Inspection on 16/07/08 for Bellsgrove

This inspection was carried out on 16th July 2008.

CSCI found this care home to be providing an Poor service.

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

Bellsgrove 14/01/09

Bellsgrove 02/08/07

Bellsgrove 20/02/07

Bellsgrove 22/06/06

Bellsgrove 05/01/06

Bellsgrove 15/09/05

Bellsgrove 10/12/04

Bellsgrove 15/10/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

1 Marten Road

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Bellsgrove Bellsgrove 250 Cobham Road Fetcham Surrey KT22 9JF Lead Inspector Jane Jewell Unannounced Inspection 10:30 16th July 2008 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 Bellsgrove DS0000013568.V367001.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. Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bellsgrove Address Bellsgrove 250 Cobham Road Fetcham Surrey KT22 9JF 01372 379596 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) bellsgrove@hotmail.com Mr Somasundaram Logathas Mrs Shyamala Logathas Mr James Iswurdut Sobun Care Home 14 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (5), Learning disability (1), Mental Disorder, of places excluding learning disability or dementia - over 65 years of age (5), Old age, not falling within any other category (14), Sensory impairment (1) Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Categories DE, LD and SI apply to a named service user only. 5 service users may fall within categories DE(E) or MD(E). For up to 5 additional places for day care within categories OP, DE(E) or MD(E). 2nd August 2007 Date of last inspection Brief Description of the Service: Bellsgrove was first opened as a care home in 1982. The current owners purchased the property in 2001. it is a family run care home registered to accommodate up to fourteen older people. The home is a large detached converted domestic property situated in the village of Fetcham, with a range of local shops nearby. The home is presented across two floors, with a passenger providing level access to the first floor. Residents accommodation consists of fourteen single bedrooms with half providing en-suite facilities. Communal space consists of a combined lounge dinning room and conservatory. There is a rear garden, which has a patio and seating areas. The front is in the main paved to provided off road parking The fees for residential care are currently £450 to £650 per week, depending on the services and facilities provided. Extra such as: newspapers, hairdressing, chiropody, toiletries are additional costs. Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is Zero star. This means the people who use the service experience Poor quality outcomes. The information contained in this report has been comprised from an unannounced inspection undertaken over seven hours and information gathered about the home. Prior to the inspection the home was asked to complete an Annual Quality Assurance Assessment. This contained only some information about the home, which was fed back to the provider and manager during the inspection in order to address for the future. The inspection was facilitated by the manager (Mr J Sobun) and in part by the provider (Mr Logathas). The inspection involved a tour of the premises, observation, examination of records and discussion with residents and staff. There were eleven residents living at the home at the home at the time of the inspection. The focus of the inspection was to look at the experiences of life at the home for people living there and access the progress made towards meeting the shortfalls in practices noted at the last inspection. Signs of residents wellbeing/ill-being (terminology used for observing behaviour for people with dementia) were observed. Relatives and health care professional were also consulted with and their views and experiences are also included in this report. Surrey Social services are currently investigating a safeguarding referral made to them by visiting health care professionals regarding aspects of care at the home for residents who have complex needs. This had not been concluded at the point of inspection. Although the provider stated that they would not enter into a voluntary agreement with social services to suspend future placements at the home during the course of a safeguarding investigation, the provider has stated that they have suspended placements themselves until the conclusion of the safeguarding . In order that a balanced and thorough view of the home is obtained, this inspection report should be read in conjunction with the previous inspection reports. The Inspector would like to thank the residents, staff and management for their assistance and hospitality during the visit. What the service does well: A sample of comments made by residents who were able to verbally communicate their experiences at the home included; “Nice place to live” and “quite happy here nice easy home to live in”. Many signs of resident’s wellbeing were also observed in residents who are not able to verbally Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 6 communication these included relaxed body language, smiling and touching staff. Relatives spoke positively about their experiences of the home. A sample of their comments: “its like an extended home I like the smallness family run element to it and that everyone knows everyone else ”; “always a relaxed atmosphere”; “She has made friends with other residents its like a little family she has real companionship”; and “I like the totally relaxed atmosphere at the home”. Residents are helped to exercise some choice and control over their lives with flexible routines being a part of daily practice at the home. A resident said: “I go to bed and get up when I want”. Resident’s lives are enriched by the strong links with families, which is valued and supported by the home. A sample of relative’s comments included: “Offered drinks and staff always welcoming”; “I have freedom of access any time I want, given refreshments and I have stayed for Christmas lunch in the past” and “very good at communicating and keeping me updated on any changes and they always celebrate birthdays”. Some good practices were observed in the management of end of life care. Some opportunities are provided for occupation and stimulation, comments included: “they seem to have a varied list of activities”; “more music would be nice including inviting musicians in”; “I don’t do a lot, the nicest thing is that they don’t bully you into doing any of the activities”. Residents live in a homely environment, which is decorated and maintained to a good standard a relative said: “residents can move freely around” All but three staff, including the manager, are family members of the joint providers. Relatives felt that this was could have a positive influence on the home as they provided a family orientation and a stable staff team. Comments about staff included: “I like the fact that there is no change in staff it’s the same staff all the time”; “Staff are very considerate and gentle” and “terrific, very good kind and polite”. What has improved since the last inspection? What they could do better: Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 7 The most significant improvement that must occur and improve outcomes for residents is in the management of the home to ensure that it provides a clearer sense of leadership and clarity on the roles of the manager and provider. This has resulted in the provider being written to by the commission outside of the inspection process in order to secure compliance with the areas of shortfalls noted in this report. Residents would benefit from a more comprehensive care planning system that guides staff in all aspects of personal and health care needs and which improves resident’s safety through the better management of individual risk. That the needs of prospective residents need to be assessed by a suitably qualified persons prior to admission in order that their needs are identified and can be met safely at the home. Prospective residents and their representatives need to have access to a range of up to date accurate information about the home and the services it provides in order that they can made informed decisions. Although residents receive the health care intervention they need from a range of health care professional, they are being placed at potential risk by poor communication and co-ordination between the home and some health care teams. Not all of the homes practices and the lack of understanding of the roles and responsibilities under safeguarding adult’s procedures did not offer adequate protection to residents from the potential risk of harm. The management of offensive odours must improve to ensure a pleasant environment in which to live, visit and work. Comments received included: “Environment always clean occasionally smells a bit but they are usually pretty quick at cleaning it up and without any fuss” and “sometimes a bit wiffy”. The family connection of most staff, the sometimes adhoc staffing arrangements and lack of good record keeping make it difficult for the manager to manage staff and monitor whether adequate staffing levels are being maintained. The provider is addressing issues around some staff’s poor command of English. In response to the draft inspection report the provider and manager completed an improvement plan that clearly stated the actions they are undertaking to address the shortfalls noted in this report and demonstrated commitment towards addressing these shortfalls promptly. Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 8 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. Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 9 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 Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 10 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 and 5 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. Prospective residents and their representatives need to have access to a range of up to date accurate information about the home and the services it provides in order that they can maKe informed decisions. There is a process in place to ensure that resident’s needs are assessed prior to them entering the home, this needs to be completed to a good standard. The home is able to meet the needs of residents who have low to medium assessed needs. EVIDENCE: There is limited up to date information about the home and the services it provides, this does include a brochure, statement of purpose and service user Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 11 guide. The homes statement of purpose and service user guide had not been updated for some years and did not currently reflect the range of services, facilities and terms and conditions at the home. Due to the emergency nature of many of the residents admission, the majority of relatives consulted with said that they had not received much information prior to their relatives admission, other relatives spoke of receiving the homes brochure. In order to ensure that residents and their representatives have up to date and accurate information about the home in order to help them make an informed choice about whether to move to the home it has been required that the homes literature be updated and made available. The manager reported that residents are provided with a written contract of terms and conditions of residency with the home. This can be used with residents and their families to make explicit the placement arrangements and clarify mutual expectations around rights and responsibilities. In line with the amendments to the care home regulations in 2006 the manager agreed to ensure that residents terms and conditions of residency now include a description of the services offered, the arrangements for charging and paying of additional services and a statement whether any of the above conditions are different where a service users care is being funded by another party other than the service user. Pre-admission documentation was viewed for a recent admission to the home, this included an assessment of the residents needs by the provider , medical report and a personal history from a relative. The homes assessment did not accurately reflect the needs of the resident, as significant information about their needs had not been included or evidenced that this was taken in account when identifying whether their needs could be safely met a the home. It could not be evidenced when the assessment had been undertaken as it had not been signed or dated. The manager was however able to confirm that the assessment had been undertaken prior to the resident moving it. It was discussed that a good process is in place to ensure that a comprehensive assessment process could be undertaken prior to any admission, however there is a need to ensure that this process is followed and completed to a suitable standard to ensure that residents needs are fully assessed and which guide staff on the actions to be taken to ensure that new residents needs are properly assessed and planned for. A sample of comments made by residents who were able to verbally communicate about their experiences at the home included; “Nice place to live” and “quite happy here nice easy home to live in”. Many signs of resident’s wellbeing were observed in residents who are not able to verbally communication these included relaxed body language, smiling and touching staff. A sample of comments made by relatives about their experiences of the home included: “its like an extended home I like the smallness family run element to it and that everyone knows everyone else ”; “always a relaxed atmosphere”; “very caring family”; Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 12 “home from home” and “I like the totally relaxed atmosphere at the home”. There is a wide range of needs being accommodated at the home this includes residents who are currently receiving significant nursing input from district nurses, residents who have mild and complex dementia including challenging behaviour. Through observation of the daily practices, interactions between residents and staff, tour of the environment and examination of care plans it was concluded that the home is able to demonstrate that it is able to meet the needs of residents with low to medium assessed needs including some challenging behaviour. A recent safeguarding investigation by social services highlighted shortfalls in the home meeting the needs of residents with complex needs including some nursing elements. The provider now demonstrated a greater understanding of the range of needs that the home is able to meet and the point at which residents needs go beyond that which the home can safely meet. Residents representatives consulted with spoke of being provided with the opportunity to visit the home with their relative in advance to assess the quality, facilities and suitability of the home. All of the relatives consulted with said that they had been referred to the home through local Alzheimer’s society. Intermediate care is not offered at the home therefore this standard is not assessed. Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 13 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 and 11 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. Residents would benefit from a more comprehensive care planning system that guides staff in all aspects of personal and health care needs and which improves resident’s safety through the better management of individual risk. Residents receive the health care intervention they need from a range of health care professional, but are at potential risk from poor communication and co-ordination of some health care intervention. Residents are protected by satisfactory systems for the recording, handling and storing of medication. Practices seen promoted and protect resident’s privacy and dignity. Good practices were observed in the management of end of life care. Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 14 EVIDENCE: Five plans of care were looked at in detail, these comprised of several documents including basic information, daily notes and a plan of care. These provided some guidance for staff on the needs of residents and how to meet them. The provider spoke of their plans to improve the care planning process through the further development of person centred planning which is a good practice model in the care of people who have dementia. It was discussed that this should include the development of personal histories, which can aid understanding of the current needs of a person who has dementia. Relatives spoke of their involvement in the care planning process and review. Care staff demonstrated limited involvement in the care planning process but felt that they could reference them at any time. Staff did however demonstrated a familiarity with the most needs of residents. A relative commented “caring this comes at the top of their list of priorities”. Good practices were noted in the development of assessments and individual agreements on the use of pressure mats, that alert staff to a resident’s movement during the night. These agreements once fully implemented will provide individual information on how they are to be used to promote independence and to not be used to restrict movement. Good practices were observed by a member of staff in the support of a resident who displayed some challenging behaviour, however these good practices seen were not recorded in their care plan as guidance for all staff to follow and thus provide consist support. The manager and provider agreed to improve the behavioural guidelines in the care plan. The home was previously required to undertake residents risk assessments in regards to the prevention of falls. Although some progress had been made to undertake this, these did not provided sufficient guidance on potential risk and the actions needed to reduce or managed identified risks. Of additional concern was the lack of individual risk assessments of the risks faced and posed by residents, referred to as generic and specialist risk assessments. The lack of manual handling risk assessment for residents, especially for residents who require full support to move was of particular concern and places residents at potential risk of poor manual handling technique. To ensure residents safety is promoted the home has been required as a matter of urgency to ensure that written personal risk assessments are completed for all residents as part of their care plan, which are reviewed regularly and records the actions to manage or reduce any identified risks. It was previously recommended that care plan monthly reviews be more detailed to reflect all care objectives. The provider reported that more information is now being recorded and records showed that care plans are regularly reviewed and updated by the manager. Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 15 Records of medical intervention showed that residents regularly receive input from health care professionals including GP’s, District and specialist nurses, chiropodists, opticians and dentists to ensure residents receive a range of health care intervention. A relative said that they react quickly to request for medical advice or treatment. As a result of concerns raised to social services by visiting health care professionals additional moving and handling equipment has recently been purchased by the provider. Concern was noted by the inspector regarding poor communication and co-ordination between visiting health care teams and the home, which potentially places residents at risk of information not being passed to the appropriate people for action. This was raised with the provider and manager of the health care team at a meeting subsequent to the inspection for addressing as a matter of priority. The medicine administration practice observed was seen to be in general safe and the records demonstrated that systems have been established to ensure staff are appropriately trained and records are accurate and provide a history of what was given by who and when. Good practice recommendations are that the home develops a homely remedies policy in order to clarify when and what over the counter medications the home uses. It is also recommended that any hand written administrative instructions are signed and dated and checked and countersigned for accuracy by a second person in order to limit the risk of copying instructions wrongly. Following advice from the Commissions Pharmacy inspector it is further recommended that schedule 3 controlled drugs are recorded in a controlled drugs register in order to provide a clear audit trail of this medication. Staff consulted with showed a good understanding of good practices in preserving resident’s rights to privacy and dignity. Staff were able to give examples of how they promote these rights in their every day care practices. This was supported by the inspector’s observations of the interactions between staff and residents and the experiences of a visiting health care professional. A relative said that that their relative was always nicely presented, with hair brushed and clothes well laundered. A relative spoke positively about the palliative care provided to their relative. Good practices were noted in the development of daily plans of care where needs are changing regularly to ensure that their needs are known to staff. Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 16 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 and 15 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. Residents are helped to exercise some choice and control over their lives with flexible routines being a part of daily practice at the home. Meals are good offering flexible arrangements. Resident’s lives are enriched by the strong links with families, which is valued and supported by the home. EVIDENCE: There is evidence that residents are treated as individuals. Observation of the daily routines and discussion with residents confirm that staff accommodate resident’s personal wishes with regard to meal times, going to bed, rising and bathing. During the inspection residents were observed to move around the home choosing which room to be in and what level of company they wanted to enjoy with a resident saying “I go to bed and get up when I want”. For a few people living at the home, exercising their choice was difficult due to the level of their dementia. Staff were seen to use their acquired knowledge of a person to help them make choices for example in the choice of food, beverages and Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 17 occupation. A staff member said: “don’t tell them what to do ask them what they would like”. The manager said that there is an activities co-ordinator who visits the home for eight hours a week. A resident said that they had participated in a craft sessions and local walks. Several relatives spoke of attending a recent barbeque at the home held by the local Alzheimer’s society, which is held annually along with a seaside visit. A sample of comments about activities and opportunities for stimulation included: “There does not seem enough to occupy them or mental stimulation I have seen them sitting around the table from breakfast for the rest of the day”; “She has made friends with other residents its like a little family she has real companionship”; “they seem to have a varied list of activities”; “more music would be nice including inviting musicians in”; “I don’t do a lot, the nicest thing is that they don’t bully you into doing any of the activities”. Relatives commented upon how welcomed they are made to feel during their stay, this included being offered beverages or meals and staff being friendly and approachable. A sample of relative’s comments included: “Always offered cups of tea when visit and I can go and visit at any time I could stay for meals if I want”; “Offered drinks and staff always welcoming”; “I have freedom of access any time I want, given refreshments and I have stayed for Christmas lunch in the past” and “Very good at communicating and keeping me updated on any changes and they always celebrate birthdays”. The home was sensitive to the gender preferences of female residents when male staff are undertaking personal care, and no issues were highlighted to the inspector or noted on care plans of any gender preferences of residents. The meal at inspection was presented well with residents commenting: “excellent meals”, “ok” and a relative said “good home cooking”. It was clear that resident’s individual preferences were observed. Although there is a rolling menu it was clear that the residents benefited from a flexible and spontaneous approach to some meal times. An example was given that on a hot day they might decide as a group that a lighter meal is more appropriate. One of the joint providers was described as the main cook, the other joint provider reported that they had undertaken training on nutrition and healthy eating. Five residents ate their meals at the dining room table while others either ate in their bedrooms or on lap tables while they remained seated in lounge chairs. The manager said that these lap tables were only used at meal times and were removed after each meal enabling the resident to move around if they wished. Meal times are clearly a busy time with at least six residents requiring support to eat their meals, this involved the staff interchanging their support between residents which did not promote continuity or orientation, this was feedback to the manager for addressing. Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 18 The home was previously required to record alternative meals provided to residents, although this had not been undertaken the manager agreed to ensure that this was instigated with immediate effect in order to evidence nutrition intake of residents and also that choice is made available. Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 19 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): 16 and 18 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is an effective complaints system with evidence that relatives feel that their views are listened to and acted upon. Not all of the homes practices and the lack of understanding of the roles and responsibilities under safeguarding adult’s procedures did not offer adequate protection to residents from the potential risk of harm. EVIDENCE: There is an accessible complaints procedure for residents, their representatives, and staff to follow should they be unhappy with any aspect of the service. Relatives consulted with said that they felt able to share any concerns they had with staff. Two relatives spoke of raising minor issues with the home and felt that these had been addressed in a prompt manor. The manager reported that there have been no reported complaints to the home since the previous inspection. Staff consulted with showed some understanding of their roles and responsibilities under safeguarding adult’s guidelines and said that they had recently undertaken protection of vulnerable adults (POVA) training. It was previously required that the homes safeguarding policy be reviewed to ensure Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 20 it is in line with Surrey Multi–Agency Procedures. The manager reported that copies of this procedure has now been obtained for staff to reference. A safeguarding referral made by visiting health care professionals is currently being investigated by social services and had not been concluded at the time of the inspection or report writing. As previously noted residents are at risk of potential harm by the lack of adequate risk management strategies and guidance for staff. As part of the social services investigation the provider had been asked by the commission to undertake an internal investigation into the concerns raised. The commission concluded that the provider’s initial investigation did not meet their obligations under the care standards act and concern was noted regarding their lack of understanding of the roles and responsibilities under safeguarding adults procedures. In order to help address this the provider and manager agreed to undertake further training in safeguarding adult’s procedures and is in the process of undertaking a further investigation into allegations. Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 21 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 24 25 and 26 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. Residents live in a homely environment, which is decorated and maintained to a good standard. The home ensures that resident’s private accommodation is equipped to provide comfort and privacy. The management of offensive odours must improve to ensure a pleasant environment in which to live, visit and work. EVIDENCE: The premises consist of a large converted domestic property situated in a busy village location, with local shops and amenities within walking distance. Much effort is made to create and maintain a homely environment. The provider stated there their is an ongoing programme of redecoration with standards of Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 22 maintenance was noted to be good. A relative said about the environment that “residents could move freely around” Communal space consists of a lounge dinning room and large conservatory. There is a rear secure garden, which is accessible either by a ramp or stairs. There is patio area with seats and a large outbuilding used as storage. At the time of inspection the garden was untidy with items of rubbish and furniture, which the inspector was informed had not yet been put away from the recent barbeque. Relatives spoke of how the garden has been gradually improved over the years and now provides a nice environment in which to sit in when visiting their relatives. All residents consulted said that they liked their bedroom and that they provided everything they needed. Bedrooms were observed to have been individualised with resident’s personal effects. There is sufficient number of toilets and bathrooms located around the home, including half of the bedrooms reported to have ensuite facilities. On the day of the inspection there was a strong urine odour throughout the ground floor. The provider said that carpets are usually cleaned once a week but had not been undertaken the week of the inspection. Much feedback was received on the inadequate management of offensive odours, a sample of comments included: “they do go out of their way to clean any incontinence accidents up pretty quickly”; “Environment always clean occasionally smells a bit but they are usually pretty quick at cleaning it up and without any fuss” and “sometimes a bit wiffy”. It was previously required that offensive odours in two specified bedrooms be eliminated, which had been completed, however it was clear that there must be a more effective overall management of odours to ensure the dignity of residents and to create a pleasant environment throughout. The home was found to be warm and comfortable, with good levels of light and ventilation. There was a range of individual aids and adaptations to assist resident’s mobility and independence, including raised toilet seats, height adjustable beds walking aids, hoists and grab rails. As part of the safeguarding referral several residents have been assessed by an occupational therapist and any specialist equipment has now been provided either by the home or health care teams. Although there were systems in place for the control of infection and all staff have been trained in this area some practices were noted which did not promote good infection control, this included the use of communal creams and lack of hand washing materials. These were addressed at the time of the inspection. Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 23 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 and 30 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. Residents benefit from a stable staff team that provide gentle and considerate care, however the significant amount of staff training recently undertaken needs to be now underpinned by improving some of the practices at the home. The sometimes adhoc staffing arrangements and lack of good record keeping make it difficult to monitor whether adequate staffing levels are being maintained. People who use the service are protected by the home’s recruitment policy and procedures. EVIDENCE: Relatives and residents spoke in the main positively about staff a sample of their comments included: “I like the fact that there is no change in staff it’s the same staff all the time”; “Staff are very considerate and gentle”; “terrific, very good kind and polite”; “they make it a home” “excellent, all very good with residents all every caring and very gently which is reassuring”. All but three staff, including the manager, are family members of the joint providers. Much feedback was received by relatives on the positive effects of Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 24 the home being family run and the same staff being on duty all the time and the continuity this provided. The joint providers also work as part of the care team most days. Feedback was received from staff and relatives that they felt that there was usually sufficient staff on duty to meet the needs of residents. A relative said “Always sufficient staff on duty there is always one of them sitting in the lounge only on every few occasions are there less than enough when one of them has had to pop out but I have to say it is very adequate for the majority of the time”. Staffing levels could not be confirmed as the staffing rota did not reflect the adhoc staffing arrangements often occurring between family members. This clearly presents difficulties for the manager in being able to be accountable and manage the day to day staffing arrangements and is further discussed under standard 31 of this report. The home has been required to ensure that staffing roster clearly record the staffing on duty at any time in order to be able to evidence staffing levels and ensure that there is accountability of the staff on duty at any one time. Variable feedback was received in staff sometimes poor communication skills, comments included “English always isn’t that good but mum does not have any problem understanding or being understood” ; “Communication can be quite difficult at times as English not the first language for most staff”; “I don’t have any problems communication with staff” and “all staff speak English some better than others”. The provider reported that a staff member on duty who’s English was noted to be difficult to understand clearly, was currently undergoing English lessons and they were no problems observed in residents being understood by them. However it was fedback to the provider to further address that this as this limits conversations with residents, their families and health care professionals. There is little turnover or recruitment needed at the home. The personal files of the last appointed staffs were inspected and these showed that a robust recruitment process is followed which includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing. The manager reported that over half of the staff team have attained a National vocational Qualification (NVQ). Much commitment has been shown by the provider in improving staff training with a significant amount of training having recently been undertaken by the provider and staff over the last few months. The home had previously been required to undertake further staff training with additional training in dementia and manual handling recommended as part of an ongoing safeguarding investigation. The staff and provider who attended recent training by the Alzheimer’s society spoke of the benefits this training had in adding their further understanding of good practices in the care of people who have dementia. There was some evidence that this training had already started to further improve practices, for example in care planning and the promotion of independence, however training in manual handling, needs to be underpinned by improved practices in the management of risks through the Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 25 development of manual handling risks assessments and recent training in infection control needs to be translated into safe hygiene practices. A health care professional said of the staff “very kind but they sometimes lack the knowledge of care principals”. Staff consulted with spoke of attending all of the mandatory areas of training necessary to work safely with residents this included recently attending manual handling training. Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 26 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 33 35 36 38 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is not being managed effectively due to lack of clarity and confusion in the role of the manager and provider, which has impacted on the practices at the home. Staff felt well supported to undertake their roles and residents will benefit further through consistent close supervision to ensure that recent training translated into improved practices. The health and safety of residents and staff is in the main promoted and protected , however improvements must be made in the way the home managers residents individual risks to ensure there safety is promoted. Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 27 EVIDENCE: The registered manager is a registered nurse and was previously the owner manager of the home before it was purchased by the current owners. The registered manager has many years experience in managing services for older people and work part time at the home. They reported that they also work as a trainer in aspects of social care for various colleges. There was no evidence that they have undertaken regular training at the home, to keep themselves updated in changes in practices. Both the manager and provider agreed to undertake manager training in safeguarding adults in order to improve their understanding of their roles and responsibilities. The management arrangements at the home are currently complex and confusing with the joint providers also significantly involved in the day to day running of the home. This clearly affects the running of the home and the manager’s ability to meet their legal accountabilities due to the restrictions on them by the provider’s presence, confusion over roles and tasks, lack of understanding by the provider of aspects of the daily running of a home, significant employment of the providers family members and limited decisions making abilities of the manager. This was discussed with the provider and manager who agreed as a matter of priority that the management must provide clearer leadership and direction. Residents and relatives did not always know who the manager was and who the provider was but all said they felt confident to approach any member of the management team. A sample of comments made about the management team included: “Logas is first class who is the chap that runs it always has time to chat”; “Logas is a real help to me he is really on the ball”; “James is very considerate”; “he likes that things are done professionally and if they are not he will call you in the office” and “james very helpful can ask him anything and very kind”. Previous to the inspection concern has been expressed by the commission to the provider regarding their lack of understanding of their legal responsibilities in overseeing the home and providing a thorough and impartial investigation into allegations made under safeguarding adult’s guidance. At inspection the provider now demonstrated their motivation in improving their working knowledge and commitment to improving areas of shortfall at the home. As part of the homes quality assurance process the manager reported that it is there practice to send out annual feedback cards to relatives and residents, however this had not yet been undertaken this year and was planned to be undertaken in the near future. The provider and manager reported that practices changes made in response to previous feedback has included photographs on the wall and the development of the garden. Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 28 Staff consulted with felt that they were well supported by the management team and are in the main supervised by the manager working directly with them. A staff member said of the manager “he tells you if you are doing something wrong”. In order to ensure the effective implementation of all of the recent training into improved practices consistent staff supervision needs to undertaken by the management team. Residents are encouraged to retain control of their own finances for as long as they are able to do so and if unable then this responsibility is taken on by a relative or another responsible persons external to the home. The manager stated that they do not manage the personal finances for any current residents. Written guidance is available on issues related to health and safety. Records seen at inspection showed that all of the necessary servicing and testing of health and safety equipment has been undertaken. As previously noted in order to safeguard residents from potential harm from the risks they faced and posed the way in which the home manages risk must be improved. The provider reported that systems were in place to support fire safety, which included: regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills. They reported that a fire risk assessment had been undertaken, which recorded the actions necessary to ensure fire safety at the home. The home was previously required to ensure that all appropriate accidents and incidents must be sent to the Commission. The provider and manager reported that incidents noted by the inspector had been reported but no record of these have yet to been located by the commission. As there is a history of items not received by the home sent from the commission and vica versa the provider agreed to review the way in which they communicate with the commission to ensure an audit trail of information sent. Although the providers are in daily contact with the home they or a representative are required to undertake at least monthly-unannounced visit to the home (required by Regulation 26 of the Care Homes regulations) and produce a report on the outcome of this visit . The provider acknowledged that they did not realise that they have to undertaken this as part of their responsibilities and have just starting to complete them. The provider was reminded of the importance of these visits in order for them to be able to monitor standards at the home and ensure that the necessary shortfalls in practices are being addressed. Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 29 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 2 2 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 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 1 3 3 3 3 x 3 3 1 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 3 3 x 2 Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 30 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 Regulation 4(1)(c) & Schedule 1 & 5(1)(a-f) Requirement The Statement of Purpose and service user guide is reviewed to reflect the services, facilities and terms and conditions at the home and in accordance with the National Minimum Standards. That these are made available and are reviewed regularly, in order to inform prospective residents and their relatives about the homes services and facilities. That the needs of prospective services users have been assessed by suitably qualified persons prior to admission in order that their needs are identified and can be met safely at the home. That written personal risk assessments are completed for all service users as part of their care plan, which are reviewed regularly and records the actions to manage or reduce any identified risks, to ensure that resident’s safety is promoted. That robust procedures are put into place which ensures the DS0000013568.V367001.R01.S.doc Timescale for action 30/09/08 2 OP3 14(1)(a) 30/08/08 3 OP7 13(4)(c) 30/08/08 4 OP26 16(2)(k) 30/08/08 Bellsgrove Version 5.2 Page 31 5 OP27 17(4) Sch 4(7) 6 OP31 10(1) effective management and eradication of offensive odours throughout the home, this is in order to provide a pleasant dignified environment in which to live. That a copy of the duty roster of 30/08/08 all persons working at the home and a record of whether the roster was actually worked be maintained and kept at the home, in order to be able to evidence staffing levels at the home at any time. That the registered provider and 30/09/08 the registered manager shall having regard to the size of the home, the statement of purpose, and the number and needs of service users carry on or manage the care home with sufficient care, competence and skill. 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 OP9 Good Practice Recommendations That hand written Medication Administration Records (MAR) are checked and countersigned by a second member of staff for accuracy in order to reduce the risk of instructions being copied wrongly. That the medication procedures include the arrangements for the management and use of homely remedies or over the counter medication and an approved list of such medication is available. That schedule 3 controlled drugs are recorded in a controlled drugs register, which includes the recording of tow signatures for each administration, in order to provide a clear audit trail of this medication. 2 OP9 3 OP9 Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Bellsgrove DS0000013568.V367001.R01.S.doc Version 5.2 Page 33 - 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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