Inspection on 26/06/07 for Benedict House Nursing Home

This inspection was carried out on 26th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Benedict House Nursing Home 28/05/09

Benedict House Nursing Home 19/06/08

Benedict House Nursing Home 20/02/08

Benedict House Nursing Home 17/08/06

Benedict House Nursing Home 21/02/06

Benedict House Nursing Home 25/10/05

Benedict House Nursing Home 16/06/05

Benedict House Nursing Home 16/11/04

Benedict House Nursing Home 14/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Benedict House Nursing Home 63 Copers Cope Road Beckenham Kent BR3 1NJ Lead Inspector Miss Rosemary Blenkinsopp Unannounced Inspection 09:30 am, 06: 15am 26 and 30 July 2007 th th 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.V340269.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.V340269.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 Vacant 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.V340269.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Staffing Notice issued 17 January 2000 One (1) place for a service user under the age of 65, requiring general nursing care, can be accommodated. 17th August 2006 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.V340269.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted unannounced over a two day period. On the first day of the inspection there were thirty three residents in the home and two in hospital. The home is currently operating with forty beds only, as double bedrooms have been redesigned to make spacious single bedrooms. The reduction in numbers will need to be relayed to the Central Registration Team so the certificate can be amended. Prior to the site visits the AQAA had been completed and returned. Questionnaires were sent out to residents, relatives and health professionals. During the first site visit the inspector observed practice sampled care plans and talked to staff. Questionnaires were given out to visitors who were on site. On this visit the inspector identified some areas of poor practice, which are further detailed in this report. This led the inspector to follow up these issues with a second early morning site visit accompanied by a second inspector. At this second site visit the early morning routines were observed, and the remaining records inspected. Feedback was provided to the Manager after the second day of inspection. Immediate requirements were left in respect of medications, care practice and management hours. These are further detailed in the relevant sections of this report. What the service does well: The home has significantly improved in the standard of accommodation provide both in terms of communal areas and individual bedrooms. Bedrooms have been completely revamped including redecoration coordinating bed linen and new flooring. To maintain the environment to its good standard the home employs a handyman who addresses all maintenance issues as they arise. In addition he checks the safety and condition of cot sides in use in the home on a regular basis. The home, on both visits was clean and free from odours. The home employs a full time administrator who knows the home and it’s workings. He was able to access all records requested by the inspectors. The records were found to be well organised. The home has a core team of staff who have been employed for a number of years and provide consistency within the service. Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The CSCI had agreed that the Manager could work part of her week on the floor and the remainder in a supernumerary capacity. This had been agreed February 2007. It was obvious at the two site visits that this was not working and insufficient supervision and management hours were leading to poor care practices. Problems were identified in several areas including resident’s daily life, medication and staff performance. In addition, there appeared to be a number of residents in the home who had Dementia, which is outside the home’s registration category. Assessment information of those residents case tracked was in parts brief. Assessment information must be comprehensive in content to ensure that when admitting residents staff have the skills knowledge and expertise to address the residents needs. The inspector evidenced that some care practices in operation in this home are routine and are not devised around individual residents needs. Examples of this are provided in the body of this report. Many residents were in their bedrooms and the communal areas vacant. During the three meals witnessed by the inspector, on one occasion only was the dining room used with six residents in it. There was little evidence of stimulation in the resident’s day. Staff seemed task orientated with individual and social aspects of care given a low priority. In those staff personnel files inspected, there was not in all cases evidence of robust recruitment procedures having taken place prior to commencement of employment. Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 7 Supervision of staff is undertaken, however this was not based on individual needs and personal development. Supervision needs to be tailored to support the individual staff member 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.V340269.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home conducts basic assessment on all prospective residents although the information contained within these assessments was limited and would not provide sufficient information on which to develop an initial care plan. There was little evidence of trail visits, or those visits conducted by the family prior to admission. In addition the inspector was unable to evidence what information had been provided to the resident prior to admission. Written confirmation of the home’s ability to meet needs was also not available. EVIDENCE: The inspector case tracked residents whom had been identified during the tour. As part of the case tacking the individual resident’s assessment, care plan and supporting documentation were inspected. In addition the inspector randomly sampled records to evidence observed practice, although did not fully audit the whole case notes. The inspector noted that there were residents in the home who suffered from Dementia and this was confirmed in their records. In Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 10 addition there was one resident who was unable to speak English, and no staff in the home who could converse with her during the two site visits, however the inspectors were advised that there were staff amongst the staff team who could speak her language. Communication relied upon her using hand signals and family input. Within the files inspected, there was evidence of assessments undertaken by senior staff at Benedict House. Some of this information was limited and in one case the information contradicted that provided by the hospital staff. The issue was in relation to a resident’s ability to communicate, which the home had assessed as “OK” with no further comment, recorded. However information provided by the hospital from where she was admitted, clearly indicated communication difficulties. The inspector met with this resident and it was obvious that she had significant communication problems. The family members of this resident confirmed that she had been like this since admission to Benedict House. Included in her Benedict House assessment was her mental state; cognition was assessed as “ ALZ”, which the inspector interpreted as meaning Alzheimer’s disease. This is outside of the category of registration for which the home is registered. With immediate effect the home must only seek to admit residents whose primary care needs comply with the home’s category of registration, namely frail elderly. For those residents who are already in the home who have Dementia needs, then a full review of these residents must be undertaken. Multidisciplinary support must be brought in where this is deemed appropriate to ensure residents receive the best care. There was limited information provided from members of the multi disciplinary team or the assessment conducted under the community care procedures. Evidence of trial visits made by the residents or those made by family members or next of kin was absent. Information provided prior to admission could not be evidenced although the home has produced a Statement of Purpose. A second assessment of a residents admitted 1/6/07 contained a limited assessment undertaken by the home, a speech and language report, an initial enquiry form and a community discharge letter. The Social Services assessment had been faxed and this contained good information. The contract for this resident has been signed although it was unclear who had signed it either the relative or Care Manager or if the residents themselves signed it, in which case it would have needed to be translated for her. It was later confirmed her so had signed on her behalf. An individual service agreement was also in place. Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 11 Another care plan was inspected of a resident who had been admitted August 2006. It was clearly stated in this assessment that he suffered Dementia as well as physical health needs. There was assessment information provided through Bromley Social Services and obtained through the home’s own assessment. This resident also had an individual service agreement. A forth file of a resident admitted 3/4/07 contained the homes own pre assessment information, a path lab report from a previous home, and a letter regarding an outpatient appointment. The inspector was unable to locate the Social Services assessment or the residents contract. In another file the assessment received from the hospital clearly stated the resident had Clostridium Dificile, although this was not identified on the care plan documentation. On checking with the Manager she stated that she had received verbal confirmation that this was not the case, although there was no record of this conversation or to whom she spoke. This resident was however suffering diarrhoea. Within the Statement of Purpose there was an unusual reference in respect of care plan as follows “ adverse reaction to the care plan by the resident will result in an immediate review of the care plan by the named nurse, Manager and others”. This phrase should be reconsidered to ensure clarity. It was difficult to establish from those resident’s case tracked what information or introduction to the home they had been provided with prior to admission. Once the resident has been assessed, the home needs to provide written confirmation of their ability to meet all of the resident needs; currently this is usually by way of verbal communication. This needs to be a written statement in a letter form. Contracts are in place for those residents who are funded through the Local Authority. Private residents are provided with an individual contract. Individual contracts issued to Local Authority funded residents, from the home, are not in place. On the second site visit the inspector identified one resident to case track. The pre-admission information regarding the latest resident admitted was viewed and found to provide good information regarding the resident including the core assessment by care management dated 24/6/07 and the home’s assessment. The physiotherapist assessment was also provided. The daily records evidenced basic medical checks were undertaken on arrival in the home together with photos of wounds on admission. The Manager had already completed a number of risk assessments in relation to the individual and there was evidence of a care plan being developed. Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 12 Please see requirements 1 and 2. Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans are in place, which provide guidance to staff in respect of the care residents require. Some care practices are routine and regimented, which do not allow sufficient flexibility to address the individual resident’s needs. Medication practices introduce an element of risk to residents. Poor documentation and storage of medications heighten the risk to residents and this could lead to a medication error or incident. EVIDENCE: Each resident has an individual plan of care. Care plans have been completely revised to provide comprehensive information on the care required. The new format was introduced some months previous and staff have had time to adapt to these and use them correctly, as a good tool for providing care. A selection of care plans were randomly selected of residents identified during the site visits. One of these included a resident admitted 2001. She was heard Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 14 to continually vocalise throughout the first site visit. Her care plan reflected physical and mental health needs including one referring to her communication. The content and interventions were to a reasonable standard. This resident had a number of diagnoses including “ Senile Dementia”. Her nutrition assessment was scored at 16, which indicates dietetic advice should be sought. The inspector was unable to establish if this was the case and if the dietician had visited or provided advice. The care plan of a resident who had been admitted 1/5/07 was inspected. This resident was unable to communicate verbally in English. On enquiring about how staff communicated with this resident the inspector was advised that the family attend daily from 11:00 through the whole day. The care plan reflected physical and mental health issues, although because of specific religious needs, a stated preference on male or female carer should have been stated. This is good practice for all residents. Another care plan case tracked identified hygiene and “frequently asking for the hoist” included as issues. The latter comment should be removed/more sensitively phrased, and actually identify the residents needs. In the book marked “monthly weights and blood pressure” there were records relating to monthly weight checks. Those residents included in the case tracking had their weight entries checked. Two of the residents had great variations in their weight records, even though the period was only one month between entries. In one record the resident was 68 kilos then 60 kilos, the next month, and the month after 52 kilos. The care plan related that this resident stated “eats a soft diet”, however with such significant weight loss more specialist intervention should have been sought and more frequent weight checks recorded. Staff should have been more proactive when it was evident from their records that between March and June she had lost 16 kilos, in another month she had gained 8. On another record again the weights varied between 59 kilos to 69 kilos over the period of one month. This care plan stated “poor dietary intake”. This resident had been seen by the dietician March 07. Fluid balance charts were in use for one resident who was part of the case tracking, charts were generally well completed although some intake amounts were only around one litre in 24 hours. Another fluid balance chart indicated intake over the 24 hour period as little as 250mls on one occasion. Care plans had confirmation from next of kin indicating resident’s preference to either stay in the home or be hospitalised in the event of an emergency. The behaviour management chart in place for one resident had entries which were not appropriate, as this chart should be used for recording unusual or inappropriate behaviour. Entries such as “called for medication” indicated little in respect of inappropriate behaviour or other concerns. The inspector was Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 15 subsequently advised that this was use as a monitoring tool only, and there was full behaviour management guidelines in her care plan, although this was not inspected. Another area where more information and records relating to the decision making process need to be evidenced are those relating to cot sides. There was included in the general risk assessment, reference to cot sides although this was not a detailed assessment outlining the pros ands cons of such an intervention. The care plans inspected in many cases were without the resident’s or relative’s signature as evidence of input into the process. Daily events were limited as was review information. The records in relation to GP visits were in a separate book. Visits made by other members of the multi disciplinary team, included the dentist, dietician and chiropodist. On the first site visit the inspector witnessed a resident being taken to the bathroom with a sheet covering her. She was taken to an upper floor bathroom and transported there with the sheet over her. The inspector was told that was because she had been sick and staff needed to bath her. In the “Hygiene/Bowel book” one resident had been washed for 11 days, until she had had a bath. This resident was said to be doubly incontinent, her hair was greasy and she looked unkempt. This book evidenced regular days for bathing or showers for most residents with little variation indicated. Again this is reflective of fixed routines with little individuality. The medications were inspected on the first site visit. As the inspector arrived she could see that three resident’s medications were located on either their bedside tables or lockers. On checking their Medication Administration Records (MAR) these medications had been signed for as taken by the residents. This is not in line with safe administration procedures and introduces an element of risk. The medication charts themselves were completed with the residents photograph and known allergies. It is advised to avoid the use of abbreviations such as NKDA – which stands for “no known drug allergies”. On one chart the hand transcribed medications were without the record of medications received into the home. Eye drops were dated on opening and the fridge temperatures recorded. On the lower ground floor in the cupboard there appeared to be an overstock of maxigel and fortisip, however the inspector was advised this was for fifteen resident for whom it was prescribed. Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 16 The medication trolley was left in the corridor at one point, and although locked, it did have on an open shelf a bottle of immodium syrup and a bottle of lactulose. These were accessible to residents. On checking the controlled drugs it was evident that there was overstocking on the MST, with 238 tablets on site. The Oramorph liquid was found to be incorrect, with 100- 200 mls in stock over that which was indicated in the Controlled Drug record book. In addition it appeared that two bottles were in current use and neither had the dates of opening entered. It is important that the dates of opening are entered as Oramorph only has a 90 day life once opened. The Oramorph liquid was referred to the Manager and an investigation concluded that a miscalculation had occurred. This is of concern as it was very obvious to the inspector that the amount documented was incorrect, yet this had been apparently checked daily by two staff who did not notice it. In an occupied ground floor bedroom, tubs of aqueous cream and sudo cream prescribed for another resident were in use. In shared bedroom D7, there was sudo cream and aqueous cream, one had no label and the label on the other was obliterated, it was therefore impossible to establish whom the creams belonged. Also in this bedroom there was a tube of Movalat gel belonging to a deceased resident. This indicates that disposal of medications was not being fully addressed. In one bedroom a tube of “Traxam gel” was found. This was dated 7/10/2005 as having been issued. The tube was half to three quarters full. On checking the medication records of the resident whose name appeared on the tube, this medication was not prescribed, it is concerning that this was still in use and available. On this same medication chart the resident was prescribed Temezepam regularly although this had not been given for one month. This medication was not prescribed “as required” and should it no longer be required then the GP should have reviewed this. On the morning of the second site visit, two clear bags of medication were located in the corridor of the lower ground floor. These were accessible to any person in the vicinity and not securely stored. The Manager needs to undertake a full medication review concentrating on safe administration, storage, recording and disposal. An Immediate Requirement Notice has been issued in regard to this requirement and this needs to be addressed within 7 days. Please see requirements 3, 4 and 5. Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The observed practice in the home indicated residents had limited choice in their daily lives. Routines were prevalent and allowed little flexibility. Staff are task orientated, addressing physical health care needs with little time spent on psychological or social care aspects. Visiting is open and this allows contact and engagement with friends and family. EVIDENCE: During the two site visits the inspector observed care practice, interactions between staff and residents, signs of well being, and in general the routines built into resident daily lives. The evidence obtained during these two visits was that routines dictated the lives of residents and very little in the way of choice or individual needs was included. This was evidenced by regular bath days, early morning awakening of residents, fixed meal times and limited activity sessions. Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 18 It was noticeable that the communal areas remained empty for the majority of time, except for the afternoon activity in the lounge. Several resident were still seated in wheelchairs for this. During the two site visits only one meal was served in the dining area with the majority of residents staying in their bedrooms. The inspectors witnessed two breakfasts and one lunchtime meal served. The Manager explained that it was resident’s choice to stay in their bedrooms, and evening meal was also served in the dining room. Whilst the inspector accepts that residents should choose where they spend their day, there must be sufficient staff available to ensure that residents needs can be met, including social and psychological aspects of care. Should residents remain in their bedrooms isolation can quickly become a problem hence staff may need to spend more time with them. On several occasions the inspector was unable to find staff and usually relied upon the handyman or the administrator to find staff. The absence of staff is further compounded by the fact that several of the residents were without accessible call bells whilst other residents would not be able to use them. On the day of the first site visit in one bedroom the residents porridge was left on the chest of drawers, this was cold and the tea tepid. No staff were in the vicinity or free to assist the resident to eat. The Deputy Manager was alerted to this. Two relatives were in visiting one resident who was in her bedroom. She was sat in a wheelchair and was at right angles to the TV, so she would not have been able to see it. She had limited abilities to communicate, her call bell was attached to the wall out of reach and in any case probably would not have been able to use it. Care staff came in with the menu and read it to her. I asked how she would indicate her preferences and was advised she could answer. Her relatives stated she had not spoken for years. I asked if there was any other way of deciding her menu i.e. records on food preferences etc, the care staff were unaware of other avenues to elicit this information. With such basic information such as food and fluid preferences it is essential that good assessment information is obtained using all possible sources to get this, family, friends, home helps etc. During the period before lunch four care staff were in the dining room chatting amongst themselves. Seven residents were sat in this area, four seemed sleepy. As the inspector arrived one carer went to turn the music on and another went to get the cutlery to lay the tables. Juice was served although no choice offered. Two meals choices were offered at lunch. Each resident has an activity programme detailing those activities available. These include in house activities and outside entertainers. After lunch a quiz was underway in the ground floor lounge area with a few residents. Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 19 On the second early morning site visit the inspectors arrived to be greeted by some residents up in chairs and others being got dressed by staff. On the lower ground floor two staff were assisting a resident who was drowsy and had her eyes closed. The two staff continued to “assist her to get ready “. One gentleman was in his chair with the TV on and a clothes protector “bib” in place. The visit took place at 6:20am. Another gentleman was in his wheelchair in his pyjamas, in another bedroom the same was observed. On asking staff about the morning routines the inspectors were advised that “half of the residents on each floor had to be got up before the day staff arrived”. This statement was modified later to say “only if the resident was awake“. The inspectors checked if there was reference in care plans to the time that residents liked to get up, this was not recorded. A tour of the ground and second floor found a number of residents dressed and sat in chairs or wheelchairs in their rooms. All but one of these residents was asleep. Two residents were also in the lounge on the second floor asleep. There was no evidence of any of these individuals receiving a cup of tea or anything to eat between 6.25am and 9.15am. The inspector spoke to one care staff who was about to enter a resident’s room. The inspector queried why the carer wanted to go to that bedroom as no call bell was activated. He responded that he and another staff, were going to wake the resident to have their pad changed, then be washed and dressed. The resident was not awake at this time and would have had no choice in the matter. In another room the resident’s room door was wide open with the resident herself visible. The female resident had no clothes covering the top half and was sitting up in bed. This was noted on a number of occasions. Whilst staff said that the resident took her clothes off, they should have ensured her dignity was respected in other ways e.g. closing the door and checking on her regularly. The inspector was able to speak to two residents who were awake and not dressed. They told the inspector that they chose to wake this early. One resident was not dressed as this was her day for a bath, the inspector enquired about drinks and was told that tea was provided at 07.00am but on this occasion the inspector noted it had not arrived. The first drinks provided during the second visit was at around 9.15 am. Jugs of fluids were available, although these were placed out of reach for several residents. The hairdresser visits once a week although some of the ladies hair looked untidy on both site visits. Ms Barden, the Managing Agent explained that this was because some relatives will not provided money to pay for hairdressing or other items such as chiropody. Staff should consider engaging with residents to address items such as hairdressing, manicures and general beauty treatments, as this can prove very beneficial to residents. Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 20 One resident who had been in six weeks, said she was very happy in the home, the food was quite good and the staff were nice. The Manager must undertake a full review of the care practices, routines and activities and ensure resident’s individual needs can be met within the home. An Immediate Requirement Notice has been issued in regard to this requirement to be addressed within 14 days. Please see requirement 6. Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information is provided to residents and their families on how to make a complaint this also details external avenues for referral. This provides residents and their families with adequate safeguards should the service fall below standard. Staff were aware of how to action suspected abuse and the reporting of such. Staff understood the term whistle blowing and its uses. EVIDENCE: Complaints information is available within the home on display and included within other documents. The compliant information available in the hall contained details of the CSCI. The CSCI have received no complains regarding this service since the last random inspection. There has been one adult protection investigation, which was concluded satisfactorily. The information provided on the AQAA form stated that the home had received no formal complaints since 2005. Within the homes own complaints log the last one recorded was dated 5/01/05. The complaints record provides information on the compliant the action taken and the outcome. The home has an adult protection procedure, within which the information was clearly laid out. Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 22 Evidence of POVA training which had been completed 2006, and this was evidenced in one of those personnel file’s sampled. Staff in the home confirmed that they had received training on abuse and how to deal with it. Staff with whom the inspectors met demonstrated a working knowledge of abuse and how to report the matter although more information should be provided on external bodies. Staff were aware of the persons although vague on how to actually contact them. The staff knew that complaints should be reported to the person in charge, when they were made, and taken seriously. Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has benefited from ongoing upgrading, maintenance and regular servicing of equipment, all of which provides a safe and comfortable place for residents to live. EVIDENCE: The current Managing Agent has worked hard to upgrade all areas of the home and continually strives to further improve them. Since taking over the management of Benedict House, new carpets, redecoration, furniture and fittings have been provided. In addition specialist equipment such as an assisted bath have been installed to make it easier to bath residents who have mobility problems. Bedrooms are individually colour coordinated to promote variety. Residents are encouraged to personalise their bedrooms and this was evident in many rooms. Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 24 Ms Barden proposes to redevelop the garden to encourage residents and their families to use it. In addition there is to be a large flat screen TV bought for the lounge so that all residents can see it, and hopefully this may encourage more residents to spend time in the lounge. The handyman was on site and was addressing maintenance issues as they came up. Anyone can report repairs or faults to him, including staff, residents or visitors. The handyman would inspect any equipment brought into the home. The home was very clean and tidy. Domestics were busy throughout the home cleaning, tidying and generally ensuring the areas were as pleasant as possible. One area that needs more attention paid is where fresh plants or flowers have been brought into the home. On the first floor lounge there were three plants two almost dead, and one, which was still in its cellophane packaging, was dying. Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are provided in sufficient numbers although the lay out of the building and focus of staff tasks makes it difficult for all residents needs to be addressed on an individual basis. Newly recruited staff need to be subject to greater pre employment checks/scrutiny to ensure robust recruitment procedures, thereby ensuring residents are in safe hands. Training to improved practices must be implemented to ensure resident’s needs are met. EVIDENCE: The home works with two qualified staff during the day time and one at night . Care staff, ancillary workers, an administrator and handyman all work to support the home. At both site visits the inspectors met with staff on duty and interviewed several. One of the staff interviewed was a qualified nurse from night duty, who was on the bank. She had worked for four years in this capacity. She confirmed training in statutory topics, although admitted this had been through the use of video tapes only, with no practice undertaken. She had not received supervision nor had she received training on Dementia or Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 26 Clostridium Dificile and in fact had no knowledge of the latter. This is of concern as it is common within the elderly population and there was a query as to whether this was present in the home. She had returned to work after a period of one year and her induction had been four hours. Break periods were for one hour although as the only qualified person on duty this can be difficult. A day staff member was interviewed, she had been in post eleven months and confirmed she had completed appropriate recruitment procedures and CRB clearance. Induction had been for two weeks working supernumerary and covered many aspects of the workings of the home. She confirmed training in care practices, abuse, infection control, and basic food hygiene. On topics which the inspector selected for questioning she demonstrated a good knowledge. The laundry lady met the inspector. She has a working knowledge of infection control principals although had a limited knowledge in relation to COSHH. Staff need to be provided with training suitable to do the work they do. They need to be aware of issues, which impinge on their work such as abuse. It is recommended that all staff have training of abuse as well as the statutory topics. Another qualified staff was also a bank staff. This was her first day back after a period of eighteen months away for maternity leave. The inspector did not go through formal interview questions with her due to this absence. A second care worker was interviewed who had commenced employment in 2003. She confirmed training in mandatory topics in-house. She had also completed NVQ 2, a one-day first aid course, infection control and abuse training. She demonstrated a good knowledge on subjects the inspector questioned her about. During the second site visit there were five staff on duty, one qualified and four care staff. One carer was wearing a peaked hat whilst addressing care for residents. When the inspectors mentioned this to her she said it was because her hair was a mess. Other comments received from staff indicated that in their opinion staffing levels should not include the Manager and at times they were too low to fully address care. The qualified staff in this home work long days. This must be monitored to ensure that they are not becoming overly tired. The Manager stated that staff were closely monitored for these effects on their work, and action would be taken to reduce their hours if evidenced. The inspectors selected the personnel files of staff with whom they had met. In the first personnel file the application form was completed and the work history dated back to 2001. A health declaration was on file. The two Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 27 references were without official stamps although on Benedict headed forms. Induction covered many essential topics to the work undertaken. Training certificates indicated training through the video sessions as well as other sources. Supervision forms were completed regularly, although this is a standard form and allows little in the way of personal and individual development and discussion. A second staff file was inspected. Again this contained evidence of identity checks, application form and interview notes. The employment history was for only 2 years and all abroad. The CRB was for another employment and there was no evidence of POVA checks. The two references had no official stamps to verify authenticity. All references should be verified. An induction form was in the file. Other personnel files inspected had the same content and usually the same issues. One qualified nurse had a copy of her NMC pin card on file, not her statement of entry as required. Evidence of checks made on PIN numbers must be retained as well as a copy of the statement of entry. The results of CRB checks were written in the front of the file. This included the CRB number and the result, although this did not have the signature of the person validating it. Proof of a valid CRB check should be retained on site for checking by the CSCI. All new employees must be subject to CRB clearance and POVA first checks. CRB’s are not transferable and must be obtained for each employment. Employment history should go back at least ten years and any employer in the care industry must be approached for a reference, even if it is not the last employer. All gaps in employment history must be explored and satisfy the registered person. Certificates confirming training were on file covering both mandatory topics and those relevant to residents needs. Nineteen staff have completed the NVQ level 2 training. The home is in the process of introducing a standard appraisal form. A sample of this was seen and was considered a good format. Please see requirement 7 and 8. Please see recommendation 1. Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 28 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is managed by an experienced nurse although she is required to undertake additional training to enhance her existing management skills to satisfy the CSCI requirements. Evidence of regular servicing to equipment was available. Increased staff fire training must be addressed to ensure staff are competent in this area. Quality assurance measures should include an annual review of the service to identify shortfalls in the service provided and seek to improve on these areas. Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 29 EVIDENCE: The Manager started at Benedict House December 2006. She is in the process of completing the CSCI procedures to become the Registered Manager. In February 2007 the CSCI agreed that the Manager could split her week to spend some time working on the floor and some time supernumerary. Following the two site visits this has now been reviewed. From 31 July 207 the Manager will be wholly supernumerary to the staffing levels and not work on the units as an essential part of the staff numbers. An Immediate Requirement Notice has been issued in regard to this requirement. The Manager and Deputy Manager need to work opposite one another to maximise the management cover over the seven day period. During the second site visit it was noted that several bags containing infected materials were not on proper foot operated hangers. They were on the floor and in some cases open. On the ground floor there was a yellow bag on the floor and two red bags in the bathroom. In the sluice room on the lower ground floor, there was a yellow bag open and on the floor. This is an infection control contravention, particularly in a home where there are two residents with MRSA and some very frail people. On both visits there was a resident on the lower ground floor who was expectorating a lot of sputum into containers. These containers were then put into yellow bags again this was located on the floor not on a proper hanger. On the second site visit the inspectors discussed quality assurance with the Manager and systems for auditing the care. The inspector was informed that there were no systems in place except for the monthly provider visits and corresponding reports. However evidence of internal audits produced at the site visit referred to checks on care plans, pharmacy and residents monies. These had all been done recently and the care plan audits three times. The Manager was not aware of any review undertaken regarding the quality of the care. A number of service contracts were viewed and were all in date with servicing and checks made as appropriate to maintain the safety of individuals. However, the last fire alarm service was undertaken in August 2006. Good practices states more than one annual service should be conducted, hence this is due. It was also evident from the records relating to fire drills that these were not taking place as required by the Fire Regulatory Authority. Records for one drill undertaken in 11/03 and another on 08/06 for day staff were in place, plus records for the weekly fire alarm checks. There were no records relating to night staff. The emergency lighting was tested 11 July 2007. Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 30 The Manager must ensure that all staff receive regular fire training including drills to maintain their knowledge and competence should such an event occur. An Immediate Requirement Notice has also been issued in regard to this requirement to be addressed within 14 days. A detailed infection control procedure must be implemented and staff practices monitored to ensure the safety of residents, staff and all visitors. There were PAT stickers in place to confirm annual servicing of portable electrical items. There was a registration certificate in the hallway and an in date Employer’s Liability Insurance Certificate. The resident’s monies were checked and found to be accurate with receipts in place to confirm expenditure. Please see requirements 9 and 10. Please see recommendation 2 Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 31 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 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 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 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 32 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 only residents within the homes registration category are admitted. This Requirement is outstanding from previous time frame for action of 30/09/06 and is restated. The Manager must ensure that all resident are subject to robust assessment procedures and all information obtained prior to admission. 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. Supporting documentation must be relevant and updated. This Requirement is outstanding from previous time frame for action of 31/05/06 and is restated. Timescale for action 31/08/07 2 OP3 14 30/09/07 3. OP7 15 30/09/07 Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 33 4. OP9 13 The Manager must ensure that robust procedures are in place for storage, administration and recording of medications. An Immediate Requirement Notice has also been issued in regard to this requirement and this needs to be addressed within 7 days. The Manager must ensure that resident’s needs are met and that they are provided with privacy dignity and respect. All care is provided to meet the individual’s care needs The Manager must undertake a full review of the care practices, routines and activities and ensure resident’s individual needs can be met within the home. An Immediate Requirement Notice has been issued in regard to this requirement to be addressed within 14 days. The Manager must ensure that there are sufficient numbers of staff on duty at all times to meet resident’s needs. The Manager must ensure that all staff are subject to robust recruitment checks including CRB, POVA, and two authentic references. The Manager must be wholly supernumerary to the staffing levels and not work on the units as part of the staff numbers. An Immediate Requirement Notice has been issued in regard to this requirement. 30/08/07 5 OP10 6. OP12 12 30/08/07 12 30/08/07 7 OP27 8. OP29 18 30/08/07 19 30/08/07 9 OP32 9 30/08/07 Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 34 10 OP38 23 The Manager must ensure that all staff receive regular fire training including drills to maintain their knowledge and competence should such an event occur. An Immediate Requirement Notice has also been issued in regard to this requirement to be addressed within 14 days. 30/08/07 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 OP28 2 OP33 Refer to Standard 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. Benedict House Nursing Home DS0000010127.V340269.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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.V340269.R01.S.doc Version 5.2 Page 36 - 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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