. 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
Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 Page 7 contacting your local CSCI office. Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 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 Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. Standard 6 was not applicable. The home did not provide current residents and their representatives with enough information about the home. Residents were admitted only when detailed assessments had been completed and when the home was clear their needs could be met. Staff had a clear understanding of residents needs and specialised training had been provided to support them. EVIDENCE: The statement of purpose needed further review to give people enough information about the services offered by the home. Most residents had been given a copy of the service user guide. The registered manager said that service user guides were not issued to residents on the dementia unit. The registered manager needed to provide existing residents with appropriate information about the home. Resident’s needs had been assessed to ensure their needs could be met before they were admitted to the home. A new assessment form had been
Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 Page 10 introduced; this needed minor review to ensure it contained all aspects of residents needs. A programme of dementia training had started which would help staff to meet the specialised needs of the residents in the home. Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 Page 11 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): 7, 8 and 9. The residents care plans did not clearly detail the action to be taken by staff to meet resident’s needs and did not yet show that residents and their relatives had been involved in the development or reviews. The medication systems had improved but policies and procedures needed to be reviewed to prevent residents being put at risk. EVIDENCE: All residents had care plans generated from an assessment. Three care plans were looked at. A new care planning system was gradually being introduced. The plans contained some relevant information but still did not consistently contain enough detail to enable carers to meet the resident’s needs. Falls risk assessments were not included in two of the plans, the third care plan contained a risk assessment but this had been generated following a number of falls. There was no evidence to support residents or their relatives had been involved in the development or review of the care plans. Reviews by staff had taken place every month on two of the plans. The registered manager was reminded that residents admitted on the Care Management Programme or under the Mental Health Act 1983 must have full details of staff responsibilities included in the plan.
Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 Page 12 Various risk assessments were in but interventions were not always recorded. Appropriate weighing equipment had recently been provided and regular recording of residents weight had commenced. The home was using a new medication system and this had improved the safety of the system. The medication policies and procedures needed minor review. Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 Page 13 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): 14 and 15. The home provided a varied menu and the residents were able to exercise choice about what they ate. EVIDENCE: Two residents said they were offered choices about many aspects of their care; this included choices about meals, activities and how they spent their day. A hot trolley had been provided for mealtimes but was not used. Hot plated food was being taken through for residents when seated at the table. Residents made positive comments about the food. One resident said ‘there is always a choice’; another resident confirmed that liquidised diets were served in separate portions. The times that meals were served had been changed following discussion with residents, relatives and staff. Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. The complaints process in this home is good and residents and their relatives were confident any concerns would be dealt with. Information about the complaints procedure was not easily accessible to all residents. EVIDENCE: Records had been maintained of any complaints or concerns raised and any action taken. The procedure was available to some residents who had been given the service user guide. One resident said she would speak to senior staff if she were unhappy. Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 25 and 26. The standard of décor was gradually improving but in some areas was still poor and did not present a safe, homely and comfortable place for residents. There was no documented programme of planned maintenance and renewal to support future improvement. The gardens were accessible and safe for residents and their visitors to use. EVIDENCE: Redecoration of the home was ongoing and a number of rooms looked brighter. However the standard of décor and furnishings in bedrooms still varied a great deal. There was still no programme of maintenance and renewal to support that further redecoration and refurbishment was planned but the registered manager said this was being developed. Double-glazing units had failed and some still needed replacement. Minimum furnishings were not provided in all rooms, the reasons for this had not been included in the care plan. Not all rooms had lockable storage space. Risk assessments did not support non-provision of sink plugs in resident’s rooms.
Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 Page 16 Radiator covers were in place. The home was free from offensive odours in all areas other than the lounge dining areas on the dementia unit. The rear patio and ramp to the gardens had been repaired and new garden furniture was available. Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The registered manager still did not operate safe and robust recruitment practices; appropriate checks had not been carried out which potentially left residents at risk. Resident’s needs were met by a well-trained and competent group of staff and this improved quality of life for the residents. Staffing numbers met the assessed needs of the residents. EVIDENCE: The staffing rota was clear and showed the home was compliant with the staffing levels required. The home had recruited permanent staff and this had improved staff morale. Three residents said there were enough staff on duty; one said ‘there is always someone around to help’. Two staff files were looked at. It was clear that the registered manager had not followed a safe recruitment procedure despite serious concerns raised at the last two inspections. The Criminal Records Bureau and Protection of Vulnerable Adults First process was discussed in detail with the registered manager. The registered provider was made aware of this serious concern. Staff had received appropriate training to meet the needs of people living in the home. Residents said staff were ‘very friendly’ and ‘always helpful’. Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 Page 18 Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 36, 37 and 38. The systems for consultation with residents, visitors and staff are good with evidence that the home had responded to any issues raised. Records required by regulation and for the protection of residents were not consistently maintained. EVIDENCE: Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 Page 20 Meetings for staff, residents and their relatives had been held. A resident satisfaction survey had been done in June 2005; the results were available to interested people. As at the last inspection the records of staff supervision could not be accessed. A new format had been developed and staff appraisals had commenced. This would be reviewed at the next visit. Appropriate records were kept of any resident’s monies held by the home. The registered provider had still not completed a record of his monthly visits under Regulation 26 and a further requirement was made. The electrical installation test certificate was still overdue. The registered provider and registered manager were advised that this needed to be addressed as a matter of urgency. Staff had received first aid training. Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 2 X X X X 2 3 2 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 2 1 1 Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? yes 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 OP1 Regulation 4 Requirement The registered person must ensure that the statement of purpose meets the requirements of regulation and the contents of the standard. Timescale of 2/5/05 not met. The registered person must ensure new and existing residents are issued with a service user guide. Timescale of 2/05/05 not met. The registered person must ensure that the resident’s plan of care sets out in detail the action to be taken to ensure all aspects of health needs are met. The plan must be drawn up with the involvement of the resident or representative and reviewed by care staff at least once per month and updated to reflect changing needs. Timescale of 2/5/05 not met. The registered person must ensure that all risks to residents are identified and appropriate care to reduce those risks is recorded for all areas of care. Timescale of 2/5/05 not met.
DS0000022470.V266105.R01.S.doc Timescale for action 16/01/06 2. OP1 5 16/01/06 3. OP7 15 16/01/06 4. OP7 13 16/01/06 Belgarth Nursing Home Version 5.0 Page 23 5. OP7 15 6. OP9 13 7. OP16 22 8. OP19 23 9. OP29 19 10. OP36 18 11. OP37 26 12. OP38 13 The registered person must ensure where a resident is on the Care Management Programme or subject to requirements under the Mental Health Act 1983, the care plan indicates how the home will fulfil its responsibilities. The registered person must review medication policies and procedures to reflect current guidance from the Royal Pharmaceutical Society. Timescale of 22/08/05 not met. The registered person must provide all residents with information about the complaints procedure. Timescale of 08/08/05 not met. The registered person must ensure there is a development plan to evidence a programme of replacement and renewals, with particular reference to resident’s bedrooms. Timescale of 22/08/05 not met. The registered person must operate a thorough recruitment procedure ensuring the protection of residents. Timescale of 11/4/05 not met. The registered person must ensure care staff receive formal supervision at least six times a year. Previously a recommendation. The registered provider must provide the Commission with a copy of the documentation to support Regulation 26 monthly visits. Timescale of 11/4/05 not met. The registered person must ensure the electrical installation test certificate is up to date. Timescale of 18/07/05 not met. 16/01/06 16/01/06 16/01/06 16/01/06 05/12/05 16/01/06 05/12/05 05/12/05 Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 Page 24 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 OP3 OP24 Good Practice Recommendations The registered person should revise the assessment documentation to ensure that it contains all aspects as listed in standard 3.3. The registered person should ensure that each room is audited for contents against standard 24 and this is discussed with the resident and their representative, to ascertain their wishes. These wishes regarding furnishing should then be recorded as part of their care plan. The registered person should ensure that residents are provided with a lockable space unless their risk assessment determines otherwise. The registered person should ensure residents are supplied with a sink plug unless their risk assessment suggests otherwise. The registered person should ensure failed double-glazed units are replaced. The registered person should ensure a minimum ratio of 50 care staff are qualified to NVQ level 2 or equivalent. 3. 4. 5. 6. OP24 OP25 OP25 OP28 Belgarth Nursing Home DS0000022470.V266105.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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