Inspection on 11/12/06 for Bennetts Castle Care Home

This inspection was carried out on 11th 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

Bennetts Castle Care Home 14/02/06

Bennetts Castle Care Home 31/10/05

Bennetts Castle Care Home 07/02/05

Bennetts Castle Care Home 09/11/04

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 Bennetts Castle Care Home Bennetts Castle Lane Dagenham Essex RM8 3UU Lead Inspector Mrs Sandra Parnell-Hopkinson Key Unannounced Inspection 11th December 2006 09:00 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 DS0000054253.V323482.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. DS0000054253.V323482.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bennetts Castle Care Home Address Bennetts Castle Lane Dagenham Essex RM8 3UU 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 8517 7710 010 8517 7718 manager@bennettscastlecare.com Castle Care (UK) Ltd Mrs Denise Jacqueline Galluzzo Care Home 60 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places DS0000054253.V323482.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th February 2006 Brief Description of the Service: Bennetts Castle Care Home is a purpose built home, on three levels, situated in a residential area of the London Borough of Barking & Dagenham. It is close to local shops and is in easy reach of a bus route to the surrounding shopping areas of Dagenham Heathway, Romford and Ilford. The home offers 24 hour residential care for 60 older people with dementia and/or are frail elderly people. All bedrooms are single rooms with en suite toilet and handbasin. The home operates in four units which are Leeds, Hastings, Windsor and Arundel, and these are on levels ground and first, with the laundry area being situated on the second level. Each unit has its own lounge and dining area but residents are free to visit other units without restriction. There is a wellmaintained rear garden which has seating areas for residents, and there are car parking facilities for visitors. A CCTV monitoring system is in place around the external perimeter of the home for security reasons. The home employs sufficient numbers of experienced and skilled staff to meet the needs of the residents, and staff numbers will be increased if the needs of residents determine this. Personal care is provided on a 24-hour basis, with health needs being met by visiting professionals, or by relatives or staff accompanying service users to hospital appointments or other healthcare specialists as required. The statement of purpose and the last inspection report were available in the reception area of the home, and a copy of the statement of purpose will be provided on request. At the time of the inspection the fees for dementia care were £550. per week, with additional fees for hairdressing and chiropody. Special rates have been agreed with commissioning authorities. DS0000054253.V323482.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection undertaken by the lead inspector, Mrs. Sandra Parnell-Hopkinson on the 11th December 2006 from 08.45 hours until 17.00 hours. The registered manager was available throughout the time to aid the inspection process, and at the beginning, during and the end of the inspection the responsible individual was also present. During the inspection the inspector was able to talk with and observe service users, staff members, the responsible individual, the registered manager, the activities co-ordinator, some relatives, the cook and the laundress. A sample of residents’ files were case tracked, together with the viewing of staff rotas, training schedules, activity programmes, medication administration, maintenance records, accidents records, fire safety records, menus, complaints and staff recruitment processes and files and a pre-inspection questionnaire which was returned by the proprietor. Some health professionals were also contacted by telephone and all said that the care provided at Bennetts Castle Care Home was of a high standard. Two commissioning local authorities had also previously visited the care home and there reports were available for viewing. Both reports stated a high level of satisfaction with the service. A tour of the premises, including the laundry and the kitchen, was undertaken and all of the rooms were clean with no offensive odours present anywhere within the home. The garden was well maintained with seating areas for residents. All staff were observed to treat residents with kindness and respect. Residents appeared well dressed and groomed and happy. There was a real feeling of calm throughout the home with no resident being hurried at any time. This is a real achievement in a home where over 90 of the residents are older people with dementia. Where possible the inspector chatted to some residents, although this was difficult due to the varying levels of dementia, but it was evident from some of these discussions that residents liked the food and the care workers. There was very good interaction between all of the staff, and between the staff and residents. All of the six relatives spoken to expressed a very high level of satisfaction with the care being given. As part of this unannounced inspection the quality of information given to people about the care home was looked. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide, statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of wider study that CSCI is carrying out about the information that people get about care homes DS0000054253.V323482.R01.S.doc Version 5.2 Page 6 for older people. This report will be published in May 2007. Further information on this can be found on the CSCI’s website www.csci.org.uk. At the end of the inspection the inspector was able to provide feedback to both the proprietor and the registered manager. What the service does well: The statement of purpose and the service user guide is very comprehensive, but this information could be produced in a simpler format to aid the understanding of those people living with dementia. However, information regarding menus is very well presented in both pictorial and word formats and this is available on all of the dining tables. Before prospective residents and their relatives make a decision on whether to move into Bennetts Castle care home, residents are invited to spend the day at the home wherever possible. This gives the manager and her staff a good opportunity to observe both the prospective resident’s behaviour and the interaction between that person, the other residents and staff. Care plans and risk assessments are comprehensive and cover all aspects of the care of the resident, and the manager is now compiling night care plans for each resident together with continuing work on life histories. This latter work is proving more difficult because of the lack of co-operation from some families. The manager has a very good relationship with health professionals who visit the care home. Appropriate signage and décor is in place throughout the home and this makes it easier for residents living with dementia to find their way around the home, and especially to toilets. The home has developed good relationships with the community, and art students from a local comprehensive school (Robert Clack) visited the home for a period of one week and painted different shop fronts along the corridors on the ground floor. These shops fronts include a dress shop, bakery, green grocer, grocery and butcher. As a consequence the corridors are very bright and contain many areas of interest for those residents with dementia who like to walk up and down the corridors. The exercise has been very beneficial to the residents, and apparently the students enjoyed their time at the care home. Another local youth group (St. Vincent Youth Party) are also involved in the home and students visit the home on a weekly basis to sit a chat to residents. Before the visits the manager and the activity co-ordinator met with the students to talk to them about the care home and dementia and what to expect when visiting the home. Also as many of the residents had worked at the local Ford Works, there are many pictures around the home of the local area and the Ford Works. DS0000054253.V323482.R01.S.doc Version 5.2 Page 7 Activities are very focused on residents retaining daily living functions such as washing, dressing and undertaking any household functions such as helping to clear tables, dusting, keeping rooms tidy and conversing. The retention of these skills takes a lot of time, and the most important thing to give residents living with dementia is “time.” Rushing and hurrying them is upsetting and confusing. It was very apparent during the inspection that this concept is the focus of the care at Bennetts Castle care home. It was very evident that the home is operated for the benefit of residents, and every effort is made to retain the independence of those living with dementia, and for them to continue to exercise choice and control over their lives. The routines of daily living and activities are flexible and varied to the individual needs and capacities of residents, together with their religious and social preferences. Training courses for care workers is of a high standard, and the low turnover and sickness levels for staff has meant that a consistently good service is delivered to residents. This was enforced by comments from relatives and a visiting health professional. What has improved since the last inspection? What they could do better: A simpler format for the service user guide and the statement of terms and conditions could be produced to make this information easier to understand for those residents living with dementia. This was discussed during the inspection and the manager and the responsible individual were very keen to begin work on this area. DS0000054253.V323482.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000054253.V323482.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000054253.V323482.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, and 5 (standard 6 is not applicable to this service) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users and their relatives have the information required to enable them to make an informed choice about where to live, and do not move into the home without having had a comprehensive assessment of need undertaken, and been assured that these will be met. Both service users and their relatives have an opportunity to visit and assess the quality, facilities and suitability of the home before making a decision to move in. The service user guide contains clear information with regard to the terms and conditions of residency for those service users who are funded by a local authority, and service users who are self-funding have a contract which is clear and comprehensive. DS0000054253.V323482.R01.S.doc Version 5.2 Page 11 EVIDENCE: The statement of purpose and service users guide includes detailed information about the service provided and this is available to all prospective residents and relatives. Before a decision is taken to accept a new resident, that person is invited to spend a day at Bennetts Castle care home wherever possible, and a comprehensive assessment of need is undertaken by a person qualified to do so. When visiting the home, an allocated member of staff helps them to feel comfortable in their surroundings, and endeavours to ensure that they are not unduly confused with too much information. Information as to the terms and conditions of residency is provided to all residents and these are contained within the service user’s guide. Actual contracts are entered into with self-funding service users and these are being reviewed to ensure that they are in line with the recommendations made by the Office of Fair Trading in its’ recent report on contracts and care homes. Service users who are supported by a local authority are provided with a contract by that authority. All information is being reviewed to ensure that it is in formats which can be more easily understood by people living with dementia. Relatives and friends are told that their support and involvement in the continued care of the person living with dementia is important, and that they can bring in familiar objects that have real meaning to the person with dementia. Care staff at the home have undertaken training in caring for people living with dementia and are fully able to understand the constantly changing needs of these residents. On admission a key worker is allocated to the new resident, and that worker is responsible for ensuring that the care plan is followed and any changes are recorded and put into practice. A photograph of the key worker, together with the person’s name is put into the service user’s bedroom. Intermediate care is not provided at Bennetts Castle care home. DS0000054253.V323482.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, personal and social care needs of each service user are set out in an individual care plan. They can be assured that their health care needs are fully met, that they are protected by the home’s policies and procedures for the administration of medication, and that they will be treated with respect and their right to privacy upheld. Service users are also assured that at the end of life they and their families will be treated with care, sensitivity and respect. EVIDENCE: The files of six residents were inspected. All had a comprehensive assessment from which had been produced a comprehensive care plan which was regularly reviewed on a monthly basis, or more frequently if necessary, and had been updated to reflect changing needs and current objectives for health and DS0000054253.V323482.R01.S.doc Version 5.2 Page 13 personal care. The manager will be developing specific night care plans for all residents. This will ensure that even better care is being delivered on a consistent basis over each 24 hour period. Some telecare equipment is being used to alert staff to those residents who may get out of bed, but be in danger of falling. Some residents who are at a high risk of having frequent falls have hip-protectors, and this is with the consent of the resident – where possible – the family and health professionals. It was evident that, as far as is possible, residents are involved in the drawing up and reviewing of their care plan, and relatives are invited to attend the annual reviews, and are kept informed of any intermediate changes. Service users are encouraged to remain as independent as is possible and are therefore assisted in undertaking personal and oral hygiene on a daily basis. It was evident from talking to staff that they considered this to be an important part of the care programme, even though it could be very time consuming in getting the individual to undertake these tasks themselves. Staff were very aware of the importance of listening to what the resident was saying, and getting to know the meaning of words and phrases used by an individual resident. From observation it was apparent that staff recognised the importance of maintaining eye contact and being on the same level, not hurrying or interrupting and ensuring that the resident had any aids they needed such as hearing aids, glasses and dentures. The inspector was able to talk to some of the residents and in spite of the level of dementia, was able to be assured from the conversations that their health care needs were being met. One resident was able to say that “I see the doctor and the nurse, and I like them.” Relatives spoken to were all very complimentary about the health care being delivered to residents, and one resident’s son said “My mum couldn’t be in a better place, the care is excellent and all of the staff are very friendly and caring.” Another resident’s son said “my dad is the luckiest man alive to be living here, and if he didn’t have dementia he would say the same.” It was possible to speak to a visiting district nurse who also spoke very highly of the care being delivered, and generally of the home. She said that “I have been visiting here for about a month and it is one of the best home’s that I have visited.” As with the production of menus in pictorial format, so the manager may wish to give consideration to producing daily living tasks in a pictorial format, as this may assist in the continued independence of the person living with dementia. Continence programmes were in place, and staff were observed to be discreetly ensuring that residents were encouraged to use the toilets in accordance with their programmes. DS0000054253.V323482.R01.S.doc Version 5.2 Page 14 The majority of residents are mobile, and the continued mobility of residents is a high priority for staff, which results in minimum use of wheelchairs. Currently no resident has a pressure sore, and care staff monitors this closely. All residents are registered with a GP, and also have the services of an optician, dentist and chiropodist. All aids such as spectacles, hearing aids and dentures are marked with the name or initials of the owner, and staff ensure that such aids are in good working order and used by the resident. Nutritional screening is undertaken on admission, and residents are weighed monthly. Appropriate action is taken if necessary with the involvement of the GP, nutritionist or dietician. Residents are never sent to hospital or to attend appointments outside of the home without being accompanied. Wherever possible family and friends are encouraged to support these appointments, but where this is not possible then a member of staff will accompany the resident. In discussions with the manager she demonstrated an awareness that some behaviours in residents living with dementia, such as refusing food, quiet rocking, or really challenging behaviour, could be due to an individual experiencing pain. Therefore, she was very well aware of the need to exclude this when trying to understand what residents are trying to express through their behaviour. All senior staff have completed training in the administration of medication and during the inspection all records in this area were generally found to be in very good order. Staff monitor the condition of service users on medication and if there are any concerns, they would call in the GP. Currently there are no service users who are able to self-medicate. When giving PRN medication, and it states 1 or 2 tablets, the staff must ensure that the actual number of tables given is recorded so that accurate records can be maintained of medication given against that prescribed and received. Also where hand written entries are recorded on the MAR sheets, such as when a person returns from hospital with medication, then two people should sign the recording. Finally when medication has been stopped or changed, staff must ensure that the source and date of the instruction is recorded on the MAR sheets. Staff were observed to knock on bedroom doors before entering, and obviously had a good knowledge and understanding of the needs of residents with regards to what they preferred to be called. Staff were seen to treat residents with respect, understanding and kindness. During discussions with some staff it was very evident that they enjoyed working with people living with dementia. DS0000054253.V323482.R01.S.doc Version 5.2 Page 15 The control of infection is, and must remain, a high priority for all members of staff. The management ensure that training is provided together with all necessary equipment. From viewing the care plans and talking to the manager and some staff, the inspector was satisfied that residents who may be dying, are treated with care and dignity, and the necessary religious rites observed where appropriate. However, more detailed end of life care needs, in line with the Department of Health guidance, were discussed with the manager and she will now be developing more detailed care plans in this area. End of life care planning is not just about the actual wishes after death, but the desired plan of care leading up to the process of dying and death. Staff may benefit from some additional training in this area and the registered manager is directed to the guidance currently given by the Department of Health and the Commission for Social Care Inspection, both of which can be found on the respective web sites. In discussions with the registered manager it was evident that any resident wishing to remain at the care home rather than being transferred to hospital would be enabled to do so with the appropriate services being provided. Support is also given to the families and friends of residents who may be dying. The accident records were also inspected and these were well documented with details of the necessary action taken recorded. Regulation 37 notification are being sent to the Commission wherever necessary, and the information contained in these is very comprehensive. DS0000054253.V323482.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users can be assured that the lifestyle experienced in the home generally matches their expectations and preferences with regard to social, cultural, religious and recreational interests and needs. All service users are helped to exercise choice and control over their lives and to maintain contact with family and friends and the local community as they wish. They can be assured that they will receive a wholesome appealing balanced diet in congenial surroundings, and at times convenient to them. EVIDENCE: The home employs an activities co-ordinator who works 5 days per week, and who is very proactive. The home is a member of National Association for Provider of Activities for older people (NAPA), and the activities co-ordinator is currently in discussion with the management on the acquisition of a qualification in this field. There is a general programme of activities available DS0000054253.V323482.R01.S.doc Version 5.2 Page 17 for residents on all four units, and residents are also able to participate in activities which are being undertaken on units other than their own. These include singalongs, board games, bingo, drawing, quizzes and visiting entertainers. Day trips are also organised but these are less frequent because of the need to have 1 carer to 1 resident in view of the dementia suffered by all residents. Since the majority of the residents at Bennetts Castle care home have a diagnosis of dementia, their concentration span is very short and this does make the organising of activities very difficult. However, all residents have had an activity assessment completed and this is providing guidance on the appropriate level of activity for each individual. All unit seniors undertake an hourly check of all residents to make sure of their whereabouts within the home, and that they are safe. The manager and the activities co-ordinator have been very proactive in forging community contacts, and art students from a local comprehensive school have painted various shop fronts onto the walls of the ground floor corridors. This has proven to be very beneficial to the residents, and indeed the students gained satisfaction from this project as it gave them an important insight into the lives of older people. Currently the activities co-ordinator and the staff are engaged in creating a social club on a Thursday evenings. This will be open to relatives as well as to all residents, and people will be able to use this as an actual social club where they can sit and chat, play darts, snooker and other board games, as well as have refreshments. The home is very committed to ensuring that there is “life after supper” as stated by the activities co-ordinator. Another young people’s group is also engaged within the home, and visit residents on a weekly basis to sit and chat. The involvement of the students within the home is done with the consent of the parents. Before becoming involved in the home, time is taken to speak to the young people about dementia and what the home is and offers. This gives them some understanding before any involvement and has been of great help and benefit to both young people and the residents of Bennetts Castle care home. In the reception area of the home there is a large nativity scene, and during the inspection residents were seen making decorations using old CD’s and coloured foil paper. Residents are now also involved in making and writing a Christmas card to their relatives, and these cards will contain a photograph of the resident as a memento for their families. This has been done with the consent of the residents, where possible, and their families. Pet therapy also plays an important part in the life of the home, and the responsible individual has a dog called Monty, and he is a favourite with the DS0000054253.V323482.R01.S.doc Version 5.2 Page 18 residents and relatives. Sensory sessions are an important way of providing mental and physical stimulation to people, and where the home does not have a sensory room outside help is sought. Recently an organisation called ZooLab visited the home. Zoo-Lab is one organisation that provides animal therapy sessions which allows residents to interact with various animals. This stimulating experience also promoted verbal interaction between residents and staff, and enabled the rekindling of memories of past times for some of the residents. Professional animal handlers present such animals as rabbits, snakes, spiders and so on. Residents are encouraged to be ‘hands-on’, but no one is coerced into participating if they do not wish to do so. One resident told the inspector that “I held a snake, did you see my picture?” Staff said that there were lots of “oohs and aahs” from the residents during the session. Staff do give great consideration and time to the retention of an individual’s daily living skills, and the task of assisting a resident living with dementia in washing and dressing can be very time consuming. Some residents like to dust, help clear the tables, and fold napkins and they are encouraged to do this. Others help in the garden with planting plants or bulbs into tubs or raised flower beds when the weather permits. One resident who has many trophies in his bedroom is engaged in the polishing of these on a regular basis. The manager ensures that staff are given the time to sit and talk to residents on a small group or individual basis, and the further development of the life histories will help in this area. During the inspection it was observed that staff did spend time sitting and talking to either individual residents or a small group of residents. Activity resources are available throughout the home, and are always to hand for residents to use. There are regular visits by local clergy and if any resident wishes to attend a religious service outside of the home then this would be arranged. Other annual festivals are celebrated and these include the birthdays of residents. Currently all of the residents are white British and of a Christian denomination. However, within this wide spectrum residents of different denominations are enabled to practice their specific Christianity. It was apparent from discussions with the manager and her staff that if there were residents from other ethnic, religious or cultural groups then their wishes would be respected and other religious festivals would be celebrated in the same way as Christmas and Easter. Although there are set mealtimes, residents can exercise choice in relation to these as these are made flexible and varied to suit an individual’s preferences and capacities. Four meals per day are served and these are: • • Breakfast Lunch DS0000054253.V323482.R01.S.doc Version 5.2 Page 19 • • Tea Supper Drinks and snacks are freely available between these times, and during the night. Lunch was observed being served, and the meals were nicely presented and served and residents were not being hurried. Sufficient staff were on hand to give assistance where required. Menus were viewed and these give a choice for residents, but there are also other choices available if neither of the main dishes are liked. Menus have been produced in pictorial format to aid choice, and another method of enabling choice is by the use of other senses such as smell, sight and touch of the actual meal. The cook is well aware of the recorded dietary and cultural needs of each resident and does listen to their comments about the meals, and makes adjustments and changes where necessary. The cook and care staff are also very aware of the importance of providing “finger” foods where residents are experiencing difficulty in using cutlery. During the inspection it was observed that there were plentiful supplies of fresh fruit and vegetables. Some residents have chosen to sit in the lounge area for their meals, and these are served at small tables, and others have chosen at times to have their meals in their bedrooms. All of the dining rooms are nicely furnished with the tables being properly laid with tablecloths, cutlery, drinks and cruets. Many of the residents spoken to said that they enjoyed the food and one resident said “lovely, I like the meat pie.” It was apparent from talking to some residents and staff, and from observation, that residents can choose when to get up and go to bed. Contact with family and friends, and the local community, are encouraged and periodic residents/relatives meetings are held. It was obvious during the inspection that the preferences of residents are catered for, and Staff are very aware that Bennetts Castle care home is the home of the residents and try to make this as appealing as is possible. The manager and staff were also very aware of the need to minimise any reduction in the freedom of residents to walk about the home, and realistic risk assessments are in place that balances safety with the individual’s right to be as free and in charge of their actions as possible. The manager also ensures that the rights of all residents are recognised and addressed and balances the needs of all with the needs of individuals. Appropriate signage and décor is in place to aid the orientation of residents living with dementia. DS0000054253.V323482.R01.S.doc Version 5.2 Page 20 DS0000054253.V323482.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): 16 and 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users and their relatives can be confident that they will be given information on how to complain, that their complaints will be listened to, taken seriously and acted upon and that service users will be protected from abuse. EVIDENCE: As part of the inspection process, the inspector asked some residents and some relatives if they knew about the complaints procedure and how to make a complaint and who to. Many of the residents were not able to comprehend the question, but some were very clear that they knew who to complain to and were happy that they would be listened to. All of the relatives spoken to said that they were aware of the complaints procedure, knew who to complain to and were confident that any complaint would be listened to and acted upon. Indeed one relative said that “even the smallest concern is listened to and dealt with immediately.” Also as part of the inspection process the complaints log was viewed and this was found to be comprehensive in that complaints are recorded together with the action taken to resolve them. There have been very few formal complaints, but where these have been received they have been responded to in writing. The complaints policy and procedures are available within the home to residents and relatives. DS0000054253.V323482.R01.S.doc Version 5.2 Page 22 Because of the difficulty of residents living with dementia to express verbally concerns or complaints, staff are very observant to the changing behaviours of residents in case they are unhappy. The manager is currently working on producing a very simplified format of the complaints policy to make this more meaningful to residents. Complaints and concerns made to the manager are always taken seriously, acted upon and viewed in a positive way. Where an incident needs external input from other agencies such as the Commission, local adult protection, then advice is sought in order to clarify difficult judgements. Training records viewed and staff spoken to confirmed that all staff had received training in adult protection and recognising and reporting any adult abuse. This is especially important in the care of people living with dementia, since abuse is more likely to go unrecognised because of the inability of such residents to verbally express themselves. In discussions with the manager and some staff, it was also apparent that they are vigilant to the possible abuse between resident and resident/s. The manager does not act as appointee for any resident, but some personal expense monies is held for residents. The records for financial transactions were inspected and found to be in good order. The manager is very proactive on acquiring information and knowledge on new legislation, and was very informed on the new Mental Capacity Act which comes into effect in 2007. The promotion of the rights of the individual are paramount to the manager and staff at the home, and this was evidenced during the inspection process. DS0000054253.V323482.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): 19, 20, 21, 22, 24, 25 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users live in a safe, well-maintained environment with sufficient and suitable lavatories and washing facilities. Any specialist equipment required by a resident is provided, and their bedrooms reflect their own choices with their own possessions around them. The home is clean, pleasant and hygienic. EVIDENCE: A tour of the premises was undertaken and the home was found to be well-lit, clean, pleasant and hygienic with no offensive odours anywhere in the home. Specialist equipment such as hoists and handrails were evident, tele-care equipment, such as infrared beams, is used to alert staff when residents who are in danger of falling get out of bed. Any other equipment would be provided where necessary to enable a resident to maintain independence. DS0000054253.V323482.R01.S.doc Version 5.2 Page 24 All of the bedrooms are single with en suite toilet and handbasin, and all of the bedrooms are fitted with a call alarm system which is located within easy reach of each resident’s bed. There is a mixture of suitable baths and showers which gives a resident choice. Toilet door-frames have been painted in a different colour with appropriate signage to aid orientation for people living with dementia. All of the toilets were equipped with toilet paper, towels and soap, and hot water was plentiful. The manager and staff are proactive around infection control and staff have undertaken training in this important area. Work had also been undertaken to identify individual bedrooms with signage which is familiar to the occupier. Bedrooms have been personalised by the individual, and fixtures and fittings are of a good standard. Residents are encouraged to bring in some of their own furniture. The lounge/dining areas are well furnished and carpets are not highly patterned which prevents visual disturbance. There are various lounge areas throughout the home, which means that residents have a choice of places to sit quietly, and to meet with relatives. Residents were able to walk around the home freely without being told to “sit down” by care staff, and the murals of shop fronts on the walls of the ground floor corridors adds to the ambience of the home. The rear garden area is laid to paving and lawn and has sitting areas for residents. When the weather allows, residents are free to walk in and out of the garden areas as they wish. The inspector visited both the kitchen and laundry areas and both are very well maintained, were clean and hygienic. The food was correctly labelled and dated in the fridges, and all other foods were being stored appropriately, and the chef was aware of the food hygiene requirements. The laundress was very aware of health and safety around the use of washing materials, and the COSHH regulations. DS0000054253.V323482.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): 27, 28, 29 and 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The procedures for staff recruitment are robust and provide safeguards for the protection of service users, and due to the training, numbers and skill mix of staff service users can feel that they are in safe hands. EVIDENCE: The workforce at Bennetts Castle care home is very stable and only recently has it been necessary to recruit new staff. The recruitment processes are very robust with the necessary application forms being completed, interviews undertaken and the required references and criminal records bureau disclosures obtained. All new staff undertake an intensive induction training in line with the Skills Council requirements, and shadow experienced care staff for the first few weeks of employment. From talking to staff, inspecting the training records and observation, it was apparent that staff have the opportunities to undertake various training courses, and that such training is then put into practice within the home. Some staff have undertaken intensive training in dementia care and medication administration. Other staff have undertaken training in supervisory development, infection control, fire safety, manual handling, care planning, DS0000054253.V323482.R01.S.doc Version 5.2 Page 26 nutrition, adult protection, health and safety, food hygiene and reduced incontinence. At the time of the inspection there were sufficient staff on duty to meet the needs of the residents, and in discussions with the proprietor and the manager it was apparent that if additional staff are required at any time then such staff would be rostered. There is little use of agency staff and any gaps in the rota are generally covered by permanent staff. This has certainly been to the benefit of residents since it does provide consistency of care which is extremely important for people living with dementia. Approximately 50 of the care staff have been trained to NVQ level 2 and some to NVQ level 3, and the remainder of the staff are currently undertaking the NVQ level 2 qualification. All staff are given a copy of the General Social Care Council’s code of conduct and practice and are employed in accordance with this. DS0000054253.V323482.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is run and managed by people who are fit to be in charge and able to discharge their responsibilities fully to the benefit of service users. Service users are safeguarded by the accounting and financial procedures of the home, including the management of their finances where necessary. Staff are appropriately supervised and the health, safety and welfare of service users and staff are promoted and protected. EVIDENCE: It was evident during the inspection that the home is being very well managed and both the manager, the responsible individual and the organisation are keen to work in collaboration with external agencies and the Commission. DS0000054253.V323482.R01.S.doc Version 5.2 Page 28 Through staff training, supervision and good management staff are ensuring that residents receive a high standard of care and that the home is run in their best interests. In discussions with the staff they said that the management style is open and inclusive and that they receive regular supervision. Supervision is undertaken by 1:1 sessions, direct observation of care practices, annual appraisals and group team meetings, and this was evidenced from viewing the staff files and records. The financial records for the maintenance of residents’ monies were inspected and these were found to be in good order with receipts being kept around expenditure. Maintenance records including fire safety, fire alarm testing, insurance, lift maintenance, electrical and gas checks, boiler, central heating systems and water temperatures were viewed and found to be up to date and in good order. PAT testing is also carried out annually. There had been a recent visit from the local environmental health officer and everything around food hygiene and safety was found to be in good order. The manager ensures that policies and procedures are reviewed on a regular basis and that she keeps up to date with new and changing legislation. Spot checks and quality monitoring systems provide management evidence that practice reflects the homes policies and procedures. Unannounced night visits are made by both the manager and the responsible individual to ensure that the care being delivered at night is also consistent with the ethos, policies and procedures of the home. These checks have been found to be very effective and have resulted in some staff members being dismissed for sleeping on duty. The responsible individual has produced a quality assurance audit, regularly undertakes the regulation 26 monthly monitoring visits which are unannounced and are very comprehensive covering both the good areas and areas for improvement. Feedback from a recent survey was sent to all relatives and is available within the home. The manager undertakes quality assurance questionnaires with staff, health professionals, relatives and residents, where possible, and arranges relatives/residents meetings and uses the information gained to make any improvements or changes in the service delivery. Information gained from complaints, concerns and compliments are also used to influence service delivery. Suitable accounting and financial procedures are in place to demonstrate the current financial viability of the business and to ensure that there is effective and efficient management of the home. Accounting systems are also in place to ensure the good management of residents’ finances. DS0000054253.V323482.R01.S.doc Version 5.2 Page 29 The health and safety of both residents and staff is a high priority and the manager ensures safe working practices by way of training and the provision of any necessary equipment, together with appropriate risk assessments which are regularly reviewed. DS0000054253.V323482.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 3 4 3 4 X 3 3 4 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 3 3 3 3 3 DS0000054253.V323482.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO 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. 2. Standard OP7 OP9 Regulation 15 13 (2) Requirement Timescale for action 31/01/07 The registered manager must ensure that the care plans cover night care in more detail The registered manager must 20/12/06 ensure that where 1 or more tablets are prescribed PRN, then a record must be kept of the actual number of tables administered on each occasion, and that any hand written entries are signed by two people, and that the source of any instruction to stop or change medication is written onto the MAR sheet, signed and dated. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000054253.V323482.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 DS0000054253.V323482.R01.S.doc Version 5.2 Page 33 - 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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