Inspection on 14/04/05 for Bellevue Residential Care Home

This inspection was carried out on 14th April 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bellevue Residential Care Home 10/05/07

Bellevue Residential Care Home 17/08/06

Bellevue Residential Care Home 25/11/05

Bellevue Residential Care Home 04/11/04

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

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

CARE HOMES FOR OLDER PEOPLE Bellevue Residential Care Home 51 Church Road Clacton on Sea Essex CO15 6BQ Lead Inspector Sara Naylor-Wild Unannounced 14 April 2005 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. Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bellevue Residential Care Home Address 51 Church Road Clacton on Sea Essex CO15 6BQ 01255 473976 01255 473976 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) Anglia Care Homes Ltd Mrs Sandhya Sadadew Care Home 10 Category(ies) of Dementia - over 65 years of age (DE(E)), 10 registration, with number Mental Disorder, excluding Learning Disability or of places Dementia (MD), 1 Mental Disorder, excluding Learning Disability or Dementia - over 65 years of age (MD(E)), 10 Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 10 persons). 2. Persons of either sex, aged 65 years and over, who require care by reason of mental disorder (not to exceed 10 persons). 3. One person, whose name was made known to the Commission in February 2003, under the age of 65 years, who requires care by reason of mental disorder. 4. The total number of service users accommodated in the home must not exceed ten persons. Date of last inspection 30/11/2004 Brief Description of the Service: Bellevue is a detached house situated in a quiet residential area within walking distance of the seafront and local facilities. Accommodation is on two floors; a passenger lift provides access to facilities on the first floor. The home provides a garden area to the back of the premises. Parking is available to the front of the premises. Bellevue provides a long-term residential service for 9 older people with either dementia or mental disorder and one person under 65 years of age with mental disorder. Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on one day in April 2005, over 6 hours. 21 of the 38 National Minimum Standards were inspected. The inspection process included: discussions with the manager, two staff, two service users, examination of documents and premises observations. There were a number of outstanding issues from the previous inspection report and in total 10 requirements and recommendations have been made. What the service does well: What has improved since the last inspection? What they could do better: The care planning documentation should be developed to reflect good practice in person centred planning, to maximise the opportunity for service users to experience individual care that supports their independence. The opportunities for service users to participate in fulfilling activities that occupy the day and enable them to make the most of their skills, should be provided. The staff availability to participate in activities outside the home should be considered. Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - Stage 4.doc Version 1.30 Page 6 The specialist registration of the service must be supported by the training and development of the staff working there. These acquired skills would also develop the quality of service users experiences of the service. 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. Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - 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 Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - 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) 2, 3, 5 and 6 The service users’ contracts were not available at the time of inspection. Service user needs are assessed prior to moving into the home, although the format used gathers limited information, it does enable a decision to be made regarding whether the home will be able to meet the service user’s needs. Trial visits are offered to prospective service users before moving into the home The home does not provide intermediate care. EVIDENCE: There had not been any recent admissions to the home since the previous inspection, however there were completed assessments on exisitng service users’ files. The amount of detail contained in these varied and those of the best quality contained full details of both the service user’s abilities and their life history. This will enable the home to develop a care plan, which supports both the service user’s current abilities and understands how their past may affect their needs. Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - Stage 4.doc Version 1.30 Page 9 Documentation such as the Service Users Guide and Statement of Purpose highlight the practice of offering trial visits before moving into the home. A service user described attending a number of trial visits to the home prior to moving in. Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Care plans were present for service users, however these were not person centred in their format. Much of the consistency of care provision was reliant on the small stable staff team who had a good understanding of the individual service user’s needs. Service users’ health care needs were monitored and responded to appropriately. Staff treated service users with respect and sensitivity. Medication was recorded and administered appropriately EVIDENCE: The three care inspected plans varied in their content. Generally they did contain details of service users’ needs and gave generalised instructions for staff in meeting these. However, this detail varied and none of the plans were person centred and addressed how individual strengths should be supported. This did not provide evidence of how staff support service users’ independence. Care plans had not been reviewed for 6 months at the time of inspection. Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - Stage 4.doc Version 1.30 Page 11 Records indicated that service users’ physical and mental health well being was adequately supported. The records for medication were updated and completed to a good standard, and observation of staff dispensing lunchtime medications demonstrated a satisfactory practice. Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 and 15 The daily routine of the home was informal and allowed service users’ flexibility and choice. The provision of occupation and activity was not sufficient. Service users were able to exercise some choice over their lives, within the limits of the home. Meals are provided in sufficient quantities and are homely and wholesome. EVIDENCE: As previously found on inspection, the observations and discussions with service users supported the view that the routines of the home are not fixed, but respond to the day’s events and the needs of service users. The small size of the environment, service user group and staff group provided opportunity for the home to operate day to day on an informal basis. One service user spoken with attended a day centre, which they enjoyed as an opportunity to meet people outside the home. The provision of activity in the home appeared limited and service users were not occupied in activities during the visit. In particular, there were not activities incorporated into the day Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - Stage 4.doc Version 1.30 Page 13 which responded to the needs and abilities of those service users with dementia. The midday meal was served according to the planned menu, and was said to be tasty by service users. They said they liked the cooking and were happy with the amount they received. Snacks of biscuits were also offered midmorning and afternoon. Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The complaints policy and procedure was in place, and service users knew who to complain to. The policy relating to protection of vulnerable adults requires review. EVIDENCE: There had not been any complaints received by the home since the last inspection. A record of all complaints and their outcomes are maintained by the home. Service users spoken with said they knew who to complain to and were confident that it would be dealt with. The inspector was able to witness a service user questioning the manager regarding aspects of their care. This exchange was carried out confidently and received positively by the Manager, evidencing a proactive response to complaints within the home. The abuse policy required further review to ensure it contains direct reference to the steps outlined in the Essex Vulnerable Adults Guidelines. Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The premises are an older style property and therefore have some disadvantages in the layout of the building, however the owners seek to reduce the impact of these and overall the home provides a suitable environment for service users, which is clean and hygienic. EVIDENCE: There had not been any significant changes to the environment since previous inspections. The home was not purpose built and therefore intrinsically is not designed for the use it currently serves. The premises has changes in floor levels and limited spaces in corridors, however the proprietors have sought to reduce the impact of this through ramps and notifying signage, which should be kept under review. Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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, 29 and 30 Staff numbers are sufficient to meet basic needs of service users within the home, although numbers do not support service users being escorted outside the home. Staffing numbers should be reviewed to reflect the aims and objectives of the home. Documentation relating to the employment of staff was not accessible. Staff training includes some mandatory and specialist issues relevant to service users’ needs, but needs further development. EVIDENCE: Staffing numbers are maintained at two staff on duty during the waking day. From discussions with service users and staff it was clear that whilst within the home this provided sufficient levels of attendance, these numbers did not allow staff to leave the building with service users. Therefore, limiting the opportunities for service users to take part in activities outside the home. The staff files could not be sampled at this inspection as they had all been removed from the home by the manager prior to the inspection. She stated that this was in order to catch up with the paperwork outstanding from previous inspection reports. Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - Stage 4.doc Version 1.30 Page 17 From discussion with staff there was evidence that staff had completed training in relation to some health and safety issues, and dementia care. There was a training programme planned for the coming year, and the manager was asked to consider further how specialist knowledge and skills relating to mental health and dementia diagnosis could be included. Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - Stage 4.doc Version 1.30 Page 18 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) 33, 35, 36 and 38 The home has an informal family atmosphere, in which service users felt happy and safe. The records relating to service users’ monies must be available for inspection at all times. Staff are not consistently provided with formal supervision. Records relating to protection of service users and safe operation of the home were generally up to date and stored safely, with the exception of those removed by the manager mentioned elsewhere in this report. Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - Stage 4.doc Version 1.30 Page 19 EVIDENCE: Many service users at the home were unable to provide an account of their experiences of the service. However, the observations of their interaction with staff during the day demonstrated the relaxed and happy relationship they had with staff. Staff showed sensitivity in meeting needs of service users whose cognitive impairment presented challenges to their role. The records relating to service users’ monies were not on the premises as the manager had taken these home to update. Staff spoken with did not provide evidence of regular supervision, they did feel that the small group of staff allowed them greater access to the manager and that informal supervision was always taking place. Records and certificates relating to health and safety were up to date . These included gas and electrical safety, fire precautions and equipement. Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 1 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 2 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 2 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 3 x 1 2 x 3 Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - Stage 4.doc Version 1.30 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5, Requirement The registered person must develop the Service Users Guide to include details as laid down in Regulation 5 of the Care Homes Regulations, and NMS 1. This standard was not assessed at this visit and is therefore carried over to the next inspection. The registered person must develop the care plans in the home to include specific detail regarding how the service users’ needs are being met, and to ensure that they meet mental health good practice guidance. This is a repeat requirement. The registered person must ensure that service users wishes in respect of daily living and activities are respected, with particular reference to preferences on going to bed. This is a repeat requirement. The registered person must ensure that the homes policy in respect of protection of vulnerable adults from abuse reflects current practice and guidance. This is a repeat requirement. Timescale for action 31st August 2005 2. OP7 15 31st July 2005 3. OP14 & OP12 12 31st July 2005 4. OP18 13(6) 31st July 2005 Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - Stage 4.doc Version 1.30 Page 22 5. OP19 23 6. OP29 19, Schedule 2 7. OP30,OP27 & OP4 18 8. OP33 24 9. OP36 18 (2) 10. OP37, OP35, OP2 17 The registered person must ensure the premises are suitable for the purpose of achieving the aims and objectives of the service. This refers specifically to the flooring. The registered person must ensure that the home is proactive in respect of recruitment, adheres to the services written policy and that records required by Regulation are obtained prior to appointment. This is a repeat requirement. The registered person must ensure that there is a staff training and development programme, which meets National Training Organisation requirements, and responds to the identified needs of service users. This is a repeat requirement. The registered person must ensure there is an effective quality assurance and quality monitoring system within the home. This standard was not assessed at this visit and is therefore carried forward to the next inspection. The registered person must ensure that staff receive regular supervision, which follows current good practice guidelines. This is a repeat requirement. The registered person must ensure that the home’s records required by Care Homes Regulations 2001 are updated and maintained. 31st July 2005 31st August 2005 30th September 2005 31st August 2005 30th September 2005 11. 12. 13. Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - Stage 4.doc Version 1.30 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The registered person should develop the pre admission assessment to ensure that it contains sufficient detail to determine the suitability of admission and commence a care planning process. The registered person should keep the issues regarding changes in floor height under review, and take further remedial action if required. The registered person should attain an Occupational Therapists assessment of the premises. The registered person should ensure that a plan of works are developed in response to the risk assessments undertaken in respect of radiator surface temperatures. The registered person should ensure that 50 of staff attain NVQ level 2 or above by 2005. The registered manager should obtain NVQ level 4 in management by 2005. The registered person should ensure that there is an effective quality assurance and quality monitoring system within the home and that anonymity is preserved when seeking service users views through this medium. 2. 3. 4. 5. 6. 7. OP19 OP22 OP25 OP28 OP31 OP33 8. 9. Bellevue Residential Care Home I56-I05 S59848 Bellevue V220522 140405 - Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 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. 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