Inspection on 09/04/08 for Benridge

This inspection was carried out on 9th April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Benridge 16/10/08

Benridge 03/05/07

Benridge 29/08/06

Benridge 03/01/06

Benridge 11/07/05

Benridge 17/01/05

Benridge 07/06/04

Benridge 17/11/03

Benridge 25/04/03

Benridge 17/09/02

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Benridge 53 Queens Road Southport Merseyside PR9 9HB Lead Inspector Mike Perry Key Unannounced Inspection 9th April 2008 09:30 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.V362200.R01.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.V362200.R01.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 admin@benridge.demon.co.uk 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.V362200.R01.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 3rd May 2007 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 £450 per week. Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. 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. As part of the inspector the inspector completed a short observational assessment [SOFI] of resident and staff interactions and some observations from this are included in the report. Comment cards [survey forms] were also sent to the home and given out by the manager to try and gain more views as to how the home is run from staff and relatives. Two staff and 2 relative surveys were returned and comments have been used to formulate this report. Visiting professionals such as social workers were also contacted as to their views of the care in the home. 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 five of the resident’s care plans, staff files and staff training records and health and safety records. What the service does well: There is information available for new and prospective residents in the home. 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, which contains a very good pen portrait and social history followed by a list of care Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 6 interventions. The care plans are reviewed by the manager and kept up to date on a monthly basis. One care plan was for a resident who presented with challenging issues around management of personal care and also family dynamics. There was evidence that the home had liaised well with health and social care professionals and that there was a care plan in operation so that all staff were aware of the issues and that these were reviewed with social workers regularly. Social workers spoken to were pleased with the management of this resident. 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 a notice board, which advertises some activities during the week. 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. There is also an orientation board in the hallway. During the inspection the inspector spent time observing levels of resident involvement and well being using a short observational tool [SOFI] and the results of this were positive. Staff were available to assist residents and this was done in a supportive manner and with some skill. The feeling of well being of the residents observed was good. Staffing in the home is fairly stable with minimal turnover. This was supported by both relative and staff interviews. 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 care needs and these are maintained. 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 although there is still work to complete. Relative’s comments were positive and all felt the care the care in the home was good. Comments included: ‘The majority of the carers that provide the care to my mother are kind and considerate and are aware of her needs’ ‘Staff are very patient with residents. One is very disturbed and shouts – they are very good and spend time. My relative has had chest problems and they are very quick to call the doctor’. What has improved since the last inspection? Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 7 Since the last ‘key’ inspection in May 2007 there have been two pharmacy inspections and requirements and recommendations made have been acted on and the medication administration system has been changed so that there is now a safe medication procedure. Although there is still some way to go there has been some progress around the requirement to ensure more activities for residents. a staff member is currently working at personalising the activities and there has been some funding to upgrade to garden area at the rear so that residents will be able to access this. The garden project should be complete in the next month. There has been improvement to the care environment in that there have been new furnishings in many of the day areas and bedrooms. Carpeting and décor has also been completed. The home presented as bright and maintained. The malodour present on the last visit was not detected on this inspection. Included in this the home have tried to ensure that appropriate orientation aids are available in the home such as signs for areas, including toilets and names on bedroom doors. The manager aims to develop this further. What they could do better: Some care needs are not always listed on the care plans in any great detail or are not considered. For example a resident who is being cared for long periods in bed and has poor mobility has no in depth assessment of mobility needs. There is currently no staff trained in moving and handling assessments and care staff have training that is not practically orientated [based around a DVD training system]. Some staff have not been shown how to the use the hoist therefore otherwise than on a pre recorded disc. Another resident spends long periods in the bedroom and does not socialise in the main day areas due to behavioural issues. The care plan has no real assessment of this however and there is no plan to ensure that some socialisation does occur and how this can be progressed. One resident prefers a vegetarian diet. The care plans states that ‘ the meal of the day can be given without the meat’. This was discussed as this diet offers little choice and may be nutritionally unbalanced. Care records show some weight loss for this resident and there needs to be extra planned input including a vegetarian diet and possible referral to the dietician. The care plan needs to reflect this diversity in some detail. Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 8 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. There is a menu board in the main hallway advertising the meal of the day. There is no real choice available unless residents ‘request’ and alternative. There have also been comments already made around the lack of a vegetarian alternative for one resident. In terms of quality the menu needs to show a daily choice for residents and this needs discussion with residents on an ongoing basis. Access to bathing facilities was again discussed with reference to enabling choice for residents and disabled access. The manager stated that the shower facility would be developed to make it more accessible which would be appropriate. These recommendations therefore remain. Bedrooms seen were generally well personalised. The shared rooms need to have curtain screening installed to assist with privacy and choice for residents Again this still needs to be addressed from the previous inspection. The laundry area was clean and tidy. There were aprons and protective gloves available for staff. The floor is in need of a repaint so that it is easier to clean. Staff reported that they had undergone some general training in abuse awareness via a DVD that the home have purchased. Some staff have also attended external courses but by no means all and some staff have had very little training in this area. New staff interviewed had not had this covered on any depth on the induction programme and this needs to be addressed. Through interviews the inspector became aware of an incident that occurred some time ago involving alleged abuse. This was not reported through the appropriate safeguarding channels. All such allegations or incidents need to be reported through so that agreed procedures can be invoked and the issues fully addressed. There is training available in the home. Currently only 30 of staff have NVQ qualifications although more are currently taking these qualifications. There is a standard induction programme and ongoing training is available. This is still heavily reliant on DVD training and work sheets although the home are trying to access external training although this needs to be further extended. Staff interviewed had had induction but this needs more depth around introductions to dementia care, safeguarding / abuse, and manual handling. Staff files were seen. One staff has been employed with issues disclosed on the application form that needed much further investigation by the manager. The staff file did not contain any interview notes regarding the risk factors associated with the decision to employ this member of staff. This must be addressed and adequate and proper record made. Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 9 During the inspection there was a lack of any business or service plan for the next year. It is important for the manager to have a clear vision of where the service needs to develop and to share this with staff and residents or their representatives. This includes. For example, how the home intend to meet statutory requirements. There is some daily management of resident’s personal allowance due to resident’s inability to manage these independently. The records seen lacked some attention to detail. For example there was only one signature on the transaction sheet. Also there was an entry that a relative had handed in a sum of money but there was no record of a receipt given for this. The home manages the personal allowance for a majority of the residents and it would be prudent for records to evidence regular auditing. 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. 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 informed. Also staff interviewed were unclear about the manual handling practice for some residents and there is a lack of both practical training and consistency of practice [see health and personal care]. 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.V362200.R01.S.doc Version 5.2 Page 10 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.V362200.R01.S.doc Version 5.2 Page 11 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): Standards 1 and 3 Quality in this outcome area is good. 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 and 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. 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. Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 12 Residents are admitted to the home following assessment by senior staff. Records seen were clear and cover main areas. There is an assessment made based on activities of daily living and extra notes are made if necessary. There were also copies of appropriate social work and health care assessments on file. The home has ‘emergency’ admission beds funded by social services and if used the residents are assessed soon following admission by the home. Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 13 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): All key standards. 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 overall so that residents are treated with respect and their dignity maintained. There is still a need to develop some aspects of care planning 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. Five were seen 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. The care plans are reviewed by the manager and kept up to date on a monthly basis. One care plan was for a resident who presented with challenging issues around management of personal care and also family dynamics. There was evidence that the home had liaised well with health and social care professionals and Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 14 that there was a care plan in operation so that all staff were aware of the issues and that these were reviewed with social workers regularly. Social workers spoken to were pleased with the management of this resident. Some care needs are not always listed on the care plans in any great detail or are not considered. For example, a resident who is being cared for long periods in bed and has poor mobility has no in depth assessment of mobility needs. There is some confusion amongst staff interviewed as to how this resident should be moved. Some staff are using a hoist and others are not. This was discussed in general terms of management of people with mobility needs and their assessments. There is currently no staff trained in moving and handling assessments and care staff have training that is not practically orientated [based around DVD training]. Some staff have not been shown how to the use the hoist therefore. This area was highlighted on the last report and still needs attention. The resident in question needs a more thorough moving and handling assessment as a priority. Another resident spends long periods in the bedroom and does not socialise in the main day areas due to behavioural issues. The care plan has no real assessment of this and there is no plan to ensure that some socialisation does occur and how this can be progressed. One resident prefers a vegetarian diet. The care plans states that ‘ the meal of the day can be given without the meat’. This was discussed as this diet offers little choice and may be nutritionally unbalanced. Care records show some weight loss for this resident and there needs to be extra planned input including a vegetarian diet and possible referral to the dietician. The care plan needs to reflect this diversity in some detail. 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. 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 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. This was discussed on the last inspection. Overall the care plans do offer a reasonable outline of care needs and resident’s background, which can be quickly accessed but, there really needs to be more in-depth assessment and planning in terms of residents who require this. Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 15 There is evidence that residents’ health care needs are being met. Doctor’s visits are included in the care files. The chiropodist visits on a regular basis. Since the last key inspection in May last year there has been two visits by the pharmacy inspector from the Commission. The system of administration has been changed and the issues highlighted by the pharmacists have been addressed so that the medication administration is now consistent and safe. There are no residents self-medicating as this is judged as high risk due to the level of cognitive impairment. The home have devised a self medicating risk assessment form however so that residents can be assessed if needed and some independence in this area can be retained. 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. Staff administrating medicines must all be appropriately trained and this was discussed with management. 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 and that this is recorded. Staff have also attended an external course as this was recommended previously. Residents seen were appropriately dressed and were clean and well presented. Relatives stated that the standard of personal hygiene for residents is 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. This was recommended on the last inspection and the manager stated that this would now be addressed as all bedrooms have been upgraded. Relative’s comments were positive and all felt the care the care in the home was good. Comments included: ‘The majority of the carers that provide the care to my mother are kind and considerate and are aware of her needs’ ‘Staff are very patient with residents. One is very disturbed and shouts – they are very good and spend time. My relative has had chest problems and they are very quick to call the doctor’. Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 16 Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 17 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 remains a need to develop a fuller programme so that residents can experience improved engagement on a daily basis and enhance quality of life. 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. 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. There is also an orientation board in the hallway. Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 18 Staff reported that there is limited time to sit and socialise with residents as this depends on other work tasks such as laundry duties. There is some time in the afternoons however and since the last inspection there has been some work started [but not yet completed] in developing the garden area so that residents can get out in the fresh air on a more regular basis. One staff member interviewed is currently looking at individualising resident activities and building a more comprehensive programme. Social activities are listed in the care file and these were seen and include some trips out but these appear to be for residents whose relatives escort them. One staff commented ‘ we rarely get the opportunity to get residents out much’. During the inspection the inspector spent time observing levels of resident involvement and well being using a short observational tool [SOFI] and the results of this were positive. Staff organised a game of bingo for part of this and the activity was well paced so that residents could join in and enjoy the social aspects of this. There were at least 3 staff available to assist residents and this was done in a supportive manner and with some skill. The feeling of well being of the residents observed was good. One resident was distressed on occasions but staff were able to offer support and some comfort in a sensitive manner. There remains some work to do. For example chairs are set against walls, which discourages social interaction and the previously mentioned work has to be completed but overall there has been progress and staff clearly have some skills in this area that can be further developed. 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. This may follow if the developments described are positive. 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 is a menu board in the main hallway advertising the meal of the day. There is no real choice available unless residents ‘request’ and alternative. There have also been comments already made around the lack of a vegetarian alternative for one resident. In terms of quality the menu needs to show a daily choice for residents and this needs discussion with residents on an ongoing basis. Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 19 Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 20 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): Key standards Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents concerns are listened to and addressed by the manager but there needs to be better understanding amongst staff and appropriate referral to safeguarding procedure when required so that residents can be assured of protection. EVIDENCE: There is a complaints procedure and this is made available through the service user information. Relative’s spoken to or supplied feedback through the survey were aware of how to complain and felt that management were very approachable and responsive and that they would listen. 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. Some staff have also attended external courses but by no means all and some staff have had very little training in this area. New staff interviewed had not had this covered on any depth on the induction programme and this needs to be addressed. Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 21 Through interviews the inspector became aware of an incident that occurred some time ago involving alleged abuse. This was not reported through the appropriate safeguarding channels, the home preferring to do an in-house investigation. This was discussed with the manager as all such allegations or incidents need to be reported through to Social Services so that agreed procedures can be invoked and the issues fully addressed. The home has received one complaint since the last inspection which was investigated by the manager. The complainant received a written reply although this was not in the set time scales. Also, the final letter was not on file although this was later found and put on file by the manager. It is recommended that a ‘tracking’ form be devised to accompany each complaint so that each stage can be better monitored and audited. Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 22 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): Key standards Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall there has been some progress in developing the environment but this needs to be completed so that residents can benefit from a more fully developed home and have an improved life style. EVIDENCE: 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 completed since the last inspection visit. Also sinks have been replaced in bedrooms. In addition to this the garden area has been developed at the rear of the home and will soon be complete so that residents will be able to access fresh air more readily. Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 23 There has also been re carpeting and décor on many areas. There is now no malodour, which was apparent on the last inspection. 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 the managers, following previous requirements, have made some attempt to reduce any barriers to residents orientation by introducing appropriate signage for toilets and day areas as well as residents bedrooms. Clocks are available in lounges and there is an ‘orientation’ board in the main hallway. This can be developed further. Externally there is still some upgrading work to do on gutters and windows to the rear of the building. 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. Residents and relatives felt the home was satisfactory generally and could see the improvements. 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 again discussed with reference to enabling choice for residents. The manager stated that the shower facility would be developed to make it more accessible which would be appropriate. These recommendations therefore remain. 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’]. Again this still needs to be addressed from the previous inspection. The laundry area was clean and tidy. There were aprons and protective gloves available for staff. The floor is in need of a repaint so that it is easier to clean. Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 24 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. Staffing of the home is consistent in terms of staff numbers so that care needs can be met. There needs to be further development of some aspects of the training programme so that the home can evidence staff are competent to carry out care tasks. EVIDENCE: For 22 residents at the time of the inspection there was the manager, one senior carer and 3 other carers, domestic staff and a chef. The administrator who supports the team has not been working in the home for some time. Staffing in the home is fairly stable with minimal turnover. This was supported by both relative and staff interviews. 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 care needs and these are maintained. There is training available in the home. Currently only 30 of staff have NVQ qualifications although more are currently taking these qualifications. There Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 25 needs to be at least over 50 staff trained to this level so that staff can be more confident about carrying out direct care. There is a standard induction programme and ongoing training is available. This is still heavily reliant on DVD training and work sheets although the home are trying to access external training in, for example, adult protection and some staff have attended courses in dementia care, safeguarding and medication management although this needs to be further extended. Staff interviewed had had induction but this needs more depth around introductions to dementia care, safeguarding / abuse, and manual handling. Staff interviews, training records and discussion with the manager support this. Relatives interviewed were positive when talking about the staff and comments received were very positive regarding the daily standard of care giving. Staff files were seen and the recruitment standards concerning necessary checks to ensure staffs fitness were carried out satisfactorily. One staff has been employed with issues disclosed on the application form that needed much further investigation by the manager. The staff file did not contain any interview notes regarding the risk factors associated with the decision to employ this member of staff. This must be addressed and adequate and proper record made. Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 26 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): Key standards. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The managers display a willingness to listen to the needs of residents and relatives and to act in their best interests, but there needs to be better developmental planning overall and attention paid to the detail of service provision so that the home can achieve improved quality. 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. Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 27 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 although there is still work to complete. The manager completed an Annual Quality Assurance Assessment [AQAA] prior to the inspection which is a self assessment of the service and allows the management to reflect on their practice and to plan for the future. This was completed without any attention to forward planning or development of the service as a whole. During the inspection there was a lack of any business or service plan for the next year. It is important for the manager to have a clear vision of where the service needs to develop and to share this with staff and residents or their representatives. This includes. For example, how the home intend to meet statutory requirements. 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 records seen lacked some attention to detail. For example there was only one signature on the transaction sheet. Also there was an entry that a relative had handed in a sum of money but there was no record of a receipt given for this. The home manages the personal allowance for a majority of the residents and it would be prudent for records to evidence regular auditing. This was discussed with the manager who will ensure that the provider, during regulation 26 visits [monthly recorded audit visits to the home] includes an auditing process of the personal allowance. 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. 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 informed. Also staff interviewed were unclear about the manual handling Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 28 practice for some residents and there is a lack of both practical training and consistency of practice [see health and personal care]. Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 29 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 30 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 Timescale for action Care plans must include more in- 14/08/08 depth care interventions for all identified care needs so that these can be met effectively and evaluated regularly. In particular there is a need to review: • • • One residents mobility needs One residents dietary needs One residents need for progressive socialisation Requirement As listed in the main body of the report. [Last requirement dates 01/01/07 and 01/08/07 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. DS0000005398.V362200.R01.S.doc 14/08/08 Benridge Version 5.2 Page 31 [Timescale 01/08/07 not met] 3 OP18 13(6) Any allegation of mistreatment must be reported through using the agreed safeguarding procedures. All staff must receive adequate raining in particular there must be increased emphasis in the induction programme. This is so that residents can be assured of protection. The environment of the home must continue to be developed with reference to good practise guidelines for dementia care so that resident’s quality of life can be further improved. A development plan must be drawn up which addresses this need. [Timescale 01/08/07 not fully met.] 5 OP29 19(1) All staff records must be complete with respect to any management decision to employ staff following the consideration of any issues relating to ‘fitness’ to work with vulnerable people. With respect of the staff discussed a full note of the managers interview and risk assessment must be recorded. This helps ensure that residents are protected. 6 OP38 13(5) All staff must be adequately trained in moving and handling and the training must be approved and have a practical DS0000005398.V362200.R01.S.doc 14/08/08 4. OP19 23(1) a 14/08/08 01/05/08 14/08/08 Benridge Version 5.2 Page 32 component. [See recommendation below regarding he training of a moving and handling assessor]. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Refer to Standard OP7 Good Practice Recommendations Relatives should be involved in all care planning on an ongoing basis and this should be recorded. It is recommended that permanent curtain type screens be installed in shared bedrooms so that residents and staff can more easily ensure privacy. It is recommended that the menu be further developed to offer a daily choice of meal as well as supplying diverse diets such as vegetarian meals. A checklist or tracking form should be introduced to audit more effectively the process of any complaints received and investigated. The bathing facilities should be evaluated with respect to the residents’ needs and choice. An upgrading of the shower facility would be appropriate. The laundry room floor needs repainting to ensure easier cleaning. The training programme should continue to be developed with reference to comments in the report especially around induction standards covering dementia care and safeguarding. The manager should consult and produce a development plan for the service and share this with staff and residents / representatives. The residents personal allowance records should contain 2 signatures for all transactions. Receipts should be provided DS0000005398.V362200.R01.S.doc Version 5.2 Page 33 1 2 OP10 3 4 5 OP15 OP16 OP21 6 7 OP26 OP30 8 9 OP33 OP35 Benridge 10 OP38 and the records should be audited by the manager / provider on a routine basis. It is recommended that a staff member attend moving and handling assessors training so that the quality of the monitoring and demonstrations of moving and handling are better informed. Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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 © 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 Benridge DS0000005398.V362200.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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