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Inspection on 30/05/07 for Belmar Nursing Home

Also see our care home review for Belmar Nursing Home for more information

This inspection was carried out on 30th May 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

One member of the team is employed as an activities organiser. Although there is still work to do on this area of service provision, having a dedicated member of staff with direct responsibility for activities is a strength of the service. The people spoken to clearly enjoy the meals provided at the home. Medication procedures are well organised, with qualified staff taking responsibility for the storage and administration of medication. Eleven of the 16 care staff have achieved NVQ level 2 or above. Good recruitment procedures are in place, meaning that appropriate staff are employed and people living at the home are protected by the recruitment checks, which take place. There have been a number of recent meetings involving staff and people living at the home, meaning that people are involved in and being kept up to date regarding developments at the home.

What has improved since the last inspection?

This is the first inspection since the home was registered in January 2007.

What the care home could do better:

The registered manager and the staff team are working hard to introduce a robust system of care planning for each person at the home. The regular reviewing of care plans, alongside individualised risk management strategies will be a big improvement, meaning that changes are responded to and potential harm minimised. Individual weekly plans, incorporating domestic tasks, personal shopping and leisure/educational/social activities should be put in place. This will promote personal development for each person. A full review of the arrangements for the safekeeping of money, alcohol and cigarettes must take place and a system of auditing introduced. This will help to protect people from possible financial abuse. All parts of the home must be well maintained and decorated to a reasonable standard, making the Belmar a pleasant and attractive place to live. All staff must receive training appropriate to the work they perform. A review of competency for each staff member and the development of a training matrix for the home will make this more manageable. Regulation 26 visits must take place monthly and reports be sent to the CSCI. These visits can monitor progress towards meeting the shortfalls identified at this inspection. Quality assurance and quality monitoring systems must be established, however it is recognised that this may not be a priority at this point in service development. The registered provider must comply with the requirements of the fire safety and health and safety agencies.

CARE HOME ADULTS 18-65 Belmar Nursing Home 25 Clifton Drive Lytham St Annes On Sea Lancashire FY8 5QY Lead Inspector Lesley Plant Unannounced Inspection 30th and 31st May 2007 09:30 Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 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 Belmar Nursing Home DS0000069174.V342425.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 Adults 18-65. 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. Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Belmar Nursing Home Address 25 Clifton Drive Lytham St Annes On Sea Lancashire FY8 5QY 01253 739534 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) Belmar Care Home Ltd Mrs Lynne Millar Care Home 44 Category(ies) of Dementia - over 65 years of age (4), Mental registration, with number disorder, excluding learning disability or of places dementia (40) Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only: Code PC, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Dementia over 65 years of age: Code DE(E) (maximum number of places: 4). Mental disorder, excluding learning disability or dementia: Code MD (maximum number of places: 40). The maximum number of people who can be accommodated is: 44. Date of last inspection N/A Brief Description of the Service: Belmar Nursing Home is situated in a residential area of Lytham St Annes. The home provides a number of lounge and dining rooms plus a conservatory, which is the designated smoking room. Parking is available at the front of the building and there is a small garden area at the rear. The home is currently registered to provide personal and nursing care to up to 44 people, with 40 places for people with mental health problems and four places for people over 65 with dementia. In January 2007 the home was sold and newly registered with the CSCI. The Belmar had previously been registered with another care provider and had been operating for some years. Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over two days. All the key national minimum standards were assessed, plus opportunities for personal development. At the time of the inspection there were 36 people living at the home. The inspector spoke to two nursing staff; three care staff, the registered manager and six people living at the home. Records were viewed and a tour of the building took place. Information was also gained from a pre inspection questionnaire completed by the registered manager and from two feedback surveys completed by health professionals in contact with the home. In January 2007 the home was sold and newly registered with the CSCI. The Belmar had previously been registered with another care provider and had been operating for some years. This is the first inspection for this newly registered home. What the service does well: What has improved since the last inspection? This is the first inspection since the home was registered in January 2007. Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. An assessment takes place before new people are admitted to the home, meaning that people are only admitted if their needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: File documentation was viewed in relation to an individual who had been recently admitted to the home. An assessment by the community mental health team and a care programme approach (CPA) assessment had taken place. A qualified nurse from the Belmar had then undertaken an assessment to ensure that the home could meet this persons needs. The assessment format used by the home is detailed and includes information regarding; diet, continence, mobility, hygiene, physical health and mental health. This information was used to inform the care plan, which showed that key areas of need, such as how staff should respond to symptoms of mental distress and help to reduce alcohol intake were being addressed. Assessments are only carried out by qualified and experienced staff. Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is poor. Lack of consistency in reviewing care plans and risk strategies and the lack of individualised procedures, mean that changes may not be responded to and all needs may not be being met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In January 2007 the home was sold and newly registered with the CSCI. The Belmar had previously been registered with another care provider. The people currently living at the home have in the main lived at the Belmar for some years. The registered manager is working hard to update care plans and introduce new systems. The new system of care planning, in place for most people in the home, clearly identifies separate areas of need and details the support required. However some old documentation is still in place, meaning that for some people, the Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 10 direction for staff is not detailed enough to ensure all needs are met and changes responded to. Three of the files viewed showed that monthly reviews are taking place, in line with the Nursing and Midwifery Council standards for reviewing nursing plans. However other files showed that not all elements of support are being reviewed. For one person, guidance regarding how staff are to respond to aggressive behaviour has not been reviewed since 2004. Progress needs to continue, with particular focus on developing individualised procedures for people who may be aggressive or drink excessively. It is also important that where possible, individuals are fully involved and agree with their care plan and where this is not the case and restrictions have to be imposed, that any such restrictions are agreed with relatives and/or other professionals involved with the person. Minutes of a recent meeting were viewed, when all those living at the home were given the opportunity to discuss day-to-day routines and activities. This meeting was well attended, with activities, clothing/labelling and smoking being discussed. These meetings are a good opportunity to involve everyone living at the home in discussing any necessary changes, which may need to be made. It is important that any restrictions, such as accessing bedrooms are introduced individually as part of the care plan. This also applies to any restrictions on accessing spending money. The registered manager acts as appointee for a number of people living at the home and has been reviewing each persons benefit entitlement to ensure that income is maximised. For some people, money is held on their behalf. Changes need to be made to these arrangements and this is addressed under standard 23 of this report. Some risk assessments and risk management plans are in place and address such areas as aggressive behaviour, use of bed rails and the risk of pressure sores. Again there are inconsistencies, as regular reviews are not taking place for all people. Risk assessments must be reviewed as part of the monthly care plan review. The registered manager is aware that improvements need to be made. There was some evidence of good practice regarding risk management. One person requires bed rails and this had been risk assessed, a harm reduction plan put in place and discussed and agreed with the closest relative. It has been identified that people smoking in their bedrooms poses a fire risk and the registered manager and staff are working hard to try to minimise this risk. Regular room checks take place and records are kept of these. It is acknowledged that some people, who have previously had more freedom to smoke in their bedroom, still persist in doing so. The regular room checks, Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 11 individual discussions, individual agreements and continual observation of staff should continue. Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. The lack of individualised activity plans means that personal development is not being promoted. People enjoy the meals that are provided and visitors are made welcome. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The people living at the home now have more opportunities to take part in organised activities. A member of staff is now employed purely as an activities organiser. During the inspection people were supported to take walks out of the home and arts/crafts activities took place in the afternoon. There is also a weekly cookery class, whereby a small group will go out and purchase ingredients and then cook a meal. During the inspection a number of people were observed enjoying the art and craft sessions and the activity organiser stated that people at the home also Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 13 enjoyed bingo. It is acknowledged that for many people with mental health problems their motivation levels may be low and that for some people their medication may also reduce motivation levels and that encouraging involvement in activities will not always be easy. A number of people have connections with the community mental health team and are able to access activities held at this base. Posters were displayed in the home, giving details of recent and forthcoming events such as a clothes show and a singer performing at the home. Visitors are made welcome and staff record on the daily notes if someone has received a visit or had contact with their family. Locks have been fitted onto bedroom doors, when this has been requested. People have unrestricted access to all communal areas of the home. The conservatory and another communal room have been designated as smoking areas, although not everyone living at the home complies with this. At present the domestic staff clean the bedrooms. A small number of people do change their own bedding and tidy their room, but this is not the norm. Individual weekly activity plans could incorporate some routine domestic tasks as well as activities in and outside the home. At present bulk shopping is carried out by staff, who purchase cigarettes and alcohol on behalf of a number of people living at the home. Opportunities for individuals to go out, with support and supervision, to purchase their own goods could also from part of the weekly plan. It may still be necessary for goods such as these to be held in safe keeping by the home. Individual weekly plans, incorporating domestic tasks, personal shopping and leisure/educational/social activities should be put in place. The introduction of more structured daily routines could in many cases have a positive impact upon mental wellbeing. Feedback from a health care professional with links to the home supports this view. “It does contain some very difficult to place individuals well. Does not attempt however to rehabilitate individuals.” And “ Overall standards need to be improved and a different ethos developed towards rehabilitation and development of clients needs.” Although rehabilitation may not be feasible or appropriate for some people living at the home, there should be individual plans, which address personal development and include meaningful activities. A full time cook and a full time kitchen assistant are employed at the home, mainly working from Monday to Friday. At weekends one of the domestic staff takes on the kitchen assistant duties and a carer is deployed to do the cooking. A four-week menu is in place. The main meal is at lunch time consisting of a choice between two hot meals, one being the vegetarian option. At tea time there is a choice of snack meals. One person requires a soft diet and the cook Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 14 confirmed that this is provided. Three people have a vegetarian diet and there are a number of individuals who have certain dietary needs due to their diabetes. Discussion with the cook confirmed an understanding of these individual needs. The people spoken to stated that they were satisfied with the meals provided and the meal eaten by the inspector was tasty and nicely presented. The registered manager is considering changes to the menus and serving arrangements, as at present meals have to be carried upstairs from the basement kitchen. Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. Personal and health care needs are generally met. Medication is managed appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The people living at the home require different levels of assistance with personal care. Some individuals need full support in this area. Care plans address mobility and hygiene. The qualified nursing staff oversee the work of the care assistants. A daily work allocation chart guides staff in their duties, ensuring that each member of the team knows what tasks they are responsible for. One person living at the home has particular mobility problems and discussion with staff confirmed that her current wheelchair does not provide enough support or safety for use outside the home, as no harness is available. Specialist advice and assessment should be sought to address this. Daily records give good details for each person, reporting on such areas as mood, activities, medication, visitors and meals. Files contain records of regular health observations including weight monitoring. CPA reviews take Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 16 place where appropriate, as happened on the first day of this inspection, for one person at the home. Arrangements are in place for optical and chiropody services to visit individuals at the home, with people being supported to visit their dentist locally. Specialist input is provided from community psychiatric nurses and the community mental health team, who also provide input regarding alcohol reduction. Medication is stored in two medication trolleys in the nurses’ office. At present no people living at the home manage or administer their own medication. All medication is administered by qualified nursing staff. The dispensing pharmacist regularly visits the home and is available for advice. Most medication is provided in blister packs dispensed by the pharmacist. Each medication administration record contains a photograph of the person. The two administration records viewed were appropriately maintained. It is advised that any medication, such as creams or liquids, not supplied in blister packs, is dated when opened. Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is poor. Arrangements are in place for people to make a complaint. People living at the home are not sufficiently protected from potential abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints procedure is in place, which is clear and concise. A copy of this procedure, with an accompanying letter has been sent to all relatives. A copy of the complaints procedure is also on display in the home. The people living at the home who were spoken to, know who to speak to if they have a concern and the introduction of meetings will also give opportunity for views to be aired. The registered manager confirmed that the home had received one concern from a neighbour, which had been addressed. An abuse policy is in place, however this should be reviewed and improved, as it does not comply with locally agreed multi agency procedures. A number of people living at the home can display difficult challenging behaviour and until risk management strategies are improved and regularly reviewed, this remains an area of potential harm, as there are a small number of older and more frail people living at the home. Not all staff have received recent or appropriate training regarding handling aggression and this too should be addressed. Incidents of aggressive behaviour are recorded. The current arrangements for the handling of personal money must be reviewed and improved. A number of people living at the home have agreed to Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 18 have their money held on their behalf and small amounts given out during the week. This is working well for these people, meaning that only small amounts of alcohol are purchased each day. For others there is a system whereby a member of staff carries out bulk purchases of alcohol and cigarettes, which are then distributed at agreed times. Whilst it is important that agreed restrictions on alcohol and money continue to be introduced as part of the care plan, the current arrangements do not provide enough protection. Money, alcohol and cigarettes are not being safely held. The records for one person showed that his balance of money was not actually available at the home and the registered manager was alerted of this. Due to concerns raised during the inspection the registered manager immediately took remedial action. However a full review of the arrangements for the safe keeping of money, alcohol and cigarettes must take place and a system of auditing introduced. This is essential in order to protect people from the possibility of financial abuse. Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is poor. Not all parts of the home are well maintained or decorated to a satisfactory standard, meaning that the home is not an attractive place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Belmar had a change of owner in January 2007, meaning that the home was newly registered with the CSCI. During this registration process the new owner was made fully aware of the improvements needed to the fabric and furnishing of the building. This improvement programme has commenced, with repairs to the boiler being carried out and the main hallway decorated. The nurses’ office has been enlarged and is now centrally placed, with easier access. The back garden has been tidied and the greenhouse repaired. One person living at the home has an interest in gardening and this is being supported, by repairing the greenhouse and making a vegetable plot. During the inspection contractors were in the building assessing the next stage of Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 20 refurbishment, which will be the decoration and re carpeting of all the corridors and communal rooms. This refurbishment programme must continue, as there are still areas of the home, where standards of décor are poor. Some of the bathrooms and toilets have shabby and unhygienic flooring and there are also plans to refurbish these rooms. It is acknowledged that although this refurbishment programme may take some time, progress must continue. The local fire and rescue service have visited the home and are monitoring progress in addressing shortfalls they have identified. Timeframes have been set and the registered manager is working towards meeting these. There are four cleaning staff employed who work on a rota basis seven days a week. There is also a full time laundry worker. The laundry is sited in the rear garden of the home. Two of the domestic staff are undertaking NVQ training relevant to their role. There are sluice facilities and arrangements in place for the disposal of clinical waste. Although many areas of the home are shabby, the general cleanliness was satisfactory. Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is adequate. The majority of staff are qualified nurses or have achieved NVQ awards, meaning that they have the potential to provide a good service. Appropriate recruitment procedures are in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff team consists of six qualified nurses, 16 care staff, seven ancillary staff, an administrator and the registered manager. One member of care staff has responsibility for organising activities. Staff appeared to have good relationships with those living at the home and those spoken to felt that since the change of ownership their was now more direction for staff and that the home was more organised. The qualified nursing staff lead the care staff in their duties and the senior care staff also have a supervisory role. Eleven of the sixteen care staff have achieved NVQ level 2 or above, with four staff soon to commence the level 2 award. Two of the domestic staff and one of the kitchen staff are enrolled on NVQ programmes relating to their work roles. The NVQ certificates for three randomly selected staff were viewed. The percentage of qualified care staff exceeds the 50 as detailed in the National Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 22 Minimum Standards for care homes. The registered manager was advised to liaise with the NVQ assessor to ensure that the units being undertaken are relevant to working with people with challenging behaviour and mental health problems. Recruitment records for four recently appointed staff were viewed. Documentation includes; an application form, two references; a health declaration and for three of the files, a criminal records bureau disclosure. The fourth person was awaiting criminal records bureau clearance and following a check of the protection of vulnerable adults register, was working under the supervision of senior staff. Records for two recently appointed nursing staff showed that checks to confirm their registration with the Nursing and Midwifery Council had taken place. Recruitment was discussed with the registered manager, who explained that a new application form had been introduced and each file now had a useful checklist to help to ensure that all documentation is received. Although a high percentage of staff are either qualified nurses or have achieved NVQ awards there is work to be done to ensure that all staff have the appropriate skills to undertake their duties. Some staff have undertaken training prior to commencing at the Belmar or were involved in training courses arranged by the previous owner. Discussions with two staff and the registered manager confirmed that not all staff have undertaken relevant or recent training in all essential areas. Some of the team have undertaken moving and handling, dealing with aggression, food hygiene and infection control training. All staff must receive training appropriate to the work they perform. The registered manager should review the competency of each member of the team and complete a training matrix detailing all essential training. This will then form the basic training plan for the home. There should also be a comprehensive and timely induction programme for new staff. Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. Regular meetings keep people up to date with developments. There are some working practices in place, which promote the health and safety of those living and working at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of Belmar has managed social care services for over ten years, prior to this worked in hospitals and has experience of working with people with mental health problems. The manager has recently registered with the CSCI and has previously been the registered manager of another home in Lancashire. The manager worked at the home prior to it being bought by Belmar Care Home Ltd in January 2007. Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 24 The registered manager is a qualified Registered Mental Nurse and is soon to commence NVQ level 4 in management. The registered manager is keen to make improvements both to the fabric of the building and also to the nursing and support service provided. In order to discuss proposed changes, several staff meetings have been held, including a separate meeting with night staff. There has also been a meeting attended by the new owner, in order that staff could meet him and hear about plans for the home. The registered manager has a weekly meeting with the nursing staff and is demonstrating that all staff are being kept up to date with developments. Two members of the care staff spoken to stated that they felt recent changes were improving the home and that there was now a clearer direction for the team. Since January 2007 the focus has been on making improvements to essential elements of service provision. Quality assurance and quality monitoring has not yet been established. This was discussed with the registered manager and it was agreed that the formal surveying of relatives or professionals involved in the home would not be appropriate at this time. It was agreed that the focus should be on the areas for improvement already identified. The registered provider is required to carry out monthly visits to the home to monitor and report on the quality of the service. One such visit has taken place and a report sent to the CSCI. These visits, with reports being sent to the CSCI must take place at least once a month and are vital to demonstrate and evidence that the ongoing improvement programme is continuing. The health and safety agency have visited the home and made a number of recommendations, which the registered manager is addressing. One of these is the temperature testing of water and this should be put into place and records kept. Records were viewed regarding checking of the gas installation, lift and hoist maintenance, the testing of electrical appliances and records of fire drills. Radiator guards and window restrictors are in place. Not all staff have undertaken basic health and safety training, such as moving and handling. The home is working towards meeting fire safety recommendations. The registered manager has obtained a fire safety video to use as part of a staff awareness programme and during discussion it was advised that it might be appropriate to share this with some of the people living at the home. Belmar Nursing Home DS0000069174.V342425.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 Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 1 X LIFESTYLES Standard No Score 11 2 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 2 X 2 X X 2 X Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 26 N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 Standard YA6 YA9 YA23 Regulation 15 13 13 Requirement Each person must have care plan, which is regularly reviewed. Risk assessments and risk management plans must be in place and regularly reviewed. A full review of the arrangements for the safekeeping of money, alcohol and cigarettes must take place and a system of auditing introduced. All parts of the home must be well maintained and decorated to a reasonable standard. All staff must receive training appropriate to the work they perform. Regulation 26 visits must take place monthly and reports sent to the CSCI. Quality assurance and quality monitoring systems must be established. The registered provider must comply with the requirements of the fire safety and health and safety agencies. Timescale for action 30/08/07 30/08/07 30/06/07 4 5 6 7 8 YA24 YA35 YA39 YA39 YA42 23 18 26 24 23 30/03/08 30/11/07 30/06/07 01/01/08 30/08/07 Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 27 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 YA6 Good Practice Recommendations Where restrictions have to be imposed, any such restrictions should be agreed with relatives and/or other professionals involved with the person. Where possible, individuals should be fully involved in the drawing up of their plan. There should be individualised procedures in place for people who may be aggressive or may drink excessively. Individual weekly plans, incorporating domestic tasks, personal shopping and leisure/educational/social activities should be put in place. Specialist advice and assessment should be sought regarding equipment to enable one person with severe mobility problems to go out of the home. The abuse policy should be reviewed and amended to comply with locally agreed multi agency procedures. All staff should undergo appropriate training regarding handling aggression. The registered manager should review the competency of each member of the team and complete a training matrix detailing all essential training. There should be a comprehensive and timely induction programme for new staff. The registered manager should gain a management qualification at NVQ level 4. Water temperatures should be regularly tested and records kept. The training programme for the home should include training in health and safety related topics. 2 3 4 YA6 YA9 YA11 YA12 5 YA13 YA18 6 7 8 YA23 YA23 YA35 9 10 11 12 YA35 YA37 YA42 YA42 Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Belmar Nursing Home DS0000069174.V342425.R01.S.doc Version 5.2 Page 29 - 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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