CARE HOMES FOR OLDER PEOPLE
Benridge 53 Queens Road Southport Merseyside PR9 9HB Lead Inspector
Mike Perry Key Unannounced Inspection 3rd May 2007 10:00 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 Benridge DS0000005398.V332322.R02.S.doc Version 5.2 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.V332322.R02.S.doc Version 5.2 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 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.V332322.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Service users to include 27 (DE) One DE bed to be for one named Service user (GS) who is currently under the OP category 29th August 2006 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. Valerie Flint manages the home. 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. The current fees for the service are £410 per week. Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was a ‘key’ inspection for the service and covered the core standards the home is expected to achieve. The inspection took place over a period of two separate days. The inspector met with residents and spoke with members of care staff on a one to one basis and the registered manager. Visiting relatives were also spoken to. Service user comment cards were also given out to try and gain more views as to how the home is run and what it is like to live there. Four of these were returned and comments have been used to formulate this report. A tour of the premises was carried out and this covered all areas of the home including the resident’s rooms [not all bedrooms were seen] and gardens. Records were examined and these included three of the resident’s care plans, staff files, staff training records and health and safety records. The inspection was positive overall and the management of the home were open and supportive of the inspection process. In terms of overall outcomes for residents in the home there needs to be an emphasis on developing the way the day is structured so that residents are more engaged in activity. The home environment can be improved in line with good practice in dementia care so that residents are better enabled to access all areas including outdoor space so that the quality of daily living can be improved. What the service does well:
There is information available for new and prospective residents in the home. Most relatives surveyed and spoken to felt that they had received enough information so that they were able to exercise informed choice about moving into the home. Residents are admitted to the home following assessment by senior staff. Records seen were clear and cover main areas. There were also copies of appropriate social work and health care assessments on file. All of the residents have a care plan recorded in their file. The care plan is a single sheet, which contains a very good pen portrait and social history followed by a list of care interventions. Residents’ health care needs are being met. Residents spoken to discussed trips to the doctor and one resident discussed how the chiropodist visits on a regular basis. One resident on a special diet was monitored well. Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 6 Medication administration recording [MAR] sheets were clear and accurate and practises ensure that resident’s medication is given on time and safely. Residents seen were appropriately dressed and were clean and well presented. Relatives stated that the standard of personal hygiene for residents is consistent. The social atmosphere in the home appears warm and relaxed. Staff where observed to be interacting and supporting residents around tasks such as giving drinks and meal times. There is opportunity for socialisation at meal times with the dining room being pleasantly furnished and tables well laid with tablecloths and cutlery. Residents were observed to interact well and clearly enjoy the experience. The home is clean and satisfactorily maintained internally so that resident’s living space is comfortable. There is disability access to the front of the home. The home is consistently staffed and staff were seen to have the necessary skills to support residents in the home. There is training available in the home. Over 50 of staff have NVQ qualifications so that staff have the background knowledge to carry out care. Relatives interviewed were positive when talking about the staff and comments received were: ‘Staff are approachable and caring’. ‘The staff give good care. My father is happy’. Staff files were seen and the recruitment standards concerning necessary checks to ensure staffs fitness were carried out satisfactorily. The home are able to demonstrate systems whereby the quality of the service is under review and that they listen to the wishes of relatives who generally speak on behalf of the residents in the home. For example the annual quality assurance audit includes attention to relative’s feedback and the home also collects comments in the ‘appreciation file’. There is some daily management of resident’s personal allowance due to resident’s inability to manage these independently. Some records were seen and these are individualised. What has improved since the last inspection?
There has been some work completed since the last inspection to try and make care plans more personalised so that individual needs are better identified. Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 7 There have been some wardrobes purchased and some décor has been completed since the last inspection visit. Also some sinks have been replaced in bedrooms, improving the environment for residents. Since the last inspection the laundry has been painted and this area was clean and tidy. There were aprons and protective gloves available for staff. Requirements made previously around the management of legionella risk have been addressed. What they could do better:
Some care needs are not always listed on the care plans. For example one resident is being attended to by the district nurses for leg wounds but this is not recorded on the care plan. staff need to be aware of all care needs so that they are making the correct care interventions on a daily basis and that they are being evaluated. Evaluations should be in more detail and set against the main aims and objectives of the care plan so that they can be measured. This was discussed on the last inspection. Relatives interviewed were clear that they are kept up to date and informed of any changes in the care of residents in the home. Those interviewed did not have any real idea of the existence of a care plan however and had not been asked to review this with staff on an ongoing basis Although there is not an immediate need to address issues around residents self-medicating the home should develop the necessary risk assessments, which may be useful for enabling greater independence for some residents. The staff who are eligible to administer medications should have a written competency checklist signed of by the manager of the home. Currently there is no such record, which should help to ensure a set standard in this area. Some residents share bedrooms and portable screens were noted to be in situ. The screens can be awkward to move and rather cumbersome and they also cannot be used by residents independently. Fixed curtains are recommended to enable more independence for residents. Staff reported that there is limited time to sit and socialise with residents as this depends on other work tasks such as laundry duties. Residents were observed in the main day areas. The TV is constantly on but there is no engagement from residents. The positioning of furniture does not encourage social interaction. One resident commented ‘the staff are nice but we just sit all day. I want to get out and do my shopping but I can’t. I’m a bit bored’. Another said ‘ it looks a nice day but we can’t get out. I’ve never been in the garden’. A relative commented; ‘there seems to be little activity although we
Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 8 were promised this when [resident] was first admitted’. There was discussion with the manager as to how the social care in the home could be improved and a requirement is made to achieve this. There were comments made by visitors and relatives about the odour in some areas of the home. The management need to develop an action plan to deal with this problem as it affects resident’s dignity. The building is an older style ‘hotel’ type lay out over a number of floors. This presents difficulties with orientation for the resident group and there is currently a lack of orientation aids to assist in enabling people to move around the home. Externally there is some upgrading work to do on gutters and windows and this is currently under way. The garden area and patio area off the small day room are not accessible for residents and have not been developed. Comments made in other areas of this report support the need for access to other areas of the home especially outdoor. Access to bathing facilities was discussed with reference to enabling choice for residents. The manager stated that the shower facility could be developed to make it more accessible which would be appropriate. Bedrooms seen were generally well personalised. The shared rooms need to have curtain screening installed to assist with privacy and choice for residents. Currently there is no member of staff trained as assessor for moving and handling of residents and this would be a strong recommendation as physical demonstrations of moving and handling would be better in formed and training needs better monitored. 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. The summary of this inspection report can be made available in other formats on request. Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 9 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.V332322.R02.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is information available in the home so that new and prospective residents can make an informed choice regarding whether or not to move in. assessments are carried out prior to admission so that the home are ensured that care needs can be met. EVIDENCE: There is information available for new and prospective residents in the home. There is a brochure and ‘service user guide’ which explain the facilities, staffing, and how the home operates. Most relatives surveyed and spoken to felt that they had received enough information so that they were bale to exercise informed choice about moving into the home. Some relatives raised the issue of fee structure and were unclear about recent charges. One commented ‘ the fees seem to change a lot without reason’. This was discussed with the manager and there would appear a need to clarify things, as there has been a recent increase in social service funding which now needs to be reflected in contracts.
Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 11 Residents are admitted to the home following assessment by senior staff. Records seen were clear and cover main areas. There were also copies of appropriate social work and health care assessments on file. One resident admitted has had psychiatric review to assist in correct placement in the home and there was evidence on the file that the home have also consulted with the Commission for social care inspection regarding the appropriateness of the placement in the home. Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Personal care needs are met consistently overall so that residents are treated with respect and their dignity maintained. There is a need to develop some aspects of care planning and standards around medicines administartion so that all needs are addressed and staff can have consistent guidance on care interventions. EVIDENCE: All of the residents have a care plan recorded in their file. Three were seen in depth and discussed with care staff. The care plan is a single sheet, which contains a very good pen portrait and social history followed by a list of care interventions. There has been some work completed since the last inspection to try and make these plans more personalised. One plan listed needs around encouraging socialisation and also mentioned personal food preferences for example. Some care needs are not always listed on the care plans however. For example on e resident is being attended to by the district nurses for leg wounds but this is not recorded on the care plan. staff need to be aware of all care needs so
Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 13 that they are making the correct care interventions on a daily basis and that they are being evaluated. Care is evaluated on a regular basis although entries under this heading should be in more detail and set against the main aims and objectives of the care plan so that they can be measured. This was discussed on the last inspection. Relatives interviewed were clear that they are kept up to date and informed of any changes in the care of residents in the home. Those interviewed did not have any real idea of the existence of a care plan however and had not been asked to review this with staff on an ongoing basis. It is recommended that care staff do include relatives in the care planning process and record any reviews as part of the evaluation process. This can be quite informally of needed and recorded appropriately. There is evidence that residents’ health care needs are being met. Doctor’s visits are included in the care files. Residents spoken to discussed trips to the doctor and one resident discussed how the chiropodist visits on a regular basis. One resident has diverse needs in that she has a condition that requires a specialised diet and staff were knowledgeable on the way this affected the residents life and the need for monitoring. There are no residents self-medicating as this is judged as high risk due to the level of cognitive impairment. At least two residents interviewed however were minimal in their level of impairment and the need to assess residents in terms of ability to self medicate is important if some independence in this area can be retained. There is currently no risk assessment tool for this purpose. Medication administration recording [MAR] sheets were clear and accurate. Medicines are received into the home on the MAR sheets and there is a return to pharmacy record. The supplying pharmacist does audit the medicines on visits to the home and a record of this was seen [ written record recommended the last inspection]. Staff administrating medicines must all be appropriately trained and this was discussed with management. Since the last inspection staff administering medicines have undergone some training using a DVD and questionnaire system. A designated staff member also ensures that staff are observed in their practice. Not all staff that administers medicines have background knowledge to NVQ level and this would be recommended as it supports good and safe practice. The staff who are eligible to administer medications should have a written competency checklist signed of by the manager of the home. Currently there is no such record, which should help to ensure a set standard in this area. Residents seen were appropriately dressed and were clean and well presented. Relatives stated that the standard of personal hygiene for residents is
Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 14 consistent. Staff understood the concepts of privacy and dignity for residents and could give examples of how to maintain this. Some residents share bedrooms and portable screens were noted to be in situ. The screens can be awkward to move and rather cumbersome and they also cannot be used by residents independently. Fixed curtains are recommended to enable more independence for residents. Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported to be involved in some activities although there is a need to develop a fuller programme so that residents can experience improved engagement on a daily basis and enhance quality of life. A choice of good quality home cooked food is provided to the residents who enyoy their food in pleasant surroundings. EVIDENCE: The social atmosphere in the home appears warm and relaxed. Staff where observed to be interacting and supporting residents around tasks such as giving drinks and meal times. The hairdresser was visiting during the inspection and this was the focus of some engagement for residents. There is a notice board, which advertises some activities during the week although this is blank of most days. The manager explained that only outside’ activities are advertised such as the visiting therapist that involves residents in physical activities [chair exercises etc] on a weekly basis.
Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 16 Staff reported that there is limited time to sit and socialise with residents as this depends on other work tasks such as laundry duties. ‘This is a lot of work in the morning – afternoons are a bit freer. We sometimes escort residents out locally on trips to the park but this is only occasionally’. One staff member commented that residents love the garden but cannot get out without staff escort and this is rare. Residents were observed in the main day areas. The TV is constantly on but there is no engagement from residents. There is no radio available. Chairs are set against walls, which discourages social interaction. Staff when they interacted with residents were positive and supportive and residents were easily engaged. One resident commented ‘the staff are nice but we just sit all day. I want to get out and do my shopping but I can’t. I’m a bit bored’. Another said ‘ it looks a nice day but we can’t get out. I’ve never been in the garden’. Relatives awareness of activities in the home is limited indicating that perhaps more could be done with relatives in involving them in the daily social life. Relatives comments where positive however regarding the staffs ability to interact and support residents. One did comment that ‘there seems to be little activity although we were promised this when [resident] was first admitted’. Records of residents’ activities are kept and these confirm the observations and comments made. Relatives said they were free to visit. One relative is currently unhappy with visiting arrangements and the managers are reviewing this with liaison with social services and an individual care plan has been drawn up. Dinnertime was observed. The opportunity for socialisation is emphasised with the dining room being very pleasantly furnished and tables well laid with tablecloths and cutlery. Residents were observed to interact well and clearly enjoy the experience. All residents are encouraged to join in at meal times. There was some discussion with the manager regarding how the social aspects of the home can be developed. The Alzheimer’s decease web site has excellent information and ideas, which should prove useful. Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure so that residents rights can be upheld and people feel that concerns are addressed. Management are aware of local procedure to report alleged abuse so that residents can be protected. EVIDENCE: There is a complaints procedure and this is made available through the service user information available. Relative’s spoken to were aware of how to complain and felt that management were very approachable and responsive and that they would listen; ‘if I wanted to complain I would see the manager’. The information available includes the contact details of The Commission for Social Care Inspection [CSCI]. The management were aware of the local procedures for reporting of any allegations of mistreatment although staff had only limited understanding in this area. Staff reported that they had undergone some general training in abuse awareness via a DVD that the home have purchased. Since the last inspection the managers have also accessed external training to compliment in-house sessions. A recent complaint, which was investigated under adult protection, was discussed and reviewed. There has been appropriate liaison with social services
Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 18 and an individual care plan has been devised so that the complainant has agreed visiting rights [the main body of the complaint was around visiting and taking a resident for outings]. Part of the complaint was investigated by the home and the reply to the relative involved was rather brief and did not satisfy the complainant who has since fed this back to the home. An issue arising out of the complaint involved some discussion in the use of restraint. This was discussed with the manager and the homes policy reviewed which is in line with good practice. The manager was aware of rights and responsibilities in this area. Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,20,21,24,25,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is maintained satisfactorily and is clean so that residents are comfortable but there needs to be a focus on developing the internal and external environment with regard to good practice in dementia care so that residents are enabled to live a more independent life. EVIDENCE: The general environment of the home was assessed in depth and there was discussion with the manager on how the home needs to be developed in line with good practice guidance for people with dementia. The home is clean and satisfactorily maintained internally so that resident’s living space is comfortable. There is disability access to the front of the home. There have been some wardrobes purchased and some décor has been
Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 20 completed since the last inspection visit. Also some sinks have been replaced in bedrooms. There were comments made by visitors and relatives about the odour in some areas of the home and these were identified on the inspection. The management need to develop an action plan to deal with this problem as it affects resident’s dignity. The building is an older style ‘hotel’ type lay out over a number of floors. This presents difficulties with orientation for the resident group and there is currently a lack of orientation aids to assist in enabling people to move around the home. For example there is marked lack of appropriate signage for day areas and ways in which residents can identify their bedrooms. There are no clocks, orientation boards etc in living areas. There is no focus of engagement apart from the TV. Residents can wander and some congregate around the entrance area of the home. Externally there is some upgrading work to do on gutters and windows and this is currently under way. The garden area and patio area off the small day room are not accessible for residents and have not been developed. The small day room on the lower ground floor is kept locked unless requested to open the door and is therefore generally not accessed. This room was discussed in terms of resident use. Residents and relatives felt the home was satisfactory generally but the above were areas that were felt to need attention. [Comments made in other areas of this report support the need for access to other areas of the home especially outdoor]. Not all of the bathrooms are used, as one is not assisted [does not have hoist]. The shower facility cannot be accessed if a resident has physical disability or mobility / balance / perception problems associated with dementia. There is a parker bath, which is more often used. Access to bathing facilities was discussed with reference to enabling choice for residents. The manager stated that the shower facility could be developed to make it more accessible which would be appropriate. Bedrooms seen were generally well personalised. The shared rooms need to have curtain screening installed to assist with privacy and choice for residents [discussed under social care and daily life’]. Since the last inspection the laundry has been painted and this area was clean and tidy. There were aprons and protective gloves available for staff. * With respect to developing the dementia care environment the Alzheimer’ s disease Society [ADS] website has excellent information and advice. A
Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 21 recommended publication is ‘The dementia care environment’ published by ADS. Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing and recruitment processes in the home enable residents to receive a good standard of basic care so that needs are met. Staffing numbers may not be adequate if the home is to develop improvements in social care as recommended. EVIDENCE: For 25 residents at the time of the inspection there was the manager, one senior carer and 2 other carers, domestic staff and a chef. There is also an administrator who supports this team. Staffing in the home is fairly stable with minimal turnover. This was supported by both relative and staff interviews. Given the comments earlier in the report around the need to develop socialisation and activity for residents the ratio of staff to residents is not high. There are no laundry staffs and comments received indicate that this also takes up a lot of staff time together with other care tasks. One relative commented ‘generally I am happy with the level of care but at times the staff are overstretched’. The presence of a chef all of the day is a very good support. The evidence of the inspection over all is that there is sufficient staff to meet basic care needs and these are maintained.
Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 23 There is training available in the home. Over 50 of staff have NVQ qualifications although this does not always relate to the senior staff role as some of these do not have this qualification. There is a standard induction programme and ongoing training is available. This is heavily reliant on DVD training and work sheets. Since the last inspection the home have accessed outside training in, for example, adult protection and some staff have attended courses in dementia care although this needs to be further extended [staff interviews support this]. Relatives interviewed were positive when talking about the staff and comments received were: ‘Staff are approachable and caring’. ‘The staff give good care. My father is happy’. Staff files were seen and the recruitment standards concerning necessary checks to ensure staffs fitness were carried out satisfactorily. Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): All key standards. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed well and residents and relatives are able to contribute towards the ethos in the home which is managed in the residents’ best interests. EVIDENCE: Val Flint is the manager of the home. Val was registered with CSCI in 2005. She worked previously in the home and has completed her Registered Managers Award at level 4 NVQ. During the inspection she was able to demonstrate an understanding and empathy for residents with dementia. An administration officer who has also worked in the home a number of years supports Val. The administrator has taken on the role of ‘Responsible Person’ and completes quality audits on a monthly basis as required by regulations.
Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 25 The home are able to demonstrate systems whereby the quality of the service is under review and that they listen to the wishes of relatives who generally speak on behalf of the residents in the home. The annual quality assurance audit includes attention to relative’s feedback and the home also collects comments in the ‘appreciation file’. There are some internal audits carried out such as regular risk assessments of the environment. The manager displayed an open attitude to the inspection process and was keen to meet and improve standards. Some requirements and recommendations from the previous inspections have been addressed. There is some daily management of resident’s personal allowance due to resident’s inability to manage these independently. Some records were seen and these are individualised. The homes policy statements have been seen previously and include good practice guidance around receiving of gifts and staff responsibilities regarding management of resident’s finances. The general risk assessments form the basis of the health and safety management in the home. Records seen were up to date and the ongoing management ensures residents safety. Requirements made previously around the management of legionella risk have been addressed. Moving and handling management was assessed. The home has hoists in each area and staff are given training via DVD and questionnaire. Currently there is no member of staff trained as assessor and this would be a strong recommendation as physical demonstrations of moving and handling would be better in formed. Accident recording and reporting policy was discussed. Records for one resident recorded accidents [falls] on two occasions but there was no record of whether relatives had been informed. This is a recommended good practice and should be carried out when accidents occur with residents. Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 26 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 3 2 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 1 2 X X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 Requirement Care plans must include care interventions for all identified care needs so that these can be met effectively and evaluated regularly. [Last requirement date 01/01/07 not met] 2 OP12 16(2) n A fuller programme of activities for residents must be made available and this must include access to outside space so that resident’s quality of life can be further developed. The environment of the home must be developed with reference to good practise guidelines for dementia care so that resident’s quality of life can be further improved and the home can meet the needs of people with dementia. A development plan must be drawn up which addresses this need. 4 OP26 16(2) k The problem identified with offensive odours in the home
DS0000005398.V332322.R02.S.doc Timescale for action 01/08/07 01/08/07 3 OP19 23(1) a 01/08/07 01/08/07 Benridge Version 5.2 Page 28 must be addressed so that resident’s dignity can be preserved. 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 Refer to Standard OP2 Good Practice Recommendations The relatives discussed on the inspection should be reassured regarding the fee structure and appropriate contracts updated for residents. The evaluations on the care plan should be in more depth and identify any progress [or not] made against the goals or objectives of the care. Relatives should be involved in all care planning on an ongoing basis. There should be a risk assessment tool for residents who may be able to self medicate to some degree. The manager should develop a written competency assessment for all staff administering medicines and this should be signed of so that there is a record of set standards in this area. It is recommended that permanent curtain type screens be installed in shared bedrooms so that residents and staff can more easily ensure privacy. The bathing facilities should be evaluated with respect to the residents’ needs and choice. An upgrading of the shower facility would be appropriate. Management should give some thought to developing orientation aids to assist residents in getting around the home. There should be sufficient staff to spend quality time with residents and develop a programme of activities.
DS0000005398.V332322.R02.S.doc Version 5.2 Page 29 2 OP7 3 4 5 OP7 OP9 OP9 6 OP10 7 OP21 8 OP19 9 OP27 Benridge 10 OP38 It is recommended that a staff member attends moving and handling assessors training so that the quality of the monitoring and demonstrations of moving and handling are better informed. It is recommended that any accident occurring with residents should be reported to relatives and if not why. 11 OP38 Benridge DS0000005398.V332322.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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