Inspection on 07/02/06 for Bentley House Nursing Home

This inspection was carried out on 7th February 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 12/04/06

Bentley House Nursing Home 12/04/06

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 Yvette Delaney Unannounced Inspection 7th February 2006 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bentley House Nursing Home DS0000004386.V282771.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.V282771.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.V282771.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. 12th May 2005 Date of last inspection Brief Description of the Service: Bentley House care home is a converted large house 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. The home has car parking facilities. 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.V282771.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on a weekday between the hours of 08.30 am and 7.40 pm. This was the second visit for this inspection year and was carried out by three inspectors. One of the inspectors was the pharmacist inspector for the Commission for Social Care Inspection who visited the home on the 8 February 2006. The pharmacist inspector examined in depth Standard 9, which looks at the management of medicines in the home. The Care Manager and Home Manager were present at this inspection. Staff in the home co-operated fully with the inspection. Managers and staff were proactive in their response to the inspection and were keen to improve practices and the environment to ensure the service users’ needs are met. The inspection process involved a tour of the home, discussions with the managers, examining care profiles, case tracking, discussions with staff, residents and relatives. Records related to residents, staff, the environment and operations in the home were examined. These include maintenance, servicing contracts, care profiles, accident records and policies and procedures. Details in a pre-inspection questionnaire sent to the home prior to the inspection provided factual information on the home. Comment cards sent to the home and given to residents and relatives also informed this report. Six comment cards were received from relatives. Their views are detailed in the following table: Outcome of Relatives/Visitors Comment Cards – 6 received Yes 1 2 3 4 5 6 7 9 Do staff/owners welcome you in the home at any time? Can you visit your relative/friend in private? Are you kept informed of important matters affecting your relative/friend? If your relative/friend is not able to make decisions, are you consulted about their care? In your opinion are there always sufficient numbers of staff on duty? Are you aware of the home’s complaints procedure? Have you ever had to make a complaint? Do you have access to a copy of the inspection reports on the home? 6 6 5 5 3 4 3 3 2 2 2 2 No No response/ Comment 1 1 1 It is getting better now Not always 1 1 A copy is available in Page 6 Bentley House Nursing Home DS0000004386.V282771.R01.S.doc Version 5.1 10 Are you satisfied with the overall care provided? 4 1 one of the corridors. 1 Most of the time. Other comments made include: “…Staff shortages: on the whole this is much better now, although there can be odd times still when there are not enough staff on over a weekend.” “They do seem to have to wait a long time to be taken to the toilet.” “…also feel they could be a little gentler in their handling of the patients, they bruise very easily.” “…up to now everything seems very good. Staff have been very pleasant and welcoming a friendly crowd.” “…looked after well at all times, the staff have been friendly. Staff have been cheerful and welcoming.” “They keep me informed with any problems with her health.” What the service does well: What has improved since the last inspection? Working and care practices have improved in the home and improvements are ongoing. Improvements made include the organisation of care profiles to ensure information could be easily found and that paperwork used was appropriate and relevant to the care delivered in the home. A new activity organiser has been appointed and as a result the number and type of activities taking place in the home have increased. Two relatives Bentley House Nursing Home DS0000004386.V282771.R01.S.doc Version 5.1 Page 7 spoken with said that the home had improved, one relative had thought about taking their relative out of the home but now felt “okay”. One relative said that there are more activities and residents enjoy living in the home. What they could do better: There are a number of areas for improvement that must be addressed these include: • Some care plans require further review to ensure that the care needs identified and instructions to staff fully reflect the current needs of individual residents. A proactive system for auditing and monitoring care plans needs to be in place. The management of medicines must improve to ensure the needs of residents are met. Food must be dated and sealed properly before being put into fridges or freezers to minimise the risk of food poisoning. The laundry is untidy and dirty and is in need of improvement. Statutory training needs to be brought up to date for all staff. The lack of attendance and updating in mandatory training requirements could result in staff using inappropriate techniques and not responding appropriately to an emergency situation. • • • • • 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.V282771.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.V282771.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, 4 and 5 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. The manager ensures that prospective service users and/or their families have the opportunity to assess the suitability of the home before making a choice, which could involve a trial stay before they make a decision. EVIDENCE: Eight residents’ records were examined. Pre-admission assessments carried out covered all the areas required to prepare an appropriate plan of care for individual residents admitted to the home. Information obtained was complete and the type of care planned in most cases would meet the needs of residents. Care plans for residents recently admitted to the home reflected their initial assessment and there was further information to demonstrate updating of assessments on admission. Residents and their families spoken with said they were happy with the care they are receiving. Residents and relatives felt sure that all their care needs will be met and had been involved in the initial assessment of their care needs. Bentley House Nursing Home DS0000004386.V282771.R01.S.doc Version 5.1 Page 10 Residents and their families are invited to visit the home prior to admission, giving them the opportunity to decide if the service is suitable for them. Some residents spoken to stated that their families had visited the home and that they had trusted them to make a good decision. Bentley House Nursing Home DS0000004386.V282771.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 and 10 There are improvements in care plan documentation, continued improvement will ensure that all care plans provide current details of the health, personal and social care needs of individual residents. Medication records did not reflect accurately what had been administered to the service users in all instances. Improved practices will support meeting the needs of residents. Residents are treated with dignity and respect and their right to privacy protected resulting in increased confidence and expression of self worth. EVIDENCE: Eight resident care plans were fully examined and it was noted that the standard of care plans documentation had improved. Improvements made include the organisation of care plans to ensure information could be easily found and that paperwork used was appropriate and relevant to the care delivered in the home. Various care plans were available covering basic care needs such as hygiene, nutrition, mobility, and continence. Bentley House Nursing Home DS0000004386.V282771.R01.S.doc Version 5.1 Page 12 Some documentation was not titled to confirm their purpose and staff did not always sign and date information to provide an audit trail. Care plans related to oral care were included in the plans of care for meeting personal hygiene needs. Conversations with residents evidenced that hygiene practices related to cleaning teeth and maintaining clean mouths is carried out. There are a number of residents who do not have or do not wear their dentures. Care plans indicate that some residents have refused treatment and others state that their dentures hurt or are too big. This could result in discomfort for some residents when eating. Action plans examined evidence that a number require further review to ensure that all care needs identified and instructions to staff fully reflect the current needs of individual residents. Evaluation of the care provided is carried out monthly and care needs are fully reviewed 3 monthly by nursing staff. One care plan indicated that the resident would like to be involved in the review process but there was no information to demonstrate that this had taken place. Documentation of daily reports on individual residents had improved to reflect the health, social and personal care needs delivered by staff. There remains the occasional entry of “usual day” or “good night” which provides no information on the care provided by nursing or care staff for those particular days. There is also no information to explain what a “usual day” or “good day” means for individual residents. The care profiles of 8 residents with skin damage, ranging from pressure area damage, leg ulcers and dry flaky skin were examined. Risk assessments had been completed and were present in those records examined. Care plan documentation discussing residents with pressure sores, although improved, did not give clear and specific guidance on the care required in relation to the management and prevention of further skin or pressure area damage. Files examined referred to existing skin lesions but a body map relating to the positioning of sores was not completed on all occasions. The manager advised that pictures had been taken to identify the state of current wounds and further pictures to show improvement or deterioration. Audits completed did not provide sufficient detail on the progress or deterioration of the different wounds, whether treatment used was appropriate and what action had been taken. Equipment necessary for the promotion of tissue viability and a prevention and treatment of pressure sores was in evidence in the home. Access to advice from the tissue viability service offered by the local Primary Care Trust (PCT), had been obtained. Bentley House Nursing Home DS0000004386.V282771.R01.S.doc Version 5.1 Page 13 Residents have access to other health professionals, which include an optician and chiropodist. The provider has confirmed that an aroma-therapist also visits twice weekly. Records are maintained in residents’ profiles to demonstrate the outcome of these visits. Information was transferred to the care plans and actions requested were signed and dated when completed. A monthly review of residents care needs is carried out and this includes monitoring baseline observations of blood pressure, pulse, temperature and weight. Appropriate action was taken for those residents where concern is raised by referral to the GP and dietician. Audits demonstrated that not all the medicines had been administered as prescribed. Medicines had been signed as administered when they had not been and some gaps were seen on the Medicine Administration Record (MAR) chart. It could not be demonstrated whether the medicines had been administered and not signed or not administered and the reasons for nonadministration recorded. The majority of medicines administered from the Monitored Dosage System were given correctly but many audits failed as nursing staff did not record the quantities carried over from previous cycles. One medicine had been signed as administered four times a day but it was evident that it had only been administered three times a day. This indicates that the nursing staff are not referring to the MAR chart before the administration and signing directly after the transaction in all instances. Medicines had been signed as administered but were not available in the trolley. Conversely medicines were available for administration that were no longer prescribed. There was no clear procedures to review “when required” medicines and no written protocols to administer these against. Some service users’ medication was administered to other service users if they had also been prescribed it so it could not be demonstrated exactly what had been administered to each resident. Handwritten MAR charts were well written but those medicines whose dose had changed were not as clear as they should have been. The medicines in the medication trolleys were muddled and it was not apparent immediately what medicine was to be administered to the service users, which may lead to errors. Two boxes of medicines were found containing additional medicines to that labelled. It was unclear whether this was a dispensing error or nursing staff had secondary dispensed into the boxes. Two medicines in the trolley were unlabelled. The home has a dedicated medication room and secure storage within. A clinical waste contract to remove excess medication had been purchased and Bentley House Nursing Home DS0000004386.V282771.R01.S.doc Version 5.1 Page 14 medicines that were no longer required were recorded. At the time of the inspection one medicine was unaccounted for. The home had a dedicated refrigerator but the maximum, minimum and current temperatures were not recorded daily to ensure the medicines are stored within their product licences. The home has a robust checking-in procedure but they do not see the prescription prior to dispensing, which would improve practice further. The registered manager was proactive in her response to the requirements left at the time of the pharmacist inspection and she was keen to improve practice to ensure the service users’ needs are met. Both residents and relatives spoken to said that they had seen improvements in care. Residents said that they are cared for and that they felt that staff respect their privacy. Care staff were observed speaking to residents politely and in a friendly manner. Bentley House Nursing Home DS0000004386.V282771.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The lifestyle in the home related to social, cultural, religious and recreational interests is improving, resulting in an acceptable level of wellbeing for residents. Residents are encouraged and supported to maintain contact with their family, friends and the local community, resulting in supporting their social skills and increase in their mental wellbeing. Residents are encouraged and enabled by staff, with the support of their family, to exercise control over their lives resulting in increased self-esteem and quality of life. Meals provided are varied and provide a balanced diet for residents. It is not clear how residents are helped to exercise choice when deciding on meals, limiting control for residents over day to day life in the home. EVIDENCE: A new activities organiser has been appointed and has been given the responsibility to develop activities in the home. Music was playing in the background in the large lounge/conservatory area, which has been opened up to provide a large airy space. Bentley House Nursing Home DS0000004386.V282771.R01.S.doc Version 5.1 Page 16 Residents were sitting in small social groups and a number were engaged in conversation and were sociable with each other. The hairdresser was visiting at the time of inspection and a number of residents, particularly ladies, had their hair washed and styled. Some residents were sitting watching television or quietly snoozing. There was no formal activity programme evidenced at the time of inspection. Records indicating activities residents had been involved in such as dominoes, card games, music and movement, bingo and painting were maintained in individual resident files. Residents spoken to stated that they enjoyed the experience of living at the home. It was established through discussion that relatives, friends and others visit when they wish; there are no restrictions. During the course of the inspection relatives were seen to visit the home and sit with their family member in private. Relatives were able to make themselves a cup of tea and stay with their relative as long as they wish. There are signing in sheets for all visitors in the reception area. Two relatives spoken with said that the home had improved, one relative had thought about taking their relative out of the home but now felt “okay”. The relative said that there are more activities and residents enjoy living in the home. Contact is maintained with community life. Visits are made to the home by the hairdresser an aromatherapist and the local church ministers to carry out religious services. Some residents go out with their relatives and friends and there are planned trips outside of the home to local garden centres. Residents have three planned meals a day, breakfast, lunch and tea were seen. Supper is provided as a light snack for those residents who request something to eat. Lunch was served for the majority of residents in the main dining room off the kitchen. Ten residents choose to have their meal in their bedroom and there are 3 residents who are unable to swallow effectively and are receiving feeds via a tube into their stomach. The lunch offered on the day of inspection comprised of three courses. There was one main meal available, broccoli soup or fresh fruit salad, roast pork in a honey and mustard sauce, carrots, cauliflower and mashed potatoes, followed by cheesecake or rice pudding, served with cream. There was no other choice of a hot main meal on the patient list provided for that day. The inspectors were informed that residents are offered an alternative of omelette, fish, jacket potatoes or soup daily. One of the inspectors ate lunch with the residents. The meal was well presented, nutritiously balanced and was tasty. Most residents were seen to eat the meal and when asked stated that it was okay. Residents were offered assistance where required in a quiet and professional manner, encouraging independent eating where possible. Bentley House Nursing Home DS0000004386.V282771.R01.S.doc Version 5.1 Page 17 The experience of sitting with the residents at lunchtime presented a more relaxed environment. The dining room was not crowded and residents were able to sit comfortably. The registered manager has implemented “protected mealtime” during lunch due to this time being busy and chaotic when there are visitors present at the same time. Visitors can now have lunch with their relatives in the conservatory. The majority of residents enjoyed their meal, those that did not made it evident that choices available had not been fully explained to residents on the main meal available. Although residents requested the portion size they would like this was not heeded, resulting in them not eating the meal as they were served a large portion and not small as requested. Residents were offered more food when they had finished eating. Soft and liquidised meals were mixed together and served in one bowl. These were not attractively presented and residents would not be able to retain the taste of the different foods offered. There was no evidence that the cook meets with residents to get to know their likes and dislikes. A four week rotation menu is available but is not followed as demonstrated by documented evidence in a diary in the kitchen and details of the meal of the day written on the blackboard in the dining room. Bentley House Nursing Home DS0000004386.V282771.R01.S.doc Version 5.1 Page 18 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 and 18 The home has a clear and easily accessible complaints procedure, which indicates an open and positive approach to problem solving. The service ensures that residents’ legal rights are protected and have systems in place to protect them. Policies and procedures concerning the protection of vulnerable people are adequate but the absence of attendance by staff to adult protection training does not support the service in ensuring that residents are protected from abuse. EVIDENCE: The home has a complaints procedure, which briefly details how any complaint received will be managed. The procedure is displayed in the entrance hall of the home. The pre-inspection questionnaire received indicates that there have been ten complaints received in the last 12 months. The Commission has received five of these, which have been resolved. Of the others received by the home, one is ongoing and is being dealt with appropriately. Thank you cards received are also displayed in the entrance hall. When asked about making a complaint, four residents and two relatives said they would “complain to the manager” and had confidence that their complaint or concern would be acted on. Access is available to advocacy services and leaflets/notices are available informing residents and visitors of the facilities available. Some residents have Bentley House Nursing Home DS0000004386.V282771.R01.S.doc Version 5.1 Page 19 their relatives supporting and acting on their behalf when exercising their legal rights. A procedure for responding to allegations of abuse is available with clear guidance for staff. Training on adult protection is delivered in-house; training records indicate that not all staff have had an update in the protection of vulnerable adults. Bentley House Nursing Home DS0000004386.V282771.R01.S.doc Version 5.1 Page 20 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, 20, 21, 22, 23, 24, 25 and 26 The home presents as a pleasant and comfortable environment. Further improvements would increase safeguards, which promote the health and safety of residents and staff. EVIDENCE: The entrance to the home has been dressed with plants, a table and ornaments. This presents a more homely impression and detracts away from the carpet in this area, which looks worn. The Inspectors were advised that this is due to the sunlight. The inspectors were informed that there are further plans to improve the entrance to the home by lowering the roof and installing patio doors to a small secured garden. There was an unidentified odour when entering the home, as the day progressed the smell had gone. The front door to the home was unlocked, there is an alarm attached to the door, which was not very loud. Bentley House Nursing Home DS0000004386.V282771.R01.S.doc Version 5.1 Page 21 The home manager checked the alarm at the time of inspection, the batteries were changed and the alarm could be heard in the home when the front door was opened. Minor adaptations and refurbishment are being made to the home, which will involve changing the use of some rooms. Some of the changes are intended to provide an identified staff room, manager’s office and suitable sluicing facilities. Further refurbishment is planned and was seen as part of the business plan for the coming year, which has yet to be discussed and agreed with the Registered Provider. Systems have been put in place to ensure that wheelchairs available for residents are checked as safe for use. Some residents transferred in wheelchairs had the use of footplates, others who are refusing to use footplates had signed disclaimer notices. There was no evidence of the discussions, which took place to inform residents and relatives of the risks involved in not using footplates. Residents’ bedrooms and communal areas were observed to be clean and comfortable and residents were able to have their own possessions around them. The lounge area had been opened up to incorporate the two lounges and conservatory, providing a large light airy space. Some of the lights were not working in this area and these were replaced on the day of inspection. A suitable carpet cleaner has been purchased and ongoing assessments are to be made to determine those that need changing. There were concerns discussed about the standard of hygiene and the control of infection in the home. Assisted bathing facilities are provided on each floor. The home has a Jacuzzi-type bath for use by residents. Records were not available to confirm that the bath is suitably cleaned. The laundry is situated at the back of the home. This area was inspected and it was noted that the laundry was still untidy, continues to look dirty and in need of improvement. This is further emphasised by the state of the walkway on the approach to the laundry. A used incontinent pad was left on the wall in this area. The area is also designated for staff to smoke and was not clean due to the number of cigarette stub ends. Inspectors were advised that a domestic washing machine in the laundry is to be moved into the kitchen with a domestic dryer and used to launder kitchen towels and aprons. There are varied pieces of equipment and adaptations to the home to support residents in moving freely around the home. Grab rails are available in corridors, toilets and bathrooms. Hoists were observed in use and a lift is available to the first floor of the home. Bentley House Nursing Home DS0000004386.V282771.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 and 30 The number of staff on duty on the day of inspection was sufficient to meet the needs of residents accommodated in the home, which should lead to appropriate care provision and support an increase in the quality of life of individual residents. The skill mix of staff on duty on the day of inspection meets residents’ needs, ongoing training is needed to ensure that this level is maintained at all times. The procedures for the recruitment of staff are robust to ensure that all safeguards are accessed to offer protection to residents living in the home. Staff were observed to be competent to do their job but training is not up to date, which could result in inappropriate care being given and deterioration in the quality of life for individual residents. EVIDENCE: Examination of four weeks’ staff rotas identified that there are sufficient staff on duty during the day to meet the care needs of residents in the home. On average there are two nurses and six care staff on duty during the morning, two nurses and five care staff in the afternoon and two nurses and three care staff during the night shift. The home is not currently operating at its full capacity and is accommodating 36 residents. The inspectors were advised that night staff no longer do the laundry at night. Bentley House Nursing Home DS0000004386.V282771.R01.S.doc Version 5.1 Page 23 The pre-inspection questionnaire demonstrates that there are currently 13 of 27 (48 ) care staff with an NVQ qualification. The Inspector was informed that some staff have been unable to complete their NVQ due to not having access to an assessor. Further training has been accessed and arranged through a local college. Two staff files examined demonstrated that procedures for recruiting and appointing new staff members would support the protection of residents living in the home. Examination of the files showed that required security checks had been carried out. There were two relevant and appropriate references on file and identification information was available. Evidence that Criminal Records Bureau checks had been carried out and the outcome received before the employment of new staff. Details of a current Personal Identification Number (P.I.N.) for one nurse was seen and confirms their eligibility to practice as a nurse. Training records examined show that staff have the opportunity to undertake training. Statutory training, which includes fire and moving and handling, is not up to date, which could result in staff using inappropriate techniques and not responding appropriately to an emergency situation. Evidence of other training attended by staff include palliative care and care staff have watched training videos addressing principles of care, moving and promotion of continence. There was no evidence of an induction programme for nurses joining the home. Documentation available evidenced that a new carer had undertaken an induction period of 12 weeks. Mentors had been identified and following completion of the induction documentation had been signed by the employee and both mentors to confirm. Bentley House Nursing Home DS0000004386.V282771.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, 32, 33, 35, 36, 37 and 38 The home has a competent manager who is capable of being responsible for ensuring that residents benefit from effective management within the home. The management and leadership approach is one which considers the rights of residents and safeguards and protects their interests and welfare. The lack of a formal quality assurance system does not ensure that the home is run in the best interests of residents. Accounting and financial procedures maintained in the home are suitably managed thereby safeguarding the residents’ stay in the home. Pooling of residents monies is practiced, management procedures in place to manage this practice ensure that their financial interests are safeguarded. Supervision procedures implemented are not appropriate to monitor the care practices delivered by individual staff and ensure that residents’ health, safety and welfare are maintained at all times. Bentley House Nursing Home DS0000004386.V282771.R01.S.doc Version 5.1 Page 25 Records are organised, accessible and securely stored, which should safeguard residents’ rights and best interests. Some areas related to the health, safety and welfare of residents have been reviewed, there remain areas that if not reviewed and improved may result in harm. EVIDENCE: The care manager took up her post in September 2005 and has been confirmed as the registered manager for the home by the Commission. The manager has a varied nursing experience of working with older people in care home environments and is a qualified nurse. Discussions were held about the Registered Manager Award, which when a decision is made as to which approach to take the manager hoped to start this year. There is evidence that she has completed training courses relevant to the needs of residents accommodated in the home, which includes palliative care. Through discussions with the managers and staff it was identified that there are clear lines of management responsibility and an awareness of each other’s role and responsibilities. The atmosphere in the home is relaxed and relationships between residents were positive. Residents were observed to be sociable, hold conversations with each other and had an awareness and knowledge of day to day activities in the home. Equally, the relationship between residents and staff demonstrated that they have a good rapport. The registered manager operates an ‘Open Door’ policy, making herself accessible to residents, relatives and staff. Active steps have been taken to encourage residents and relatives to attend planned meetings. Inspectors were informed that there was no attendance at the last meeting held in October 2005. A further meeting had been planned for the 8 February 2006. A notice had been placed in the reception area to advertise the meeting. The manager informed the Inspectors that plans were to hold an open surgery in an attempt to encourage residents and relatives to attend. Further methods used to improve communication between the home, residents and relatives is the production of a newsletter. The home has some quality monitoring in place, which involves surveying residents and relatives. The last survey took place in September 2005 and Bentley House Nursing Home DS0000004386.V282771.R01.S.doc Version 5.1 Page 26 although not a good response there was evidence of the returned questionnaires. The home manager advised that she is planning to carry out another survey. Letters received by the Commission following the owners’ monthly unannounced visits to the home do not provide sufficient information for follow up on the quality of services provided in the home. It was established through discussion with the managers and examination of staff files, that there is not currently a formal system of supervision of staff in the home. The manager advised that group supervision had taken place, which does not demonstrate that staff are receiving appropriate supervision. The home manager manages financial procedures in the home. A business plan for the year is being developed and a copy of this was seen. A valid and current insurance liability certificate is displayed in the home. The preinspection questionnaire identified that staff working in the home are not involved in the financial management affairs of residents. The home manager manages small amounts of residents’ personal monies. Monies are kept in a suitable locked facility. Records were examined which demonstrated that information related to all transactions is available. All monies are pooled and individual receipts are kept to indicate money spent. If a resident goes into deficit, monies are taken from petty cash so residents don’t “go without”. Letters are then sent to relatives handling residents’ affairs notifying them of the need for additional funds. Records are available to show that funds are audited and money is balanced, computerised records were seen. Individual residents’ records and other personal confidential information related to staff and residents are secured in locked cabinets, in the manager’s office. Computers in the home are password protected. Maintenance checks being carried out include checking of fire alarms and fire doors for closure and the emergency lighting. There was evidence that kitchen and laundry equipment had been serviced in the last 12 months. Water temperature and valve checks were made to ensure that water was being delivered at a safe temperature. It was evidenced through maintenance records and contracts that all equipment and appliances used in the home include the lift, hoists, baths and showers have been serviced and certificates examined were up to date. Legionella risk assessment has not been completed. Data sheets related to the Control of Substances Hazardous to Health are available in the home. Procedures have been changed to ensure staff practice safely when attending to residents’ care needs. Systems for disposing of clinical waste and dirty linen Bentley House Nursing Home DS0000004386.V282771.R01.S.doc Version 5.1 Page 27 have improved. Facilities separate to the sluice are provided for staff to wash their hands. Systems have been put in place to ensure that wheelchairs available for residents are safe for use. There was no evidence of the discussions, which had taken place with residents and relatives where there had been refusal to use footplates. The laundry was inspected and it was noted that the area was still untidy, continues to look dirty and in need of improvement. The door to the cleaners’ cupboard containing cleaning equipment and products was noted to be unlocked. This practice does not ensure the safe storage of chemicals at all times and could present a hazard if there is a resident who wanders. The kitchen was seen and refurbishment work has been completed. Records for cleaning and temperatures of the fridges and freezers have been kept up to date. It was noted that food is not dated or sealed properly before putting into the fridges or freezers. Cooked meat defrosting in one of the fridges was not labelled or dated and plans were to use this to prepare a meal for the residents; these practices increase the risk of food poisoning. Bentley House Nursing Home DS0000004386.V282771.R01.S.doc Version 5.1 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 3 3 2 3 3 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 2 2 3 2 Bentley House Nursing Home DS0000004386.V282771.R01.S.doc Version 5.1 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 S.3 Requirement The registered manager must ensure that the resident and/or their family are involved in the care planning process where possible. A review must be carried out on all residents who wear dentures. Oral health care plans must include the care needs of residents who have dentures, with reference to eating. Records, which include body maps must be maintained of the incidence of pressure sores, the care prescribed, treatment given and details of the outcome of care. The medication policy must be rewritten to reflect good practice in medicine management and all staff must be trained to adhere to the policy. All prescriptions must be seen and checked prior to dispensing and a system installed to check all dispensed medicines and Medicine Administration Record (MAR) charts received into the home. DS0000004386.V282771.R01.S.doc Timescale for action 31/03/06 2 OP8 12, 13, S.3 31/03/06 3 OP8 12, 13, S.3(n) 31/03/06 4 OP9 13(2) 08/03/06 5 OP9 13(2) 31/03/06 Bentley House Nursing Home Version 5.1 Page 30 6 OP9 13(2) S. 3(3)(i) 7 OP9 13(2) S. 3(3)(i) 8 9 OP9 OP9 13(2) 13(2) 10 OP9 13(2) 11 OP9 13(2) sch 3(3)(i) 12 13 14 OP9 OP9 OP9 13(2) 13(2) 13(2) The 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 hand written MAR charts must accurately record all the medication the service user has been prescribed, the strength of the medicines and the correct dose and these medicines must be available for administration. All medicines must be administered as prescribed in all instances. All nursing staff must refer to the 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. Written protocols for all “when required” doses must be written and endorsed by a clinician to ensure correct use. Staff drug audits must take place on a regular basis to confirm staff competence and appropriate action must be taken if errors in administration and recording are found. All medicines that are no longer required must be removed from the medicine trolley. All medicines available for administration must be labelled. A maximum, minimum and current thermometer must be purchased to monitor the medication refrigerator and the three temperatures must be recorded on a daily basis to ensure the medicines within are DS0000004386.V282771.R01.S.doc 31/03/06 09/02/06 09/02/06 09/02/06 08/03/06 08/03/06 09/02/06 09/02/06 22/02/06 Bentley House Nursing Home Version 5.1 Page 31 15 OP14 16 OP15 17 18 OP18OP30 OP22 19 OP26 20 OP30 21 OP30 22 OP33 stored within their product licences. 12 The manager must ensure that the residents are given choice regarding the meals provided and where this is not possible their wishes considered. 14, 16, The presentation of liquidised S.3 and soft meals must be reviewed to support residents in maintaining and appreciating the taste of different foods. 12, 13, 18 All staff must attend adult protection training. 23 Residents must be discouraged from using wheelchairs without footplates. Staff have a duty of care to ensure residents are using equipment safely at all times. Appropriate risk assessments must be carried out with details of discussions with residents and their families. 13, 16 The manager must ensure that the laundry area is maintained in a clean, organised and suitable fashion. 18(1)(c) The Registered Manager must ensure that all staff are up to date with mandatory training requirements. 18(1)(c) The Registered Manager must ensure that all staff attend ongoing training on conditions that affect the health and welfare of residents living in the home. For example diabetes, nutrition and tissue viability. 26 The registered provider must make unannounced visits to the care home at least monthly to monitor the standard of care provided, inspect the premises, records of events and any complaints. A report on the conduct of the home must be prepared and a copy forwarded to the Commission. DS0000004386.V282771.R01.S.doc 31/03/06 31/03/06 31/03/06 31/03/06 30/04/06 31/03/06 30/04/06 31/03/03 Bentley House Nursing Home Version 5.1 Page 32 23 OP33 24, 26 24 OP36 18 25 OP38 16 26 OP38 13 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 available for inspection. The registered provider and manager must ensure that all care staff are formally supervised a minimum of six times a year, clear and informative records must be maintained and available for inspection. The manager must review procedures in the kitchen to ensure that opened food, which is to be stored or frozen, is labelled, dated and suitably secured prior to storage. The manager must ensure that the room containing cleaning equipment and products is locked at all times to prevent possible harm to the residents. 30/04/06 30/04/06 07/02/06 07/02/06 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 Refer to Standard OP7 OP15 Good Practice Recommendations Daily health related statements, need to be completed consistently to demonstrate care prescribed and care given. Evidence should be available to demonstrate how residents are made aware of menu choices at mealtimes and how residents are supported to exercise choice. Bentley House Nursing Home DS0000004386.V282771.R01.S.doc Version 5.1 Page 33 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.V282771.R01.S.doc Version 5.1 Page 34 - 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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