CARE HOMES FOR OLDER PEOPLE
Benthorn Lodge 48 Wellingborough Road Finedon Northants NN9 5JS Lead Inspector
Helen Abel Unannounced Inspection 08:20 27 November 2007
th 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.V354354.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.V354354.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.V354354.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 1st December 2006 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.V354354.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection inspected Benthorn Lodge against the Care Standards Act 2000. This was the third unannounced visit to the home following on the last key inspection in December 2006. The inspection method used was ‘Inspecting For Better Lives’, which is based on outcomes for the residents. The service history, and findings from two unannounced visits in February and May 2007, and the Annual Quality Assurance Assessment were examined as part of this inspection. The visit took place on the 27th of November 2007 from 8.20 am and lasted over 6 hours. The method called ‘case tracking’ was used to determine the standard of care provided in the home. This involved identifying three residents with varying levels of care needs and looking at how these are being met by the staff at the home. Discussions were held with residents themselves and other residents; speaking with staff providing the care; checking records relating to their health and welfare; viewing their personal accommodation (with their consent) as well as communal living areas used. Checking record relating to the health and safety, staff/recruitment records, and training records. What the service does well: What has improved since the last inspection?
A new controlled drugs cupboard is in place, which makes sure that these medicines are stored safely. Systems are in place to ensure resident’s finances are safe and accessible to them. The outdoor area near the front door is now well presented and free from debris, and is attractive and offers a seating area for residents in the warmer weather. Benthorn Lodge DS0000012705.V354354.R01.S.doc Version 5.2 Page 6 What they could do better:
The Statement of Purpose and Service User Guide must be updated and made available for residents and their families. This would inform prospective residents and their families about the aims, objectives and philosophy of the home, about it’s services, facilities and current staffing. A summary of this information should appear in the Service User Guide. To review each resident’s care around holding a key to their bedrooms as part of a risk assessment framework. This process would recognise individual resident’s needs and promote freedom and choice. In addition review the identified resident’s risk assessment around non-key holding arrangements. To review all care plans and risk assessments to include details around nutrition including weight gain and loss and action to be taken; this should also include the provision of any nutritional supplements. This would safeguard resident’s care needs. Provide further medication management training for staff administering medication. This would ensure staff receive up-to-date training around administering medicines and make sure residents are protected from harm. Improvements to be made to ensure meals are unhurried, so that residents are offered assistance and given adequate quantities, choice and variety of food. The quality of food should be reviewed. This will ensure residents receive a balanced and nutritious diet and residents can take pleasure in eating. A programme of routine maintenance must be produced that accurately reflects the renewal and replacement of equipment and decoration. This would ensure residents live in a safe and well-maintained home. Ensure sufficient bathing facilities are available. The identified ground floor bath to be mended, this will ensure residents will have full bathroom facilities within close proximity of their accommodation. Ensure suitable arrangements for maintaining satisfactory standards of hygiene in the home so that it is free from offensive odours. The downstairs areas of the home and some identified bedrooms permeate an offensive odour. This would ensure all residents live in an environment that is clean, pleasant and hygienic. A number of areas require repair and significant attention around the home resulting in poor outcomes for residents. Ensure all call systems points include the long lead as part of the specialist equipment residents required in their bedrooms. Benthorn Lodge DS0000012705.V354354.R01.S.doc Version 5.2 Page 7 Take action to minimise risks in an identified residents bedroom around the positioning of a supplementary heating, as part of an environmental risk assessment. This would reduce the risk of burning from the heater and falling due to its position and provide residents with a safer environment. It was noticed the laundry area on the ground floor door was unmarked and left open and was accessible to residents that may wander in. This area should be identifiable with a sign and made secure in order to safeguard residents. The current staffing levels and skill mix of staff does not meet resident’s needs and should be reviewed. Staffing levels in the home must ensure they meet resident’s specific assessed needs. The staff rota does not accurately show which staff are on duty at any time and whether the rota was actually worked. This would ensure that a clear record is kept of the numbers and skill mix of staff on duty throughout the day. Staff training around dementia care to be revisited and appropriate training and guidance given to staff. No member of staff is to be employed within the home without a POVA First Check and a Criminal Records Bureau Check; and two written references. Making sure proper recruitment checks take place to ensure residents are protected. Recommendations were made around: Following a Person Centered Planning Approach for Older Persons. This would provide focused care on the individual person. To consider providing daily choice of breakfast and drinks with weekly cooked breakfasts. Providing serviettes and choice of condiments (salt and pepper and sauces etc) where possible. These changes will provide residents with a more pleasing mealtime experience. Some care plans sampled were found to hold care records dating back over years. These records should be appropriately stored elsewhere and only current information be held on the care plan. This would ensure a current plan of care is available for staff to follow. The complaints procedure should be updated and include how complaints can may be made and who deals with them. This will ensure residents their relatives and friends can be confident their complaints will be listened to and taken seriously. To develop the existing quality assurance system. Draw up an annual development plan based on a cycle of planning - action-review- reflecting aims and outcomes for residents, and demonstrating how the service is run in their best interests Benthorn Lodge DS0000012705.V354354.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Benthorn Lodge DS0000012705.V354354.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.V354354.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents do not have the full information they need to make a decision about living at the home. EVIDENCE: The Statement of Purpose available was the same document produced at the last Commission for Social Care Inspection visit in May 2007. Later staff produced a large folder and reported this was an extension of the Statement of Purpose with a range of information including: profiles of staff with their photographs and their training up to 2005. The file didn’t include any reference to recent training or an amended complaints procedure, a Residents Charter and some other information.
Benthorn Lodge DS0000012705.V354354.R01.S.doc Version 5.2 Page 11 Completed resident’s questionnaires were illustrated in graphs showing the homes strengths and weaknesses. The Statement of Purpose is available in a variety of texts sizes from 10-24 and a copy of the most recent inspection report was also included. The Statement of Purpose must be reviewed and updated. The registered provider should refer to the Regulations for guidance on information to be included and include a summary of this information to appear in the homes Service User Guide. This would provide prospective residents with the information they need to make an informed choice about living at Benthorn Lodge. Two of the resident’s case tracked had signed their written contracts/ statement of terms and conditions with the home. The statement of terms and conditions makes reference to residents holding a key to their bedroom. However staff confirmed that because some residents wandered and have taken items out of other resident’s rooms that all bedrooms were kept locked. Residents would need to ask staff to gain access to their own rooms during the day. Two residents expressed dissatisfaction with this to the Inspector. The registered provider, Mr Bennett spoke of removing this service from the homes contract. The Inspector suggested reviewing each resident’s care around holding a key to her/ his bedroom as part of a risk assessment framework. This process would recognise individual residents needs and promote freedom and choice. One resident’s case tracked had a risk assessment in place to reflect the arrangements around not-holding a key but the Inspector suggested to review the risk assessment, as this had been carried out in 2004 and staff had not reviewed this risk assessment since then. Benthorn Lodge DS0000012705.V354354.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 poor. This judgement has been made using available evidence including a visit to this service. Resident’s health and personal care is poorly met and residents are not treated with respect and dignity. EVIDENCE: Three resident’s were spoken with and their care plans examined. They told the Inspector “ There is nothing to do here” “ I don’t like it here” The girls are good here” Care records showed care plans are reviewed regularly but they were difficult to follow and did not provide guidance to staff as to how to meet people’s needs. To develop care plans further it is recommended the home follow the Person Centrered Planning Approach for Older Persons. This would provide
Benthorn Lodge DS0000012705.V354354.R01.S.doc Version 5.2 Page 13 focused care on the individual person. Two care plans examined had been produced on a computer and when reviewed and printed off for staff to follow resulting in the last sections missing around nutrition and activities. Risk assessments were not in place for one resident case tracked, and another resident risk assessment had not been updated around the risk of leaving the home and alcohol restrictions. One individual had left the home on their own (this was not safe for them to do) in March 2007 and this appears not reported onto the Commission for Social Care Inspection as a reportable incident. Weighing programmes for some residents have taken place and such checks need to be firmly established. Staff reported associated concerns around some resident’s nutritional intake. Staff appeared confused around which residents had food supplements, as this was not detailed on individual care plans. Some of the care plans sampled were found to hold records dating back to 2004. It is recommended these are appropriately stored elsewhere and only current information be held on the care plan. Medication records were sampled for residents case tracked and were in good order. However the practise observed when administering medicines by staff was poor. The staff member used a large jug of water and scooped a twohandled beaker in for some water and handed this to a resident and used the same beaker for the next resident. At first the staff member did not wear protective gloves and used her hands to pass the pills out from the box and over to the resident. This is unhygienic and poor medication practise. Staff require further training to develop good medication management and keep residents safe. The inspector observed often poor staff interactions with residents. It was noticed that some staff members would speak very loudly almost shouting at residents when simply interacting with residents; some staff would use false jollity, which appeared patronising. One staff member joked about how she would get into trouble as they had all had some toffees and residents now wouldn’t be able to eat their lunch. A resident became anxious and inquired would the staff member really get into trouble. One resident was told they would be going out, and looked surprised and tried to ask for information. The staff member was prompted by the Inspector to tell the resident where they were going. Staff member responded, “I will tell you later when you have your coat on”. This didn’t help the resident who remained unsure what was going to happen next. The Inspector asked the staff member again to explain to the resident what was happening. The staff member did so. A resident was being made ready by a staff member to go out on a cold winters day without some underwear items and socks. Again the Inspector intervened and prompted the staff member to provide these items. Benthorn Lodge DS0000012705.V354354.R01.S.doc Version 5.2 Page 14 A staff member continually got a resident’s first name mixed up when trying to calm her down. Another resident was very agitated at breakfast and staff spoke in a firm and unhelpful manner. The resident became more agitated and more upset. Later the Inspector intervened and suggested some guidance on how to help the resident. Staff confirmed receiving training for dementia but this was not evident, as some staff did not appear to treat residents with respect and dignity or have an awareness of dementia care good practise Benthorn Lodge DS0000012705.V354354.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a wide range of recreational interests provided. Meals times are not adequately catered for. EVIDENCE: There is an Activity Coordinator who organises regular activities and assisted a resident out to a local community event during the morning of the inspection. The Activity Coordinator told the Inspector about the wide range of activities provided and is aware of residents like and dislikes. Resident’s case tracked had participated in recent activities with the Activity Coordinator - wartime sing-alongs, going to the Over 60’s Club, chapel service, prayers in the home, skittles, making Christmas cards. Staff reported a strong emphasise on making sure all residents take part in regular activities they enjoy. Photographs of residents were evident in the homes hallway notice board and provided information about events at the home. These initiatives are positive for residents.
Benthorn Lodge DS0000012705.V354354.R01.S.doc Version 5.2 Page 16 The Inspector observed breakfast being served in the various lounges. The breakfast was poorly organised and staff appeared rushed between residents. One group of groups of residents had dry bread and cornflakes and a hot drink. Another group of residents had cornflakes and bread and butter and jam and a hot drink. Both these groups of residents were not consulted about choice of cereals or drinks. Another group of residents had porridge. The cook later said she had been busy with a visitor and this had been a distraction. It was noted there were no serviettes provided and that tables were bare with no condiments, placemats or table settings. Four weekly written menus offer a varied choice and included liver dishes regularly as required for a resident case tracked. Once a week at breakfast boiled eggs are offered and once a month a cooked breakfast. Staff reported residents particularly enjoyed the cooked breakfast. The Inspector observed lunchtime in some of the dinning areas. A resident asked twice for more potatoes and was told there was none. Staff later reported there were more potatoes available. The Inspector sampled the pudding, coconut sponge and custard and found the portion size to be small and both the coconut sponge and custard didn’t taste good. Resident’s food portions were found to be small at breakfast and at lunch. Improvements must be made to ensure meals are unhurried with residents given sufficient time and assistance; a real choice of breakfast and drinks; review portion sizes and quality of cooking; provide more regular cooked breakfasts; provide serviettes, placemats, choice of condiments (salt and pepper and sauces etc) where possible. These changes will provide residents with a more pleasing mealtime experience. Another resident was reported to become upset when eating around other resident so the individual was allowed to eat alone later. The Inspector felt this was unreasonable to expect the resident to wait five hours for the next meal. Staff agreed to move back to the original dinnertime. This was carried out straight away and staff reported the resident appeared settled and ate well. Benthorn Lodge DS0000012705.V354354.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure available for residents, their relatives and friends. EVIDENCE: A copy of the complaints procedure is available in the Statement of Purpose and was reviewed in November 2007 confirmed the registered providers but still requires updating. Reference was made to responding to written complaints only and did not refer to other complaints made verbally through residents and visitors. The complaints procedure must be clearly described and informative and should be made available when the resident first moves in. The registered provider confirmed there have been no complaints received since the last inspection. An anonymous concern was received in May 2007 to the Commission for Social Care Inspection with areas of concern around Health and Personal Care, Daily Life and Social Activities, Environment, Staffing and Management and Administration. The Inspector visited unannounced to follow up this information and eight requirements were made as a result of this visit. Two of the residents case tracked have advocates and play a useful role in supporting residents. Benthorn Lodge DS0000012705.V354354.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Attention is required to parts of the home where the standard of décor, maintenance, and hygiene is inadequate and does not meet the needs of the resident group. EVIDENCE: The exterior of the home is attractive and offers a seating area for residents in the warmer weather. The front garden is well presented. A number of areas for improvement were observed around the home as follows: The bath in toilet number 5 was broken and was also identified broken in May 2007 and was due for repairs then. Near room 24 a bathroom was
Benthorn Lodge DS0000012705.V354354.R01.S.doc Version 5.2 Page 19 found to have a wooden toilet seat left leaning against the wall, and the tops were missing off the bath taps. In bedroom 4 one side of the wardrobe door was missing, in room 23 the floor was dirty and stained in one area and the adjacent landing carpet outside needs attention. There was a strong smell of stale urine outside two rooms. Both mattresses had been left to air and one mattress appeared soiled with ground in black marks and should be replaced. The carpet in one room should be replaced as it is stained with bleach stains, is old and warn, and looks unsightly. Staff reported the upstairs lounge three-piece suite is due for replacement, this was found to be dirty with grimy armrests. The registered provider reported that the downstairs lounge is having a new carpet fitted shortly. However the downstairs areas permeate an offensive odour. One of the fire exit stairways are dirty and had odd shoes and cigarette ends placed in a corner. This area is accessible by residents and should be made safe and well maintained. Call systems points are provided in every room but do not include the long leads that would help individuals to call for help when in bed (except for 2 residents). These should be provided as part of the specialist equipment residents require. It was noticed the laundry area on the ground floor door was unmarked and left open and was accessible to residents that may wander. This area should be identifiable with a sign and made secure in order to safe guard residents. Benthorn Lodge DS0000012705.V354354.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Resident’s needs are not met by the number and skill mix of staff and provide a poor service to residents. Staff recruitment procedures are weak and residents are not protected by recruitment policies and practices. EVIDENCE: Residents told the Inspector: “I love it here, it’s nice here” Nothing much to do here” “The carers are good” “No interference” Staff reported the cleaner was off all week and there was no one to cover the half day cleaning post so care staff had to undertake these tasks. Another staff member was reported absent. Staff appeared rushed and overworked when undertaking all tasks with residents. Benthorn Lodge DS0000012705.V354354.R01.S.doc Version 5.2 Page 21 The staffing rota shows two people on each shift and extra support with the Activity Coordinator who was observed undertaking care tasks. The domestic was recorded as working but staff reported her absence all week. The Inspector observed four staff working above the care hours recorded on the staff rota. The night staff member is indicated as working alone with no on call support staff recorded on the rota. Additional care hours to cover peak times are highlighted on the rota with no care staff allocated to these shifts. The staff rota does not accurately show which staff are on duty at any time and whether the rota was actually worked. Currently fifteen residents have dementia impairments and therefore will need a specific staffing level to reflect care required. Three residents require two or more staff to help with their care at key times. The current staffing levels, and skill mix of staff does not meet resident’s needs. Staffing levels in the home must be reviewed to ensure they meet residents assessed needs. This aspect was raised as a requirement at the last key inspection. Throughout the Inspectors visit of over six hours staff did not appear to have an awareness of how to put dementia care theory into practice and were often dismissive of resident’s requests and needs. The same aspects were raised at the last inspection in December 2006. Staff training around dementia care should be revisited and appropriate training and guidance offered. A staff member reported not having any recent dementia training. The home has a dedicated training officer and the Registered Provider confirmed Dementia training had been made available to staff. Staff recruitment records were sampled. One staff member’s records included all the required checks apart from two references. Another staff member had commenced work without references and a POVA check. Staff reported confirmation of the POVA check but the registered provider was unable to forward evidence of this as agreed on inspection. Managers must make sure evidence of proper recruitment checks is in place to ensure residents are protected. Benthorn Lodge DS0000012705.V354354.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home lacks direction and has falling standards and poor outcomes for residents. EVIDENCE: The registered manager is Mrs Bennett who is also the registered provider. The home lacks leadership and a firm management approach. Care staff were open to advice and guidance from the Inspector and carers appear to take the lead in the running of the home. Both the registered providers Mr & Mrs Bennett spend some hours in the home during the week. On the week of inspection Mrs Bennett was not present in the home but had worked earlier in
Benthorn Lodge DS0000012705.V354354.R01.S.doc Version 5.2 Page 23 the week as the cook. Mr Bennett was present on the inspection and assisted the Inspector. A staff member spoke keenly about the “Safer Food Better Business” initiative and how this had improved provision in the kitchen. Questionnaires are sent out at intervals to residents and their families, friends and relatives and the results published. This information needs to inform future planning of outcomes for residents. There was good evidence of resident’s finances being well documented and monies held, located and accounted for. Advocates have been appointed and are involved in supporting some resident’s financial interests. Other record keeping was not well organised around residents care planning, and staff recruitment records. A resident’s recent death had not been reported to the Commission for Social Care Inspection (CSCI). The registered provider must ensure Regulation 37 reports are sent without delay to the CSCI around a resident’s care or significant incidences that occur in the home. This will safeguard each resident’s best interests. Benthorn Lodge DS0000012705.V354354.R01.S.doc Version 5.2 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 1 2 x x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 1 2 1 2 2 2 2 1 STAFFING Standard No Score 27 1 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 3 x 2 x Benthorn Lodge DS0000012705.V354354.R01.S.doc Version 5.2 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 OP1 Regulation 4 Requirement A Statement of Purpose and Service User Guide must be updated and made available for residents and their families. This would inform prospective residents and their families about the latest aims, objectives and philosophy of the home, about its services, facilities, and current staffing. The Registered Provider should refer to the Regulations for guidance on information to be included and include a summary of this information to appear in the homes Service User Guide (Previous timescale expired 30.06.07) 2. OP2 5 To review each resident’s care around holding a key to their bedrooms as part of a risk assessment framework. This process would recognise individual residents needs and promote freedom and choice.
DS0000012705.V354354.R01.S.doc Timescale for action 27/01/08 27/01/08 Benthorn Lodge Version 5.2 Page 26 3. OP7 15. 4. OP8 17 5 OP9 13 6. OP15 16 7. OP19 23 In addition review the identified resident’s risk assessment around non- key holding arrangements. To review all risk assessments and ensure they are kept under review. This would ensure residents are kept safe. To review all care plans and include details around nutrition and provision of any nutritional supplements, including weight gain and loss and appropriate action taken. This would safe guard resident’s health care needs. Provide further Medication Management training for staff administering medication. This would ensure staff receive current training around administering medicines and residents are protected. Improvements to be made to ensure meals are unhurried with residents offered assistance and given adequate quantities, choice and variety. Quality of food to be reviewed. This will ensure residents receive a balanced and nutritious diet and residents can take pleasure in eating. A programme of routine maintenance must be produced that accurately reflects the renewal and replacement of equipment and decoration. This would ensure residents live in a safe well maintained home. (25/05/07 This date has expired) 27/01/08 27/01/08 27/01/08 11/12/07 01/01/08 8. OP21 23 Ensure sufficient baths facilities are available. The identified ground floor bath to be mended, this will ensure residents will
DS0000012705.V354354.R01.S.doc 01/01/08 Benthorn Lodge Version 5.2 Page 27 have full bathroom facilities within close proximity of their accommodation. (25/05/07 date expired repairs still outstanding) 9. OP26 16 Ensure suitable arrangements for 11/12/07 maintaining satisfactory standards of hygiene in the home - to be free from offensive odours. The downstairs areas of the home permeate an offensive odour and identified bedrooms. This would ensure all residents live in an environment that is clean, pleasant and hygienic. (25/05/07 date expired) 10. OP19 23 A number of areas require repair and attention as identified during the inspection, Completion of this work would make a safer and more comfortable environment for residents and staff Ensure all call systems points include the long lead as part of the specialist equipment residents required in their bedrooms. It was noticed the laundry area on the ground floor door was unmarked and left open and was accessible to residents that may wander in. This area should be identifiable with a sign and made secure in order to safe guard residents. The current staffing levels, and skill mix of staff does not meet resident’s needs and should be reviewed. Staffing levels in the home must ensure they meet resident’s specific assessed needs. The staff rota does not
DS0000012705.V354354.R01.S.doc 31/01/08 11. OP22 16 27/12/07 12. OP26 13 01/01/08 13. OP27 18 31/01/08 14. OP27 17 27/12/07
Page 28 Benthorn Lodge Version 5.2 accurately show which staff are on duty at any time and whether the rota was actually worked. This would ensure residents have a clear record of the numbers and skill mix of staff on duty throughout the day. 15. OP30 18 Staff training around dementia care to be revisited and appropriate training and guidance given to staff. No member of staff is to be employed within the home without a POVA First Check and a Criminal Records Bureau Check; and two written references. Making sure proper recruitment checks take place to ensure residents are protected. Ensure Regulation 37 reports are sent into the Commission for Social Care Inspection (CSCI) when reporting incidences without delay around a resident or significant incidences that occur in the home. This will safeguard resident’s best interests. 31/01/08 16. OP29 19 27/11/07 17. OP37 37 27/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations To develop care plans further it is recommended the home follow the Person Centered Planning Approach for Older Persons. This would provide focused care on the individual person. Some care plans sampled were found to hold care records dating back over years. It is recommended these records
DS0000012705.V354354.R01.S.doc Version 5.2 Page 29 2. OP7 Benthorn Lodge 3. OP15 4. OP16 5. OP33 be appropriately stored elsewhere and only current information be held on the care plan. This would ensure a current plan of care is available for staff to follow. To consider providing daily choice of breakfast and drinks with weekly cooked breakfasts; providing serviettes and choice of condiments (salt and pepper and sauces etc) where possible. These changes will provide residents with a more pleasing mealtime experience. The complaints procedure should be updated and include how complaints can may be made and who deals with them. This will ensure residents their relatives and friends can be confident their complaints will be listened to and taken seriously. To develop the existing quality assurance system. Draw up an annual development plan based on a cycle of planning action-review- reflecting aims and outcomes for residents, and demonstrating how the service is run in their best interests. (Recommendation raised at the last inspection) Benthorn Lodge DS0000012705.V354354.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection East Midland Regional Office Unit 7 Interchange 25 Business Park Bostocks Lane Nottingham NG10 5QG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Benthorn Lodge DS0000012705.V354354.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
