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Inspection on 16/06/05 for Benedict House Nursing Home

Also see our care home review for Benedict House Nursing Home for more information

This inspection was carried out on 16th June 2005.

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.

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

The environment had significantly improved. New carpets, re-decoration, furniture and individual items had enhanced bedrooms and communal areas. New equipment had been installed including an assisted bath/shower and a standing hoist. Residents related positive comments about the home and staff team. One resident was particularly pleased with the laundry systems.

What has improved since the last inspection?

The home has recently appointed a new manager which, with the current Registered Providers, gives a solid management structure. The deputy has been in post for a long period offering consistency and assistance during the manager`s induction. Many of the staff have been in post for several years and know the workings of the home.

What the care home could do better:

The care plan documentation and records relating to medication need to be improved. The current care plan format, if fully completed and reviewed, is appropriate but it was evident that some information was not cross-referenced or included in the daily care. Psychological and emotional needs were rarely reflected in the care plans although inclusion of these are essential to provide an holistic approach to care. The management should continue to recruit permanent qualified nurses as only three permanent staff are employed including the manager.

CARE HOMES FOR OLDER PEOPLE Benedict House Nursing Home 63 Copers Cope Road Beckenham Kent BR3 1NJ Lead Inspector Rosemary Blenkinsopp Unannounced 16 June 2005 13.45 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 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. Benedict House Nursing Home G51-G01 s10127 Benedict Hse UI v224491 160605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Benedict House Nursing Home Address 63 Copers Cope Road, Beckenham, Kent BR3 1NJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8663 3954 020 8658 1337 Sunglade Care Ltd Vacant Care Home with Nursing 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Benedict House Nursing Home G51-G01 s10127 Benedict Hse UI v224491 160605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Staffing Notice issued 17 January 2000 Date of last inspection 16/11/04 Brief Description of the Service: The home is a detached house located in a residential area of Beckenham. The home provides nursing care for those service users in the category older people. the home provides accomodation for 48 service users. Bedrooms are located throughout the home with communual areas on the ground floor and an additonal sitting room on the second floor. Catering and laundry services are provided in house. The home is managed by Andmedia care who have been in place since april 2004, having taken over the role from BML. Andmedia care have previous experience of nursing and care home and has used this to the benefit of Benedict House. Sunglade Care Ltd are the providers Benedict House Nursing Home G51-G01 s10127 Benedict Hse UI v224491 160605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted as an unannounced over three and half hours. The inspector met with four residents individually, all of whom were able to provide relevant information. A small group of residents gave limited responses. Two care staff spoke to the inspector regarding their work in the home. A tour of the home was undertaken including individual bedrooms and communal areas. The kitchen and laundry areas were not inspected Four care plans and the off-duty rota and medication charts were inspected. What the service does well: What has improved since the last inspection? What they could do better: The care plan documentation and records relating to medication need to be improved. The current care plan format, if fully completed and reviewed, is appropriate but it was evident that some information was not cross-referenced or included in the daily care. Psychological and emotional needs were rarely reflected in the care plans although inclusion of these are essential to provide an holistic approach to care. The management should continue to recruit permanent qualified nurses as only three permanent staff are employed including the manager. Benedict House Nursing Home G51-G01 s10127 Benedict Hse UI v224491 160605 Stage 4.doc Version 1.30 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. Benedict House Nursing Home G51-G01 s10127 Benedict Hse UI v224491 160605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Benedict House Nursing Home G51-G01 s10127 Benedict Hse UI v224491 160605 Stage 4.doc Version 1.30 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 standard(s) EVIDENCE: No standards were assessed in this section Benedict House Nursing Home G51-G01 s10127 Benedict Hse UI v224491 160605 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7,8,9,10. The standard of care plan documentation did not fully reflect the residents’ needs. The limited information on some medication charts would introduce an element of risk to the resident EVIDENCE: Three care plans were randomly selected from those residents whom the inspector had identified during the tour. The three residents included one with leg dressings, one who was singing and calling out continually during the inspection and another resident who was in for respite care. The residents’ care plans had photographs in place and reflected their identified needs. Supporting risk assessments for manual handling and nutrition were in place. Psychological and social aspects were not generally included. In one of the care plans under the daily events, it was stated that a resident was crying, described as depressed and frequently confused. However none of these issues were detailed in the care plan and no intervention recorded to address them. Benedict House Nursing Home G51-G01 s10127 Benedict Hse UI v224491 160605 Stage 4.doc Version 1.30 Page 10 Care plans focused on personal care, pressure areas and mobility. Generally risk assessments were not cross-referenced with the initial assessment information or the care plan. Within risk assessment when risk was identified it did not prompt additional intervention i.e. a high-risk nutritional assessment and a low body weight should prompt additional input into the resident’s nutrition. The care plans have a section for agreement by the resident or the relative. However these were rarely completed. The medication charts for one floor were viewed. The medication procedure and the storage facilities were not inspected. Clear photographs were in place. Generally the medication received was recorded, although the section to detail allergies was not completed. Creams were not signed for. Some medication had been hand transcribed on to the medication charts. This information should be checked and signed as correct by two staff. The use of abbreviations should be avoided. In the event that PRN medications are prescribed, full and comprehensive information in respect of its uses, maximum dose and duration must be recorded. Please see requirements 1 and 2. Benedict House Nursing Home G51-G01 s10127 Benedict Hse UI v224491 160605 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12,13. Social and leisure activities are provided and individual choice respected. EVIDENCE: Residents were seen to spend time either in their bedrooms or communal areas. There are two communal areas and the dining room is located on the ground floor. In all areas fluids were available and tea was served during the afternoon. In the top lounge soft sweets were available for residents. For those residents in bed call bells were at hand and staff were located in the communal areas. One resident had his computer although his recent deterioration in physical health had led him to be bed bound currently. He had books and magazines, which he said he enjoyed. Another resident liked her room as she could see the comings and goings on the road outside. Visiting is open and visitors were arriving as the inspector toured. Activities are provided including external entertainment. A cream tea is planned for relatives and residents. TV’s and radios were available. Two residents made favourable comments about the food. Benedict House Nursing Home G51-G01 s10127 Benedict Hse UI v224491 160605 Stage 4.doc Version 1.30 Page 12 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 standard(s) 16. The home provides avenues for raising concerns. Residents felt that their concerns were listened to and actioned. EVIDENCE: The complaints procedure was not on display as it was being reviewed to reflect the change from NCSC to CSCI, the current Regulating Authority. The manager should ensure that information is available whilst the complaints procedure is off-site. The procedure contains timeframes for reponses. The CSCI has received no complaints regarding this service. Residents said that they would raise concerns with the staff or the proprietors and had quickly felt confident in the abilities of the new manager. The residents stated that they met with the manager and the Registered Providers regularly. Benedict House Nursing Home G51-G01 s10127 Benedict Hse UI v224491 160605 Stage 4.doc Version 1.30 Page 13 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 standard(s) 19,20,21,22,23,24,25. The environment provides residents with pleasant and comfortable surroundings to live in. EVIDENCE: The home is located over three floors with lift access via two lifts. The home was clean, tidy and hazard free. Carpets have been replaced and new easy chairs purchased. The majority of bedrooms have been redecorated recarpeted and made to look very individual with paintings, curtains and individual bedding. Those waiting for refurbishment were clean, tidy and presentable. There has been a new Arjo bath and shower installed on the top floor. Some bedrooms had flowers and plants, individual fruit and sweet were also evident. The bedrooms are a mix of single and shared all with a wash hand basin. Privacy curtains were in place. Equipment was seen to be used, including pressure relieving mattresses, raised toilet seats and hoists. Call bells tested were in working order. Benedict House Nursing Home G51-G01 s10127 Benedict Hse UI v224491 160605 Stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29. There are sufficient staff to provide care for the residents. The newly introduced recruitment procedures provide further safeguards to residents. EVIDENCE: The inspector met with two care staff, one a long-standing member, the other had been in post two months. The manager has been in post two weeks. The off duty indicated that the home was working below its staffing notice, however there are currently nine vacancies and the inspector had no evidence that care was compromised because of this. Agreement must be sought from the CSCI, to vary the staffing levels when vacancies occur. Staff supervision has lapsed. The manager plans to resurrect this. The staff duty rota indicated that a team of qualified bank staff supported the three permanent qualified nurses. Some of the bank staff had regular shifts indicated on the duty sheet. Within the care staff team, there are four vacancies. The new manager has quickly identified recruitment as an issue and she was interviewing staff during the inspection. Another full day of recruitment is planned for the forthcoming week. The manager has revised the recruitment procedure, formalising the interview questions and tightening up on the documentation including proof of identity. Staff confirmed induction and training, although certificates were not inspected on this occasion. Benedict House Nursing Home G51-G01 s10127 Benedict Hse UI v224491 160605 Stage 4.doc Version 1.30 Page 15 Staff work long days on duty, which is approximately twelve hours. This system can be beneficial to residents’ care, however, staff must be provided with sufficient breaks and time off between the working days. Staff did confirm that they worked long days. One staff said that she had got “used to them”. Both staff also confirmed that they had sufficient breaks and time off. Please see requirement 3. Please see recommendation1. Benedict House Nursing Home G51-G01 s10127 Benedict Hse UI v224491 160605 Stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33. The Registered Providers, with the newly appointed manager, provide strong management to the home. Issues impacting on health and safety are actioned and great emphasis is placed on this. EVIDENCE: The tour of the home indicated that health and safety aspects were addressed and the staff were aware of these during their daily work. Evidence of good health and safety practices included that those wheelchairs in use had fitted footplates, correct use of the hoist and general positioning of items that residents need e.g. call bells in close proximity to residents. The hot water was found to be satisfactory on all outlets tested. New hot water mixer valves have been fitted on all the ground floor and first floor water outlets. Within the next two weeks all mixer valves will be in place. Benedict House Nursing Home G51-G01 s10127 Benedict Hse UI v224491 160605 Stage 4.doc Version 1.30 Page 17 The Regulation 26 visits are not been conducted. The Registered Providers are in the home weekly or more often, which was confirmed, by residents, staff and the manager. Residents confirmed that they had opportunities to discuss any issues with the manager or proprietors. Regulation 26 visits must be conducted monthly and a report made on the findings. Please see requirement 4. Benedict House Nursing Home G51-G01 s10127 Benedict Hse UI v224491 160605 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 x STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x 3 3 2 x x x x x Benedict House Nursing Home G51-G01 s10127 Benedict Hse UI v224491 160605 Stage 4.doc Version 1.30 Page 19 yes Are there any outstanding requirements from the last inspection? 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 7 Regulation 15 Requirement The Manager must ensure care plan documentation. Risk assessments and rewiews reflect all of the residents needs. Previous date for completeion 31/1/05 The Manager must ensure that records relating to medication are comprehensively completed. Previous timeframe for completeion 30/11/04. The Registered Person must ensure that the staffiing notice is adhered to. The Registerd Person must conduct Regulation 26 visits and leave a report on the findings. Previous timeframe 31/12/04 Timescale for action 30/9/05 2. 9 13 30/7/05 3. 4. 27 33 18 26 30/7/05 30/7/05 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 36 Good Practice Recommendations All staff in the home should recieve formal supervision six times a year and include all elements of standard 36.3. G51-G01 s10127 Benedict Hse UI v224491 160605 Stage 4.doc Version 1.30 Page 20 Benedict House Nursing Home Commission for Social Care Inspection River House 1 Maidstone Road Sidcup DA14 5RH 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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