Inspection on 21/04/06 for Belvoir House Care Home

This inspection was carried out on 21st April 2006.

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

Belvoir House Care Home 19/04/07

Belvoir House Care Home 20/10/05

Belvoir House Care Home 24/05/05

Belvoir House Care Home 30/12/04

Belvoir House Care Home 02/09/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Belvoir House Care Home Brownlow Street Grantham Lincs NG31 8BE Lead Inspector Moya Dennis Key Unannounced Inspection 21st April 2006 09:00 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 Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Belvoir House Care Home Address Brownlow Street Grantham Lincs NG31 8BE 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) 01476 565454 01476 565454 Barnby Gate Ltd Mr Naraindranath Jagroo Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th October 2005 Brief Description of the Service: Belvoir House is a detached, nineteenth-century, stone property, raised above pavement level, situated approximately 200 metres from the town centre of Grantham and a variety of shops and amenities. The home is registered to provide personal care for twenty-four older people of both sexes. Accommodation is situated on two floors and is served by a shaft lift. There are sixteen single and four double bedrooms, one lounge/dining area and a separate lounge. An enclosed patio and garden area is situated at the front of the property. A ramped area gives direct access from the front door to the street. The home does not have its own car park. There is a payphone for the use of residents. Fees range between £321 and £397 per week. Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was undertaken using a review of all the information provided by the manager relating to Belvoir House and visiting the home. The inspection was unannounced and took place over 6 hours. A tour of the premises was conducted with the Senior Care Assistant in charge of the shift. The main methods of inspection used were case tracking - which involved tracking the care of selected residents, examining their records, discussing their experiences of care and listening to their views; speaking to care staff, observing care practices and interviewing any visitors with their agreement. A full range of documentation was also inspected. What the service does well: What has improved since the last inspection? What they could do better: There is very little activity for residents and lack of choice, which should be addressed by implementing a programme of group or individual activities. Staff shortages restrict care staff from providing ‘one-to-one’ activities. For various reasons, communications between staff and with management are poor. Handovers do not happen at every shift change, there are no regular staff meetings and staff do not receive regular training, appropriate for their roles. Problems with the boiler are unresolved and the heating of the lounge/diner is sporadic, supplemented by portable heaters. Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 6 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. Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5, 6. The quality rating for this outcome group is adequate. This judgement has been made from gathered during the inspection, which included a visit to the service. The routine procedure for introducing prospective residents to the home is satisfactory. Admissions from hospital are less satisfactory and assessment information does not always reflect the primary needs of prospective residents. EVIDENCE: One resident had moved from another home that was unable to meet their increased level of need. Family members came to visit Belvoir House prior to admission. Assessment information was received by the home, and the service user and their family were confident that staff would be able to meet the assessed needs. The home’s statement of purpose states that care plan is to be completed within 48 hours; this was implemented. One resident, admitted from hospital required dementia care. Their family were satisfied with the level of personal care delivered but were not confident Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 9 that staff understood the complexities of delivering care to people with various types of dementia. Staff have received no specific dementia training since being appointed. One staff member spoken to had previous experience of dementia care but two other staff on duty were unaware of any issues relating to dementia. All admissions are on a trial basis. One resident was on Intermediate Care and was seen to be encouraged to maximise their independence by being encouraged to do tasks for themselves, with supervision as necessary. Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, The quality rating for this outcome group is good. This judgement has been made from gathered during the inspection, which included a visit to the service. Care plans provide full information outlining individual needs of residents. There are good links with local health services. Residents are treated with respect at all times. EVIDENCE: Care plans included a photograph of the residents and provided relevant information in a clear format. Assessments are based on activities of daily living and include manual handling plans. There is a full range of risk assessments, including the consent for use of cot sides. The signature of the resident or their representative evidences user involvement in care plans and reviews. All plans are reviewed monthly. GP visits are recorded, evidencing that health problems are reported promptly. Community nursing notes are kept in the home. Accident report forms are Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 11 used, completed copies detached and placed on the appropriate resident’s file, ensuring confidentiality. Keys are provided for bedrooms but no resident or their representative chooses to lock their room. Care staff were seen to interact with residents in an appropriate manner and residents said they would feel comfortable in raising any concerns with staff or management. One resident said they regretted male care staff leaving but said, “All the staff here are lovely, I get on well with all of them”. No resident chooses to self medicate. Medication is appropriately stored and medication records are well kept. The pharmacist visits every week to deliver medication and collect surplus stock. Staff confirm that they use the Safe Handling of Medication distance learning pack. Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. The quality rating for this outcome group is adequate. This judgement has been made from gathered during the inspection, which included a visit to the service. Social activities and leisure opportunities are very limited. Residents are not able to go into the community as much as they would like. Visitors say they are well received and made welcome by staff. Menus are adequate but meal times are not evenly spaced. EVIDENCE: Previous inspection reports identified that there were insufficient activities for residents. Care staff reported that it can be difficult to motivate some residents in organised activities and although there is no structured activity there have been occasional impromptu sessions of dancing, exercise to music, dominoes and singing. Staff shortages have limited these sessions of late. One resident remarked that care staff had previously taken them to a local park but this had not been possible for some time; “They’re much too busy these days”. Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 13 Residents gave examples of how they are able to exercise choice, such as in clothing, times of getting up or going to bed, meal times and food preferences. Two visitors were asked for their views; one said staff always fetched them a chair and offered a cup of coffee. Their parent shared a room, by choice. They remarked, “The home is very good, I’ve no complaints. I visit 2-3 times a week and I’m always made very welcome”. Another visitor remarked that their parent had always been well groomed and their previous high personal standards were maintained by the home. “She’s looked after very well… always clean and well turned out … never untidy”. There is a payphone in the corridor for residents’ use but this was out of order at the time of inspection. There are staffing problems with catering and staff said they have to cover for absences. Menus are on a four-week rota. The menu board outside the dining room was not in use at the time of the inspection. Residents have a choice of cereals, porage, toast, grapefruit or boiled eggs for breakfast. There is a choice of meal at lunchtime and sandwiches or hot snacks for tea. Meals are timed in such a way that breakfast lunch and tea are very close together but there is a 12-hour gap between supper and breakfast. It is recommended that these times be reviewed in consultation with residents and their representative to ensure that residents are ready for meals during the day but not go for prolonged periods without eating. Although the menu lacked imagination, residents said they were satisfied with the range and quality of meals. One resident said, “The meals are very nice but there’s sometimes too much”. The kitchen was clean and well organised but sandwiches for residents’ tea were prepared and covered by 11 am because no kitchen staff would be on duty that afternoon to prepare tea. Four residents need liquidized meals. The cook confirmed that they were liquidised together, rather than each part (meat, veg, gravy, etc), separately. These meals were not seen on inspection but the cook confirmed that the results looked less than appealing. It is recommended that this practice be reviewed to ensure that every meal is presented in an appetising manner, and to promote equality for residents unable to voice their own opinions or personal preferences. Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. The quality rating for this outcome group is adequate. This judgement has been made from gathered during the inspection, which included a visit to the service. Arrangements for reporting complaints are satisfactory. Most staff were not aware of procedures to follow regarding adult protection issues. EVIDENCE: No complaints have been recorded since the last inspection. The complaints procedure is displayed in the hall and staff knew the correct procedure to follow. A copy of Lincolnshire Adult Protection Committee policies and procedure is available for reference but two staff were unable to give acceptable responses to an adult protection scenario. They did not know how to recognise and report potentially abusive situations. Some responses demonstrated a complete lack of awareness of adult protection issues. Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. The quality rating for this outcome group is good. This judgement has been made from gathered during the inspection, which included a visit to the service. The home provides a safe and homely environment but the heating in the lounge/diner is inadequate. Residents’ rooms meet their needs. EVIDENCE: The home was generally well maintained. It was reported that a maintenance worker visits three times a week. The area immediately outside the front door was untidy, with discarded furniture lying next to the bins. There is a small garden accessible to residents. Bathrooms and lavatories were adequate and clean. Toiletries were left out in one bathroom but this had been risk assessed and felt to be acceptable as no residents in that area were independently mobile. Specialist equipment was Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 16 provided where necessary and a rotunda was seen used appropriately. Rooms varied in size and one room seen appeared to be too small to accommodate a wheelchair. Deep gouges in the door and frame evidenced the lack of room to manoeuvre. Some residents choose to share and these rooms were fitted with dividing screens. Residents are encouraged to personalise their rooms and all had done so. All rooms were fitted with call bells, with switches easily accessible to residents. Problems with the central heating boiler remain unresolved. At present the temperature in the lounge/diner is maintained by the use of halogen heaters, as necessary. The use of these heaters has been risk assessed. Residents said they were warm and the room was comfortable at the time of inspection. The manager reports that repairs to the heating system will take place in warmer weather, as the system will need to be drained. The home was clean and odour free at the time of inspection. Residents remarked that although there were often staff shortages the standard of cleanliness was always good. Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30. The quality rating for this outcome group is adequate. This judgement has been made from gathered during the inspection, which included a visit to the service. Staffing levels are inadequate at present but new staff have been recruited and are expected to be in post in the near future. Staff interviewed said they had not received specific training in care delivery. EVIDENCE: Some residents and two visitors remarked that staff often had to cover for absences. Four members of staff said that on occasions care staff also covered laundry, cooking and cleaning roles in addition to their own. They said that shortages had an impact on the amount of time they were able to spend with residents. They said they were often asked to work extra, or longer shifts but felt under no pressure to so. Recruitment procedures were robust, and all policies followed. One member of staff had received 4 weeks induction, one had 6 weeks shadowing experienced staff and one said they had “one or two weeks”. All staff interviewed during inspection had received training in manual handling, food hygiene, fire safety, infection control and manual handling. One had also had training in safe handling of medication and was undertaking National Vocational Qualification (NVQ) level 2. Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 18 One member of staff interviewed had previous knowledge of dementia care but confirmed that no training had been offered on dementia since she moved to the home. Two staff members had no awareness of dementia issues or that specific skills were needs to care for people with dementia. Future training programmes should address this lack of awareness. Staff raised concerns that there was no formal handover from the night shift to the morning shift and that information was not always adequately relayed to the team. They confirmed that handovers take place at all other shift changes. Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 35, 36, 37, 38. The quality rating for this outcome group is adequate. This judgement has been made from gathered during the inspection, which included a visit to the service. Recent staff shortages have had an impact on morale. There are various communication issues, which can affect the quality of care and lives of service users and may even put them at risk. There are good recording practices and no health and safety issues were identified. EVIDENCE: The manager was not present at the inspection. Staff said they found him approachable but they did not think the present problems would be quickly resolved. They said they were able to put their views to the manager but thought they were not acted on. They report that communication between each other, and with management is not good at present. One said, “ The Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 20 standard of care is brilliant but staff levels are not good and team spirit is poor.” There is no forum for discussing problems and staff concerns, other than approaching management individually. One said, “ A lot of us feel we need to be careful what we raise in case things are taken personally.” All confirmed that staff meetings are not scheduled, the last one being in February and there are no plans as yet for another. No staff had received regular supervision; two had received one supervision in 12 months and one said they had received none but had been appraised twice in two months. It is recommended that staff receive formal supervision six times per year. Accounting procedures for residents’ personal allowances were satisfactory, two accounts were sampled and found to be correct. Staff files demonstrated that correct recruitment policies had been followed Health and safety documentation was found to be up to date. There was a comprehensive range of risk assessments and evidence that these were reviewed on a regular basis. Health and safety issues identified during previous inspections have since been addressed. Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 21 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 1 X 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 2 x x 3 1 3 3 Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 22 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. Standard OP3 Regulation 14 (1) Requirement The registered person must ensure that appropriate skill mix and numbers of staff can meet assessed needs of residents. The registered person must ensure that staff receive appropriate training for the work they perform. The registered person must ensure that staff are appropriately supervised. Timescale for action 27/04/06 2 OP30 18 (1) (c) (i) 18 (2) 14/07/06 3 OP36 14/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP12 OP15 OP15 Good Practice Recommendations It is recommended that sufficient activities are provided to ensure the needs and wishes of the residents are met. It is recommended that meal times be reviewed to ensure that residents eat at regular intervals. It is further recommended that when meals are liquidised, each part of the meal be done so separately. Belvoir House Care Home DS0000002588.V290085.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 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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