CARE HOMES FOR OLDER PEOPLE
Bennetts Castle Care Home Bennetts Castle Lane Dagenham Essex RM8 3UU Lead Inspector
Mrs Sandra Parnell-Hopkinson Unannounced Inspection 14th February 2006 10:15 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 Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 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. Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 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 (43), Old age, registration, with number not falling within any other category (17) of places Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st October 2005 Brief Description of the Service: Bennetts Castle is a purpose built home in a residential area of Dagenham it is close to local shops and is in easy reach of a bus route to the surrounding towns. The home offers 24 hour care for 43 older people with dementia and 17 older frail people. The home does not provide any nursing care. All accommodation is in single bedrooms. Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over four and a half hours. The inspection focused on the key standards 9, 10, 13, 16, 27, 28 and 35 which were not tested at the previous inspection on the 31st October, 2005. Discussions took place with the service manager, the registered manager, the administrator, the head cook and several members of the care staff. The inspector also had the opportunity to undertake a tour of the whole home, speak to several residents and also relatives/friends who were visiting the care home. There was a very good atmosphere evident within the home which was decorated for Valentine’s day. Service users appeared well cared for and were spoken to with respect by staff who appeared happy in their work. The majority of the service users are living with dementia, and the home has the necessary signage and décor to aid orientation, and staff receive regular training in the provision of quality care to these residents. From discussions with staff there is very much a “team” atmosphere and this is to the benefit of service users. All of the requirements identified in the previous inspection report had been complied with. What the service does well:
Service users health care needs are well met, and with the employment of the new activities co-ordinator the social care needs of all service users will improve. A programme of social activities is being planned to meet the needs of service users living with dementia and of those who are frail older people. Special occasions are celebrated and on the day of the inspection the home was decorated with Valentine’s day decorations and the staff were dressed in pink or red. Also some of the service users had chosen to wear pink or red with heart shaped jewellery. During the early afternoon there was a small church service in which many service users took part, and many played musical instruments such as tambourines and maracas. One service user who is generally very shy attended a recent cabaret evening, through
Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 Page 6 encouragement by the new activities co-ordinator, and was dancing and really enjoyed himself. In discussions with service users they all said that they were happy with life in the home; that generally staff were always kind and caring and ready to give help when required. The service manager has produced menus in both written and picture format for the benefit of service users living with dementia or short-term memory loss, and this is helping in giving service users more control over the choice of meals. Relatives and friends spoke well of the home and the staff and said that any complaints are listened to and dealt with. Some relatives who were able to attend the relatives meetings said that the meetings were constructive and that they were able to give their views. The minutes of these meetings are made available in several areas of the home so that all visitors can read them if they wish. The manager and staff are to be congratulated for this partnership working with service users and relatives/friends which can only benefit all parties. What has improved since the last inspection?
The new manager is now well settled and is ensuring that all staff undertake regular training in many areas, and especially with regard to providing positive care to service users. The new activities co-ordinator is making improvements to the social care programme and is booked to undertake a dementia awareness course within the next few months. The requirements from the last inspection have been complied with, and all bedrooms and en-suites are checked on a regular basis to ensure that they remain in good decorative order and that furnishings remain in good condition. Also during the inspection there were no unpleasant odours in any part of the home. Fire drills are now done at least four times a year and records are maintained. Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 Page 7 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. Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 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 Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 Although pre-admission assessments are carried out for all residents prior to them moving into the home, during the inspection it was found that one admission was not in accordance with the registration conditions of the care home. EVIDENCE: On checking that requirement 2 from the last inspection had been complied with, that is “risk assessment must be completed for the service user who is identified as having behavioural problems”, it was evident that this service user had mental health problems. Due to the The home is registered to admit service users with dementia over the age of 65 years, and those older people not falling within any other category other than old age. Therefore, it will be a requirement that all admissions must be within the conditions of registration.
Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 Page 10 Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 9 and 10 Due to a requirement made at the previous inspection, it was necessary to view several care plans and generally these were informative and up to date. However, in certain areas they do need to be expanded and be more specific. There are clear medication policies and procedures for staff to follow and staff involved in medication have received appropriate training. Service users who are responsible for their own medication are protected by the home’s policies and procedures for dealing with medicines. Residents are treated with respect and the arrangements for their personal care ensure that their right to privacy is upheld. Generally aids to hearing, seeing and mobility are maintained in good order, but there are occasions when this does not happen, and in those instances this detracts from the quality of the overall care. EVIDENCE: Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 Page 12 There is currently one service user who takes responsibility for her own inhaler and there is an up to date risk assessment on her file. The care staff responsible for medication remind the service user to take the inhaler at the appropriate time, and this is recorded on the MAR sheet. The inspector accompanied two separate senior care workers on a medication round and it was evident that the correct procedures were followed. Service users were given their medication individually and between each administration clean cups were used, the cabinet locked and the service user observed taking the medication, and the MAR sheet signed. Medications are reconciled by the care managers on a daily basis. In discussions with the manager it is evident that some service users are now wearing hip protectors because of their risk assessment around falls. It is essential that this is details in the care plan and also the frequency of washing/changing the hip protectors, and also the frequency of washing/creaming the service user’s skin. From observations and from discussions with staff, service users and relatives it was evident that residents generally are treated in a respectful and sensitive manner. Staff understood the need to respect an individual’s dignity through practices such as in the way they addressed residents and when entering bedrooms, bathrooms and toilets. However, one resident did say that there are times when some staff are a bit “short” and gave an instance when she asked for a cup of tea and the member of staff said “don’t be selfish, can’t you see that we are busy washing and dressing people”. This incident was discussed with the manager who will address this as a general issue with all staff. One relative said that “Mum’s hearing aid is not always working and not always cleaned, and that because they visit often they replace the battery and clean the aid.” This was discussed with the manager who will reiterate with staff the need to ensure that all aids to hearing, seeing and mobility are always in good order. If this is not done it is detracting from the quality of life for the service user. As many of the service users are living with dementia, decision making and dementia can often be an area of potential conflict with families. Making a judgement about the validity and competence of a decision of a person with dementia often presents difficulties. Knowing when to respect their wishes may become problematic if the person with dementia is seen, for example, as being capable of certain activities of daily living yet at the same time incapable of other activities such as managing their own finances. They may have capacity at one point in time but lack this capacity a few hours later. Any approach should ensure that the decision making has reference to the resident’s values and beliefs. It should seek to preserve the autonomy of the
Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 Page 13 person with dementia by seeking information on the known values and beliefs of that person when competent. Also in this respect it is important that the oral, hair, skin and nail care of residents with dementia are included in more detail in the care plans. The inspector had discussions with the manager around the possibility of liaising with the local dentist to arrange for a dental hygienist to visit the home to talk to both service users and care staff. The implementation of the Mental Capacity Act in 2007 will be key to helping to resolve some of the problematic issues which arise when caring for people living with dementia. Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 13 Visiting times are flexible and visitors to the care home are made to feel welcome in the home so that residents are able to maintain contact with their family and friends. There are regular relatives’ meetings, and relatives spoken to during the inspection said “we feel that we can openly discuss any problems”. EVIDENCE: Those visitors spoken to during the inspection said “staff always make them feel very welcome” and that they “are encouraged to join in with celebrations and other activities taking place in the home.” Minutes of the meetings held for relatives are on display at various points in the care home. Two relatives gave really positive feedback and said “any problems with Mum, somebody always rings them and lets them know what has happened” and that “minutes of relatives’ meetings are always available to those who cannot attend.” Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 16 The home’s complaints policy/procedure provides residents and their relatives with the appropriate information to ensure that their complaints are dealt with promptly, effectively and to their satisfaction. However, as many of the service users are living with dementia, it is essential that there are appropriate systems in place to enable such service users to be able to express their likes, dislikes and dissatisfaction in a meaningful way, and that care staff ensure that all service users are listened to. EVIDENCE: There is a written complaints policy and procedure and the records indicate the number of complaints received, details of the investigation and any action taken. The service users who were able to express a view and relatives who were spoken to during the inspection said that they felt able to make complaints and raise issues and that they would be listened to. However, it is important that those service users who have communication problems, because of dementia or other disabilities, are enabled to make complaints and express likes and dislikes through means other than written, formal process. Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No standards were looked at at this inspection because the key standards 19-26 were inspected at the inspection on the 31st October, 2005. However, the requirement made at the previous inspection regarding odour and maintenance was met. EVIDENCE: The inspector made a tour of the home and there were no unpleasant odours, and particular attention was made to the rooms identified in the last inspection report and everything was in good order. Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27 and 28 Staffing levels are satisfactory and there are sufficient care staff on duty to meet the current assessed needs of residents. The staffing ratios are approximately 1:4 during the day and 4 staff on duty at night, 2 of whom are senior carers. There are sufficient ancillary staff to ensure that food, meals and nutrition are fully met, and that the home is maintained in a clean and hygienic state free from unpleasant odours. Staff training is ongoing and more than 50 of care staff are now trained to a minimum of NVQ level 2. The care staff and ancillary staff have, and will continue to receive training in caring for people living with dementia. EVIDENCE: The manager confirmed that staffing levels could be increased according to the changing needs of service users. There was an up to date staff rota showing which staff were on duty at any time during the day and night. There is no deputy manager, but in the absence of the registered manager it is normally the service manager who is in charge, but in the absence of both of these a designated care manager would be in charge. During discussions with the manager and staff it was evident that staff are given good opportunities to attend training courses, and especially those that enable the individual to gain a qualification such as NVQ’s at different levels.
Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 Page 18 Training schedules were also looked at during the inspection. Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 35 The inspector was satisfied that the registered manager ensures that safeguards are in place for those service users who lack capacity to manage their own financial affairs. For those service users who are able to manage their own money but which money may be held for safekeeping by the administrator, it is recommended that both the service user plus another signatory sign when money is exchanged. EVIDENCE: Currently neither the manager nor the company acts as an appointed agent for any service user. Written records of all tr5ansactions are maintained and receipts kept where necessary. Secure facilities are provided for the safekeeping of money and valuables on behalf of service users and records and receipts are kept of possessions handed over for safe keeping. Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 Page 20 Where the family of a service user holds money, the administrator contacts the family member responsible as and when funds need to be replenished. This system appears to work well with the exception of a particular service user where the funds are held by a relative but very rarely handed over to the home for the use of the service user. The manager is very aware that this could constitute financial abuse and the matter is being dealt with by the appropriate local authority adult protection co-ordinator. In the meantime the company is providing the funds to enable the service user to be provided with toiletries, clothing, hairdressing and so on. However, the manager should be ensuring that the local authority makes interim financial arrangements since the service user is supported by a local authority social services department. The company is to be commended for its action in ensuring that the service user is not being disadvantaged in this instance. Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x x x x x x x x x STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x 2 x x x Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 Page 22 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 OP3 Regulation 14 Requirement Timescale for action 15/02/06 2 OP7 12(1)(a) 3 OP7 15 4 OP35 16(2)(l) That the manager ensures compliance with the conditions of registration, and that service users are only admitted to the home within the categories of OP and DE. That the manager ensures that 20/02/06 all aids to hearing, seeing and mobility are maintained in good order at all times That the manager ensures that 25/02/06 the care plans for people living with dementia are more detailed around choice, social and personal care needs That the manager ensures that 15/02/06 residents plus a second signatory sign when money or other valuables are exchanged 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 Good Practice Recommendations
DS0000054253.V283400.R01.S.doc Version 5.1 Page 23 Bennetts Castle Care Home Standard Bennetts Castle Care Home DS0000054253.V283400.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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