Inspection on 18/12/06 for Bennett House

This inspection was carried out on 18th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bennett House 28/06/06

Bennett House 21/12/05

Bennett House 22/06/05

Bennett House 23/01/05

Bennett House 10/09/04

Bennett House 16/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Bennett House Park Lane Woodside Telford Shropshire TF7 5HR Lead Inspector Janet Adams Key Unannounced Inspection 18th December 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bennett House DS0000020538.V325636.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. Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bennett House Address Park Lane Woodside Telford Shropshire TF7 5HR 01952 582588 01952 582080 lynf@accordha.org.uk 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) Accord Housing Association Limited Mrs Stephanie Matthews Care Home 45 Category(ies) of Dementia (26), Old age, not falling within any registration, with number other category (19) of places Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may accommodate a maximum of 45 service users. The home may accommodate a maximum of 45 Elderly Persons of whom 26 may be suffering from Dementia and 1 may have physically disabilities under 65 years of age. The home may from time to time admit persons between the ages of 60 and 65 years of age, upon consultation with the Commission for Social Care Inspection. 28th June 2006 3. Date of last inspection Brief Description of the Service: Bennett House is registered as a care home for up to 45 older people requiring personal care, which may include up to 26 older people designated as having dementia. Some people come to live at the facility on a short-term respite basis. Many people move into the home permanently after attending the day care centre, which is also on the site of Bennett House. The Accord Housing Association owns the home, and the Registered Manager, Stephanie Matthews, transferred within the Accord Group to be in charge of Bennett House in July 2005. The home, situated in the Woodside area of Telford, is a purpose-built bungalow style building, which during the past year has been subject to a lot of financial investment, refurbishment and team effort to improve the living accommodation provided there. It is divided into four separate units, each unit comprises of single bedrooms, bathroom, separate toilets, a lounge area and a kitchen/dining area. As the home is in the centre of the extensive regeneration project, which is ongoing within the locality, it is anticipated it will benefit from the local community facilities, which are currently being upgraded. The ranges of fees currently charged are between £348.88 and £390.28 per week. Day centre fees are £35.78 per day. Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The aim of the inspection was to follow up on the progress made since the last inspection of the home on at the end of June this year. One inspector carried out this inspection visit to the home, which lasted eight hours. A second CSCI inspector also attended the inspection for a few hours to carry out observations of the care and support residents received on the unit, which accommodated residents with dementia, related illness. Some weeks before the inspection was carried out, CSCI (The Commission for Social Care Inspection.) wrote to the home to request some necessary information to assist with this process. This meant that although Bennett House knew the inspection was imminent, they were not aware of any date or time. The inspection was carried out by observing activity within the home, inspecting the premises, having an ‘in depth look’ at records for residents and staff, observing, talking and listening to over half of the 44 people living there, (6 were in hospital,) and a variety of staff on duty at the time of the inspection. A few visitors were also happy to chat with an inspector. The Registered Manager, Mrs Matthews was not on duty at the time of the inspection. However, a follow up discussion was held with her in the days following the inspection. Discussions with the management team took place throughout the day and feedback about the conclusions of the inspection was given at the end. Management and staff were wholly co-operative throughout and assisted inspectors in their tasks, for which they extend their thanks. A variety of information from other sources confirmed what was seen at the inspection, including the results of a survey carried out by CSCI, when 25 of the 44 people living there, five relatives and one visiting professional all shared information about life at Bennett House. Ten staff members and residents also made some written comments for the inspector on the day of the inspection. A total of 29 out of a possible 38 National Minimum Standards for Older People were assessed on this occasion. What the service does well: It was positive to see that the recent challenges the staff team have faced over the past year have been resolved and the home has continued to more than meet National Minimum Standards for some parts of the service and support it Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 6 provides for its residents. The home meets most of the individual personal and health care needs of the elderly people living at Bennett house on a short and long-term basis in a desirable manner. Many residents spoken to stated they were happy to be living at Bennett House, felt safe, and were well cared for. Others who were not able to confirm this as a result of their medical conditions all expressed feelings of well being when observed during their daily pastimes. One resident commented: ‘I think Bennett house is very good, the staff are all very good to me, I really like the place.’ It is obvious that Accord Housing who owns the home focus very much on involving and empowering people to have their say about life at Bennett House. Many of the systems seen in place make sure they involve and explore peoples’ choices and opinions before going ahead to make changes. Keeping all residents busy in a variety of daily life and social activities is considered to be vital at Bennett House. The whole care team embrace the issue of activities to make sure people have the support they need to live as full a life as possible. A variety of activities seen being held and planned were as a result of people living there being involved in deciding what they were interested in and enjoyed doing. These are reflected in the commendable home management systems such as quality monitoring, welcoming comments and complaints, and staff supervision seen to be emerging as pockets of excellence. The current staff members also deserve recognition for supporting the home during recent challenging times. A core of committed staff have enabled resident care to be a priority despite working with and supporting a variety of new staff settle into their roles as part of their day to day duties. Where areas of improvement have been identified by Accord Housing during their internal quality assurance reviews, CSCI are confident that the provider will manage these satisfactorily. What has improved since the last inspection? The efforts of the staff team to improve systems has meant that 10 out of the 12 Statutory requirements made at the last inspection by CSCI have now been fully met. Positive staff recruitment and retention has resulted in the home almost being fully staffed with a permanent team, which has resulted in the use of agency staff being significantly reduced. The home management team are now fully established. The way staff are supervised and supported showed how the management team are working together to improve staff morale and competence. Continued commitment to the upgrade of the home by its owners has resulted in new furnishings being provided for the conservatory. Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 7 The standard of recordkeeping in residents’ care records has continued to improve, as has the way the home manages its medication systems. The home team are committed to ensure working relationships with the local GP practice continue to improve to ensure residents get the care and support they need. What they could do better: 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. Bennett House DS0000020538.V325636.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 Bennett House DS0000020538.V325636.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): 3&4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Bennett House’s admission procedures clearly demonstrate they can meet the long and short- term needs of people thinking about moving in there. This makes sure prospective residents and relatives have all the information they need to choose a home, which will meet their needs. EVIDENCE: Prospective residents are given the opportunity to spend time at Bennett House in a way that suits himself or herself, either by making a short visit, or spending some time at the home. Many people move into the home after attending the day centre, which is also located within the home. Some move in for respite care or permanently. Conversations with a group of six residents confirmed that they had all become familiar with the home in this way before they moved in. Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 10 Admissions are not made to the home until a full needs assessment has been undertaken by a skilled and experienced member of staff as well as a social work professional. Evidence seen in four sets of records confirms that the assessment is conducted professionally and sensitively and has involved the family or representative of the resident. They are being carried out in enough detail to assure residents, their relatives and staff that the home can meet their needs. People are only admitted to the home if Bennett House management is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. One staff member was observed to be preparing a bedroom and the paperwork for someone moving into the home later in the day for short-term care, in a most professional manner. It was positive to see the room being checked to make sure all of the necessary equipment detailed in the person’s assessment records was ready and waiting for the person moving in. Twenty of the 25 residents who filled in comment cards in readiness for the CSCI inspection confirmed they had received enough information about Bennett House before they moved in so they could decide it was the right place for them. Five people could not remember what information they had, but another commented that he had the paperwork about a month before he moved in. Another wrote ‘I think the home is good on this score!’ Bennett House DS0000020538.V325636.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care, which a resident receives, is based on their individual needs thus promoting good health. Staff have a good attitude to their work and the principles of respect, dignity and privacy are put into practice. EVIDENCE: Comments received from the residents living at the home showed they all agreed that they liked living at Bennett House, felt well cared for and the staff respected their privacy. One resident wrote: -‘I feel quite happy here. I have no complaints’. All five relatives comment cards received at CSCI confirmed they were happy with the overall care delivered in the home. Two recent letters of appreciation from relatives shown by a senior carer during the inspection confirmed the service Bennett House provides continues to be most satisfactory. One relative wrote; -‘I’m very pleased with the home and all the staff.’ Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 12 Although some people who live at the home are not fully able to answer questions and write their opinions about Bennett House down, a second inspector spent over two hours in the unit where people with dementia related conditions live. Observations of the behaviours of these individuals in response to the care and support they were given during this time showed that the people living there appeared to be happy, were well groomed and had the support of plenty of knowledgeable staff on duty to give them the personal attention they needed. Seven residents were actively involved in a group activity with the staff and two ladies went to the hairdresser during this time. An in depth look at four care plans showed that this information has improved a great deal since the last inspection. The plans now also include a variety of risk assessments for important issues such as manual handling, nutrition, falls and tissue viability. Other assessments, where staff are willing to support residents to take some risks which may have an impact on their rights, include methods used to safely continue to self administer their own medication, and use bedrails. Care records also contain noteworthy attention to detail about the person’s key worker and how that person takes ‘special responsibility’ of individual residents’ needs. All resident care records seen had photographs of their key worker. Residents spoken to during the inspection were appreciative of the support they received from their individual key worker and were aware of arrangements the home made when that person was on leave for holiday etc. The details seen in the easy to understand paperwork shows residents or their representative understand and participate in their care planning. The use of photographs of the past and present times of the residents show they are being involved in a meaningful, individualised way. The home ensures that each resident’s plan is reviewed regularly and involves the resident, and where agreed, their family. All four sets of care records looked at in depth confirmed this. It is positive the home use an ‘induction form’ for all new residents including those on short term respite care, so that staff can double check the new residents are well informed and are aware of the day to day lifestyles in the home. All members of staff regard the care plan as a working tool, they understand the plan and work to it. One staff member was seen to be preparing the care records for the second of the two admissions due to move into the home that day. Care plans demonstrated residents’ right of access to health and remedial services is upheld. This was seen clearly recorded in two sets of records looked at, for a lady attending various hospital appointments and a resident who had recently had a medication review by his GP. Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 13 The health care needs of those residents too frail to leave the home are managed effectively. The outcome of recent communication between CSCI and the local medical practice confirmed that aspects of the working relationship between them and the home had improved. It is noteworthy that monthly well being ‘clinics’ continue to be held between the home and mental health team for residents on Bluebell Unit with the full involvement of residents and their next of kin/supporters where necessary. Discussion of this matter with the team leader who coordinates this clinic confirmed family members were most appreciative of the attention and support residents were receiving. There have been several improvements in the way medication is managed in the home. For instance, residents who have the capacity are encouraged to keep and take their own medication. The records of one individual who selfadministers his own inhalers clearly describes how this is safely achieved. When the seven statutory requirements, which were made as a result of a CSCI specialist pharmacy inspection, were explored, 6 were seen to be fully met. CSCI are confident the one requirement not fully met soon will be in the very near future when the current draft medication policy has been updated and finalised to account for the safe management of medicine for residents who are on leave from the home. It is also positive that all 3 recommendations to improve good medication management practices had been carried out. Staff were seen and heard to respect residents’ privacy and dignity. For example, toilet needs were handled discretely. A carer reminded a resident where the toilet was so that she remained independent. The staff were seen to interact well with individuals and it was evident that relationships are close but still professional. Bennett House DS0000020538.V325636.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The social, cultural and recreational activities provided at Bennett House meet the current residents’ expectations. Dietary needs of service users are very well catered for with a balanced and varied selection of food available that meets service users tastes and choices EVIDENCE: Residents at Bennett House continue to enjoy a full and stimulating life style with a variety of options to choose from to make this happen. The home has sought the views of residents informally on a daily basis as well as formally at the regular resident meetings, and in the home satisfaction survey carried out in November this year. The actions carried as a result of such meetings and surveys shows that the routines, activities and plans are resident focussed, regularly reviewed, and can be quickly changed to meet the individual residents needs at Bennett House. A weekly domino club has recently been set up for such a reason. It is noteworthy that any decisions residents make not to participate in activities are also respected. Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 15 Bennett House has appointed an activities coordinator since the last inspection. Although she was not on duty, it was evident from information seen and discussions with residents and staff that she was settling into her role and was building on the already excellent links the home has established within the Woodside and Madeley areas of Telford. A meal booked for later in the week was arranged to be held at a local venue as a result of this. The minutes of the two most recent meetings held by the activity coordinator showed they were attended by over 30 residents, and shows that residents at Bennett House are still actively involved in choosing what they’d like to do as part of formal activities held in the home as well as on the communal units where they live. Posters seen on display advertised a variety of seasonal festivities for the month of December and were seen to explore and meet diversity and equality issues to meet cultural and religious needs. Discussions about the activities planner seen on display on one unit resulted in a visiting relative commenting that the well being of his 99 year old mother had much improved due to the level of social events she’d participated in since moving into Bennett House. Residents are actively encouraged to keep in contact with family and friends living in the community. Visitors are welcome at any time and facilities are available for them to have a drink or a meal with the resident. This was demonstrated by the welcoming offer of a drink and snack the brother of a resident received when he called in to visit at lunchtime. The layout of the home means that there are several locations residents can entertain their visitors apart from in their bedrooms. The conservatory is especially popular for this purpose as residents stated you can ‘have a nice private family gathering in there’ Established systems seen in place confirm there are daily written details about the activities people are involved in. An activity tracker form continues to be used to record this in the care plans. It is positive this form is also used to describe individuals’ moods and behaviours in response to some activities in the records of individuals with dementia related illness. Continued links with the branch of the local Alzheimer’s Society has meant staff are accessing lots of ideas and information to encourage meaningful pastimes for residents. Observations of the way staff managed a communal activity of making paper chains on the unit where people with dementia related illness live resulted in it being a successful source of stimulation which created a focus for reminiscence as well as a satisfying practical activity for the 7 residents involved. Health promotion activities are also held on a regular basis in the home for residents at the home continue to have the opportunity and support to maintain and regain independence. Food is considered to be highly important at Bennett House and meal times considered a social occasion. Lunchtime observations in two different parts of the confirmed that knowledgeable staff gave assistance to those residents who Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 16 needed help to eat, in a discrete and sensitive manner. Tables were seen set to promote people’s independence, and choice, for instance, those who were able to pour themselves a cup of tea they way they preferred it were encouraged to do so. The minutes of a resident meeting held on Rosebud Unit three days before the inspection confirmed residents thought the meals were of a very high standard, and that where special dietary needs were required, they were always followed. Discussion with a catering team member confirmed she was aware of this positive feedback. The menu is varied, balanced and nutritious. The home is proud of its ‘Gold’ Healthy Eating Award from Telford and Wrekin Council, and the cook makes sure there are a number of choices on the menu including a healthy eating option. All four communal areas where residents live in the home have well equipped kitchen areas, which are stocked with foodstuffs and beverages to prepare drinks and snacks in between the main meals provided by the main kitchen throughout the day. Risk assessments for the safe use of kettles etc were discretely available to prompt staff to maximise resident safety in these areas. Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to robust, effective complaints procedure that enables them or their supporters’ views to be listened to and acted upon. Management systems and on-going training regarding adult protection provides staff with the relevant knowledge to safeguard service users from many types of abuse. EVIDENCE: Very clear, easy to understand complaints information continues to be available in several areas around the home including the reception area and the ‘information zone’ known as ‘the lay by’. This information is backed up by a good system for the manager to record, investigate and monitor any complaints. The manager supplied information before the inspection to confirm that there had been 10 complaints about the ‘home part’ of the service since October 2005. These issues had all been thoroughly investigated and had been very well managed. The home is to be commended for its excellent complaints management systems. Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 18 As a result of one of the complaints, a multi agency adult protection agency investigation is still in progress. The professional way Accord Housing and key members of the home management team have carried out their responsibilities, in relation to this investigation has been very positive. As a result of this, Accord Housing and the home have demonstrated to CSCI that improvements to many of its day-to-day management systems are robust and working well to make sure resident well-being is being promoted. Analysis of staff training information shows the home management are committed to make sure new starters receive adult protection training as part of their induction, and that established team members have refresher training for this matter. All residents and relatives who returned their comment cards to CSCI before the inspection as well as conversation with three residents in private confirmed that they are very satisfied with the service provision, feel very safe and well supported. All residents stated they knew who to speak to if they were unhappy, and would know how to make a complaint. Comments received included: ‘My family would help me if I needed to.’ ‘My key worker would help me.’ ‘I would not be frightened to go to the office.’ Advocacy groups are advertised within Bennett House to encourage their involvement and raise people’s awareness about such services. Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,24,25 &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 continues to be improved and adjusted to provide residents with a clean, comfortable and well maintained home to live in. EVIDENCE: The ongoing financial investment by Accord Housing has ensured that Bennett House provides a very well maintained, comfortable, attractive home which has all the specialist equipment and adaptations needed to meet their current individual resident’s needs including those people with dementia related illness. Call bells are left within reach of residents and these were overheard operating and also tested at random. The home records confirmed them to be regularly maintained and serviced. Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 20 On this occasion it was seen that the furniture in the conservatory had been replaced and complimented the décor chosen by residents. As well as a good selection of general aids such as hoists, beds and bathing equipment, the home also ensures that equipment is individualised for each resident. For instance, to make sure a resident being admitted for a five week respite stay at the home was looked after properly, arrangements were made for a specialist bed to be obtained. This was delivered and installed by a specialist company. Very detailed risk assessments of the equipment made sure staff has clear written information to guide them how to use it safely. Many parts of the home were safely equipped, with the exception of convector heater seen in Jasmine unit was turned on in use without a protective guard. Nine residents were proud to show one inspector their bedrooms, and the seven bedrooms of those whose records were looked at were also seen. The furnishings and fittings have been replaced where necessary to provide a high quality, well maintained bedrooms, adapted to meet the wishes of the present resident, complimenting the personal effects they brought into the home with them. Residents continue to be full of praise for the refurbished bathrooms as they are comfortable and easy to use. The water supply on one unit was seen to be temperamental on the day of the inspection, however staff all confirmed that this was a temporary hitch and that the water supply was usually fine. Random checks of hot water outlets confirmed the recently installed thermostats were doing their job and keeping temperatures within safe limits. All residents’ comments confirmed the home is always well lit, clean and tidy and smells fresh. Bennett House has a proactive infection control policy, clinical waste is properly managed and stored in all parts of the home. However, when the laundry was visited the pet cat was seen to be asleep on the clean table linen. . Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29, &30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recordkeeping does not show staff employed at the home are recruited, trained, skilled and in sufficient numbers to fully meet the aims of the home and meet the changing needs of residents. EVIDENCE: Clear, easy to understand rotas were seen in use and show the home is adequately staffed. Observations on the unit accommodating eleven individuals with dementia related conditions were positive and showed that the two staff allocated to this areas had the skills and expertise to meet their needs. Residents are generally satisfied that the care they receive meets their needs, but there are some times when no one is available to immediately help them. This issue was reflected in resident and staff comments as well as being observed on one unit when the only carer allocated to that area was not available. One resident was seen attempting to take another to the toilet. It was the main comment made by ten residents and staff as part of a mini survey carried out on the inspection day. Six staff members requested to speak to the inspector to express their concerns about changes in staffing levels. It was reported that the home team no longer have additional support of extra staff rostered as ‘ floaters’ to work as extras in the parts of the home Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 22 that need it. One staff member felt that the workload on the unit she was working on was only manageable because some of the residents were in hospital. When this matter was discussed with a senior carer on duty, it was confirmed that staffing levels were being closely monitored, and now that the home team was a lot more stable, the additional team members were not needed as frequently as they used to be. It was confirmed that Accord Housing had reviewed the staffing requirements for the home to make it more cost effective. Discussion with another senior carer supported these comments. Both felt the home was adequately staffed to meet the current needs of the residents, as 6 residents were in hospital. It was confirmed that the second senior on duty was the person who ‘floated’ to assist on the units where resident need the most support. Rotas for the period from 27/11/06 – 7/1/07 were seen and examined and confirmed this. It was reported that there were vacancies for three part time carers and the use of agency staff has been reduced in line with the appointment of permanent staff members. The above issues show that communication within the home needs to be improved so staff are aware of the support they will receive during their shift to support and care for the residents in a safe and satisfactory manner. It is recommended the home demonstrate more openness about how staffing levels are calculated in relation to residents’ changing dependency needs, and how they will make sure there is a positive balance between resident well being and budget management. As part of the improvements to monitor the staff team, a training chart was developed earlier in the year so that the manager could see at a glance what training her team have already had and would need to take in order to comply with legislation as well as meeting peoples needs. Another senior carer spoken to confirmed she had been delegated the responsibility to ensuring this will be carried out. It is of note that that 50 of the carers at the home are NVQ qualified. However, case tracking of 5 sets of staff records confirms that there are still some areas of training, which need attention, especially with regard to meeting manual handling legislation. A conversation with a staff member confirmed this to be an issue as one of the residents on the unit she worked on needed two people to transfer one of the residents, and that it was a challenge to find a second person who was ‘hoist trained’ to assist her. This was discussed at feedback of the inspection, and it was reported that plans are already in hand to provide this training. Lack of available records requested for three new starters meant that their files could not confirm whether the previous robust recruitment procedures seen at the home were being maintained. Their records were reported to be at head office, and staffing issues there meant fax copies could not be forwarded across to Bennett House. Records of two other individuals recently employed at the home, which were available, and were seen to meet the regulations and the national minimum standards. Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 36, &38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Accord Housing have ensured Bennett House is managed by an experienced, suitably qualified, competent individual who ensures the management and administration of the home is based on openness and respect, with effective quality assurance systems. This has resulted in good outcomes for service users in most areas of care. Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 24 EVIDENCE: The professional manner in which Accord Housing, the management team and the staff of Bennett House responded to this inspection confirmed that many open, inclusive management systems continue to exist at the home. Although the manager was not on duty at the time of the inspection, evidence showed her full involvement and commitment to keep improving the lifestyle for the people living, visiting and working at the home. ‘Case –tracking’ of four sets of staff records confirmed supervision of the team performance and professional development was being was being encouraged and monitored effectively. Excellent attention to details relating to meeting goals for the service as well as individual training needs were seen. The systems for resident consultation are excellent with evidence suggesting that their views are sought and acted upon. The home continues to have an effective quality assurance system in place. Satisfaction surveys continue to be held annually. Any other information about the ongoing changes in the home is shared with everyone at resident and staff meetings. Minutes of these meetings with actions planned to be carried out were seen on display throughout the home in a large print user-friendly format. The consistent administration systems in the home have resulted in the excellent system for the management of monies and valuables kept in safekeeping for residents being maintained to a high standard. The majority of health, safety and welfare of service users and staff are promoted by the home’s established safe working systems. All necessary service and maintenance records requested were seen to be up to date and complied with most health and safety legislation showing the home’s commitment to providing a safe place for people to live. However, some shortfalls in safe working systems in the home were evident: • Specific risk assessment to maximise safety for some individuals had not been achieved. Spot-checking of the records of a resident seen smoking a cigarette on his own in the smoking lounge showed there was a lack of a risk reduction tool for this matter. Analysis of the accident recording system showed that a person who had experienced a fall a month earlier did not have care records reviewed and risk assessed to make sure the chance of falling again was kept to a minimum. As recorded earlier, the home’s pet cat was seen asleep on clean table linen in the laundry, which poses a risk infection control measures to manage resident health and safety. A convector heater seen in use without a protective guard also posed a risk of injury if a resident or visitor came into close contact with it. • • • Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 25 The above issues were discussed with the senior carer at the end of the inspection to make sure priority would be made to remedy these issues at the earliest opportunity. A few days after the inspection, a discussion with the registered manager about the infection control issues and the heating had been addressed appropriately. Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 x 18 3 3 3 x 3 x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 4 x 4 4 x 2 Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The homes’ MDS system must not be released to residents when they wish to stay away from the home. The home must either make arrangements with the Pharmacy to have the required medication packed into alternative containers or if very little warning is given by the resident, instigate a secondary dispensing procedure. (Previous timescales of 30/06/06,and 10/09/06not met.) The registered persons must ensure Staff files are available for inspection and contain all relevant recruitment documentation necessary to ensure the protection of service users. All staff must meet necessary mandatory training as required by Health and safety legislation, including moving & handling etc. (Previous timescales of 10/09/06 not met.) Timescale for action 28/03/07 2 OP29 19 30/01/07 3. OP30 18 (1) 28/03/07 Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 28 4 OP38 13 (4)(b) 5 OP38 13 (4)(b) The registered persons must ensure all activities service users participate in are free from avoidable risks, including cigarette smoking. The registered persons must ensure all activities service users participate in are free from avoidable risks. Care records must be reviewed when a resident is injured as a result of an accident. 30/01/07 30/01/07 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. Refer to Standard OP26 Good Practice Recommendations It is strongly recommended that each unit have an automatic sluicing disinfector available to ensure the safe disposal of bodily waste, to reduce the risk from contamination and to control the spread of infection, and to check that the chemicals used to disinfect equipment are effective at low water temperatures. It is strongly recommended that the home management team improve communication to demonstrate openness how the home will be staffed at all times to meet the changing needs of the residents on a day-to-day basis. 2 OP27 Bennett House DS0000020538.V325636.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Bennett House DS0000020538.V325636.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!