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Inspection on 03/11/05 for Benslow Nursing Home

Also see our care home review for Benslow Nursing Home for more information

This inspection was carried out on 3rd November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home was completely refurbished in 2003, and the building is well decorated and comfortably furnished. Although nursing care is provided, the atmosphere is that of a home designed and run for the benefit of the residents. It provides a comfortable and homely environment for the residents. All the residents who took part in the inspection said that they are happy in the home and that the staff provide a good quality of care. All the residents spoken to praised the quality and variety of the meals. One resident said, "There are good things here. My room is nice and the food is wonderful." Another commented that "The staff are nice and they have patience with us". All the care staff spoken to were enthusiastic about their work. The staff were observed to have a good relationship with the residents and to treat them with courtesy and respect. However some residents made a complaint about the behaviour of certain members of staff, as a result of which disciplinary action has been taken.

What has improved since the last inspection?

There has been some improvement in the number and range of activities that are available for residents in the home, and the residents spoken to said that they have more opportunity to make choices and decisions about their lives in the home. Many of the residents spoken to confirmed that the care workers organise activities that they enjoy. The care workers said that they encourage the residents to take part in activities, and they spend time individually with the residents who are unable to take part in the communal activities. The home was clean throughout, and a system has been put on place to ensure that the kitchen is thoroughly cleaned on a regular basis. The Commission carried out a pharmacy inspection in the home on 29th June 2005. Several requirements were made to improve the practice of administration, recording and storage of medication. On this occasion the medication round was observed, and good practice was seen for the administration and recording of medication.

What the care home could do better:

The main area for further development is to ensure that the residents` care plans provide accurate and detailed information on all their needs, including social activities and their needs to improve and maintain a good quality of life. The care plans would benefit from a person centred approach that involves the resident in decisions about their care, and reflects their views and wishes. The risk assessment format must also be reviewed, and appropriate risk assessments must be put into place for each resident, with full details of the risk and of the procedures for managing the risk. Two residents were recently admitted to hospital due to problems with their catheters, which would have been prevented if the nursing staff had up to date training and information on the changes in catheter care. Several residents mentioned specific staff who are not respectful to them. One person said, "Some of the staff are just wonderful like angels, but that all gets spoiled by the few, like a rotten apple in a barrel. It`s those few who upset you who can ruin your day". The issues that they raised were discussed with the manager, and it was reported that disciplinary action has been taken. It was disappointing to note that once again where bed rails were in place, covers were not always in place. The use of bed rails without appropriate covers constitutes a serious risk of injury to the service users. Enforcement action will be considered if this requirement is not complied with.

CARE HOMES FOR OLDER PEOPLE Benslow Nursing Home Benslow Rise Hitchin Hertfordshire SG4 9QY Lead Inspector Claire Farrier Unannounced Inspection 3rd November 2005 at 9:30 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 Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 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 Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 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 10th April 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.V264415.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two inspectors. Including preparation time, a total of 14 hours was allocated to this inspection. During their time in the home the inspectors spoke with eight residents, two visitors and four members of staff, and discussion took place with the manager. The interaction between residents and staff was observed. The records were checked of residents’ care, medication, health and safety, staffing and residents’ money. This was a positive inspection, and several areas of improvement were seen. All the residents spoken to were happy in the home, although some commented on the behaviour of some members of staff. Requirements have been repeated concerning risk assessments, personal information and the safe use of bed rails. The number of requirements made does not detract from the overall outcome. The manager and staff provide a good quality of care and the home provides an attractive and comfortable environment for the residents. What the service does well: The home was completely refurbished in 2003, and the building is well decorated and comfortably furnished. Although nursing care is provided, the atmosphere is that of a home designed and run for the benefit of the residents. It provides a comfortable and homely environment for the residents. All the residents who took part in the inspection said that they are happy in the home and that the staff provide a good quality of care. All the residents spoken to praised the quality and variety of the meals. One resident said, “There are good things here. My room is nice and the food is wonderful.” Another commented that “The staff are nice and they have patience with us”. All the care staff spoken to were enthusiastic about their work. The staff were observed to have a good relationship with the residents and to treat them with courtesy and respect. However some residents made a complaint about the behaviour of certain members of staff, as a result of which disciplinary action has been taken. Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: The main area for further development is to ensure that the residents’ care plans provide accurate and detailed information on all their needs, including social activities and their needs to improve and maintain a good quality of life. The care plans would benefit from a person centred approach that involves the resident in decisions about their care, and reflects their views and wishes. The risk assessment format must also be reviewed, and appropriate risk assessments must be put into place for each resident, with full details of the risk and of the procedures for managing the risk. Two residents were recently admitted to hospital due to problems with their catheters, which would have been prevented if the nursing staff had up to date training and information on the changes in catheter care. Several residents mentioned specific staff who are not respectful to them. One person said, “Some of the staff are just wonderful like angels, but that all gets spoiled by the few, like a rotten apple in a barrel. It’s those few who upset you who can ruin your day”. The issues that they raised were discussed with the manager, and it was reported that disciplinary action has been taken. It was disappointing to note that once again where bed rails were in place, covers were not always in place. The use of bed rails without appropriate covers constitutes a serious risk of injury to the service users. Enforcement action will be considered if this requirement is not complied with. Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5 The home has sufficient information on the needs of the residents, in the form of assessments carried out before they move into the home, to enable their needs to be met. However the format of assessment scores does not always provide an accurate appraisal. EVIDENCE: Each resident has an assessment file that contains a personal profile and an assessment carried out before they are admitted to the home. A resident who has recently moved into the home confirmed that the manager visited him in hospital to assess the help that he needed, and they helped him to settle into the home. Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 10 The assessments seen include physical and mental health, behaviour, falls, pressure sores and nutrition. There are details of the person’s needs under each heading and a numerical score to provide a measure of their dependence. However the score for one person who is totally dependent and nursed in bed indicated that her needs are “medium”. This indicates either that the assessment was not accurate, or the scoring system does not provide a realistic outcome. The personal profiles give a picture of the person’s family history and interests, but those seen were not in the words of the resident, and showed little evidence of the input of the resident or their family (see Standard 7). There has been no change in the format since the last inspection, but the care plans are currently under review (see Standard 7). The home employs sufficient nurses to meet the resident’s nursing needs, and the care staff have appropriate training. The manager ensures that residents whose needs change are re-assessed and alternative suitable accommodation is provided for them. One resident does not speak English, but a member of staff speaks her language. Two visitors to the home were spoken to, who were looking for a suitable home for their mother. They said that they were looking for cleanliness, no smells, and friendly staff, and they were impressed with Benslow. Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 11 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 individual needs of residents are set out in care plans to ensure that all their needs are identified and can be met. The information is brief and in some cases inadequate. Residents said that most members of staff treat them with respect, but this is compromised by the display of some inappropriate notices in their rooms. EVIDENCE: The care plans of four residents were inspected. They contain information on the resident’s health and personal care needs. Some provide clear and easily accessible information on the resident’s health and personal care needs, with comprehensive procedures for meeting the needs, but in several cases the details of the care needed are not sufficiently detailed. For example, for one person the care plan stated “need all help washing and personal care”, but there were no details of what help is needed, how the staff should provide it, and the person’s wishes for how their personal care should be provided. The care plan stated that she is “unable to maintain personal hygiene, ensure she has a bath or shower at least once a week”, but the record of baths was not completed, and no baths were reported in the daily record. Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 12 The nursing staff and the care staff complete separate daily reports for each resident, but what they record does not always refer to the care plan needs. The care plans state the person’s personal care and health care needs, but there is no care plan for the person’s quality of life, for example how they spend their time and how they make decisions and choices about their lives. There is no indication that the resident has been involved in drawing up the care plan and personal profile (see Standard 3), and setting their own goals. It was reported that the format of the care plans is currently under review. All the care plans contain risk assessments, but they take the format of a checklist with no further information. For example, a risk assessment for falls states that there is a medium risk of falls, and this is controlled. It does not specify the risks, or the procedure for management to ensure that the risk is controlled. The risk assessment for the use of bedrails states that bedrails are needed, but not the risks of using bedrails, and the need for covers on the bedrails (see Standard 38). There were no risk assessments in place for several residents for whom bedrails are used, or for a resident who uses oxygen in her room. The residents spoken to said that most of the staff treat them with respect and provide a good quality of care. One person said, “The staff are nice and they have patience with us”, and another said that the staff are all very good. However several residents mentioned specific staff who are not respectful to them. One person said, “Some of the staff are just wonderful like angels, but that all gets spoiled by the few, like a rotten apple in a barrel. It’s those few who upset you who can ruin your day”. The issues that they raised were discussed with the manager. The staff that were observed during the inspection had a good relationship with the residents, and were patient and caring towards them. Notices were again seen on the en-suite bathroom doors in some of the resident’s rooms, stating what size incontinence pad they require. This practice provides an inappropriate display of personal information and does not respect service users privacy and dignity. The home employs sufficient qualified nurses to meet the needs of the residents who need nursing care. Evidence was seen of in improvement in the health of several residents, including one man who no longer needs nursing care. The Commission carried out a pharmacy inspection in the home on 29th June 2005. Several requirements were made to improve the practice of administration, recording and storage of medication. On this occasion the medication round was observed, and good practice was seen for the administration and recording of medication. Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 13 All the residents are monitored for the possibility of pressure sores. The wound care for one resident was fully recorded in her care plan, including pictures of the pressure area, but another person had a grade 3 pressure sore that was not monitored in such detail. The Commission has not been notified of this serious pressure sore. (See Standard 38.) Two residents were recently admitted to hospital due to problems with their catheters, which would have been prevented if the nursing staff had up to date training and information on the changes in catheter care. The care plan for one resident with diabetes states that his blood sugar should be monitored three times a week. The records show that it is monitored once a week, and there is no record of insulin administered as a result. The home has a good relationship with the GP, and evidence was seen that residents are referred for mental health assessments when required. The home is not registered for dementia care, but it is inevitable that some residents will develop a measure of dementia. Appropriate referrals have been made when this has occurred, and one resident is currently waiting for a transfer to a more suitable placement. The details in the care plan for a resident who has been diagnosed with possible dementia do not provide sufficient information. There is information on management of confusion and aggression, but no specific details of her individual behaviours and the procedure for managing them. Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 14 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 There has been some improvement in the number and range of activities that are available for residents in the home, and the residents spoken to said that they have more opportunity to make choices and decisions about their lives in the home. EVIDENCE: There is a list of activities on the notice board in the main lounge, including crafts, a quiz, bingo, reminiscence and beauty therapy. Nine residents took part in an exercise group in the lounge during the morning of the inspection. Many of the residents spoken to confirmed that the care workers organise activities that they enjoy. An activities co-ordinator is not employed in the home. The care workers carry out activities when the care work is finished. One of the care workers has had training in arts and crafts, and she is going on activities course in November. She will be freed from the care rota to organise activities for two hours every afternoon. The care workers said that they encourage the residents to take part in activities, and they spend time individually with the residents who are unable to take part in the communal activities. Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 15 The residents spoken to on this occasion felt more involved in decision making than previously. They are consulted about the food that they like, and they were given a choice of food for lunch during the morning, so that they knew and looked forward to what they were going to eat. Everyone spoken to praised the quality and choice of food. One resident said that she would like to have internet access for her computer, and the manager will discuss this with her and her family. Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 16 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 The home has a comprehensive complaints procedure in place, and any complaints are properly investigated and recorded. Several residents felt that complaints that they have made are not investigated. EVIDENCE: Several residents mentioned specific staff who are not respectful to them (see Standard 10). Two residents said that they felt that complaints they have made are not treated seriously. One said that a complaint was made but the staff were not even told off, and the resident was not told the result of the complaint. However there was no record of a complaint being made until the issues were brought up during the inspection. The son of this resident did not want to complain in case his parent was bullied as a result. Another resident said that a complaint was made but it was not taken seriously, although in that case the behaviour complained about had not happened again. The issues that they raised were discussed with the manager, and following the inspection it was reported that disciplinary action has been taken as a result. It was reported that the residents didn’t want to make a complaint, but they wanted the behaviour to stop. Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 17 Evidence has been seen that complaints are investigated and recorded appropriately in the home. It is possible that not all members of staff treat all concerns reported to them as complaints. All complaints must be recorded and investigated appropriately, and the results must be reported to the complainant. This may help to build trust among the residents and their families so that they feel confidence that they can make complaints without fear of retribution. Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 18 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, 22, 24 and 26 The home and gardens are well maintained and provide a comfortable and attractive environment for the residents. Individual and communal facilities are appropriate for the residents’ needs. This ensures that the residents are able to maximise their independence and live in a safe and comfortable environment. EVIDENCE: Benslow Nursing Home is a three storey building, The building is owned by a property company, Macrame Properties Ltd, which is responsible for the upkeep of the fabric of the home and the garden. The home is well maintained both inside and out. It has a garden at the side, accessed through the front door, with lawn and shrubs, a patio and sheltered sitting places. The home is situated in a quiet residential neighbourhood just over a mile from the centre of Hitchin. Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 19 The home was clean throughout, including the areas that were noted to need cleaning during the last inspection. A system has been put in place to ensure that the kitchen is thoroughly cleaned on a regular basis. The maintenance man was in the home during the inspection, and several residents commented that any repairs that are needed, such as to the TV aerial, are dealt with without delay. Two visitors to the home, who were looking for a suitable home for their mother, commented on the attractive appearance and cleanliness of the building and the lack of unpleasant odours. They also liked the size and appearance of the bedrooms, and several residents also said that they like their rooms. There are three shared bedrooms, one of which is shared by a married couple who also have a small private lounge. The other two shared rooms are occupied by residents who have chosen to share, and one said that she likes the company. Screening is provided in these rooms to provide privacy when it is needed, but in one shared bathroom there was no clear indication of whose belongs were whose, and Steradent for one resident was left out so that it was accessible, causing a possible safety risk (see Standard 38). The home provides sufficient equipment for the residents, with a variety of hoists and baths, and handrails in the corridors, bathrooms and toilets. Four wheelchairs were seen stored in the bedroom and bathroom of a resident who is nursed in bed, which is an infringement of her private space. Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 20 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 Staff numbers in the home are sufficient to ensure that all the residents’ needs are met, and the staff receive appropriate training. Good recruitment procedures and staff training make sure that, as far as possible, service users are supported and protected in the home. EVIDENCE: The home’s regular levels of staff are eight for the early part of the day, six for the later part of the day and three during the night, including two registered nurses on each shift. The home now has sufficient permanent nurses, and no agency nurses have been employed recently. Some agency care workers are needed to fulfil the rota due to staff illness. The home has robust policies and procedures for recruitment. Two staff files for recently recruited members of staff were inspected. They both contained all the required information, including good references, confirmation of the NMC PIN, and a satisfactory CRB (Criminal Record Bureau) disclosure. Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 21 A new deputy manager has been appointed, and she is responsible for organising the rotas and ensuring that the nursing staff are fully trained and supervised, to maintain the knowledge and skills that they need for the NMC (Nursing and Midwifery Council) registration. Two residents were recently admitted to hospital due to problems with their catheters, which would have been prevented if the nursing staff had up to date training and information on the changes in catheter care (see Standard 8). The deputy manager will ensure that they receive regular updates to ensure good practice in nursing care in the home in future. The company provides a comprehensive training programme that covers all the statutory training and other training as required for the specific needs of the service users. The staff confirmed that they have appropriate training, including training for the NVQ qualification. Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 22 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 home actively seeks the views of the residents and other involved people in order to ensure that a good quality of care is provided. Adequate records are maintained for the effective management of the home and monitoring of heath and safety procedures. The practices in some areas must be tightened up to ensure that there is no risk to the health and safety of the residents. EVIDENCE: Sandra Tyers has been acting manager for almost a year, and she has now applied for registration as manager of the home. She has many years experience of managing care homes, and she was Operations Manager for Benslow Management Company before she became acting manager of this home. She is studying for NVQ4 and the Registered Managers Award. Mrs Tyers is not a registered nurse, but the deputy manager is a nurse, and she takes responsibility for the supervision and training of the nursing staff. Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 23 A system for quality assurance has been established, and the first annual surveys should be completed by the end of March 2006. Questionnaires have been prepared for residents, relatives and professionals, and their comments will be recorded as a graph in order to monitor changes in their perception of the quality of care provided. Residents’ and relatives’ meetings take place in the home, and residents and relatives also give their views on the home at the residents’ annual reviews. The proprietor makes monthly visits to the home to monitor the quality of care provided. The arrangements for management of residents’ money were checked inspected and appeared to be accurate. Money is stored safely and adequate records are maintained in order to protect service users from financial abuse. The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff follow the home’s policies and procedures. All the staff have training in moving and handling, fire safety, food hygiene and infection control as part of their induction. Four health and safety concerns were noticed during the inspection:1. All the beds in the home have bed rails that can be used if needed for the safety of the resident. Several bed rails were again seen to be in use, but without the use of the covers that are required to prevent the risk of injury. Appropriate risk assessments were not in place for all residents for whom bed rails were in place (see Standard 3). This requirement was also made following the last inspection, with a timescale of 31st August 2005. The use of bed rails without appropriate covers constitutes a serious risk of injury to the service users. Following this inspection it was reported that all bed rails have now been fitted with covers when in use. 2. There has been a problem with water temperatures in the home, with the cold taps running warm. Water temperatures in all outlets have been measured twice a day, and the record showed that the cold water measured between 14°C and 28°C, and the hot water between 40°C and 46°C. It was reported that this was an ongoing problem, which has not been addressed since it first occurred in April 2005. Following the inspection it was reported that thermostats have been fitted to regulate the temperature of the hot taps. 3. A tube of Steradent denture cleaner was seen in a shared bathroom. This could be a risk to the residents who use the bathroom. Following the inspection it was reported that the Steradent has been stored securely and a risk assessment has been put in place for the residents. 4. The Commission was not been notified of the occurrence of a serious grade 3 pressure sore (see Standard 8). Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 24 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 3 X X 2 X 3 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 X 3 X 3 X X 2 Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 25 Are there any outstanding requirements from the last inspection? YES 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 Regulation 13(4)(c) Requirement Risk assessments do not provide adequate information on the management of risk. Appropriate risk assessments are not in place for all residents. Appropriate and adequate risk assessments must be put in place for all residents, and kept under review. (Previous timescale of 31 August 2005 not met) Timescale for action 31/01/06 Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 26 2 OP7 15 Several of the care plans seen do 31/01/06 not provide sufficient details of the procedures to meet personal care and health care needs. They do not provide information on the resident’s quality of life. There was no evidence of the involvement of service users in decisions about their care. The registered person must ensure that all care plans provide adequate and appropriate information on all the resident’s needs, and that recording in care plans is relevant and informative. Service users must be enabled and encouraged to make decisions about their care Problems with catheter care 31/01/06 occurred because the nursing staff did not have up to date information and training on the changes in catheter care. The registered person must ensure that the nursing staff have appropriate training and access to information to update their professional skills and provide appropriate nursing care for the residents. (See Regulation 18 (1) (c) (i)) Notices were seen on the ensuite bathroom doors in some of the resident’s rooms, stating what size incontinence pad they require. Personal information should not on open display in residents’ rooms. (Previous timescale of 31 August 2005 not met) 3 OP8OP30 12(1)(a), 18(1) 4 OP10 12(4)(a) 30/11/05 Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 27 5 OP10 12(5) Several residents gave specific examples of staff acting in a manner that is unprofessional and disrespectful. The manager must ensure that staff are aware of the effects of their behaviour on the residents, and that they treat all residents with respect at all times. 30/11/05 6 OP16 22(3) Several residents felt that complaints that they have made are not investigated. All complaints must be recorded and investigated appropriately, and the results must be reported to the complainant. 30/11/05 7 OP22 23(2)(l) Four wheelchairs were seen stored in a resident’s bedroom. Adequate and appropriate storage must be provided for all equipment in the home. 30/11/05 8 OP38 13(4)(a) A tube of Steradent denture cleaner was seen in a shared bathroom. This could be a risk to the residents who use the bathroom. All substances that are hazardous to health, including Steradent denture cleaner, must be stored securely at all times. 03/11/05 9 OP38 13(4)(c) The bed rails on several beds were in use, but appropriate covers for the rails were not in place. Appropriate procedures for the use of bed rails must be followed at all times. (Previous timescale of 31 August 2005 not met) 03/11/05 Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 28 10 OP38 37 The Commission was not been notified of the occurrence of a serious grade 3 pressure sore. Notifications must be submitted without delay concerning any serious injury to a resident. 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 29 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 © 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 Benslow Nursing Home DS0000019288.V264415.R01.S.doc Version 5.0 Page 30 - 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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