CARE HOMES FOR OLDER PEOPLE
Benridge 53 Queens Road Southport Merseyside PR9 9HB Lead Inspector
Mr Paul Kenyon Unannounced Inspection 16:15 3 January 2006
rd 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 Benridge DS0000005398.V271301.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. Benridge DS0000005398.V271301.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Benridge Address 53 Queens Road Southport Merseyside PR9 9HB 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) 01704 530378 benridge@themacs.org Benridge Care Homes Ltd Mrs Carole Ann McLaughlin Mrs Valerie Flint Care Home 27 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (2) of places Benridge DS0000005398.V271301.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is regisered with the CSCI. Twenty five places are to be registered in the category of DE(E) with 2 places registered in the category of OP for two named service users 11th July 2005 Date of last inspection 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. The home is managed by Valerie Flint. 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 DS0000005398.V271301.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second inspection to be held at Benridge this inspection year (April 2005 to March 2006) and was unannounced. The inspection used National Minimum Standards for Older People to measure the quality of care offered by the service. Twenty-one residents were living at the home at the time of the inspection. The inspection took place during the late afternoon and early evening and lasted a total of three and a half hours. The inspection included a tour of the premises as well as examination of a number of records. The nature of the disability of residents is such that no direct views about the service could be gained on this occasion. The Inspector used indirect observation of care practice as well as the degree to which the service had met minimum standards to assess the care provided at Benridge. What the service does well:
The service is good at ensuring the privacy and dignity of residents. This is achieved through the environment as well as through the care practice adopted by staff. The home’s induction process places an emphasis on the privacy and dignity of residents. The service is good at enabling residents to maintain family contacts. There is also provision for the service to remain independent from the financial affairs of residents. The nature of the disability of residents is such that they are not always in a position to manage their own finances. In these cases, independent appointees are in place linked to residents’ families to ensure independence in such matters. The service is good at providing a good quality of food and pays attention to the nutritional needs of residents as identified in care plans. Food storage areas are organised and food stocks are sufficient and the kitchen is well equipped. The dining room is big enough to accommodate all residents. The service is good at providing information to residents and their families about how a complaint can be made and provides the contact details of the Commission For Social Care Inspection. Benridge DS0000005398.V271301.R01.S.doc Version 5.0 Page 6 The service has improved the interior decoration of the home over the past few years and this continues as a rolling programme of refurbishment. The home has an organised laundry facility and was the building was noted to be clean and hygienic during the visit, free from offensive odour. The service monitors the training provided to the staff team and mandatory training is provided to staff as well as training relating to the disability of residents. The service provides structured induction to new staff over a twelveweek period, which results in an appraisal of their performance during this trial period. The service has a registered manager who demonstrated an awareness of the needs of residents during the inspection. The service is good at recognising the role of families and other independent groups when dealing with resident finances and where the home provides assistance with residents monies, deals with them in an accountable fashion. What has improved since the last inspection? What they could do better:
While the health needs of residents are met in the main, the home needs to ensure that evidence is provided of action taken when the weights of residents significantly alter from month to month. This only applied to one person identified at the inspection. The service needs to provide evidence that any changes in weight have been acted upon. Benridge DS0000005398.V271301.R01.S.doc Version 5.0 Page 7 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 DS0000005398.V271301.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Benridge DS0000005398.V271301.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No standards in this section were measured during this inspection. Standard 3 was examined at the last inspection and was met. EVIDENCE: Benridge DS0000005398.V271301.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): 8 and 10. Standards 7 and 9 were measured at the last inspection and were met. Residents have their health needs met in the main. Evidence needs to be available to confirm action taken when weight loss occurs. Residents benefit from an environment that maintains their privacy and from a staff team that takes their dignity into account. EVIDENCE: The service maintains detailed records of every contact that each resident has with a medical practitioner. In addition to this, a summary of the health care agencies involved with each person have been summarised in individual records for each resident. These records suggested that all residents have been registered with a local surgery. Records suggested that health needs outlined in care plans had been identified and that appropriate contact with medical agencies had been met according to the individual needs of residents. Records suggested that General Practitioner had been contacted when health needs changed, that District Nurses had been involved with two people who have had pressure sores (and have now been
Benridge DS0000005398.V271301.R01.S.doc Version 5.0 Page 11 discharged from this service), that community psychiatric nurses were involved and that Continence Advisors had been contacted to re-assess the needs of some residents. Records also provided evidence that vaccinations against influenza had been given during the latter part of 2005. All residents are weighed on a monthly basis. Records suggested that the weight for most residents had remained stable. This weight monitoring applies to those individuals who are on specialised diets. One person identified during the inspection had experienced some weight loss. There was no evidence that any action had been taken to investigate this. This is raised as a requirement in this report. All staff undertake an induction period that extends over twelve weeks. The induction concludes with an appraisal of their performance. Included within the induction period are a number of issues that centre on the rights of residents. This includes reference to their privacy and dignity. For all staff, a resident charter has been made available to them for reference and the staff team has signed this. This provides an expectation that all individuals receiving care will be supported in a dignified manner. The environment is such that there are three shared bedrooms. Only two are doubly occupied at present. In those cases, screening is available to ensure that each person receives privacy while being supported in their personal care. In addition to this, two separate hand washbasins are also available in each of these rooms enabling further privacy to be ensured. All toilets and bathrooms have locks to them, which further ensures privacy yet these can be opened from the outside in the case of emergencies. Indirect observation of the staff team noted that privacy was taken into account. One resident required personal care, the member of staff ensured that the bedroom door was closed during this time. In addition to this, another resident needed assistance with toileting. Again the door was closed to ensure that the person’s dignity and privacy could be upheld. Benridge DS0000005398.V271301.R01.S.doc Version 5.0 Page 12 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): 13, 14 and 15. Standard 12 was measured at the last inspection and was met. Residents benefit from having contact with their families and other visitors. The service endeavours to enable residents to be as independent as possible taking their needs into account. Residents benefit from a service providing wholesome meals that take dietary needs into account. EVIDENCE: While no visitors were seen during the inspection, the visitors’ book did reveal that a number of residents had received visitors over the past few weeks. Provision is available within the home to enable residents to receive visitors in private. The nature of the disability of residents is such that many are not able to handle their financial affairs. In those cases, residents have had family members or solicitors appointed to deal with their own affairs. As a result, the financial interests of residents remain independent of the home and in turn the service facilitates this. Residents in the past have used advocacy services although no one does at present. Information is available within the home about an advocacy service and information is given to prospective residents and their families at the point of referral. A number of bedrooms were viewed during the inspection and were noticed to include the personal effects of residents.
Benridge DS0000005398.V271301.R01.S.doc Version 5.0 Page 13 Menus are available and are put on prominent display Past menus suggested that the main meal of the day is lunchtime with a lighter, yet cooked meal being provided during tea. Only one person requires support with eating and this is presented as a softer diet. Discussions with the cook noted that he was fully aware of this as well as the nutritional needs of other residents who had special diets. The nutritional needs of these individuals are outlined within care plans. In one case, special food supplements have been prescribed and were recorded on a medication administration sheet. A record of food provided is maintained and this would enable an overview of the nutritional intake of residents to be assessed if required. Food stocks are stored in a separate area and were organised with a plentiful supply of tinned and frozen food available as well as fresh vegetables and fruit. The kitchen is well equipped and was noted to be clean and hygienic. Evidence was available to suggest that both cooks employed in the home have successfully obtained Intermediate Food Hygiene course. A dining room is available and can cater for all those resident at Benridge at present. Benridge DS0000005398.V271301.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): 16. Standard 18 was measured at the last inspection and was met. Residents and their families have the information they need to make a complaint about the service. EVIDENCE: A complaints procedure is available and contains information in respect of timescales as well as the contact details of the Commission for Social Care Inspection. A complaints record is maintained although no complaints have been received by the service. The Commission for Social Care Inspection has not received any complaints about the service since the last inspection. Benridge DS0000005398.V271301.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 and 26 Residents live in an environment that is well maintained and well decorated. The home is clean, hygienic and free from offensive odour. EVIDENCE: A tour of the premises was undertaken. The home continues to have a rolling programme of redecoration within the home. One room was being redecorated during the visit while another had had a new carpet laid on the day of the visit. A system for identifying repairs is in place. No maintenance staff are employed at present yet it is hoped that one will be recruited soon. The building presents as a well-decorated and home-like environment. A laundry is available and is separate from the food storage area. The laundry is organised and contains a number of industrial washing and drying appliances. A system of identifying residents’ laundered clothes is in place to minimise loss and confusion. Hand wash facilities are in place in the laundry. Benridge DS0000005398.V271301.R01.S.doc Version 5.0 Page 16 The home was noted to be clean and hygienic throughout during the day of the inspection with no offensive odours noted in any area. The home has purchased devices, which are designed to expel a monitored amount of air freshener on a regular basis. These are situated throughout the building. Protective equipment is available as well as a system for the disposal of clinical waste. All hand wash areas had soap and paper towels available. Benridge DS0000005398.V271301.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): 29 and 30. Standard 27 was measured at the last inspection and was met. Residents now benefit from a staff team, which has been subject to a robust recruitment procedure. Residents benefit from receiving care from a staff team that receives periodic training. EVIDENCE: A requirement at the last inspection noted that one file had only one reference, no proof of identity and no evidence of a Criminal Records Check. This has now been addressed. Training records are available for staff and this suggested that training focuses mainly on mandatory topics. Training has been provided in dementia awareness and this reflects the needs of the resident group at present. Both cooks have recently obtained an intermediate food hygiene award. A structured induction programme is in place. This takes place over a twelveweek period and ends with an appraisal of the staff member. The most recent induction record was examined during the visit and this included a host of issues that staff needed to know about supporting residents at Benridge. Such topics included practical issues such as fire awareness and working patterns as well as issues centred on the values to be used when supporting residents such as privacy and dignity. Benridge DS0000005398.V271301.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, 35 and 38. Standard 33 was measured at the last inspection and was met. Residents benefit from receiving a service that is managed by an individual who has the experience of their needs. Residents’ financial interests are safeguarded. The service has now updated and reviewed its general risk assessments. EVIDENCE: The Manager was approved by the Commission for Social Care Inspection in 2005. This individual has worked for some time within Benridge as an Assistant Manager and remains conversant with the needs of the residents there. The majority of residents have appointees who deal with their finances given that theses individuals are no longer able to manage these independently. There are some cases in which the Manager deals with some finances. In these cases, records are maintained, monies are securely stored, the system is accountable and monies are individually stored as opposed to being pooled.
Benridge DS0000005398.V271301.R01.S.doc Version 5.0 Page 19 A requirement at the last inspection highlighted the need for general risk assessments to be updated. This has now been done. Each hazard posed to residents and staff has been identified with a judgement made using a consistent system as to the degree of risk associated with each issue. Benridge DS0000005398.V271301.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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X X 3 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 X X 3 X X 3 Benridge DS0000005398.V271301.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. Standard OP8 Regulation 12 Requirement The home must provide evidence of action taken in relation to the weight of a resident identified during the inspection Timescale for action 06/01/06 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 Benridge DS0000005398.V271301.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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