CARE HOMES FOR OLDER PEOPLE
Belle Vue House Little Heath Gamlingay Bedfordshire SG19 3LL Lead Inspector
Don Traylen Unannounced Key Inspection 15th December 2006 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 Belle Vue House DS0000015226.V321731.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 Vue House DS0000015226.V321731.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Belle Vue House Address Little Heath Gamlingay Bedfordshire SG19 3LL 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) 01767 650226 01767 650226 Mrs Christine Lake Mrs Christine Lake Care Home 3 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (3) of places Belle Vue House DS0000015226.V321731.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th January 2006 Brief Description of the Service: Bellevue House is a large family residence that stands in an acre of attractive gardens in a quiet, rural setting. The property is situated in the village of Gamlingay, accessible by a single dirt track off the main road. The home has been established for over 12 years and is registered to take three service users over the age of 65 years, who may be people with age-related mental health needs. The registered provider, Mrs Christine Lake and her husband, live in the property. The home is furnished to a high standard. One member of staff is employed for one day each week and the proprietor has an arrangement with a suitably qualified person who can manage the home when holidays are arranged or when other circumstances prevail. Fees charged by the home are from £445 perweek to £465 per week. The lower amount being the fee charged and paid by a Local Authority and the later being the fee charged to privately paying service users. Belle Vue House DS0000015226.V321731.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. It is recommended to read this report in conjunction with the report for the last inspection on the 19/01/2006. The registered provider, Mrs Lake, is also the registered manager. At the time of inspection two service users were living in the home. This inspection visit was brief, and the inspector judged that the inspection should ensure that the previous findings of good quality care are continuing. Observations were made of interaction between the provider and two service users. The home’s admissions processes were assessed and records of assessments and care plans were read. The two resident service users were spoken to and a lengthy discussion with the registered providers was conducted. In previous inspections the home has been judged to have met all the key standards and their pre-inspection hypothesis was that the service would continue to provide a good quality service where service users interests are promoted. What the service does well:
Service users are shown every respect by the polite and courteous yet caring attitude shown by Mrs and Mr Lake. Care plans are appropriately written and well maintained and are kept by service users in their rooms. The home is a real home for service users. It is very comfortable and warm and ordinary. Each service user shares the home and there is a normal feel to the home. There is a total absence of any institutionalisation or feel that this is other than a family home. The quality of meals and food provided and the fact that everybody eats together at the main dining table adds to a normal and ordinary way of living. Mrs Lake and Mr Lake communicated in a straightforward and open manner when talking to aeither of the service users. Communication is made in a calm and respectful way and service users were observed to be given time to respond and time to absorb the circumstances and situation and were not pressured into replying. The home has frequent visits from relatives of service users. Family involvement is promoted and regular telephone calls from service users to family occur. Service users enjoy excursion of an ordinary everyday nature.
Belle Vue House DS0000015226.V321731.R01.S.doc Version 5.2 Page 6 On the day of inspection they had been invited to attend a local school’s musical concert. 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. The summary of this inspection report can be made available in other formats on request. Belle Vue House DS0000015226.V321731.R01.S.doc Version 5.2 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 Belle Vue House DS0000015226.V321731.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5, Quality in this outcome area is good. Service users have sufficient opportunity to assess if the home is suitable for their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose was read and discussed with the manager that it would be worth considering reviewing the document so that it included a section that describes the homes approach to protecting their vulnerable service users. Assessments for permanent placement in the home are arranged by the Care Manager and by the home prior to admission and opportunities to visit are made to any prospective service user. The manager stated she would assess any service user to ascertain they could be provided with the appropriate care.
Belle Vue House DS0000015226.V321731.R01.S.doc Version 5.2 Page 9 The home experienced a late delivery of a care management assessment carried out by the PCT for a service user for whom respite was arranged. The assessment did not provide a complete description of the service user or his needs. Since that last inspection there are only two service users living in the home, one of who is staying there on a temporary ‘respite’ basis. Each of the two service users had been given a contract stating fees to be paid and services and the period of the temporary residence. Intermediate care is not provided. Belle Vue House DS0000015226.V321731.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11, Quality in this outcome area is good. The utmost respect and appropriate care is planned for service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans are kept in service users rooms and are well maintained and clearly informative. The medication records had been maintained but the registered manager must seek a pharmacist advice and support for maintaining medication administered records, so that all prescribed medication is pre-written onto medication administration sheets. The manager must also request the pharmacist to supply medication in sealed packs or ‘blister’ packed supplies. The pharmacist support service provided by the PCT should be considered as a source of advice and assistance.
Belle Vue House DS0000015226.V321731.R01.S.doc Version 5.2 Page 11 The recent death of one service user had been sensitively managed. The family confirmed their appreciation of the understanding and care provided by the home and had maintained close communication with the manager Mrs Lake. She discussed the circumstances and effects of the loss of this service user. Respect was evident in this discussion and in the observations made of the personal interaction the manager and her husband conducted with both service users. Service users needs are met in a pragmatic and respectful manner. Sufficient contact with District Nurses and other community services are made to ensure the health and welfare of service users is attended to. Belle Vue House DS0000015226.V321731.R01.S.doc Version 5.2 Page 12 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): 12,13,14,15, Quality in this outcome area is good. Service users lifestyle meets their expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One service user has visit from his family and the other service user has regular telephone contacts and visit from his family. Belle Vue House DS0000015226.V321731.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Service users are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mr Lake is undertaking a refresher course in Protecting Vulnerable adults. The two emergency/relief staff have received training in Protecting Vulnerable Adults from Abuse provided by Cambridgeshire County Council. The manager is very aware of the limited environment that the service users live in and the limited social contact they have. The home has a written policy stating there approach to abuse and the home adhere to Cambridgeshire County Council’s guidelines regarding adult abuse procedures. Belle Vue House DS0000015226.V321731.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26, Quality in this outcome area is good. The home is very well suited to service users needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All the Standards in this section were met at the last inspection and have again been met at this inspection. One service users has a specialist electric bed to assist him arise and this has been purchased by the home. The emotional atmosphere and the safe, clean and comfortable conditions of the home are suitable for the service users’ needs and expectations. Belle Vue House DS0000015226.V321731.R01.S.doc Version 5.2 Page 15 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): 27,28,29,30, Quality in this outcome area is good. Service users benefit from the familiar and the regularity, of key people who provide their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All Standards were assessed and met at the previous two inspections. At the time of inspection Mr Lake was waiting to attend a refresher course in ‘Adult Protection’ training. Because the home has familiar and regular staff, it appeared that the service users were re-assured by this fact and benefited emotionally by this. Belle Vue House DS0000015226.V321731.R01.S.doc Version 5.2 Page 16 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): 31,32,33,35,38, Quality in this outcome area is good. Service users best interests are upheld in this care home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspections have demonstrated that service users’ best interests are upheld by the management approach and philosophy of this home. After discussing with the manager she stated she is intending to write into their Statement of Purpose how the home protects vulnerable adults. Belle Vue House DS0000015226.V321731.R01.S.doc Version 5.2 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Belle Vue House DS0000015226.V321731.R01.S.doc Version 5.2 Page 18 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 OP9 Regulation 13(2) & Schedule 3 (3)(i) Requirement The registered manager must seek pharmacist support to arrange for written administration record sheets so that amounts of medication are clearly recorded and for medication to be supplied in suitable sealed packaging or other sealed containers. Timescale for action 15/02/07 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 Refer to Standard OP1 Good Practice Recommendations The home’s Statement of Purpose should be reviewed to consider inclusion of the home’s approach to protecting vulnerable adults from abuse. Belle Vue House DS0000015226.V321731.R01.S.doc Version 5.2 Page 19 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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
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