Inspection on 21/05/08 for Belmont Castle

This inspection was carried out on 21st May 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Belmont Castle 09/02/09

Belmont Castle 08/05/07

Belmont Castle 05/02/06

Belmont Castle 25/04/05

Belmont Castle 08/11/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Belmont Castle Portsdown Hill Road Bedhampton Hampshire PO9 3JW Lead Inspector Craig Willis Unannounced Inspection 21st May 2008 9:30 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 Belmont Castle DS0000062222.V363534.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. Belmont Castle DS0000062222.V363534.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Belmont Castle Address Portsdown Hill Road Bedhampton Hampshire PO9 3JW 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) 023 9247 5624 023 924 50910 belmont@lrh-homes.com London Residential Healthcare Ltd Mrs Michelle Shann Care Home 40 Category(ies) of Dementia (40), Dementia - over 65 years of age registration, with number (40), Old age, not falling within any other of places category (40), Physical disability (6), Physical disability over 65 years of age (6) Belmont Castle DS0000062222.V363534.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. All service users must be at least 55 years of age A total of six service users may be accommodated in the PD and PD(E) category 8th May 2007 Date of last inspection Brief Description of the Service: Belmont Castle is set in three acres of well-maintained gardens. It is situated in a quiet residential area with views of Portsmouth and the Solent. Most of the bedrooms have en-suite facilities. There are two dining areas, two sitting rooms, a TV lounge and a small library area. The home has a shaft lift that services the three floors on which bedroom accommodation is situated. There are car parking facilities at the home. Current weekly fees range between £540 and £850 exclusive of personal items such as hairdressing, chiropody, newspapers and toiletries. Belmont Castle DS0000062222.V363534.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 2 star. This means the people who use this service experience good quality outcomes. The evidence used to write this report was gained from a review of the information the provider sent to us since the last visit and the previous inspection report. This information included incident reports and an annual quality assurance assessment. We also received completed surveys from seventeen people who live in the home. A site visit to the home was made on 21 May 2008. During the visit we spoke with people who live in the home, the manager and staff on duty. The communal areas of the building were viewed and documents relating to the running of the home were inspected during the visit. What the service does well: There are good systems to assess people’s needs before they move into the home and give them information about how the home operates. This helps to assure people that the home will be able to meet their needs. People’s needs are set out in care plans, which give staff most of the information they need to provide the right care. The home provides a good range of activities to meet people’s different needs and provides a choice of good food that people generally like. People are supported to keep in contact with their family and friends and visitors are made to feel welcome. The home has good systems to deal with complaints and respond to allegations of abuse. This gives people confidence that any complaints they make will be taken seriously and investigated. The home is well maintained and provides a homely, comfortable and safe environment that meets people’s different needs. There are enough staff working in the home at all times to meet people’s needs. The home is well managed by a qualified person, who supports staff to do their job effectively. There are good systems to assess the quality of the service provided and plan improvements. Belmont Castle DS0000062222.V363534.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Belmont Castle DS0000062222.V363534.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 Belmont Castle DS0000062222.V363534.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): Standards 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good systems to assess people’s needs before they move into the home and give them information about how the home operates. This helps to assure people that the home will be able to meet their needs. EVIDENCE: The manager reported in the annual quality assurance assessment for us that people have a full needs assessment before they are offered a place in the home. We looked at the files of six people who live in the home during the visit. Each person had an assessment of their needs that was completed before they moved into the home and was developed once they moved in. This assessment included people’s mobility, personal care, social, spiritual and cultural needs. Seventeen people who live in the home completed a survey for us; eight said they received enough information about the home before they moved in so Belmont Castle DS0000062222.V363534.R01.S.doc Version 5.2 Page 9 they could decide whether it was the right place for them. Of the nine people who indicated they did not receive enough information, five said they came to visit the home themselves or a relative dealt with their move into the home. The home does not provide intermediate care, therefore standard six is not applicable. Belmont Castle DS0000062222.V363534.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): Standards 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are set out in care plans, which give staff most of the information they need to provide the right care. The systems to manage people’s medication are generally good and help to keep people safe, however, they would be improved by more secure storage of controlled drugs. EVIDENCE: Following the last inspection, three requirements were made. These concerned the systems to keep people safe if they use rails to prevent them falling out of bed, assessment of the risk of people falling and injuring themselves and making sure that people are assessed by a health professional if they have been injured in a fall. These requirements have all been complied with. The files of six people who live in the home were inspected during the visit and all contained a care plan. Since the last inspection the manager has introduced a new care planning system and all the plans have been re-written Belmont Castle DS0000062222.V363534.R01.S.doc Version 5.2 Page 11 to provide clearer information on the care people need. The care plans had been developed from the initial needs assessments and set out how these needs should be met. Most of the plans clearly set out how staff should meet the person’s needs, although one of the plans inspected was vague in places. For example, the section on how the person may be affected by dementia states they “may be confused”, without giving specific information on what the person is likely to be confused about and how staff should provide reassurance and support. This was discussed with the manager during the visit who agreed that more information was needed in this section and reported that she would ensure this happens. The plans include an assessment of any risks identified, for example concerning people’s mobility or how they take their medication. The risk assessments contain action that should be taken to minimise the risks identified and had been updated as a result of incidents, for example after people have had a fall. The manager reported that no-one at the home currently needs to use bed rails to keep them safe and that new procedures have been implemented to ensure bed rails are only used following an assessment that they are safe and there is a system of regular checks. All of the care plans seen had been reviewed each month, with amendments made where people’s needs had changed. People had signed the plans where possible to indicate that they were involved in the care planning process. Staff spoken with said they found the information in the assessments and care plans to be accurate. Records inspected demonstrated that people have access to a range of health services, including GP, district nurse, dentist, chiropodist and optician. Records of visits were kept in people’s file and included any advice from the practitioner. These records demonstrated that people have been supported to access health services following a fall. Of the seventeen people who live in the home that completed a survey for us, fourteen said they receive the medical support that they need. One person said they would like to see their GP more often, but did not indicate that the home staff were preventing them. People who live in the home are able to control their own medication, following an assessment that this is safe. Where people are not able to, or don’t want to control their own medication, it is administered by staff who have completed training. Medication held by the home is stored in a locked trolley and cabinets and most tablets are provided in blister packs. A specific fridge is used for medication that must be refrigerated. The fridge is checked daily to ensure it is operating at the correct temperature. The medication administration record for the current month was inspected and had been fully completed. This gives a record of medication that has been received into the home and when staff have supported people to take their medication. At the time of the visit some people were prescribed controlled drugs. These were separately recorded in a controlled drug register, although they were not stored in a controlled drugs cabinet. The records for one person were checked and the balance recorded matched the tablets held. The regulations covering controlled drugs have Belmont Castle DS0000062222.V363534.R01.S.doc Version 5.2 Page 12 changed recently and they are now required to be kept in a specific controlled drugs cabinet. People spoken with said staff treat them well. During the visit staff were observed responding to people in a manner that maintained their privacy and dignity, for example waiting for a reply before entering a bedroom and providing discreet support to someone who was concerned they could not find the toilet. Belmont Castle DS0000062222.V363534.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): Standards 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a good range of activities to meet people’s different needs and provides a choice of good food that people generally like. People are supported to keep in contact with their family and friends and visitors are made to feel welcome. EVIDENCE: The home has a staff member responsible for co-ordinating the activities provided. As well as group activities, time is set aside for one-to-one activities, for example staff were supporting one person to file and paint their nails during the visit. Group activities include games such as cards and bingo, craft activities such as making greetings cards, visiting entertainers and outings. The activities co-ordinator had a good understanding of people’s needs and how activities should be planned to meet them. The home has an open visiting policy, with visitors able to come to the home at any time. People spoken with during the visit said their relatives were always made to feel welcome. Belmont Castle DS0000062222.V363534.R01.S.doc Version 5.2 Page 14 People spoken with said they were able to decide how they spent their time and what activities they took part in. People are able to practise their religion, with spiritual leaders made welcome in the home, for example so that people can receive communion. Support is also provided for people to travel to places of worship if they wish. The home has a menu that is planned for four weeks, with alternatives available on request. People spoken with said the food was good and confirmed they were able to have something different if they wanted. Details of people’s specific dietary needs were included in the care plans. Kitchen staff spoken with demonstrated a good understanding of these needs. Belmont Castle DS0000062222.V363534.R01.S.doc Version 5.2 Page 15 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): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has good systems to deal with complaints and respond to allegations of abuse. This gives people confidence that any complaints they make will be taken seriously and investigated. EVIDENCE: The home has a complaints procedure, which is included in the service users’ guide and displayed in the home. The home has received one complaint in the last year. This was from a relative and concerned the loss of personal items belonging to a person who lives in the home. The complaint was investigated and records were available of the findings. The person who made the complaint was written to with the findings of the investigations and the action that the home was going to take. The person making the complaint also contacted us, as they were not happy with the initial response to their complaint. Evidence was seen in the records that the person making the complaint was satisfied with the final outcome. People spoken with during the visit said they were confident any complaints they made would be taken seriously and investigated. Seventeen people who live in the home completed a survey for us; thirteen said they are aware of the home’s complaints procedures. Belmont Castle DS0000062222.V363534.R01.S.doc Version 5.2 Page 16 The home has procedures in place to respond to allegations of abuse and staff have received training in the safeguarding adults procedures. Staff spoken with demonstrated a good understanding of different types of abuse, signs that someone may be being abused and what to do if abuse is witnessed, reported or suspected. Belmont Castle DS0000062222.V363534.R01.S.doc Version 5.2 Page 17 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): Standards 19 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well maintained and provides a homely, comfortable and safe environment that meets people’s different needs. EVIDENCE: All of the home’s communal areas were inspected during the visit. All areas were clean and well maintained. The home is arranged in two wings, with a separate dining room and lounge in each wing. There is also a library and additional quiet lounge in the old part of the building. Each wing has a bathroom with an adapted bath and all but six of the bedrooms have en-suite facilities. There is a passenger lift to all three floors that are used by people who live in the home. People said the home is kept clean all of the time and their bedrooms were very comfortable and had all that they needed in them. One of the bedrooms is currently shared and had a screen to help people Belmont Castle DS0000062222.V363534.R01.S.doc Version 5.2 Page 18 maintain their privacy. The manager reported all people who occupy a shared room are offered a single room when one becomes available. All seventeen people who live in the home that completed a survey for us said the home was kept fresh and clean. The home has a maintenance person and staff reported that maintenance is completed quickly when required. There is a plan of refurbishment for all parts of the home. There is a large, well-maintained garden, with areas that are accessible to people with greater mobility needs. The home has a separate laundry room, with machines capable of washing soiled clothes if necessary. There are infection control procedures in place and hand washing facilities in the laundry room, kitchen, toilets and bathrooms. Staff are provided with protective clothing, for example gloves and aprons, and were seen using them during the visit. Belmont Castle DS0000062222.V363534.R01.S.doc Version 5.2 Page 19 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): Standards 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are thoroughly checked, well trained and employed in sufficient numbers to meet people’s needs. EVIDENCE: Following the last inspection two requirements were made concerning checks on staff before they work in the home and staff training. These requirements have been complied with. The home has seven or eight care staff between 8am and 6pm, four care staff between 6pm and 10pm and three or four care staff between 10pm and 8am. In addition there are domestic, maintenance, activities and administrative staff and the manager. People spoken with said they thought there were enough staff to meet their needs. Staff spoken with said they thought there were sufficient staff on all shifts. The manager reported that all staff working in the home have had suitable preemployment checks. The records of five staff employed in the last year were inspected and contained confirmation that a Criminal Records Bureau (CRB) disclosure had been obtained, confirmation that the person was not on the Belmont Castle DS0000062222.V363534.R01.S.doc Version 5.2 Page 20 protection of vulnerable adults (POVA) list as unsuitable to work in a care home and two written references. We also checked the records of six kitchen staff employed through an agency. These records also contained confirmation that they had been thoroughly checked before working in the home, including a CRB disclosure and POVA list check. Staff complete an induction when they start work, which is based on the skills for care common induction standards. Nineteen of the thirty-six care staff have completed the National Vocational Qualification in care at level 2 or above and ten are currently completing the award. The home has a training programme in place, with courses including first aid, food hygiene, fire safety, infection control, moving and handling, risk assessment, safeguarding adults, medicine management, continence and challenging behaviour. Since the last inspection additional training in dementia care and skin care has been provided to staff. Staff spoken with said they thought the training was relevant to their role and gave them skills and knowledge to meet people’s needs. People spoken with said staff had the right skills to meet their needs. Belmont Castle DS0000062222.V363534.R01.S.doc Version 5.2 Page 21 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): Standards 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed by a qualified person, who supports staff to do their job effectively. There are good systems to assess the quality of the service provided and plan improvements. EVIDENCE: Two requirements were made following the last inspection that fire risk assessments must be completed for people using the service and incidents affecting people’s well being must be reported to us. These have both been complied with. The manager returned to work at the home in February 2008 following a period of extended leave. She has a number of years management experience Belmont Castle DS0000062222.V363534.R01.S.doc Version 5.2 Page 22 and a management qualification. During the visit the manager demonstrated her knowledge of the service and a commitment to ensure that the service continues to improve. Staff spoken with said they receive good support from the manager. A senior manager from the company visits the home each month to assess the quality of the service provided. Reports are made of these visits and sent to the manager. The reports contain details of any actions that are required and these are followed up at the next visit, including whether any requirements from inspection reports have been complied with. People who live in the home and their relatives are regularly consulted about the quality of the service provided, through both meetings and surveys. The results of these consultations and regular audits are used to plan improvements to the service. The manager reported that she does not have a formal development plan and agreed to look at whether one would help with her planning. The home looks after money for people to keep it safe, but the manager does not operate any accounts or act as an appointee for anyone. The money of three people was checked and found to match the records. Receipts were available and the money was individually stored in the safe. The manager reported in the annual quality assurance assessment that most equipment in the home is regularly serviced and checked to ensure it is safe. During the visit we sampled servicing records for the fire alarm and extinguishers, gas system and the lifts, which had all been serviced on time. The home’s electrical circuits were due for their five-year test in September 2007, but this has not yet been completed. The manager reported this had been delayed due to planning for other building work but agreed to arrange the tests as soon as possible. Individual fire risk assessments have been completed for everyone who lives in the home. These documents assess whether there are any specific risks people face, for example their mobility or actions that may pose a fire risk, and includes what action staff should take to minimise the identified risks. A record is kept of accidents and incidents in the home and the action that has been taken as a result. Where appropriate, the home has informed us of the event. Belmont Castle DS0000062222.V363534.R01.S.doc Version 5.2 Page 23 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X 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 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Belmont Castle DS0000062222.V363534.R01.S.doc Version 5.2 Page 24 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 OP9 Regulation 13(2) Requirement Controlled Drugs, including Temazepam, must be stored in a Controlled Drugs cupboard complying with the Misuse of Drugs (Safe Custody) Regulations 1973. Timescale for action 21/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Belmont Castle DS0000062222.V363534.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Belmont Castle DS0000062222.V363534.R01.S.doc Version 5.2 Page 26 - 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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