Inspection on 13/12/06 for Bellstone Residential Care Ltd

This inspection was carried out on 13th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Bellstone Residential Care Ltd 05/03/09

Bellstone Residential Care Ltd 10/12/07

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 Deborah Kerr Unannounced Inspection 13th December 2006 10:00 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.V323472.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.V323472.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 Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (22) of places Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 The Home is registered for one named service user with dementia (DE E), as detailed in correspondence dated 27.12.04 30th January 2006 Date of last inspection 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 range from £331 – £365 per week. These do not cover additional costs for example, the hairdresser, chiropodist and personal items such as toiletries and receipt of daily newspapers. Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over nine hours during a weekday. This was a key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from a quality assurance survey undertaken by the home, 2 residents ‘Have your say about’ and 3 relatives/visitors comment cards. Time was spent talking with 7 residents, 4 staff, and a relative. Time was also spent with the deputy manager and manager. A number of records were inspected including those relating to residents, staff, training, medication, quality assurance and a selection of policies and procedures. What the service does well: What has improved since the last inspection? What they could do better: Consideration should be given to providing information about the home and how to complain in a format suitable for all residents including those with a sensory impairment. A check of the Medication Administration Record (MAR) charts reflects that staff need to be more vigilant when recording and administering medication. Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 6 To promote residents independence and minimise the number of falls, an assessment of the home must carried out by a qualified person such as an occupational therapist. Risk assessments need to be undertaken to protect the health, welfare and safety of residents in relation to falls and assistance sought from a falls co-ordinator. The palliative care and end of life needs of the residents need to be documented in their care plan so that they are assured at the time of their death staff will treat them and their relatives with care sensitivity and respect. The career history of new employees including those from overseas must be checked and any gaps investigated to ensure the employee is not a potential risk to residents. Staff supervision should meet the recommended six sessions per year. To protect the health safety and welfare of residents, staff must receive training for the use of cleaning materials to comply with the Control of Substances Hazardous to Health (COSHH) regulations. Alternative measures must be established to hold fire doors open instead of using door wedges. 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.V323472.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6, Quality in this outcome area is good. Prospective residents can expect to be provided with detailed information about the home, however cannot be assured that the information will be available in an suitable format to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s statement of purpose, service users guide and colour brochure provides prospective residents with detailed information about the services provided. The statement of purpose has been amended to reflect that the one named resident with dementia has recently passed away and is therefore no longer residing at the home. The manager needs to make an application to the Commission for Social Care Inspection (CSCI) for a variation to remove this condition from their certificate of registration. There are several residents living in the home with a visual and/or hearing impairment. Consideration should to be given to providing information in a suitable format to meet their needs. The manager confirmed they had been in Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 9 contact with the visual impairments team to visit the home to assess the needs of one resident registered blind. Resident’s files contained a written contract setting out the terms and conditions of services provided and living in the home, including a three month trial period and their current fee. These were being reviewed and updated annually. Each resident had a pre admission needs assessment completed; these were very detailed and provided information about the resident’s health, personal care and general well being. A statement was seen on each assessment confirming that the home is able to meet their individual needs. On admission an interim care plan had been written stating the level of assistance required by the resident and identified immediate goals. Residents spoken with confirmed they had been given the opportunity to visit the home prior to moving in. One resident confirmed they had stayed at the home previously for respite following an operation. They commented, “ I have fitted in very well, I am happy here and the food is very good”. A relatives comment card stated. “ I have nothing but praise for the home, I could not wish for a better place for my relative”. The home does not provide intermediate care, however, they do offer respite care if and when a bed is available. Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11, Quality in this outcome area is good. Residents can expect to have care plans in place that reflect their health and personal care needs, however they cannot currently expect to have their health, safety and welfare protected by the home’s procedures for administering medication and systems for the prevention of falls. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans of three residents were inspected and contained detailed accounts of the resident’s personal care, medical history and daily routines. These routines had been discussed and agreed with residents and detailed their preferences of how they chose to spend their day and the level of support they required. An audit of the accident log reflected in the last five months twenty-nine falls had been recorded, these were mostly attributed to three residents. Several residents were observed holding onto doorframes for support. This was discussed with the manager who agreed to look into reviewing risk assessments of the three residents in relation to the number of falls and to Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 11 seek advice from a falls co-ordinator. A discussion was held with the manager about having an assessment of the home by a qualified person such as an occupational therapist to ensure residents have the necessary aids and equipment to promote their independence and minimise the number of falls. Progress notes charted the resident’s general health, well being and specific health needs. For example, the notes of one resident with a history of angina reflected their health had been deteriorating. Staff made an urgent appointment for the resident to see the cardiologist and requested a visit by the general practitioner. Another resident had been supported to attend a hospital appointment for a cataracts operation. The progress notes also documented the systems for monitoring resident’s health and referred to the appropriate charts, for example a resident who has been diagnosed with Coeliac disease requires a special gluten and wheat free diet has a nutritional screening form. Another resident who has a catheter fitted to help manage their continence has a waterlow chart. Evidence was seen that other health charts were being used to monitor resident’s health and these were being reviewed on a regular basis. Risk assessments had been completed for individual tasks, for example standing and mobility, transfers, bathing, position in bed, using the stair lifts and the use of wheelchairs outdoors. Where required pressure relieving equipment had been provided for the prevention of pressure areas developing. Records confirmed that residents also receive regular support from the district nurse team where required. Comments seen in the quality assurance survey confirm residents and their relatives are happy with the care they receive, for example one resident commented, “I am very pleased with the care I receive” and a relative had written “The love and care my relative receives from the manager and the dedicated staff team is excellent”. A senior member of staff was observed administering medication. The home uses the NOMAD dossette boxes prepared by the pharmacist. Each Medication Administration Records (MAR) chart had a front sheet with the photograph of the resident for identification purposes. The MAR charts were seen and reflected thirteen errors. The errors had occurred over the previous two days and highlighted a significant number of missed signatures. Further investigation showed that in all but two instances the medication had been administered but not signed. Antibiotics prescribed for one resident had not been administered at 7am and 2pm on the 12th December. Another resident had been prescribed two consecutive courses of antibiotics, however the MAR chart did not clearly reflect where the first course had stopped and the second commenced. There was a gap of a few days in between but this did not clearly show if this had been two courses or one consecutive course with omission of signatures in between. The MAR chart did not clearly reflect the number of antibiotics received into the home and administered to the resident. Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 12 Residents were observed being called by their preferred name and felt that staff respected their privacy. Staff were observed knocking and waiting before entering resident’s rooms. The interactions between residents and staff were observed to be friendly and appropriate. The home has a detailed death and dying policy. It states that the specific arrangements surrounding the death of a resident and takes into account the different requirements of spiritual and religious rituals before, after and at the point of death. The manager confirmed that resident’s personal wishes at the time of their death are discussed during the initial assessment, however these are not documented in the residents care plans. The palliative care and end of life needs of the residents need to be documented in their care plan so that they are assured at the time of their death staff will treat them and their relatives with care sensitivity and respect. Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is good. Residents can expect to live in a home that supports a lifestyle that matches their expectations and can expect to receive a good standard of fresh and appealing food with a wide variety of choice as part of their daily diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents and relative’s notice board in the dining room displayed a range of services and activities on offer. These included church services and visits from a church group called ‘Songbirds’ who were scheduled to perform Christmas Carols. A Christmas Trade and Joy fair had been arranged for residents to purchase gifts and a Christmas party was scheduled for the 14th December. The mayor was scheduled to visit the home to wish residents a Merry Christmas followed by mince pies and sherry. Residents spoke of parties being held to celebrate residents’ birthdays and most recently a married couple had celebrated their 61st wedding anniversary. Additional information advertised a make up party and a calendar showing the dates of the hairdresser visits. There were also details of the funeral of a resident that had recently passed away for those wishing to attend. Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 14 The home is located near to the sea front and provides opportunities for residents to access the promenade, local shops, the Spa Pavilion Theatre and local clubs and associations, such as a club for the blind and stroke association. Staff spoken with confirmed that in the summer month’s residents are often escorted to beach for an ice cream or a coffee or out for lunch to the pub. Activities available in the home consist of board games, quizzes, card making flower arranging, musical entertainment and reminiscence games. In the afternoon residents sitting in the sun lounge were observed taking part in a quiz, and were clearly enjoying the activity. However one residents “Have your say” comment card stated, “I do not attend activities due to blindness”. Other residents with a visual and/or hearing impairment or not as sprightly due to deterioration in age, health and cognitive impairments were observed either sitting in their rooms or in the other lounge unoccupied. Consideration should be given for more opportunities for stimulation through leisure and recreational activities to these residents. The manager confirmed that they had been in contact with the visual impairment team to work with a resident who is registered blind to develop ways for them to become more independent and to provide staff training. Residents in the sun lounge were engaged in general conversations about things happening in the home and about items of news. They were discussing the celebrations being prepared to commemorate Lady Diana’s death at Wembley Stadium next year. Residents spoken with described what it was like living in the home. They felt the home met their expectations and commented “Personally I think this is a very good service, the people are nice, staff are very good and helpful, the food is very good, I couldn’t wish for anything better” and “ I am very happy at the home”. A relative was visiting during the inspection and accompanied their relative to a hospital appointment. Other residents spoke of receiving regular visits from family and friends. Residents are supported to hold small amounts of money, which is locked, in a communal safe in the office. Residents rooms do not have secure lockable storage facilities for them to have access to their own money, however they are provided with a portable box safe on request. With the exception of one resident the home does not manage resident’s financial affairs. This is managed either by a power of attorney or relatives. The company secretary has an agreement with one resident and their power of attorney to manage their finances. Their benefits and pension are paid directly into the resident’s bank account. Banks statements seen confirmed all transactions and the balance was correct. Residents who choose to have monies held in the office have a cashbook, which logs all transactions of monies withdrawn and paid in. Two signatures are required for all transactions. The cash balances, records and receipts were checked for two residents and were found to be accurate. Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 15 Food was nicely presented and looked appealing and appetising. Residents had a choice of meal. The menu rotates on a four weekly basis and provides residents with a varied and balanced diet. The menu for the day of the inspection was a choice of roast chicken and stuffing, roast potatoes and parsnips, carrots and cabbage or a cheese or egg salad. The dessert was a choice of moose or ice cream or fruit. Each resident has their own choices of breakfast; any changes to their preferred choice are written on the board in the kitchen for the cook and changed on their list. Specific diets were catered for; sugar free foods had been purchased for a resident who was diabetic and wheat and gluten free foods for a resident that has the condition Coeliac. The home users local suppliers for their meat and purchases fresh vegetables from their local supermarket. A limited stock of frozen foods is purchased. The stocks of dry and refrigerated foods were seen, these were of good quality and were being used and stored appropriately and in accordance with food safety standards. Where the home buys in bulk, dates and labels need to be applied to the food, for example a large block of cheese had been cut into smaller more manageable pieces, however there was no date of purchase or expiry date. Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 16 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): 16,18, Quality in this outcome area is good. Residents can expect to have their concerns listened to and responded to and be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Neither the home nor the Commission for Social Care Inspection (CSCI) has received any complaints. The homes complaints log confirmed this. Each resident is provided with a laminated copy of the home’s procedure on how to complain, this also directs them to the Commission for Social Care Inspection (CSCI) should they wish to pursue their complaint further. The complaints procedure informs the resident that every complaint will be acknowledged within two working days and that their complaint will be investigated and hopefully resolved within twenty-eight days. Resident’s spoken with felt if they had any complaint or concern they would tell either a member of staff or the manager and were confident that they would be listened to and their concerns dealt with. A relatives comment card stated,” I have no complaints to make about the home, I think it is a wonderful place”. The home has a detailed policy and procedure in place for the protection of vulnerable adults. This policy was reviewed in July 2006. Each resident has a copy of the “No secrets” leaflet with the details of the Suffolk inter agency policy, customer first telephone number and a copy of the homes adult protection procedure in their room with the details of the Commission for Social Care Inspection (CSCI). Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 17 A booklet about adult protection, which covers types and definitions of abuse, is issued to staff and used for training. Staff spoken with confirmed they were aware of the whistle blowing and adult protection procedure, they confirmed they would report any concerns about improper conduct of their colleagues towards a resident to the manager. Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 18 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): 19,20,22,24,25,26, Quality in this outcome area is adequate. Residents can expect to live in a well-maintained and welcoming environment, however cannot expect to have their safety protected until appropriate aids and equipment are provided and arrangements are made for fire doors to close automatically in the event of fire. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Bellstone Residential Home is situated close to the seafront and is in easy walking distance of the promenade, local shops, bus station and churches. The home is nicely presented both inside and out and was found to be clean, bright and well maintained and had no unpleasant odours. Accommodation is on two floors with access by three staircases, two are fitted with a stair lift. A tour of the home was made and residents spoken with commented on the good care they received and how much they enjoyed the food. There was a relaxed and happy atmosphere around the home; a lot of laughter was heard and good interaction between residents and the staff was observed. Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 19 Communally there is a range of facilities available. A large television lounge is situated at the front of the house and a sun lounge leading out into the garden and patio area. Two dining rooms provide residents with a choice of where to eat or they can choose to eat in their own rooms. Rooms were nicely decorated and evidence was seen that residents had brought their own possessions with them to personalise their rooms. Several bedrooms had been redecorated. All residents’ bedrooms are fitted with a call bell and had a door lock. They are offered the opportunity to hold a key to their room. There are three staircases leading to the first floor. Two have chair lifts fitted. These are serviced on a regular six monthly basis by Stannah and operate on a different circuit in the event of a power cut. The passenger lift is still out of action; this has been an on going issue highlighted at the inspection in March 2005 and is still offered as a facility in the homes brochure. Consideration should be given to how residents residing on the first floor will access their rooms when they are no longer able to safely use the stair lift. A number of residents in the home are frail and use a walking frame to aid their mobility and have been risk assessed on their ability to use the stair lift. Residents were observed using the stair lift, however one resident was seen leaving their frame at the bottom of the stairs and using the doorframes on the upper floor to support them on their way to their room. A discussion took place with the manager about the need for an assessment of the premises by a qualified person to assess the home to ensure there is sufficient aids and equipment to meet the needs of the residents. During a tour of the home it was noted that a number of doors to residents rooms were wedged open using doorstops. This was discussed with the manager who acknowledged the inspector’s concerns but stated it was the resident’s choice to have their doors open. The manager showed the inspector a letter from the fire and rescue service confirming they are to undertake an inspection of the home on the 23rd January 2007. The manager agreed to consult with the fire service regarding alternative arrangements to contain fires in the event of an emergency. Water temperatures were tested and found to be within the safe recommended temperature of near to 43 degrees centigrade. Radiators are fitted with wooden covers that are in keeping with the age and style of the home and meet environmental health and safety requirements. A good supply of plastic aprons, disposable gloves, liquid hand soap and paper towels were available in all bathrooms and toilets. The laundry is fitted with two washing machines; one has a sluice cycle, which the home uses in conjunction with red dissolvable bags for soiled laundry. Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, Quality in this outcome area is good. Residents can expect to be supported by a staff team in sufficient numbers who have the skills and knowledge to care for them, however gaps in application forms relating to the past employment of new staff must be investigated to ensure they do not pose a potential risk to the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three staff recently left employment, therefore the manager and deputy manager have been working shifts to cover these vacancies. They have undertaken a vigorous recruitment process and are in the process of second interviews. Staff rotas were seen and confirmed that 1 senior member of staff and two care staff work an early shift from 7–2.30pm. 1 senior and 1 care staff work on a late shift between 2.15-9.30pm, supported by an additional member of staff between the hours of 3-8pm. The home has 1 waking night staff and 1 sleep in staff between the hours of 9.15pm and 8am, supported by the manager or deputy who are on call in case of emergencies. The night staff crosses over with the early shift for an hour in the morning providing an additional person to help with breakfasts. Additional support staff consists of 3 housekeepers from 8-11.30am and a cook between 8.30 and 1.30pm. Staff spoken with confirmed that staffing levels were adequate to meet resident’s needs. Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 21 Staff files seen confirmed the home operates an appropriate recruitment process, which includes obtaining all the necessary paper work including police and protection of vulnerable adults (POVA) checks. Staff are issued with a copy of their terms and conditions of employment. Two of the new employees were from overseas and a copy of their immigration and work permits were seen on file. The application form of one of the employees stated that they had been in this country since 2000; apart from 5 months employment from April to July 2006 there was no record of employment history. This was discussed with the manager who needs to explore and record the outcomes to assess the fitness of the employee to work with vulnerable people. The home has a total of 11.5 care staff and 6 ancillary staff, 4 staff currently hold a National Vocational Qualification (NVQ), which gives a total of 33 of trained staff. However a further three staff have commenced a NVQ at level 2 and the deputy manager has commenced the registered managers award and combined level 4 NVQ. Training records and staff files reflected a commitment to staff training and development. Recent training consisted of a confusion and dementia study day, induction training, how to use a nebuliser, malnutrition screening using the MUST form, infection control, care of medicines and fire safety. The three newest staff commenced a learn direct working in care induction standards programme in July 2006. Time was spent talking to staff on duty; they generally felt supported in their roles. Two of the staff were recently new to the team, one commented, “I like working here I am just getting to know the residents, it is a fulfilling job and every day is different”. They confirmed that they have attended training including induction, medication, fire safety and had watched a video about adult protection. Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 22 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): 31,33,34,35,36,37,38, Quality in this outcome area is good. Residents can expect to live in a home, which is effectively managed, however cannot expect to have their safety protected until the home’s working practices comply with the Control of Substances Hazardous to Health (COSSH) regulations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Bellstone Residential Home continues to be a family run business. Amanda King is the registered manager. She is a registered nurse and maintains her registration by working at a local hospital one day a week. She is supported by a deputy manager who takes over the responsibility of the running of the home in her absence. Residents and staff spoke well of the manager and deputy describing them as supportive and approachable. Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 23 The home operates an effective quality assurance and monitoring system. At the last inspection the manager showed the inspector questionnaires that had been printed and were ready to be sent out to staff, GP’s, District Nurses and other professionals, visitors and residents. The home supplied copies of the returned questionnaires from residents to the Commission for Social Care Inspection (CSCI). The questionnaires were divided into four sections, nutrition, communication, your home and your care. Responses to the questionnaires were generally very positive; any negative responses were checked and improvements made to improve the service where required. The home has employers liability insurance through Ecclestone Insurance Company and is protected against loss of registration, personal accidents, terrorism, employment practice and directors and officer’s liability and computer breakdown. The current certificate was seen on display. The manager had been to visit the accountant during the inspection and discussed the financial viability of the home now and future plans. They agreed to forward a copy of the homes business and financial viability plan to the Commission for Social Care Inspection (CSCI) for inspection. A number of policies were seen including, dealing with death and dying, complaints, adult protection, reporting incidents and accidents, infection control and management of resident’s monies and financial affairs. These were detailed and had recently been updated to reflect changes in practice. The policy for dealing with resident’s finances confirmed that residents are supported to retain or enhance their financial independence by keeping their own money. Residents moving into the home are risk assessed on their ability to manage their own affairs, this is carried out in conjunction with relatives, social workers and if required the general practitioner. Where residents monies are held by the home, appropriate records are kept of all transactions. Each resident’s money is kept separate and not pooled. Residents are offered the support of an independent advocate to help them manage the affairs. Records reflected that supervision of staff is taking place, however these are not occurring with the frequency to meet the recommended six sessions a year. Supervision notes showed that relevant topics were being discussed at these meetings, which included work related issues, working with the team and feedback on general performance. The manager confirmed that when the deputy has completed their registered managers award they would take on a more active role to assist the manager in the supervision of staff. Notification death, illness and other events under regulation 37 of the Care Homes Regulations was discussed with the manager. They have informed the to Commission for Social Care Inspection (CSCI) of the deaths of residents and one occasion of an attempted break-in, however the manager was informed they need to inform the CSCI of any event in the home which adversely affects the well being or safety of any resident. This includes admissions to hospital as a result of illness or an accident. Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 24 Floors in bathrooms and toilets were clean but were sticky underfoot, a discussion with a domestic confirmed they used disinfectant but were not diluting the product in line with the manufacturers instructions. Toilet cleaning materials, such as ‘seigiene’ were being decanted into unmarked bottles, without the appropriate Control of Substances Hazardous to Health (COSHH) data in case of spillages or other emergencies. The fire logbook was seen and all tests for the fire fighting equipment and alarm systems were up to date. All staff had received fire instruction in January and July 2006. A letter was seen confirming that the Fire and Rescue Service were to visit the home to undertake an audit in January 2007. Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 25 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 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 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 2 3 X 2 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 3 2 2 Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 13 (4)(b) (c) Requirement The registered manager must make arrangements for risks that adversely affect the health and safety of residents, such as falls are identified and managed within the risk management framework. The registered manager must make arrangements for the recording and safe administration of medicines in the care home. The registered manager must make sure the palliative care and end of life needs of the residents are documented in their care plan so that they are assured at the time of their death staff will treat them and their relatives with care sensitivity and respect. The registered manager must ensure that precautions for containing fires are not impeded. The registered manager must demonstrate that an assessment of the home is undertaken by a qualified person such as an occupational therapist to ensure residents have the necessary DS0000064695.V323472.R01.S.doc Timescale for action 06/02/07 2 OP9 13 (2) 15/12/07 3 OP11 12 (3) 06/02/07 4 5 OP19 OP22 23(4)(i) 13 4 (a) (b) (c) 15/12/07 06/02/07 Bellstone Residential Care Ltd Version 5.2 Page 27 6 OP29 Sch 4 (6) (f) 7 OP37 37 8 OP38 13 4 a aids and equipment to promote their independence and minimise the number of falls. The registered persons must 06/02/07 ensure that any gaps in employment records are explored prior to the appointment of staff. The registered manager must 14/12/07 inform the CSCI of any event in the home which adversely affects the well being or safety of any resident. This includes admissions to hospital as a result of illness or an accident. The registered manager must 14/12/07 ensure that all cleaning materials, which are potentially hazardous, must not be decanted into unlabelled bottles in line with the Control of Substances Hazardous to Health (COSHH) regulations. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The service users guide and other information about the home should be available in a format suitable for the people with a visual and other sensory impairments. Information about the home needs to reflect that the passenger lift is out of action and is no longer offered as a facility. Consideration should be given for more opportunities for stimulation through leisure and recreational activities to residents with a visual and/or hearing impairment or not as sprightly due to deterioration in age, health and cognitive impairments DS0000064695.V323472.R01.S.doc Version 5.2 Page 28 2 OP1 3 OP12 Bellstone Residential Care Ltd 4 OP38 Where the home buys food in bulk, dates and labels need to be applied to the food, for example a large block of cheese had been cut into smaller more manageable pieces, however there was no purchase or expiry date. Bellstone Residential Care Ltd DS0000064695.V323472.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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.V323472.R01.S.doc Version 5.2 Page 30 - 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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