Inspection on 26/06/07 for Belle Green Court Care Home

This inspection was carried out on 26th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Belle Green Court Care Home 03/01/06

Belle Green Court Care Home 03/06/05

Belle Green Court Care Home 01/03/05

Belle Green Court Care Home 02/07/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Belle Green Court Care Home Off Belle Green Lane Cudworth Barnsley South Yorkshire S72 8LU Lead Inspector Mrs Jayne White Key Unannounced Inspection 08:15 26th June 2007 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 Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Belle Green Court Care Home Address Off Belle Green Lane Cudworth Barnsley South Yorkshire S72 8LU 01226 718178 F/P 01226 718178 none 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 Diwan Chand Mrs Sylvia Forster Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons accommodated shall be aged 60 years and above There are 20 beds registered for nursing (N) only, and 20 beds registered for personal care (PC) only. One specified service user under the age of 60 years may reside at the home. 3rd January 2006 Date of last inspection Brief Description of the Service: Belle Green Court is a care home that provides nursing and/or personal care and accommodation for 40 older people. Mr Diwan Chand owns the home. The home occupies a central position in the village of Cudworth in Barnsley, central to all local amenities. It is a purpose built two storey building with an accessible garden area. There is a passenger lift. All bedrooms are single with en-suite facilities. There are car-parking facilities at the front of the building. Written information about the home is kept in the office. This includes the statement of purpose and the guide for service users that includes the range of fees and a sample contract/terms and conditions. The most recent inspection report from CSCI was on display in the entrance hall. The manager provided information to CSCI with reference to the fees charged. This was £334.50, with extra charges for hairdressing and chiropody (if the community chiropodist wasn’t used). The National Health Service nursing care contribution is in addition to these fees and ranges from £87.00 to £139.00 dependant on the level of National Health Service assessed need. Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit took place between the hours of 8:15 and 17:15. The inspector visited without giving any notice. Before the inspection surveys were sent to a range of people, asking them about the home. Six came back from people who lived at the home; four from health and social care professionals, three from relatives and five from staff. During the inspection, parts of the building were inspected, the inspector read some records, observed care practices and talked to seven residents and four members of staff. Also taken into account was other information received by CSCI about the service since the last inspection. The inspector wishes to thank the residents, staff and owners for their time and co-operation throughout the inspection process. What the service does well: Belle Green Court was well managed. People who used the service, their representatives and health and social care professionals generally expressed a high degree of satisfaction with the service. The home had a warm, friendly and welcoming atmosphere. People who lived at the home were relaxed and happy to talk about the care provided. They all said that they were satisfied with the care that they received. On the whole, the admission process provided people with information they needed about the home. They were invited to visit the home prior to their admission, to assess the quality, facilities and suitability of the home. People who lived at the home were observed to be receiving personal care in a manner that respected their privacy and dignity. Overall, the health, personal and social care that people received was based on their individual needs, which were identified in the plan of care. People who used the service were able to make choices about their life style. There was a good programme of leisure and social activities available. People were encouraged to maintain contact with their family, friends and the local community as they wished. Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 6 The majority of people enjoyed their meals and said the meals were of a good standard, with choices and alternatives provided. People who used the service were able to express their concerns and had access to a robust, effective complaints procedure. They were protected from abuse and had their rights protected. The home was clean, comfortable, well presented and well maintained with pleasant communal areas. There was an experienced and stable team of staff, including a mix of carers and ancillary staff. These were in sufficient numbers to support the people who used the service and to support the smooth running of the service. Staff had received training so that people were appropriately cared for. People were encouraged to look after their own money. On the whole, the health, safety and welfare of people and staff were protected. What has improved since the last inspection? What they could do better: Make it clear in the information provided to people whether the home provide a service to rehabilitate people to return home after an illness or hospital admission. This will ensure that people and their relatives are clear whether this is the service to be provided. People or their relative should then sign the plan of care that will outline the care to be given. Include risk assessments for the use of bed rails and self-administration of medication in the plan of care, to demonstrate how decisions have been made. Have separate files for each individual plan of care or place dividers in the file they are kept, so that records for people are more easily identified. Identify the current stock for medication carried forward from one month to another, to assist thorough auditing. Confirm with the person’s GP on admission their current list of medications, so that all prescribed medication is administered from that date. Remove continence protectors from lounge chairs to maintain people’s dignity. Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 7 Review the menu in consultation with people living at the home, so that all their preferences are taken into consideration and provision of meals other than traditional English food is explored. Maintain all the garden area so that the view of the garden is a pleasant area for all people living at the home to look at. Replace the temporary manhole cover with a permanent one to ensure the safety of people who use and visit the service. Ensure protection of vulnerable adults checks are received before staff commence work at the home, so that people living there are sufficiently protected from the risk of abuse. Ensure all notifiable incidents are reported to CSCI, including incidence of pressure sores graded at level 2. This is so that CSCI can monitor the action taken and make a judgement about the quality of the service being provided. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 1, 3 & 6 were inspected. The home did not provide an intermediate care service. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. On the whole, people seeking to use the service or their representatives had the information they needed to choose a home, which would meet their needs. They had their needs assessed, so that the service would be able to determine whether they could meet their needs. EVIDENCE: A full needs assessment was carried out for people prior to their admission. The nurse on duty also said the manager also visited prospective people prior to their admission. This confirmed that the service was appropriate for the person and provided staff with the information to formulate an individual plan of care. Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 10 People who lived at the home said they or their representative had been invited to visit the home prior to their admission, to assess the quality, facilities and suitability of the home. All surveys returned by people who lived at the home said they received sufficient information about the care home to make decisions about going to stay/live there and received a contract that detailed the terms and conditions of their stay. Their comments included “when my wife needed respite we were given the names of three homes. We phoned Belle Green Court and were invited to visit. We didn’t go to the others. It prepared us for when we needed a home full time” and “yes. Full information was given, everything as expected”. One relative said “I am concerned that, while it was made clear to the home that mum was placed there to recover from a serious illness, the intention was to rehabilitate her to go home – however, during her stay there has been little attempt to support the aim or to re-build her independence”. Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 7, 8, 9 & 10 were inspected. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Overall, the health, personal and social care that people received was based on their individual needs, which were identified in the plan of care. In general, the principles of respect, dignity and privacy were put into practice. EVIDENCE: Three individual care plans were inspected on a sample basis. Overall, the plans set out in detail the action that was required by staff to ensure that all aspects of people’s needs were met. The care plans had not been consistently completed with the involvement of the person or their representative. This would give them the opportunity to agree with staff the help that they needed to live as independently as possible. Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 12 Consent forms by families were in place for the use of bed rails. This does not demonstrate their use has been assessed as part of a risk management framework to safeguard the person. Records of healthcare visits were maintained and these confirmed GP’s, chiropodists and other healthcare professionals were visiting people who lived at the home. The plan of care for each person was not kept in a separate file. The file they were kept in did not contain dividers to identify easily, which records belonged to which person. This does not facilitate for ease of finding information. Surveys from people living at the home said they always or usually received the care and medical support they needed. Their comments included “when I lost my wife the matron and staff gave love and understanding and space when I needed it”, “there is a good understanding between the home and the medical centre” and “the care and attention is first class”. All health and social care surveys said the care service sought advice and acted upon it to manage and improve individual’s health care needs and that individual’s health care needs were met by the service. They said staff had the right skills and experience to support individual’s social and health care needs and responded to the different needs of individuals. Their comments included “there is an individualised approach, sensitivity”, “I feel the service provides individualised person centred care for their residents”, “they embrace training and education to improve care”, “staff always seek advice when necessary and take good care of patient. Patients are always well looked after in the home”, “patients choices are always taken into account by staff and staff support patients in all the ways they want to be cared for”, “always good, informed discussions about individual service users and their needs. Always prepared to question me as needed. Always prepared to challenge me in the interests of residents. Excellent. Sensitive in approach. Flexible and adaptable. I have always been impressed by the approach. People are treated as people. A feature of care in Belle Green is the individualised approach and the support offered to individuals to make choices. A strength of this home is its approach to the individual and its sensitivity to individual need”, “nursing staff make appropriate referrals for specialist palliative care services including cancer and non cancer diagnosis. Staff appear to strive towards high standards of care for the residents I have been involved with”, “managers and nursing staff support and promote education in all areas of care”, “staff always appear willing to take advice and seek advice, making the best interests of the service user and their families. I have worked with home staff in some challenging complex palliative care situations”. Information from relatives’ surveys about the care their relative received included “we had to alert staff and suggest a doctor’s visit” in respect of meeting that particular person’s care needs. One relative said, “I certainly Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 13 have had no discussion about mum’s care plan, or seen a copy of it”. Another relative said “overall care at Belle Green Court very good. I think I have made an excellent choice of care home to put my relative in knowing they are not being mistreated and everyone treats them with respect”. In general people were not responsible for their medication. The manager said this was because people did not want to look after their own medication. This was confirmed in discussions with them. The guide for service users, however, identifies the home will promote independence and autonomy. Having no people responsible for their medication does not promote this philosophy. Having people maintain responsibility for their medication is especially important for people who are expected to return home and manage their own medication. An inspection of the homes medication storage and administration systems was undertaken. There was a separate locked room for storing medication. The home had an appropriate system for storing and administering controlled drugs and two staff appropriately signed the controlled drugs record. Nursing staff were responsible for administering medication and received training in the safe handling of medicines. The date, the quantity of medication received from the pharmacy and the signature of the person making the entry was recorded on the medication administration record (MAR) for medication provided in a monitored dosage system. For medication not provided in the monitored dosage system a separate record was used. Medication carried over from the previous month was not recorded on the MAR. This meant an exact identification of current stock could not be made without looking through all records since a person’s admission. Medication for people admitted to the home was recorded and the amount they had received. It was noted however, that further medication was added to the original medication, after admission, that hadn’t been administered from the date of admission. The manager said this was because family had brought it in at a later date. This meant people may be without prescribed medication. One person who returned their survey said, “occasionally, some tablets run out as it seems they are not re-ordered when running low”. Surveys from health and social care professionals said they felt the care service supported individuals to administer their own medication or managed it correctly where this was not possible. Surveys from relatives said there were occasions when they had ‘run out’ of medication. One said “this would not have been an issue if they had encouraged self-medication, which they had always done at home. Another said, “according to my mother she’s had certain tablets which she hasn’t had Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 14 before!! These concerns were raised with the manager and nurse on duty. There was a system in place for the ordering of medication. The manager and nurse said they couldn’t recall ‘running out’ of medication. They said sometimes there was a change of medication or a temporary medication was required and there was sometimes a delay in obtaining the medication because of the communication/liaison between the hospital, GP and the pharmacy. People commented that they were well cared for by helpful and kind staff who treated them well and found them respectful of their privacy. Staff were observed approaching people in a respectful manner. There was clear and respectful communication between people and staff, for example, at mealtimes and appropriate assistance was given. Staff were able to describe how they cared for people in a respectful and sensitive manner. They could describe how they respected the privacy and dignity of people, for example, knocking on peoples’ doors before entering and these were observed being put into practice. All personal care was carried out in the persons’ rooms or toilet/bathroom areas ensuring their privacy. Lounge chairs were noted to have continence protectors on them. This does not promote privacy and dignity for some person’s needs; neither does it promote use of the chairs by other people or visitors. All surveys from health and social care professionals said the care service respected individual’s privacy and dignity. One professional said, “when I am examining a patient they always care about privacy and look after the patient with dignity. Staff make every effort to respect privacy and dignity. I am always invited to see residents referred in the privacy of their own rooms”. Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 12, 13, 14 & 15 were inspected. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who used the service were able to make choices about their life style. There was a good programme of leisure and social activities available. The meals were of a good standard, with choices and alternatives provided. People were encouraged to maintain contact with their family, friends and the local community as they wished. EVIDENCE: The daily routines within the home were flexible. People who lived there said that they could spend the day as they wished. They described how they got up and retired to bed as they wished. They said it was their choice what they did during the day. People said they were encouraged to furnish their bedroom with their personal possessions to create a home from home environment. Surveys returned from people that lived at the home said activities arranged were always or usually what they could take part in. Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 16 An activities coordinator was employed. Activities such as aromatherapy, snooker, crafts, board games; manicures, karaoke, musical exercises and quizzes took place on a regular basis. People were encouraged to keep in touch with local news, by discussion of recent events, reported in the local newspaper each week. In-house entertainment was arranged, as were religious services. Activities took place in both large and small groups and on an individual basis where this had been identified. The activity co-ordinator said activities were arranged by liaising with the nurses about people’s social care needs. People living at the home spoke positively about the level of activities that were available and said that “there is an activity lady who is employed to do this and entertainers visit us quite frequently”, “great variety of activities” and “I join in any activities that I am able to take part in e.g. dominoes etc, but there are some I cannot join in because of my hearing”. There were people who said that they were able to “do their own thing” and spend time on their own, but that is how they preferred it. Comments by relatives in regard to activities and meals included “the daily menu only offers very traditional English food. The home appears very traditional – residents tend to be taken out by relatives – activities seem to be fairly standard e.g. dominoes, bingo etc – the TV is permanently on in the lounge”, “I would like to see mum in a group situation rather than her sitting on her own hour after hour! I realise age and disabilities put a strain on this”, “I feel if anything my mother does not have enough involvement in social activities” and “mother complains that there is little variety in the meals – more a set menu on a weekly rota”. People living at the home were able to have their relatives and friends visit at any reasonable time. People spoken with felt a good choice of menu was offered. The food served was what they enjoyed. The cook had been employed at the home for several years and had a good understanding of people’s individual needs. She said the menu was a four weekly menu. The cook said the menu was reviewed on a regular basis based on people’s likes, dislikes and “what they want”. Menus were displayed, to assist people living at the home in choosing their meals. People described the food and meals they received by saying “there is an alternative choice each meal. The presentation of the meals speaks for itself. Food isn’t just banged on the plate”, “the food is first class, like a five star hotel. Great variety, well cooked, well presented, extremely appetising” and “the meals are well cooked and presented, but the diet is rather monotonous. More variety in the menu would be welcome”. Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 16 & 18 were inspected. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who used the service were able to express their concerns. They had access to a robust and effective complaints procedure. They were protected from abuse and had their rights protected. EVIDENCE: The complaints procedure ensured that people and their relatives were aware of how to make a complaint and who would deal with them. Discussions with people identified that they were satisfied with the care provided and “had no grumbles”. They confirmed that if they did have any problems about their care, the manager and staff were “approachable” and would listen and resolve any concerns they may have. Immediately prior to the inspection a complaint was received by the CSCI about the admission process of the home. This was referred to the provider to investigate, who will report back to the complainant. All but one of the surveys returned from people living at the home identified people knew how to complain and who to speak to if they weren’t happy. Their comments included “I haven’t needed to complain yet. My pet subject is about good homes and bad, especially bad homes. It can put people off coming into Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 18 homes when the media go on and on about these places, but not about homes like ours”, “whilst one is aware if a complaint is warranted, my experience over the six years of my aunts stay, there has been no reason to complain on any situation whatsoever”, “I have not found it necessary to speak to anyone because I’m not happy” and “I haven’t felt the need to complain up to now”. Surveys from health and social care professionals said the care service responded appropriately if they had raised any concerns. Not all surveys returned by relatives confirmed they knew how to make a complaint. If they had raised a concern, however, they said it had been dealt with appropriately. One relative said, “I don’t know how to complain about the care provided, but if I had to I would find out. It may be in the home’s brochure”. Inspection of the home’s brochure confirmed the complaints procedure was included. There was an adult protection policy and procedure that promoted the protection of people from harm or abuse. The pre-inspection questionnaire identified policies/procedures/codes of practice were in place to protect people from abuse. Staff received training in the protection of vulnerable adults. They were able to describe how they would protect people living at the home from abuse. Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 19 & 26 were inspected. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home was clean, comfortable, well presented and well maintained with pleasant communal areas. EVIDENCE: Surveys returned from people living at the home said the home was always or usually fresh and clean. One resident said “the most fresh and clean home I have ever been in. I have inspected all the homes in the Barnsley area and in some cases beyond and by far the Belle Green Care home is absolutely the ultimate in fresh and clean”. People said that they were happy with their living environment, their bedrooms were comfortable and on the whole that they had everything they needed. Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 20 The home was well decorated and maintained in a comfortable and welcoming manner, including homely touches of pictures and silk flowers. Furniture and fittings were of a good standard and presented a homely environment. Access around the home was good. The communal areas were comfortable and offered sufficient space for the number of people that used them. All the bedrooms had en-suite toilets and wash hand basins. People were able to personalise their rooms with pictures, photographs, ornaments and some furniture and all were very pleased with their rooms. A handyman was employed at the home and a routine programme of maintenance was in place. The immediate garden area was well maintained with a pleasant patio area. The view from some of the rooms however was of grass that was overgrown and not a pleasant area to look at. One relative said “it would be nice if the surrounding gardens were tidied up or maybe laid to grass. First impression is oh dear it looks as though it’s neglected which is not true of the interior”. Outside the front of the building there was a temporary cover placed over a manhole secured by bricks. This was because the manhole did not have a cover. This presented a hazard for people and others who may access the area. The manager said it was the result of another service damaging the cover and they were awaiting an outcome to their complaint. The home was clean and free from smells. An exceptional level of cleanliness was observed. One resident commented, “the domestic staff do a good job and take care with things we value”. Laundry facilities were sited away from food preparation areas and areas used by people who lived there. This ensured the laundry process did not impose on the life of people living at the home and that good infection control measures were in place. Hand washing facilities were provided. People spoken with were satisfied with the laundry service, but one relative said, “that laundry should be checked correctly and given back to the correct person. When things go missing it makes me shudder to think that someone else could be wearing my relatives clothes”. Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 27, 28, 29 & 30 were inspected. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There was an experienced and stable staff team. There was a good mix of carers and ancillary staff. There were sufficient numbers of staff to support people and for the smooth running of the service. Staff recruitment was insufficient to safeguard people from the risk of abuse. Staff had received training, so that they were competent to meet peoples’ needs. EVIDENCE: Surveys returned from people who lived at the home confirmed staff listened and acted on what they said. They identified staff were always or usually available when they were needed. All people spoken with spoke positively about the care that they received. They spoke highly of the staff team and gave praise regarding the helpfulness and friendliness of staff. Some of their descriptions included “in this home we have a system of alarms, both in public rooms and bedrooms. We have a button on a lead and when pressed a … lights up with the number of the room needing help”, “the staff are brilliant - on hand all the time. A most caring and understanding nursing staff”, “nothing too much trouble any time” and “support is given when asked for. Never refused”. Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 22 The staff rota demonstrated that there was a good skill mix of staff to meet the assessed needs of people. Sufficient ancillary staff were employed to ensure standards relating to food, meals and nutrition were fully met. The home was maintained in a clean and hygienic state. The pre-inspection questionnaire identified 50 of care staff held NVQ Level 2 in Care. Two staff held a first aid certificate. Staff stated they had opportunities for training and this had included NVQ Level 2 in Care, protection of vulnerable adults, level 2-infection control, first aid, food hygiene and video training including principles of care and moving and handling. Five staff files inspected identified staff had received induction training and training in health and safety, death and dying, pressure area care, fire safety, food hygiene, communication, principles of care, managing swallowing difficulties, drugs and the elderly, wound care, tissue viability, medication, emergency first aid and protection of vulnerable adults. The pre-inspection questionnaire identified staff training during the last 12 months as NVQ Level 2 in Care, induction, management of health and social services, customer service, infection control, risk assessment, fire safety, supervisory management, nutrition, moving and handling and lymphodeama management. Future training was to include NVQ 2 customer service, infection control, NVQ 2 Health and Social Care, venepuncture and equality and diversity. Staff surveys confirmed they received supervision and support. They confirmed they received training to do their job and their comments included “my previous job experiences have helped me to do my present job as well as various in-house courses I have undertaken to gain knowledge of my working environment. I use my own initiative, but in some circumstances, for major repairs, various tradesmen are brought in anyway”, “the establishment where I work has a longstanding policy about training. We all train to keep up to date with matron’s guidance”, “I’ve undertaken a supervisory management course. Currently undertaking level 2 in infection control. I am due to do clinical venepuncture course. I attend regular palliative care meetings” and “my training included induction, infection control, NVQ Level 2 in Care, fire training, adult protection, health and safety, food hygiene”. In regard to the staff team they said, “everyone works as a team. Everyone looks after one another. Any grievances are swiftly resolved. Better than family. A good amount of respect and discipline is portrayed throughout the home”, “we all work as a team. Our goal is to make Belle Green Court like the resident’s own home and to be there for them”, “I feel all members of staff work as a team, as everyone knows each other’s roles” and “ we work well and maintain good communication”. Surveys from health and social care professionals said staff had the right skills and experience to support individual’s social and health care needs. Their comments about the staff and their training and skills included “staff are caring and courteous and follow instructions as necessary”, “they embrace training and education to improve care. They appear to work well as a team”, “staff are trained and are usually trained by senior staff. I have only good things to say Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 23 about home and staff and will recommend it to anyone”, “I have delivered palliative care training in the home. Two staff members attend bimonthly palliative care link meetings” and “excellent communication, excellent leadership, good patient and family support”. Relatives’ comments about staff taken from their surveys included “the staff are extremely friendly and caring and the home seems to run well. The staff are very competent and I have observed them being trained by their NVQ assessor”, “not knowing what are the right skills, I would say they seem competent” and “they are very friendly and approachable, they seem to enjoy their work and it has the feeling of a large family with matron as the mother”. Five staff files were inspected. The record did not identify when a criminal records bureau (CRB) check had been applied for. Three members of staff had commenced employment without a current full CRB and without satisfactory clearance of a protection of vulnerable adults (POVA) register check. In two of the cases a CRB from previous employment had been used. One of these members of staff was in charge on the shift. To reduce the risk of harm to people living there, a signed declaration from the member of staff must be obtained, to confirm they are not listed on the protection of vulnerable adults register. They must also include on the person’s file that there were no complaints from people about their conduct until a full CRB was returned. The manager was also required to apply for a CRB and obtain a POVA first check as soon as possible. Satisfactory written explanation of gaps in employment were not documented. This meant the service could not demonstrate people were sufficiently safeguarded from the risk of abuse. Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 31, 33, 35 & 38 were inspected. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. On the whole Belle Green Court was well managed. People living there, their representatives and health and social care professionals generally expressed a high degree of satisfaction with the service. Overall, the health, safety and welfare of people and staff were protected. EVIDENCE: The registered manager had many years experience within the caring profession. This enabled her to contribute to the care of people and communicate a clear sense of leadership to staff. People that lived there, their relatives, staff and health and social care professionals described the manager Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 25 and service as “ it feels organised and feels under control”, “an extremely well organised, well run, clean home. The matron is a treasure”, “Belle Green, from the matron down to the handyman, through the entire nursing staff – brilliant. A truly well run and well staffed operation” and “the matron is excellent who becomes a friend after a short while”. The manager had a good knowledge of the needs of people and she was committed to providing a good quality of service. There was a relaxed and friendly atmosphere within the home. Staff spoken with stated that they enjoyed working at the home. People were able to look after their finances, if they wished and had the capacity to do so. They were billed for any services incurring an extra charge. Where the manager was responsible for the payment of personal allowances, written records of all transactions were maintained. The record of monies held on behalf of a person was maintained. The inspection of one record confirmed the record balanced with the monies held. On the whole the financial transactions were signed by two people to confirm the transaction. Where financial transactions occurred the description of what the monies were used for was recorded. When the building was inspected fire exits were free from obstruction. Discussions with staff and staff records identified they had received fire training. The fire risk assessment was dated 12 June 2007. Hazardous substances were securely stored. The pre-inspection questionnaire identified servicing or certification was in place for gas installations, central heating system, fire equipment, portable electrical appliances, fixed wiring, legionella, hoists and call systems. It also identified water temperature checks were carried out. On the whole notifiable incidents were being reported to the CSCI, but incidence of pressure areas at grade 2 had not been. This meant CSCI were not informed of all incidents in the care home. This is necessary; so the service can identify the measures they have taken as a result of the incidence. This enables CSCI to monitor the action taken and make a judgement of the quality of the service being provided. Good moving and handling techniques were observed, which meant people were being moved safely. Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 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 2 X 3 X 3 X X 2 Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 OP3 OP7 Regulation 4 (1) (c) 14 (1) (c) 15 (1) & (2) Requirement The statement of purpose must include whether the home provides a service to rehabilitate people to return home after an illness or hospital admission. If this is the type of service people require, this must be part of the assessment process. Specific details of how they will rehabilitate people must be included in their plan of care, so that people and their relatives are clear of the service to be provided to assist them to return home. The plan of care must be formulated with the involvement of the person or their representative and signed by them. This gives them opportunity to agree with staff the help they need to live as independently as possible. The plan of care must identify whether people have been assessed to manage their own medication, so that their independence and autonomy is maintained. DS0000006472.V329487.R01.S.doc Timescale for action 30/09/07 2. OP7 15 (1) 31/07/07 3. OP7 OP9 15 (1) 31/07/07 Belle Green Court Care Home Version 5.2 Page 28 4. OP7 15 (1) 5. OP19 23 (2) (o) 6. OP19 OP31 OP38 OP29 OP31 23 (2) (o) 7. 19 (4) (b) (i) 8. OP29 OP31 19 (11) 9. OP29 OP31 19 (10) (a) & (b) 10. OP29 OP31 19 (11) Bed rails must only be used where this has been identified as part of a risk assessment to safeguard the person’s well being. All the garden areas must be well maintained to provide a pleasant area for people to look at. The manhole cover to the front of the building must be replaced, so that the grounds are safe for people and visitors. A CRB must be applied for, for the identified member of staff, so that people living at the home will be sufficiently safeguarded from the risk of abuse. The member of staff without a satisfactory POVA first check must sign a declaration to confirm they are not listed on the protection of vulnerable adults register until verification is received. This will indicate there has been some action to safeguard people from the risk of abuse. Staff must not commence work until a satisfactory POVA first check has been received. The date this was applied for and received must be documented, so that the service can demonstrate people living at the home are sufficiently safeguarded from the risk of abuse. Where a member of staff commences employment without a full CRB being issued, they must be supervised by an appropriately qualified and experienced member of staff, pending receipt of the full CRB. This must be demonstrated, so that the service can demonstrate people living at the home are DS0000006472.V329487.R01.S.doc 31/07/07 31/07/07 31/07/07 03/07/07 26/06/07 26/06/07 26/06/07 Belle Green Court Care Home Version 5.2 Page 29 11. OP29 OP31 19 Schedule 2 12. OP31 OP38 37 (1) (c) sufficiently safeguarded from the risk of abuse. Where there are gaps in employment, a written explanation of those gaps must be demonstrated. This is so that the service can demonstrate people living at the home are sufficiently safeguarded from the risk of abuse. The CSCI must be informed if a person living at the home develops a pressure area of grade 2 or above. This will enable CSCI to monitor the action taken and make a judgement about the quality of the service being provided. 10/07/07 26/06/07 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 OP7 OP7 OP9 Good Practice Recommendations That separate files or dividers are used for people’s plans of care, so that records can be easily identified. When people are admitted their current prescribed medication should be checked with the GP, so that they receive all their prescribed medication from the date of admission. Medication carried forward from one month to the next should be recorded on the medication administration record. This will enable an efficient and correct record of current stock and efficient auditing of medication. Continence protectors should not be placed on lounge chairs as this compromises people’s dignity. The menu should be reviewed in consultation with people living at the home, so that all their preferences are taken into consideration and provision of meals other than traditional English food is explored. 3. OP9 4. 5. OP10 OP15 Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Belle Green Court Care Home DS0000006472.V329487.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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