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Inspection on 05/10/07 for Belvedere Lodge

Also see our care home review for Belvedere Lodge for more information

This inspection was carried out on 5th October 2007.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Information about the home and pre-admission assessment processes ensures that residents` needs will be met at Belvedere Lodge. Residents can be assured that their care needs will be met and that they will be treated respectfully and with dignity. Residents are able to participate in a range of activities and are well fed. Residents can be assured that any complaints they have will be listened to and acted upon and that improvements have been made to safeguard them from harm. Residents live in a home that is comfortable, safe and well maintained. Residents are looked after by a loyal and stable staff team. Improvements have been made in working practices meaning that residents are better supervised. Significant improvements have been made in the running and management of the home, however the manager has yet to be registered with CSCI. Resident`s safety has improved and the staff benefit from stronger leadership.

What has improved since the last inspection?

Information about the home is now up to date and readily available. This means that any prospective resident, and their representatives, will be able to make a more informed choice about whether the home is the right place for them. The homes pre-admission assessment processes have been strengthened, to ensure that a better judgement is made about the suitability of the home to meet the residents needs. Information that is kept about each resident, the care planning documentation, is of a better standard, and is now consistently reviewed and updated. The plans are individually prepared for each resident and this means that they will each receive the specific support that they need. However a comment has been made about one residents plan under `what they could do better`. There is improved resident supervision and activities in the communal areas of the home with more interaction between residents and the staff. This means that residents are likely to have a better quality of day-to-day life. There is better evidence that staff have received training in a range of relevant subjects, that they are supervised in their role and that their awareness of safeguarding adult issues has been strengthened. The standard of record keeping in all areas is now of a good standard.

What the care home could do better:

Ensure that pre-admission assessment processes include a full detailed history, and all background knowledge of the resident is determined so that any previous difficulties are shared. The home should ensure that placing local authorities provide this information so that any placement has the best possible chance of succeeding. Care planning documentation and risk assessments must be updated promptly in order that the level of risk can be reduced or eliminated, and a plan of action for staff to follow must be devised Staffing numbers must be calculated against resident dependency levels to ensure that at all times, there is the appropriate staff availability to meet the health and welfare needs of each of the residents. The home manager must make application to CSCI for registration without further delay.

CARE HOMES FOR OLDER PEOPLE Belvedere Lodge 1 Belvedere Road Westbury Park Bristol BS6 7JG Lead Inspector Vanessa Carter Key Unannounced Inspection 5th October 2007 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 Belvedere Lodge DS0000026496.V350718.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.V350718.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 Post Vacant Care Home 20 Category(ies) of Dementia - over 65 years of age (20) registration, with number of places Belvedere Lodge DS0000026496.V350718.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 2nd May 2007 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. The cost of placement at the home is between £440-480 per week and is dependent upon assessed need. Additional costs are made for a range of 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.V350718.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, made after visiting the home for one full day. The newly appointed Home Manager was present throughout as was Mrs Sam Hawker, Director for Ablecare Homes. Evidence was gained from this visit and from a number of other sources, namely:Information collated from a number of resident and relative survey forms Directly speaking with a number of the residents Case tracking a number of residents Speaking with care staff Observation of staff practices and interaction with the residents Examination of some of the homes records Information supplied by the Director of Ablecare Homes and the Home Manager in the “Annual Quality Assurance Assessment” (AQAA), received directly following the inspection. Since the last inspection in May 2007, the home has made significant improvements in the service delivery and outcomes for residents. All requirements made following the last inspection have been met, evidencing that the home have responded appropriately to concerns being raised by the Commission. The staff team should be commended for their commitment to improving standards and enhancing the quality of life for the residents. What the service does well: Information about the home and pre-admission assessment processes ensures that residents’ needs will be met at Belvedere Lodge. Residents can be assured that their care needs will be met and that they will be treated respectfully and with dignity. Residents are able to participate in a range of activities and are well fed. Residents can be assured that any complaints they have will be listened to and acted upon and that improvements have been made to safeguard them from harm. Residents live in a home that is comfortable, safe and well maintained. Residents are looked after by a loyal and stable staff team. Improvements have been made in working practices meaning that residents are better supervised. Significant improvements have been made in the running and management of the home, however the manager has yet to be registered with CSCI. Resident’s safety has improved and the staff benefit from stronger leadership. Belvedere Lodge DS0000026496.V350718.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? Information about the home is now up to date and readily available. This means that any prospective resident, and their representatives, will be able to make a more informed choice about whether the home is the right place for them. The homes pre-admission assessment processes have been strengthened, to ensure that a better judgement is made about the suitability of the home to meet the residents needs. Information that is kept about each resident, the care planning documentation, is of a better standard, and is now consistently reviewed and updated. The plans are individually prepared for each resident and this means that they will each receive the specific support that they need. However a comment has been made about one residents plan under ‘what they could do better’. There is improved resident supervision and activities in the communal areas of the home with more interaction between residents and the staff. This means that residents are likely to have a better quality of day-to-day life. There is better evidence that staff have received training in a range of relevant subjects, that they are supervised in their role and that their awareness of safeguarding adult issues has been strengthened. The standard of record keeping in all areas is now of a good standard. Belvedere Lodge DS0000026496.V350718.R01.S.doc Version 5.2 Page 7 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. Belvedere Lodge DS0000026496.V350718.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.V350718.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, 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information made available about the home and the pre-admission assessment processes ensure that residents can be assured that their needs will be met at Belvedere Lodge. Belvedere Lodge DS0000026496.V350718.R01.S.doc Version 5.2 Page 10 EVIDENCE: The Statement of Purpose and Service Users Guide had been updated prior to the last CSCI visit, however on this occasion both were available within the home for anyone to see. This means that any prospective residents who may visit the home, will be able to make an informed choice about whether the home is the right place for them, and the current resident will be able to refer to the home guide. Those resident survey forms that were returned to CSCI stated that they had received enough information about the home. Written contracts are in place for all residents and these include a statement of terms and conditions of residency. The pre-admission assessment processes of a number of new residents were examined, to determine how the home makes a decision that they can meet the residents specific care needs. 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. This enables the home to make a good “present day” judgment regarding the prospective resident. It would be good practice for the home to always ensure that they get a fuller family and social history to ensure that they are aware of any previous placement difficulties and family dynamics. New residents and their relatives are encouraged to visit the home prior to placement being offered. Placements are arranged on a month’s trial basis with a review of how things have gone, taking place at the end of this period. This will involve all the necessary parties. Belvedere Lodge DS0000026496.V350718.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, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured that their care needs will be met and that they will be treated respectfully and with dignity. EVIDENCE: Four care plans were looked at, including one person who had only recently come to live at Belvedere Lodge and one person, whose placement had gone awry and no longer lived at the home. The plans each contained guidance for the staff on how identified needs should be met. The plans of the two longer term residents had been updated and were based upon a new assessment of care needs. This is good practice and will ensure that any new needs are identified and planned for. Discussion with the manager evidenced that it will be the practice that each resident have their needs reviewed at least annually, but definitely as often as is necessary. The residents have signed their monthly care plan reviews where they have been able. Belvedere Lodge DS0000026496.V350718.R01.S.doc Version 5.2 Page 12 The care plan for the newly admitted resident was based upon a comprehensive assessment of need that included personal care needs, personal well-being, communication, skin care, mental state, mobility and history of falls for example. The plan was well written and gave a clear insight into the residents needs. Whilst the plan for the resident who no longer lived at the home was also good, it did not contain information about their previous history, but had recorded “came from another care home”. The home must ensure it obtains a full history from the placing authority, so that it can be certain it is able to deal with any challenges it may then face. The care planning documentation for one resident, whose risk of choking had recently increased, had not been updated and a plan of action to eliminate or reduce the level of risk had not been devised. Whilst it is recognised that this is only a very recent occurrence, the home could have failed in its duty of care should a further have incident have occurred that resulted in hospitalisation. The care plans are supported by a number of risk assessments and significant improvements have been made in the undertaking of these assessments. Staff have attended training sessions and will now ensure that the resident remains at the heart of the risk assessment process. Manual handling risk assessments result in a safe system of work being devised. Nutritional assessments determine the level of risk that a resident may be at from malnutrition. Since the last inspection the home have purchased a set of chair scales as a number of resident are unable to stand on weighing scales or would refuse to do so. The home should ensure that they continue to monitor weights appropriately as they have changed from imperial to metric recordings, but had not thought to look at comparisons. Where pressure sore development is identified as a risk a plan of action is devised to prevent sore formation. One resident that was part of the case tracking process, had such a plan, and whilst in the lounge was seated upon a special cushion. None of the current residents have pressure sores, but a few are “at risk”. District nursing services will be asked to be involved when their advice and support is needed and the records of this previous involvement was seen for a number of residents. A written record is maintained of any contact with GP’s, District Nurses, CPN’s, chiropody, opticians and dentists. One GP wrote in a CSCI survey form “we have previously had concerns about some senior staff not being available when we visit and not communicating our medical recommendations to the staff. The management have now changed procedures”. As part of this inspection a full review of the homes medication systems was planned; however, this did not take place. The manager and deputy, however, were observed going through the process of accepting delivery of a new months supply, checking supplies against the medication administration sheets and then storing them away safely. Belvedere Lodge DS0000026496.V350718.R01.S.doc Version 5.2 Page 13 The midday medication round was not observed. The home wrote in their AQAA that they work closely with their local pharmacy to provide expert advice when this is needed and that medication reviews are arranged with GP’s as necessary. Evidence was seen where a GP had amended a resident’s medications to resolve problems of falling. During the course of the inspection the staff were observed carrying out their duties and interacting with the residents. Improvements have been made in the availability of staff in the communal areas and this means that staff/resident interaction was greater. For one particular resident this meant that they had more stimulation and were therefore calmer and more relaxed. On a number of occasions, staff were observed to use distraction techniques if residents behaviour was changing, or they were about to do something that was unsafe - “would you like to come and help me lay the tables for dinner”. The home will always try and continue looking after any of their long-term residents who develop end of life care needs, but would expect to be supported by the GP, district nursing services and the family, where appropriate. The home would not consider admitting anyone to the home that was already at end of life stage. Discussion took place with the manager and some staff members regarding a recent example where the home had successfully looked after a resident who had lived at the home for many years. Staff felt rewarded to be given the opportunity to care for the resident right up to the end. Belvedere Lodge DS0000026496.V350718.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 good. This judgement has been made using available evidence including a visit to this service. Residents are able to participate in a range of activities and are well fed. EVIDENCE: During the course of the inspection a range of activities took place. One resident was looking around the new garden, some were walking around independently with or without walking aids, others were reading the newspapers and chatting with staff or other residents about current affairs. The sing-a-long session was enjoyed by many of the residents. One resident who had been sleeping in their chair sat bolt upright when one song started, sang every single word, and when the song finished settled back to sleep again. In the afternoon a music man played the keyboard and sang, with most of the residents joining in. A record is kept for each resident of the activities that they have participated in. Some events are arranged on a planned basis whereas others are arranged as and when, and maybe on a one to one basis. One resident wrote in the CSCI survey form “I am confined to my room now because of my health and I do miss the parties and the singing, although I hear what is going on”. Belvedere Lodge DS0000026496.V350718.R01.S.doc Version 5.2 Page 15 The home produces a regular newsletter and the last one was displayed in the hallway. The letter referred to events that have taken place and those that are planned. There were pictures of the recent garden make over, details regarding staff changes and staff NVQ successes. Residents who are able to, wander around the house and the garden as they wish. Some residents were taking breakfast later than the others and some residents chose to sit in the quiet lounge, or the dining room rather than the main lounge. This evidences that the residents can make choices in what time they eat and where they spend their time. Care planning documentation makes note of the preferred time of getting up and going to bed for each resident (usual preferred routine). The home has an open visiting policy and visitors can come and go at any reasonable time. There were no visitors to the home on the day of the inspection. One resident said “I like it when my family visit, they talk to everyone else too”. Although CSCI relative survey forms were left at the home for completion none were returned to CSCI for inclusion in this report. The home has a four week planned menu and residents are provided with a varied and balanced diet. Roast meals are served twice a week. The midday meal comprises of just one choice however staff are fully aware of each resident’s likes and dislikes and an alternative would be provided if the planned meal was not acceptable. On the day of inspection the meal served was mushroom soup followed by fish and chips and then fruit crumble of ice cream. One resident said, “I have just had a lovely dinner, the food here is always good”. Four residents returned CSCI survey forms, two said the meals were always liked and two said they usually were. Belvedere Lodge DS0000026496.V350718.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 good. This judgement has been made using available evidence including a visit to this service. Residents can be assured that any complaints they have will be listened to and acted upon and that improvements have been made to safeguard them from harm. Belvedere Lodge DS0000026496.V350718.R01.S.doc Version 5.2 Page 17 EVIDENCE: The homes complaints procedure is included in the homes statement of purpose and a copy is displayed in the hallway on the notice-board. Residents spoken with during the course of the inspection expressed their contentment and said they would talk to the staff if they were unhappy. Four residents completed CSCI survey forms and said that they knew what to do to complain. The home maintains a log of all complaints and compliments received. The number of compliments received far out weighs the complaints. Families had written to the manager regarding the excellent care of their relative, and two others had written after attending the homes barbeque party. The home has received two complaints since the last inspection. The records evidenced the actions that had been taken by the home manager in dealing with the issues raised. The other complaint was also referred to CSCI and social services under safeguarding adult procedures. In this instance any safeguarding issues were not as a result of the care the resident received at Belvedere Lodge. The home responded appropriately when concerns were raised and participated in the strategy planning process in a professional and responsible manner. The home has policies and procedures in place to ensure that residents are safeguarded from any form of abuse. The majority of the staff team have attended safeguarding adults training and Bristol City Council “No Secrets” guidance is readily available for staff to refer to. Events prior to the last inspection mean that the staff have heightened awareness of abuse issues and the consequences that their actions may have upon the safety of the residents. Those staff spoken to during the course of the inspection demonstrated a clear understanding of adult abuse matters and their responsibilities. One staff member said “the residents may be confused, but if I was told something, they may be telling me about something that did happen. I would not ignore it”. Belvedere Lodge DS0000026496.V350718.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 good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is comfortable, safe and well maintained. 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 shrubbery. The gardens to the rear of the home have been redesigned since the last inspection with monies that the home secured from a department of health grant. The pathways now enable residents to wander in the garden, lighting has been installed and also a water feature. These sensory additions may benefit the residents by providing a more stimulating environment. The area is much improved “all the colours are looking so lovely” was a comment received from one resident. Belvedere Lodge DS0000026496.V350718.R01.S.doc Version 5.2 Page 19 The communal rooms are all on the ground floor. There are two lounges, one large and one small, and a separate dining room. All rooms are well decorated and furnished appropriately – the home benefits from regular upgrading as the provision of a comfortable and clean environment is important to the service providers. The large lounge is set up mainly for the use of the TV and music, whereas 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 stair-lift, 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. Since the last inspection the home have purchased a number of items of equipment, recognising the need for such equipment as their residents get older and frailer. Some of the bedrooms have en-suite 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, and some have door alarms fitted so that night staff will be alerted to any resident who may wander during the night. Residents are encouraged to personalise their rooms as they wish. The home employs designated domestic staff who work each weekday. The home was clean, tidy and fresh smelling throughout. The laundry facilities are sited in an attached building to the rear of the house. Since the last inspection larger industrial washing machines and tumble dryers have been installed, thereby reducing the amount of time care staff have to be absent from the main part of the home attending to laundry tasks. Belvedere Lodge DS0000026496.V350718.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. Residents are cared for a loyal and stable staff team. Improvements have been made in working practices meaning that residents are better supervised. EVIDENCE: The staff team at Belvedere Lodge is well established with many of the staff having worked at the home for many years. This means that residents will be cared for by staff that are familiar with their needs. There is no use of agency staff and any vacant shifts are always covered “in-house”. The staff team is made up of the home manager, a newly appointed deputy manager, two senior care assistants, care assistants, one cook and two domestics. There are a couple of care staff vacancies at the moment. A concern has recently been raised with CSCI by a relative regarding adequate staffing levels in the evenings and this was discussed with the home manager and the staff team during the inspection. The general consensus was that two staff members are appropriate after 4pm with the current group of residents, but this was not adequate in recent circumstances. The home must ensure that staffing levels are always appropriate to the dependency levels of all residents, and that extra staff are allocated to work should any residents develop a higher level of needs. Belvedere Lodge DS0000026496.V350718.R01.S.doc Version 5.2 Page 21 Observations made during this inspection visit were that there were improved arrangements for the supervision of residents in the communal areas. Staff explained that at least one member of staff must be present in the lounge/dining room at all times, and that this is rigorously instigated. A requirement following the last inspection has been met. The home has 11 care staff and of these, four have achieved at least an NVQ level 2. Three other staff are working towards their awards. One of the senior care staff, plus the home manager have been enrolled to do NVQ level 4 whilst others are enrolled to do level 3. The home shows real commitment to having a trained workforce. This means that residents will be cared for by competent, skilled staff who are able to meet their needs. There have been just two new members of staff since the last inspection. Their recruitment files were examined in order to determine the processes the home use in employing suitable staff. The home follows safe vetting and recruitment procedures, by asking for a written application form to be completed, two satisfactory written references and CRB and POVAfirst checks prior to employment starts. The home continues to recognise the importance of training and delivers a programme of training including mandatory training (manual handling, food hygiene, first aid and fire awareness) plus other relevant training. The induction-training programme for new recruits has been revamped, and one of the new workers was currently working through this, but evidence was not seen to verify this during the inspection. Staff training files were all in order and evidenced that the staff team have attended a range of different training courses, including those listed above and in addition record keeping awareness, protection of vulnerable adults, safe medication procedures, pressure area care and risk assessment. The manager has renewed her “training for trainers” manual handling instructor certificate despite the home manager in another of the Ablecare homes taking the lead for staff training in manual handling. These measures will ensure that staff are always fully trained in safe manual handling procedures and this will enhance resident safety. Belvedere Lodge DS0000026496.V350718.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. Significant improvements have been made in the running and management of the home, however the manager has yet to be registered with CSCI. Resident’s safety has improved and the staff benefit from stronger leadership. EVIDENCE: Since the last inspection, the deputy manager has been promoted to the position of home manager. She has however yet to make application to CSCI for registration, and this must be done without further delay. She has worked at the home for many years and has played a key role in supporting the previous home manager. She has completed parts of the NVQ level 4 Managers award and plans to now continue this until completion. The day to day management of the home is also undertaken by the deputy manager, two senior care assistants and a Director of Ablecare Homes. Belvedere Lodge DS0000026496.V350718.R01.S.doc Version 5.2 Page 23 The home had completed a service satisfaction survey earlier in the year and then following the last inspection in May 2007, submitted an improvement plan to address the large number of requirements issued. This detailed how the home was going to make the changes and how they were going to monitor that the changes were effective. The home has shown compliance with all the shortfalls and this evidences their commitment to raising standards in the home. The home has procedures in place to look after monies for a number of residents. An account sheet is held for each resident and receipts are kept when money is withdrawn. The accounts were not checked on this occasion however the homes records have always previously been in order. All senior staff members undertake formal supervision of junior staff with the home manager overseeing all arrangements. The records were seen and evidenced that this is done on a regular basis. Since the last inspection some of the senior staff have had supervision of staff training in order that they can undertake this task effectively. Work performance and training and development needs are discussed. The previous home manager had completed a final appraisal with each staff member before his retirement – these provided an in-depth and detailed assessment of each worker’s abilities. A number of the homes records were examined as part of the inspection process, and marked improvements have been made in the quality of record keeping. A large proportion of the staff have attended record keeping training and their learning was evidenced. All records requested were easily produced. Examples where improvements were noted include the following:Bed rail risk assessments and consent for there use Monitoring of incidences such as falls and other accidents Risk assessment processes and outcomes Quality of recordings in the daily logs Staff training files A look at the fire safety records evidenced that the staff team has attended fire drills and training at regular intervals. The checks on the equipment and alarm system have all been completed at the appropriate intervals. The deputy manager has delegated responsibility for fire safety in the home and will be attending fire warden training next month. No health and safety concerns were raised during the course of this inspection. Although the homes maintenance records were not checked on this visit, these have previously always been in order. Belvedere Lodge DS0000026496.V350718.R01.S.doc Version 5.2 Page 24 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 3 3 Belvedere Lodge DS0000026496.V350718.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2)b Requirement The care plan for one specific resident must be updated to highlight the increased risk of choking. A plan of action for the staff to follow must be devised. Ensure that at all times staff are working in such numbers as are appropriate for the health and welfare of the residents Staffing numbers must be calculated against resident dependency levels. The home manager must make application to CSCI for registration. Timescale for action 05/11/07 2. OP27 18(1)a 05/11/07 3. OP31 9 05/12/07 Belvedere Lodge DS0000026496.V350718.R01.S.doc Version 5.2 Page 26 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 OP3 Good Practice Recommendations Ensure that pre-admission assessment processes include a full detailed history and background of the resident, so that any previous difficulties are shared. Look at each resident’s newly recorded metric weight and compare with previous imperial weight recording. 2. OP8 Belvedere Lodge DS0000026496.V350718.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Belvedere Lodge DS0000026496.V350718.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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