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Inspection on 19/06/08 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 19th June 2008.

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 home has been well maintained to a good standard by the current Responsible Individual, Andrea Barden. The home employs a full time Maintenance Manager, who works hard with the support of Andrea Barden to continually improve and maintain a good standard in the home. The home was particularly clean fresh and odour free on both days of the site visit and that was even at 07:55am in the morning. The home has retained a number of its staff including the qualified nurse team for a number of years. This provides residents with staff who understand the workings of the home and provides consistency in care. Bedrooms are personalised and individually decorated. Equipment is provided for the individual residents needs.

What has improved since the last inspection?

Since the last inspection there have been a number of areas where improvements have been made. The Responsible Individual has appointed a new Manager who has been in post for two days at the time of the site visit. The home has also appointed a new administrator and recruitment for care staff is ongoing. Improvements have been made in respect of the environment with on going redecoration and refurbishment of communal areas, as well as when possible upgrading of bedrooms. The staff personnel files inspected contained POVA first clearance as well as CRB confirmation. The records generally were well organised with information easy to access. The administrator had good systems in place to ensure records were well maintained. Resident`s money was securely stored. Medication records and storage had improved since the last key inspection.

What the care home could do better:

The home needs to further develop the current care plans, so that it incorporates comprehensive information about the residents, on which the staff can base their care, and includes that information obtained through the assessment process. The routines in the home need to reflect resident`s choice as this has been the subject of several comments including those from residents, staff and two relatives. The routines in the home need to be flexible to accommodate individual`s preferences. An accurate complaint log needs to be developed for use.A review of the staffing levels needs to take place, to ensure two staff per floor is implemented to safely meet residents` needs. Mandatory training, and that specific to the resident population in the home needs to be improved upon to ensure staff are competent in the roles that they undertake. Resident`s financial records must detail all income and expenditure. Quality assurance measures to include the views of relatives and residents.

CARE HOMES FOR OLDER PEOPLE Benedict House Nursing Home 63 Copers Cope Road Beckenham Kent BR3 1NJ Lead Inspector Miss Rosemary Blenkinsopp Key Unannounced Inspection 19th and 23rd June 2008 07:55 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Benedict House Nursing Home DS0000010127.V364688.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. Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 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 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) 020 8663 3954 020 8658 1337 none 10/10/06 Sunglade Care Ltd Elaine Veronica Hitcham Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 48 26th June 2007 Date of last inspection Brief Description of the Service: Benedict House is a large detached building situated in a residential area of Beckenham. It is near to local town facilities, and can be reached by public transport. The home is an older building, and is adapted to provide nursing care of older people. The home’s owner lives in the vicinity, but he does not oversee the day-to-day control of the home. Management is carried out by andmedia care, who have done so for over five years. Accommodation is on four floors (lower ground, ground, first and second floors), and there are bedrooms situated on each floor. Access to all floors is facilitated by two passenger lifts. There is a mixture of single and shared rooms, and some have en-suite toilet facilities. The home is in the process of reviewing some shared bedrooms to large single accommodation. There are communal areas situated throughout the home, with a large lounge and a separate dining area on the ground floor. Smaller quiet areas are on the first and second floors. The activities room on the lower ground floor leads out through patio doors to a small garden, which is enhanced by a patio area and tubs of flowers. Parking is provided to the front of the building. The fees in this home range between £570.00 to £725.00. Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 5 Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 1 star. This means the people who use this service experience adequate. The inspection was conducted over two half-day periods. The new Manager facilitated the second site visit. Periods of observation were undertaken on two floors. Prior to the inspection the Manager had completed the AQAA and forwarded this to the CSCI. Seven comment cards were provided and returned during the inspection including four from residents. During the visit the inspector met with two relatives and several residents. Staff were interviewed as part of the site visit. All of the information obtained from the sources identified above has been incorporated into this report. A selection of documents were inspected including care plans, staff personnel files as well as health and safety records. Feedback was provided to the Manager at the end of the inspection. Other information which has been considered when producing this report and rating, is the information supplied and obtained throughout the year including Regulation 37 reports and complaints. Comments received in a relative’s comment cards included the following “staff make my mother as comfortable as possible and look after her needs” A resident comment card included the following “people are very good and older staff have more experience”. In addition the food was said to be good and a choice of food was referred to Staff shortages were referred to in two comment cards with particular reference to the need for 2 per floor. What the service does well: The home has been well maintained to a good standard by the current Responsible Individual, Andrea Barden. The home employs a full time Maintenance Manager, who works hard with the support of Andrea Barden to Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 7 continually improve and maintain a good standard in the home. The home was particularly clean fresh and odour free on both days of the site visit and that was even at 07:55am in the morning. The home has retained a number of its staff including the qualified nurse team for a number of years. This provides residents with staff who understand the workings of the home and provides consistency in care. Bedrooms are personalised and individually decorated. Equipment is provided for the individual residents needs. What has improved since the last inspection? What they could do better: The home needs to further develop the current care plans, so that it incorporates comprehensive information about the residents, on which the staff can base their care, and includes that information obtained through the assessment process. The routines in the home need to reflect resident’s choice as this has been the subject of several comments including those from residents, staff and two relatives. The routines in the home need to be flexible to accommodate individual’s preferences. An accurate complaint log needs to be developed for use. Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 8 A review of the staffing levels needs to take place, to ensure two staff per floor is implemented to safely meet residents’ needs. Mandatory training, and that specific to the resident population in the home needs to be improved upon to ensure staff are competent in the roles that they undertake. Resident’s financial records must detail all income and expenditure. Quality assurance measures to include the views of relatives and residents. 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. Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 9 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 Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 10 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): 3. People using the service experience adequate quality outcomes in this area. We made this judgement using a range of evidence, including a visit to this service. The pre-admissions procedures provide residents with limited information which they require in order to make any decision regarding placement at Benedict House and to establish whether the service is right for them. Staff have some information on which they can assess the needs of the resident, to ensure that they can meet those individuals’ needs and on which to base an initial care plan. EVIDENCE: Those care plans sampled for case tracking also had the assessment information included as part of the process. There was evidence of the home’s own assessment having been conducted by either the Manager or a qualified nurse. There was also an initial enquiry form completed indicating if a provisional visit would be undertaken by the relatives. Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 11 In the second files there was an assessment of the resident outlining his needs. There was supporting information from the placing authority which provided good information. Within this form there was a diagnosis of Multi Infarct Dementia however there was a statement to say that the residents’ needs would be best met in a frail elderly facility. Whilst this is the case the home must ensure that during their assessment that they are able to met residents’ needs and not simply accept the statement made from the placing authority. In addition there was a referral letter from Bromley Hospitals and an enquiry form which indicated a visit made by the family prior to admission. A third care plan also contained the home’s assessment although areas such as hobbies, dietary needs, physical and skin condition were blank. Without such information it would be difficult to establish if pressure relieving equipment was required or referral to the dietician necessary. Information from the referring hospital and the discharge summary from the previous residential care home had been received. The information under the Community Care Act from the placing authority was to a good standard. It was difficult to establish what information had been provided pre-admission to the resident regarding the service, or how they had been consulted regarding their admission. Contracts issued by Benedict House were in place, although they did not detail the bedroom to be occupied. The service agreements from the funding authority were also on file. The Statement of Purpose will need to be amended to reflect the change in management and the staffing structure. Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience adequate quality outcomes in this area. We made this judgement using a range of evidence, including a visit to this service. Residents care needs are met by staff in the home supported by members of the multi disciplinary team. The emphasis on physical healthcare interventions and routines detracts for personalised and individual care. The information in care plans provided limited information for staff to deliver the care, particularly in respect of social needs. Without comprehensive information inconsistencies in care and approach, can occur with may negatively impact on resident’s health. Medications were safely managed which provides protection to residents EVIDENCE: The care plan of a resident admitted in June 08 was inspected. This care plan contained the manual handling assessment, nutritional risk assessment as well as the skin integrity assessment. It was noted that this resident had identified high risks in several areas. In the event that high risk is identified through the Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 13 assessment process then clear interventions should be put in place to reduce or eliminate the risk. This care plan was set out on the standard format used in the home which covers activities of daily living. This was limited to physical problems although within the assessment information there was reference to psychological and social needs which could have been incorporated. Significant areas of psychological care were omitted, all of which should have been included in the initial care plan, as these included confusion, which is a relevant factor for any newly admitted resident. The second care plan was also that of a newly admitted resident. Their care plan was less well completed with the manual handling, pressure sore, nutritional and falls risk assessments all blank. There was another document which was a manual handling assessment and this was completed although this needs to detail the type of hoist and sling to be used. There was no care plan at all in place for any of the residents presenting needs. Whilst the we accepts that the two residents had only been in the home for a few days an initial care plan should be in place and expanded upon as more information is known about the resident. The purpose of the assessments is to provide some basic information relating to the resident’s needs. In the third care plan, the pressure sore and nutrition assessment were both in the high risk category. Only two areas were identified under the care plan section personal hygiene and diabetes. The diabetic care plan was limited and to the nutritional aspects of care but little on other effects such as foot care and eye problems. It had been clearly identified that skin integrity issues were present yet there was nothing in the care plan to inform staff what measures had to be taken to prevent tissue damage. In the main residents and advocates signatures were not in place, to confirm that they had inputted in to the development of the care plan. The fluid charts were incomplete without totals for the resident’s intake over the 24 hour period and entries such as “water”, gave no indication of the amount. There was evidence of long periods between entries. This resident was catheterised and accurate fluid balance records are important. Without accurate records it would be impossible to establish if the resident was having sufficient fluid intake to maintain her state of hydration. The multidisciplinary sheet had entries by the visiting professionals including the GP. The records gave the date of the visit and a report on the visit. The standard of these entries was variable with some providing good information others less so. Entries such as “all residents seen today” in the GP book gave no information on what the GP had actually said or done for individual residents. Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 14 Weight records were in place in care plans. Weights are recorded routinely monthly. In three care plans, it was evident that residents had lost weight, this was particularly concerning as two of them had a low weight to start with. Closer monitoring and/or interventions from other health professionals may have been required to ensure an adequate weight was maintained. Medications are undertaken by the two RGN’s on duty the home has two clinical storage areas for medication and two trolleys. The observed practice of medication administration was correct with individual medications signed after the resident had taken them. The medications were inspected with the RGN. Those records relating to controlled drugs were accurate and the amounts correct with the stock balance. Eye drops were dated on opening as were other items of medication in use which had a short self life. The supporting medication charts were completed with the amount of medication received recorded. Those medications which were disposed of had supporting records retained. Those medications to be administered “as required “, had full instructions provided. Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 15 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 People using the service experience adequate quality outcomes in this area. We made this judgement using a range of evidence, including a visit to this service. People who use the service have a choice of a varied selection of activities provided including external entertainers for them to participate in. Some choices are provided which means residents are enabled to input into their day. More flexibility is required in the daily routines to promote resident’s independence and enhance individuals’ well being. EVIDENCE: Relatives were seen visiting throughout the day, the first one arriving mid morning. They ststed that they visited very week and was happy with the care their relative was receiving. They also said staff engaged with them and their relative and they were made welcome on arrival. The resident stated that they too was happy and “well looked after”. The majority of the residents remained in their bedrooms throughout the course of the morning. This has been the subject of previous discussion with Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 16 the home. The Responsible Individual stated that residents prefer their own bedrooms and choose not to spend time in the lounge. The lounge is beautifully decorated and furnished, with a large TV, radio and other activities available so use of it should be encouraged, to prevent isolation and promotion of a community spirit. The lunch was observed on the second site visit 23 June. The tables were set with clothes, serviettes, cutlery and juice provided. Salt and pepper was not available on the tables. Of those residents who were in the dining room for lunch, ten were seated in their wheelchairs for the meal. Two hot meals were offered, both meat based. Alternatives could be provided on request. Routines do prevail throughout the home although some choices are incorporated into this including a choice of menu. The staff group consist of male and female care and qualified staff therefore gender care issues can be addressed. However such preferences must be stated and known to staff. One male worker was observed to be addressing personal care on a female resident, although it was not recorded if that was the resident’s choice. Several comments including those from residents, staff and two relatives referred to the lack of choices and activities provided within the home. The routines in the home need to be flexible to accommodate individual’s preferences including rising and retiring times. Staff tended to focus on meeting physical health needs and there was little evidence of engagement on a social level, such as reading the newspapers to residents, chatting to them, engaging in board games etc. One resident has specific cultural and religious needs which are met by the family mainly. However staff need to be familiar with what the specific issues are around caring for someone with a different faith, culture or ethnic origin, to ensure they can maximise that individual’s life whilst living in the home. This resident was known to be a vegetarian with other dietary needs yet this was not incorporated into her plan of care. Those residents who remain in their bedroom should be offered and provided with individual activities by staff. The new Manager was already aware of some of the routines which prevail within the home and was intending to raise this with staff to introduce more flexibility. Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 17 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. People using the service experience adequate quality outcomes in this area. We made this judgement using a range of evidence, including a visit to this service. Complaints information is available for residents to access. The records retained on site did not detail all complaints received. Staff had a working knowledge and understanding of adult protection and whistle blowing, regular updating is required in these areas, to ensure that they are familiar with current guidance and contact points. EVIDENCE: Information regarding complaints was on display in the hallway providing information on internal contacts and external bodies. The home has a complaints’ book although there were no records of recent complaints, the Responsible Individual stated that there had been no official complaints raised since 2005. It is important that all complaints and concerns are fully recorded including the action taken. In addition there needs to be a record of whether the complainant is satisfied with the outcome of the investigation. Those records need to accurately reflect the number of complaints and issues raised in the home. This needs to be actioned with a complaints log retained. Again, the recording and subsequent investigation of complaints was something which the new Manager was aware of, and that needed to be reviewed. Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 18 During the staff interviews they were asked about abuse and what action to take should this be suspected or witnessed. All staff were clear that this should be reported and cited internal avenues for this. In relation to external contact points the CSCI were referred to although the single point of contact was less well known. Staff were aware of the different forms that this may take and overall demonstrated a working knowledge of the subject. Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 19 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 and 26. People using the service experience good quality outcomes in this area. We made this judgement using a range of evidence, including a visit to this service. The homely environment is maintained to a good standard, clean and hazard free. Sufficient equipment and facilities are provided to meet resident’s needs. The various communal areas, lift access and specialised equipment all add to benefit resident’s daily lives EVIDENCE: The environment was particularly clean and odour free this was even at the first site visit which was conducted 07:55 am. In a home where there are a lot of residents who are incontinent, odours can prevail. The maintenance, cleanliness and presentation to the home are all to be commended. The current Responsible Individual, Andrea Barden works hard to ensure the environment is well maintained and on going improvement in the home have Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 20 been evident. Improvements include replacement of equipment, a newly installed specialised bath, re-carpeting of areas as well as refurbishment and upgrading of bedrooms. The handy man addresses many repairs and all of the general maintenance internally and externally at Benedict House. All of these provide residents with a comfortable well equipped home in which to live. Communal areas including sitting areas and the dining room are spacious nicely presented and make for comfortable areas for relatives and friends to visit. Bedrooms were personalised not only with resident’s own mementoes but with individual curtains, bedding, pictures etc. Shared rooms had appropriate screening. Clocks and calendars were evident in some areas. There was sufficient equipment seen to be available and used including pressure relieving mattresses, hoists, zimmer frames and wheelchairs. Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience adequate quality outcomes in this area. We made this judgement using a range of evidence, including a visit to this service. Staffing needs to be reviewed so sufficient numbers are available to meet the resident’s needs. Ancillary and administration staff work to support the care staff. Staff are subject to recruitment procedures which are sufficiently robust to ensure the staff employed are suitable, fit and healthy to undertake the job. Staff are provided with some training and induction to enable them to undertake the work they perform and provide residents with the support they need. EVIDENCE: At the time of the two site visits there were two Registered Nurses and five care assistants for thirty five residents. The Manager is supernumerary to these numbers. On the top floor one care assistant as seen to be looking after eleven residents with occasional help sourced from the middle floor. This is unsatisfactory particularly in light of the need to hoist residents, where two staff should be present to ensure they are safely managed. The new Manager was aware of this and had got agreement to increase the staffing on this floor to two care staff, although this was not yet implemented. The staffing increase needs to be addressed as soon as possible to ensure safety of residents and staff. Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 22 Those staff who were interviewed confirmed that they had been subject to recruitment procedure and this was checked by sampling staff personnel files. The personnel files were well laid out with information easy to access. Application forms were completed evidence of identity checks health declarations and references were on file. Evidence of POVA and CRB checks were retained. Some of the files had the original CRB form attached once these have been checked then they should be disposed of as the information is confidential. Only those of the recently employed staff should be retained for checking by the CSCI. Most references were confirmed by way of a company stamp or headed paper. Those staff who were on duty were interviewed as part of the site visit. The staff interviewed included care staff, a qualified nurse and a domestic. All staff confirmed that they had received training although one stated that there had been little in the way of external courses as most were in house. External training is beneficial as it not only updates you on the subject but allows for networking and sharing of practice related experiences. Staff were knowledgeable about most of the topics on which they were questioned which included infection control, MRSA abuse and whistle blowing. One area which needs further training is Clostridium dificile, as some care staff were unaware of it; however the qualified nurses were very up to date on the subject. The qualified nurse, who is going to take the clinical lead, due to the absence of a trained nurse Manager, was very good clinically on the topics discussed with her. The training matrix evidenced limited amounts of training received within the last twelve months. Topics such as abuse had last been conducted February 07 and first aid 2005. Twelve staff were due to attend first aid training 23 July 08. The mandatory topics had not been addressed, for all staff within the stated timeframes and there was little training in relation to resident’s conditions. Seventeen staff have achieved NVQ level 2 and one level 3. Evidence of regular staff supervision and annual appraisals was limited. Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. People using the service experience adequate quality outcomes in this area. We made this judgement using a range of evidence, including a visit to this service. The home has a new Manager who is experienced at management level in residential care setting although he is not a qualified nurse. Health and safety servicing and maintenance is addressed to ensure the home is safe for residents. Quality assurance measures are limited therefore give little information on how the service can be improved upon to benefit residents. EVIDENCE: Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 24 The previous Manager left two weeks prior to the inspection. The new Manager has previous experience as a Deputy Manager in a residential care setting which was regulated by the CSCI. He has an NVQ level 4 and the RMA qualification. He is familiar with the Standards and Regulations that govern Care Homes. He is not a nurse although will be the Manager of this nursing home. In such cases it must be clearly established which nurse will take the clinical lead and from whom she will receive clinical supervision. This was clearly identified to Andrea Barden, before the appointment and re iterated during the site visit to the Manager. He as fully aware of the criteria and was investigating avenues to obtain clinical supervision for the lead nurses who will be Margaret Okon and Xui Ping. A selection of health and safety service certificates were inspected to ensure that the environment and all equipment in the home was safe. These included checks for the hoists and lift under the LOLER regulations. The gas and electrical certificates were all current. The fire alarm had been services November 07 and extinguishers within the last twelve months. Records relating to fire drills were in place and had staff signature to confirm attendance. The fire drills included those specifically for night staff. Emergency lights tests were also recorded. Weekly fire alarm testing indicated different zones were tested In some bedroom doors, wedges were in use. On asking about this the we were advised that residents wanted their doors to be open so they could see people. All fire doors must be kept shut except those, which are on automatic release when the fire alarm sounds. Further advice should be sought from the fire officer. Two residents’ finances were checked and found to be correct as specified on the balance sheet. There were no receipts for some purchases and expenditure had been agreed by the Manager. All income and expenditure must be recorded and receipts retained to verify expenditure. Two staff need to sign in the event that the resident themselves is unable to do so. In relation to quality assurance measures there was little supporting records of audits and meetings to demonstrate monitoring of the care provided. The minutes of a staff meeting held July 07 was the only meeting record available. Audits on care plans and pharmacy had been conducted by the previous Manager approximately two to three months although none since January 2008. The reports arising out of Regulation 26 visits the annual review of the service and other auditing and monitoring evidence was not available. Without seeking the views of all of those who use the service it is impossible to identify the areas where improvements are required. Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 25 Regulation 26 visits must take place monthly unannounced and a report on the findings left. The Responsible Individual is in the home very frequently and has been there daily since the Manager left, however evidence of the Regulation 26 visits still need to be retained. Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 26 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 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 X 3 Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 27 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 Requirement The Manager must ensure that there is evidence of comprehensive assessment reports, details of information provided and consultation with the residents prior to placement. Confirmation in writing on the home’s ability to meet their needs must be provided. The Manager must ensure that all care plans are fully reflective of residents’ individual physical, physiological and social needs and have input from the residents or their advocate. Supporting documentation must be relevant and updated. Some progress has been made on this requirement. 3 OP14 12 Routines in the home must be flexible enough to promote choice and independence for residents. 30/09/08 Timescale for action 30/09/08 2. OP7 15 30/09/08 Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 28 4 OP16 22 5 OP27 6 OP30 18 18 7 OP33 24 8 OP35 17 Complaints records must accurately reflect all those received with the investigation and outcome. A summary of all complaints must be retained Sufficient numbers of staff must be on duty at all times to safely manage residents Staff must be provided with sufficient training to undertake the work they do. This includes mandatory training and those topics relevant to residents needs. Systems must be in place for reviewing and improving the quality of care that includes the views of all those involved with the service. Records of all transactions relating to residents monies must be retained with receipts and signatures as evidence of expenditures. 30/09/08 30/07/08 30/11/08 30/11/08 20/09/08 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 OP28 Good Practice Recommendations The Manager should ensure that practice is monitored to reflect training provided to staff. The Manager should ensure that all staff are subject to supervision, which is individual to their needs. 2. OP33 Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Benedict House Nursing Home DS0000010127.V364688.R01.S.doc Version 5.2 Page 30 - 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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