CARE HOMES FOR OLDER PEOPLE
Belmont View Hailey Lane Hailey Hertford Hertfordshire SG13 7PB Lead Inspector
Mr Neil Fernando Unannounced Inspection 3rd May 2006 9:55 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 View DS0000019286.V293465.R01.S.doc Version 5.1 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 View DS0000019286.V293465.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Belmont View Address Hailey Lane Hailey Hertford Hertfordshire SG13 7PB 01992 450304 01992 459067 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) www.quantumcare.co.uk Quantum Care Limited Care Home 60 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (60), of places Physical disability over 65 years of age (60) Belmont View DS0000019286.V293465.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th January 2006 Brief Description of the Service: Belmont View is a care home providing personal care and accommodation for 60 older people, including those with a physical disability and or dementia. It is owned by Hertfordshire County Council and operated by Quantum Care Limited. The home is situated on the outskirts of Hoddesdon, with local shops a short distance away. The home was opened in 1996; it is purpose built and consists of a two storey building with two units for 15 people on each floor. All the bedrooms are single and have toilet en-suite facilities. There is a passenger lift to access both floors. There is a large garden that is well maintained and landscaped in order to provide access to all parts. The weekly placement fee for each service user is between £ 400 and £580. Belmont View DS0000019286.V293465.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the first inspection for the inspection year 2006/7. The last inspection was carried out on 18.01.06. Belmont View is one of many care homes managed by Quantum Care Limited in the Hertfordshire area. It is registered to accommodate a maximum of 60 older people, including those with a physical disability and or dementia. At the time of the visit, there were 59 service users including 3 for respite care in residence. The site visit element of this inspection lasted for just over 4.5 hours during which time 14 service users, 2 visiting relatives, 8 staff members including the Manager were spoken to. A number of records were examined and a tour of the premises was also undertaken. What the service does well:
The inspection main finding is that all of the Standards assessed on this occasion bar four, have been achieved. The home’s assessment and admission process is robust thus ensuring that the residents’ needs could be met on admission to the home. Evidence indicates that the care planning process and monthly review system, involving the service user and significant others are being implemented to good effect. Staff members including the Manager were able to demonstrate how care is planned and reviewed to address the identified needs of individuals, who require complex health and social care. Service users appeared to be comfortable and received care and attention in a timely and sensitive manner. Residents’ interests, expectations and aspirations are being sought by staff members and fulfilled as appropriate. The catering facilities appeared to be managed and delivered to the satisfaction of the resident group. Service users are treated with dignity and respect, and their right to privacy, upheld. The home is comfortable and a high standard of cleanliness was maintained. In spite of many service users being mentally frail, there is very good evidence to show that they are encouraged to make it their home, through inclusion in decision-making and encouragement to personalise individual rooms. There are well-established systems including the management of complaints, adult protection and staff recruitment to ensure the safety of service users. Belmont View DS0000019286.V293465.R01.S.doc Version 5.1 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. Belmont View DS0000019286.V293465.R01.S.doc Version 5.1 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 View DS0000019286.V293465.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5. Standard 6 is not applicable. The home’s assessment and admission process is robust, which ensures that the service user’s identified needs could be met on admission. It is also good to note that the service user and significant others are being proactively encouraged/supported in the decision-making process. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be good. EVIDENCE: The home has an up-to-date statement of purpose and a service user’s guide to the home. Evidence available indicates that a copy of the guide is made available to the service user, their representative and professionals, as appropriate. A service user guide was seen and some residents spoken to, said that they have read it and appropriate assistance was also offered by their respective key worker where clarification was required. Good evidence is available to demonstrate that Standard 1 has been exceeded. The case records for 8 service users were examined and these include comprehensive details of the completed pre-admission assessment undertaken by a care staff and a member of the home management team. Information
Belmont View DS0000019286.V293465.R01.S.doc Version 5.1 Page 9 gained shows that the arrangements to enable service users and their relatives/friends the opportunity to visit and make an informed decision about the facilities offered at this establishment is satisfactory. They would spend time looking around, speaking to service users and staff members, and seek clarification on any issue arising. Service users are admitted on a trial basis to give them ample opportunity to decide if they want to stay; this process also provides the home’s staff time and opportunity to further assess the needs of the service user. A review meeting is held at the end of the trial period (approximately 4/6 weeks) with the service user, relatives and placing authority, and only then the placement is made permanent. Service users and significant others are being empowered to participate in the decision making process, on issues that matter to them. Belmont View DS0000019286.V293465.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. All aspects of health and personal care are being delivered appropriately; some care plans need attention. The administration and control of medication ensures the well being of service users. Residents are being treated with dignity and respect and their privacy, guarded. The overall impression gained is of a service user group well cared for. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be good. EVIDENCE: Care plans were viewed for 14 service users; in the main, they reflected a good level of information with respect to the identified needs of the residents. The care plans are very clear and easy to follow. They are very personalised and give a good picture of the service users’ needs and their personality. It is however noted that the social, recreational and cultural needs and religious preferences were not included in 5 of these care plans; a recommendation has therefore been made. Service user’s spoken with reported that their needs were being well met; they provided some good examples of how staff members assist them to meet their needs. Belmont View DS0000019286.V293465.R01.S.doc Version 5.1 Page 11 Identified health care needs are being addressed and observations are maintained, in order to respond quickly to any change; as noted from the daily record of relevant occurrences. Care plans are being reviewed monthly to reflect changing needs and objectives for health and personal care. Minutes of monthly reviews are noted to be comprehensive and well documented. The staff team including the Manager are to be commended for their hard work and effective implementation of the monthly review system. All residents are registered with a GP from three local group practices. Service users also enjoy full support from the local community health services. At the time of the inspection, there were 4 residents who were receiving daily visits from District Nurses. Medication is appropriately stored and administered. At present, no service user administers their own medication although the home would support anyone who wishes to and is able to do so. Medication records (MAR sheets) for 14 residents were examined and these are noted to be in good order. Throughout the inspection, staff members were seen to be courteous and the interaction between staff and service users, very pleasant and relaxed. Staff treated service users with respect at all times and all aspects of their privacy and dignity were assured – this is a fine example of a very good practice and Standard 10 has been exceeded. Belmont View DS0000019286.V293465.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Service users are very clear that the home matches their expectations and preferences. Social contact with family and friends is good. The food offered is of a good quality and is served in comfortable settings. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be good. EVIDENCE: Consistent with the previous inspection report, service users are being assisted to follow the lifestyle of their choice as discussed and agreed at the time of their assessment. Information gained from records, 14 residents and 2 visiting relatives clearly indicates that they are extremely satisfied with their lifestyle at Belmont View. Staff members have good expertise to proactively support the social life of residents, in particularly those with dementia. Overall, good evidence is available to show that Standard 12 has been exceeded. Service users and 2 relatives confirmed that relatives and friends are able to visit residents at any time and they are always made welcome. Many service users retain several past contacts, from whom they receive visits. They are able to entertain their visitors in the communal areas, the grounds or their own bedroom, if they so wish. Representatives from the local church visit the home and provide for spiritual expression and friendship.
Belmont View DS0000019286.V293465.R01.S.doc Version 5.1 Page 13 Many service users are quite articulate and very able to raise various issues that matter to them. Unfortunately, “residents meetings” have not occurred for a significant period of time. Service users felt that they would benefit from regular meetings, in order to discuss their wishes and feelings on issues that matter to them. This aspect of communication system should be reintroduced as this would demonstrate that service users are being encouraged to echo their wishes and feelings, thus influencing the decision making process. Information gained from staff, service users and examination of care plans and menus indicates that service users and their relatives are consulted regarding residents’ culinary likes and dislikes. Service users are involved in menus planning; Menus lists viewed suggest that the variety and quality of food offered at this home is of a good standard. Many service users said that alternative meals are provided if they don’t want the meals on the menu. Service users expressed a good deal of satisfaction with respect to food available to them. Belmont View DS0000019286.V293465.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The complaint procedures are well advertised and relatives and significant others should be able to make a complaint. Also, the systems in operation should offer adequate protection to service users. Once the remaining staff members receive essential training on Adult Protection, it would reinforce the existing systems, which would further ensure the safety of service users. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be satisfactory. EVIDENCE: Staff members interviewed including the Manager demonstrated an understanding of the procedures and their responsibilities towards ensuring that any complaint is dealt with speedily and satisfactorily. Information is available to service users, relatives and professionals on how to make a complaint and how the home intends to deal with it. Service users and relatives spoken with displayed confidence in that they would be able to make a complaint, if they dissatisfied with any aspect of the service. Given the mental frailty and dementia level of other service users, it has not been possible to gain any accurate information on their views and experience on the subject. The home has received two complaints since the last inspection in January 2006; these have been dealt with satisfactorily. The whistle blowing policy is available and accessible to the staff team. The home also had procedures on the protection of vulnerable adults. Discussion on the procedures is part of the induction for all new staff members and this subject is also included in the NVQ assessment for those members undertaking this course. It is commendable that over half of the staff including members of
Belmont View DS0000019286.V293465.R01.S.doc Version 5.1 Page 15 the management team has received training on Adult Protection. This essential training should be extended to the remaining members as well. Belmont View DS0000019286.V293465.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. The environment is safe and well maintained and service users live in comfortable surroundings. The home is pleasant and the standard of cleanliness maintained is of a commendable standard. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be good. EVIDENCE: The communal areas and bedrooms are decorated and furnished in a style to reflect the period features of the building - the corridor areas are decorated with mirrors and attractive paintings. Many of the rooms look out onto the front yard and gardens to the sides. All areas viewed are accessible and well maintained. Bedrooms viewed provide evidence of the occupant’s belongings and other personal effects. New kitchens and flooring have been installed on each of the units in the previous year. A rolling programme of maintenance and redecoration is in place and this ensures a good standard of physical environment. Belmont View DS0000019286.V293465.R01.S.doc Version 5.1 Page 17 The structure of the building internally and externally remains satisfactory. Overall, the accommodation generates a warm and domestic atmosphere; service users appeared to be happy and comfortable with their physical environment. A high standard of cleanliness was evident throughout those areas viewed. Although a significant number of residents were incontinent, there were no mal-odours present. This is quite an achievement; the domestic staff team are to be commended for their hard work. Suitable arrangements are in place for the storage and collection of domestic and clinical waste. Belmont View DS0000019286.V293465.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The establishment continues to provide the staffing levels required by day and night, and service users’ needs are being addressed. The recruitment process for staff is robust, which means that service users are in safe hands. NVQ assessment for staff should be given a higher profile. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be good. EVIDENCE: On the day of the inspection the home was adequately staffed; Staff duty rota viewed for the period between 8.04.06 and 5.05.06 reflected a pattern of good staff cover for the day and night shifts. In addition to the care staff team, the home has administration, maintenance, catering and ancillary staff members, and these arrangements remain satisfactory. Training profiles for individual staff members are maintained and training received, recorded. Records for 4 members show that they have received mandatory training and a variety of other courses have been attended, including Basic and Intermediate Dementia. There are 9 staff members who have completed NVQ Level 2 or equivalent. Another 14 members are currently undertaking the same assessment. The home has therefore achieved a ratio of 18.3 of care staff with an NVQ Level 2 or equivalent. A recommendation is therefore made. Robust recruitment practices are observed to offer protection to service users and staff, in line with legislation; all documentation including CRB and POVA
Belmont View DS0000019286.V293465.R01.S.doc Version 5.1 Page 19 checks was maintained on the staff files; a sample of 6 files including those for the 2 latest recruits were viewed. Belmont View DS0000019286.V293465.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 36 and 38. Management systems are being implemented to good effect, which means that staff members are being appropriately supported and managed. Implementation of the requirement/recommendation identified would, no doubt, further promote the health, safety and welfare of service users and Staff. Based on available evidence including a visit to this service, the quality in this outcome area is judged to be satisfactory. EVIDENCE: The Registered Manager left on 1.04.06 for another post within the organisation. The previous Deputy manager has taken on the responsibility for managing this establishment since 1.02.06. He has been a member of the management team for 3.5 years. The Manager reported that a recruitment drive is in progress to fill the Registered Manager’s post. Information gained from 7 staff members spoken with indicates that formal supervision of staff is taking place within the stated frequency and staff
Belmont View DS0000019286.V293465.R01.S.doc Version 5.1 Page 21 meetings, regularly. The management systems are transparent and service users and staff members reported that the management team are very supportive. The home has good procedures to ensure the health and safety and welfare of service users and staff. Risk assessment of the physical environment is carried out as appropriate. As indicated earlier, mandatory training has been provided. The fire alarm system including smoke detectors and emergency lighting is serviced within the required frequency. Fire drills are taking place monthly and weekly tests of break-glass have been carried out, and records maintained as required. However two observations are made: a) Night staff members have not participated in any fire drill; fire drills are not held at night times; b) Whilst the Manager reported that hot water temperature is tested, a record had not been maintained. The Manager is aware that remedial actions are required. Belmont View DS0000019286.V293465.R01.S.doc Version 5.1 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 4 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 X X X X X x 4 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x 3 x 2 Belmont View DS0000019286.V293465.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? N/A 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 OP38 Regulation 23 (4) Requirement The Manager must ensure that: i) Night staff members participate in some fire drills; ii) Some fire drills are held at nighttimes, as appropriate. Timescale for action 30/06/06 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 OP7 Good Practice Recommendations The care plan should reflect the identified social, recreational and cultural needs and religious preferences of the service user. “Residents’ meetings” should be initiated to encourage/assist them to exercise choice and control over their lives. Essential training on Adult Protection should be made accessible to the remaining staff members who have not received this training.
DS0000019286.V293465.R01.S.doc Version 5.1 Page 24 2 OP14 3 OP18 Belmont View 4 5 OP28 OP38 NVQ assessment for staff should be given a higher profile. Maintain a record of hot water temperature tests. Belmont View DS0000019286.V293465.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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