Inspection on 10/12/07 for Bellstone Residential Care Ltd

This inspection was carried out on 10th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Bellstone Residential Care Ltd 05/03/09

Bellstone Residential Care Ltd 13/12/06

Bellstone Residential Care Ltd 30/01/06

Bellstone Residential Care Ltd 12/10/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Bellstone Residential Care Ltd 23-29 Beach Road West Felixstowe Suffolk IP11 2BL Lead Inspector Jill Clarke Unannounced Inspection 10th December 2007 09:36 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 Bellstone Residential Care Ltd DS0000064695.V356375.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. Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bellstone Residential Care Ltd Address 23-29 Beach Road West Felixstowe Suffolk IP11 2BL 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) 01394 278480 01394 276597 Bellstone Residential Care Ltd Mrs Amanda Laine King Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th December 2006 Brief Description of the Service: Bellstone Residential Care Home is situated close to the sea front in Felixstowe. The home is registered to provide care for a maximum of 22 older people. The home has a condition of registration to provide care for one named resident with Dementia. The home has a range of communal areas consisting of a television room at the front of the house with a sun lounge to the rear, through which the garden can be accessed. There are two dining rooms. The garden is small yet attractive with a lawn, seating and borders with plants and a water feature. There are sixteen single rooms and three shared rooms. Each room is furnished and centrally heated. There is a call bell system throughout the home. Access to the first floor is by two staircases, which have stair lifts. There is wheelchair access into and around the home. A mobile library and church representatives regularly visit the home. A detailed statement of purpose, colour brochure and a service user guide provides detailed information about the home and access to local services. Each resident has a contract of terms and conditions; which is reviewed annually and describes what services are included and sets out their individual agreed fee. Fees as given in the service Users Guide: Single Room £365.00 Shared Room £341.00 En-suite Room £395.00 Respite Room (short stay) Room Rate 10 The fees do not cover additional services such hairdresser, chiropodist and personal items such as toiletries and receipt of daily newspapers. Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, undertaken over 7 hours, which focused on the core standards relating to older people. We also assessed the outcomes for the people living at the home against the key Lines of Regulatory Assessment (KLORA). The report has been written using accumulated evidence gathered prior to, during, and contact made following the inspection. Prior to the inspection Commission for Social Care Inspection (CSCI) surveys were sent to the home. This gave an opportunity for people using, working in, and associated with the service, to give their views on how they think the home is run. At the time of writing this report 3 residents (who had been supported by their relative to complete the form), 12 relative/advocate, 9 staff, and 3 Healthcare professionals surveys had been returned. Comments from which have been included in this report. Prior to the inspection, the agency was asked to complete an Annual Quality Assurance Assessment (AQAA). This provides the CSCI with information on how the home is meeting/exceeding the National Minimum Standards, and any planned work for the next 12 months. Comments from which have also been included in this report. The Registered Manager was not available during this inspection. However the Deputy Manager was available throughout, to answer any questions and provide records to support work undertaken at the home. A tour of the building took in all the communal rooms, dining room and a sample of 3 bedrooms. Records viewed included, care plans, staff recruitment and training records, menus, staff rotas, complaints policy and medication records. Everyone involved in the inspection was very supportive and helpful. What the service does well: We found the home has a relaxed and welcoming atmosphere, which reflected comments made by relatives ‘the friendliness and welcoming manner plus the staff’s helpfulness is what Bellstone does well’. Taking into account the home was not purpose built, but adapted from 3 large Victorian Houses; the owners are continually reassessing the environment to ensure it meets the needs of the people living there. This is further summed up by a relative’s comments that ‘The care home provides a safe, warm and pleasant environment with comfortable, well-furnished bedrooms and a very homely feel. They also commented on ‘the food is good and seems much looked forward to’. People Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 6 we spoke to during the inspection described the food as “quite nice”, “good” and if they did not like what was on the lunch menu, they would have a salad instead. Residents and relatives comments on the staff included “they are good”, ‘the staff at Bellstone are wonderful, always happy and smiling – I have no fault to find’ and ‘I can not fault it’ Staff work with the residents to develop a personalised care plan, which gives staff clear guidance on how they wish to be looked after. What has improved since the last inspection? What they could do better: The home needs to ensure all staff have been trained and feel competent in supporting residents with their physical and behavioural health needs. This is to ensure that they treat the person with respect, and where they feel a resident is not ‘being cooperative’, look at their own practice to see if they have handled the situation appropriately. We have not mentioned the illness, as it could lead to the person being identified, however this was full discussed during the inspection. The home must ensure that staff are following safe systems of recording and giving out medication. This is to ensure that the residents have received their prescribed medication, and staff are completing records accurately to confirm this has happen. Staff should continue developing the range of activities they provide, to include work undertaken on a 1 to 1 basis, for those residents who prefer not to join in with groups. Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 7 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. Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. The home does not offer intermediate care, therefore standard 6 was not assessed. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People are given enough information on what the home has to offer and have their needs fully assessed before they move in, so they, and the home can be sure the service offered is right for them. EVIDENCE: The home’s Service Users Guide’ sets out ‘information for prospective residents, their family and friends’. The booklet also contained a 3-fold, coloured information sheet, which included photographs of different aspects of the home, and more localised information, including a ‘How to find us’ map on the back. The Service User Guide gives people an insight on the aims of the family run home, and how to apply for a place. It informs people that most of the current resident’s ‘are in their 80’s and 90’s’. They mention their ‘fairly rigid assessment criteria for admission to Bellstone’, in order to ‘maintain a balance Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 10 between those residents requiring minimal assistance, to those requiring all care’. To obtain this balance, and taking into account their ‘present residents and staff morale’, they ‘aim that any new residents will require minimal assistance’. Prospective residents, family and advocates are ‘encouraged to visit Bellstone before continuing with their application’. Where people are unable to visit the home, the Manager or their deputy will visit the person at home, or current care setting. A relative told us how ‘very hard’ staff worked, to help their relative ‘settle in’ and the family ‘were made to feel very welcome whenever’ they visited. We looked at the pre-admission assessments and contracts for 2 new residents who had move into Bellstone during the last 3 months. We found the preassessments very comprehensive, which enable staff to gain a good insight on not only the level of help the person was looking for, but focuses on retaining the person’s independence and emotional well-being. They also looked at the persons ‘perception’ of why they needed to move into a care setting. The quality of the information showed that the resident, their family, and if applicable friends, social and health professionals had all been involved in supplying information. Residents surveyed told us that they had all received a contract, and been enough information about the home before they moved in, to support them in deciding if it was the right place for them. This reflected feedback given by relative who also confirmed that they had been given enough information about the home to help them make decisions. When asked if they felt the home was able to meet their next-of-kin / friends needs, the replies were equally split between ‘always’ and ‘usually’. Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can expect to be fully involved in saying how they wish to be cared for. However, people cannot be assured that they will always receive their prescribed medication, which could affect their health. EVIDENCE: The home informed us through their AQAA that they use the information taken from ‘the pre-admission assessment to produce an “interim” care plan. This is based solely on the information and preferences expressed by the resident’. This initial care plan ‘runs for no more than 4 weeks’, during which time staff record what level of assistance a resident requires, and any ‘relevant observations’. We looked at 3 residents care plans. They were very informative and the quality of the information showed that the resident had been fully involved to ensure that the information given, reflected their preferences and wishes. For example ‘likes to get herself up and ready for the day, if needing help (resident’s name) will buzz for a carer to assist’. Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 12 Staff are given guidance on how the person likes to spend their day, which included any information given on assistance required with their personal care, ‘present health and dietary needs’ and relevant medical, and personal history. There was information on why the resident felt they wanted to move into residential care, and any social and mental health needs. Records showed when they had visited the chiropodist, dentist or had their eyesight checked. There was information on resident’s communication needs for example, they informed staff that 1 resident ‘finds it very frustrating’ when they ‘can not get words out and screams’. The home prides themselves on each person having an ‘holistic’ care plan which covers all their social, physical, mental health needs, which is ‘devised with the resident’, at the end of the 4-week period. A healthcare professional felt that being able to ‘holistically’ cater ‘to the individual’, was an area that the home did well in. However, when we read the daily record sheet (4th November to 9th December) for a resident with more complex needs, the way the information was recorded, indicated that staff may have difficulty in managing their needs. The information did not fully reflect that staff were ensuring the person’s dignity and respect, whilst dealing with their apparent challenging behaviour, and manual handling needs. Comments included ‘not very co-operative’, ‘nasty tonight’ and ‘hard work when we took (resident) to bed (resident) was shouting and screaming so we had to get a lifting belt for (resident’s) legs as well as (resident’s) arms and lift (resident) on to the bed’. With a second reference made to using the ‘lifting belt and one under legs’ to get the person off the floor as they ‘couldn’t weight bear’, we raised our concerns with the Deputy Manager over the manual handling techniques staff were using. They felt that staff most likely meant they had used a hoist “where the strap goes under the legs”. Besides current care needs, the ‘advance care planning – end of life’ ensured their wishes had been noted. The AQAA stated that staff had also ‘devised a “poorly resident” checklist to work through with relatives when a resident is dying to confirm notification details, contact numbers etc’. The Deputy Manager also informed us that they would be attending ‘latter life care’ training in January. Residents surveyed told us that they ‘always’ received the care and medical support they needed. Relatives/advocates asked if they felt the home was able to meet the different needs of the people using the service (taking into account their cultural and diversity needs) 6 replied ‘always’, (‘I have every confidence that they do meet the different needs of people’, ‘as far as we know’) and 3 ‘usually’. Where 2 people had not ticked a box to indicate their reply, their comments included ‘unable to score as I have no knowledge about Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 13 this other than how the service meets the needs of my own relative’ and ‘ not applicable – question irrelevant’. When we sat with residents in the privacy of their own rooms, we noticed that staff knocked, prior to entering. In the dining room and lounge, staff politely addressed residents. The home informed us (AQAA) that ‘the maintenance of privacy and dignity underpins every aspect of our daily care’. Discussion with the management and information given in are plans, showed they had attended risk assessment training to help them identify, which are classed as having a high risk of falling. They had been seen by their GP and falls assessor, and where required, provided with ‘hip protectors’ and receiving Calcium and Vitamin D supplements, to reduce the risk of injury if they fell. The home uses a commercial ‘blister pack’ monitoring dosage system (a card with see-through pockets, which holds the set dose of medication to be taken), to dispense medication. This, and medication that cannot be put into the blister packs, is supplied by the local pharmacist every 28-days. When staff give a resident their medication, they initial the resident’s Medication Administration Records (MAR) to confirm it has been given, or write a code to say why the resident had not taken it. During the last inspection we identified shortfalls (see key Inspection report dated 13 December 2006) where staff had not completed the MAR chart after giving the resident their medication. During this inspection, the MAR charts looked at had been completed to say residents had been given their medication, or staff had written the appropriate code. There was a system in place to record all medication coming in and out of the home. The AQAA confirmed that ‘staff are trained in the safe storage and administration of medication’. This reflected the feedback (surveys) given by staff who are responsible for giving out medication ‘we got the training from the pharmacy’s company before we started to give medication to the resident’. Another member of staff said that they have ‘been supervised on many occasions’ when administering medication. We did a sample check of 3 resident’s tablets (not held in a blister pack) and found shortfalls for 2 of the residents, which showed that although staff had signed to say the person had taken the medication, it was still in the pharmacist box. We checked the number of tablets left for 4 further residents, against the home’s MAR chart. In all of the cases we found medication left in the box, which according to the MAR chart had been given. To safeguard the residents welfare, by ensuring that they receive their medication as prescribed, we asked, and confirmed in writing to the home following the inspection, that they must take urgent action to address the situation. They replied, within the required timescale informing us of the action they would be taking to address the situation, which if required will include disciplinary action being taken. Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 14 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at the home can expect to be supported to make choices about their lifestyle, and be offered home cooked meals which meets their individual preferences. EVIDENCE: Care plans seen gave a good level of information on how the person wished to spend their day, and also their early morning routine ‘likes to have a lay in until 8.30 and will call for a cup of tea to help her wake up’. It also informed us that if they are not going out with their relative, they liked to ‘watch their television, and ‘finish reading’ their newspaper. Care plans also gave information on the person’s ‘network and support’ systems in place, which staff said they ‘encourage’ them to keep in contact with. For example, their family members, friends, and any clubs they belong to. There was also information given on the resident’s ability to socialise ‘likes own company’ and if they could shop unaided. Staff were given good guidance about a resident’s evening routine which included that they like ‘to have a large tea’ in their room. Carers were informed that they should take the tea up on a tray ‘with their evening paper’ Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 15 whilst the resident was watching ‘the evening news’ .Staff were then informed to go and check at ‘6.45 and help (resident’s name) get ready for bed as this can be a time where they are at most risk of falling’. Residents surveyed, were asked if they felt there were activities arranged by the home that they could take part in, 2 replied ‘always’ and 1 ‘usually’. A relative felt ‘more outside activities would be appreciated but space within the building and grounds is a limiting factor’. Another relative said that ‘it would be lovely to see everyone more active physically and mentally’ however they did acknowledge that it ‘is easier said than done’. Pre-admission assessments gave information on residents previous involvement in domestic tasks, and if they would require any supervision in undertaking these. The activity list did not show any domestic activities, such as baking being undertaken. On the residents notice board there was a list of routine activities undertaken each day of the week. Such as Monday – Ball Games, Thursday Arts and Crafts, Sunday Bingo. We gave 2 residents the list to look at, to find out which ones they took part in. They could only remember the Bingo activity (which they enjoyed), and said we would be better asking staff about the activities. The AQAA informed us that the home keeps an ‘activities book showing what was done and who participated’, which the staff showed us. This showed limited activities had been recorded for October (6th cut nails) and November ( 27th ‘asked if they wanted to play cards or do quiz said no’ and 29th singer), however during December staff had completed it on a daily basis. It showed were residents had refused an activity (8th) chatted, played cards or joined in with crosswords. On the 3rd ‘gave out Christmas cards and helped to write’. The same core of 3 to 6 residents was undertaking the activities. Where staff had written that residents had refused an activity, it did not show if all the residents in the home had been asked. Taking into account those residents who prefer spending time in their bedroom, there was no information on what time staff may spend with them. Discussions with staff showed that they do go in and sit and talk, but had not thought of writing this in their daily notes. As part of ‘what we could do better’, the home is hoping a member of staff will volunteer to attend a training course in ‘activities for the elderly and act as co-ordinator’. Residents spoken with said they were looking forward to the Christmas party on the 20th. Other activities, which staff had arranged for December was a visit from the Chiropodist and hearing clinic, ‘St Peter and Paul’s songbirds and the Mayor’s visit on the 19th. Care plans recorded people’s different faiths and religions. The home also ‘benefits from regular visits from a Christian support worker who takes short services in the home and will liaise with churches of other dominations to arrange spiritual support’. The AQAA informed us that they ‘provide open visiting and encourage residents to see their visitors in their own rooms and always provide Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 16 refreshments’. Which residents confirmed happened, and also that their family and visitors are invited to attend the ‘in-house’ entertainment, the next being the Christmas party. They also said that ‘the visiting library’ supplies large print books and talking books as required’. Residents have a ‘visiting shop that sets up a display of clothing, toiletries, make-up, cards/writing paper, pens and pencils where residents can purchase goods with their own spending money. Newspapers are delivered daily on request’. Residents are asked to give staff information on their likes and dislikes, which is included in their care plans. We joined some residents in the dining room, just as they were finishing their dessert. A copy of the menu was on the table, and the dining area had a relaxed atmosphere, with residents chatting to each other. They said there was always “plenty of food”, with 1 person saying that if they did not like what was on the menu, they would “normally have a salad”. We asked residents their views on the meal they had just eaten. They told us that they had enjoyed the “cottage pie” which was “quite nice” but felt the pudding “lagged behind a bit”. People we surveyed said they ‘always’ liked the meals provided at the home. Care records show that resident’s nutritional needs are being monitored. Staff were being given useful information on people’s individual preferences, such as ‘likes to eat very small meals’ reminding staff if the resident’s plate is piled high ‘they will not eat a meal’. Comments on a relative’s survey informed us that staff ‘are extremely careful with my mother’s diet which is critical to her continued health’. Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect their concerns to be listened too, and appropriate action taken by the staff to address them. EVIDENCE: Following the last inspection the home was asked to consider providing information on how to make a complaint, in ‘a format suitable for all residents including those with a sensory impairment’. The AQAA informed us what action the home had taken to address this ‘we provide each resident with a copy of the homes complaints procedure (in their rooms and on the residents notice board) in appropriate formats i.e. large print and audio tapes’. We saw the policy hanging on the back of the doors, when visiting residents in their bedrooms. Residents spoken with, felt comfortable to raise any issues or concerns they have with staff direct. This reflected feedback given to us in residents surveys, where all 3 people saying that they knew who to speak to if they were unhappy, or wanted to make a complaint. The AQAA informed us that they had not received any complaints. Training records seen, showed staff had undertaken training in safeguarding residents welfare as part of their training. A ‘No Secrets’ leaflet was seen on the notice board, and information given in the last report confirmed that all residents had been given a copy of this. Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 18 There was no information given in the AQAA, as to whether they had signed up to the local safeguarding teams website, to keep their knowledge updated, or if anyone had undertaken the ‘Train the Trainer’ courses, run by the team, to enable consistency in the content of ‘safeguarding’ training. The AQAA did state CareAware Advocacy Service, which offers advice ‘for the funding of long term care for older people’, and information ‘about the new lasting Power of Attorney arrangements had been made available to residents and their visitors’. As mentioned in the ‘Staffing’ section of this report, the home now ensures that checks are undertaken to confirm a person’s identify, and that they safe to work with vulnerable people, before they start work at the home. Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect a clean, comfortable environment, which within the constraints of the building, supports people to be independent. EVIDENCE: As stated in our last report the home ‘is situated close to the seafront and is in easy walking distance of the promenade, local shops, bus station and churches’. When we visited, residents were making good use of the new ‘sun lounge’, which was light and airy. When we visited people in their bedrooms, we observed that they had been personalised with their possessions. Bedside tables, although serviceable, the surface was worn, and it had lost its ‘waterproofing’. This was further evidenced, where a resident was seen to have knocked their drink over, when we helped ‘mop up’ the drink, we noticed that it had soaked into the wood. Staff said all the tables will be “revarnished” at the same time. Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 20 When we asked residents about their bedrooms, we were informed that the “beds are very comfortable”. Some areas of paintwork did look worn, however would be addressed as part of the on-going maintenance work. The AQAA informed us that they ‘do most of our own redecorating which means we can be more flexible about how and when we do it thereby minimising disruption to residents’. The AQAA informed us that staff had arranged for someone from the sensory impairment team to visit’ and support a resident to be ‘more independent within ‘ their surroundings’. Rooms were clean and free from any unpleasant odours. Since the last inspection an Occupational Therapist (OT) has undertaken an assessment of the environment. The report we were shown, set out action to be taken by the owners to improve/make more suitable environment to meet the range of people’s needs. Discussions with management confirmed that they would be analysing the information given in the report, and look at how they action the points raised. Once completed, they would be sending us a copy, to confirm work they would be undertaking. Following the last inspection, and issues raised that the home’s information booklet still referred to the ‘out of action’ passenger lift, was still listed as a facility. The coloured booklet we were shown, confirmed that this has now been removed. In the Service Users Guide, -people are informed that the ‘vertical lift is awaiting refurbishment and is therefore temporarily out of action’. When assessing potential residents, mobility needs are taken into account, and people are informed that access to the first floor is via stairs, or 2 chair lifts. During the last inspection we raised concerns ‘that a number of doors to residents rooms were wedged open using doorstops’. They informed us that the Fire Officer would be doing an inspection of the home in January 2007, and they would consult with them re looking at ‘alternative arrangements to contain fires’. At the start of this inspection, we found 3 residents’ bedroom doors wedged open with a hoist, waste bin or a wooden doorstop. Staff said that they had consulted with the fire officer during their visit, and were in the process completing of their Fire Risk Assessment. They were also in the process of looking to fit suitable door closures. This will enable residents to have their bedroom doors held safely back, and in the case of a fire, would automatically close, to give protection until help arrived. A relative felt the ‘only complaint’ they had was the ‘lack of space for residents in the sitting rooms’, and they hoped the ‘alterations they are having in the back garden of the care home – this will be greatly improved’. This has included the new sunroom, and we could see from the window the new decking area, which due to the cold weather was not in use. Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 21 As part of the home’s infection control procedures, liquid soap, paper towels, disposable plastic aprons and gloves were freely available around the home for staff to use. The laundry was neat and tidy, and the home used ‘red dissolvable bags’, to reduce the amount of handling of linen soiled with bodily fluids. Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 22 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to be looked after by trained staff, in sufficient numbers to meet their individual needs. EVIDENCE: When we asked people living at the home if staff are available when they needed them, all 3 completing the surveys replied ‘always’. Staff also felt that the current staffing levels met the assessed needs of the people they were looking after. The AQAA informed us that a ‘senior member of staff and 2 care staff work an early shift from 7-2.30pm, 1 senior carer and 1 care staff work on a later shift from 2.15 – 9.30pm supported by an additional member of staff from 3-8pm’. On arriving at the home, and being informed that the Manager was not available, we were assured by the Deputy Manager that they were not included in, with the 3 care staff, therefore we would not be taking them away from providing ‘hands on’ care. During the night (9.15 – 8.00 am), the home has 1 ‘awake member of staff supported by 1 sleep-in staff’. Additional support consists of 3 housekeepers from 8 – 11.30am and a cook between 8.30 and 1.30pm. Therefore any catering or cleaning required outside this time would be undertaken by the care staff. Both the Manager and their Deputy, take turns in being ‘on call’, so they are able to support staff in emergencies. Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 23 Relatives/advocates asked if they felt the care staff had the right skills and experience to look after people properly, 9 replied ‘always’, and 3 ‘usually’. Comments included ‘the qualifications are displayed in the foyer and the staff seem to be efficient and caring’. This reflected the feedback given from visiting Health Care professionals, whose comments included ‘I have attended to patients in the Bellstone on many occasions over many years, I have always found the care given to the residents to be of a high standard, and if the staff have any concerns, they do not hesitate to contact us’. During our last inspection, we identified that the home was not always ensuring they obtained a full employment history for new staff. Without this information they would be unable to check the reason for any gaps in their employment. They would also be unable to confirm the reason why they had left any previous jobs working with vulnerable people. We looked at 2 sets of recruitment records, for staff who had been employed since the last inspection. Application forms showed that the applicants had given a full employment history, and staff had obtained copies of paperwork to confirm the person’s name and address. Criminal Bureau Records (CRB) had been undertaken for both staff. Where 1 had started prior to the CRB information coming back, the applicant’s name had been checked to ensure it did not appear on the Protection of Vulnerable Adults (POVA) register, which alerts management that previous concerns had been made about their conduct. For 1 of the applicants, there was only 1 (from their last employer) of the 2 required references held on file, so we were unable to confirm that both had been obtained. When we fed this back to the Deputy Manager, they confirmed that 2 written references had been obtained, but they were unable to locate it at that time. We contacted the home following the inspection, to see if they had been able to find the reference, they confirm they had not been able to. They said that they had contacted the person sending the reference, and asked if they could send a copy, which they were waiting for. Information held in the files showed that staff were given a copy of their Job Description (so they knew what was expected of them), company rules, and feedback from their interview. The AQAA informed us that after discussions within a team meeting, staff said they would prefer to cover shifts themselves. This then enables the management to take their time and find the ‘right’ person for the job, rather than rush to fill a vacancy. They felt that ‘early indications are that newly appointed staff are enjoying their work and seem quite settled in their post’. When we asked new staff if they felt their recruitment had been undertaken fairly and thoroughly, they replied ‘yes’, with 1 person informing us that that ‘lots of questions were asked about myself and what I would like to get out of being a carer’. They also felt their induction covered everything they needed to know. Comments included ‘I had a 3 month induction and started off doing Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 24 shadow shifts with other qualified carers until I felt happy to do this on my own’. Information in the AQAA (completed on the 18/09/07) informed us, that out of their 16 care staff, 6 held a National Vocational Award (NVQ) level 2 or above, and 4 further staff were working towards the qualification. The Deputy Manager holds the Registered Managers Award and NVQ level 4 in Care. As part of their improvement plan, the AQAA states that during the next 12 months they ‘hope to have a further 4 staff at NVQ level 4’. Staff surveyed said that they were given training that was relevant to their role, and helped them understand and meet the needs of the residents’. However 1 member of staff felt they wanted more up-to-date training on dealing with a ‘violent’ resident. Time spent talking to a member of staff confirmed that they were being “kept up to date” with their manual handling training, so they know how to support residents with their mobility safely. They also said that they had undertaken “3 days dementia” training. Discussions with staff, and training records seen, gave us no evidence that care staff had attended specialist training to support a resident’s more complex needs (see Health and Personal care section of this report). However, a member of staff they had done some reading on the subject. Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect the home to be run by an experienced Manager, who leads a staff team committed to working in the best interests of the people they care for. EVIDENCE: We were aware that the Manager works 1-day a week (normally a Tuesday or Wednesday) at a local hospital to maintain their nursing registration, and planned our visit for a Monday. Unfortunately, we selected the day that the Manager was at the hospital. However, in their absence due to the Deputy Manager working closely with the Manager, they were more than able to answer any questions we had. We could also use the Manager’s comprehensive feedback given in the AQAA, to let us know what had been happening since our last inspection, and their aims for the next 12 months. Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 26 The home continues to be a family run business, who are greatly involved in the running and monitoring of the service (the second floor of the home is the families private accommodation). Staff spoken with, and surveyed, were positive about the support they received from both the Manager and the Deputy Manager. Comments included ‘she is always available if there are any problems’, ‘we can go to the Manager at any time’, “very supportive”, “need help management always there for you treated like part of the family”. A relative told us that if care staff were unable to answer any of their queries when they visited at the weekend, they knew they could contact the home during the week, and their query would be dealt with by the ‘extremely obliging’ Manager. The AQAA informs us of the systems the home has in place, to enable people using the service to share their views. This includes completing their annual quality assurance questionnaires sent out to ‘residents, staff, relatives and visiting professionals at the home’. In discussing the feedback given in our surveys, and the homes own, we identified some of the same comments made, and the staff were able to tell us what action they had taken to address the comments. Following the last inspection, we identified that the staff were not receiving 1 to 1 supervision, at least 6 times a year to enable them to be given feedback on their performance, and if required identify any training needs. In the AQAA the Manager said they were not meeting the recommended 6 sessions, however staff were having supervision 4 times a year, which reflected the information given in the staff surveys. They felt due to the ‘close working relationship between management and staff on a daily basis most issues, problems, ideas, suggestions and training requirements’ had already been discussed. This resulted in them having ‘nothing left to talk about’ during the 1 to 1 meetings, and staff felt they could make better use of this time. Staff we spoke to, and feedback given in the surveys showed that staff felt they were being well supervised and supported. The signed ‘supervision contract’ between management and staff , enables either person to arrange an additional supervision sessions if required. People are encouraged to look after their own monies, however the home has arrangements in place to keep money in safekeeping for a resident if they want to. A check of 1 resident’s money held was correct to the home’s records. Care plans also listed people’s personal property. Record keeping was generally found to be good, apart from the shortfalls identified where staff had signed for medication they had not given, and a copy of 1 reference missing. The main care plan, which gave guidance on how the resident wished to be looked after was typed, and where staff had written in the daily reports, it could be easily read, and was both dated and signed. Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 27 Information supplied in the AQAA showed that the home had the required Polices and Procedures in place, to ensure the welfare of both people living and working at Bellstone. All the polices had been reviewed during the last 12 months. Training records and information given in the staff surveys, showed that staff are receiving heath and safety training, such as manual handling, so they know how to support residents to move safely. When we walked out of the new sunroom into a corridor, there was a small step, which could be a trip hazard. Staff said that this had been identified in the OT report, and now, with the completion of the sunroom, action would be taken to alert people to the step. We were also informed that (see environment section of this report) that the home is currently undertaking their Fire Risk assessment,. The Food safety officer had undertaken a check of the catering arrangements in March 2007, which raised no concerns, however they were asked to start using the ‘safer food better food standards folder’. They now have in place, which records work undertaken by catering staff to ensure good practice is maintained. Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 28 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 3 3 4 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 2 3 Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 29 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 OP9 Regulation 13 (2) Requirement The registered Manager must make arrangements for the recording and safe administration of medicines in the care home. Repeat requirement from the 13 December 2006. Timescale for action 20/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP38 Good Practice Recommendations Where staff use manual handling techniques they should be recording the exact equipment used, so management can monitor that staff are following safe procedures. Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Colchester Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Bellstone Residential Care Ltd DS0000064695.V356375.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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