Inspection on 14/04/05 for Benton House Nursing Home

This inspection was carried out on 14th April 2005.

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

Benton House Nursing Home 01/10/08

Benton House Nursing Home 06/02/08

Benton House Nursing Home 12/03/07

Benton House Nursing Home 19/04/06

Benton House Nursing Home 12/10/05

Benton House Nursing Home 08/12/04

Benton House Nursing Home 14/09/04

Benton House Nursing Home 07/02/04

Similar services:

Whiteley House

Tyndale Avenue

2-10 Norfolk Road

Bennfield House Nursing Home

Eastfield Residential Home

Sign Health

Springwood

Fairburn Mews

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

CARE HOMES FOR OLDER PEOPLE BENTON HOUSE Gattison Lane Rossington Doncaster South Yorkshire Lead Inspector Gordon Chivers Unannounced 14 April 2005 09:00. The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. BENTON HOUSE Version 1.10 Page 3 SERVICE INFORMATION Name of service Benton House Address Gattison Lane Rossington Doncaster DN11 0NQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01302 864979 01302 863435 Roy Bernard Susan Carol Bennett Care Home with Nursing 36 Mental Disorder over 65 Category(ies) of Dementia over 65 registration, with number of places BENTON HOUSE Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: A condition of registration is that only one nmaed person under 65 may reside at the home That Mrs Bennett acquires the relevant management qualification in line with the National Minimum Standards (Older People) That Mrs Bennett acquires training on mental health nursing. That the home appoints a full time, named, first level registered mental health nurse to oversee the provision of mental nursing care to service users Date of last inspection 8th December 2004 Brief Description of the Service: Benton House Care Home is situated in Rossington, Doncaster. It is within reach of local shops, a post office, a 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 facilitate access between the floors. The communal areas are located on the ground floor and comprise of two lounges, a smoker’s room and a dining room. The kitchen and laundry facilities and the office are also found on the ground floor. There is a garden at the rear of the building and parking spaces are provided at the front. BENTON HOUSE Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over eight hours from 9.00 a.m. to 5.00 p.m. The inspection consisted of a tour of the home, an examination of key documents such as case files, personnel files, policies and procedures, records of inspections, tests and maintenance, and other records kept by the home, and interviews with service users, a relative, staff and management What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. BENTON HOUSE Version 1.10 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection BENTON HOUSE Version 1.10 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Service users are admitted to the home on the basis of full assessments of their needs which ensures that the staff are aware of their care needs and able to meet them. EVIDENCE: The case file of a service user who was admitted to the home two months ago contained full personal details, full assessment of need and risk assessments. However, the file was not explicit that this was a trial placement and no date had been set for a formal review to decide upon permanency. During the course of the inspection, the relatives of a prospective service user were given a thorough tour of the home. BENTON HOUSE Version 1.10 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 The home produces thorough care plans; but have not undertaken reviews on a monthly basis or involved service user’s representatives in reviews. Therefore staff may not have up to date information of the care needs of the service users. This could lead to service users not receiving the correct care. The home’s procedures for the administration of medication are implemented fully therefore safe guarding service users. The daily records in case files demonstrate the appropriateness of the care provided to service users near the end of life, and so staff are able to care for them and their family in a sensitive manner. EVIDENCE: All the case files examined contained a care plan which linked assessed needs to care objectives to action by staff. This information also contained assessments of and plans to meet service users’ health, cultural and social needs. However, not all care plans are being reviewed on a monthly basis, and relatives are not involved in these reviews. BENTON HOUSE Version 1.10 Page 9 The case files contained extensive information regarding service users’ health needs and how they would be met. Contact with health care professionals is recorded. Policies and procedures for the administration and management of medication are in place, which are fully implement by the home’s management and nursing staff. All medication is stored appropriately in a secure treatment room. Five of the senior care staff who support the nurses in the administration of medication are currently undertaking accredited training. Staff relate to service users with respect and courtesy, and demonstrate patience and understanding. This was confirmed by service users and their relatives. Locks have now been fitted to all bathrooms and toilets to protect the privacy and dignity of the service users. The case files revealed the care and comfort given to service users in the last days/weeks of life. Evidence of sensitivity shown towards relatives during and after this time was also recorded. All case files now contain records of service user wishes regarding their funeral arrangements based upon information provided, in many cases, by their families BENTON HOUSE Version 1.10 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,15 The home provides a range of activities which are relevant to the assessed needs of service users which makes their days enjoyable. Meals are balanced and nutritious and taken in a well-decorated dining room, and so service users nutritional needs are met and meals taken in a comfortable environment. EVIDENCE: There is an activities organiser who develops activities based upon the needs and care objectives of service users. The work and records of this Activities Organiser are integrated with the case file and care plan and taken into account at time of review. There is a specific activities room where work is done with service users on a one to one and small group basis. Outings and entertainment are provided. The religious and cultural needs of service users from ethnic minorities are well documented and records show how these can inform basics lifestyle issues such as diet and dress, and how staff, sometimes in conjunction with families, meet these. BENTON HOUSE Version 1.10 Page 11 There is a fortnightly menu which is changed from time to time and service users are invited to choose the set meal or an alternative. A balanced and varied diet is always available. Service users influence the menu planning through their expressed likes/dislikes and also a record kept by the cook of the service users’ choice sheets which reveal patterns of consumption and avoidance. The speech therapist also recommends staged diets based on her professional assessments. One service user interviewed said the food was good. Meals are taken in a well decorated and well furnished dining room, although the tiles beneath the serving hatch are in need of replacement. BENTON HOUSE Version 1.10 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,18 The Complaints. Procedure is correctly implemented therefore enabling service users and their family to express any concerns and problems resolved. Those service users who wish to vote have been supported in so doing enabling them to participate in public issues that effect their life. The manager is investing in training its staff in the awareness and prevention of abuse of vulnerable adults, which will ensure that service users are protected from harm and abuse. EVIDENCE: There is a complaints procedure, which references the CSCI. The complaints record book shows that the two complaints received over the last year were investigated and dealt with correctly by the manager Since the last inspection the manager, with the support of Social Services has now enabled those service users who wish to vote and who are capable of making an informed decision to cast their vote. The manager has devised a form using symbols to enable service users to more fully understand how to vote and how to choose between candidates. This same format has been utilised in other aspects of life in the home such as in care planning and in choosing activities. The manager has undertaken the local authority Adult Protection training. It is her intention to cascade this training down to the home’s staff. All staff are undertaking an Abuse Awareness training course at Doncaster College. There are no staff on the POVA list. One relative commented upon how well staff cope with aggressive behaviour from service users. BENTON HOUSE Version 1.10 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21,22,24,25,26 Although improvements have been made to the decoration and the furnishings over the last 12 months, further improvement is needed to ensure that service users have living accommodation that is comfortable and homely. The lack of specialist equipment for all services uses could affect the well-being of the service user and staff. EVIDENCE: Union Healthcare have indicated an intention to improve the decoration and furnishings of the communal areas and some improvements have been achieved in the last twelve months. However bathing and toileting facilities remain in need of upgrading as do the staircase carpet, hallway and visitors lounge. A concerted effort is underway to bring the bedroom décor and furnishings up to the required standard. BENTON HOUSE Version 1.10 Page 14 The home is clean and hygienic. Union Healthcare are awaiting quotes for a new impermeable finish to the laundry floor and walls. The kitchen and the food store are in good order and well equipped, although the edging strip at the junction of the floor and walls of the kitchen requires a new sealant. The Company agreed in January to submit an action plan to the CSCI indicating areas of refurbishment that would be carried out with timescales. This has not yet been received. A new parker bath has been fitted in one of the downstairs bathrooms and the two toilets adjacent to the lounge have had new floor covering Aids and adaptations such as mobile hoists, handrails along corridor walls, a passenger lift and radiator guards are in place. Some individual service users have had personal assessments leading to specialist equipment being provided. However there is an absence of some specialist bathing and toilet facilities such as grab rails and supports around the toilets upstairs which effectively prevent service users on this floor from using them. Most beds now have new headboards, and quotes have been sought for new bedroom furniture and lockable cabinets. Large notices pinned on bedroom walls represent an institutional culture. Lighting and ventilation appear adequate and there is emergency lighting throughout the home. The sprinkler type taps in service users’ bedrooms have been replaced, and in so doing all the pipes have been replaced. The home is clean and tidy, and there are procedures in place for the control of infection. Some of the old armchairs in the lounge and bedrooms emanate an unpleasant odour. An additional handyman has now been employed to manage the maintenance of the home. BENTON HOUSE Version 1.10 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28 Over 50 of the care staff have qualified to NVQ level 2, so that staff now have the skills and competencies to n]meet the needs of the service users. EVIDENCE: Of the fifteen care staff in the home, ten have achieved NVQ level 2 and three are currently undertaking the course. BENTON HOUSE Version 1.10 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,35,36,38 The manager will have achieved her qualification in Management by June 2005, which will give her the competencies to manage the home effectively so safeguarding the service users and staff. This will also ensure that policies and procedures are followed by staff. The current systems for monitoring and improving upon the quality of the care systems, environment and management systems of the home are underdeveloped and so does not enable service users and their family to have an opportunity to express their views and so influencing how the home operates. Case files and the personnel files are monitored by the manager to ensure policies and procedures are adhered to and to enable her to identify where improvements are needed in these areas. The manager has a very good system for meeting the training needs of its staff ensuring staff have the necessary skills to provide the care service users require. BENTON HOUSE Version 1.10 Page 17 Once fully developed the new supervision system will help support the training programme, which will be further enhanced once the appraisal system is developed. EVIDENCE: The manager has made a considerable improvement to the care practices and management systems of the home. Union Healthcare have reviewed the manager’s supernumerary hours, but have concluded not to increase them even though the manager remains of the opinion that she has insufficient hours to fulfil all of the management and administrative duties. The manager has worked to develop a culture of continuous improvement amongst the staff who would appear to have taken it on board and are contributing ideas and suggested improvements. Staff meetings are minuted and also provide information. The manager has had little success in eliciting the opinions of relatives and representatives of service users. There is an undated Business Plan, but none of its objectives appear to be current. Many of the service users personal allowances are managed by the staff and a record of all transactions is kept together with all receipts. However, not all the entries have been witnessed by two members of staff, and there is no record of these records having been audited. The manager has developed a training matrix for the home as a whole which identifies the training staff need, the training staff have had, and the training staff are currently undertaking. Staff interviewed referred to the emphasis now placed upon training. The manager has also recently developed and implemented a formal supervision system. However, this is in its infancy, and not all staff fully understand it or have had supervision on a regular basis. The manager is considering delegating some supervisory duties to senior staff. There is no formal appraisal system in place, nor do staff have Personal Development plans The manager has undertaken a risk assessment of thirty-one different aspects of the home. She has involved members of staff in a review of these assessments currently underway. Staff receive training in all aspects of health and safety, and there are records of fire drills. An inspection by the Fire Prevention officer in March, 2005 identified that the seals around the fire doors were in need of replacement, and this work was being carried out on the day of the inspection. The home has an Accident and Incident file which retains copies of all notifiable incidents. BENTON HOUSE Version 1.10 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x 2 2 x 2 3 2 STAFFING Standard No Score 27 x 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 x 2 x 2 2 x 3 BENTON HOUSE Version 1.10 Page 19 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 14,15 Timescale for action All care plans should be reviewed 1st June every month and representatives 2005 of the service users should be involved occasionally. The action plan for the 30th June refurbishment of the communal 2005 areas required by the last two inspections must be submitted to CSCI immediately; and that action plan must not include any unacceptably long time frames for any of the identified work to be completed. (Previous immediate time scale not met). The bathing and toileting 1st August facilities should be refurbished 2005 and redecorated by the date given by Union Healthcare. All bedrooms should be 1st October redecorated, have new carpets, 2005 headboards and lockable facilites, and old furniture replaced. The laundry room must be 1st October provided with impermeable floor 2005 finishes and readily cleanable wall finishes. (Previous timescale of 30/11/04 not met). The edging strip at the junction 1st July of the floor and walls of the 2005 kitchen requires a new sealant Version 1.10 Page 20 Requirement 2. 19 23 3. 21,22 12,23 4. 24 23 5. 26 23 6. 26 23 BENTON HOUSE 7. 33 24 8. 35 17 9. 36 18 A formal system for monitoring the opinions of service users and their representatives should be developed, and this information combined with other sources be used to develop an annual Business Plan. All recorded transactions of service users personal monies administered by the home should be witnessed by two members of staff. Staff should be formally supervised at least six times per year, and a staff appraisal system should be developed. 1st.August 2005 1st June 2005 1st July 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard 3 19 24 27 31 35 Good Practice Recommendations At the beginning of a trial placement, the refering social worker, the home and the service user should agree a date for the formal review of that trial placement. The room set aside for service users to meet visitors in private could be made to look more welcoming. Staff should desist from pinning notices in service users bedrooms. The area manager and the manager should continue to review the range of managerial and administrative tasks and the time available to undertake these effectively. The manager should ensure that she acquires the relevant management qualification by 2005 The area manager should audit the records of service users personal monies administered bythe home. BENTON HOUSE Version 1.10 Page 21 Commission for Social Care Inspection 1st Floor, Barclay Court Heavens Walk Doncaster DN4 5HZ 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 BENTON HOUSE Version 1.10 Page 22 - 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. 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