CARE HOMES FOR OLDER PEOPLE
Benthorn Lodge 48 Wellingborough Road Finedon Northants NN9 5JS Lead Inspector
Helen Abel & Sarah McIntyre Unannounced Inspection 14th March 2008 08:30 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 Benthorn Lodge DS0000012705.V360933.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. Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Benthorn Lodge Address 48 Wellingborough Road Finedon Northants NN9 5JS 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) 01933 682057 benthorn.lodge@ntlworld.com Mr Frank Bennett Mrs Pam Bennett Mrs Pam Bennett Care Home 18 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (4) of places Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The Home will limit its services to the following service user categories: No person falling within the category Older Persons (OP) can be admitted where there are already 4 persons of category OP in the home. No person falling within the category DE(E) can be admitted where there are 18 persons in the category DE(E) already in the home. The total number of service users in the Home must not exceed 18. 2. 3. Date of last inspection 27th November 2007 Brief Description of the Service: Benthorn Lodge is a home providing personal care and support for 18 Older People, by reason of old age and dementia. Community healthcare professionals meet healthcare needs. The home is situated on a main road leading into the centre of Finedon and is within easy access of public transport and local shops. The home comprises of a three-storey building of which the first two floors are used for resident’s accommodation. The original frontage of the house has been retained so that the home blends in with others in the road. There is off road parking at the side of the house, and a small paved garden to the front, which is accessible for residents. Accommodation is provided in both single and shared rooms, one of the single rooms has en suite facilities. A copy of the last inspection record is held in the home’s office. Current fees are between £331.60- 348.55 per week. Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of the inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people and their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting six people and tracking the care they received through looking at their records, discussion, where possible, with them and care staff and observation of care practices. People who live at Benthorn Lodge prefer to be called “service users.” Planning for this visit included: examining the last two inspection reports and the improvement plan raised from this last inspection; assessing the service history of the home including the reporting of significant events and correspondence from the registered manager/provider; and examining surveys returned from service users and their supporters. This was an unannounced Inspection with two Inspectors present throughout. The Inspection started at 8.30 in the morning and lasted over four hours. The home’s registered manager/providers were not on duty at the time of our visit. Senior staff assisted with the inspection process. The visit included a selected tour of the building, inspection of records and indirect observation of care practices, and the serving food at two mealtimes. Both Inspectors spoke with a number of service users, visitors and staff. The quality rating for this service is 1 star. This means the service users who use this service experience Adequate quality outcomes What the service does well:
New service users have written information they need to make a decision about living at the home. New service users are admitted into the home after a full assessment of their need has been made. Care plans included detailed daily records, a regular weighing programme, and a photograph of each service user. Clear records of visits by healthcare professionals such as GPs and Opticians had been kept and evidence of seeking medical intervention when required. Generally all care records examined where up to date and in good order. Service Users meetings do not take place but service users are due to be formally surveyed in November 2008. Service users receive good opportunities for leisure and social activities and enjoy a balanced varied diet. Service users are encouraged to remain part of the community by going out to a variety of activities including “Over 60s Club” and Coffee Mornings. Families of service users had no concerns over how safe relatives are, and commented on how friendly and approachable staff were. Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 6 Photographs of the service user were displayed in the reception area and appear friendly and welcoming. All parts of the home inspected were clean and well presented apart from one bedroom. Service users bedrooms viewed appeared highly personalised. Staff recruitment records were examined and were mostly satisfactory. What has improved since the last inspection?
The Statement of Purpose and Service User Guide has been updated. This informs prospective service users and their families about the aims, objectives and philosophy of the home, about it’s services, facilities and current staffing. Service users can now hold a key to their bedrooms as part of a risk assessment process. This process recognises individual service users needs and promotes freedom and choice. Staff have received further medication training. This will ensure service users are protected from harm. Improvements have been made to mealtime arrangements so that residents are offered assistance and a wider choice and variety of food. A range of maintenance has been undertaken with the renewal and replacement of equipment and decoration. This will ensure service users live in a safe and well-maintained home. Arrangements for maintaining satisfactory standards of hygiene in parts of the home have taken place and continue to be improved. This will ensure all service users live in an environment that is fresh, pleasant and hygienic. Call systems points include the long lead are part of specialist equipment offered in the home. They are still being considered within a risk assessment framework for each individual service user. An identified service users positioning of a supplementary heating in their bedroom is to be included in their care plan within their risk assessment. This would provide the service user with a safer environment by reducing the risk of burning from the heater and falling due to its position. Care plans have been reorganised to ensure they include only current information. This would ensure an up to date plan of care is available for staff to follow. Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 7 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
Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New service users have information they need to make a decision about living at the home. EVIDENCE: The Statement of Purpose was viewed and has been recently updated. This document includes a range of information including profiles of staff with their photographs and their training records and a Residents Charter. The inspection report was held in the office and reference should be made to where the current inspection report is held in the Statement of Purpose. This would further provide prospective service users have the information they need to make an informed choice about the home. The complaints procedure still needs some amendments.
Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 11 New service users are admitted into the home after a full assessment of their need has been made. New service users had contracts in place including information the room to be occupied and provision of key. These were signed by provider and service user / or representative. Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users health and personal care is met, but staff do not always treat residents with respect and dignity. EVIDENCE: Service users care plans were mainly up to date but risks assessments were not detailed or reflected current needs. There was evidence of a service user being able to balance risks and making choices in relation to mobility; and family involvement in decision- making processes were confirmed verbally by a relative. Care plans included detailed daily records, a regular weighing programme, and a photograph of each service user. Some photographs in care plans need replacing and a new service user requires a photograph. One person’s care plan included preferences after death, which may give the service user some comfort.
Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 13 Clear records of visits by healthcare professionals such as GPs and Opticians had been kept and evidence of seeking medical intervention when required. The Inspector observed medicines being administered and found medication practice to be safe and records well kept, legible and completed appropriately. The Inspector observed a staff member introducing a visitor to a service user from a culturally diverse background in a disrespectful manner. One service user was observed with their elasticised trousers on the wrong way and was heard complaining to staff they were cutting into their skin. Another service user was given their own stained jacket to wear. It is important that service users wear their own clothes in a dignified way and may need assistance to do this. A third service user was observed for some time with a dried on unclean nose and was eating a meal. The dignity of this service user was not being attended to by staff. Staff need awareness raising around treating service users with respect and dignity. Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12- 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive good opportunities for leisure and social activities; and enjoy a balanced varied diet. EVIDENCE: A group of service users were observed by the Inspector enjoying taking part in morning activities including: Connect 4, indoor bowls and singing. The activities person was very enthusiastic and was ensuring that everyone was involved; however it is noted that some more gender appropriate activities for male service users could be encouraged. Visitors are encouraged and made welcome confirmed by staff. Service users are encouraged to remain part of the community by going out to a variety of activities including “Over 60s Club” and Coffee Mornings. Several comments received from surveys confirmed that visitors were asking for activities, as they were not evident at their visits to the
Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 15 home. Staff confirmed that activities mainly take place took place in the mornings only. There appeared to be no restrictions on getting up or retiring. Service users were able to move around the home as they wished. One visitor told the Inspector that most of the service users were invited to attend their daughter’s wedding, which was very much being looked forward to by the service users concerned. Lunch was observed by Inspectors to be all home cooked, well-presented and individual tastes taken into account. Relatives also thought food was of good standard and that there relatives were encouraged to eat. The cook would check each morning with each service users to find out their wishes and preferences around the meals being served for the day. One service user requested, “Could I have some proper coffee? ” Staff confirmed they would be able to arrange regular supplies of coffee in a cafetiere for the individual. Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected from abuse. EVIDENCE: The complaints procedure has been updated but needs a further update. This will ensure service users, relatives and friends can be confidant their complaint will be listened too and taken seriously. Staff reported having recent Adult Abuse training. Advocates are involved with service users in the home in particular around financial affairs. Staff confirmed some awareness of new legislation - The Mental Capacity Act 2005 and the rights of service users and their capacity for making decisions. Some training for staff around rights of people living in the home would be beneficial. These measures help to ensure service users are protected from abuse. Families of service users had no concerns over how safe relatives are and commented on how friendly and approachable staff were. Comments made were “Staff are fantastic” and “Do things over and above” Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 17 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): 19, 26, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from a comfortable homely environment. EVIDENCE: Photographs of the service user were displayed in the reception area and appear friendly and welcoming. All parts of the home inspected were clean and well presented apart from one bedroom but this area had significantly improved following on our last visit to the home. Service users bedrooms viewed appeared highly personalised. A fire exit was blocked with items but staff confirmed this had been checked with the Fire Authority. Managers are advised to check this again and make any further adjustments. Hot water testing take place but needs to be done more regularly in order to ensure hot water temperatures are safe. It was noted the carpet to rear stairway, whilst
Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 18 not generally used by service users may be unsafe to staff who regularly use this area. A comment received from a visitor confirmed, “There is no back garden for residents to sit outside in the summer, so they are mostly indoors all day.” Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 19 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): 27-30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff meets service users needs. EVIDENCE: Staff recruitment records were examined and were mostly satisfactory. A new staff member had all the full recruitment checks in place. It was noted that past recruitment records sometimes did not contain two written references. Managers were reminded two written references must be obtained before appointing a member of staff. A new staff member’s Induction record is ongoing and is still awaiting basic skill training. Senior staff are overseeing this. The Inspector advised an Induction package should be brought together to ensure new staff have received basic training at the start of their employment. Advice was given to senior staff around the General Social Care Council Code of Conduct and where to obtain copies. Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 20 Staffing rotas were examined and appeared in good order. Staff reported receiving recent training around moving and handling, administering medication and fire training. Dementia training is still to be organised and was a requirement to be met at the last visit. There was evidence of appraisals for staff development and staff reported staff meetings are not held regularly. Arranging more regular meetings would help staff to be more competent in their jobs. Some comments received from surveys were as follows: “The care received at he home has been superior to any hospital and above. I visit the home daily and staff ring me with any query” “High turn over of staff, not sure if qualified. More mental stimulation for my mother would help.” “I always find staff very kind and caring to the patients whatever their differences. Everyone is looked after well.” Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 21 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): 33, 34, 37, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from an adequately run home and generally safe working practices. EVIDENCE: The registered manager and registered providers Mr & Mrs Bennett were not present on the day of our visit and the outcomes relating to 31, 32 were not inspected on this occasion. Two Inspectors spent time observing the morning from the serving of breakfast through to the lunch time period. We moved from area to area and
Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 22 spoke with service users, visitors and staff. The service users would benefit from a more structured day and better organisation. This could be explored further with the registered manager/provider. Relevant insurance cover is in place and displayed in the home’s main reception area. Generally all care records examined where up to date and in good order. Service Users meetings do not take place but service users are due to be formally surveyed in November 2008. Providing regular Service Users meetings maybe a quick and regular way of getting feedback about the current services provided. Some of the required fire checks were not up to date and do not ensure the health and safety of service users and staff. A survey confirmed, “I did express my concerns around carpet lifting/dangerous, radiator cover not fixed, lack of light bulbs- these were sorted out but took a while.” It was noted the laundry door was left unlocked with cleaning materials and a sluice. This area should be made safe for service users and the door kept locked. Staff reported call bell cords were being individually assessed for service users. This information should be included in the risk assessments for each individual service user. Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 23 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 3 3 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x x x 3 2 Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 24 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 OP7 Regulation 15. Requirement To review all risk assessments and ensure they are kept under review. This would ensure residents are kept safe. Timescale for action 14/04/08 2. OP25 23 3. OP30 18 27/01/08 timescale from previous inspection 27th November 2007 has expired. Hot water testing to take place 14/04/08 regularly in order to ensure hot water temperatures are safe for service users, and minimise the risk of scalding. Provide staff with training around 14/04/08 Dementia Care Good Practise to meet the changing needs of the service users. 31/01/08 timescale from previous inspection 27th November 2007 has expired. Ensure monthly emergency lighting checks and quarterly fire safety checks take place. This will protect the health and safety of service users and staff. 4. OP38 23 14/04/08 Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP10 OP12 Good Practice Recommendations To provide awareness raising / training for staff around treating service users with Respect and Dignity. To provide more gender appropriate activities for male service users. This would provide all service users with equal opportunities to pursue activities they enjoy. In line with the latest procedures, the complaints procedure needs to be altered to give the complainant the choice of the initial stage to go the investigating body- the local social services department- now the lead agency for investigating complaints- as well as the home. To provide staff with Mental Capacity Act 2005 Training so as they understand their responsibilities, and the rights of service users living in at Benthorn Lodge. A fire exit was blocked with large items. This aspect needs checking with the local Fire Authority to ensure the current practise is safe, and service users safety and wellbeing is maintained. The carpet to the rear stairway is worn, whilst not generally used by service users may be unsafe to staff who regularly use this area. Establish regular Service Users meetings as a quick and regular way of getting feedback about the current services provided; and is in the best interests of the service users. The laundry area should be secured to safeguard service users who may wander in. Assessment of call bell cords should be included in the risk assessments for each individual service user within their care plan. OP16 4. 5. OP18 OP19 6. 7. 8. 9 OP19 OP33 OP38 OP38 Benthorn Lodge DS0000012705.V360933.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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