This inspection was carried out on 1st November 2006.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.
The inspector made no statutory requirements on the home as a result of this inspection
and there were no outstanding actions from the previous inspection report.
CARE HOMES FOR OLDER PEOPLE
Belmont House Love Lane Bodmin Cornwall PL31 2BL Lead Inspector
Elaine Bruce Key Unannounced Inspection 1st November 2006 09:15 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 House DS0000038589.V313389.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 House DS0000038589.V313389.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Belmont House Address Love Lane Bodmin Cornwall PL31 2BL Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01208 75057 01208 78836 belmont@almondsburycare.com www.almondsburycare.com Almondsbury Care Limited Mr Paul Seels Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (40) Belmont House DS0000038589.V313389.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. Service users to include up to 40 adults aged over 65 with dementia (DE(E)). Service users to include up to 40 adults aged over 65 with a mental illness (MD(E)). Variation in age in respect of one named person under 65 years Additional variation in respect of one named person under 65 years with Dementia (DE) Total number of service users not to exceed a maximum of 40 Date of last inspection 10th November 2005 Brief Description of the Service: Belmont House is a large mature property with a purpose built extension on the outskirts of Bodmin. The home is situated in a pleasant residential area and provides nursing care for older people with a dementia or a mental disorder. Car parking is available in the grounds of the home. The grounds include attractive gardens with a patio area. Accommodation is spread over three floors with an inter-connecting shaft lift available if required. The top floor of the home provides bedroom accommodation only. The ground and first floor have bedrooms and communal areas. Security in the home is supported by the use of key pads which allow the service users freedom of movement on each floor of the home. Belmont House DS0000038589.V313389.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The key inspection at Belmont House took place on the 1st November 2006 over 7 hours and was carried out as an unannounced inspection. Care records, staff files and essential maintenance documentation was inspected as well as the premises. Staff and visitors to the home were spoken to during the course of the inspection. Direct feedback (on standards in the home) from the service users is difficult to obtain due to their high care dependency levels. The registered manager was spoken to at the commencement of the inspection and the deputy manager assisted the inspector during the course of the day. A representative from Almondsbury Care Limited spoke to the inspector on the telephone on the afternoon of the inspection. Some information for the inspection was gathered via the pre inspection questionnaire completed by the home prior to the inspection. The weekly current scale of charges for care at Belmont House is from £467 to £733. What the service does well:
During the course of the day four visitors to the home were spoken to. Each visitor expressed very positive comments on the kindness of the staff who are looking after their relative. The relatives/representatives have been asked to provide information in the form of a life history. This information is very important to build a picture of the service user and help understand the complex and difficult situations that can arise at the home due to the dementia/mental health needs of the service users. Some of the service users at Belmont House have very complicated care needs. The training and support that the staff receive enables them to care for these service users which is a credit to the staff and management team. Belmont House DS0000038589.V313389.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 House DS0000038589.V313389.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 House DS0000038589.V313389.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s statement of purpose and service user guide documentation (as well as a brochure) provide prospective service users/family with details of what the home provides helping an informed decision about admission to the home. Senior management staff are involved in the service user pre admission assessment procedure to ensure that the home will be able to meet their care needs. EVIDENCE: The home has a statement of purpose document in place that meets all the requirements of The Care Homes Regulations (2001). The statement of purpose document is available in the home as well as the service user guide. It
Belmont House DS0000038589.V313389.R01.S.doc Version 5.2 Page 9 was noted that some small updating is required to include changing the organisation of the National Care Standards Commission to the Commission for Social Care Inspection. The documentation states that all service users have a right to an anti-discriminatory service. In addition to the statement of purpose and service users guide a brochure is available which gives detailed information on Belmont House. The Company that owns the home has also set up a web site with information about Belmont House with a link to the CSCI website where the most recent inspection report can be accessed. All documentation on Belmont House is provided to the service user and or their family member or representative. All potential new admissions to the home are assessed by the registered manager or one of his senior nursing staff prior to admission. A pre admission assessment document is then completed and signed and dated as required for the National Minimum Standards. Where the assessment has been undertaken through care management arrangements the manager accesses a summary of the assessment. Belmont House is providing a specialised service for service users with a dementia and all staff receive regular training in this area by one of the senior nursing staff members. Documentation also shows that staff have access to detailed guidance and training materials. Documentation is in place to evidence that service users and their representatives are welcome to visit the home prior to admission. There is also a policy and procedure in place to guide staff on the full pre admission process. Belmont House DS0000038589.V313389.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service user’s health, personal and social care needs are being met by the staff and multidisciplinary staff as required. Visitors commented that their relatives were treated with kindness, respect and dignity. EVIDENCE: Each service user has a care plan in place. Each care plan includes a large amount of information to include a risk assessment, current mental health needs assessment and moving and handling assessment for example. There is evidence of regular monthly reviews of the care plans taking place and the daily records that complement the care plans are good. Relatives/representatives have been involved in care planning with important
Belmont House DS0000038589.V313389.R01.S.doc Version 5.2 Page 11 information being provided to the home in the form of a life history. In addition to the care plans the care staff record the daily personal care delivery (to each service user) and fluid intake of particular service users who are at risk. It was noted that there were some gaps in information in these important fluid intake records which should be addressed. It was also noted that at this time the documentation suggests that weekly baths are the routine. Consideration should be given to reviewing this to ensure that this is meeting the needs of all the service users. Health care needs are identified in the service user care plan and how the home is meeting these needs. In addition other health care information/services to include chiropody and optician for example are documented. Evidence is in place that the service users are being weighed regularly. Each service user is registered with a general practitioner. A good nutritional screening tool is being used to identify service users who may be at risk of malnutrition. During the course of the day four visitors were spoken to. Each of these visitors spoke positively about the kindness of the staff to their relative and how they are made to feel very welcome when they visit the home. Particular attention is given to ensuring privacy and dignity when delivering personal care. The home operates a key worker system so that staff member can build up a special relationship with that service user. It was noted that consideration had been given to improving communication with a service user whose first language is not English. The home has in place a policy and procedure on death and dying to guide staff in this sensitive area. In care planning documentation information is gathered on the future wishes of the service user under the heading of “saying goodbye”. Belmont House DS0000038589.V313389.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides the service users with opportunities to meet their social care needs. Visitors to the home are encouraged and welcomed. Family and representatives are encouraged to provide information on the service users to help the staff support the service users in making choices. The meals provided at the home are good with special diets catered for and healthy eating encouraged. EVIDENCE: The staff at Belmont House have worked considerably hard to gather life history information on each service user. This information is nicely collated in a “life history” book. It is from this life history book that the social care needs of the service users are identified. A social activities diary is kept which evidences that the identified social care needs of the service users are being
Belmont House DS0000038589.V313389.R01.S.doc Version 5.2 Page 13 met. An example of the regular visiting activities that are taking place include an accordion player, guitar and singing for example. Staff facilitate a number of regular activities at the home for example skittles. The home are presently planning social activities for the Christmas period. The home is supported by a very good league of friends who fund raise on behalf of the home and make purchases for the home to the benefit of the service users. Records evidence the regular visitors to the home and it was noted during the course of the inspection that all visitors to the home are welcomed by the staff. Four visitors who were relatives of the service users were spoken to during the morning of the inspection. All the visitors expressed very positive comments about the care that their relative is receiving. All visitors to the home are asked to sign the visitors’ book in the entrance of the home. The main meal at the home on the day of the inspection was chicken wrapped in bacon with sweet corn, cabbage, gravy and boiled potatoes. This was to be followed by syrup sponge and custard. The main meal of the day is at midday. An alternative meal is always available to include a healthy options choice. On the day of the inspection the alternative meals included a vegetable stew or choice of salads. The alternative sweet available was apricot and custard or fresh fruit or yoghurt. The home has recently included a continental breakfast choice twice a week to make a change from the cooked breakfasts that are also provided. The home employs two cooks and a kitchen assistant over seven days of the week. One of the cooks has obtained her intermediate food handling certificate qualification. The other cook and kitchen assistants have obtained their basic food hygiene certificate. A recent inspection of the kitchen by the District Council Environmental Health Officer concluded that the standards in the kitchen were good. The staff were noted to be attentive when helping the service users with their drinks and meals. Belmont House DS0000038589.V313389.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure provided to the service users/representatives in the service user guide and displayed in the home. The home has in place adult protection policy and procedures and training to provide staff with the knowledge and understanding of adult protection issues to protect service users from abuse. EVIDENCE: The home has a complaints policy and procedure that is clearly displayed in the entrance of the home. The complaints policy and procedure is also available in the service user guide. This documentation is formal and it is suggested that the policy and procedure that is on display is provided to the service users and their representatives. The home has not received any complaints since the last inspection report. The home has in place a policy and procedure on adult protection. Policies and procedures are available to all staff in the office and the adult protection and procedure is individually issued to staff. Documentation is also available on whistle blowing. Adult protection training includes the watching on an adult protection video. Some staff have attended the adult social care department
Belmont House DS0000038589.V313389.R01.S.doc Version 5.2 Page 15 adult protection training and it is recommended that more staff receive training in this important area. It is also recommended that updated adult protection procedures are accessed from the local adult social care department. Belmont House DS0000038589.V313389.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Belmont House is a well maintained environment providing service users with a comfortable and safe place to live. EVIDENCE: Belmont House is positioned in a residential area just outside Bodmin. The facilities that Bodmin has to offer can therefore be easily accessed. Car parking is available at the home. Belmont House is a well maintained home with a staff member specifically employed for these duties. There is a rolling programme to improve the
Belmont House DS0000038589.V313389.R01.S.doc Version 5.2 Page 17 decoration, fixtures and fittings and considerable improvements to the whole environment have taken place over the last year. The home has a number of single bedrooms as well as a number of double bedrooms. Bathing facilities have recently been upgraded. Communal space includes three lounges and a dining room. The home was found to be clean on the day of the inspection although it was noted that odour control could be improved in the entrance and main corridor of the home. During the course of the inspection it was noted that although considerable improvements to the environment have taken place more attention could be given to following good practice guidance on environments for service users with a dementia. For example each bedroom in an area of the home has the same coloured duvet and bedroom doors are the same colour. These are small examples where a client centred approach has not been taken. Belmont House DS0000038589.V313389.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are appropriate to meet the needs of the service users. Staff training is ongoing. Correct recruitment procedures should be followed at all times to ensure the safety and well being of the service users. EVIDENCE: Staff work a variety of shifts to include twenty four hour cover with a qualified nurse always on duty. It is noted that the staff team to include management are a very stable team and where there has been agency cover used it has been consistent with the same staff. On the day of the inspection recruitment procedures for one staff member had not been followed correctly. This can place service users at risk and recruitment procedures should be reviewed. The home has in place equal opportunity guidance procedures for the recruitment of staff. The recruitment of overseas staff has worked very well at Belmont House.
Belmont House DS0000038589.V313389.R01.S.doc Version 5.2 Page 19 Staff members receive an induction training when they join the home. This training includes in house specialised training on meeting the specialised care needs of the service users at the home. The management team recognise the importance of a skilled, trained work force. Statutory training is taking place regularly to include moving and handling, first aid and fire drill training. It is recommended that where possible more staff undertaken NVQ 2 training in care. During the inspection the visitors to the home spoke about the kindness of the staff. Staff spoken to during the course of the inspection presented as kind and caring although very busy. Belmont House DS0000038589.V313389.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is supported well by the senior staff in providing clear direction and leadership throughout the home. EVIDENCE: The registered manager is a long standing staff member supported by a long standing senior management team. He works to continuously improve services and provide an increased quality of life for the service users. The manager is a qualified nurse and is undertaking his registered managers award studies. It is recommended that a management qualification is obtained as
Belmont House DS0000038589.V313389.R01.S.doc Version 5.2 Page 21 soon as is possible. The manager is fully aware of current developments both nationally and by CSCI and plans the service accordingly. The manager is supported in his duties by two senior staff members who each have been given specific tasks and duties. One of these senior staff members has obtained her registered managers award. A representative from the Company regularly visits the home as per their statutory duties. They provide support to the home with the development and implementation of quality assurance systems and policies and procedures. Staff are involved in regular meetings which are minuted. A meeting has recently taken place and the home plans to have these approximately every two months. Where finances are held on behalf of service users records are in place to evidence ingoing and outgoing expenses. The home has a good record of meeting relevant health and safety requirements and legislation. A central file is held in the home with all contracts in place for the maintenance of all equipment in the home. Belmont House DS0000038589.V313389.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Belmont House DS0000038589.V313389.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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. 2. 3. 4. 5. 6. Refer to Standard OP7 OP16 OP18 OP28 OP29 OP31 Good Practice Recommendations To ensure that all documentation in regard to the service users is completed accurately to include the fluid intake records. To provide the complaints policy and procedure that is on display to the service users and their representatives. To provide external adult protection training to as many staff as is possible. To encourage more staff to undertake NVQ training. To follow the correct recruitment procedures at all times. For the manager to obtain a management qualification as soon as is possible. Belmont House DS0000038589.V313389.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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
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