CARE HOMES FOR OLDER PEOPLE
Benslow Nursing Home Benslow Rise Hitchin Hertfordshire SG4 9QY Lead Inspector
Patricia Rogan Key Unannounced Inspection 10th May 2006 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 Benslow Nursing Home DS0000019288.V292714.R01.S.doc Version 5.1 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. Benslow Nursing Home DS0000019288.V292714.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Benslow Nursing Home Address Benslow Rise Hitchin Hertfordshire SG4 9QY 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) 01462 459773 Benslow Management Company Limited Mrs Sandra Tyers Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Benslow Nursing Home DS0000019288.V292714.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Registered numbers shall remain at 33 subject to the continued occupancy by a married couple. When one permanently leaves, for any reason, numbers will reduce to 32 3rd November 2005 Date of last inspection Brief Description of the Service: Benslow Nursing Home is a care home providing personal care and nursing care with accommodation for 33 older people. It is owned by Benslow Management Company Limited, which is a private company. It was first registered under the Registered Homes Act (1984) in January 1996. The home is situated in a quiet residential neighbourhood just over a mile from the centre of Hitchin. It consists of a three storey building, and the interior is decorated to a high standard. All the home’s bedrooms have en-suite facilities. There are three double bedrooms, one of which is below the standard size. It is occupied by choice by a married couple, and it is a condition of registration that the room should revert to single occupancy if either of the couple permanently leaves the home for any reason. There is a passenger list between the floors. The home has a garden at the side, accessed through the front door, with lawn and shrubs, a patio and sheltered sitting places. Benslow Nursing Home DS0000019288.V292714.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an inspection of all the key standards and took place over three days. This included preparatory work, examining documents, policies and procedures and one full day and early evening in Benslow, meeting with residents in private and observing the way that care was given and making a tour of the premises. A further day was spent speaking with family or friends of some residents and professionals who visit the home. What the service does well: What has improved since the last inspection?
Steps have been taken to address the requirements made at the previous inspection. New care plans have been introduced and identify how resident’s individual needs can be met. Residents said they had been involved in this. The risk assessments are in a new format and set out how risk can be minimised. All bed rails which were being used had covers on them. The residents said they are spending more time in the garden in the hot weather and like having the gazebo and umbrellas to provide shade. In consultation with the residents, the manager is exploring ways of introducing more varied activities and stimulation for the residents. There is a system in place to investigate complaints and residents and relatives said they were confident about speaking to the manager if they had a concern. Staff have been reminded that all substances hazardous to health, including Steradent should be stored securely at all times, to minimise risk to residents. Recording of pressure sores and tissue viability has been improved and with the permission of the resident or their representative, vulnerable skin areas are noted on all admissions and readmissions to the home and photographs taken if appropriate. Benslow Nursing Home DS0000019288.V292714.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Benslow Nursing Home DS0000019288.V292714.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Benslow Nursing Home DS0000019288.V292714.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Intermediate care is not provided, therefore Standard 6 in not applicable. Service users are assessed prior to moving into the home in order to ensure that his or her needs can be met. It is the manager or her deputy who carries out the assessments and residents said they were told why they were being assessed. Families said they were not always present for the assessment but were usually contacted shortly afterwards. EVIDENCE: Case files held written assessments which were completed prior to the resident moving into Benslow. These assessments covered most areas of the prospective resident’s needs and is used alongside any information provided by the referring agency or hospital. Residents and families said they were asked to add any additional information not already provided. These assessments were held on file and all were signed by the person making the assessment. Not all assessment had been signed by the resident. When a resident is unable to sign, it would be helpful to explain this on the assessment. Benslow Nursing Home DS0000019288.V292714.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 The care plans and risk assessments have recently been put into a new format. Each resident’s needs are written down with ways that the needs can be met and how any identified risks will be minimised. Where it is required service users’ health care needs are met by the qualified nurses on duty and by medical professionals who come into the home. The wound treatment programme has been enhanced. The administration and storage of medication has stringent policies and procedures in place and only those trained to administer medication are allowed to do so. Most service users said they were treated with respect and dignity. However, despite a requirement being served following two previous inspections there was a new notice on the front of a resident’s bathroom door about continence pads. This notice was removed immediately. EVIDENCE: An inspection of several case files showed that the care plans reflected the individual needs of the resident and a signature by the resident evidenced that they were involved in this. The staff rota showed that qualified nurses are always on duty and feedback showed that there is a good working relationship with other health professionals. Medication administration training records
Benslow Nursing Home DS0000019288.V292714.R01.S.doc Version 5.1 Page 10 were seen. Observation of staff and discussion with residents was generally very positive. The positive comments were marred by those staff who do not always speak to residents while attending to residents. In addition, despite two previous requirements, the resident’s dignity is not protected when notices about which continence pad to use is stuck on the resident’s bathroom door in full view. The manager dealt with this immediately and therefore a requirement will not be made on this occasion. If this reoccurs, it will be taken very seriously. Benslow Nursing Home DS0000019288.V292714.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The majority of residents appeared to be satisfied with their experience in Benslow. Residents were seen sitting in the lounge and varied activities are available. Two members of staff are directly involved in arranging a variety of activities. One or two residents said they would like to be able to ‘go on an outing now and again’. Visitors came into the home during the inspection and there are others who visit the home on an occasional basis. Several residents said they feel their relatives are made welcome. Residents’ choice of where they wanted to spend their day was respected. A varied seasonal menu is available and residents are asked what meals they would like. EVIDENCE: Residents said that they are encouraged to go into the lounge and socialise with other residents. Residents said they had taken part in such things as quizzes keep fit and dominoes. Several residents said they had been asked what they would like to do and this is being made available where possible. They also said they had enjoyed watching visiting entertainment from musicians and singers. Those who prefer to remain in their own room are welcome to do so. During the inspection, some residents went into the garden where umbrellas and a gazebo provided shade. Several residents said they have attended residents and relatives meetings and that they feel they are listened to. Fewer family members have attended these meetings but said they were confident any difficulties or queries would be responded to and acted
Benslow Nursing Home DS0000019288.V292714.R01.S.doc Version 5.1 Page 12 upon. For those who would like to go out there are staffing implications and records show this has been discussed with the manager in the past. Residents said they enjoyed their meals and if they do not like the choices available and alternative is provided. Fluid charts are used for those residents who are unable to feed themselves or are unable to ask for extra drinks. Benslow Nursing Home DS0000019288.V292714.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Records are kept of any concern which is raised and CSCI are notified according to regulation. Records are kept to show how the complaint is investigated. There are policies and procedures in place, including a whistle blowers policy to protect residents from abuse. All staff are made aware of these policies during induction and during supervision and are expected to follow them in their working environment. Not all staff have taken full responsibility for adhering to these policies and procedures. Staff must follow the procedures which are in place to air any concerns they have and not burden residents and families with adverse comments about colleagues. EVIDENCE: All senior staff have the ongoing responsibility of ensuring that a high standard of care is provided to protect residents from abuse. Any training needs to achieve this outcome is reported to the manager. There is an expectation that all staff are vigilant and will take responsibility for ensuring that all residents are protected by reporting poor practice as soon as possible in order for this to be addressed. Residents and visitors have heard senior nursing staff criticising the manager because she is in charge of a nursing home without having a nursing qualification. These unsupportive comments undermine the confidence of residents and can be regarded as a form of abuse. All staff have had training in the protection of vulnerable adults and providing good quality care. Guidelines are in place to air concerns or grievances and there is also the whistle blowers policy available to all staff.
Benslow Nursing Home DS0000019288.V292714.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 There is a maintenance programme in place and repairs are remedied as they arise. This is with the exception of the ongoing problem of hot and cold water having variable temperatures which are outside the accepted guidelines. The manager and proprietor gave assurance that this is going to be corrected very shortly. The weather was warm on the day of the visit and with the exception of the office, temperatures were at a comfortable level for the residents and staff. The cleanliness of the home was of a good standard. One carpet required cleaning and this was due to be done within the week. EVIDENCE: The home appeared to be well maintained with the exception of the variable water temperatures which has been noted at previous inspections. The manager and proprietor have given reassurance that this is to be investigated and resolved as a matter of urgency. Residents’ rooms were at a comfortable temperature and fans were available if needed. The manager’s office is long and very narrow and was excessively hot. Opening the window caused papers to fly around and leaving the door open does not provide privacy if needed.
Benslow Nursing Home DS0000019288.V292714.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 29 and 30 The rota showed that there is a qualified nurse on duty at all times. The training schedule is up to date and covers a wide range of identified training needs. Outside agencies are involved in training where appropriate. Several members of staff including the manager and the deputy manager are trained in medication administration. The manager is about to undergo the advanced medication training. The recruitment policy is adhered to and all staff have had a Criminal Records Bureau (CRB) check. EVIDENCE: There is a skill mix of care staff and there is always a qualified nurse on duty. Mandatory training is provided for all staff and training needs are also identified through observation of practice and during supervision. Paperwork showed that care staff were given access to other training organisations as required. Non-care staff also have training relevant to the roles they have in the home. CRB records were available for examination. Benslow Nursing Home DS0000019288.V292714.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33, 35 and 38. The registered manager is competent and keeps up to date with the National Minimum Standards and other regulatory requirements. There is greater focus on person centred care and the new care plans reflect this. Records show that the administration of finances and reporting of concerns regarding finances, have been correctly carried out. Relevant policies and procedures are in place to promote the health, safety and welfare of the service users and staff. EVIDENCE: The manager has previous experience of managing homes and has developed her expertise in this post. She has ensured that there is a qualified nurse on duty at all times. A comparison of the previous care plans and the new format of the care plans shows that the manager is keen to move forward with more person centred care. Positive feed back from several residents, their family members and some staff shows that progress is being made to ensure that the home is run effectively for the benefit of the residents. The few exceptions identified in earlier parts of this inspection report are being addressed.
Benslow Nursing Home DS0000019288.V292714.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTE3CTION 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 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Benslow Nursing Home DS0000019288.V292714.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP10 Regulation 12(4)(a) Timescale for action All staff must treat residents with 01/06/06 respect and dignity by ensuring that discretion is used when providing information about care needs and by assisting in a courteous and friendly manner at all times. Professional relationships must be maintained between staff and with service users. Staff must use the appropriate channels to discuss any concerns they have and must not cause distress to residents by discussing or criticising colleagues in the presence of residents or family members. 01/06/06 Requirement 2 OP18 12(5) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations
DS0000019288.V292714.R01.S.doc Version 5.1 Page 19 Benslow Nursing Home 1 Standard OP19 CSCI should be informed when the repairs to the water temperature controls have been completed. Benslow Nursing Home DS0000019288.V292714.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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