Inspection on 12/04/06 for Bentley House Nursing Home

This inspection was carried out on 12th April 2006.

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.

Other inspections for this house

Bentley House Nursing Home 08/09/09

Bentley House Nursing Home 19/08/08

Bentley House Nursing Home 07/02/06

Bentley House Nursing Home 12/05/05

Bentley House Nursing Home 03/02/05

Bentley House Nursing Home 16/08/04

Bentley House Nursing Home 01/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Bentley House Nursing Home Twenty One Oaks Bentley Atherstone Warwickshire CV9 2HQ Lead Inspector Jackie Howe Key Unannounced Inspection 12th April 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Bentley House Nursing Home Address Twenty One Oaks Bentley Atherstone Warwickshire CV9 2HQ 01827 711740 01827 712901 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) Dr E Bellamy Mrs Gail Seegobin Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47), Terminally ill (4) of places Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may also provide care for the person named in the application dated 14 November 2005. 7th February 2006 Date of last inspection Brief Description of the Service: Bentley House care home is a converted large home offering personal and nursing care for up to 47 persons in the category of old age, over the age of 65 years. Service users in this home can be accommodated for long or short term care. The home provides accommodation on two floors in 47 single bedrooms. Eight of the single bedrooms offer varied en-suite facilities. All areas of the home are accessible by wheelchairs and there is a passenger lift for the use of residents. Off road parking is provided at the front of the home in an allocated space. Bentley House is situated in a rural location on the border of Warwickshire and Leicestershire about two miles from Atherstone and offers panoramic views over the countryside. The location of the home does not offer easy access to local shops, local transport services and other community amenities. Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place between the hours of 9.30 am and 5.15pm and was unannounced. This was the first inspection of the new inspection year 2006/07, and was undertaken by three inspectors. One of the inspectors was the pharmacist inspector who visited the home on the 13th April 2006 to look in depth at standard 9 and her comments have been included in this report. The registered manager was present throughout the inspection, as was the home manager; which included a tour of the home, speaking with residents and their relatives and members of staff. Inspectors accessed records kept in the home and read care plans. A number of ‘comment cards’ were sent to the home prior to the inspection, and a good number were returned. Views of the home as expressed by residents and relatives/ visitors have been used in the report. The inspectors would like to thank the staff in the home for their hospitality, and positive response to the inspection, as it is appreciated that this was the second inspection in a short period of time. Due to the timing of the inspection some of the requirements made in the last report had not yet met the timescales for completion. What the service does well: The home whilst large has a welcoming feel, it is bright and airy, and enjoys beautiful views over the gardens and surrounding farmland. There is evidence of activity taking place, Easter bonnets were on display, as well as information on forthcoming events. Staff were seen to be welcoming and friendly. Their attitude towards the residents in their care was kind and responsive, and the relationship between the manager and the staff was positive. Comments received indicate that staff offer a good standard of care. Comments included: ‘ Very impressed with the standard of care both for my mother who is resident and my elderly father who visits every day.’ Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 6 There is a positive and ‘holistic’ feeling in the home, and the manager has introduced personal touches with small indoor water features and provided quiet relaxing areas for residents to use. Training opportunities available for staff development are good, and the manager has proactively sourced training courses at local colleges, and made best use of distance learning opportunities for staff. A number of staff have enrolled on courses to obtain NVQ qualifications. What has improved since the last inspection? What they could do better: Systems for ensuring staff are appropriately supervised are yet to be introduced. Whilst generally staffing levels are adequate for the number of residents currently in the home, at some key times, for example meal times, when a number of residents require assistance at the same time, it is inadequate. The manager should consider ways that the needs of residents can be better met by reorganising or restructuring. Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 7 Residents are unable to lock their own personal rooms, and the registered manager must ensure that locks and keys are provided for those that should want them, to enhance the privacy and dignity of residents in the home. 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. Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 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 Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 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 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the home. The home ensures that prospective service users and/ or their families have the opportunity to assess the suitability of the home before making a choice of home. All residents are assessed prior to moving into the home and given assurances that their needs can be met by the home and the services offered. EVIDENCE: The manager undertakes all the pre admission assessments, the majority of which recently have been undertaken in a hospital setting. Pre admission records and assessments read covered all of the areas required by the standards. Initial assessments made are reviewed, and there was evidence this is done regularly following an admission. Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 10 New paperwork introduced by the manager is more informative and assists nursing staff with the initial care plan. Residents and relatives spoken with confirmed that assessments had been undertaken prior to admission and that they had had an opportunity to visit the home and choose a suitable bedroom. Relatives said they felt informed about the home and its facilities. A copy of the home’s Service User Guide is available in each personal bedroom; this was reviewed within the last six months. The Statement of Purpose is displayed in a communal area along with other information for visitors. Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 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, 10 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. Care plans are improving, some elements are full and informative, however further development is needed to provide the staff with all the necessary information to meet individual residents’ needs. Health needs of residents are met with evidence of liaison with health and social care professionals on a regular basis. The medicine management has improved since the last inspection. More attention to details is needed in some aspects and records. Personal support is offered in such a way as to maintain resident’s privacy and dignity, but the inability to lock personal rooms could affect the privacy of some individual residents. Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 12 EVIDENCE: Four individual care plans were read, and two others accessed for specific information. Improvements noted in the previous inspection report have been maintained. There was evidence to show that care plans are regularly reviewed, and the manager said that she and the nursing staff are proactive in involving families and other care professionals in the review process. Daily care records, which monitor food and fluid intake and give information about the day-to-day care needs of an individual, are kept in resident’s personal rooms, and the manager said that relatives were welcome to read and contribute to these. One gentleman visiting his wife said that he found this information very informative, and helpful. Whilst significant improvements have been noted and maintained, some elements of the care plan need further improvement. One gentleman who was assessed as being at high nutritional risk did not have a care plan associated with this risk and the fact that he had lost weight had not been reflected in his needs. Some care plans did not contain a body map on which to identify a pressure area. Photographs taken of pressure sores or wounds are kept securely on a computer index and named and dated appropriately. The manager said that the permission of all residents was obtained before photographs were taken. A disclaimer used in the plans of some residents using bed rails had not been signed by the next of kin. The manager said that this was because some relatives live far away. It was suggested that a record of a verbal discussion could be recorded in these circumstances. Evidence was seen in care files that professional health workers are involved in monitoring the health outcomes. Throughout the inspection evidence was seen that residents were treated with respect and were spoken with courteously. Comments received indicate that relatives feel that the care provided is good. ‘My wife is very affectionate, and that affection is returned by the staff who look after her. ‘ Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 13 The majority of audits indicated that the medicines had been administered as prescribed. Nursing staff robustly check the prescriptions and the dispensed medicines received into the home. One dose of warfarin was ambiguously written and it could not be demonstrated exactly what the new dose was or what had been given. New service users medication is not checked with the prescriber for accuracy before administration. A few gaps were found on the MAR (Medication Administration Record) chart. From audits these medicines had been administered but not signed directly after the transaction. One medicine had been signed as administered when it had not been. Overall the nursing staff have improved their practice to a generally safe level and more attention to detail is needed to ensure they meet the required standard. The registered manager is keen to improve practice further and had implemented new medication policies, undertaken regular staff drug audits to confirm nursing staff competence, which was commended. Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 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): 12,13,14,15 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. Significant progress has been made to provide daily living and social activities that are flexible and varied to suit service users expectations and preferences. The dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: There is a formal activities program in place and service users were asked for their comments regarding this and other opportunities for social activity. Their comments included: The vicar visits and we can see him/her personally if we wish. Holy Communion happens weekly. We play dominoes and bingo and sometimes go to Stratford and the garden centre. We made Easter Bonnets last week. Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 15 The events diary for the summer months displayed in areas around the home included an Easter Bonnet Parade, a Garden Party, Fathers Day celebrations, a visit from the Performing Arts Theatre Group and singer. The daily activities program each week was displayed in several areas of the home, activities each week include a bingo session, a variety of games, shopping trips and mobility to, with visiting entertainers, (singers) visiting monthly. Service users are able to have visitors at any reasonable time and family members were visiting service users throughout the day during the inspection. Their views were sought on the service provision and comments included; We like the changes that have been made with the rooms, (lounges and conservatories). Service users buzzers are not ringing as much as they used to. Mealtime activities were observed and resident’s views were sought regarding meals in the home and comments included: Meals are excellent. Sometimes my liquidised food doesnt look nice with gravy added. I can have a choice. We can have supper -- but I dont. The manager talked about the changes in food provision that have taken place since the last inspection and these included: • Ensuring kitchen staff receive a diet sheet with the identified dietary needs of any new resident on their admission to the home and records were evident in the kitchen to confirm this. • Service users are asked daily whether they wish to have their main meal in the dining room or in their bedroom and confirmed by service users. • Meal times are being reviewed against service users needs. • Liquidised food is portioned individually and we are considering purchasing food moulds. • We have contacted a nutritionist for support and advice and are waiting to hear from her. • We have introduced a protected mealtime policy whereby visiting relatives can meet privately with their family member if visiting over a mealtime period. The menu for the day was attractively displayed around the home and service users spoken with knew what they were having for lunch that day. This was roast beef, yorkshire pudding, vegetables, potatoes and gravy. At the onset of the meal aprons were offered to service users and plate guards provided where necessary. Tables were set attractively with flowers, tablecloths and serviettes in place. Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 16 Some service users were seen not using their knives but cutting their food with a fork. They appeared to find cutting the meat and yorkshire pudding this way difficult and a small number of service users were seen not to eat their meat, which suggests that this might have been because it could not be cut up easily. Three staff were in the dining room at the start of the meal as other staff were involved in taking lunch to people who had chosen to eat in their bedroom. This number was not sufficient enough to provide the necessary support to meet individual support needs for people in the dining room although, these staff did their best to accommodate needs. However, five service users appeared to need one to one support and one lady waited some time for individual support from a staff member. As staff came back from serving lunch to people in their bedrooms they offered appropriate support where needed to service users in the dining room. All staff support was offered in a way that was respectful and at a level and pace to the service users understanding. A good practice recommendation was discussed with the manager regarding considering a ‘staggered’ lunchtime provision so that people requiring individual support from staff have this for the necessary time needed. The Registered Manager, when giving advice and support to concerns being raised by visiting relatives over the dietary needs of their family member, was understanding of their concerns and explained the risks involved for the resident if eating solid foods, explaining the difference between soft and liquidised food. The Registered Manager explained how the staff team were working with speech and language therapy services to insure risks could be minimised. Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the home. Complaints are handled objectively. Residents and relatives are aware of the complaints procedure and feel confident that their concerns will be investigated. Working and care practices observed indicate that residents are protected from abuse. EVIDENCE: The home has a complaints procedure, which details how a complaint received will be managed. Detail of the complaints procedure is within the Service Users Guide a copy of which is given to each resident. Comments cards received indicate that relatives and visitors to the home are aware of the home’s complaints procedure but had not had to make a complaint. The complaints file kept in the home showed that no complaints had been received since the last inspection, and the recording systems allow interested parties to see how complaints have been addressed and if they have been upheld or not. Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 18 The manager said that not all comments received are recorded as complaints if they are viewed as a minor concern, which can be immediately rectified. Residents spoken with confirmed that they understood the complaints procedure and knew who to go to with any concerns. They stated that they would normally speak with the manager except if it was regarding food in which case they would probably speak to the cook. Training on adult protection and to safe guard vulnerable people from abuse is given ‘in house’ with the use of a video and questionnaire, and evidence was seen that 28 staff members have attained this training in the last 7 months. Training on recognising signs of abuse will also form part of the NVQ training for staff. The manager is hoping to access training for senior staff via the Warwickshire Quality partnership. The manager said that she had a copy of the multi agency policy for Warwickshire, and had personally updated the home’s abuse policy since taking up her post. A copy of the home’s ‘whistle blowing’ policy was also seen. The home does not currently have a copy of the Department of Health ‘No Secrets’ document. A recommendation has been made. Recruitment procedures show that the home is vigilant in seeking full working histories of new employees and that CRB and POVA checks have been undertaken. Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 19 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, 26 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. The standard of the environment within this home is generally good and providing service users with an attractive and homely place to live. Further improvements are being considered which will safeguard and promote the health and safety of the people living and working there. EVIDENCE: The entrance to the home is warm and welcoming and a display of plants, flowers and Easter bonnets reflected the time of year. Service users spoken with said they had enjoyed making the Easter decorations. Information regarding activities and other home information was displayed in the reception area and staff were available to assist visitors and ensure that all persons entering the home were known. Service users and visiting relatives spoken with thought the changed arrangements of providing open lounges and conservatories had been an Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 20 improvement however, two visitors discussed the loss of somewhere to meet in private, they were not aware that a room for holding a meeting in private was still available. This is a spacious home which promotes easy and free movement for all service users, many of whom are using wheelchairs. Minor adaptations and refurbishment is being made to the home and this includes changing the use of some rooms. The manager has already re-sited her office into the main part of the house and is now closer to resident’s living accommodation. Work is ongoing to provide an identified staffroom and resite the sluicing facilities in the home. The Registered Manager and housekeeper discussed the progress being made regarding the laundry area in the home, which was identified at the last inspection as needing improvement. The concerns are being addressed and an action plan for refurbishing this area to make it a more secure and improved laundry facility is being considered. The Registered Manager said that it is intended to remove unused equipment and provide a specific area for folding washed linen and clothing. Comments from service users and family members said that The Housekeeper is very good and clothes are well cared for. The grounds were generally tidy and accessible to service users, who spoke of being able to access the patio area during the warmer months. Some service users were sitting in the conservatories and enjoying watching the birds coming into the garden. A gardener is employed and further improvements are being made. There is an enclosed garden area, which the Registered Manager is hoping to make more accessible for people needing a safer place to sit when outside. There is an area outside the laundry however that is being used for the storage of unused equipment, which, the Registered Manager said, was waiting to be collected by Refuse Department. The untidiness of the area did not reflect well against the standard of care provision inside the home and looked unsightly. A good practice recommendation was made that a skip be provided so that unused equipment could be stored more safely and tidily. The laundry area is still the designated smoking area for staff and the Registered Manager said that discussions regarding the smoking policy for the home is continuing and a more suitable area is yet to be agreed. Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 21 The use of footplates on wheelchairs has been discussed with service users and risk assessments have been completed. A good practice recommendation was discussed with the Registered Manager to ensure that the non-use of footplates is reviewed with service users on a regular basis to ensure that they continue to be safe. Resident’s bedrooms were observed to be clean and comfortable and service users are able to have their own possessions around them. The kitchen area was clean and in good order and safe working practice was observed. For example, all persons entering the area wear hats and aprons and there is an out/in system for prepared food and returning crockery and utensils back into the kitchen. Domestic staff spoken with said that the recent changes in the environment had generally been good. Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 22 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, 30 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. Significant progress has been made in addressing staff training needs so that service user needs can be appropriately and safely met. The number of staff employed is sufficient to meet the individual lifestyle needs for the people living in this home. The recruitment policy and procedure for this home in general ensures that service users are supported and protected from harm by the people caring for them. EVIDENCE: There were sufficient staff on duty during the day to meet the care needs of service users in the home however as identified in this report a review of the deployment of staff at mealtimes should take place to ensure that individual needs are being appropriately supported. In the short time there has been since the last inspection there has been significant progress made by the Registered Manager to provide opportunity for staff to undertake training. Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 23 For example, six staff have been enrolled on a Care Introduction Standards programme, five carers are enrolled on the Foundation of Palliative Care, of which the Registered Manager is a Facilitator and a newly appointed staff member is an accredited Moving and Handling Trainer. Further training is being accessed to include, Diabetes, Infection Control and Dealing with Difficult People. The Cook has a Certificate in Food Hygiene. Records show that new staff are completing an induction programme and a good practice recommendation was discussed with the housekeeper regarding the development of an induction programme for kitchen and domestic staff to ensure that people using cleaning equipment and kitchen equipment do so safely. The records of three new staff members showed some gaps in ensuring all recruitment documentation is accessed prior to working in the home, this included on one occasion only one reference being received and one staff file having no photo identity. POVA and Criminal Records Bureau, (CRB) checks are taking place and records being maintained of induction and mandatory training. Throughout the inspection visit staff were observed to treat service users with dignity and respect and positive interactions were observed between service users and staff at all times. Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 24 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, 36 and 38 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. The registered manager and her senior team operate with good leadership and direction, so that resident’s needs are identified and action is taken to meet those needs. The manager provides clear and comprehensive guidance to staff. A recent quality assurance audit has not been undertaken, implying that the registered manager or the provider are not fully aware of the feelings and thoughts of the residents living in the home. Pooling of residents monies is practiced. Management procedures ensure that resident’s financial interests are safeguarded. The manager has a good understanding of the areas for service development and considerable planning is in place indicating how this is going to be resourced and managed. Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 25 EVIDENCE: The registered manager has now been in post seven months, and her management style is proactive. Staff spoken with said that she was making positive improvement and that they found her to be ’very fair’ and a good decision maker. In the short time has been since the last inspection visit it is pleasing to note that the Registered Manager is taking positive steps to raise standards within the care home. Morale within the staff team is good and the atmosphere in the home was warm and welcoming. Comments received from relatives, were also positive. ‘ I am pleased to say that after the new manager’s arrival the improvement in staff morale and the care mother is getting is amazing.’ The manager has now secured funding in respect to attaining the Registered Managers Award and feels confident that she should be able to complete this by the deadlines set. The manager operates an ‘open door’ policy, and has moved her office to be central within the home and within easy access to staff and residents. She demonstrated a commitment to seeking out the views of those using the home, but so far has had limited response. Resident / relative meetings held in the home have been poorly attended, and the meeting held in February again only had two attendees. An annual survey to gather the views held by residents and relatives/ visitors, which was initiated in February, had also been poorly responded to. The inspector looked at the ways the home was informing visitors to the home about these events and systems. Most information is displayed on the notice board as people enter the home and sign in. It was observed that most visitors did not see the information displayed and were not aware that a survey was being undertaken. This was discussed with the home manager and it was suggested that the home should take more of a proactive stance and send out questionnaires by post informing visitors of the reasoning behind seeking the views of people who use the service, and of the home’s eagerness to respond. Responses to the Commissions questionnaires in comparison, has been good. A new system for supervision is being considered but has not as yet been introduced, to ensure that staff receive appropriate and regular supervision by Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 26 designated senior carers. Team meeting minutes are comprehensive and show that these are taking place regularly. Procedures in the kitchen have been reviewed to ensure that opened food, which is to be stored or frozen, is labelled, dated and suitably secured prior to storage. During a tour of the environment food storage in the kitchen was seen to be satisfactorily and in line with the reviewed practice. Steps had been taken place on to ensure that the room containing cleaning equipment and products is locked at all times and this was the situation on the day of the unannounced visit. Health and safety checks continue to take place and records seen were up-todate and in good order, and this included fire safety. Fire safety training had taken place on the 11th of April 2006. The accident and incident records being held in the home show that none had occurred since 8th of January 2006. Safe working practice is being ensured through effective training during the induction period and as part of mandatory training for all staff to include moving and handling, infection control, food hygiene and first aid. Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 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 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 1 x 3 Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 28 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 12, 13 Requirement Timescale for action 30/06/06 2 OP9 13 (2) schedule 3(3)(i) 3. 4. OP9 OP9 13 (2) 13(2) The registered manager must ensure that care plans fully indicate the care that is required for each individual resident. Care needed to minimise risks identified in risk assessments, must be accurately planned for and monitored. The exact directions of all 20/04/06 medicines received must be recorded and quantities of all medicines received or balances carried over must be recorded to enable audits to take place to confirm staff competence in medicines management. All medicines must be 14/04/06 administered as prescribed in all instances. All nursing staff must refer to the 14/04/06 Medicines Administration Record (MAR) chart before the administration of medicines and directly sign following the transaction or record the reasons for non-administration. The MAR chart must accurately reflect what has been administered within the home. DS0000004386.V289041.R01.S.doc Version 5.1 Bentley House Nursing Home Page 29 5. OP9 13(2) 6. OP15 14, 16 7. OP10 12 8. OP26 13, 16 9. OP33 24,26 All new service users medication must be confirmed with the prescriber on entry to the home in addition to those receiving respite care. This must be undertaken at the earliest opportunity The presentation of liquidised and soft meals must be reviewed to support service users in maintaining and appreciating the taste of different foods. (Requirement at last inspection) 31/3/06 The registered manager must consult with service users on whether they want to be able to lock their bedroom door and have a key and supply one, unless a risk assessment indicates otherwise. Evidence of this consultation must be kept and repeated on every new admission to any room without a lock and key. The registered manager must ensure that the laundry area is maintained in a clean, organised and suitable fashion. (Outstanding from previous inspection) The registered provider and manager must ensure that a suitable system is established for reviewing and improving the quality of care, personal and nursing, provided in the home. The outcome of these must be shared with the commission and reports made available for inspection. (Outstanding from previous inspection) 20/04/06 30/06/06 30/06/06 30/04/06 30/04/06 Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 30 10 OP36 18 The registered manager must ensure that all staff are formally supervised a minimum of six times a year, clear and informative records must be maintained and available for inspection. (Outstanding from previous inspection, new timescales given). 30/10/06 Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 31 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. 4. 5. Refer to Standard OP15 OP18 OP19 OP30 OP33 Good Practice Recommendations It is recommended that a ‘staggered’ mealtime provision be considered so that service users requiring individual support to eat their meal are able to do so. The inspector recommends that the home retains a copy of the Department of Health ‘No secrets’ document. It is recommended that a skip be provided so that unused equipment can be stored more safely and tidily in outside areas. It is recommended that new staff coming to work in domestic areas of the home receive a recorded induction into safe working practices. The home manager should adopt a more proactive approach towards quality assurance and seeking the views of residents, relatives and visitors. This will enable the manager to set objectives for the home and ensure that the views of those using the home are being considered. Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Bentley House Nursing Home DS0000004386.V289041.R01.S.doc Version 5.1 Page 33 - 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. 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