Inspection on 08/09/09 for Bentley House Nursing Home

This inspection was carried out on 8th September 2009.

CQC 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 CQC judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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 07/02/06

Bentley House Nursing Home 12/05/05

Bentley House Nursing Home 03/02/05

Bentley House Nursing Home 16/08/04

Bentley House Nursing Home 01/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Bentley House Nursing Home Twenty One Oaks Bentley Atherstone Warwickshire CV9 2HQ Lead Inspector Julie McGarry Key Unannounced Inspection 8th September 2009 08:45 DS0000004386.V377260.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 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) Bentley House Ltd Manager post vacant Care Home 47 Category(ies) of Dementia (9), Old age, not falling within any registration, with number other category (47) of places Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 47 Dementia (DE) 9 The maximum number of service users to be accommodated is 47 2. Date of last inspection 19th August 2008 Brief Description of the Service: Bentley House Nursing Home offers personal and nursing care for up to 47 older people. Service users in this home can be accommodated for long or short term care. Bentley House was originally the Merevale Estate Colliery manager’s house and has been converted for use as a care home. The original country house has been converted to lounge areas and offices on the ground floor with a Day Centre on the first floor. The old stables were converted to kitchen and dining room. A purpose built ‘new wing’ houses residents’ bedrooms, bathrooms and offices for nurses and manager. 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 are two passenger lifts for the use of residents. There is ample parking in the home’s car park to the side of the main house. 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. Whilst 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.V377260.R01.S.doc Version 5.2 Page 5 the home has two mini buses to support people to access the local community. Additionally, there is an ‘In-house’ shop for people to buy goods.. Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is a one star; this means that people using the service receive adequate outcomes. This was a key unannounced inspection visit. This is the most thorough type of inspection when we look at key aspects of the service. We concentrated on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. We carried out this unannounced key inspection over two days. As the inspection was unannounced the registered owner, manager and staff did not know we were going. A Pharmacy Inspector was also involved in the inspection; she carried out a full inspection of the medication management systems and safety. Before the inspection we looked at all the information we have about this service such as information about concerns, complaints or allegations; incidents; previous inspections and reports. Registered care services are required to complete an Annual Quality Assurance Assessment (AQAA). The AQAA provides information about the home and its development. At this key inspection we used a range of methods to gather evidence about how well the service meets the needs of people who use it. Some time was spent sitting with residents in the lounge watching to see how residents were supported and looked after. These observations were used alongside other information collected to find out about the care they get from staff. We also looked at the environment and facilities provided and checked records such as care plans and risk assessments. There were 32 people in residence on the day of our inspection. Three people using the service were identified for case tracking. This is a way of inspecting that helps us to look at services from the point of view some of the people who use them. We track peoples care to see whether the service meets their individual needs. Our assessment of the quality of the service is based on all this information plus our own observations during our visit. Throughout this report, the Care Quality Commission will be referred to as us or we. Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 7 At the end of the visit we discussed our preliminary findings with the manager of Bentley House Nursing Home. What the service does well: Anyone wishing to move to the home has their needs assessed before they move in to ensure that their needs can be met properly. People are supported in a respectful manner and their personal care needs are met. Staff are knowledgeable about the people who use this service. They have a good understanding of their roles and responsibilities. People are supported to gain access to advice from health professionals where they need it so their health needs can be met. People are supported to keep in touch with their families and friends so that they do not lose relationships that are important to them. The service provides daily in-house activities. This provides people who live there the opportunity to participate in their interests and preferences both within and outside of the service. The number of staff on duty enables the needs of the people living there to be met. The home has both male and female staff reflecting the gender make up of those who live there. What has improved since the last inspection? All requirements made at the last inspection have been met. Improvements have been made to identify and minimise risks to the health or well being of people living in the home. This includes the risk of poor nutrition and developing pressure sores. The home has a good system in place with regard to the appointment of staff. Records seen show that references are always obtained and staff are not appointed prior to safety checks being undertaken. Staff starting work under a PoVA First are being supervised appropriately. A new door entry system has been put into place that helps to ensure staff know who is entering the home to prevent unwelcome visitors and protect the vulnerable people living there. Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 8 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving into the home benefit from having their care needs assessed before admission so that they can be sure the home can meet their needs. People and their families are provided with information and visit the service prior to admission to enable them to make an informed choice. EVIDENCE: The AQAA completed by the manager tells us, ‘Prospective residents and relatives can visit the home at anytime to view the home. Residents can visit for an overnight trial or visit us for the day. A comprehensive brochure is available detailing our accommodation, terms and conditions and a Service Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 11 Users Guide is available. Residents have a community care plan and a signed contract. A pre-assessment is conducted before entry into the home’. To find out whether this was the case, three people were case tracked during this inspection. This involved looking at their care files talking to them and their family where possible, and talking to the staff that care for them. Their living accommodation and the facilities available to them were also looked at. People who are considering moving in have access to copies of the Service Users Guide and Statement of Purpose. Whilst both documents are informative, they would benefit from being updated to provide current details about the manager, the Care Quality Commission and fees. Relatives and people who may wish to use this service are encouraged to visit have a look around and stay for the day before they decide if they would like to move in. This was confirmed by relatives spoken to during the visit. This ensures that people have enough information to make an informed choice about whether they would like to live at Bentley House or not. The care files of the two most recently admitted people to the Home were reviewed to identify whether appropriate pre-admission processes take place at Bentley House. Both files seen contained the standardised documentation used during the preadmission process. All assessments were undertaken by the manager. Information obtained during the pre-admission assessment was detailed. Relevant information regarding care needs, dependency and risk assessments are obtained. This information is used to decide whether the Home would be able to meet peoples needs. A conversation was held with one person who recently moved into Bentley House. It was noted that they had settled in well, felt safe, and thought the staff were all kind friendly and attentive to their needs. This person told us that they were happy to be living at Bentley House. Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each resident has a plan of care but a lack of consistent detailed recording may result in inconsistent care being provided. Residents have access to health care services that meet their assessed needs. Staff have a good understanding of how to offer care and support to each person. Medication management must improve to ensure safe handling and administration of peoples medicines. EVIDENCE: The AQAA completed by the manager tells us ‘Assessments are carried out on monthly basis including pressure sores, nutritional, dependency and moving Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 13 and handling. Pressure sores are evaluated and tissue viability professional consulted for advice. Medication management has improved with the support of the Primary Care Trust’. To find out whether this was the case, three people were case tracked during this inspection. This involved looking at their care files talking to them and their family where possible, and talking to the staff that care for them. Eight people’s medication records were looked at by a pharmacy inspector. People at the home were seen to rise at their own pace and receive unhurried support eat their breakfast of choice. Everyone was well groomed and dressed in appropriate, good quality clothing indicating they are supported to maintain a good self image. Three peoples care plans were looked at. The care files covered all the main areas of care including medical history, personal care, pressure care, nutrition, continence and mobility. There is evidence to show that improvements have been made to identify and minimise risks to the health or well being of people living in the home. For example, good recordings were seen for the management of pressure care support. Records on one person’s plan tells staff about the needs for pressure relieving equipment, support to be moved on a two hourly basis, appropriate use of toiletries, and need for referral to tissue viability support. Staff spoke to were able to explain how care needs to be provide to support this individual, and discussion with the individual tells us that improvements in the management of their skin integrity has been achieved. This meets with the requirement set at the last inspection. Another example of good recording practices were seen for one person at ‘substantial risk’ of poor nutrition. The risk plan for this person shows they require ‘support and supervision to have a well balanced diet and sufficient fluid intake’. Monthly weight charts are being maintained to monitor any weight changes and daily records detail what this person has to eat and drink each day. We spoke with this person about their diet and they told us that they enjoy their meals and have stable diet. We met with one person and their relative during the visit, we were told that both are ‘generally happy’ with the care X receives. We were told that this person’s health and wellbeing has improved. Comments include ‘I am happy with my care’, ‘I feel better now than when I came in’. ‘X looks better now’, ‘X has not lost any weight, and enjoys her meals’. Entries in peoples health records show that they are being supported to attend health care appointments to monitor and treat diagnosed health needs. Peoples records show that they are being supported to attend routine health Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 14 appointments such as annual health checks, dental check ups, chiropody support, and eye tests. It is evident that the manager and senior staff have made efforts to improve the quality of the care plans. However there are shortfalls in peoples care plans and risk assessments with recordings. For example, an entry in one person’s daily record states ‘very aggressive and abusive towards staff’. There are no care or risk assessment plans to guide staff on how this person needs to be supported to ensure safe and consistent approaches to care provision. When this was discussed with the manager, immediate steps were taken to update this person’s care file to include a behavioural care and risk assessment plan. Records in two peoples care plans are dated and signed by staff to show when they were last reviewed or amended. Plans in one person’s care file are not signed or dated by staff, thus it is not clear if the needs assessed are up to date. One care file seen contains, in places, an incorrect name of the person who the care file relates to. This could lead to confusion and inconsistent care being delivered. We saw that care plans are not written from the point of view of the person using the service. A more person centred approach to care planning would help remind staff about the way the person would wish to be treated and how they would like their care to be delivered. The manager informs us that all care plans are currently being reviewed and where appropriate updated to reflect people’s needs and consideration to a person centred approach to care planning will be considered. People spoken to told us that they are supported in a respectful manner and their personal care needs are met. Staff are knowledgeable about the people who use this service. They have a good understanding of their roles and responsibilities. The pharmacist inspection took place on a different day to the main inspection. Eight peoples medicines were looked at together with their Medicine Administration Record (MAR) chart, care plans and daily records. Two nurses were spoken with and all feedback was given to the deputy manager. The medicine room was too hot to safely store medicines within. This may affect their stability and so not work as intended. Medicines were stored in two locked medication trolleys. One was too small to hold all the medicines. The medicines were scattered throughout and it was difficult to find all the medicines to administer. This may increase the risk of errors. We were assured that an additional trolley was to be ordered to solve this problem. Most of the medicines were stored in a locked facility in the medication room, but an open box containing surplus medicines was seen. Anyone gaining entry to the medication room would have access to these medicines. Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 15 The home had installed and implemented a good system to check the prescriptions prior to dispensing and to check the medicines received into the home. Hand written MAR charts were poor. The nurses on duty were unable to identify what information had not been recorded. One MAR chart was not dated so all information recorded would be meaningless in the future. Nurses had failed to record the quantities of some medicines received so it was not possible to demonstrate whether these had been administered as prescribed and the records actually reflected practice. Not all allergies had been recorded. Audits indicated that the majority of medicines had been administered as prescribed and records reflected practice. A few errors were seen. Nursing staff had signed to record they had administered some medicines when they had not. Reasons for non-administration were not always recorded and gaps were seen on the MAR chart. The manager had installed a quality assurance system, but this was not refined enough to identify individual staff practice, so who was responsible for the errors seen could not be identified. The two nurses spoken with had a reasonable understanding of the medicines they handled and understood the clinical needs of the people they looked after. The care plans were reasonably detailed. It was possible to see why some of the medicines had been prescribed. External healthcare visits had been recorded so it was possible to read why a medicine had been discontinued or started for example. The manager was in the process of updating them to include information such as protocols detailing the administration of medicines prescribed “when required”. During the inspection it was noted that all people living at this service are treated with respect and dignity. Personal care was carried out in privacy and all those seen were appropriately dressed in clean clothes and looked comfortable and neat. Each person was able to spend time where they choose and during our observations of working practice, it was evident that staff are knowledgeable about the likes and dislikes of people living in the home and were kind, caring and generally attentive towards them. Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14, and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers activities so that people in the home can maintain their enduring interests. People benefit from a nutritious and varied diet. People who require support to eat their meals would benefit from timely assistance. EVIDENCE: The AQAA states ‘Social activities are diverse, we support group activities, individual activities and support residents who prefer to stay in their rooms and are bedfast. A church service held in the home on a monthly basis. Visitors are encouraged to attend are activities and the home invites professional entertainers into the home. Meals are nutritious and choices are offered. The Home has rooms for family gathering and parties’. Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 17 To find out if this was the case, a discussion was held with the manager, staff, people who use the service and visitors to the home regarding recreational activities on offer. An activities list is on display at the reception area. The range of activities include, trips out in the local area, arts and crafts groups and visits from external entrainment such as musician and singers. Some of the people spoken to told us that they join in the activities, this was observed during the afternoon entrainments. Other told us they prefer to watch or spend time in their rooms reading and are respected in their choice to do so. Relatives and friends were seen coming and going from the home and appeared comfortable and welcomed. We spoke to one relative who told us she was always made welcome when visiting. Relatives spoken to commented positively on the care being provided. Visits from members of the clergy are arranged at the home to enable people to practice their faith. One person commented that their faith is important to them and they are happy with the services. The manager informs us that the home has adopted a new approach to supporting people in maintaining a well balanced diet. The manager encourages people to have their meals in the main dining area rather than a ‘silver service’ meal in their own rooms. The manager states that she hopes to develop a more social occasion for people during their meals which she believes will improve people’s enjoyment of food and better meet their nutritional needs. We are informed that for those who wish to remain in the rooms, they will be supported to continue to do so. We observed the lunchtime meal in the dining lounge. There was meal choice of scampi or beef, accompanied by potatoes and vegetables. An appetising pudding was offered. Residents spoken with knew what to expect for lunch, and we observed staff asking people what their choice was whilst before the meal. There were positive comments made about the food at Bentley Care Home, such as there is plenty to eat and the food is very good, and we have a good cook. All of the meal was well presented, looked appetising and nourishing, and appropriate plates and cutlery were used. Staff were not always available to offer timely assistance to residents who needed help eating their meal. During the meal, only one member of staff was in the dining room offering support to approximately 15 people. During this time we observed one person sitting at a distance from their table who could not reach their food, and another person did not eat their meal. When we spoken with the second person, they told us that they did not receive the meal they requested. Staff were not available to observe this and as a result this person ate very little at lunch time. Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People would benefit from all staff receiving refresher training in the protection of vulnerable adults. Staff have not consistently responded in a manner that ensures people are protected from abuse. EVIDENCE: The AQAA states ‘The complaints procedure is placed in the home for resident, families and staff next to the registration details of the home. A copy of the complaints procedure is in the service user guide and the statement of purpose’. To find out if this is the case, we requested the concerns, complaints and compliments folder, looked at staff records and talked to staff about complaints and safeguarding the people who live there. The home has a complaints policy, this is displayed in the home for the benefit of the people who use the service or visitors. People who live here and Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 19 relatives spoken were clear about who they would speak to should they have any concerns. The Home has policies and procedures regarding adult protection which according to information received on the AQAA, were updated in July 2009. Four staff spoken with demonstrated a satisfactory understanding of the types of abuse they might encounter and to whom they should report any concerns. The home recently identified and responded appropriately to one safeguarding concern. However when case tracking another person’s daily records, we noted two entries to show that another person has expressed concerns about how their care is delivered. On consultation with the manager we were told that she was not aware of one of the recordings, and in response to the information detailed in the second recording, has reviewed their care and increased support to this person to ensure two members of staff provide support at all times. On review of this person’s care plan, we found that the care plan was not updated to reflect this change in care practice and staff on duty were not aware of the change when we discussed it with them. The home has started a ‘close observational record’ for this person in response to this person’s concerns, however due to the content of both recordings, both matters should have been referred to the local authority under safeguarding protocols. Peoples money is held in safekeeping by the home. Two peoples records were checked. Each transaction is being signed by staff as verification of money passed to people or spent on their behalf. Receipts are being kept as further evidence of money spent. Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live here benefit from a home that is well maintained and furnished so that people live in a clean, comfortable environment. EVIDENCE: As stated in the last inspection report, Bentley House is a large converted house with beautiful views over the Warwickshire countryside. 47 single occupancy bedrooms are provided over two floors and are located in one ‘wing’ of the property. A large lounge and conservatory provides Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 21 comfortable and spacious communal accommodation. A spacious dining room and smaller ‘Quiet Lounge’ are also available for people to use. The public areas in the home are clean, bright and airy. Easy chairs are grouped socially so that residents are encouraged to interact with each other. The home is has a programme to improve the decoration, fixtures and fittings. Information provided in the AQAA told us that, since the last inspection, ‘nine bedrooms have been refurbished to a high standard, floors in some rooms have been replaced with a wood effect covering, which is easy to clean and reduce odours. Windows have been replaced. The home is accessible to all wheelchair users and two lifts can take a stretcher. The home operates a comprehensive laundry service away from the main home.’ To find out whether this was the case, the living accommodation and the facilities available to people who live at the home were looked at and residents and their families were spoken with. On our arrival at the home, we found that a new door entry system has been put into place. Staff need to respond to the home’s door bell and allow visitor access. Staff explained that people are free to leave by accessing the door release pad by the front door. Several bedrooms, including the people involved in case tracking, were viewed. Rooms were comfortable, well decorated and had good quality furniture and co-ordinating soft furnishings. Eight rooms have ensuite facilities. All the rooms viewed were personalised with people’s own belongings and looked as though it belonged to the person. The home is currently undergoing some construction work to provide a dementia care unit. The manager explained how this work is being carried to cause as little disruption to people who live in the home. Equipment is available to assist residents and staff in the delivery of personal care, which includes assisted baths, moving and handling equipment including hoists. Pressure relieving equipment such as cushions and various types of mattress are available for people who have an identified need for them. The home has relevant policies and procedures in relation to infection control and health and safety. The laundry area has good systems of infection control. The laundry room is equipped with sufficient commercial equipment to manage the soiled laundry for the home and is satisfactory for the control of infection. The home also provides staff with disposable gloves and aprons and paper towels. Staff were observed to wears aprons and gloves when providing support with personal care. Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 22 The kitchen was clean and well organised. Records were kept of the fridge and freezer temperatures showing appropriate temperatures to maintain good food safety. Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are protected by robust recruitment procedures that have been followed to ensure staff are suitable to work with vulnerable adults. People would benefit from a staff team who are appropriately supervised. This would help in staff development and ensure staff have the appropriate knowledge and skills to carry out their jobs. EVIDENCE: The AQAA tells us ‘Nursing and care staff have relevant qualification. The majority of our care staff are trained to level 2, Senior Care Staff have level 3. All staff are CRB checked and the nurses pin number checked with the NMC (Nursing and Midwifery Council). Staff are offered appropriate training including dementia, palliative care, control of infection.’ Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 24 To check that this is the case, we looked at three staff files, spoke with staff and the manager. The manager told us that the usual staffing complement planned in order to meet the needs of the 32 people currently living in the home includes two qualified nurses and six care staff throughout the day. Waking night staff are on duty, including one nurse and three carers to meet peoples needs should they required assistance. There is sufficient ancillary staff to ensure that care staff do not spend undue lengths of time undertaking non-caring tasks. Three weeks of duty rota records looked at confirmed that the staffing complement mentioned above is planned for and generally met with the support of agency care staff and the manager occasionally covering nursing duties. There is at least one registered nurse on duty at all times. The manager has additional nursing hours available and provides a ‘hands on’ approach to nursing care each morning before commencing management duties. From our observations it is evident that peoples’ basic health and personal care needs are met. A health and social care student is currently providing support to the activities co-ordinator in meeting people’s social needs. The personnel files of two recently recruited staff were examined and both contained evidence that satisfactory checks such as Criminal Record Bureau (CRB) Protection of Vulnerable Adult (PoVA) and references are obtained before staff commence employment in the home. From records and discussion with staff, we found evidence to show that staff starting work with a PoVA first are being supervised until CRB checks are received. Robust recruitment procedures and pre-employment checks should protect the vulnerable people living in the home. Records seen that 74 care staff who work at the home have achieved a minimum of level two in the National Vocational Qualification in care. This above the minimum level required of 50 . This should mean that staff should have the necessary skills and knowledge to provide a good standard of support to the people who live there. Evidence was available that new staff undertake an induction programme and have access to mandatory training in fire safety, abuse awareness and moving and handling. This should mean that staff are updated in safe working practice. From discussions with the manager, staff and records seen, staff are not receiving regular planned supervision. Records showing appraisals of staff performance were also not available. The manager states that supervision and appraisals will become standard practice at the home. Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of some areas of health and safety practice needs to be improved to ensure people are protected from potential risk of harm. EVIDENCE: The manager is new to post, taking up her position in July 2009. She is not currently registered with us and has been advised that this is required to Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 26 comply with the law. Staff were aware of lines of accountability within the Home and reported that they receive excellent support from the new manager. The Annual Quality Assurance Assessment (AQAA) completed by the service manager was completed to an adequate standard. It states ‘The home manager has an open door policy and a hands on approach to managing the home. We have a robust administrative system for managing residents’ money’. A system for evaluating the quality of the service provided is being introduced and includes consultation with residents. The manager recently carried out a questionnaire survey with residents which included feedback from some relatives. Information from the questionnaires has been collated, and information shows that : 74 of people felt their rooms were satisfactory 62 of people were satisfied with their meals and drinks 92 of people reported that they received excellent support in maintaining their privacy and dignity 97 of people were satisfied with the activities offered. The manager informs that other audits are being carried out at the home to ensure the quality of care delivered is monitored, for example, the home has made arrangements for the medication to be audited by a Primary Care Trust Pharmacist and states that plans are in place to carry out infection control audits as well as monthly quality audits of the home. When discussing supervision with staff it was noted that annual appraisals have taken place in the past but there is no formal supervision system. The manager agreed that currently formally documented supervision does not take place and there were no supervision records to review. As identified by the pharmacy inspection, management of medication must improve to ensure they are stored in compliance with their product licences, a quality assurance system must be installed to assess nursing staff competence in their handling of medicines and records are being completed appropriately. When requested, the manager was unable to provide us with Regulation 26 visits. Registered providers are required to carry out such visits at least once a month and records of the visits must be available and open to inspection. The home must ensure that all staff are aware of the lines of accountability in relation to safeguarding. This will help ensure that areas of concerns are addressed appropriately in line with the home’s policies and procedures in safeguarding people. There was evidence from a random check of records that equipment is regularly serviced and maintained health and safety checks are carried out. Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 27 A number of checks are made by staff to make sure that peoples health and safety is maintained. Records showed that the fire alarm system had been regularly tested and serviced to make sure that it was working properly. Records show that not staff have participated in fire drills in the past year. A gas landlord certificate was seen and showed that this is due to be carried out soon. As previously noted, people’s money is held in safekeeping by the home. Two peoples records were checked. Each transaction is being signed by staff as verification of money passed to people or spent on their behalf. Receipts are being kept as further evidence of money spent. Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 3 x x x x 3 x 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 2 Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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 OP8 Regulation 13 Requirement All areas of risk are identified, and appropriate plans in place to minimise Any risks. This relates specifically to supporting people with behavioural needs. This will ensure the appropriate and consistent care practices are used. All medicines must be stored in compliance with their product licences and in a locked facility at all times. This is to ensure the stability and safely of the medicines in the home 3. OP9 13 (2) The medicine chart must record the current drug regime as prescribed by the clinician. It must be referred to before the preparation of the service users medicines and be signed directly after the transaction and accurately record what has occurred. This is to ensure that the right Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 30 Timescale for action 31/10/09 2. OP9 13 (2) 31/10/09 31/10/09 medicine is administered to the right service user at the right time and at the right dose as prescribed and records must reflect practice. 4. OP9 13 (2) A quality assurance system must be installed to assess nursing staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribed and records do not reflect practice. This is to ensure that individual nursing staff practice is assessed on a regular basis and appropriate action is taken if audits indicate that nurses do not administer the medicines as prescribed. The service must ensure the polices and procedures relating to safeguarding people are followed by staff and management to ensure people are safeguarded from harm. This is to ensure that people are supported by staff who respond in a way that promotes their safety and protection. Regulation 26 visits must be carried out at least once a month by a registered provider. 31/10/09 5. OP18 38 30/12/09 6. OP33 26 30/11/09 7. OP31 This is to comply with the Care Homes Regulations 2001. Section 11 The manager must submit an Care application to become the Standards registered manager of the Act service. This is to ensure the manager takes action to comply with the DS0000004386.V377260.R01.S.doc 30/10/09 Bentley House Nursing Home Version 5.2 Page 31 Care Standards Act. 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 OP1 OP7 Good Practice Recommendations The home needs to ensure that the information provided to prospective residents details up to date information. Care files should contain the correct names of the people for whom the plans relate to. This will help ensure correct and consistent care is delivered individuals. Care plans for the people at the home could be improved to demonstrate a person centred approach to care planning. It is advised that two nurses write and check any hand written entries on a MAR chart. This is to ensure that they record all the relevant details such as date, dose, quantities received and any allergies. The home should take action to ensure there is appropriate levels of staff available at meals times to provide support to those who need it. This is to ensure people are able to enjoy their meals and benefit from a nutritious diet. All staff should have supervision at least six times each year and an annual appraisal. This is to help in staff development and ensure staff have the appropriate knowledge and skills to carry out their jobs. Staff should be involved in regular fire drills. This is to ensure all staff respond appropriately should there be a fire. 3 5. OP7 OP9 6. OP15 7. OP36 8. OP38 Bentley House Nursing Home DS0000004386.V377260.R01.S.doc Version 5.2 Page 32 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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