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Inspection on 20/02/08 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 20th February 2008.

CSCI found this care home to be providing an Poor service.

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

It was evident that money is invested in the home not only on furniture and fittings but staffing as well. Bedrooms had been refurbished to a good standard. The Responsible Individual has a hands on approach to managing the home and works closely with staff. Ms Barden provides good support to staff in the day to day running of the home

What has improved since the last inspection?

The Manager has been in post since 4 September 2006, and has addressed some of the clinical issues, which were in need of attention. It was evident that since the last inspection those medication systems had improved both in terms of record keeping and storage.The handyman has addressed the fire training in the home. He provided records of those fire drills conducted as well as some of the outcomes.

What the care home could do better:

The evidence of the assessment process, conducted prior to any resident being admitted, including initial information provided, trial visits and contracts, should be available for staff to refer to and the inspectors to access. Care plans should be comprehensive in content to reflect all of the residents needs. Supporting risk assessments must be in place where required. Staff must be able to address resident`s needs in a professional and timely manner and have an understanding of all aids and equipment in use for residents in their care. Residents should be supported to be as independent as possible and provided with a range of individual and communal activities to promote their social needs. The recruitment of staff is not robust enough to protect residents and this needs to be rectified. It was evident that Criminal Record Bureau (CRB) checks are not been undertaken nor Protection of Vulnerable Adults (POVA) clearance obtained prior to commencement of employment. An immediate requirement was left regarding this matter. Staff must be knowledgeable about adult protection procedures including reporting and recording of such events. The Manager was off sick during this site visit. In the absence of the Manager, the records and documentation need to be available and staff aware of how to access them. This was not the case when the complaint information was requested. Staff training needs to be improved upon including the statutory training. Staff need to have regular updates on statutory topics. In addition training relevant to the conditions of the residents nursed within Benedict should be addressed. The servicing of all items and equipment must be in line with the associated Regulations.

CARE HOMES FOR OLDER PEOPLE Benedict House Nursing Home 63 Copers Cope Road Beckenham Kent BR3 1NJ Lead Inspector Miss Rosemary Blenkinsopp Unannounced Inspection 20th February 2008 09:30 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.V360126.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.V360126.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 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) 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.V360126.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 2nd December 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 is easily 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 approximately two 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 on the ground floor and lower ground floor, as well as smaller quiet areas 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.V360126.R01.S.doc Version 5.2 Page 5 Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The site visit was conducted unannounced by two inspectors. At the time of the inspection there were eighteen vacancies. There were two qualified staff on duty that assisted the inspectors. Mrs Barden, who is the Responsible Individual arrived mid afternoon morning, and assisted the inspectors, whilst the administrator provided all items requested. All staff were friendly and helpful throughout the day. Currently there are 45 bedrooms in use as some of the double rooms have been converted to single with en suite facilities. The home continues to be maintained to a good standard with items of equipment, specialized beds hoists and lifting equipment all available. Redecoration, new carpets furniture and fittings have made a significant impact on the living accommodation for residents and staff working in the home. Those residents and relatives with whom the inspector met were in the main positive about the home, staff and treatment that they received. Records, which were inspected, were generally satisfactory. What the service does well: What has improved since the last inspection? The Manager has been in post since 4 September 2006, and has addressed some of the clinical issues, which were in need of attention. It was evident that since the last inspection those medication systems had improved both in terms of record keeping and storage. Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 7 The handyman has addressed the fire training in the home. He provided records of those fire drills conducted as well as some of the outcomes. What they could do better: The evidence of the assessment process, conducted prior to any resident being admitted, including initial information provided, trial visits and contracts, should be available for staff to refer to and the inspectors to access. Care plans should be comprehensive in content to reflect all of the residents needs. Supporting risk assessments must be in place where required. Staff must be able to address resident’s needs in a professional and timely manner and have an understanding of all aids and equipment in use for residents in their care. Residents should be supported to be as independent as possible and provided with a range of individual and communal activities to promote their social needs. The recruitment of staff is not robust enough to protect residents and this needs to be rectified. It was evident that Criminal Record Bureau (CRB) checks are not been undertaken nor Protection of Vulnerable Adults (POVA) clearance obtained prior to commencement of employment. An immediate requirement was left regarding this matter. Staff must be knowledgeable about adult protection procedures including reporting and recording of such events. The Manager was off sick during this site visit. In the absence of the Manager, the records and documentation need to be available and staff aware of how to access them. This was not the case when the complaint information was requested. Staff training needs to be improved upon including the statutory training. Staff need to have regular updates on statutory topics. In addition training relevant to the conditions of the residents nursed within Benedict should be addressed. The servicing of all items and equipment must be in line with the associated Regulations. Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 8 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.V360126.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.V360126.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): 1, 3 and 4. (Standard 6 is not applicable to this service). People who use the service receive Adequate quality in this outcome area. This is based on all information including the site visit. The Statement of Purpose and the Service User Guide provide information to enable the prospective person to use the service and their representatives make an informed decision as to whether the home can meet their assessed personal, health and social care needs. An assessment of need is undertaken prior to admission making sure that the person to use the service and their representatives are confident that staff have the necessary specialist skills and ability to care for the person to be admitted. Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 11 EVIDENCE: The home is registered for up to 48 residents in the category Old Age – not falling within any other category. The inspector viewed pre assessments information for two residents who had been recently admitted to the home. The inspector had seen both of these residents during the course of the inspection and met with the relatives of one. The inspector did attempt to converse with both residents, although little information was obtained. Both residents had in place an assessment conducted by a senior nurse in the home. One gentleman had been admitted 21/1/08. The assessment conducted by the home outlined the activities of daily living including the assistance that he required. The information was comprehensive and would have provided staff with a good base line on which to produce a care plan. Other information included an enquiry form and a Bromley Hospitals assessment summary dated 9/1/08, which contained good information. There was no information relating to trial visits made by the resident or their family although the administrator had shown these relatives around and said that the enquiry form partially evidenced this. The inspector was unable to locate the funding authority contract, although delays in issuing these from Bromley Social Services are known to occur. The Statement of Purpose and Service Uses Guide were both available. In the second file selected for inspection the assessment information included a discharge summary and an assessment conducted by Lambeth Primary Care Trust, which was very informative. In addition there was the home’s own assessment. Again the enquiry form indicated a pre admission visit had been undertaken prior to placement. Please see requirement 1. Benedict House Nursing Home DS0000010127.V360126.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 who use the service receive Adequate quality in this outcome area adequate. This is based on all information including the site visit. Care plans need to be more detailed to ensure that staff are aware of how assessed personal, health and social care needs of the individual are to be met: ensuring that they respect the person’s dignity and privacy. The service has a medication policy and procedure accessible to staff; the completion of medication records ensured that the person using the service could be confident that medication is administered correctly within regulations. EVIDENCE: The new care plans have been in place for over a year now. All resident’s information is in this format, which is easy to use. If care plans were fully completed and included all necessary information pertaining to the resident it would provide comprehensive guidance. The inspector was able to access information quickly and easily. Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 13 We followed through the two residents whose admission information had been viewed. Care plans included photographs of residents and general information including next of kin details and contact numbers. In general care plans covered physical health care required including diet, pressure areas and communication. The care plan for communication included a number of issues, which should have been separated out into individual problems, as they would need different interventions. The content of the interventions required to address the problems were reasonably well completed Date indicating when care plans had been generated were omitted nor was there any indication of residents or relatives involvement by way of a signature. Supporting risk assessments were in place including a general risk assessment and those relating to manual handling, skin integrity and falls. The assessment for nutrition was not in place although within this care plan, there was a problem indicating the resident needed a soft diet. The care staff and the RGN’s complete daily events separately. The inspector checked the weight book for the two new residents neither had their weight entered. The manual handling assessment needs to detail the actual hoist to be used and type of sling. Appointments through the multidisciplinary team i.e. optician, dental etc, were recorded although retained separate to the care plans. Within the daily events reference to multidisciplinary visits were recorded. In the GP file there was limited information such as “ saw all residents “, although other entries provided more information. All information in respect of multidisciplinary team visits must be fully recorded and where appropriate actioned. Care plans are audited by the Manager and records relating to these audits were available. From the records seen six audits had been conducted since 29/1/07. It was noted that several residents whilst in their rooms were sat in wheelchairs, even though easy chairs were available. This should be monitored as not only can this be uncomfortable, but also it can cause damage to skin and bony prominences. This needs to be reviewed. Comments were received from two people, one from a relative and one from a resident regarding personal care. The two comments indicated a reluctance and delay when residents required the toilet and the resident felt that they were perceived as” a nuisance”. One relative pointed out that her mother’s hearing aids were applied incorrectly and this was why she was unable to hear. Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 14 This was a common problem she said. Staff need to be familiar on the use of all aids required by the residents and how to apply these. Some of the first aid boxes were checked and found to be depleted of essential items such as plasters. Someone should take responsibility for ensuring that these are stocked with appropriate items and items replaced as necessary. The medication systems were inspected with the assistance of the RGN on duty. Generally the records were to a reasonable standard with resident photographs and a list of their individual allergies attached to the front the file, as well as in most cases, on the Medication Administration Chart (MAR). There was no over stocking noted and the medication trolley was tidy. Those medications checked were in date. Records relating to the clinical room temperature and fridge temperatures were in place. The sharps disposal bin was dated on opening. Eye drops were dated on opening. Records for those medications received in to the home were in place. On one chart the medication administration information was without a staff signature although this appeared for the record of received medications at the bottom of the chart. Medication records must be fully completed with signatures and not open to interpretation. Medications for disposal had two staff signatures in place and other information included the amount to be disposed of and the resident’s name. The home has a contract for collection of the drugs disposal bin. It was noted that medications prescribed “ PRN” had the maximum dose indicated, other information should include the reason for the medications, and where applicable the duration. Hand transcriptions of medications should have two staff signatures in place to confirm the accuracy of the information recorded. The home has one medication stored and administered under Controlled Drugs Regulations. The amount in stock was correct when checking the Controlled Drug register and records were completed for administration. In the controlled drug cupboard was a morphine injection, which was that of a deceased resident, this should have been returned to the pharmacy. The correct creams were in individual bedrooms for those residents who required creams to be applied. A medication audit was conducted October 07 by the supplying pharmacist and two other audits were conducted by the Manager recorded as 31/1/08 and 10/12/07. Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 15 The medication systems recording and storage had improved since the last key inspection. Please see requirements 2 and 3. Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 16 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 who use the service receive Adequate quality. This is based on all information including the site visit. Generally staff endeavour, to encourage and support the people who use the service to maintain their independent living skills; the home tries to be flexible, however the choice of routines and activities were not always met. The food in the home is of a reasonable quality; mostly meeting the dietary needs of the people who use the service more needs to be done relating the choices available concentrating on healthier options; staff need to be more sensitive when helping people to eat making sure respect the persons right to choice, dignity and independence. EVIDENCE: During the course of the morning we observed that many residents spent time in their bedrooms some in the first floor lounge. The ground floor lounge Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 17 remained empty until after lunch when some residents were brought to this area. This has been an issue and the inspector has had this related to her on two occasions and related this to the Manager. The inspector asked Ms Barden about this and was advised that it was resident’s choice. Some residents in this home are unable to make their own decision and in such cases the next of kin should be involved in the residents care plan. The staff should discuss with residents and their relatives preferences and choices in their daily lives and these decisions should be incorporated into care plans and recorded. We met with several visitors who were in the home throughout the day from early morning until late afternoon. Two relatives arrived as early as ten in the morning. They stated that they visited weekly and felt that their relative was well cared for. They felt staff were welcoming and they were offered a drink usually. Other visitors related favourable comments regarding the home the staff team, and the care that their loved ones received. One daughter said she felt guilty about having to put her mother into a care home but realised that she was unable to care for her. During the course of the tour, residents were observed to be well presented with make up and jewellery on. During the lunch nine residents were in the dining room, six of whom were in wheelchairs. Tables were set up with some cutlery and serviettes although menus and salt and pepper were absent. It was noted that two hot choices of food were served that being fish or chicken casserole. The choice of meal is recorded in a menu book and it is from this information that staff serve the meal. One staff assisted two residents to eat mashing one resident’s food into a pulp. Plate guards were available although not used. It was noted that some of the residents would have benefited from these as they spilt food onto their laps. Juice was served with the meal. One resident commented, “can’t complain about the care and the lunches are very good.” One to one engagement between staff and residents was task orientated. There was little communication between residents. Limited signs of well being were observed. There were no formal activities taking place during the course of the site visit. TV’s newspapers and visitors provided the entertainment. Ms Barden did advise the inspectors that outside entertainers are bought into the home and this had been evidenced on previous site visits. The inspector interviewed the granddaughter of one of the residents included in case tracking. She stated that her grandmother has been in the home for three weeks. Prior to admission she had looked on the Internet; obtained reports and visited local homes before deciding that Benedict met the criteria for her grandmother. She felt that the home was very clean, odour free and that the bedrooms and communal areas were decorated and furnished in a homely style, not institutionalised. The Manager of the home had visited her in Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 18 the community and undertook an assessment. The Manager also had conversations with Social Services and subsequently offered a place at Benedict House and confirmed that they could meet her assessed care needs. The family were able to choose her room and to bring in items of furniture, bedding, ornaments and pictures. The granddaughter stated that her grandmother did not like the hoist so the home has provided an adjustable bed. The granddaughter stated that the family had input into formulating the care plan and making sure that the care provided by the home met her assessed needs. The granddaughter said that her grandmother’s choices were respected, however she did not like the food very much but this was remedied by the family bringing in food she liked, as some member of the family visited every day. Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 19 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 who use the service receive Adequate quality. This is based on all information including the site visit. Complaints are not handled properly to provide the people who use the service with confidence that their concerns will be listened to, taken seriously and acted upon or recorded within the set timescales within the homes’ complaints policy and procedure. Policies and procedures relating to safeguarding people who use the service are in place; however some of the staff are not familiar with the guidance and are therefore could be placing the people who use the service at risk. EVIDENCE: The complaint information was available in the hall and contained details of the CSCI. The CSCI have received one concern regarding this service since the last inspection. This was in relation to residents not spending time in the communal areas and left in their bedrooms for long periods. This had been referred to the Provider for action. The homes own complaints log was unable to be located either by the nurse in charge or Ms Barden. The Manager was off sick on the day of the site visit, hence at this visit, the complaints information could not be inspected. Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 20 The home has an adult protection procedure, within which the information was clearly laid out, although this needs local, external contacts to be added. The Bromley Interagency Guidelines were also available in the office. The inspector met with two staff and discussed adult protection matters. They had an understanding of the topic although demonstrated a limited knowledge in respect of reporting and recording such events. In addition their knowledge of whom externally they could approach about reporting such matters was limited. All staff should have their knowledge of such matters refreshed including reporting mechanisms. Please see requirement 4. Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 21 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 who use the service receive Good quality. This is based on all information including the site visit. The physical design and layout of the home enables the people who use the service to live in a safe, well maintained and comfortable environment that is decorated and furnished to a good standard; encouraging and supporting the people who use the service to maintain their chosen lifestyle and independence. EVIDENCE: The home has significantly improved since the current management company took over. All areas of the home were clean, tidy and odour free. Communal areas were homely and domesticated with comfortable seating and surrounds. Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 22 Areas were nicely decorated with curtains and soft furnishings in place. Some of the double bedrooms have been refurbished to provide single accommodation with ensuite toilets and wash hand basins. Bedrooms were personalised. Call bells were in reach in some bedroom not all, and fluids available. Staff must ensure that residents have access to call bells, fluids and any other item, which may make their lives more comfortable, such as the remote control. The front of the building was well presented it was tidy and the stairway had pot plants with spring flowers which made it feel welcoming. There are plans to fit each bedroom door with a door guard, which automatically releases the door when the fire alarm sounds. The home continues to replace the current beds with special hi/low nursing beds. Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 23 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 who use the service receive Poor quality. This is based on all information including the site visit. Currently staffing levels are adequate; staff are trained and skilled to provide the appropriate levels of care to meet peoples assessed needs; however with the increasing dependency of the people who use the service, staffing levels must be kept under review. Recruitment procedures are unsatisfactory; the lack of consistent checks, (CRB and POVA), introduce an element of risk to the people who use the service to feel vulnerable and unsafe in their chosen environment. Training in mandatory and specific residents related topics, needs to be improved upon to ensure that staff are competent in the work that they undertake in taking care of the people who use the service particularly in meeting their individual needs; and that they have updates at the specified intervals ensuring their training is current and in line with legislation. EVIDENCE: The staffing in the home includes two qualified nurses during the daytime period and one during the night. Carers and ancillary staff support the nurses Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 24 in providing care. At the time of the inspection there were two qualified nurses, five care workers, one laundry assistant, a handyman, three domestics and a chef plus an assistant cook. One staff member did comment that because of dependency, more staff were needed as some residents needed a lot of attention. This staff member also stated that hoisting residents with one staff member sometimes occurred because of staffing levels. All manual handling practices in the home must provide sufficient safety to residents, be correctly supervised and at no time introduce an element of risk. The RGN interviewed had been in post six weeks. She confirmed recruitment procedures including CRB clearance, however when her personnel file was checked this was not the case. She confirmed that she had received a five-day induction where she was supernumerary. The topics covered during that period, included medication procedures, fire, health and safety. She was unable to confirm manual handling training or infection control. The second staff member had been in post two years and had a limited recollection of her induction. Since her employment she stated that she had received training in manual handling, health and safety, fire and had done first aid “ at College “ separate to this employment. Abuse training had been conducted June 07. Supervision was said to be every six months by the Manager. Supervision covered working in the home, residents and identified training needs. Staff when asked about supervision indicated this was direct when working on the floor not a formal session. The home has standard supervision form, which is to be used for all staff. The home employs four students and has access to five bank staff. There was evidence on the rotas to show that students were employed on the night shifts. Students had covered twelve shifts during the month of February. Ms Barden explained that they were not nursing students but students on College courses who were allowed to do a limited amount of hours per week. The maintenance person was on duty in the home as was the administrator. The administrator had been supplied by a local agency. This person had been employed for 4-5 weeks at the home; she was not recruited by the home, but supplied by the agency. On the day of the inspection she had received her enhanced CRB check through the post – this being obtained by the agency. However it transpired that the Registered Person at the home had neglected to check that she had a CRB check or POVA check before allowing her to commence employment at the home. It is the responsibility of the Registered Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 25 Person to obtain assurances from the agency that the person has been through the correct recruitment and selection procedures before they commence employment. This information should be in writing and be available in the home. This was discussed at the time of the inspection during the feedback session and the Registered Person was made aware of her responsibilities when employing agency staff. The Administrator had started at the agency 7th January 2008;and the date of the enhanced CRB check was 13th February 2008. The administrator had received this on 20th February 2008. The countersignatory was from the recruitment agency. Five Personnel files were inspected during the site visit; there were instances in these files that evidenced that regulations had not been adhered to and that some staff had been working without a CRB check or a referral to POVA. This situation was brought to the attention of the Registered Person and an immediate requirement, in respect of this issue, was made at the time of the inspection. The recruitment procedures and in particularly the absence of CRB and POVA first clearance expose residents to risk. This is further referenced in the section headed staffing. An immediate requirement was left regarding CRB and POVA checks on staff. This must be addressed. There was evidence of training in the five personnel files seen at the time of the inspection. The files showed evidence of induction being undertaken by staff commencing employment and that new staff worked with an experienced member of staff until they were conversant with the needs of the residents. Evidence in the files confirmed staff received mandatory training including moving and handling, first aid, food hygiene and health and safety including fire safety. It was difficult to evidence if this had been updated at the specified intervals. There was evidence of specialist training being accessed for staff including dementia care, infection control, safe administration of medicines, communication skills, equality and diversity, nutrition, swallowing difficulties, pressure area care as well as privacy and dignity. The files seen contained certificates showing staff had completed training. The home also offers staff the opportunity to undertake NVQ 2 qualifications. There did not appear to be an annual training plan in evidence; it is recommended that the Registered Manager completes an annual training plan and submits this document to the CSCI as soon as possible. This would enable management and staff to make sure that mandatory training is always current. Please see requirement 5. Please see recommendation 1. Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 26 Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 27 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 and 38. People who use the service receive Adequate quality. This is based on all information including the site visit. The management and administration of the home is based on openness and respect, has effective quality assurance systems in place that have been developed by a qualified, competent manager. Records confirming regular servicing of equipment were in place ensuring compliance with health and safety legislation; making sure that the people who use the service are in a safe, well maintained environment. Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 28 EVIDENCE: The home has a full time Manager who is a qualified nurse. At the time of the inspection she was off sick and it was uncertain when she would return full time although part time working was a possibility. The Deputy Manager left late 2007. Ms Barden is in the home daily and is supporting staff during his period. The CSCI need to be advised of the managerial arrangements during the period that the Manager is off sick and /or working part time. The information must identify the management arrangements during the absence of the Manager. In the personnel files there was some evidence of supervision and appraisal being implemented. The records showed irregular supervision sessions for staff. It is recommended that these functions should be more structured and that documentary evidence of these sessions be more individualised, there does appear to be evidence of group supervision being organised such as a session for staff on the 30/01/2008 on pressure area care. An annual appraisal system needs to be in place enabling the Registered Manager to institute a personal development programme for all staff identifying training needs and any problems being experienced by the individual. Two residents finances were checked and found to be in order. The resident’s monies are kept in separate envelopes in the safe at the home. Each resident has their own account sheet and the homes’ accountant audits once each month and signs to say that the accounts are correct. Only pocket money accounts are administered by the home; twenty-four residents have these accounts that are used for hairdressing, newspapers, podiatry and toiletries. The registered person does not hold Power of Attorney for any residents in her care The inspector saw records of audits as referred to in previous section of this report. Information arising out of audits should be considered a tool on which improvement ca be based. The minutes of the staff meeting were seen this was held 31/7/07. The records in respect of fire procedures and servicing of the equipment were inspected. The home has previously produced a fire risk assessment although this was not available at this site visit. A fire risk assessment and emergency plan needs to be developed for the service. The fire certificate indicated quarterly servicing of the system and was dated 30/1/07. The handyman conducts weekly alarm testing and monthly escape route checks. Fire drills were recorded as having taken place regularly with three so far this year including two for day staff and one for night staff. The records relating to these had short notes and the handy man discussed the drill Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 29 with the inspectors. He was confident that all staff will be provided with sufficient training, and if staff demonstrated a poor response he will re schedule a test when they are on duty. All staff must have regular updates in fire procedures, it is recommended that night staff have training four times a year, and day staff twice a year. Training should include all staff in the home, including ancillary, temporary and bank workers. The last gas call out was dated 22 October 2007, although this was not the annual service check. Ms Barden stated that servicing had taken place during this visit. Evidence of this needs to be forwarded to the CSCI. Stickers confirming Portable Appliance Testing( PAT) were in place for portable electrical items dated June 07. The five-year electrical certificate was valid conducted December 2006. The lift had been serviced May 07 .The lift is classed as lifting equipment therefore is subject to LOLER regulations of six monthly servicing. Stickers confirming the LOLER inspection of hoists were dated 18/07/07. In April 2007 the water facilities were inspected. The insurance liability cover was in place. Regulation 26 visits are conducted and Ms Barden is in the home frequently, and at this time due to the Managers absence she is in the home daily. Please see requirement 6. Please see recommendation 2. Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 30 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 3 9 3 10 2 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 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 31 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 Timescale for action 30/06/08 2 OP7 15 3 4 OP8 12 13 OP18 All residents must be issued with contracts to ensure that they are informed of all fees charged and are aware of the services provided. Confirmation of the homes ability to meet needs must be provided in writing to evidence that they have fully assessed the resident and are able to meet prospective residents needs. 30/06/08 Care plans must be fully reflective of resident’s individual physical, physiological and social needs to provide staff with a framework on which to give care. Supporting documentation must be relevant and updated to ensure those needs identified are current. This is now outstanding Previous time frame for action 31/05/06. This is now outstanding. Residents must be treated with 30/06/08 dignity and respect including privacy. All staff must be conversant with 30/06/08 adult protection and whistle blowing procedures including DS0000010127.V360126.R01.S.doc Version 5.2 Benedict House Nursing Home Page 32 5 OP30 18 6 OP38 23 referral to external bodies as this would provide residents with assurances and safety mechanisms in such events. Previous time frame for action 30/09/06. This is now outstanding. Staff must be updated in 30/06/08 mandatory topics at the specified intervals and a record of training is retained to ensure that they are competent and sufficiently skilled to deliver care . All equipment including the lift 30/06/08 must be subject to regular servicing to ensure it is safe for staff and residents use . 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 OP30 2 OP36 Refer to Standard Good Practice Recommendations It is recommended that the Registered Manager produce an annual training plan to provide evidence that staff have received training at the appropriate intervals . It is recommended that the Registered Manager produce a record of all supervision sessions with staff. Benedict House Nursing Home DS0000010127.V360126.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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