CARE HOMES FOR OLDER PEOPLE
Benoni Nursing Home Ltd 12 Carrallack Terrace St Just Cornwall TR19 7LW
Lead Inspector Richard Coates Announced 7 & 8 April 2005 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 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 Version 1.10 Page 3 SERVICE INFORMATION
Name of service Benoni NUrsing Home Ltd Address 12 Carrallack Terrace St Just Cornwall TR19 7LW 01736 788433 01736 788433 kernowcare@aol.com Benoni Nursing Home Ltd Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 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 Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: none Date of last inspection 14 September 2004 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 to the main door is fairly steep in places, but is negotiable by a wheelchair user 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 Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection of Benoni Nursing Home took place over two weekdays. The duration of the inspection was about 12 hours. An inspector who is a qualified nurse spent part of the first day reviewing the care plans, healthcare, infection control systems and medication arrangements. Inspectors examined care plans, other records and policies and procedures and toured the premises. They spoke to a number of staff, service users and visitors, observed care staff and service users interacting and had discussions with the responsible individual and the registered manager. Comment cards were submitted by officers of the Social Services Department. What the service does well: What has improved since the last inspection?
The records for staff contain more of the information and documents required by regulations. The policy and procedure for adult protection has been revised to meet the required standard and to conform with Department of Health guidance and this will better protect vulnerable people. The responsible individual has made monthly visits to interview service users and staff, inspect the premises and has provided reports to the commission as required by regulation. Staffing levels in the afternoon have been increased following a review, ensuring improved levels of care for service users. Benoni Nursing Home Ltd Version 1.10 Page 6 Service users rooms have lockable spaces for people to store valuables or, where people are self-medicating, their medicines. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Benoni Nursing Home Ltd Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Benoni Nursing Home Ltd Version 1.10 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 standard(s) 1 and 3 The service users guide provides clear information to enable people to make a choice about whether they want to live in the home. The registered manager or other staff complete a detailed assessment of need following admission, but an adequate assessment is not completed before admission to ensure that the home can meet the needs of prospective service users. EVIDENCE: The statement of purpose and the service users guide comply with the standard and are provided in a folder to prospective service users. The records of service users contain detailed needs assessments and risk assessments which had been carried out after admission. The registered manager, or other staff member, visits prospective service users in their current situation but do not consistently record their assessment or obtain an assessment from the commissioning authority in order to confirm that the home can meet the needs of the service user. A recommendation was made in respect of the consistent dating and signing of assessment records. Benoni Nursing Home Ltd Version 1.10 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 standard(s) 7,8,9 and 10 Care plans inform and direct staff in detail on how the needs of service users are to be met, but risk assessment needs developing in some areas. The healthcare needs of service users are monitored and appropriate services accessed. The systems for administration of medication follow the Royal Pharmaceutical Society guidelines, but the policy and procedure for staff should be presented more clearly. Care staff respect the privacy and dignity of service users. EVIDENCE: The inspectors case tracked three service users. Care plans were set out as individual plans for each area of need or care activity with clear objectives. The plans contained evidence of regular review and evaluation. There was evidence of the monitoring of healthcare needs and access to healthcare agencies – GP, specialist nurse, optician, and dentist. Care plans include the treatment of pressure areas, and equipment for pressure relief is provided. Service users stated that their care needs were well met. A number of service users have cot sides on their beds. A risk assessment is needed to set out the advantages and disadvantages of cot sides for each individual and to record, if possible, the consent of the service user or a representative. The storage facilities, records and procedures for medicines were inspected. Advice was given in respect of
Benoni Nursing Home Ltd Version 1.10 Page 10 the handling of one specific medicine and a recommendation made about writing the policy and procedure in plainer language. Service users reported that staff were kind and friendly, skilled at their work and respected their privacy and dignity when providing care. Placing officers felt that staff understood the needs of their clients and were satisfied with the overall care provided to service users that they were involved with. A relative reported satisfaction with the care being provided. A high proportion of staff are qualified at NVQ level 2. Benoni Nursing Home Ltd Version 1.10 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 standard(s) EVIDENCE: These standards will be assessed in the unannounced inspection later in the year. Benoni Nursing Home Ltd Version 1.10 Page 12 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 standard(s) 16 and 18 The arrangements for dealing with complaints as set out in the complaints procedure are straightforward and open and made available to service users and their representatives. The policy and procedure for adult protection complies with the standard and has been circulated to all staff so that they are aware of the issues. EVIDENCE: The complaints procedure is provided to all service users and their representatives. A record is maintained of all complaints and compliments. Service users who spoke to the inspectors had not felt the need to make any complaints and were satisfied with the service that they were receiving. There is a policy on whistle blowing, a policy and procedure on the protection of vulnerable adults, which complies with the standard, and a procedure on the handling of service users’ money. The responsible individual and the registered manager demonstrated an understanding of their responsibilities for the protection of vulnerable adults and in respect of the protection of vulnerable adults list. Staff felt confident in their understanding of adult protection issues. The provider has investigated one complaint in the last year, which concerned issues of staff competence. This was partially upheld and appropriate action was taken. The commission was satisfied with the manner in which the investigation was carried out. Benoni Nursing Home Ltd Version 1.10 Page 13 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 standard(s) 26 The home is clean and hygienic and provides a safe environment in this respect. There are satisfactory systems in place for infection control. EVIDENCE: The premises were clean and hygienic. Toilets, basins, the bath and shower were clean and hygienic. There is an infection control procedure. All service user rooms have hand-washing facilities with liquid soap and paper towels, and an alcohol based hand cleanser. However, these facilities are not provided in some bathrooms and toilets and a recommendation is made for this. Staff reported that there were good supplies of disposable aprons and gloves. The laundry is situated in a separate building. The sluice is situated in a separate room. The washing machines are of an industrial standard. A steam cleaner is used regularly in service user rooms. Service users confirmed that their accommodation was kept clean and hygienic. Benoni Nursing Home Ltd Version 1.10 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30 The numbers and the skills of the staff are generally meeting the needs of service users. Recruitment practices do not comply fully with regulations, with appropriate references not being consistently obtained and potentially putting people at risk. There is a lack of evidence that new staff receives an induction to the ‘Skills for Care’ specification and this could result in staff lacking awareness of basic skills, the values of care and the home’s procedures. EVIDENCE: The staff roster demonstrates that a qualified nurse is on duty at all times, with three care staff on duty during the day and one care staff at night. An additional member of staff is currently on duty at all times to provide a one to one level of care contracted for one specific service user. A cook is on duty for all mealtimes, with a kitchen assistant/catering assistant at core times. There is a general assistant/handyperson and adequate domestic staff. The care staff have achieved a high level of qualification of 79 at NVQ 2, exceeding the 50 recommendation in the standard. Some aspects of the staff records have improved. However, there are still some staff (who were existing staff at April 2002) for whom Criminal Records Bureau disclosures have not yet been obtained. These were required by the Department of Health by October 2004. A requirement has been set in respect of obtaining these disclosures. There is no evidence that a structured induction meeting the required contents is provided to new staff. The provider also needs to ensure that all staff receive regular refresher training in infection control and food hygiene. Training dates for moving and handling were booked.
Benoni Nursing Home Ltd Version 1.10 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35,36,37 and 38 The provider has introduced some systems for quality monitoring, but these are not sufficient to demonstrate that the home is meeting its objectives. A small error had been made in the management of service users’ money held for safekeeping and this raises a concern about attention to detail in this area. The arrangements for supervision of staff do not meet the required standard. Staff do not receive regular formal supervision with a supervisor or manager. The records required by regulation and records for service users comply with the regulations. Records for staff do not fully comply with the regulations and this potentially compromises the safety of service users. The provider has systems in place to promote and protect the health and safety of staff and service users. EVIDENCE: There is a system for supporting service users to complete questionnaires about the services and facilities. Examples of these were inspected. There is no
Benoni Nursing Home Ltd Version 1.10 Page 16 evidence of recording feedback from relatives, visitors and other stakeholders. The results of surveys have not been analysed and made available. There is a recent development plan for the home. The home manages money for safe keeping for a small number of service users. A check of the cash held and the records showed that a small sum of money belonging to one service user had been mixed with that of another service user. This error was correctable through the detailed records kept. A number of required records were inspected and were satisfactory. Service user records meet the specification of Schedule 3 to the regulations. Records for staff, however, do not all have photographs and, as previously stated, Criminal Records Bureau disclosures have not been obtained for a number of staff. The registered person provided detailed information about maintenance records and safety checks in the pre-inspection questionnaire. The inspector checked a sample of these against the original record and found them accurate. There are risk assessments and moving and handling assessments for all service users. The last visit by the Environmental Health Officer was on 4 March 2005 and reported the good use of systems and procedures in respect of food hygiene. There is a plan to refit the kitchen where the work surfaces and cupboards are nearing the end of their safe working life. Fire training for staff is recorded regularly. However, the provider needs to ensure that the home’s fire risk assessment, which is not yet completed satisfactorily, is completed and submitted to the fire officer and a satisfactory version developed. Benoni Nursing Home Ltd Version 1.10 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 1 x 2 x 1 2 2 Benoni Nursing Home Ltd Version 1.10 Page 18 yes 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 OP30 Regulation 18(1)(a) and (c) Requirement The registered person must provide induction training to the Skills for Care specification to all staff appointed since April 2002. Fourth notification. Previous timescale of 31 January 2005 not met. The registered person must establish and maintain systems for reviewing and improving the quality of care provided at the home, including the quality of nursing. Fourth notification. Previous timescale of 31 March 2005 not met. The registered person must ensure that persons working at the home receive supervision at least six times a year. Fourth notification. Previous timescale of 31 January 2005 not met. The registered person must maintain records for staff which comply with the regulation and schedule. Fourth notification. Previous timescale of 31 January 2005 not met.
Version 1.10 Timescale for action 30 June 2005 2. OP33 24(1) 30 June 2005 3. OP36 18(2) 30 June 2005 4. OP37 17(2) and Schedule 2 30 June 2005 Benoni Nursing Home Ltd Page 19 5. OP3 14(1) 6. OP29 19(1)(b) and Schedule 2 23(4) 13(4) (a) (b) and (c) 18(1)(c)( 1) 7. 8. 9. OP37 OP37 OP30 The registered person must not provide accommodation to a service user at the care home unless the needs of the service user have been assessed by a suitable qualified or trained person. All assessment records must be signed and dated. The registered person must provide evidence to the commission of submitting applications for Criminal records Bureau Disclosures for all staff who have not obtained these. The homes fire risk assessment must satisfy the requirements of the fire service. Risk assessments must be completed for all service users where cot sides are employed. Staff must receive regular refresher training in food hygiene, health and safety and infection control. 8 April 2005 31 May 2005 30 June 2005 30 June 2005 31 October 2005 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. 4. Refer to Standard OP3 OP9 OP26 OP35 Good Practice Recommendations Where a number of different formats and types of assessment have been recorded at the same time by the same person the records should be page numbered. The medication policy and procedure should be reviewed and consideration given to re-writing it in plain language. Hand washing facilities or alcohol based cleanser should be available in all bathrooms, toilets and the sluice room. A service users money held for safe keeping should be held as an individual amount of cash which corresponds to the balance on the record. Benoni Nursing Home Ltd Version 1.10 Page 20 Commission for Social Care Inspection 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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