CARE HOMES FOR OLDER PEOPLE
Benton House Nursing Home Gattison Lane Rossington Doncaster South Yorkshire DN11 0NQ Lead Inspector
Ian Hall Key Unannounced Inspection 12th March 2007 07:50 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 Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Benton House Nursing Home Address Gattison Lane Rossington Doncaster South Yorkshire DN11 0NQ 01302 864979 01302 863435 None 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) Union Healthcare (North) Limited ** Post Vacant *** Care Home 36 Category(ies) of Dementia - over 65 years of age (36), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (36) Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A maximum of three persons between the age of 60 years and 65 years may be accommodated to receive Nursing Care or Residential Care, be accommodated in the categories DE(E) and MD(E) within the total of 36 registered beds. One specific service user under the age of 60, named on variation dated 20th November 2006, may reside at the home 19th April 2006 2. Date of last inspection Brief Description of the Service: Benton House Care Home is situated in the village of Rossington near Doncaster. It is within reach of local shops, a post office, church and other local amenities. The home is registered to provide both nursing and personal care for up to 36 service users in the category of older people with dementia and mental disorder. Benton House is an extended detached house. It provides its accommodation on two floors. There is a passenger lift to provide access between floors. The communal areas are located on the ground floor and comprise two lounges, a smoker’s room and a dining room. The kitchen and laundry facilities and office are also found on the ground floor. There is a garden at the rear of the building with limited parking available at the front of the building. Information about the home and services available is detailed within the homes Statement of Purpose and Service User Guide. Information gained on the 12th March 2007 indicated the current fees range from £420.00 for personal care to £470.00 plus the free nursing care component for nursing care. Additional charges are made for hairdressing and chiropody. These fee charges only applied at the time of inspection, more up to date information may be obtained from the home. Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over seven and a half hours on the 12th March 2007. The emphasis of the inspection was placed upon meeting service users, a visitor and the staff team. The inspector toured the site to observe the redecoration and refurbishment that had taken place since the last inspection. The inspector case tracked 3 service user files and associated records. What the service does well: What has improved since the last inspection?
Communal areas had been redecorated with some items of furniture and soft furnishings renewed. Corridor walls had been redecorated and lighting improved. The laundry area had been enlarged, insulated and provided with easily cleansable wall surfaces. Service users whose rooms had been redecorated and refurbished were happy with the outcome; they were pleased to have been offered a choice of colour scheme. Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 3, 6. The home had written information describing the service for potential service users and their relatives. Assessments of service users had been completed prior to them moving into the home, these are required to ensure that the home and staff were able to meet their needs. The staff team had received a range of training to ensure that they understood the needs of service users and were equipped to meet them. EVIDENCE: The three case records examined had copies of pre-admission service user care assessments. These provided a detailed picture of each service user and their physical, psychological and social needs. These were needed to ensure that the Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 9 home is suitably equipped and able to meet prospective service users care needs. This assessment had been used to compile the initial care plan. A visitor and one service user were able to confirm that they had been involved in the choice of care home, and had taken the opportunity to visit before making a decision to live at Benton House. Case files inspected contained a copy of a contract/statement of terms and conditions. These detailed the fees, including any extra charges, and the facilities and standard of care service users can expect to receive. Intermediate Care is not provided at Benton House. Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 7, 8, 9, 10, 11. Service users were well cared for. There were written care needs assessments and care plans in place to identify what help and support service users needed. The medication system was well managed with policies and procedures in place to guide staff and protect service users. EVIDENCE: Care records of three service users were inspected. A number of recognised assessment documents had been used to measure service user needs. These included mobility, mental ability, state of nutrition, and areas of risk such as falls. These provided a baseline for staff to assess service user progress or increasing level of need. This enabled staff to plan the help and support service users needed. Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 11 Reassessment of service users and their changed needs were appropriately recorded. Daily records were made of the care and activities provided for each service user. Details of service users religious and cultural needs and the gender of staff that they wished to support them with their personal care were clearly identified. The visitor spoken with was able to confirm that they had been involved in making the care plan and that they could have access to them whenever they wanted. Lockable facilities were provided within bedrooms for service users who were able and wished to retain control of their own medication. Records were kept of medication received, and disposed of. Medication was securely stored and administered according to the doctor’s instructions. Records of medicines given were completed in full and correctly. Staff were observed assisting service users to take their medication safely. The manager confirmed that the supplying chemist provided guidance and support for staff to ensure service user safety. Policies and procedures to inform staff and protect service users taking medications were current and available for inspection. The visitor spoken with was most complimentary and clearly stated his great satisfaction with all aspects of the care and services that staff provided at Benton House. Service users who were able to confirmed that “staff were angels” and that “they were very helpful”. Service users said that the staff respected their privacy. The inspector observed staff knocking on bedroom doors and waiting to be invited in before entering. Relatives meetings had been held and minutes of these meetings were available within the home. Discussion with three service users and four staff identified that a range of health professionals visited the home to assist in maintaining health care needs. These included community psychiatric nurses, district nurses, chiropodist and general practitioners. Detailed records of these visits and their outcome had been made following each visit. A wide range of aids to assist service users with mobility problems were provided; these included lifting hoists, walk in showers, assisted baths, walking frames and wheelchairs. Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 12, 13, 14, 15. A visitor and service users said that suitable activities provided at the home to keep them stimulated Visits from relatives and friends were encouraged ensuring that service users kept in touch with people who were important to them. A visitor and service users said the food was good and they were offered choice; special dietary needs and preferences were recorded in the individual care plans. EVIDENCE: Service users confirmed that they were able to go to bed and rise as they chose. Breakfast was being served throughout the morning to service users who had chosen to stay in bed longer. Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 13 None of the service users currently leave the home unless accompanied by members of their family or staff. Links had been established within the local community in particular with the local Labour Club. Staff accompanied service users to places of local interest weather permitting. There was a relaxed atmosphere throughout the home with service users observed to be reading, listening to music and watching television. Dedicated staff were employed to organise activities that stimulate service users and encourage social interaction. Entertainers visited the home for the benefit of service users. The breakfast and lunch offered to service users both appeared and smelled appetising. It was served hot, was well presented with a good choice being offered. Several service users who required them had special diets provided for health reasons. Staff were observed to encourage and assist service users with meals as needed. Mealtimes were unhurried; meal size was in accordance with service user choice with extra portions available as required. The cook was observed preparing and baking cakes and buns for service users. She confirmed that these were freshly made each day. Service users said they enjoyed them with their cups of tea and there was always plenty to eat. A list of birthdays had been provided for the cook who said she prepared birthday teas for service users. The menu was displayed in each dining room there were records of service users choice of meal or amount of diet consumed. Service users dietary likes and dislikes were known to staff to enable them to choose meals for service users who were unable to express their preferences. The dietician had assisted with compiling the balanced diet. Adapted cutlery was available to assist service users to maintain their independence. Service users weights were recorded regularly to monitor their health and wellbeing. Service users and staff confirmed that foods and drinks were provided throughout the day and night time as needed. Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 16, 18. The home had a complaints procedure to allow service users to raise any concerns. The staff had been trained in the recognition and reporting of abuse and relevant checks were made prior to them starting work, this reduced the risk of harm to vulnerable service users. EVIDENCE: One complainant had brought a number of concerns to the manager’s attention. One element of these concerns that had been investigated was founded in part. Prompt action had been taken to deal with these concerns within the home’s policy and procedure. The acting manager was waiting for a response from the complainant to be able to conclude the matter. The complaints procedure was available for service users, their relatives and staff. Staff had been provided with training in adult protection procedures to ensure service users were safe, and to inform staff what to do if an allegation was made. The inspector’s discussions with staff demonstrated that they felt confident and able to respond to concerns or complaints competently. Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 19, 20, 24, 26. The home was clean, tidy and was maintained to ensure that service users live in safe surroundings. The bedrooms were comfortable, clean, homely and reflected personal choice. Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 16 EVIDENCE: Service users said the home was always clean, warm, well lit and there was always enough hot water. Lighting in corridor areas was by means of fluorescent lighting fitments; these were being replaced with domestic lighting to provide a softer light and less institutional appearance. Corridors had been repainted areas of worn carpet were yet to be replaced. Lounge and dining areas had been redecorated with new furnishings as required. Work was continuing to refurbish and update the décor and furnishings. Soft furnishings, pictures, flowers and ornaments were used throughout the home to provide a homely domestic setting. The staff call system had been renewed to enable service users to summon assistance when they required it. Bedroom doors were marked and damaged and required painting. A number of bedrooms continue to require redecoration and refurbishment. Visitors and service users whose bedrooms had been redecorated were pleased to have been offered a choice of colour scheme. The bedrooms had been provided with new carpets, matching curtains, bedding and soft furnishings. Service users and visitors had personalised their rooms with a variety of items of their choice including photographs and other mementoes. Bedrooms were lockable with keys available for service users who wished to exercise their choice and lock their own door. There was no written schedule of work available to demonstrate the companies planned redecoration and refurbishment programme for Benton House. There was level access throughout the home with handrails provided to assist service users to maintain their independence and mobility. A passenger lift was provided in addition to the staircases to enable service users to access the first floor bedroom area. Toilets were easily accessible as they were close to both lounge and dining areas. Toilets had been adapted for service users with physical disabilities. The toilets were equipped with door locks promote service user privacy and independence. There was an adequate number of baths, assisted bathing facilities were provided in convenient locations for service users. Bathing and toilet facilities had been upgraded to a high standard, staff had provided homely features to provide a warm and welcoming environment. Hot water temperatures were restricted and regularly checked in accordance with Health and Safety requirements to ensure service user safety. Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 17 The laundry area had been extended and refurbished to improved lighting, ventilation and included readily cleansable surfaces. Additional works including shelving were yet to be completed. These improvements reduced the risk of cross infection and provided a safe environment for service users and staff. Staff confirmed that protective clothing was readily available whenever they needed it. Clinical waste was properly managed and stored. Appropriate seating has been provided in the secure garden for service users wishing to sit outside whenever the weather permitted. Service users that use this area could feel safe as they could easily observe and be observed by staff. Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 27, 28, 29, 30. Adequate numbers of staff were deployed to meet service user’s needs. Staff had received statutory training to help them meet the needs of service users. Checks had been made on staff to reduce the risks to vulnerable people. EVIDENCE: Sufficient staff were available to meet service users care needs. Additional staff were on duty to undertake housekeeping, laundry and maintenance tasks. Dedicated staff were provided whose responsibility is to provide activities for service users. Staff confirmed that they were well supported in their work with a trained nurse always being on duty. The staff files examined confirmed that CRB checks and correct company staff recruitment policy and procedures had been followed in each of the three files selected for inspection. Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 19 The staff training and development plan was examined and was seen to identify staff training needs, courses completed and courses being undertaken. Staff spoken with confirmed they had undertaken statutory training and updates e.g. moving and handling, fire prevention. They were involved in national vocational qualification training and dementia care training. The numbers of staff trained to level 2 NVQ in care exceeded the minimum 50 required by The National Care Standards Act 2000 and the associated Regulations. Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 31, 33, 35, 38. Staff said the acting manager was supportive and approachable and there was a well-established system of professional supervision. Service users were involved in making decisions about their care and had control over issues that affected their lives. Checks had been made on the major systems in the home such as fire and gas installations to ensure the home was safe for service users. Fire training had been provided for staff to reduce the risk to service users in an emergency. Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 21 EVIDENCE: The acting manager is an experienced trained nurse who is working towards her NVQ4 and registered managers award. She is well supported by trained qualified nurses in charge of each span of duty. The service users and staff spoken with said the acting manager was approachable, very professional and they had complete confidence in her. The homes management employed a range of methodologies to measure service users satisfaction with the care and services provided. This included a company self-assessment quality assurance system this was audited by the area manager. Results of the recently conducted surveys had been analysed and comments used to further develop the service. Regular service user and staff meetings are held with minutes being kept that were available for inspection. There are monthly monitoring visits made to the home by the area manager who submits detailed written reports of their monitoring visits to the company and CSCI (Commission for Social Care Inspection). All staff had received management supervision, this had taken place at planned intervals; this is required to fully ensure individual staff development and monitoring care practices. Staff had received training on moving and handling, first aid, fire prevention, food safety and infection control. This ensured staff were prepared for their roles and responsibilities to meet service users needs and maintain their safety. The manager handles money on behalf of some service users, account sheets were kept, receipts were available for all transactions, and all transactions were witnessed by a second individual. Records were up to date and well ordered to ensure the best interest of service users. The homes policies and procedures met the required standards. Statutory servicing and checks of equipment were complete. Health and Safety at Work risk assessments had been undertaken and reviewed regularly. The Health and Safety Executive had conducted an unannounced inspection of Benton House and were satisfied with the actions that had been taken to maintain service user safety. Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 x x x 2 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 23 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 OP19 Regulation Requirement Timescale for action 24/01/08 2. OP20 3. OP24 4. OP19 13, 16, 23 The registered person shall ensure that the premises are kept in a good state of repair both internally and externally. Previous requirement not met 24/01/07 13, 16, 23 Lighting at the home must be domestic in character, changes of fluorescent corridor lighting fitments were incomplete. Previous requirement not met 01/08/05, 01/02/06 and 28/02/07 13, 16, 23 The registered person shall provide in rooms occupied by service users adequate furniture, bedding and other furnishings, including curtains and floor coverings, and equipment suitable to the needs of service users. Replace worn and damaged items of furniture and carpets. Previous requirement not met 01/10/05, 01/02/06, 30/09/06 and 30/01/07 24 Provide a written schedule of work detailing anticipated start
DS0000015851.V327153.R01.S.doc 01/06/07 24/01/08 01/07/07 Benton House Nursing Home Version 5.2 Page 24 and completion dates for each planned area of redecoration and refurbishment works for Benton House. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP31 Good Practice Recommendations The acting manager should submit her completed managers registered application by 01/06/07 Benton House Nursing Home DS0000015851.V327153.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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