CARE HOMES FOR OLDER PEOPLE
Benoni Nursing Home Ltd Benoni 12 Carrallack Terrace St Just Cornwall TR19 7LW Lead Inspector
Richard Coates Unannounced Inspection 25th October 2005 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 Benoni Nursing Home Ltd DS0000061997.V250698.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. Benoni Nursing Home Ltd DS0000061997.V250698.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Benoni Nursing Home Ltd Address Benoni 12 Carrallack Terrace St Just Cornwall TR19 7LW 01736 788433 01736 788433 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) Benoni Nursing Home Ltd Ms Susan Janice Mason Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability over 65 years of age of places (2), Terminally ill over 65 years of age (2) Benoni Nursing Home Ltd DS0000061997.V250698.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To admit one named service user aged 60 years Date of last inspection 7th April 2005 Brief Description of the Service: Benoni is a detached building situated in a residential area of St Just. The home is registered to provide accommodation and care, with nursing, for a maximum of 20 service users. This can include two service users with a physical disability on admission and two service users with a terminal illness on admission. Bedrooms are situated on the ground floor and first floor, and there are two bedrooms for service users receiving residential care on the second floor. There are three double rooms. The first and second floors are accessed by a shaft lift. The grounds are modest in size and there are areas for sitting outside. The slope from the road and car parking area to the main door is fairly steep in places, but is negotiable by a person in a wheelchair with assistance. There is a small step and a threshold at the main entrance; these are accessible with a wheelchair with assistance. The home has a strong link with the community and town of St Just. The registered provider is Benoni Nursing Home Ltd. The responsible individual is Mrs Helen Hutson. Benoni Nursing Home Ltd DS0000061997.V250698.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a planned unannounced inspection. The aims were to review compliance with the requirements set in the last inspection report dated 7 April 2005, and focus on the key standards not included in that inspection. The provider’s compliance with the requirements from the last inspection had been followed up by a visit to the home in July and a follow up letter in August. The inspector spent a weekday at the home and spoke with the registered provider, staff and residents, toured the premises and examined documents and records. The inspector is grateful to the staff and residents for their kind cooperation and assistance during the inspection. What the service does well: What has improved since the last inspection?
The registered manager has developed and introduced an induction-training programme which complies with the industry standard. The commission will review the delivery of induction training to new staff at future inspections. The staff records are now more consistent in containing the items and documentation required by regulation. There has been significant progress on obtaining Criminal Records Bureau Disclosures for the ‘existing staff’. This task had been completed by the required date. The records for recently admitted residents showed that an initial assessment had been recorded before admission to determine if the home was able to meet their needs, and a detailed assessment had been completed following admission to support good care planning. Risk assessments have been completed for all residents where cot sides are in use. The internal redecoration of the premises and replacement of ceiling tiles has made the home brighter and more cheerful.
Benoni Nursing Home Ltd DS0000061997.V250698.R01.S.doc Version 5.0 Page 6 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. Benoni Nursing Home Ltd DS0000061997.V250698.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 Benoni Nursing Home Ltd DS0000061997.V250698.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): 1 and 3 Prospective residents do not appear consistently to receive written information about the home to support them in making a choice. The needs of residents are assessed before they move in so that they can be assured that the home can provide adequate care. EVIDENCE: Standard 1, relating to the statement of purpose and service users guide was not inspected in detail. However, one recently admitted resident did not feel that she had received sufficient information about the home. The responsible individual stated that information documents were recently up-dated, were awaiting completion and may not have been issued. The records for two residents were case tracked. One record contained a copy of the care management assessment and care plan from the commissioning authority. The other did not contain a copy of the assessment and commissioning information. A qualified member of staff had recorded an initial assessment during a visit to the prospective residents to determine if the home would be able to meet their needs. The qualified staff had then, following admission,
Benoni Nursing Home Ltd DS0000061997.V250698.R01.S.doc Version 5.0 Page 9 completed a detailed needs assessment and risk assessments for both residents. This included, for example, a moving and handling assessment, a tissue viability assessment and nutritional screening. The assessments, in the main, covered the issues for assessment specified in standard 3.3, although they lacked detailed information about the social interests, activities and religious needs of residents. All residents have written care plans. Benoni Nursing Home Ltd DS0000061997.V250698.R01.S.doc Version 5.0 Page 10 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 Detailed written care plans direct and inform staff about how to meet the residents’ health, personal and social care needs. EVIDENCE: All residents have written care plans. The care plans set objectives, and detail clear directions and information for staff on meeting the needs of residents. Each resident has a series of individual plans in specific areas, for example, mobility, personal care, tissue viability and catheter care, detailing the care interventions required. Care plans include risk assessments covering, for example, the risk of falls and the use of cot sides on beds. Care plans had regular recorded evaluations. Nursing staff record regular notes in relation to the nursing care provided. Residents were aware in general terms about their care plans, but had not signed the record to confirm their involvement. Given the frailty of some residents, this is understandable. Where residents are not able to sign the care plan, a relative or representative could be asked to do this. The care plans contain social activity plans but it was not clear how successfully these are implemented for each resident. Benoni Nursing Home Ltd DS0000061997.V250698.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, 13, 14 and 15 Residents are supported to make choices about their daily life, but the arrangements for activities and meeting religious and recreational interests require review and development. EVIDENCE: Residents have the opportunity to exercise choices within a range about meals and their daily routines. A number of other menus are available for residents who do not enjoy the main choice at lunch. Times of getting up and breakfast are varied to suit individual preferences as far as possible. Staff discussed how they support residents to choose their clothes for the day and plan their preferences for meals. One resident, who stated that he would like to do more, felt that there were insufficient staff to support him in exercising a full choice in his daily routine. The arrangements for leisure and recreational activities need to be reviewed. The level of frailty of many residents is such that they can no longer participate in previously popular activities, for example bingo. The provider needs to consider introducing more one to one, or small group, activities. The home has been through a difficult period of reduced occupancy recently and this disrupted the provision of organised entertainment and activities. There have been no recent concerts or entertainment events and there is no monthly religious service at present.
Benoni Nursing Home Ltd DS0000061997.V250698.R01.S.doc Version 5.0 Page 12 Residents reported that family and friends can visit them at all reasonable times and see them in private in their rooms, if preferred. Relatives felt that the home has a pleasant and welcoming atmosphere. The record of visitors is kept in the hall. The responsible individual reported that residents have not requested any restrictions on visits currently. The responsible individual stated that the majority of residents have informal arrangements or power of attorney arrangements with their families or solicitors for the management of their financial affairs. The responsible individual continues to support one resident to access her benefits and this has been previously declared to the commission. Residents and their representatives would be informed about Age Concern or solicitors if they required an external agent to act as an advocate. Residents can bring personal possessions into the home and this is subject to negotiation before admission. Breakfast is available from 8.00 to about 10.00 and can be taken in the resident’s room or in the lounge/dining area. The main meal is served at 12.30. Tea is at 17.00 and is a choice of sandwiches, savouries and cakes. A drink and snack is available later in the evening. The menu records a wholesome and nutritious diet. Individual preferences and dietary needs are recorded in the kitchen. The lunch on the day of the inspection was well presented and appetising and residents reported that they had enjoyed it. Liquified meals are prepared for two residents at present, and three residents have their food chopped. These residents receive varying levels of assistance with eating. Nutritional screening is carried out at admission. There are no specific special diets being provided but some residents receive a nutritional supplement. There is a guidance chart on the wall in the kitchen for the use of thickeners in liquids. The cook has recently completed an intermediate food hygiene certificate. The refrigerator and vegetable store were clean and well ordered. The main meal is no longer served from a trolley in the lounge/dining area. Residents’ meals are served individually from the kitchen. Given the distance to the lounge/dining room and residents’ own rooms, the plates should be covered when in transit from the kitchen. Benoni Nursing Home Ltd DS0000061997.V250698.R01.S.doc Version 5.0 Page 13 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): These standards were included in the announced inspection earlier in the year. EVIDENCE: Benoni Nursing Home Ltd DS0000061997.V250698.R01.S.doc Version 5.0 Page 14 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 and 24 Residents live in an environment which is generally safe and well maintained, and have access to comfortable indoor facilities and modest outdoor facilities. EVIDENCE: Benoni is situated on the edge of St Just. The path down from the road and car parking area is quite steep at points but can be managed by a wheelchair user with assistance. There is a small granite step and threshold to the main entrance, which can also be managed by a wheelchair user with assistance. The grounds are modest in size, but attractively planted and provide a small area for residents by the front door. The fire service reported in a letter dated 13 October 2005 that a satisfactory standard of fire safety was evident. The most recent environmental health officer food hygiene report dated 6 May 2005 was mainly satisfactory; the environmental health officer noted that that no progress had been made in replacing the kitchen worktops and storage facilities.
Benoni Nursing Home Ltd DS0000061997.V250698.R01.S.doc Version 5.0 Page 15 The home is currently being redecorated internally in a lighter colour scheme and this has achieved a significant difference in making the home brighter and more cheerful. The internal suspended ceiling tiles are also being replaced. The home continues to provide the same area of communal space as at April 2002. The lounge and dining area is separated into an outer larger area and a smaller inner area. The inner area is being rearranged to provide more space. The furniture is domestic in character, but some of the chairs are showing signs of age and need to be thoroughly cleaned or replaced. Lighting in these rooms is domestic in nature and the outer area is sunny and bright from natural lighting during the day. Residents’ rooms generally provide the furniture and fittings specified in the standard and are satisfactorily furnished. A number of adjustable beds are in use, but standard divan beds satisfactorily meet the needs of many residents. The doors to residents’ rooms do not have locks as specified in the standard, and it is recommended that the provide install these in accordance with the preferences and risk assessment of the residents. Each room has a lockable storage space. Benoni Nursing Home Ltd DS0000061997.V250698.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 EVIDENCE: A recorded roster details the duties worked by all qualified, care and ancillary staff. The staffing level on the roster was one qualified staff and three care staff through the morning until after lunch, one qualified staff and two care staff through the afternoon and early evening, and one qualified and one care staff at night. There is currently an additional member of staff providing one to one care for a resident. The staffing had been reduced proportionately while the home had a number of vacancies in recent months. However, it is the commission’s view that the minimum staffing level for safety during waking hours, when the home is at or near capacity is one qualified staff with three care staff. The provider is required to ensure that this level of staffing is maintained now that the home is at or near to capacity again. It is also important to ensure that staff stagger their breaks to ensure that care and attention is available to residents at all times. There is a cook during the daytime and evening, a domestic, a general assistant/handyperson, and a health and safety officer/fire warden. The provider was advertising for staff. The records for recently appointed staff lacked documents required by regulation. One lacked a photograph, evidence of identity and a Criminal Records Bureau Disclosure/POVA check. The second lacked references and a photograph, evidence of identity and a Criminal Records Bureau Disclosure/POVA check. A check of a sample of the records of existing staff
Benoni Nursing Home Ltd DS0000061997.V250698.R01.S.doc Version 5.0 Page 17 showed that one member of staff did not have Criminal Records Bureau Disclosure on file. An enforcement notice has been served in relation to the failure of the provider to obtain Criminal Records Bureau Disclosures or “POVA first” checks before employing staff. Benoni Nursing Home Ltd DS0000061997.V250698.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): 36 and 38 Staff do not receive regular formal supervision to ensure that they understand the requirements of the job and the philosophy of care in the home, to give them an opportunity for confidential discussion with their supervisor and to review their training needs. EVIDENCE: The registered manager has carried out some preparation for a structured system of supervision but staff reported that regular formal supervision has not been introduced. The supervision of staff remains informal and unrecorded. Annual appraisals are being completed. Standard 38 for safe working practices was not inspected in detail as this was done at the previous inspection. However, the following issues were identified. Benoni Nursing Home Ltd DS0000061997.V250698.R01.S.doc Version 5.0 Page 19 There was no warning notice displayed in relation to the storage of oxygen cylinders. A notice was obtained and set up during the inspection. The carpet is rather worn in some areas of the ground floor corridor. Two staff were observed using an unacceptable ‘through arm’ lift to assist a resident to stand from a chair. Benoni Nursing Home Ltd DS0000061997.V250698.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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 15 3 3 X X X 2 X X STAFFING Standard No Score 27 2 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X 1 X 2 Benoni Nursing Home Ltd DS0000061997.V250698.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP36 Regulation 18(2) Requirement The registered person must ensure that persons working at the home receive supervision at least six times a year. Fifth notification. Previous timescale of 30 June 2005 not met. Staff must receive regular refresher training in food hygiene, health and safety and infection control. The registered person must supply a copy of the service users guide to each service user. The registered person must review and develop the programme of activities and facilities for recreation in the home. The registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the home in such numbers as are appropriate for the health and welfare of service users. The current staffing levels in the afternoon of one qualified staff and two care staff must be
DS0000061997.V250698.R01.S.doc Timescale for action 31/12/05 2 OP30 18(1)(c) (1) 5(2) 16(2)(m) and (n) 31/12/05 3 4 OP1 OP12 25/10/05 31/12/05 5 OP27 18(1)(a) 31/10/05 Benoni Nursing Home Ltd Version 5.0 Page 22 6 OP29 19(1)(b) and Sch 2 7 OP29 19(1)(b) and Sch 2 reviewed. The registered provider must submit evidence of having made an application for a Criminal Records Bureau Disclosure for the three staff for whom a disclosure is not on file, and, evidence of the application for a ‘POVA first’ check where this has been requested. The registered person must obtain a Criminal Records Bureau Disclosure or ‘POVA first’ check for all staff appointed in the future before they are employed at the care home. The registered person must not employ a person to work at the care home unless he has obtained the information and documents specified in Schedule 2. The registered person must review the training of care staff in moving and handling and ensure that only techniques deemed safe under current guidelines and good practice are used in the home. 21/11/05 25/10/05 8 OP29 19(1)(b) and Sch 2 25/10/05 9 OP38 13(5) 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP7 OP38 OP20 Good Practice Recommendations The service user or their representative should sign the care plan. Plated meals should be covered when in transit from the kitchen to the lounge/dining areas or service users’ rooms. The registered person should review the condition of the chairs in the lounge/dining area and clean, refurbish or
DS0000061997.V250698.R01.S.doc Version 5.0 Page 23 Benoni Nursing Home Ltd 4 5 OP24 OP38 replace them as appropriate. The registered person should provide locks on the doors of service users’ rooms in accordance with their risk assessments and recorded preferences. The registered person should replace the worn carpet in the ground floor corridor. Benoni Nursing Home Ltd DS0000061997.V250698.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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