Inspection on 31/07/06 for Benham Nursing Home

This inspection was carried out on 31st July 2006.

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

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

Other inspections for this house

Benham Nursing Home 08/05/08

Benham Nursing Home 13/04/07

Benham Nursing Home 26/01/06

Benham Nursing Home 16/08/05

Benham Nursing Home 23/09/04

Benham Nursing Home 04/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Benham Nursing Home 217-219 Spital Road Bromborough Wirral CH62 2AF Lead Inspector Les Smith Key Unannounced Inspection 31st July 2006 08:30 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 Benham Nursing Home DS0000020931.V296282.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. Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Benham Nursing Home Address 217-219 Spital Road Bromborough Wirral CH62 2AF 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) 0151 334 8533 0151 334 8533 Mr Michael Richard McGowan Mrs Pamela Canbaz Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 29 OP (N) and 1 named adult (N) under 65, 13 OP (PC) within an overall number of 43 26th January 2006 Date of last inspection Brief Description of the Service: Benham is a care home providing both personal and nursing care for up to 43 older people. It is located in Spital, Wirral and is close to the facilities of Bromborough. The home stands in its own grounds and is made up of two former dwelling that have been adapted and extended to provide accommodation in a mixture of single and double bedrooms and with communal lounge and dining room areas. A conservatory and a pleasant, welltended garden are situated at the rear of the building. Local amenities such as shops, cafes and a library are within a ten-minute walk and the home has its own minibus. Fees range from £391 to £446 according to whether personal care or nursing service required. Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on 31st July and 2nd August 2006 and lasted for a total of 10 hours. During the visit time was spent examining records, policies and procedures and a tour of the home was undertaken. Discussions took place with residents, relatives, members of staff, the deputy manager and the homeowner. Relatives and residents were unanimous in their praise for the home, the care provided and all made comments to support their view, ‘the staff are very caring’, ‘we are very well cared for’, ‘overall it is very good here’. Members of staff were observed to be going about their work in a cheerful manner and clearly had good relationships with the residents. The home had completed a pre-visit questionnaire and questionnaires were distributed to residents, relatives and GPs prior to the visit. A summary of the responses is detailed below. Responses to questionnaires sent to a random selection of residents Yes 1 2 4 10 3 5 6 7 8 9 11 Have you received a contract Did you have enough information about the home before you moved in Do staff listen and act on what you say Do you know how to make a complaint Do you receive the care and support you need Are staff available when you need them Do you receive the medical support you need Are there activities arranged by the home that you can take part in Do you like the meals at the home Do you know who to speak to if you are not happy Is the home fresh and clean 11 11 14 9 Always 9 6 14 4 4 13 11 No 3 3 0 5 Usually 5 7 0 3 7 1 3 Sometimes 0 1 0 7 3 0 0 Never 0 0 0 0 0 0 0 Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 6 Responses to questionnaires sent to a random selection of relatives / representatives of residents Yes 1 2 3 4 5 6 7 8 9 10 Do staff welcome you in the home at any time Can you visit your relative/friend in private Are you kept informed of important matters affecting your relative/friend If your relative /friend is not able to make decisions, are you consulted about their care In your opinion are there always sufficient members of staff on duty Are you aware of the homes complaints procedure Have you ever had to make a complaint Are you made aware of forthcoming inspections Do you have access to a copy of the inspection reports on the home Are you satisfied with the overall care provided 4 4 4 3 1 3 2 2 3 4 No 0 0 0 1 3 1 2 2 1 0 What the service does well: What has improved since the last inspection? What they could do better: A lack of effective care management has resulted in the standard of record keeping in relation to care records and associated documents failing to meet the minimum standards. Medication management has improved but still falls short of the standard required and continuing improvement is required. Regular staff supervision is not in place and needs to be addressed. Staff training could be improved particularly in relation to specialist areas. Staff Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 7 recruitment procedures are not compliant with requirements and this is an outstanding requirement from the last inspection. Staffing levels must be maintained to ensure that the correct numbers of staff are available at all times to meet residents’ needs. 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. Benham Nursing Home DS0000020931.V296282.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 Benham Nursing Home DS0000020931.V296282.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents or their representatives do not have sufficient information to allow them to make an informed decision about accepting a place and cannot be fully confident that the home is able to meet their needs. EVIDENCE: The Statement of Purpose and Service Users Guide both require updating to include all of the required information. Copies of the documents are available to prospective residents when assessing the home for suitability before making a decision as to whether to accept a place at the home and are given to all residents or their representative on admission. It is recommended that when completed the revised Service Users Guide be distributed to all current residents or their representatives as appropriate. All residents’ files examined had an appropriate Statement of Terms and Conditions or contract in place. Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 10 Pre-admission assessments were seen in the care files examined. The assessments seen were inadequate in that they did not provide sufficient information for an initial care plan to be constructed and some areas had been left blank. Where specific needs had been identified there was no indication of actions to be taken to meet those needs. The home has all the appropriate equipment and facilities to meet residents’ needs. Equipment and aids provided by the home include assisted baths, adaptions such as raised toilet seats and grab rails, hoists and slings and slide sheets for transferring and moving residents comfortably and safely. Wheelchair access is available to all areas of the home including the garden areas. Plans are being considered for the conversion of one unused bathroom to a walk-in shower room. Whilst evidence was seen that referrals are made and advice is sought from members of the multi-disciplinary team the requisite level of skills and experience both individually and collectively is not present due to a lack of staff training and effective care management. This is demonstrated by the fact that at the time of this visit there was one resident with mental health needs and several with marked cognitive impairment but there has been no training in caring for the older person with cognitive inpairment or challenging behaviour. Visitors and prospective residents are encouraged to visit the home at any time and as often and for as long as they as they wish when deciding whether to request or accept a place at the home. The home also offers trial stays with a view to permanent residency subject to availability. Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of comprehensive and consistent care planning, risk assessment and review places residents at risk of harm or injury. EVIDENCE: A random selection of care plans and associated documentation were examined on this visit. Lack of one or more required care plans was noted in most care files. The care plans that were not present ranged from basic activities of daily living to complex needs. It is a serious concern that one file examined had no care plans at all, the service user having been at the home for some months. The lack of required care plans fails to demonstrate that the interventions to meet known needs have been put in place. The risk of required care not being given due to lack of appropriate care plans is not acceptable. The standard of regular care plan review was poor with only a date being entered to indicate a review. Examples were seen of some care plans not being reviewed for varying periods of up to six months. The regular evaluation of care plans is essential to monitor the effectiveness of the care delivered and Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 12 therefore the evaluation must detail the effectiveness or otherwise of care delivered thereby justifying any changes or no change to the plan. Daily report sheets were completed in variable amounts of detail. Some members of staff record a good level of detail whilst others record non-specific comments such as “care as plan, slept well, no changes to report”, “all care given as planned, no specific changes to report” and “slept for long periods, care as plan”. Statements such as these give no indication as to the actual care delivered, the outcome of that care or how the resident has spent their day. The promotion of independence and wellbeing invariably involves an element of risk, which is managed via the completion of relevant risk assessments. The required risk assessments were not always present in the care files examined. Where risk assessments were present and reviewed, examination showed that the assessments were not always accurate and any reviews did not always reflect changes, which were evidenced in other parts of the care file. Associated documentation such as investigations done with relevant results and regular observations are poorly maintained and do not demonstrate the level of care given. The associated care documentation provides the evidence of effective care delivery together with a record of progress or otherwise and accurate record keeping is essential. Residents identified as having cognitive or sensory impairment had no plans in place to address their special needs and plans in relation to their activities of daily living failed to reflect the additional input and care required. Examination of wound management records showed that information was not always present in the detail required. Full mapping of wounds or sores must be undertaken to ensure that improvements and deteriorations can be identified in the early stages to further plan the treatment to be given. Documentation in several care files showed that concerns in relation to aspects of care had been identified e.g. Blackened area on heel, but no appropriate changes to care had been made nor was a referral to the Tissue Viability specialist nurse made. Evidence was seen that a request for referral to the multi-disciplinary team by a GP was not acted upon. Medication management has improved since the last site visit but still falls short in some aspects. Unlabelled creams were found in use. Creams are prescribed for individual residents and labelled as such. The removal of the labels and use for another resident is not acceptable. Medication was not always signed for on administration. Failure to record the administration of medication places residents at risk of harm, as nurses are unable to tell when the last dose of medication was administered. Handwritten transcriptions were seen that lacked a clear dosage, the frequency of administration and two Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 13 signatures. The temperature of the drug fridge was recorded on most days but gaps were evident and the temperature of the clinical room is not recorded. Stored medications should not be kept at temperatures in excess of 250C in accordance with manufacturers recommendations. When drugs are prescribed on a ‘take one or two as required’ the number given must be recorded. Residents and visitors to the home during the visit were very positive when spoken to in terms of the respect shown to the residents and the steps taken to ensure that privacy is maintained at all times. Residents made comment such as ‘the carers are very considerate’, ‘nothing to find fault with’, ‘couldn’t find anywhere better’. This is confirmed by the responses to the questionnaires completed by residents and their relatives or representatives. Staff members were observed interacting with the residents in a manner that respected their dignity and always addressed residents appropriately. Residents were all dressed appropriately in their own clothes and all personal care was carried out in private. Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. As far as possible residents have choice and flexibility in how they spend their day at the home but are limited in the choice of social and recreational activities that are required to promote individual independence and wellbeing. EVIDENCE: The home has an activities coordinator who is employed on a flexible hours basis. Examination of the activities for the period showed activities including board games, quizzes, softball and skittles and one to one interactions ranging from chats to taking residents out. However the cumulative hours for the period 13th June to 25th July shows a total of 30 hours which equates to an average of 5 hours per week. In view of the size of the home and the differing requirements there is a need to establish the likes and preferences to provide a fully inclusive activity programme. It is recommended that consideration be given to increasing the hours of the activities co-ordinator to full-time. This would enable more to be done to provide stimulus for those residents who cannot or who do not wish to participate in-group activities. It is strongly recommended that participation in activities be recorded in the care files. This would help to develop a profile of likes and dislikes of individual residents. It is also recommended that the activities coordinator be provided with some specialist training in the provision of activities for this client group. Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 15 The home has a large rear garden with an appropriately protected and wellstocked fishpond. The garden is well maintained and is a pleasant area with garden furniture available for those residents who wish to sit outside in good weather. The home has a policy of open visiting with friends and family welcome at any reasonable time and to stay as long as they and the resident wished. Visitors were observed to be arriving at the home throughout the day and residents were able to see their guests in one of the communal areas or in their own rooms as they wished. Daily routines are kept as flexible as possible in order to maximise individual choice and autonomy. Residents spoken to were complimentary about the assistance they received from the staff in relation to their personal choice, which was encouraged in many aspects of the daily routines. Dietary needs are well met both in terms of quantity and quality. One resident said ‘the meals were too big’ Meals seen were well presented with staff members available to assist if required and staff members were observed offering such assistance in a sensitive and dignified manner. Scoop style plates were available for those residents who would benefit from them. Menus seen demonstrated a good variety with alternative choices being available but the menus provided to the CSCI as part of the visit preparation were not the ones being used in the kitchen. Residents confirmed that there is always a choice if they do not like the main meal on offer. The questionnaires completed by the residents at the home show that 50 of respondents usually liked the meals whilst a further 21 said that they sometimes liked the meals. Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives may be confident that complaints will be dealt with in an appropriate, timely and effective manner and those residents are protected from abuse. EVIDENCE: The home has received no complaints since the last visit. There has been one anonymous concern made directly to the CSCI. The anonymous concern has been investigated by the CSCI during this visit and found to be unsubstantiated. Verbal complaints are dealt with by the registered manager but not documented. It is strongly recommended that a complaints register be established and that verbal complaints and actions taken are documented in order to demonstrate an open and transparent process. All residents are registered on the electoral roll and assistance is provided as required to enable residents to exercise their rights. The home has policies and procedures in place in relation to Protection of the vulnerable Adult including Whistle Blowing and the ‘No Secrets’ document. Staff training records showed that staff had received training in adult abuse, its various forms, recognition and procedures to follow. This was confirmed by conversations with members of the staff who were able to demonstrate awareness of adult abuse and appropriate procedures. Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment at Benham is good providing a homely, safe and comfortable place to live. EVIDENCE: A programme of redecoration is currently in progress and carpets have been replaced in several areas of the home. A tour of the home was conducted accompanied by the deputy manager. The following observations were made: Boiler room found open accessible to residents CCTV camera on dining room wall (informed camera disconnected) Rm 8 - Single bed rail in use - no bumpers Rm 7 - 2 beds both with single bed rails Rm 9 - only one bed rail covered by bumper Rm 10 - wooden commmode in very poor condition Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 18 Armchair and 2 mattresses being stored in a toilet / bathroom Rm 11 - Commode in poor condition Sluice found open The laundry was clean and well organised with appropriate equipment in place. The kitchen was clean and tidy and well organised with food stores well stocked. Fridge and freezer temperatures had not been recorded for the recorded for the last 4 months and this dealt with immediatlely by the general manager. The CCTV camera on the dining room wall has been disconnected as previously required but the perception of residents and visitors who are not aware of the disconnection is that the system is in use. The home must remove the camera to ensure that there can be no misunderstanding in respect of its use. The use of single bed rails is not acceptable and the residents who have only one bed rail in fitted must have two fitted to the bed. A number of beds were also seen with bed rails fitted but no protective bumpers in situ. The risks associated with using bed rails without protective bumpers cannot be overestimated and bumpers must always be fitted. The designated competent person must keep records to evidence regular safety checks on all bed-rails in use. The home is reminded that rooms such as sluices and other store rooms that contain hazardous items such as cleaning materials must be kept secure at all times. The home has 26 single bedrooms of which 18 have en suite facilities and 8 double bedrooms of which 2 have en suite facilities. Mobile screens are available to ensure privacy in the double rooms and residents are advised that they can request a move to a single room when one becomes available. One relative did however sate that they were not happy with the double room and had been waiting a long time for a single room to become available. Residents’ rooms are well furnished, bright and spacious with many rooms personalised by residents’ with personal possessions and memorabilia. Communal areas seen were well furnished with comfortable chairs and well used by residents. Residents’ are enabled to maximise their independence via a range of specialised equipment and relevant aids. Handrails, hoists and assisted bathrooms are available together with a call system available in rooms and all areas of the home. At the time of this visit the home was clean, tidy and free from any odours. Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are insufficient numbers of care staff employed to meet the assessed needs of the residents and recruitment policies and procedures are not robust and fail to support and protect the residents. EVIDENCE: Examination of the duty rosters showed that there are insufficient numbers of staff rostered deployed to meet the assessed needs of the residents. Concern has been expressed via various sources that staff frequently work short due to non-replacement of staff on sick leave or holiday. The staffing levels are stated to be: Residential Mornings Afternoon Night 2 1 1 (1sleeper) Nursing 1 5 1 3 1 3 Total 1 7 1 4 1 4 (1sleeper) Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 20 Examination of day off duties showed total numbers to be: Total should be Mornings Afternoon 1 7 1 4 Actual 1 5 or 1 6 1 3 to 1 5 During the previous eight weeks prior to this visit the only agency staff used was a total of 49 hrs of qualified staff and given the shortfalls seen on the off duties examined some agency replacement staff would have been expected. Questionnaires were sent to residents who were able to complete them (mainly in the residential unit) and relatives for the more infirm residents in the nursing wing. Respondents to the questionnaires sent show that 50 of residents said that staff was ‘usually’ available when they needed them and 75 of relatives were of the view that there are insufficient staff on duty. These responses support the concerns detailed in relation to staffing levels. There are currently 13 members of care staff with NVQ 2, 2 with NVQ 3 and a further four working toward the qualification. This equates to 60 of the care staff. There are only four staff members with a first aid qualification, which is insufficient to have a qualified first aider on duty on every shift. The home is reminded that registered nurses are not qualified in first aid by virtue of their nursing qualification. Examination of staff personnel files showed that two references, proof of identity and other required documents were not always present. The requirement to obtain PovaFirst clearance before commencing employment is not being adhered to. There is a need to carry out a comprehensive audit of all personnel files be carried out. This would allow for the records to be brought up to date and make certain that all required and other relevant documents were present. Training has been carried out in relation to manual handling, Food Hygiene and Protection of the vulnerable Adult. The dependency of residents admitted with nursing needs has increased a great deal in recent years. Staff training in specialist areas such as dementia, diabetes, tissue viability, stroke care and challenging behaviour is important if staff are to be able to identify and deliver the relevant care and training in these areas. Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The health, safety and welfare of residents is compromised due to the lack of effective care management and supervision at this home EVIDENCE: The homes manager was appointed in 2005 and is registered with the CSCI. On the day of this visit the manager tendered her resignation due to health reasons. The previous manager works as the deputy manager and together with the homes administrator have been at the home for many years. These members of staff together with the registered provider, who lives on site, are well known to all the residents and their families. Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 22 The multi-faceted management arrangements have not been successful in providing the clear leadership and guidance required at the home. Both staff and residents confirmed in discussion that ‘things are not as good now’. The home holds the ‘Investors in People’ award but there is no quality assurance system in place at the home. Staff meetings are held every 4 to 6 months but records seen were poor in this respect. Residents meetings are not held but the manager said that relatives are usually seen on a one to one basis but no records are maintained. Residents’ surveys are not carried out. Records seen indicated that the last ‘survey’ was in January 2005, which consisted of the manager asking a single resident the relevant questions and noting the answer given. The home does not manage any monies on behalf of the residents and accounts are maintained for incidental expenses such as newspapers and hairdressing. Invoices are forwarded to relatives or representatives as agreed in advance. The manager stated that she does carry out staff supervision but that this was behind schedule and was unable to supply any evidence to support this. Staff spoken to confirmed that they had not received any formal supervision. The Environmental Health Officer visited the home on 3rd March 2006 and all requirements made have been met. The following safety certificates were seen and were valid and in date: Hoists Portable Electrical Appliance tests Fire extinguishers inspection and service Annual Gas safety certificate Fire risk assessment Emergency lighting annual inspection Fire alarm annual inspection The following safety certificates were not available at the time of this visit: Valid 6 monthly Loler certificates for the lift The periodic Electrical Inspection certificate (expired 25th May 2006) Annual Nurse call system inspection Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 23 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 2 3 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X 3 1 2 2 Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 24 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 OP1 Regulation 4 Requirement Timescale for action 30/09/06 2. OP3 14(1) 3 OP7 14(2) 4 OP7 15(1) The registered person must produce an up-to-date Statement of Purpose setting out the aims, objectives, philosophy of care, services and facilities and terms and conditions of the home and provide a service users guide to the home for current and prospective residents The registered person must 14/09/06 ensure that new service users are admitted only on the basis of a full assessment undertaken by people trained to do so and to which the prospective service user or their representative and any relevant professionals have been party. 30/09/06 The registered person shall ensure that the assessment of the service user’s needs is (i) kept under review; and (ii) revised at any time when it is necessary to do so having regard to any change of circumstances. The registered person shall, after 30/09/06 consultation with the service DS0000020931.V296282.R01.S.doc Version 5.2 Benham Nursing Home Page 25 5 OP9 13(2) 6 OP9 13(2) 7 OP12 16(2)(n) 8 OP27 18(1) 9 OP29 19(4) user, or a representative of his and relevant health care professionals prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. The registered person must ensure that medication policies and procedures be reviewed in line with Royal Pharmaceutical Society of Great Britain and Nursing & Midwifery Council guidelines to cover all aspects of medicines management. Previous timescale of 26/01/06 not met The registered person must ensure that medication is stored securely at all times. (Refer specifically to storage of self administered medications) The registered person shall having regard to the size of the care home and the number and needs of service users – consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users – (a) ensure that at all times suitability qualified, competent and experienced persons are working at the care home is such numbers as are appropriate for the health and welfare of service users The registered person shall not DS0000020931.V296282.R01.S.doc 14/09/06 14/09/06 30/09/06 31/08/06 31/08/06 Page 26 Benham Nursing Home Version 5.2 10 OP30 11 OP31 employ a person to work at the care home unless – (a) the person is fit to work at the care home (b) the employer has obtained in respect of that person the information and documents specified in paragraphs 1 to 7 of Schedule 2 of the ‘The Care Homes Regulations 2001’ as amended 26/07/2004. 18(1)(c) The registered person shall 30/09/06 having regard to the size of the care home, the statement of purpose and the number and needs of service users - ensure that the persons employed by the registered person to work at the care home receive – (i) training appropriate to the work they are to perform; and (ii) suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work 9(2)(b)(1) A person shall not manage a 31/10/06 care home unless he has the qualifications, skills and experience necessary for managing the care home. 12(1) 31/08/06 The registered person shall ensure that the care home is conducted so as – (a) to promote and make proper provision for the health and welfare of service users; (b) to make proper provision for the care and, where appropriate, treatment, education and supervision of DS0000020931.V296282.R01.S.doc Version 5.2 Page 27 12 OP32 Benham Nursing Home 13 OP33 24(10 14 OP36 18(2) 15 OP37 17(1) 16 OP38 37(1)(c) service uses. The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home including the quality of nursing where nursing is provided at the care home. The registered person shall ensure that persons working at the care home are appropriately supervised. The registered person shall maintain in respect of each service user a record which includes the information, documents and other records relating to the service user as specified in Schedule 3 of the Care Homes Regulations 2001 as amended 27/07/05 The registered person shall ensure that the CSCI is informed in writing and without delay of the occurrence of any accidents, injuries and incidents of illness or communicable disease or any incident that has an adverse effect on the health, welfare or safety of service users. The registered person must ensure that copies of relevant certificates are forwarded CSCI when available (specifically Loler certifications for lift, periodic electrical inspection and nurse call system) 30/11/06 30/09/06 30/09/06 31/08/06 17 OP38 13(4) 30/09/06 Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations It is recommended that participation in social and recreational activities be documented on the daily report records within the individual care files. It is strongly recommended that the hours of the activities coordinator be reviewed and provision for specialist training in activities provision be provided. It is strongly recommended that a complaints register be established and that verbal complaints and actions taken are documented in order to demonstrate an open and transparent process. 2 OP12 3 OP16 Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Benham Nursing Home DS0000020931.V296282.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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