Inspection on 06/02/08 for Belmar Nursing Home

This inspection was carried out on 6th February 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Belmar Nursing Home 08/02/10

Belmar Nursing Home 04/02/09

Belmar Nursing Home 30/05/07

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

CARE HOME ADULTS 18-65 Belmar Nursing Home 25 Clifton Drive Lytham St Annes On Sea Lancashire FY8 5QY Lead Inspector Lesley Plant Key Unannounced Inspection 6 and 7th February 2008 09:30 th Belmar Nursing Home DS0000069174.V351425.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.V351425.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.V351425.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 01253 796447 belmarnh@gmail.com 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.V351425.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 30th May 2007 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.V351425.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was unannounced and took place over two days. All the key national minimum standards were assessed, plus standards relating to personal development, leisure and staff supervision. At the time of the inspection there were 35 people living at the home. The inspector spoke to two nursing staff; four care staff, the activities organiser, the registered manager and seven people living at the home. Records were viewed and a tour of the building took place. Information was also gained from other agencies and individuals with connections to the home. Since the last key inspection the registered provider has met with representatives from the CSCI to discuss the implementation of the improvement plan for the home. This information plus information gained from contact with the home since the last key inspection has also been used to inform the findings of this report. What the service does well: Staff keep clear records, which give a good indication of how each person is and what they have been doing. The system of care planning is now established. Each element of support has a separate plan of care, which is clear and is regularly reviewed. The activities organiser is able to focus attention on one area and this is working well. The cookery classes are continuing and other activities also seem popular. Having a dedicated member of staff with direct responsibility for activities is a strength of the service. The meals are tasty and nutritious, with a very good range of choice available. The people spoken to clearly enjoy the food provided at the home. The staff team is now stable and staff are building up good working relationships with those living at the home. Some good practice was observed. A member of the team was responding with extreme patience when encouraging one individual to eat his meal and another was seen to use good distraction and calming techniques with someone who was becoming verbally aggressive. Qualification training for staff is promoted at the Belmar. Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 6 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. What has improved since the last inspection? What they could do better: Where possible, individuals should be fully involved in the drawing up of their care plan. If restrictions have to be imposed, these should be agreed with their relatives and/or other professionals involved with the person. Risk management plans relating to aggression should continue to be improved, with the use of a more proactive system of recording. Individual weekly plans, addressing personal development and incorporating domestic tasks, personal shopping and leisure/educational/social activities should continue to be put in place. Medication must be administered and recorded appropriately, with monitoring checks taking place. Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 7 The refurbishment of the home must continue and a reasonable standard of cleanliness needs to be maintained. The training and supervision of staff should now be given priority. Staff need to be trained in how to respond to challenging behaviour and basic health and safety topics also need to be addressed. Quality assurance and quality monitoring systems must be established and maintained. Staff supervisions and staff meetings will help in this area. 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.V351425.R01.S.doc Version 5.2 Page 8 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.V351425.R01.S.doc Version 5.2 Page 9 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: Qualified and experienced staff carry out the assessment, prior to any person moving into the home. The records were viewed for two people recently admitted to the home. For one person, resident for just over a week the care plan was still being developed. Good information had been gathered from other professionals/agencies. The individual was subject to an enhanced CPA (Care Programme Approach), with a recent re assessment. The CPA documentation included a risk assessment and care plan, which were being used to inform the care plan being developed at the home. A legal history had also been gathered and the home had carried out a moving and handling assessment. Records were also viewed relating to an individual who had been living at the home for just over three months. Good pre admission information had been gathered and this too included information from other agencies. It was noted however, that this person had not complied with rules regarding only smoking Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 10 in a designated area, at his previous residence. This is a problematic long standing concern relating to a number of residents at the Belmar and the manager is advised to closely scrutinise all assessment information to ensure that existing problems are not compounded by admitting individuals with a history of non compliance with smoking rules. There was also evidence to show that some people had been re assessed. One individual was planning to move to another service as it was felt that his needs could no longer be met at the Belmar. This is being viewed as a positive and proactive move, which will benefit both the individual concerned and the remaining residents at the home. Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 11 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 adequate. Care plans are in place and regular reviews allow for changes to be responded to. Risk management would be further improved by using a recording system, which promotes positive and proactive responses from staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Improvements have been made to the arrangements for care planning at the home. The care plans relating to six people were viewed and discussed with staff. A separate plan of care addresses each different area of need, such as mobility, continence, nutrition and social activities and details the support required. Care plans also address issues of risk relating to alcohol and aggressive behaviour. Daily records give good details for each person and are completed for the day and nighttime periods. Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 12 Each element of the care plan is being regularly reviewed and in most cases this is happening monthly, in line with the Nursing and Midwifery Council standards for reviewing nursing plans. Examples were seen where individualised procedures had been developed regarding people who may drink excessively or become aggressive. For one person, with an alcohol reduction programme in place, reviews show an increased compliance regarding taking his medication and only smoking in designated areas. A recent review by the Community Mental Health Team stated that although still drinking there was “good progress”. Care plans are discussed with the individual concerned and there was some evidence to show that the person or their relative had agreed to the care plan, however this was not evident on all records viewed. It is 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 and records kept. This also applies to any restriction regarding accessing spending money. The registered manager acts as appointee for a number of people living at the home and has reviewed each persons benefit entitlement to ensure that income is maximised. For some people, money is held on their behalf and significant improvements have been made to these arrangements as detailed under standard 23 of this report. Risk management plans are being reviewed, however for one person a change in medication had not been reflected in his risk management plan, which gave out of date information regarding medication which could be given should he display difficult behaviour. For one person, where bed rails are required, a good risk management plan is in place. This includes checking the equipment, the use of protective rail covers and checks during the night/when in bed. This is being reviewed monthly. For another person, who would be vulnerable when going out of the home unsupervised, the plan includes directions for staff regarding monitoring her whereabouts and the daily records evidence that this person goes out regularly with staff. In the main risk assessments and risk management plans are being reviewed alongside the care plan. Incidents of aggression are being recorded. However, more detailed recording of what happened before the incident and how staff responded, could feed into the risk management plans and help staff to develop their understanding and skills in responding to situations. It would also provide better opportunity to identify triggers, possibly avoid some difficult situations and encourage positive interventions. This was discussed with the manager. Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 13 During the course of the inspection staff were observed responding to an individual who was becoming verbally aggressive. The risk management plan was followed and the person became calmer and after a little time, more cooperative. Staff appeared more focussed in their responses and more confident in communicating with people living at the home. There are still problems regarding people smoking in areas other than in the designated smoking room, which poses a fire risk. The manager and staff continue to work hard to try to address this problem. Regular room checks, individual agreements and observation by staff all aim to minimise these risks. Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 14 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, 14, 15, 16 and 17 Quality in this outcome area is adequate. Opportunities for personal development and education need to be built upon and strengthened further. 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 Belmar have very differing needs. One person is in paid employment and others are able to arrange their own social time. Some people have mobility difficulties, require intensive staff support and/or have difficulties communicating their preferences. 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 but some good progress has been made. This progress needs to be sustained and built upon. Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 15 A full time activities organiser is in post. The people spoken to were in the main, happy with the activities provided. One person stated that she enjoyed bingo and colouring and another that he enjoyed playing pool with staff. On the first day of this inspection a group were doing some modelling using clay and later on a larger group of approximately 14 people played bingo. It was observed that nearly all of the group were actively engaged in playing the game. A list of activities is displayed and staff confirmed that an entertainer visits the home every month. A hairdresser visits each week and a beautician every month. Care staff also carry out ‘beauty’ sessions, paint the ladies nails etc. The cookery classes are continuing, as observed during the second day of the inspection. A small group will go out and purchase ingredients and then cook a meal. Some people become fully involved in these sessions, whereas others prefer to pop in and out, to just watch what is going on. During the morning staff try to take those interested out for short walks, either individually or in small groups. A number of people have connections with the community mental health team and are able to access activities held at this base. The activities organiser keeps records of who has engaged in any activity and is trying to build up weekly plans for each person. Some of these plans were viewed, with one including time at the community mental health team drop in base, taking part in activities organised by the home and attending church at the weekend. This should continue and could act as a guide for care staff to follow and so introduce more structure and meaningful activities into each person’s week. Individual weekly activity plans could incorporate some routine domestic tasks as well as activities in and outside the home. A strengthened key worker role would help in developing a weekly plan for each person. It was observed that those living at the home did appear to be more focussed and staff were working hard to engage with individuals and encourage participation. 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. There is a designated smoking room. 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. A member of staff explained that the laundry worker would support individuals to tidy their bedroom as clothes are being put away and this should be encouraged. Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 16 Individual weekly plans, addressing personal development and incorporating domestic tasks, personal shopping and leisure/educational/social activities should continue to be put in place. Improvements have been made regarding how meals are provided at the home. A heated food serving trolley is now used to take food from the basement kitchen up to the dining rooms, using the lift. Previously staff carried plated meals up stairs. Meals are now served in the dining rooms, meaning that people can choose and select exactly what they want and have opportunity to see the food before they make these choices. The cook explained that there is now less wastage and that she gets good feedback from those living at the home. This is also safer as staff carrying hot meals up the stairs did pose certain risks. A list of special nutritional requirements was seen and included the need for liquidised, diabetic and vegetarian meals for certain individuals. The main meal is served at lunchtime and always includes a vegetarian option, which anyone can choose. Hot meals are also served at teatime, with the teatime menu including curry, soup and sandwiches, with homemade soup. Breakfast is normally a choice of cereals and toast, with bacon or sausage sandwiches being available at the weekend. A four weekly menu is in place and shows that plenty of choice is available. The meals served during the two days of inspection were tasty and nutritious. Fresh fruit is served each day. A ‘tuck shop’ and a soft drinks machine are also available to those living at the home. Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 17 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 adequate. Personal and health care needs are being met. Medication practices are inconsistent and could pose risks to people at the home. 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 and some people have difficulty in accepting support with maintaining personal hygiene. Care plans address all aspects of personal care, including mobility and continence. The care plans viewed were being reviewed regularly. 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. It was confirmed that an appropriate harness/belt was now available for one individual, allowing her to be taken out of the home in a wheelchair. Daily records give good details for each person and are completed for the day and nighttime periods. Records were viewed of weight monitoring and contacts Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 18 with health professionals such as GP’s. CPA (Care Programme Approach) reviews take place where appropriate. 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. Medication is stored in medication trolleys in the nurses’ office, which is kept locked when not in use. Qualified nursing staff administer all medication. A record of those staff authorised to administer medication was seen and this included sample signatures. Most medication is provided in blister packs, dispensed by the pharmacist. The dispensing pharmacist regularly visits the home and is available for advice. At a recent visit the pharmacist advised that medication, such as creams or liquids, not supplied in the blister packs, is dated upon opening. This was also advised in the last inspection report. Each medication administration record contains a photograph of the person. The medication administration records for four people were viewed, with one being accurately completed. For three people there were errors, in that medication remained in the blister pack but had been signed as being given and for one person medication remained in the pack and no entry was made on the administration record. It appears procedures are not being consistently followed. Any medication prescribed to be given under certain circumstances, such as for pain relief or to manage behaviour, must be clearly detailed on the care plan, with precise instructions and guidance for staff to follow. For one person this was clearly detailed, with good instructions for staff to follow. For the other, a change in medication had not been reflected within the behaviour management plan and staff were advised to rectify this at the time of the inspection. Medication records must be accurately completed. The medication procedures are generally good, however practices should be monitored and records audited, so that any errors are quickly spotted and rectified. It is recommended that two people check and sign any handwritten medication records, and that medication not in blister packs is dated when opened. Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 19 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 adequate. Arrangements are in place for people to make a complaint. Practices for the protection of people at the home are in place. Staff training and the further development of management strategies would provide increased protection to all concerned. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints procedure is in place and is on display at the home. The people spoken to confirmed that they would know who to speak to if they had a concern, mentioning the manager or a worker from another agency. Since the last key inspection one formal complaint has been received by the home, with two concerns being received by CSCI and another concern received by the local authority. These had been raised by local residents who have been concerned by the behaviour of some people living at the home. A very difficult situation had arisen whereby the mental health of one individual quickly declined and neighbours were distressed by his behaviour. This individual is now stable after receiving treatment in hospital. Other concerns focussed on an individual who does not comply with support regarding maintaining his personal hygiene or in wearing clothing appropriate for the weather. The manager and staff at the home continue to try to address these issues. Two meetings have been held with local residents and the police community beat manager for the area. This has given opportunity for those concerned to Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 20 air their views and to gain insight into the service provided at the Belmar. A useful protocol, regarding police liaison has been developed. The arrangements for the safekeeping of money, alcohol and cigarettes have been greatly improved and now offer more protection to those living at the home. A new written policy is in place and each person has their own account sheet, recording income and expenditure. A number of these were viewed and show that two staff and the individual, where possible sign these records. It is important that these new arrangements are maintained, monitored and regularly audited. Some individual agreements are in place regarding set amounts of spending money to be given each day/at intervals during the week. Records are also kept of money spent at the ‘tuck shop’ and these too were viewed. The policy regarding safeguarding and protection has been supplemented with clear information regarding locally agreed procedures and reporting requirements. A number of people living at the home can display difficult challenging behaviour. Risk management strategies have been introduced, incidents are recorded and some staff have received relevant training. However improvements still need to be made. Training needs to be available for all staff, with regular refresher training. Improvements in the recording of incidents were discussed with the manager and would help staff understanding in this area and allow for risk management plans to be strengthened and further developed. Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 21 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 clean or decorated to a satisfactory standard, meaning that the home is not an attractive place to live. A major refurbishment programme is underway. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Belmar is undergoing a major refurbishment programme. Since the last key inspection the majority of the ground floor communal areas have been decorated and new carpets fitted. The usage of some living and dining rooms has changed, with there now being two lounges on one side of the main hallway and two dining rooms on the adjacent side. Some bedrooms have also been refurbished, with new flooring and furniture and other areas have been decorated. Externally the gardens have been given attention with new hedging being planted and bark chipping laid on the flowerbeds. Some trees have had to be removed due to roots causing damage. Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 22 The CSCI has been provided with copies of the plans for internal alterations, which will include making some bedrooms ensuite and the provision of a new bathroom/wet room. Due to these planned changes some areas have not yet been refurbished and this will be done following the internal building work. The manager anticipates that this work will commence very soon. Planning permission has been granted to build five new bedrooms, although there are no immediate plans for this work to be carried out. The manager explained that this may not result in an increase in numbers, as some rooms are being lost in the internal changes. The manager is aware that any proposed increase in numbers would require an application to be submitted to the CSCI. There are also plans to re site the laundry in the cellar and take down the existing laundry building at the rear of the home. Although major improvements have been made, there are still some areas of the home, which remain in a poor state of decoration, including bathrooms and bedrooms. The refurbishment programme must continue. Domestic staff are in post and night staff also have some responsibility for domestic tasks, with a cleaning rota in place. However, some areas of the home were not clean, including the conservatory, some bedrooms, some bathrooms/toilets and some corridors. This was discussed with the manager, who must ensure that all parts of the home are adequately cleaned. A designated worker carries out laundry duties at the home. There are sluice facilities and arrangements in place for the disposal of clinical waste. Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 23 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, 35 and 36 Quality in this outcome area is adequate. Qualification training is promoted and good recruitment procedures are in place. The lack of basic essential training could mean that some staff may not have the necessary skills for the work they perform. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff team consists of the registered manager, six qualified nurses, 16 care staff, an administrator and ancillary staff involved in kitchen, domestic, laundry and maintenance duties. One member of staff has responsibility for organising activities. The qualified nursing staff lead the care staff in their duties and the senior care staff also have a supervisory role. Rotas were viewed, showing that appropriate levels of nursing and care support were being provided. Some good practice was observed. A member of the team was responding with extreme patience when encouraging one individual to eat his meal and another was seen to use good distraction and calming techniques with someone who was becoming verbally aggressive. Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 24 Of the sixteen care staff; six have gained NVQ (National Vocational Qualification) at level 2 or above. Five staff are currently working towards gaining their NVQ, with some due to complete very soon. There are plans for four newly appointed staff to register for this training. One staff member explained that he had originally started work as a domestic but was now doing care duties and was working towards gaining his NVQ in Care. Ancillary staff also have opportunity to complete NVQ training appropriate to their role. The manager explained that all vacancies have now been filled and that it is no longer necessary to use agency staff at the home. This will help to promote consistency and stability for the people living at the Belmar. The records for two recently appointed members of care staff were viewed. All the required checks had taken place, including references and checks against the Protection of Vulnerable Adults register. Criminal Records Bureau disclosures had been applied for. One of these staff commenced duty on the second day of the inspection and it was clear that he was being closely supervised as he worked through his induction to the home with a senior member of staff. Although qualification training is promoted there is work to be done to ensure that all staff have the appropriate skills to undertake their duties. Discussions with staff and the manager confirmed that there has been little recent training at the home. Some of the team have undertaken moving and handling, dealing with aggression, food hygiene and infection control training but updated refresher training is required. A number of more recently appointed staff have not received basic health and safety training. A training matrix for the staff team has been compiled and the manager plans to introduce internal arrangements to address some areas of basic training using DVD’s and workbooks, which would then be assessed. Following the last key inspection all staff attended conflict management and breakaway training, however this has not yet been arranged for more recently appointed staff. An induction to the home is carried out with all new staff, as observed on the second day of the inspection, when a newly appointed staff member was working through this with a senior carer. The checklist for this induction was viewed and considered useful as an introduction to the home. A thorough induction programme in line with nationally agreed standards should be developed and introduced and all staff must receive training appropriate to the work they perform. Staff supervision is carried out informally within the team, with the manager, nursing staff and senior carers all having some responsibility in this area. Formal, recorded supervision should be introduced and used to promote and support the changes being introduced at the home. Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 25 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. Quality monitoring and quality assurance systems are not yet robust enough to ensure that improvements are maintained. Health and safety checks take place but the lack of staff training could compromise the health and safety of people living and working at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the 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 is a qualified Registered Mental Nurse, is registered with the CSCI and is currently undertaking the Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 26 Registered Managers Award NVQ level 4, which she aims to complete within the next two months. A full time administrator is employed at the home. During the past year, the focus has been on making improvements to essential elements of service provision. Following the last key inspection an improvement plan was submitted to the CSCI. Good progress is being made and it is vital that this momentum of change continues. The staff spoken to were happy with the changes made and commented that they now have more direction and do not just focus on practical caring and nursing tasks. Quality assurance and quality monitoring now need to be established. A survey has been devised, for distribution to those living at the home and their relatives. This will provide opportunity to gain feedback regarding the service provided at the Belmar. The manager, administrator and the area manager for the provider organisation have regular meetings. The manager has handover meetings with the nursing staff but full staff meetings are not taking place. The area manager carries out a monthly audit at the home, talks to those living there and examines certain records. A report of these visits is sent to the CSCI and is a useful way of monitoring progress with the improvement plan. It is important that the manager also carries out audit checks, such as with the medication practices and care plans. This will help to ensure that the improvements made are being maintained. Staff meetings would also be useful and would allow for staff to share their views and ideas regarding improvements at the home. The manager confirmed that recommendations made by the fire and rescue service and environmental health agency have been followed. Water temperature checks are now taking place and these records were viewed. It is advised that the actual temperature is recorded and not just a confirmation that the temperature has been checked. The records of the fire alarm checks were also seen, as was the gas safety certificate, the record of the hoist being serviced and the controlled waste transfer record. Not all staff have undertaken basic health and safety training, such as moving and handling and this should be addressed. Refresher training also needs to be provided on a regular basis. Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 27 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 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 2 12 2 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 2 X Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 28 YES 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. Standard YA20 Regulation 13 Requirement Medication must be administered and recorded appropriately, with monitoring checks taking place. Timescale for action 29/02/08 2. YA24 23 All parts of the home must be 01/01/09 well maintained and decorated to a reasonable standard. A reasonable standard of cleanliness must be maintained. All staff must receive training appropriate to the work they perform. Quality assurance and quality monitoring systems must be established. 29/02/08 31/08/08 3. 4. YA30 YA35 23 18 5. YA39 24 29/02/08 Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 29 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 care plan. Risk management plans relating to aggression should continue to be improved, with the use of a more proactive system of recording. Individual weekly plans, addressing personal development and incorporating domestic tasks, personal shopping and leisure/educational/social activities should continue to be put in place. Handwritten medication records should be checked and signed by two people. Medication not supplied in blister pack should be signed on opening. All staff should undergo appropriate training regarding handling aggression. There should be a comprehensive and timely induction programme for new staff. Staff should receive regular supervision at least six times a year and records maintained. The registered manager should gain a management qualification at NVQ level 4. The training programme for the home should include training in health and safety related topics. 2. 3. YA6 YA9 4. YA11 YA12 YA13 YA20 YA20 YA23 YA35 YA36 YA37 YA42 5. 6. 7. 8. 9. 10. 11. Belmar Nursing Home DS0000069174.V351425.R01.S.doc Version 5.2 Page 30 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.V351425.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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