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Inspection on 12/05/05 for Bentley House Nursing Home

Also see our care home review for Bentley House Nursing Home for more information

This inspection was carried out on 12th May 2005.

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

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

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

What the care home does well

Staff working in the home were observed to be caring towards residents and were aware of residents likes, dislikes and needs. Discussions with residents confirmed that they enjoyed their meals and the choices available.

What has improved since the last inspection?

Following recent concerns it was not possible to identify improvements since the last inspection. The outcome of the inspection identifies that standards have not been maintained and there was evidence of poor working and care practice. Immediate requirements were issued at this visit requesting the managers to review working and care practices in the home. The visit also identified an increase in the number of actions required to comply with the law and National Minimum Standards.

What the care home could do better:

Although staff state they are aware of the individual needs of residents, this is based on what staff `just know` and individual assessed needs are not all identified and documented in care plans.This practice does not support the safety of residents or ensure that consistent high quality health and personal care is delivered by all staff. A proactive system for auditing and monitoring care practices needs to be in place. There is a lack of well ordered, legible and accessible care plans. The approach used by staff of `just know` presents a significant risk to residents.

CARE HOMES FOR OLDER PEOPLE Bentley House Nursing Home Twenty One Oaks Bentley Atherstone CV9 2HQ Lead Inspector Yvette Delaney Unannounced 12 & 13 May 2005 10:00 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 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 E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 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 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 Ms Claire Jane Barnes N 58 Category(ies) of OP 58 registration, with number TI 4 of places Bentley House Nursing Home E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 3 February 2005 Brief Description of the Service: Bentley House care home is a converted large home offering personal and nursing care for up to 58 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 48 single bedrooms and 5 shared 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 E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection and took place over 2 days between the hours of 10.00 and 22.00 hours on the first day of inspection and 07.00 and 19.00 hours on the second day. This was the first visit for this inspection year and was brought forward due to concerns received about care practices in the home. Staff in the home co-operated fully with the inspection. The owner made a visit to the home on the first day of the inspection. The Care Manager and Home Manager were present on both days. The inspection process involved a tour of the home, talking with the Managers, examining care profiles, discussions with staff and residents throughout both days and the examination of records and policies and procedures. The Main focus of this inspection was to observe and examine working and care practices as carried out by nursing and care staff in the home. What the service does well: What has improved since the last inspection? What they could do better: Although staff state they are aware of the individual needs of residents, this is based on what staff ‘just know’ and individual assessed needs are not all identified and documented in care plans. Bentley House Nursing Home E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 6 This practice does not support the safety of residents or ensure that consistent high quality health and personal care is delivered by all staff. A proactive system for auditing and monitoring care practices needs to be in place. There is a lack of well ordered, legible and accessible care plans. The approach used by staff of ‘just know’ presents a significant risk to residents. 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 E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Bentley House Nursing Home E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 The lack of comprehensive pre-admission assessment details means that there is not a proper assessment to assure that peoples care needs can be met prior to moving into the home. EVIDENCE: A comprehensive pre-admission assessment form is available but has not been consistently implemented. The Registered Manager carries out pre-admission assessments. Care files of eight residents who had been in the home for varied lengths of time were examined. These did not all contain pre-admission assessment documents. Those examined lacked details from which evidence of a proper assessment being undertaken could be confirmed. Residents in the home are of a high dependency; those spoken with could not confirm that they had been involved in the assessment process prior to moving into the home. Bentley House Nursing Home E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9 Arrangements for ensuring that the health, personal and social care needs of residents are identified and met are poor. These shortfalls have a potential to place residents at risk. EVIDENCE: Care plan documentation consisted of paperwork obtained from different organisations. There is no clear format and the organisation of paperwork differed in the care plans examined. Some of the forms to be completed were not legible due to repeated photocopying and incomplete. The Manager is in the process of introducing new paperwork, which has been accessed from other providers. Care plan documentation was not always signed and timed by the member of staff making the entry. Information contained in care plans did not provide evidence that a comprehensive assessment had been drawn up with each service user and or their relative. All care needs were not identified for example diet and fluids, mobility and specific health related issues related to individual residents such as high blood pressure. Comprehensive care needs assessments are available from the care management team and the outcome of the RNCC assessment, these documents were not used to inform the care planning process and therefore support the introduction of effective care. Risk assessments were not consistently carried out an example of this includes nutrition. Bentley House Nursing Home E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 10 Access is available to health professionals outside of the home, which includes the Chiropodist, GP, District nurses (the home also admits service users requiring personal care only) and the Dentist. Two concerns were raised however about the care of two residents in respect to access to health care services, one resident had complained of toothache and the assumption had been made that as the family had informed the staff that the resident always took ‘painkillers’ referral to a dentist had not been made. The second resident has a skin condition, which is being treated by the home using various techniques. Documentation examined details the deterioration of the resident’s dry skin and scratching. Referral was eventually made to the GP although concerns remain there has not been a request to the GP as to whether referral to a skin Specialist would be appropriate. Significant events had been recorded but daily entries in care plan records had not been consistently made and entries gave little indication of follow up care and appropriate referrals. There was no robust system for the prevention and management of pressure sores to ensure consistency of approach by all staff. The following concerns about the receipt, recording, storage, handling, administration and disposal of medication were discussed with nursing staff and the Care Manager: • • • There were a total of 25 omissions on Medication Administration Records, where medication had not been signed for on both floors. The majority were identified on the first floor. Eye drops and antibiotics were being stored in a domestic fridge where food is stored in the kitchenette on the first floor. Controlled drugs in the house were appropriately accounted for. There are 11 residents receiving Temazepam as a sleeping aid. Night staff maintain nightly checks of the balance of tablets remaining. The tablets and remaining liquid form were checked with the nurse on duty on the ground floor. Of the 11 checked only 2 demonstrated that the remaining balances were correct. One service user was prescribed ½ of a 10mg tablet; records suggest that she received 1 tablet (10mg) for a period of 4 days (09.05.05 – 12.05.05). Small pieces of paper were observed in medicine tots following the night shift. These did not have resident names on them, so it cannot be confirmed that medications are administered in bulk but suggested poor practice. Staff were observed to leave the drug trolley unlocked and unattended while administering medication to residents in their bedrooms. Oxygen is being stored unsecured in the treatment room on the ground floor. • • • Bentley House Nursing Home E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14 and 15 Meals provided are varied and provide a balanced diet for residents. Arrangements and management of mealtimes are not well-organised and present potential risks to the safety, well being and comfort of residents. EVIDENCE: A visit to the home on the second day of inspection at 7.00am evidenced 18 residents to be up dressed and sitting in chairs in their bedrooms, of these one resident expressed that they like to get up early every morning and these instructions were included in the care plan. Other residents were observed to be fast asleep in their chairs one resident with their head hanging down and a pillow was provided at the time of observation for support. The process leading up to lunchtime was observed to start at approximately 11.45 when residents were transferred to the dining room adjacent to the kitchen. Some residents remained in their wheelchairs and others were transferred to chairs. Residents spoken with expressed their frustration at having to wait for over 1 hour for their meal. Meals served were observed to be nutritious and a choice was available. There are a high percentage of residents who require soft or liquidised meals. An assessment of nutritional needs and details of residents likes and dislikes were not documented in care plans examined and are based on staff ‘just know’. Bentley House Nursing Home E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 12 Information was available on a form passed to the kitchen staff detailing choice and type of meals required by individual residents. Soft diets were attractively presented and service users were aware of what they were eating. Liquidised meals were not attractively presented; the entire meal was liquidised together and served in a bowl with a spoon. The cook states that this is the way in which residents want their liquidised meal served, there was no evidence to confirm this. A carer was observed to be feeding two residents at the same time this is not safe practice. The cook has been recently appointed. Food supplies had been received on the day of inspection. The kitchen was stocked with fresh food, which includes vegetables and fruit. Dry goods, fresh milk, eggs, bread, meat and chicken are also available. The cook is currently reviewing menus. There was evidence that the contents of menus had involved discussion with some residents and relatives. A choice of meal is included in the new menus. Residents spoken with had an idea of the meals on the menu on the days of inspection and were able to confirm that a choice was available to them. Seating arrangements in the dining room at lunchtime were observed to be crowded, particularly the area used by the more dependent residents who require intensive assistance with feeding. Bentley House Nursing Home E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Complaints are not handled objectively, residents and relatives are not confident that their concerns will be investigated. Working and Care practice observed indicate that residents may not be fully protected from abuse. EVIDENCE: The home has a detailed complaints procedure but individual records, evidence in complaint response forwarded to the Commission, anecdotal evidence from complainants and discussions with residents indicate that this is not followed. The Commission has received five complaints since the start of this inspection year (April 2005) alleging poor care practice. The care manager has investigated the complaints. The Commission is currently reviewing the Care Managers responses to the complaints. The responses received indicate that the investigation has not been objective and take a defensive approach. Discussions with the manager did not provide a justified reason for this approach. Comments from the manager indicate that one of the complaints has been ongoing through verbal communication and feedback. There was no evidence of a formal investigation and feedback. Comments from three residents indicate that there is no point in complaining, as nothing is done. A procedure for responding to allegations of abuse is available with clear guidance for staff. Training records indicate that not all staff have had an update in the protection of vulnerable adults. Bentley House Nursing Home E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24 and 26 The home is in need of improvements to provide a well-maintained environment with sufficient and suitable equipment and facilities, which ensure safe and comfortable surroundings, are provided for all residents. EVIDENCE: The home is not purpose built and is a converted large stately type home. The entrance to the home is not attractive, the carpet is worn and needs replacing and two empty oxygen cylinders were placed in this area. Access is available to communal areas and extensive landscaped grounds around the home for use by residents. Residents were observed sitting in the patio area at the side of the home. Concerns were discussed on potential fire risk hazards, which include storage in stairwell areas used as fire exit points and the ineffective closure of identified fire doors. Bentley House Nursing Home E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 15 There are not sufficient and appropriate bathing facilities available within close proximity for the use of residents. There is currently only one suitable bath for the use of 31 residents on the first floor of the home and a bath and shower on the ground floor for 16 residents. Discussions with staff indicate that residents on the first floor have to be transferred to the ground floor where there is an assisted bath. The manager advised that plans are to raise the level of existing baths. This needs to be put into action as a matter of urgency. Wheelchairs are available for use by residents those in use were not safe for use. Safety catches on footplates and brakes were not working properly and some safety catches were missing. Some resident’s bedrooms were observed to be clean and comfortable and were able to have their own possessions around them. The carpet in one bedroom was observed to be badly stained and attempts to clean it had not been effective. The premises were observed to be clean and free from offensive odours. There were concerns discussed about the standard of hygiene and the control of infection in the home. • • • • • • • All bins require staff to use their hands to open them and those that have a pedal mechanism are not working. The system for disposing of pads involves staff taking a large black bin around with them. This was observed to be touching clean laundry. Staff have to open and close the bin with their hands. There are no suitable and appropriately placed facilities for staff to wash their hands in between providing care for individual residents. The area the staff were observed to use was the sluice. The sluices were dirty and in need of deep cleaning and organisation. The kitchen is in need of a deep clean and some of the equipment for cooking is in need of replacing. The bin in this area is not suitable and the new cook has ordered a new pedal bin for this area. Housekeeping trolley’s containing cleaning products were left unattended. Cleanliness of carpets in resident’s bedrooms. Bentley House Nursing Home E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The procedures for the recruitment of staff are not robust to ensure that all safeguards are accessed to offer protection to residents living in the home. The deployment of additional non-care duties for night staff at weekends does not provide sufficient care hours to meet the needs of residents. EVIDENCE: Staffing numbers were appropriate to those stated in the staffing requirements on both days of the inspection. The dependency levels of residents are medium to high. Staff are task led to get the work done and maintain routines in the homes. The home is not currently operating at its full capacity. Concerns were discussed about night staff carrying out laundry duties, as this would have an adverse effect on staffing requirements. The time allocated for laundry duties is not identified on duty rotas as separate to that of care hours. Four staff files were examined these indicate that a robust recruitment process was not in place to ensure that staff are confirmed in post only following the completion and receipt of satisfactory police checks, Protection of Vulnerable Adults (POVA), two references and Nursing and Midwifery Council (NMC) register. Records examined indicate that staff have attended varied training, which includes meeting statutory training requirements. Records indicate that some staff need to receive updated awareness training on managing adult protection issues and Health and Safety which includes maintenance staff. Bentley House Nursing Home E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35, 36, 37 and 38 The home is not adequately managed this has resulted in a lack of direction and guidance to ensure residents receive consistent quality care. EVIDENCE: The Home Manager and Care Manager are responsible and accountable to the owner of the home. All non-care issues are managed by the Home Manager these include laundry, housekeeping, catering, administration and maintenance. The Home Manager also manages the budget for the home. The nurses and care staff in the home are responsible and accountable to the Care Manager. The lines of accountability for care on each floor is further defined by Registered Nurses being responsible for the floor they are managing for that day and senior carers and carers reporting to her. Bentley House Nursing Home E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 18 There have been a number of issues affecting the Care Managers performance over the past few months, which may have affected the management of the home. Discussions with staff alleged claims of not being involved in the change process. The system and the procedures carried out for the management of service users monies were discussed with the home manager. Discussions and documentation evidenced that the audit process was not robust and a procedure was not available. Discussions with the registered manager identified that staff supervision has not yet been implemented. Service records are available and up to date and policy and procedures have been implemented. Care procedures available are based on Warwickshire PCT (Primary Care Trust) guidance, these are currently not easily accessible to staff at all times. There are issues raised in this report, which relate to safe working and care practices, these include: Medication, wheelchairs, the lack of care plans which reflect all the care needs of service users resident in the home, the safe storage of oxygen cylinders and the lack of hand washing facilities. Immediate Requirements were also issued requiring action on the following: • Wheelchairs in use by residents were not safe, safety catches on footplates and brakes were not working properly. Some safety catches were missing. A clear and robust system for the receipt, accounting and safekeeping of resident’s money was not in place. Care plan documentation did not reflect a comprehensive detailed assessment of service users needs and plans for care delivery. A clear procedure for recording and mapping the progress of pressure ulcers, wounds and skin conditions with details of preventative measures was not available in a consistent format. Records did not accurately reflect the administration and accounting of Temazepam used in the home. Medication remaining did not reflect actual count and balance stated on records available in the home. • • • • Bentley House Nursing Home E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 2 15 2 COMPLAINTS AND PROTECTION 2 2 1 2 3 2 x 2 STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 2 2 2 x 2 1 2 2 Bentley House Nursing Home E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 20 Yes Are there any outstanding requirements from the last inspection? 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 OP3 Regulation 14(1)(a), 17 Requirement The Registered Manager must ensure that all service users receive a full assessment prior to admission. A copy of the completed assessment must be available in the service user files. Evidence is required to demonstrate that there has been appropriate consultation and involvement of the service user and or a representative in the pre-admission assessment process. The Registered Manager must be able to demonstrate that that the home is able to meet the required needs of the service user at the time of admission. The Manager must confirm in writing to the prospective service user that the home is suitable, and will meet their health and welfare needs, following their assessment. Evidence is required to demonstrate that care plans are drawn up with the involvement of the service user and/or their representative. Care plans must set out in detail, the action needed to be carried Timescale for action 31.07.05 2. OP3 14 (1) (c) 31.07.05 3. OP4 14 31.07.05 4. OP4 14(1)(d) 31.07.05 5. OP7 15(1), Schedule 3 (k)(m) 15(1) 31.07.05 6. OP7 31.07.05 Page 21 Bentley House Nursing Home E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 7. 8. OP7 OP7 OP8 13(4)(c), 15(2)(c) (d) 13(4)(c), 15(2)(c) (d) 12(1), 13(1)(b) (4)(c) 12(1), 13(1)(b) (4)(c) 12(1), 13(1)(b) (4)(c) 12(1), 13(1)(b) (4)(c) 9. OP8 10. OP8 11. OP8 12. OP8 13. OP9 13(2), Schedule 3 (k) 14. OP14 12 out by care staff to ensure all aspects of the health; personal and social care needs of the service user are met. Care plans must be up to date and reflect the current needs of individual service users. Risk assessments must be consistently carried out and implemented for all residents and an appropriate plan of care developed. Residents care plans and records must provide sufficient detail to enable necessary care to be provided to service users. Oral care plans, which promotes oral hygiene and informs staff on the needs of individual service users must be available. Nursing staff with the support of the Registered Manager must seek up to date specialist advice to support meeting the needs of residents. Accurate and appropriate records must be maintained of the incidence of pressure sores, their treatment and outcome in service users individual care plans. The registered manager must ensure the administration of medicines is carried out to Nursing and Midwifery Council standards. (This requirement remains outstanding from 3 February 2005) and comply with Care Homes Regulations 2001. The concerns identified in this report, on the management and administration of medications must be addressed, within a risk management framework. The registered manager must ensure that as far as practicable residents wishes and feelings are taken into account. This must 31.07.05 31.07.05 31.07.05 31.07.05 31.07.05 31.07.05 31.07.05 31.08.05 Bentley House Nursing Home E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 22 15. OP15, OP20 16. OP16 17. 18. OP18, OP30 OP19 19. OP19 include choices in day to day living in the home. One of these choices that must be addressed is time of waking and getting up in the morning. 14, 16 The arrangements at mealtimes need to be reviewed and include: An assessment and completion of a care plan detailing residents nutritional needs, likes and dislikes. Assistance at mealtimes is available in a discreet, sensitive and individual manner to each resident. The seating arrangements in the dining area at mealtimes respects the privacy and dignity of residents. Presentation of liquefied meals is considered. Menus are available in a suitable format, which enables residents to make an informed choice as to meal preference. The timing of meals. 22 The Registered Manager must ensure that complaints verbal or written and whether considered minor or major are acknowledged and dealt with promptly and effectively. 12, 13, 18 Staff must receive an update in adult protection awareness training. 13(4), 23 The Registered Manager must ensure that all parts of the home are free from hazards to safety and the home is kept in a good state of repair. Issues addressed in this report must be actioned which include the carpeted area at the main entrance of the home and the safe storage of oxygen cylinders both empty and full. 13(4)(c), The Registered Manager must 23(4) ensure that the building complies with the requirements of the fire safety regulations. Advice must E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc 31.08.05 31.08.05 31.07.05 31.07.05 31.07.05 Bentley House Nursing Home Version 1.30 Page 23 20. OP21 23(2)(b) (j) 21. OP22 23 22. OP24, OP26 13(3), 16(2)(j) (c), 12(4) (a) 18 (1)(a), (3)(a)(b) 23. OP27 24. OP29 19(1)(2) (3) (4)(a)(b) (c)(5) (6) (7), be sought on the storage of items in stairwells and the closure of fire doors. The Registered Manager must ensure that sufficient number of lavatories, washbasins, baths and showers are suitably adapted, accessible and appropriately located in the home to meet the needs of residents. High standards of hygiene must be maintained in the sluice rooms. Wheelchairs used by residents must be suitable and safe to be used at all times. Maintenance checks must be carried out on brakes and footplates. Residents choosing not to use footplates on wheelchairs must be risk assessed and the outcome recorded in care plan documentation. The premises must be kept clean, hygienic and free from offensive odours. The issues highlighted under the environment section of this report must be addressed. The numbers and skill mix of staff must be appropriate to meet the health and welfare needs of service users. Any extra non-care duties must be clearly identified on duty rotas and separate to care hours provided. The Registered Manager is requested to provide the figures for staff hours allocated to Personal and Nursing care in relation to the assessed needs of the service users. The Registered Manager must ensure staff files contain evidence that appropriate checks have been completed through police checks, the vulnerable 30.09.05 31.07.05 31.07.05 31.07.05 31.07.05 Bentley House Nursing Home E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 24 Schedule 2(5) 25. OP31 7(3)(b) 26. OP32 12, 21 27. OP33 24 28. OP35 17 29. OP36 18(2), (3)(a)(b) 30. OP37 17 31. OP18, OP30, OP38 12(1)(a), 13(4)(a) (b)(c) (5)(6), 23(4) adults register and the Nursing Midwifery Council prior to working in the home. If through ill health or other reasons the manager is unable temporarily to maintain standards the owner must make arrangements to enable the home to operate satisfactorily Evidence must be available, which confirms that the service users and staff are involved in the day-to-day running of the home and their views are taken into consideration. The Registered Manager must introduce systems which will effectively monitor and audit working and care practice in the home. These procedures must be ongoing. A procedure must be available for staff on the handling of residents monies and valuables and a robust audit system must be in place to evidence appropriate handling of resident monies. The Registered Manager is required to implement a formal supervision programme, covering supervision of all staff, which also incorporates examining care practices, to ensure that they are consistent and safely delivered. The standard of record keeping in the home must be maintained at an acceptable and safe level, consideration must be given to the organisation, format and legibility of all records related to residents. The Registered Manager must have systems in place, which ensures the health, safety and welfare of service users and staff. Action must be taken on 31.07.05 31.07.05 30.09.05 31.07.05 30.09.05 31.07.05 31.07.05 Bentley House Nursing Home E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 25 issues highlighted in this report. Staff must be receive an update in adult protection awareness training. 32. 33. 34. 35. 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. Refer to Standard OP7 OP22 Good Practice Recommendations Daily health related statements, need to be completed consistently to demonstrate care prescribed and care given. A person qualified to do so should undertake an assessment of the suitability of the premises and facilities available. Bentley House Nursing Home E53 S4386 Bentley House Nursing Home V226960 120505 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection 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. 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