CARE HOMES FOR OLDER PEOPLE
Belle Vue Nursing and Residential Home 1 Stanmore Road Heaton Newcastle Upon Tyne NE6 5SX Lead Inspector
Suzanne McKean Unannounced 19 May 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Belle Vue Nursing and Residential Home B53-B03 S393 Belle Vue Nursing & Res. Home V222880 190505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Belle Vue Nursing and Residential Home Address 1 Stanmore Road Heaton Newcastle Upon Tyne NE6 5SX 0191 2090300 0191 209 0301 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Bawi Homes Limited Mr Paul Fergus Owen Herrity CRH 49 Category(ies) of DE(E) Dementia - over 65 (49) registration, with number of places Belle Vue Nursing and Residential Home B53-B03 S393 Belle Vue Nursing & Res. Home V222880 190505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: There are no conditions applied to the registration Date of last inspection 10th & 17th January 2005 Brief Description of the Service: Belle Vue House is a purpose-built two-storey care home of traditional brick build and tiled roof construction. It is situated in the Heaton suburb of Newcastle upon Tyne. The home is well located with ease of access to the nearby Chillingham Road and its’ variety of public amenities including shops, cafeterias, schools, public houses, parks, churches and regular transport services. The home is registered to provide care with nursing to people over the age of 65 years who suffer from Dementia. Belle Vue Nursing and Residential Home B53-B03 S393 Belle Vue Nursing & Res. Home V222880 190505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over a period of 7 hours on a single day by two inspectors, both of whom have visited the home on previous occasions. Fifteen residents were spoken to during the visit and four relatives. The home has recently been the subject of increased visits as a result of a number of complaints, which are now resolved, the outcome of which has been included in this report. During the inspection records examined included, 6 care plans and medication records, the training and supervision records, the fire log as well as complaints and accident records. What the service does well: What has improved since the last inspection?
It was a positive inspection with evidence of improvement since the last inspection. The Manager and staff have undertaken a significant amount work to ensure that they are able to demonstrate their compliance with the standards. There were ten requirements identified during the last inspection and all but three have been met at or before this inspection. The care plans have been improved in both the information they contain being more detailed and in the frequency that they are reviewed and updated. The staff are now receiving supervision, formally, and the training programme is now up to date. The staff recruitment policy is now being followed for all staff being employed in the home.
Belle Vue Nursing and Residential Home B53-B03 S393 Belle Vue Nursing & Res. Home V222880 190505 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Belle Vue Nursing and Residential Home B53-B03 S393 Belle Vue Nursing & Res. Home V222880 190505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Belle Vue Nursing and Residential Home B53-B03 S393 Belle Vue Nursing & Res. Home V222880 190505 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4 and 6 Significant improvements have been made to ensure that the Manager can demonstrate the way in which the staff in the home have the skills and competencies to meet the needs of the residents. A thorough, detailed assessment is undertaken by the senior staff of the home before any resident is admitted into the home and the Manager is aware of the type of care they are able to offer. The home is not registered for and therefore does not provide intermediate care. EVIDENCE: The records are now in place to show the way the Manager makes sure that the staff are having their training and development needs identified and met. There is a programme of training for both nursing and care staff, which covers a broad spectrum of issues including clinical care needs of the service users. The training record for the staff, was examined and it identified the training which has been undertaken and those staff who have still to have the training and dates were provided which showed that these have been arranged.
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The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 & 9 Care plans providing details of each resident’s needs are in place. Staff promote and maintain residents’ health and ensures access to health care services to meet assessed needs. EVIDENCE: The Manager, Mr Herrity and the staff have made improvements to the care plan records which describe the way in which care is being given to the residents in the home. Each resident has a detailed care plan, which shows a process of assessment, planning of care, evaluation and re-assessment. Those examined were completed effectively and were in sufficient detail to allow the care to be provided according to the nursing assessment. There is a variety of assessment tools, including moving and handling, dependency and assessment of the persons skin and likelihood of developing pressure sores. Equipment was available to assist staff in preventing pressure sores and promoting continence. Records are in place that show that health care professionals such as opticians and specialist nurses were consulted and visited both regularly and as needed. The home has records to show the way medication is ordered and administered and photographs of all residents are in place. The storage of the medication is appropriate.
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The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None None of these standards were examined at this inspection so will be the focus of the next inspection. EVIDENCE: Belle Vue Nursing and Residential Home B53-B03 S393 Belle Vue Nursing & Res. Home V222880 190505 Stage 4.doc Version 1.30 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The residents and their families have shown willingness to raise their complaints or concerns in the confidence that they will be taken seriously and acted upon. Those residents who are able to explain what they think feel safe and the staff are aware of the guidance available on abuse. EVIDENCE: There is written guidance in place on dealing with complaints, which is available in a number of different areas including posted on the wall and in the service user guide. Three staff spoken to could describe the way in which a complaint could be made and were aware of the places the complaint procedure could be found. The complaints which have been made since the last inspection were examined and the records showed that these have been fully investigated and either resolved or are ongoing. Two relatives spoken to on the day of the visit confirmed that they felt satisfied that any concerns or complaints raised with the Manager or staff would be dealt with appropriately. Written guidance is in place regarding the protection of vulnerable adults. Staff confirmed that they knew about the guidance and could appropriately assist a resident if they wished to make an allegation of abuse. Staff are being given training on protection of vulnerable adults. A Protection of Vulnerable Adults investigation has taken place since the last inspection and the Manager and staff were fully involved in resolving the issues and were always helpful and willing to make any changes necessary to improve the care delivered.
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The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 22, 23, 24, 25, & 26 The home is safe, and well maintained and is well provided with toilets and bath with the on-suit facilities and communal toilets. The bathing areas offer a choice between showers and baths so that the residents can have a choice which they prefer. The flamable materials must be removed as a matter of urgency. An immediate requirement was made and the work was commenced prior to me leaving the premises. EVIDENCE: There has been a number of areas in the home re-decorated since the last inspection and this work is ongoing. During the visit both of the inspectors toured the premises and noticed that there had been an improvement in the décor and cleanliness of the home. A number of bedrooms were examined (at least 12) and were decorated and furnished in a pleasant and homely way. The staff in the home interviewed understood the importance of controlling cross infection in the home and recent advice has been sought from the
Belle Vue Nursing and Residential Home B53-B03 S393 Belle Vue Nursing & Res. Home V222880 190505 Stage 4.doc Version 1.30 Page 13 Control of Infection nurse from the NHS although a request for an audit has not been made and it is suggested that this could be undertaken to assist in the future planning for this aspect of care. The shower on the first floor was not restricted to supply a maximum temperature of 43 degree centigrade. The storage area in the rear of the building ground floor, which is a fire exit was cluttered and contained flammable materials this must be cleared to allow for safe progress through the area in the event of fire. There is a bathroom on the ground floor near to the lounge which is infrequently used, it contained a number of items which should be stored elsewhere. The Manager must undertake a review of this and ensure that the room is tidied and made more suitable for the use it is intended for. Belle Vue Nursing and Residential Home B53-B03 S393 Belle Vue Nursing & Res. Home V222880 190505 Stage 4.doc Version 1.30 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, & 30 The home is staffed with appropriate numbers of staff and there are qualified nurses on duty in sufficient numbers to meet the needs of the residents. The staff are recruited and selected using a system which ensures that they are able to care for the residents and are going to offer a safe place for them to live. The Manager is recruiting staff according to the home’s policies and the three staff files examined are complete with the necessary checks including Criminal Records checks and two references. The manager has arranged a number of training sessions on a variety of subjects as well as statutory training. The staff confirmed that they are being encouraged and supported to attend. EVIDENCE: Staffing rotas showed that the Manager is ensuring that enough staff are on duty to meet the staffing levels set down prior to the change to the CSCI without reduction. It was noted that when sickness and staff holidays occur they are usually being covered by homes own staff. When this is not possible agency staff are being used, late reporting does occasionally result in fewer staff being on duty for short periods. Four staff records were examined and were all complete however, one of the domestic staff did not have their CRB check returned prior to beginning employment, the requirement to have a CRB in place must be applied to all staff in the home.
Belle Vue Nursing and Residential Home B53-B03 S393 Belle Vue Nursing & Res. Home V222880 190505 Stage 4.doc Version 1.30 Page 15 The training record for all of the staff was examined, there is evidence of a lot of training being provided but the record was not up to date making if not possible to determine if all staff had received statutory training. It is a requirement that this must be available to allow the planning of future training needs of the staff to be identified. Belle Vue Nursing and Residential Home B53-B03 S393 Belle Vue Nursing & Res. Home V222880 190505 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 34 & 38 The Manager has worked hard to ensure that he has systems to make sure that the home is managed effectively taking into account the needs and wishes of the residents. He is continuing to consult the residents, staff and other interested parties to review the service provided and manage the staff in a way to improve care delivered. EVIDENCE: The Manager, Mr Herrity has a good understanding of the client group, there are clear lines of accountability both in the home and within the company, and he is aiming to have the relevant management qualification by the specified date. Belle Vue Nursing and Residential Home B53-B03 S393 Belle Vue Nursing & Res. Home V222880 190505 Stage 4.doc Version 1.30 Page 17 It is acknowledged that the proprietor makes regular and unannounced visits to the home however there remains an outstanding requirement for these to be recorded and made available. The personal records kept in the home of residents who are receiving assistance to manage their finances are detailed, logical and appropriate. Receipts were in place for purchases made on behalf of residents and signatures of either two staff or one and the service user were in place, and there is a small float available for the staff to access. There is a policy for supervision, for care staff and the records to support the Managers confirmation that he attempts to ensure safe working practices for moving and handling, first aid, food hygiene and infection control were in place and, although the record needs to be brought up to date. The home must have in place arrangements to ensure that persons working at the care home to receive suitable training in fire prevention and by means of fire drills and training in the procedures to be followed in the case of fire. The storage area in the rear of the building, ground floor, must be cleared to allow for safe progress through the area in the event of fire. The flamable materials must be removed as a matter of urgency. An immediate requirement was made. Belle Vue Nursing and Residential Home B53-B03 S393 Belle Vue Nursing & Res. Home V222880 190505 Stage 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 2 x 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 3 x x x 2 Belle Vue Nursing and Residential Home B53-B03 S393 Belle Vue Nursing & Res. Home V222880 190505 Stage 4.doc Version 1.30 Page 19 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP33 Regulation 26 (2) Requirement Written reports must be prepared montly by the proprietor or his representative following the visits to the home and these must be sent to the CSCI on completion. OUTSTANDING The home must have in place arrangements to ensure that persons working at the care home to receive suitable training records of which must be up to date and available. OUTSTANDING The home must have in place arrangements to ensure that persons working at the care home to receive suitable training in fire prevention and by means of fire drills and training in the procedures to be followed in the case of fire. OUTSTANDING The staff files are generally complete, however the domestic staff must also have in place a CRB prior to commensing work. The shower on the first floor must be restricted to supply a maximim of 43 degree centigrade. The storage area in the rear of Timescale for action 01.08.05 2. OP30 18 (1) 01.09.05 3. OP38 23 (4) (d) (e) 01.09.05 4. OP28 19 01.09.05 5. OP19 23 (2) (d) 01.08.05 6. OP19 OP38 23 (4) 24.05.05
Page 20 Belle Vue Nursing and Residential Home B53-B03 S393 Belle Vue Nursing & Res. Home V222880 190505 Stage 4.doc Version 1.30 the building, ground floor, must be cleared to allow for safe progress through the area in the event of fire. The flamable materials must be removed as a matter of urgency. An immediate requiement was made. 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. 3. 4. Refer to Standard OP7 OP31 OP18 OP26 Good Practice Recommendations It is recommended that the standard forms in the care plans are examined and those which do not have the facility to add the date of the entry are amended. The manager must continue to pursue the necessary management qualification, which must be competed by 2005. It is recommended that staff are given formal Protection of Vulnerable Adults training as part of their programme of ongoing training. It is recommended that the home consider asking the Control of Infection Nurse to undertake with them an audit to look at any improvements which could be made. Belle Vue Nursing and Residential Home B53-B03 S393 Belle Vue Nursing & Res. Home V222880 190505 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Northumbria House Manor Walks, Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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