Inspection on 02/05/07 for Belvedere Lodge

This inspection was carried out on 2nd May 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Belvedere Lodge 24/09/09

Belvedere Lodge 05/10/07

Belvedere Lodge 27/07/06

Belvedere Lodge 22/11/05

Belvedere Lodge 12/04/05

Belvedere Lodge 08/09/04

Belvedere Lodge 01/04/04

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

CARE HOMES FOR OLDER PEOPLE Belvedere Lodge 1 Belvedere Road Westbury Park Bristol BS6 7JG Lead Inspector Vanessa Carter Key Unannounced Inspection 2nd, 15th and 31st May 2007 16:00 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 Belvedere Lodge DS0000026496.V341698.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. Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Belvedere Lodge Address 1 Belvedere Road Westbury Park Bristol BS6 7JG 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) 0117 9731163 0117 9691973 sam.hawker@blueyonder.co.uk Willcox Bros Ltd t/a Ablecare Homes Mr John Willcox Care Home 20 Category(ies) of Dementia - over 65 years of age (20) registration, with number of places Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Those residents currently accommodated, who do not have a Dementia, may continue to live at the home as long as their needs are met No new residents will be admitted in the OP category The agreed action plan is implemented to agreed timescales Date of last inspection 27th July 2006 Brief Description of the Service: Belvedere Lodge is a care home registered with the Commission for Social Care Inspection to provide accommodation and personal care to 20 persons aged 65 years and over with a Dementia. Although the registration relates to 20 persons with a Dementia, a condition of the registration permits those persons presently accommodated who may not have a dementia to remain accommodated in the home, as long as the home can meet their needs. All new admissions will focus on persons who have a Dementia. The home is situated in a busy suburb of Bristol convenient to local shops and amenities. It is a period property and adapted to meet the needs of the residents, with provision of a stair lift, ramped access, level rear gardens, and an environment aimed at ensuring those persons with a Dementia feel comfortable. The home is owned and operated by Ablecare Homes, and the manager, Mr John Willcox, is one of the proprietors of the business. The cost of placement at the home is between £425-475 per week and is dependent upon assessed need. Additional costs are made for a range for services and these are detailed in the Homes Brochure. Prospective residents are able to find about the home by requesting a copy of this from the Home Manager. Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is an unannounced key inspection report. Three separate visits were made to the home throughout the month. The manager was present during the inspection and was supported by an Ablecare Homes Director and the Deputy Manager – all participated in the inspection process. Evidence was gained from a whole range of different sources, including: • Information provided by an Ablecare Homes Director in the preinspection questionnaire • Information taken from resident and relative survey forms • Directly speaking with a number of residents • Case tracking a number of residents • Speaking with care staff • Observation of staff practices and interaction with the residents. • A tour of the home • Examination of some of the homes records • A very detailed study of particular records following serious concerns being raised • Information that has been received by CSCI since the last inspection, from Adult Community Care Services and Healthcare professionals. The overall analysis is that the home has major shortfalls in a number of areas. Improvements must be made in the quality of life provided to some of the residents, and some of the management processes in the home. A number of requirements have been made as a result of this inspection and although a timescale of action has been given for two weeks, feedback was given to the manager and the director at the end of the visit, and there is an immediate expectation that the resident’s safety and welfare is maintained. What the service does well: Care planning processes are generally satisfactory, and residents receive the care they need. They are well fed and are provided with a variety of different meals. The home is comfortable and well decorated and well furnished. Most residents have their own bedrooms and en-suite facilities. Good meals There is a stable and loyal workforce which means that residents will be cared for by staff who are familiar with their needs. Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The information provided about the home should always be readily available for residents, and any prospective residents, otherwise they will not know what facilities and services the home state they will offer. The home must ensure that their pre-admission processes identify those circumstances where living in the home, is not deemed to be appropriate. Placement should only be offered to those whose needs can be met. Care planning is generally satisfactory but documentation must be revised whenever the need arises, to ensure they are always kept up to date. Care plan must include proper guidance for staff to follow and must be supported by robust risk assessment processes that will safeguard a resident from coming to any harm. Healthcare advice must always be promptly sought and medication systems must be safely managed. Improvements must be made with the quality of life for all residents. Any activities are arranged on an ad-hoc basis and there is no individual planning for things that each resident might like to do. Staff interact better with those residents with a lesser degree of dementia and the others are very much left to their own devices. The home must ensure that residents always have access to immediate help should they need it. Staff should always be available in the main house. All staff must receive manual handling training prior to being expected to move and transfer residents as part of their role. This will ensure that residents are not placed at risk of being harmed by staff who are not competent. The home needs to be run better to ensure that all regulations and national minimum standards are met, that the best quality care is provided, that staff work within the homes policies and procedures, the records are all well maintained and that the home is a safe place to live and to work. Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 7 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. Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 8 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 Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 9 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, 4 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements must be made in the homes pre-admission assessment processes so that if placement is arranged, new residents can be assured that the home will be able to meet their specific needs. EVIDENCE: The statement of purpose has been updated recently to incorporate recent changes within Ablecare Homes. A copy was not available in the home at the start of the last day of inspection, therefore was not initially available for inspection. It was eventually produced. If this had been requested by a prospective resident this would not have given a good impression of the home. The document covers all five Ablecare Homes and although it does contain all information as detailed in the National Minimum Standards, it may be appropriate to expand on the services available in Belvedere Lodge, for residents with a dementia. Also, in respect of the complaints procedure, the contact details for the Commission for Social Care Inspection (CSCI) needs to be included. A copy of the service users guide was seen in one bedroom. All Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 10 resident and relative survey forms stated that a copy of the service users guide had been provided, enabling them to make a choice about the home. As part of the inspection process, the pre-admission assessment of the newest resident was examined. This person had been transferred from another of the Ablecare Homes due to deteriorating cognitive impairment. The home has a good assessment tool that covers all aspects of personal and healthcare support, mobility, mental state, social interests and hobbies, personal safety and risks, religious and cultural needs. The manager and deputy manager undertook the assessment. Despite this person having impaired mobility and needing a zimmer frame to walk with, they were offered a basement room, with steps up to communal area and no stairlift. This is not good practice and does not evidence that a competent person undertakes the pre-admission assessments. Placements are arranged on a month’s trial basis with a review taking place at the end of this period with all necessary parties. The manager explained that arrangements for admission are usually made with relatives, who will have visited the home and seen what they have to offer. One relative who did visit the home informed CSCI that they thought residents looked unkempt, were unsupervised and had nothing to do – their relation was not placed at the home. It is a condition of registration that any new persons admitted to the home will have dementia care needs. Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 11 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, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents may not get their care needs met, because of the homes care planning processes, and any new healthcare needs are not always addressed. EVIDENCE: Four care plans were looked at including that of the one resident who was newly admitted to the home. The plans each contained guidance for the staff on how identified needs should be met. An ‘Ablecare Homes Care Plan’ provides a clear and easily understood picture of that persons needs, but the plan for one person was completely out of date and did not reflect their current high level of care needs. The residents have signed their monthly care plan reviews, where this was appropriate. The care plans are supported by a number of risk assessments in respects of nutrition, skin integrity, and a manual handling assessment resulting in a safe system of work being devised. For each person the level of risk associated in moving and transferring is determined. This is good practice, but they must be kept up to date. Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 12 In respects of nutritional assessment, those looked at each determined that the resident was at “low risk” but should be weighed monthly. For one resident, the staff had recorded each month for over two years “unable to weigh due to not standing”. Comparing historical and recent photographs of the resident showed they had lost a significant amount of weight, although other records evidenced that they ate well and had a very good appetite. The manager must think how the home would monitor a resident in similar circumstances, if their dietary intake was poor. Options were discussed and will be followed up via the homes improvement plan and future inspections. For one resident their care plan indicated that they were at risk of pressure sores. A risk assessment had been completed that stated that vulnerable areas should be checked morning and at night. There was no instruction for staff to take any actions during the day or over night. This shortfall has the potential to place that resident at risk of pressure sores, something that they have had on at least one previous occasion. One other resident is currently being treated for pressure sores and the district nurses are visiting the home. One relative commented on a CSCI survey form “ they take care of my relative who can be very awkward”, and another said “they treat everybody with respect ”. A record is maintained of any contact with GP’s, District Nursing Services, CPN’S, chiropody, opticians and dentists. An investigation undertaken by CSCI and Adult Community Care Services found that a healthcare professional had determined that one resident should have been receiving nursing home care for the last few years, and that there had recently been a delay in them receiving the appropriate healthcare support following a fall. Community District Nurses have in the past had concerns about the care of one of the residents who they were visiting, however the nurse spoken to during the inspection was satisfied with the care being provided to the resident they were visiting. Only a brief review of the homes medication systems was undertaken on this inspection. The home have previously demonstrated that they have safe procedures in place for the ordering, receipt, storage, administration and disposal of all medicines. Staff who are responsible for administering medications have had training to ensure they are competent. However, despite this a care assistant was witnessed placing medications from the blister pack directly into her hand - this is not an hygienic or a safe practice. This was immediately discussed with the member of staff and the manager. It is not good practice and according to the manager is not the home’s policy. The staff were observed attending to their duties diligently but there were occasions when there was very little or no contact at all with the residents who are in the same area as them. This gave the impression that the residents were ignored, and is something that has been commented on by both visitors Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 13 and healthcare professionals. This is not a respectful and dignified way in which to treat the residents, and although is not a true reflection of the care at Belvedere Lodge, it is an impression that is given. Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 14 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 adequate. This judgement has been made using available evidence including a visit to this service. Some residents are able to participate in a range of stimulating and meaningful activities, however for others their quality of life is poor and the home does little to address this. The standard of meals is good. EVIDENCE: There is evidence that residents can have a say in how they spend their time and where they spend it, but this seems to be based on long established routines. One staff member answered, when asked about a resident’s daily routine “they don’t come downstairs, but we don’t ask anymore if they want to”. Three other residents are also confined to their rooms, but each confirmed that this was their wish. One resident said “ I like to have the door propped open so I can hear what is going on elsewhere in the house and see the staff going by”. During discussions with staff members, they were asked to talk about one specific resident and each worker proceeded to just list the daily help that person needed. This suggests that the staff see their role as meeting physical needs and do not see that social activity and stimulation is important. The manager must ensure that each resident receives a level of stimulation that meets his or her needs, preferences and capacities. Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 15 Observations made during the final inspection visit were that whilst some residents (those with a lesser degree of dementia) were given the opportunity to take part in activities, for the majority they were left to their devices. One resident remained at the breakfast table for two hours after the meal had finished, and despite there being many occasions when different staff entered the room, not one made any contact with them. One resident said “I sit around and get bored” when asked how they spend their day, whilst another said “I am confined to my room and I only see the carers when they deliver my meals – I have no future”. In each person’s care plan a brief record of activities the resident had taken part in, is maintained. After each event, staff will record how successful the activity was, for example: enjoyed, did not enjoy, lost interest or refused. Examples include singing sessions, going out for walks to the shops, 1:1’s, and planting seeds. An organised activity is arranged on a monthly basis, usually a musical entertainer - there has been a recent trip to the Bowling Alley and photo’s were displayed in the hallway. From talking to staff though, the majority of activities are arranged on the spur of the moment. Two residents played a game of dominoes with a staff member. Later one resident and carer were observed discussing events in the local paper, however another carer was sat in the lounge reading the paper by herself. One relative commented in a CSCI survey form “the home should have more structured activities and regular outings”, whilst another commented “ there is a relaxed and easy going attitude”. Those residents, who were able to, were seen moving around the home independently and going out into the garden. One resident had their breakfast later than the others so there is some evidence that residents can choose their mealtimes and routines. Observations were made of one resident being assisted to make choices about what they wanted for their breakfast. The home has an open visiting policy and visitors can come in at any reasonable time. There were no visitors to the home during the inspection visit. One person wrote a complimentary letter to the manager after a recent visit that they had found the home warm and welcoming and their relative being well looked after. The home provided copies of their four week menus as part of the preinspection information, and this evidenced residents are provided with a varied and balanced diet. A roast meal is served twice a week. There is only one planned choice per day but residents are able to have an alternative if necessary. The cook had a good understanding of the dietary needs, likes and dislikes, of each of the residents. On the final day of inspection, the residents were served with sweet and sour pork, potatoes and fresh vegetables, followed by fruit salad or rice pudding. Residents spoken to after the meal said “It was very nice”, “The food here is very good”. Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 16 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 poor. This judgement has been made using available evidence including a visit to this service. Residents can be assured that any concerns they have will be listened to and acted upon, however they may not be protected from coming to any harm because of some of the homes actions. EVIDENCE: The homes complaints procedure is included in the homes statement of purpose. The complaints procedure leaflet has recently been redistributed to all relatives according to the manager and includes contact details for the Commission for Social Care Inspection. Residents spoken with during the course of the inspection said they would talk to the staff if they were not happy about anything. One resident said “they look after us well here and everything is alright” however others were not able to express their opinions CSCI have received four complaints since the last inspection. One was passed directly to the homes management team to respond to, and the actions taken were recorded in the homes complaints log, along with one other complaint that CSCI were also involved in. The other two complaints involved adult protection issues where family and healthcare professionals had raised concerns. These complaints resulted in multi-disciplinary meetings being held with adult community care services, staff being interviewed about their actions and all local authority funded placements being urgently reviewed with the purpose of ensuring the continued and ongoing safety of the residents. Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 17 The home has policies and procedures in place to ensure that residents are safeguarded from any form of abuse. A number of staff have attended safeguarding adults awareness training delivered by the local council since the last inspection. A copy of the Bristol City Council “No Secrets” guidance is kept with all other day- to- day paperwork. However, some of the homes work practices have meant that residents have not always been protected from coming to harm. The manager must ensure that the staff do not undertake any unsafe manual handling tasks that not only puts themselves at risk, but could potentially seriously injure the resident. The manager must also ensure that staff do not neglect to provide the appropriate levels of care and supervision to each individual resident. Or that any actions they take, or changes they make to the living environment, do not increase the level of risk towards any individual, causing falls. The home have participated in two adult protection investigations since the last inspection, and although have cooperated fully in the process, the manager has needed to rely upon both the deputy and the director, to provide a full account of events and to put together an action plan to prevent a reoccurrence. Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 18 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, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is well maintained and fully equipped, but the manager must ensure that all furnishings are appropriate to the needs of each individual resident. EVIDENCE: Belvedere Lodge is a three storey end-of-terrace Victorian property. It has been operating as a care home since 1983 when the Willcox family, set it up. There is a small garden area to the front of the property, laid to well established shrubs. To the rear of the home, there is a pleasant patio area with ramped access from the house, and also a garden area. The home has applied for a grant to enhance the garden, incorporating a sensory area that may benefit the residents. The communal rooms are all on the ground floor. There are two lounges, one large and one small, and a separate dining room. Both lounges have recently benefited from being redecorated and refurbished. The large lounge is set up Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 19 so that those who do not want to watch TV, can sit quietly. Alternatively the smaller lounge is a much quieter room. Stairs lead down to the basement area where the kitchen is located and where three of the bedrooms are located. Residents who are accommodated in these rooms must be fully mobile as there is no stair lift. There are two toilet rooms located near the communal areas, for one there is a small step to negotiate. There are also 2 shower rooms, 1assisted bathroom plus two other ordinary bathrooms located throughout the home. Stairs from the main hallway lead up to the remainder of the home – they are wide and a stair lift is installed that provides access to the top of the house. Those residents who are able to walk up and down the stairs are not impeded by the stairlift, as it is wide and a handrail is fitted to the other side. The majority of bedrooms are located on the first and second floors, but two are accessed from the half-landings. The home has a variety of equipment installed in the home to aid the residents. There are grab rails at various locations throughout the home, a swivel bath seat is installed in the bathroom, and raised toilet seats fitted to a number of the facilities. A number of residents need to use walking frames to get around. Some of the bedrooms have ensuite facilities – either a toilet, or a toilet and wash hand basin. There are two shared bedrooms. A number of the bedrooms are quite small but since the home was registered before the introduction of national minimum standards, they are exempt from minimum spatial requirements. Some rooms have door guards fitted so that doors can be left open, rather then wedged. One resident said “I prefer to remain in my bedroom but I like to hear what is going on elsewhere in the house, and see the staff going by”. A number of the bedroom doors have alarms fitted so that night staff will be alerted to any wandering during the night. Residents are encouraged to personalise their rooms as they wish Since the last inspection the home has undergone an extensive refurbishment programme. Bedrooms have been provided with new wardrobes, chests of drawers, armchairs and new wood-effect flooring. New identical armchairs have been put in each bedroom. However, the physical needs of the resident had not been assessed to make sure that the chair was suitable for them. This shortfall had major implications for the safety of some residents and resulted in a protection of vulnerable adults (POVA) investigation. This will also be referred to under standards 18 and 38. The home employs domestic staff who work each weekday, and were observed undertaking their duties during the final day of inspection. The home was clean and tidy throughout however but there was a very unpleasant odour outside of the main bathroom and one of the bedrooms. The manager was Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 20 requested to locate the source of the odour and make the necessary improvements. The laundry facilities are sited in an attached building to the rear of the house. There are two washing machines and two tumble dryers. Due to the large amount of washing generated, staff have to spend a great deal of time in the laundry dealing with loading the washer, transferring it into the dryers and folding up and putting away. This means that the staff are not in the main part of the house and therefore are unable to supervise the residents appropriately. The manager has been aware of this unacceptable situation for some time however is still in the process of arranging installation of large industrial equipment that will reduce the time spent by staff in the laundry. This shortfall is also referred to in standards 12 to 27. Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 21 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. Residents are cared for by a stable and loyal staff team who are familiar with their basic daily needs, however there needs to be significant improvements in staffing arrangements to ensure that the residents always have access to someone to meet their needs. EVIDENCE: The staff team at the home is well established with many of the workers having been employed for many years. There has been no agency use and any shifts that do become vacant are always covered “in-house”. This means that the residents will be cared for by staff who are familiar with their needs. The manager employs a deputy manager, two senior care assistants, seven care assistants, one cook and two domestics. The pre-inspection information provided by the home stated that all residents had ‘low dependency’ needs and that staffing levels were arranged accordingly. In reality, a small number of the residents require a higher degree of care and support, therefore the manager needs to review staffing levels to ensure that each residents needs are fully met. Those residents who were able to provide a response, said that they were generally satisfied with the care they receive, but observations made during visits to the home, evidenced that at times there is no one available to immediately help them. At the start of the visit on the 31 May, there was no staff member in the communal rooms where about 10 residents were, and Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 22 “staff were out the back”. The absence of available staff, and therefore appropriate supervision of the residents, was a feature in two of the complaints received by CSCI. The home employs two members of staff who have achieved NVQ level 2 in care, but four others are working towards achieving the award. One staff member said that they were waiting to be notified that they had successfully completed the course. Once the four staff have become qualified, the home will have a 46 ratio of trained members of staff. The home uses two training providers for the NVQ training. There has only been one new member of care staff recruited since the last inspection. An examination of their personnel file evidenced that the home now follows safe vetting and recruitment procedures, including the need for written application, two written references to be provided and CRB and POVA checks. A requirement was issued following the last inspection that their procedures be tightened up, to safeguard residents from unsuitable workers, and the home has shown compliance. The home does recognise the importance of training and delivers a programme of training including mandatory courses, for example manual handling, food hygiene, first aid and fire awareness. Since the last inspection, the home has revamped their induction-training programme for new recruits, but so far the home has not needed to use it. Despite this, the manager must ensure that all new recruits complete their mandatory training upon starting their duties, so that residents can be assured they are safely looked after. The home only had evidence to show that their new recruit had had manual handling training after working at the home for seven months. This is poor practice and may mean that residents will be cared for by staff who are not skilled or competent to meet their needs. The training plan also includes safeguarding adult training, dementia awareness, diabetes and catheter care. The home have been advised to ensure that any manual handling training involves a practical demonstration using the relevant equipment and is led by someone who has the appropriate qualifications to undertake the training sessions. The manager has already arranged for the deputy manager to undertake further training. This will be followed up as part of the homes improvement plan and at future inspections. The homes training files were in complete disarray and it was not possible to see which staff had completed recent training. This is a change from 2006 when the records were well maintained. The manager needs to ensure that staff records are kept up to date and available for inspection. Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 23 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, 36, 37 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home needs to be significantly improved to ensure that the residents live in a safe place and that they would not be harmed by any of the staff teams working practices. EVIDENCE: The home manager, Mr John Willcox, has been running the home since 1983, therefore has many years experience in the care of the elderly and those with a dementia. A discussion regarding the current management arrangements took place with the registered manager and the director. Because of all the changes in the care sector, the amount of legislation that must be adhered to, and the level of care required by increasingly older and frailer residents, and after a number of concerns that have been raised in the last eight months Mr Willcox has decided to step down from the role of home manager. The deputy manager is currently supporting the manager in the management role, along Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 24 with the manager’s daughter who is also a director of Ablecare Homes. In addition there are two senior care staff. The findings from a recent investigation evidenced that some ‘senior’ staff need to rely upon others when making decisions about a residents care. On this occasion this meant that there was a delay in the resident getting the healthcare they needed. Ablecare Homes will need to review the current management arrangements to ensure that the home is always managed competently and safely. The home completed a service satisfaction survey earlier in the year and the results were collated along with those of the other Ablecare homes. A total of 14 survey forms were completed by the residents of Belvedere Lodge, with a note that the number of returns had increased because of ‘key worker’ support in completing the forms. The survey covered care arrangements, choice of activities arranged, the home and garden environment, and about raising any complaints. The results had been interpreted but there was nothing specific recorded about Belvedere Lodge despite the fact that in some areas, namely around care planning and range of activities, there was only “half to twothirds” satisfaction expressed. This means that one-third to half of residents are not satisfied. The only action concerning Belvedere Lodge was around teatime meals however there was no evidence to suggest what action had been taken. There has been no recognition in this process regarding the number of concerns that have been raised by outside agencies. This is not evidence that the home is appropriately reviewing the quality of its service. The home has procedures in place to manage any monies they hold on behalf of the residents. A number of the accounts were checked against the records held and they tallied. The deputy manager and the two senior care assistants undertake staff supervision, the manager has no role in monitoring staff performance. From records looked at during the inspection, the work performance of one staff member was being monitored however this has been instigated by an Ablecare Homes Director and was being overseen by the deputy manager. Examination of staff supervision files evidenced that the arrangements have fallen by the way side with most staff having only received one formal 1:1 session this year. The manager was unaware of this and this is further evidence that the manager no longer has a complete overview of what is happening in the home, or is addressing the concerns that have been raised in the last seven months. A number of the homes records were not up to date. For example, some care planning documentation did not truly reflect some of the residents needs, the staff training files were in disarray, some of the daily recordings did not provide an accurate account of events, and accident records were not always completed. The manager must ensure that all records are maintained accurately to ensure that residents receive the care they need, the home has an overview of staff skills and competencies and is therefore able to meet Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 25 resident’s needs, and that appropriate actions are taken in the prevention of falls and accidents. A review of the fire safety records revealed that all staff have attended fire drills and training at regular intervals. The fire alarm system, fire fighting equipment and emergency lighting is tested regularly to ensure it is in working order. Information supplied with the pre-inspection questionnaire, stated that all relevant maintenance contracts were in place. The records were not checked, apart from ensuring that the hoist is serviced on a six monthly basis. The home have always consistently shown that maintenance is a high priority, and there is no reason to suggest that this is any different now. Where bed rails are used to maintain a residents safety, the home completes a basic risk assessment but this may not ensure it is the most appropriate method of maintaining safety. Written consent must be obtained from either the resident or a relative, ideally prior to their use, but if not at the earliest time. Their use must be clearly stated in the plan of care. Although this currently only applies to one resident, the manager has failed to ensure that proper procedures have been followed. A requirement is being made for a second time that the home obtain consent for the use of bed rails. The home’s manual handling procedures do not ensure a resident’s safety is protected. Information was provided to CSCI, by adult community care services that one resident was being lifted in their wheelchair up a small flight of steps. This is a potentially dangerous procedure that could have resulted in severe injury to both resident and staff. This practice has already been discontinued however it is of great concern that the manager and senior staff thought this an acceptable method of moving someone. Also, during an investigation into events that led up to one resident falling, it became apparent that staff manual handling training was inadequate. These examples evidence that residents are being placed at risk by some of the homes actions. There was no overall monitoring of how often a resident falls and why this might be happening however during the course of the inspection visits, the home put procedures in place to address this. This meant that any trends that may develop and that caused falls were not identified, and therefore preventative action not taken. An accident/incident record is not always completed after a fall and the home does not currently have any means of recording any follow up monitoring that they should do. The manager must ensure that this is addressed. Risk assessment processes must be strengthened. The home has already arranged training for the staff as an outcome of the CSCI investigation. The home had failed to undertake any risk assessment after providing new “one size fits all” bedroom chairs, resulting in an accident happening. Since these Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 26 events were brought to the attention of the manager, the chair has been reviewed for a number of other residents. The manager must ensure that risk assessments are completed where ‘risk’ has been identified, and must ensure that ‘the resident’ remains at the centre of the risk management process. Belvedere Lodge DS0000026496.V341698.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 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 2 X 1 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 3 3 3 3 1 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 1 1 1 Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP1 OP3 Regulation 14(2) 14(1)a Requirement The Statement of Purpose must be available on request. The manager must ensure, with regard to the pre-admission assessment, that the home is suitable for the purpose of meeting that resident’s needs. The manager must ensure that care planning documentation is kept up to date and revised as often as is necessary. The manager must promote and make proper provision for the health and welfare of resident. • Where the risk of pressure sore development has been identified, a preventative plan of action must be devised for staff to follow. • The advice of healthcare professionals must be sought when staff have raised concerns Timescale for action 15/06/07 15/06/07 3. OP7 15(2) 15/06/07 4. OP8 12(1)a 15/06/07 Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 29 5. OP9 13(2) The manager must ensure that medications are safely administered at all times. 15/06/07 6. OP12 16(2)n 15/06/07 The manager must ensure that all residents are able to take part in meaningful and recreational activities, that meet their individual and specific needs. The manager must ensure that no resident is harmed or placed at risk of being harmed, by the actions of the home. The manager must ensure that safe staffing levels are maintained in the main house at all times and residents are supervised and able to have immediate assistance. The manager must must ensure that all staff receive training appropriate to the work they are to perform • Staff should receive manual handling training prior to assisting residents in moving tasks, and documented evidence should be kept. • A training log should be kept for all staff 31/08/07 15/06/07 7. OP18 13(6) 8. OP27 18(1)a 15/06/07 9. OP27 18(1)c 15/06/07 10. OP31 8 Ablecare Homes must review current management arrangements so that the home is managed competently and safely The manager must review the quality of care delivered by the home and provide a detailed report on the measures it proposes to raise standards. This will be referred to as an DS0000026496.V341698.R01.S.doc 11. OP33 24 15/08/07 Belvedere Lodge Version 5.2 Page 30 Improvement Plan. 12. 13. OP36 OP37 18 17 The manager must ensure that all staff are appropriately supervised. The manager must ensure that all the homes records are kept up to date and are accurately maintained • Daily records must provide an accurate account of all events • Accident/Fall records are kept to look for any trends and also to record any follow up monitoring action. Residents are not subject to physical restraint unless this is the only physical means of securing their welfare. The use of bed rails must always be strictly risk assessed and then consent for their use be obtained prior to their use. This requirement is being made for a second time – the previous timescale of 07/08/06 has not been met. 30/06/07 15/06/07 14. OP38 13(7) 15/06/07 15 OP38 17(1)a The manager must maintain in 15/06/07 respect of each resident, all records specified in schedule 3, namely: • Accident records and any follow up action • An accurate log of daily records. • Written consent regarding use of bed rails to maintain safety. The manager must ensure that all unnecessary risks to the health & safety of residents are DS0000026496.V341698.R01.S.doc 16. OP38 13(4)c 15/06/07 Belvedere Lodge Version 5.2 Page 31 identified and so far as is possible, eliminated: • Risk assessment processes must be strengthened and must always be relevant to the specific individual, and staff where appropriate. Residents must be supervised so that they have access to immediate help should they need it. • 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. Refer to Standard OP1 OP8 Good Practice Recommendations The Statement of Purpose should include contact details of the Commission. The manager should look for alternative methods of measuring whether nutritional intake is sufficient to maintain body weight, and the use of standard weighing scales is not practical. Only those residents will full mobility should be offered bedrooms in the basement area. Staff should receive formal supervision at least six times a year. 3. 4. OP24 OP36 Belvedere Lodge DS0000026496.V341698.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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. 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