CARE HOMES FOR OLDER PEOPLE
Benridge 53 Queens Road Southport Merseyside PR9 9HB Lead Inspector
Paul Kenyon Unannounced 11/07/2005 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. Benridge F53 F03 S5398 Benridge V238101 11.07.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Benridge Address 53 Queens Road Southport Merseyside PR9 9HB 01704 530378 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) Benridge Care Homes Ltd Mr Paul McLaughlin Care Home 27 Category(ies) of Old age - 2 registration, with number Dementia over 65 years old - 25 of places Benridge F53 F03 S5398 Benridge V238101 11.07.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service should, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 2. Twenty five places are to be registered in the category of Dementia - over 65 years old, with 2 places registered in the category of Old people for two named service users Date of last inspection 17 January 2005 Brief Description of the Service: Benridge is a privately -run residential care home registered for twenty-seven older people. Included within this registration are twenty-five places for those individuals with dementia and two in the category of old age. The home has been open for a number of years and the Owner; Mr McLaughlin is currently the registered Manager.The home is located in a residential area of Southport on one of the main roads leading from the town centre. As a result the home is close to local facilities and near to public transport routes. The home is operated from a detached building, which has amenities on three levels. A basement level provides bedroom and communal facilities. On the ground floor are further bedrooms as well as kitchen, dining room and two lounges. Further bedrooms are located on the upper floor. A number of bathrooms and toilets are also available. All areas are served by stair lifts. Benridge F53 F03 S5398 Benridge V238101 11.07.05 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place during the late morning and early afternoon periods. The inspection lasted three and a half hours. The first part of the inspection involved speaking to a number of residents. In total eight residents gave their views. These views are included within this report. In other instances; the nature of the disability of individuals was such that it was not always possible to get a response through conversation. For those who were unable to offer opinions, the inspection involved an observation of how staff interacted with these individuals as well as evidence of how they were cared through training, care plans and other documents. What the service does well:
Residents who offered a view stated that they were ‘in good health’ and were ‘looked after’. Other comments included ‘everything is quite satisfactory’. They stated that there ‘was plenty to do in the day’ and had the choice to participate in activities if they wish ‘I join in but when you get to my age I want to put my feet up and I do’. The home is striving, through staff awareness training to meet the needs of residents who have dementia. The staff team are going through a process of dementia awareness training. This involves the staff team completing workbooks designed to determine the issues around dementia and focussing on what needs this client group has. This inspection concluded that the home takes every possible step to ensure that needs can be met before people come to live at Benridge. They review their care on a regular basis and change this care if it is necessary. The home provides a safe system of giving medication to its residents. Activities are available, are reviewed regularly and residents have the choice to join in or otherwise. The home aims to keep residents safe and apart from shortcomings in its recruitment process, has demonstrated that staff are aware of how to protect service users. The home maintains its staffing levels and gives the opportunity for residents and their relatives to say what they think about the service they receive. In short, many of the national minimum standards measured on this inspection were met. Benridge F53 F03 S5398 Benridge V238101 11.07.05 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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. Benridge F53 F03 S5398 Benridge V238101 11.07.05 Stage 4.doc Version 1.40 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 Benridge F53 F03 S5398 Benridge V238101 11.07.05 Stage 4.doc Version 1.40 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) 3 All new residents admitted into Benridge have their needs assessed in a thorough manner and this is completed before the person comes to live in the home. Assessment information is used to produce a care plan well in anticipation of the resident entering the home. Assessments allow a judgement to be made whether the needs of individuals can be met. EVIDENCE: One resident was admitted during the inspection. This admission had been planned. An assessment had been obtained from the funding authority prior to the person being admitted. This assessment was supplemented by Benridge’s own assessment form. From this, a care plan had been produced outlining the needs of the person well in advance. Staff were observed referring to the care plan as the person was admitted. Benridge F53 F03 S5398 Benridge V238101 11.07.05 Stage 4.doc Version 1.40 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) 7,9 Care plans are consistent in format for all residents, reviewed monthly and amended regularly to reflect the changing needs of the client group. The review of care plans reflected the complex needs of the client group for which the home is registered. The management team should start to determine those relatives that are willing to sign care plans on behalf of their relations. Medication arrangements are safe and residents are protected through this system. It is considered as good practice for medication training to be updated and for a controlled drugs register to be introduced. EVIDENCE: A total of six care plans were examined during this inspection. These related to those residents who had more complex needs and those who had been admitted into Benridge since the last inspection. All had been reviewed at least monthly since the last inspection in January 2005. For those care plans for people who had been admitted recently into the home, there was evidence that these had been reviewed at least monthly and in some cases had been amended. Other care plans examined included one, which related to a person with complex needs. In that care plan there was evidence
Benridge F53 F03 S5398 Benridge V238101 11.07.05 Stage 4.doc Version 1.40 Page 10 that it had been amended on several occasions reflecting new developments in that person’s care. Care plans are signed by the homes management team, and cited that relatives were happy for this to occur. It is recommended that evidence is obtained from relatives that they are happy for this situation to occur and for the management team to sign care plans. Medication is stored in a secure, purpose built cabinet and was noted to be locked at all times during the inspection. Medication records for June 2005 were examined and found to be signed consistently by staff. No residents selfadminister medication at present given the nature of the client group and this arrangement is included within each care plan. Only senior care staff administer medication. They have received training on this and certificates were available to evidence their competence in this task. It is recommended that refresher training be undertaken. The home is subject to inspections by the Pharmacy supplier. One inspection highlighted the need, as a good practice issue, for a controlled drugs register to be maintained. The Inspector in this report as a recommendation supports this. Only one resident is prescribed controlled medication at present. Benridge F53 F03 S5398 Benridge V238101 11.07.05 Stage 4.doc Version 1.40 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) 12 Residents are given the choice whether to participate in activities or not. Activities are based on the preferences of individuals. EVIDENCE: Residents commented that ‘there was plenty to do’ and that they always had the option to join in if they wished (‘I join in but when you get to my age I want to put my feet up and I do’). An activities board is on display and care plans record those activities that have been undertaken. There was evidence in care plans that these had been reviewed. The nature of the disability of the resident group is such that some activities have been maintained if reactions to them have been positive and abandoned if no interest is shown. Local religious groups attend the home occasionally. Benridge F53 F03 S5398 Benridge V238101 11.07.05 Stage 4.doc Version 1.40 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) 18 Service users are protected from abuse through the information that staff are provided with. It is considered as good practice that the care staff team should be provided with abuse awareness training in line with the training that has already been received by senior staff. The recruitment process does not protect residents. This is raised in Standard 29 of this report. EVIDENCE: A procedure is in place outlining the types of abuse that could occur as well as the action that is needed to be taken. All staff have signed this. This is supplemented by the availability of a Local Authority procedure for dealing with abuse allegations. In addition to this, policies are available which prevent staff from being involved in aspects of resident’s finances. Information (whistle blowing procedure) is also available for the action staff can take if they have concerns about care practice and have the contact details of the Commission For Social Care Inspection as an external agency to investigate concerns. The nature of the disability of the majority of the residents at Benridge is such that physical aggression can be a potential feature faced by staff. Information in dealing with physical and verbal assaults is available for the staff team included within policies and procedures. Again all staff have signed these. Senior staff have attended elder abuse training and this was evidenced through the viewing of certificates. This should be extended to all other staff. Benridge F53 F03 S5398 Benridge V238101 11.07.05 Stage 4.doc Version 1.40 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) No standards in this section were measured during this inspection. EVIDENCE: Benridge F53 F03 S5398 Benridge V238101 11.07.05 Stage 4.doc Version 1.40 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) 27,29 Numbers of staff on duty during the inspection are sufficient to meet the needs of residents and are typical. The home’s recruitment practices are inconsistent and do not fully protect residents. Requirements are raised in this report in respect of these. EVIDENCE: Staff on duty during the inspection included: -2x Deputy Managers (one supervising the shift and one on administration duties) -1x Senior Care Assistant -2x Care Assistants -1x Chef -1x Domestic staff In addition to this, a further senior care assistant was available on the premises. The recorded staff rota suggested that these were typical staffing levels for the morning, with a minimum of three during the evening and two waking staff on duty at night. An on call rota between senior staff is in operation at all times. A total of three personnel files were examined all relating to newer members of staff. Two had two references in place, a current police clearance check and information confirming the person’s identity. One file only had one reference, an out of date police clearance check and no proof of the person’s identity.
Benridge F53 F03 S5398 Benridge V238101 11.07.05 Stage 4.doc Version 1.40 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) 33,38 The quality of the service is examined independently from the home and takes into account the views of residents and their families. The health and safety of residents and staff is not promoted consistently. EVIDENCE: A quality assurance process is in place and an agent unconnected with Benridge independently does this. The process for this year is being undertaken at present. A number of questionnaires from residents and those from their families were viewed. Staff are also interviewed as part of the process. The results of these are made available through an annual conclusion that is made known to all residents, their families, the staff team and anyone considering living within Benridge. A requirement at the last inspection required that those residents who needed bed rails fitted to their beds had the situation risk assessed. This has been done. Risk assessments associated with general tasks undertaken by staff are
Benridge F53 F03 S5398 Benridge V238101 11.07.05 Stage 4.doc Version 1.40 Page 16 available but have not been reviewed recently. It is required that they are reviewed or updated at least once a year. Staff training in health and safety issues such as First Aid and Manual Handling continues. Records verified this. An approved system of visual aids assists staff in training and this is reinforced by a written test. Benridge F53 F03 S5398 Benridge V238101 11.07.05 Stage 4.doc Version 1.40 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. 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 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x 3 x x x x 2 Benridge F53 F03 S5398 Benridge V238101 11.07.05 Stage 4.doc Version 1.40 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 29 Regulation 17 Requirement A minimum of two references must be available on the personnel file identified during the inspection. Proof of staff identity must be available on the personnel file identified during the inspection Evidence of an updated criminal records check must be made available for the member of staff identified during the inspection General risk assessments must be reviewed or updated on an annual basis Timescale for action 31 July 2005 31 July 2005 31 July 2005 31 July 2005 2. 3. 29 29 17 17 4. 38 13 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.
Benridge Refer to Standard 7 9 9 18 Good Practice Recommendations It s be determined with relatives about arrangemetns for signing care plans Senior staff responsible for administering medication should receive updated training A controlled medication register should be obtaibned and used for such medications Abuse awareness training should be extended to all other
F53 F03 S5398 Benridge V238101 11.07.05 Stage 4.doc Version 1.40 Page 19 care staff Benridge F53 F03 S5398 Benridge V238101 11.07.05 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Burlington House, South Wing 2nd Floor, Crosby Road North Waterloo, Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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