CARE HOMES FOR OLDER PEOPLE
Bennetts Castle Care Home Bennetts Castle Lane Dagenham Essex RM8 3UU Lead Inspector
Ms Rhona Crosse Unannounced Inspection 31 October 2005 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 Bennetts Castle Care Home DS0000054253.V261696.R01.S.doc Version 5.0 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.V261696.R01.S.doc Version 5.0 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.V261696.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7 February 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.V261696.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced that means that the home did not know the inspector was coming. When the inspector arrived the manager was seen to be unwell and left the home before the inspection was completed. The inspector was assisted by the area manager during the inspection. There was a good atmosphere evident within the home and service users were spoken to with respect by staff. Staff took time to talk to service users whilst they went about their work, comforting some when this was needed. In the main the home is well run. Greater attention to certain areas will improve the operation of the home. What the service does well: What has improved since the last inspection?
Since the last inspection a new manager has been appointed and is working hard to improve standards within the home. One care manager has enrolled on the course to teach Dementia training and has since completed this. Bennetts Castle Care Home DS0000054253.V261696.R01.S.doc Version 5.0 Page 6 Since the last inspection all care plans have been updated and are to be continually update on a monthly basis unless changes occur in between this time. There is a new key worker system being put into place. This will improve the communication between relatives and staff as they will be more knowledgeable about their particular service users needs and the care being provided. New staff have been employed and the home are awaiting their references and CRB checks to be returned before they can commence duties. Once these staff have commenced duties the home will have no vacancies. A range of staff training is taking place and 12 staff are undertaking NVQ level 2 training, the remainder of the staff are to commence this training in December. Currently 7 staff hold the NVQ Level 2 qualification and 3 hold the NVQ level 3 qualification. 3 house keepers and 2 laundry assistants have all achieved NVQ level 2 in house keeping. 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.V261696.R01.S.doc Version 5.0 Page 7 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.V261696.R01.S.doc Version 5.0 Page 8 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): 3. The home does not provide the service standard 6 relates to. This standard is well managed with written documentation to evidence that the home can meet the needs of the proposed service users. EVIDENCE: From a selection of newly admitted service users it was observed that assessments are carried out prior to any admission. These assessments are held on file. Bennetts Castle Care Home DS0000054253.V261696.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8. Core standards 9 & 10 will be inspected at future inspections. In the main the majority of care plans were informative and well completed. However more attention to detail is required to ensure that a plan of care and risk assessment is written for all the needs of each service user. EVIDENCE: From a random selection of care plans it was seen that these plans were being updated on a regular basis. However one service user’s records made reference to behaviour problems but there was not a detailed risk assessment to ensure that staff dealt with any behavioural problems in the same way this must be addressed. One service user had had several falls these were all recorded and the service user was seen by the community nurse. It is recommended that the home make a referral to a ‘falls’ clinic who will carryout assessments to find out the cause of continued falls and offer advice. For another service user who’s daily records stated that the person was now ‘night’ wandering there was not a care plan to identify this. A corresponding
Bennetts Castle Care Home DS0000054253.V261696.R01.S.doc Version 5.0 Page 10 care plan must be written up and include a risk assessment for this service user. Health care needs were well documented with service users being referred to health professional as necessary (GP, community nurses, dietician, optician, chiropodist and dentist). Service users weight is recorded regularly and any fall in weight is being followed up seeking advice from health professionals. Medication reviews are also taking place. For one service user the information of ‘last offices’ was not completed the home must ensure that this area is completed as part of the care planning process. Bennetts Castle Care Home DS0000054253.V261696.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 and 15. Greater attention needs to be paid to activity plans to ensure that these remain current and that they enable the home to evidence that service users are being provided with activities of their choice. Meals provided met with the approval of service users. EVIDENCE: For one service user the activities care plan was not in line with the activities that the person was undertaking. This needs to be addressed. For another service user the activities care plan had not been updated since the person was admitted and identified only the outings that the service users would be interested in taking part in. The activities care plan needs to be updated with current information. The majority of service users spoken with who were able to give a view of activities and menus said that they were happy with what was being provided for them by the home. A new menu using a picture format is being created. This will assist service users who have little speech or are not sure what meal they are choosing to make an informed choice about meals they would like.
Bennetts Castle Care Home DS0000054253.V261696.R01.S.doc Version 5.0 Page 12 The menu on the day of inspection was liver and bacon or toad in the hole, mixed vegetables and mashed potatoes, with peaches and cream as desert. The menus were observed to be varied and meal choices of service users were recorded. In discussion with service users in the elderly frail unit it was stated that ‘I like the meals, we get a choice of things to eat. Today we have liver and bacon or toad in the hole’. ‘You get a choice and enough to eat, we eat well here’. ‘I like the food we get a choice every day at tea time too,’ ‘I like soup, we get that at tea time some days.’ ‘If there’s something you don’t like they will give you something else’. ‘The girls ask us what we want, I can’t remember what I chose today it will be a surprise now’. ‘I am easily pleased I get enough for my needs, I don’t ask for extras but I suppose you could have more if you asked, I don’t ask’. Service users spoken with were aware that a party was to take place and commented on the Halloween decorations. One service user stated ‘I am not interested in parties and will not be going to the party, others enjoy the activities provided and speak about them in the lounge’. Another service users stated ‘I join in anything going I like to be entertained it passes the time’. A new activities co-ordinator has been employed and it was stated that activities are to be improved. The home offers a range of activities from local shopping trips to shopping trips further afield. In-house entertainers are brought in on a regular basis (mostly singers). The manager stated that she was organising a ‘Reminiscence’ table and had asked relatives if they had any items that might be of use. Reminiscence discussions take place and all service users irrespective of whether they have dementia are able to speak about things they did in the past and what life was like for them as younger people. The home also creates a ‘life history’ for service user to enable activities and conversations to have more meaning for individuals. Service users spoke of choice in all aspects of daily life. ‘We choose when we get up and when we go to bed.’ ‘I like a lie in they let you do that’. ‘They ask us if we want a bath’, ‘I go when they ask I’m not picky but some are they’re always moaning’. There are two married couples living at the home and they have a bedroom that they share and another bedroom has been turned into a lounge for each couple. The inspector viewed the lounges and both were filled with the couples
Bennetts Castle Care Home DS0000054253.V261696.R01.S.doc Version 5.0 Page 13 own furniture and were full of personal possessions. One couple had brought their budgie with them. In conversation one couple said ‘it is home from home’ we come in here we shut the door and we have our privacy’. ‘The staff knock on the door they don’t barge in, we feel we have everything we need without the worries.’ Comments also made by the husband of the second couple were: ‘I could not cope looking after my wife anymore but we are still together that’s important, I can come down here to be on my own if I want peace and quiet.’ The home are to be congratulated for this approach which enhances the lives of the two couples living in the home. Bennetts Castle Care Home DS0000054253.V261696.R01.S.doc Version 5.0 Page 14 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): 17 and 18. Complaints are well managed with information readily retrievable. Systems are in place to ensure the protection of vulnerable service users. EVIDENCE: The home has a complaints policy and procedure. Complaints are recorded and the outcome is also documented. The CSCI address and contact number is available if the complainant does not want to raise the complaint with the home. All service users are placed on the electoral role so that they are able to vote if they choose to. The home ensures that if anyone requires the assistance of an advocate that they would receive such a service. Staff have received training in the protection of vulnerable adults. Service users and relatives meetings take place where all can have a say about the life within the home. Minutes are kept of these meetings and they are made available for relatives. Bennetts Castle Care Home DS0000054253.V261696.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20,21, 22, 23, 24, 25, 26. There are few requirements made about the maintenance of the home. The home in general was odour free. Due to the complex needs of the service users this is an ongoing task that requires a lot of work. There was one area where odour was a problem. The area manager called the cleaners back to deal with the problem immediately ensuring the comfort of that service user. EVIDENCE: The home is well maintained. At the time of the inspection decorators were in the home repainting corridors. As the home is still within the ‘snagging’ time the work is being undertaken by contractors. Some areas were to have only ‘patching’ of paintwork, the manager was not happy with this process as the ‘patch’ painting was a different colour to the original colour on the walls and gave a very poor finish. The area manager is dealing with this with the builders. The home was clean and tidy. A random selection of bedrooms and bathrooms were inspected. It was observed that the moulded skirting in some of the enBennetts Castle Care Home DS0000054253.V261696.R01.S.doc Version 5.0 Page 16 suites was coming away from the walls and no longer impermeable to urine or other spills. Room 16, 10 and room 4 had this problem Room 4 had an odour of urine coming from the en-suite. The area manager called the cleaners back to this room immediately. The home is recommended to check all en-suites to ensure the moulded skirting is secure. In room 17 the curtains had come of the curtain rail in places. Staff must report any jobs that require attention to the manager. The home provides suitable aids and adaptations for the need of frail service users. As the home is not a nursing home any specialist mattresses or cushions to aid pressure relief are provided by the community nurses who visit the home. The remaining rooms and communal areas were well maintained. Bathrooms were clean and tidy and free from odours. Clinical waste was well managed. Bennetts Castle Care Home DS0000054253.V261696.R01.S.doc Version 5.0 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): These standards are well met with ongoing training and employment documentation held was in good order, this enhances the safety of vulnerable service users. EVIDENCE: A selection of newly appointed staff employment records were inspected. These were found to hold the appropriate information required by legislation. Staff training is ongoing. 12 staff are undertaking NVQ level 2 training, the remainder of the staff are to commence this training in December. Currently 7 staff hold the NVQ Level 2 qualification and 3 hold the NVQ level 3 qualification. 3 house keepers and 2 laundry assistants have all achieved NVQ level 2 in house keeping. A three day course on dementia took place on 7/9/05 and was completed by staff on the 14/10/05. The cook and kitchen assistant have undertaken the intermediate food hygiene course on the 26 and 27/9/05 and are awaiting their certificates. Health and safety training took place on the 26/10/05. A basic first aid course and a manual handling course is scheduled for November. Bennetts Castle Care Home DS0000054253.V261696.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 38. These standards are well managed. This ensures the well being of service users, staff and visitors to the home. EVIDENCE: The manager is currently undertaking the Registered Managers Award and holds an NVQ level 3 qualification. The manager is continually updating her training in relation to the needs of the service users accommodated. The home is run in the best interests of service users with systems, policies and procedures in place for their protection and ongoing safety. Relatives and service users meetings take place and minutes are kept of these meetings. From inspection of these minutes good practice and issues about improvements are recorded in the minutes.
Bennetts Castle Care Home DS0000054253.V261696.R01.S.doc Version 5.0 Page 19 Standard 35 a core standard that relates to money held by the home for service users will be inspected at further inspections. Health and safety documentation was readily available. The passenger lift and the service lift were serviced on the 12/5/05. The fire alarm was service in July 2005. The weekly fire alarm tests are taking place and are recorded. A fire drill took place on the 15/7/05. The fire extinguishers received their annual check in July 2005. Emergency lighting was checked on the 14/10/05. The fire risk assessment for the home was dated September 2004. The 5 year electrical safety certificate is dated 14/5/004. The annual electrical portable appliance test was dated 19/7/05. The annual gas safety certificate was dated 12/7/05. The hoists, both fixed and portable were serviced on the 18/7/05. The Legionella test of the water system was dated the 12/10/05. Bennetts Castle Care Home DS0000054253.V261696.R01.S.doc Version 5.0 Page 20 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 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 3 18 3 3 3 2 3 3 2 3 2 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Bennetts Castle Care Home DS0000054253.V261696.R01.S.doc Version 5.0 Page 21 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 OP7 Regulation 15(1) & (2) 14(2)(a) Requirement Care plans must be updated to ensure that all information is current. Risk assessment must be completed for the service user who is identified as having behavioural problems. Activities must be identified and recorded in the care plan as changes occur. The moulded skirting in the ensuites of rooms 4, 10 and 16 must be re-fixed to the walls. Ensure that the bedroom curtains in bedroom 17 are re hung as hooks are missing from the rail. Improve odour control in the ensuite of bedroom 4. Timescale for action 30/12/05 30/12/05 3 4 5 OP7 OP21 OP24 15(1) & (2) 23(2)(b) 23(2)(c) 30/12/05 30/12/05 30/11/05 6 OP26 16(2)(k) 30/11/05 Bennetts Castle Care Home DS0000054253.V261696.R01.S.doc Version 5.0 Page 22 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 Bennetts Castle Care Home DS0000054253.V261696.R01.S.doc Version 5.0 Page 23 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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