Inspection on 13/08/09 for Benvarden

This inspection was carried out on 13th August 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Benvarden 13/09/07

Benvarden 19/07/06

Benvarden 22/12/05

Benvarden 05/07/05

Benvarden 25/01/05

Benvarden 25/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

Key inspection report Care homes for older people Name: Address: Benvarden 110 Ash Green Lane Exhall Coventry West Midlands CV7 9AJ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Patricia Flanaghan     Date: 1 3 0 8 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 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. 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 Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Benvarden 110 Ash Green Lane Exhall Coventry West Midlands CV7 9AJ 02476368354 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: dorethdaly@tiscali.co.uk Ms Diane Hughes care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Benvarden may also care for the person named in the application for variation of registration dated 31 May 2006 Date of last inspection Brief description of the care home Benvarden is registered to provide residential care for up to 14 older people. Nursing care is not provided at Benvarden, community health care services and support are accessed through GP surgeries, district nurse services etc. The home is situated midway between the city of Coventry and the town of Bedworth and is close to the M6 motorway. Public transport is available from just outside the home; local shops and a post office are within walking distance. Benvarden is a converted large detached house providing domestic, homely accommodation. It has a dining room, two adjacent lounges and a large conservatory. There are 10 single bedrooms, six with en suite facilities and two double bedrooms with en suite facilities. There is a six-person lift, a laundry and domestic style kitchen. Care Homes for Older People Page 4 of 31 Over 65 14 0 Brief description of the care home The home has pleasant gardens with a patio overlooking a school playing field. There is car parking for visitors to the front and side of the home. At the time of this report the service user guide for the home stated that the weekly fees ranged from £380 and £400. This does not include extra services such as hairdressing, chiropody, toiletries or newspapers. The fee information given applied at the time of the inspection; persons may wish to obtain more up to date information from the service. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection visit and was unannounced. This means that the home were not aware that we were going to visit. The visit took place on Thursday 13 August 2009 between 10:00am and 5:00pm. The home manager was on leave, we were assisted throughout the inspection by one of the senior carers. The last key inspection visit to Benvarden was undertaken on 13 September 2007. An annual service review was carried out on 18 September 2008. This did not involve a visit to the service but is a summary of new information given to us, or collected by us, since the last key inspection. The inspection process concentrates on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. Care Homes for Older People Page 6 of 31 Before the inspection we looked at all the information we have about this service such as previous inspection reports, information about concerns, complaints or allegations and notifiable incidents. This helps us to see how well the service has performed in the past and how it has improved. An Annual Quality Assurance Audit (AQAA) was completed by the manager and returned to us. This document gives information on how the home thinks it is performing, changes made during the last twelve months, how it can improve and statistical information about staffing and residents. We also sent some surveys to people who use the service, their representatives and staff so they could let us know their opinion of the service. We received two completed surveys from relatives of people living in the home. Their comments are included in the report. During 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. Time was spent sitting with people in the lounge watching to see how they were cared for and how they spent their day. Discussions were held with people who use the service, staff and a visitor to the home. Information gathered was used to find out about the care people receive. We also looked at the environment and facilities and checked records such as care plans and risk assessments. Three people living in the home were identified for case tracking. This involves reading their care plans, risk assessments, daily records and other relevant information. Evidence of care provided is matched to outcomes for the people using the service; this helps us to see whether the service meets individual needs. The manager was not available on the day of the inspection visit. We were assisted in the inspection process by senior carers. An Expert by Experience accompanied us during part of the inspection to give their views on the home. An Expert by Experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a home with an inspector to help them get a picture of what it is like to live in or use the service. Their findings are also included in this report and used as evidence when determining the quality of service provided at the home. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Records need to clearly indicate any assessments undertaken by the manager prior to each persons admission. This is to demonstrate the needs of each person have been fully identified and considered and it is clear they can be met. Falls risk assessments must clearly identify the action staff must take to minimise any potential risk of the person falling. There should be a record of all complaints or concerns raised with the home and a record of the actions taken in response maintained. This will ensure that the home can demonstrate appropriate action has been taken to address concerns and safeguard people. All serious incidents affecting the well being and safety of people must be reported to us. Appropriate pre-employment checks must be obtained for all potential employees before they start working in the home. Without these checks the home are not able to demonstrate that they have employed appropriate staff suitable to work with Care Homes for Older People Page 8 of 31 vulnerable people. Records must be available to demonstrate that staff receive appropriate training so they have the skills and knowledge to support people who use the service. Although the home surveys people living there and their relatives, they do not seek the views of other stakeholders. There are also no audits in place to monitor staff working practice, health and safety, medication or care plans. Further work should therefore be undertaken on quality assurance systems so that they are not limited to surveying people living at Benvarden and their families. 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. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home is available to people so they can make an informed choice on whether to stay at Benvarden. People cannot always be confident they have their needs assessed before they receive the service. Evidence: The home has a service users guide which gives information about the care and services provided to help people make a decision on whether they would like to stay at Benvarden. This was in large print and contained details of services offered, fees and information about staff that work at the home. The expert by experience commented in his report, All residents I talked with said they would recommend the home. One resident said, the place is very nice, the staff are very nice; I couldnt ask for anything more. The AQAA forwarded to us by the manager stated that Prospective residents have a pre assessment document completed. Care Homes for Older People Page 11 of 31 Evidence: The senior carer described the pre admission assessment process. The service receives a referral from either a social worker, family member or the person themselves. The manager or a senior carer visits the person at home or in hospital and undertakes an assessment of their needs and abilities. Information is also provided by other health and social care professionals. This should mean that the manager has sufficient information to confirm whether peoples needs can be met. We looked at the care files of three people who were admitted to the home in the last six months to assess the pre admission process. There was no pre admission assessment available in one of the files. Staff were unable to locate the pre admission assessment for this person, therefore we cannot be sure that the needs of the person were identified before they moved into the home. Assessment records were available on the other two care files viewed and care needs identified had also been fully detailed in care plan records so these could be met by staff. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 are treated respectfully and have their care needs met, but cannot be confident that any risks identified are always appropriately managed. Evidence: We looked at three care files belonging to three people. Care plans and daily records were available for each person. Each care file contained details of the strengths and abilities of the person and identified some of their needs. The care files covered all the main areas of care including medical history, personal care, pressure care, nutrition, continence and mobility. Care plans were available for most of the identified needs of each person and supplied staff with the information needed to make sure the persons needs were met safely and appropriately. For example, one person using the service showed a reluctance to receive regular support from staff to maintain their personal hygiene. This had been clearly recorded in the care plan and staff had recorded in the daily records actions taken to ensure this is addressed regularly. Care Homes for Older People Page 13 of 31 Evidence: One persons mobility care plan did not include actions to minimise any identified risk of falls. For example, it was recorded at a review of the persons mobility care plan in August that X requires lots of attention and re-assurance, can become very confused towards the evening. Will lean at times, therefore Xs balance can become compromised at times. There was no guidance on how staff should re-assure the person and how to minimise the risk of falls. A recent daily recording for this person stated that X has become very confused and agitated this afternoon. Staff to discuss with GP their concerns about Xs aggressive behaviour and about lack of X sleeping through the night. We were unable to identify evidence as to whether a discussion had been held with the GP for this person and how staff should address any aggression or distress. This means that staff have no instructions about the actions they need to take to minimise any distress or agitation the person may experience. During our inspection this person repeatedly wanted to leave the home, but there was no written guidance for staff about how to manage this behaviour thereby helping them to know how to handle the situation in an appropriate and consistent way. Peoples records show they are supported to access other health and social care professionals such as GP, community nurses and optician. Risk assessment completed for the people case tracked include identifying the level of risk for people in relation to falls, nutrition, mobility and moving and handling. These were not always updated to include recent events. For example, one of the people had recently had a fall which necessitated a hospital visit. The person had also fallen while in hospital and was badly bruised. There was no evidence available to staff to advise them on how they could reduce the risk of further falls by this person. Risk assessments are completed in order to identify any areas of risk and enable staff to put appropriate strategies in place to reduce the risks, so that people live a meaningful life, risks are reduced and well being is promoted. Care plans were not person centered and reflect that the planned care had been discussed with the person and his or her family if appropriate. Daily report entries made were limited in the information they provided and did not show what support the person had received. Writing daily records should provide details of the care and support people living in the home have received to meet their health, personal and social care needs and so reflect a persons daily well being and quality of life. These records will then provide staff with the information they need to evaluate a persons Care Homes for Older People Page 14 of 31 Evidence: care and provide up to date information when reviewing the plan of care with the person and or their relatives. None of the files we looked at contained a life history or life story for the resident. This would provide useful information which gives staff an insight into the person, their life, likes and dislikes. It can also be used to initiate conversations between staff and the person. Staff spoken with were knowledgeable about the people in their care, but the lack of documented information describing their care needs means that there is a risk of inconsistent care being delivered to people living in the home. We audited the medicines of people involved in case tracking by comparing the quantity in stock against the signatures on the medicine administration records (MAR). The audits indicated that the medicines had been administered correctly. Prescriptions are ordered for the medication required each month and are returned to the home before they are sent to the pharmacy for dispensing. The home retains photocopies of each prescription, which means they can be compared to the Medicine Administration Records produced by the pharmacy. Arrangements are in place for the safe disposal of medicines. Staff maintain accurate records of receipt, administration and disposal of medicines so an audit trail can be made. We observed safe practice when staff administered medicines to people. People living in the home were observed to be treated with respect and their dignity maintained, for example, personal care was provided in private and people were spoken to respectfully. During observation of working practice it was evident that staff were knowledgeable about the likes and dislikes of people living in the home and were kind, caring and attentive towards them. People told us, The staff look after mum very well, Im happy here, and This home suits me well. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are some opportunities for people to participate in recreational activities. Visitors are made welcome, which supports people to maintain their important relationships. People benefit from a nutritious and varied diet and are given sensitive assistance to eat. Evidence: The AQAA tells us that Residents are encouraged to participate in as many activities as they can. A volunteer activities co-ordinator attends three times a week. She encourages the residents to participate in activities with her in a group, or in twos. If they refuse this, she will spend time individually talking with them, reading to them or giving them a hand massage. Those who are able, she will offer to take on short walks. The overall atmosphere in the home was friendly and relaxed. We spoke to a visitor to the home who told us that they were able to visit at any time and were made welcome. People are encouraged to maintain links with their family, friends and the local community. Representatives from a local church visit monthly. The expert by experience spent time in the lounge and chatted to people about their Care Homes for Older People Page 16 of 31 Evidence: experience of living at Benvarden. He reported, There was a visiting hairdresser, and in one instance a manicurist, which was paid for separately but which was appreciated. I was given to understand that occasionally a PAT (Pets as Therapy) dog visits. There was a volunteer who delivers activities about twice a week but none of the residents I spoke with either knew about these activities or appreciated it if they did know. There were no activities delivered while we were in the home. There had not been many organised outside trips (and one resident stated they had been in the home 3 years) but some residents said they thought that there was talk of an outside visit being organised this summer. Some said they sat out in the grounds, weather permitted. I observed staff and residents interaction and it was good. Residents said they liked the smallness and homely feel of the home. There is a file that details the involvement for each person. For the three people we looked at in detail, there was little information recorded, for example staff had sometimes simply recorded chat as an activity, but does not detail what they chatted about, for how long and if the person had enjoyed the chat. It was therefore difficult to know whether they had participated in any activities in the home. There was no information about their interests or preferences for how they spent their time. Also there was no information about their life history. A staff member told us that future outside trips planned includes a visit to Sealife and a theatre trip for a pantomime. We saw photographs of recent events, for example a Summer fete which was held in the garden and raised funds for peoples recreational activities. The expert by experience joined the people for a meal at lunch time. He reported All residents said the food was good and of adequate quantity. No one said there was a choice but said they were sure if they wanted an alternative then the cook would oblige. Breakfast mainly was cereal and toast but residents said they could have a cooked breakfast if they wanted. Lunch was the main meal of the day. Sandwiches and cakes were offered early evening. People spoken with said they enjoyed the meals. Comments included, I get enough to keep me going, Its all very nice, and Its home cooked and plenty of it. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know how to raise concerns but cannot be confident that any complaints will be taken seriously. Unsafe recruitment practices fail to safeguard people from potential harm. Evidence: The complaints procedure is displayed in the entrance hall. This ensures that people and their relatives will know the process they need to take to raise concerns. The procedure requires updating to incorporate up to date information regarding the Care Quality Commission. The AQAA tells us that there have been no complaints received by the home since the last key inspection. There is a complaints log, but the last complaint entered was in 2007. We were therefore unable to look at how well complaints were managed, as there was no information available from past complaints made. For example, a visitor to the home explained that he had not made any complaints, but said a family member had raised some concerns about the care of their relative and was not happy with the response. We could not find any evidence that these concerns had been acted upon as there nothing recorded in the persons file or in the complaints log. The expert by experience asked some of the people living there if they knew how to make a complaint about the service. He reported that No one said they had any complaints about the home itself, in fact, they were very positive. When asked if they knew how to make a complaint, there were many different answers from, Yes, I know Care Homes for Older People Page 18 of 31 Evidence: the procedure of how to complain. to No, I wouldnt know how to. to plain misunderstanding of the question. No conclusion could be made. The expert by experience also recommended that the complaints procedure is displayed in large print for the benefit of people with poor eyesight. The local adult safeguarding team made us aware of two incidents concerning people leaving the home without staff knowledge. These were investigated under local guidelines with the co-operation of the manager. Suitable responses and actions have since been taken by the home to address these. We had not been informed of these incidents by the manager, as is required by regulations. The home has an Adult Protection Policy detailing actions that must be taken if abuse of any form is suspected. It was evident from information received from the local adult safeguarding team regarding these incidents that the homes procedure had not been followed by staff. Staff were asked about the reporting procedure for allegations of abuse and it was evident that not all senior staff were clear on this process should the manager not be available in the home. The expert by experience said that a member of staff spoken with did not understand what the term whistle blowing meant, but would refer any concerns to the manager or a senior member of staff. All staff should be able to recognise and respond to suspicion or allegations of abuse to make sure that vulnerable people living in the home are safeguarded from potential harm. The home does not follow robust employment procedures when employing staff. We looked at the recruitment records for three staff members. We found that staff had started working at the home before appropriate checks had been received. For example, two satisfactory references had not been obtained for all three staff members and two started working in the home before the outcome of their Criminal Record Bureau clearance (CRB) was known. Records showed that one person had not worked as a carer since 2000, but a copy of the duty rota verified that they had immediately been rostered to work a night shift without evidence of any supervision by management of their care practices and before references and a CRB were in place. There was only one reference on the file for this person, which was not from their last employer. The staff member confirmed that they had not had any safeguarding training, although they had been employed for seven months. We also saw from the duty rotas that another member of staff has also worked shifts before their CRB or references were obtained. There was also no evidence that these people had had an induction before their first shift. We found gaps in employment histories on the application forms for two people. We could not find any evidence of how these issues had been explored. Care Homes for Older People Page 19 of 31 Evidence: Poor recruitment practice means that people cannot be confident that they are supported by appropriately checked personnel. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Benvarden provides the people who live there with clean and pleasant surroundings. Continued work is needed to keep the premises and furnishings safe, comfortable and fit for use. Evidence: The AQAA tells us that the homes plans for improvement in the coming twelve months are to continue decorating and upgrading where necessary The expert by experience toured the home and looked in some bedrooms, with peoples permission. He commented that the home looks a bit jaded and is in need of some refurbishment. Doors and skirting boards were scuffed and need rubbing down and repainting . Whilst the carpet in the hall, stairs, lounge and dining areas is of reasonable standard, the carpet in the conservatory was worn. Many of the bedroom carpets were stained, faded and rucked up in a few cases which could be a potential trip hazard. Some rooms needed re-painting. In one of the rooms the double glazing seal had broken and the glass was clouded. Also in this room, the window lock was loose and needed re-screwing. Our inspection evidenced that that there was an ongoing need for replacement of worn carpets and decoration. We noted however that the home was clean and odour free. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 cannot be confident that staff have all the skills, knowledge and experience to meet their needs. Evidence: On the day of inspection the manager was on leave. The inspection was therefore carried out with the support of the senior carers who were also required to support the care needs of the residents in the home. There were nine people living in the home at the time of this inspection. The senior carer confirmed that as the home was not operating at full capacity staffing levels had been reduced. We were told that the current staffing arrangements for the home on a daily basis consisted of one care assistant plus a senior carer from 9am to 10pm and one waking and one sleep in carer during the night. The manager works in a supernumerary capacity. Staff were busy throughout the day, but were caring and friendly towards the people living there. However, as some people required two staff to assist them with personal care there were times when the lounge was left for long periods without a member of staff. For example, while the two carers were assisting a person upstairs, one of the people in the lounge became agitated and encouraged another person with poor mobility to walk with them. Both people became very distressed and it was over ten minutes before the carers returned to the lounge. Care Homes for Older People Page 22 of 31 Evidence: The AQAA states that all staff who have started work in the home had satisfactory pre-employemnt checks. We found this not to be the case. We looked at three staff personal files. Staff files evidenced that rigorous staff recruitment checks necessary to ensure the protection of people had not been carried out before staff were confirmed in post. The outcomes of our findings are detailed in the Complaints and Protection section of this report. The home does not maintain a staff training schedule. We were shown the training log, but his was not up to date. We were unable to determine what training staff had received recently. From discussions with the staff team we established that some staff had received training in safe working practices, however, this was outstanding for new members of staff. For example, one staff member spoken with confirmed that they had not undertaken any fire safety or moving and handling training since their recruitment six months previously. The manager stated in the AQAA that 12 of the 14 permanent care staff have a National Vociational Qualification in care. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 cannot be confident that the service is always managed in their best interests. Evidence: The registered provider is also the registered manager of the home. The manager has relevant experience and qualifications for her role. People who work in the home told us that they feel well supported by the manager. The AQAA says that the home operates an open door policy and all people are encouraged to voice any opinions or concerns about the home. We looked at how the home monitors the quality of the service it provides. We found that there were a number of aspects of the running of the home that needed more careful attention such as the care plans, recruitment practices and the quality monitoring process. Quality assurance systems in place are limited to an annual satisfaction survey of people who use the service and relatives, with the latest survey being undertaken in January 2009. The manager had analysed the results but there Care Homes for Older People Page 24 of 31 Evidence: was no evidence that the results had been shared with people who use the service. The manager had not surveyed other stakeholders, for example, GP, District Nurse or Chiropodist. There are no formally documented audits taking place. There are no residents or relatives meetings. We were told that people do not appear to be interested in these meetings. Further work is required to improve quality assurance systems to ensure that the people who live at Benvarden are happy with the quality of service provided. The AQAA gave limited details about what the home have done well in the past 12 months. For example, under the heading Staffing there are only entries about the training staff have undertaken in the past year. There is no information recorded about staff numbers on duty or the recruitment process in the home. The AQAA has stated that documentation shows what the home does well under the heading Management and Administration. There is nothing listed under the plans for improvement for the coming 12 months. There are policies and procedures for the protection of peoples finances and the home does not act as Appointee for any service user, this is the responsibility of family members. We were told that people either pay themselves or their relatives are invoiced for any extra services such as hairdressing. A random sample of records were reviewed to evidence whether the health and safety of residents and staff is maintained. For example, the lift was serviced in July 2009 and the hoist had been serviced in February 2009. Portable appliances were tested in July 2009. We noted a number of health and safety hazards during the tour of the premises. The lavatory seat in the downstairs toilet was loose which may make it unsafe for people to use. One of the light switches in the upstairs corridor did not operate and as this area was dark, it was unsafe and could be trip hazard. We had had to walk to the other end of the corridor to switch a light on. A light bulb also needed changing upstairs. The manager should ensure that all areas of the home are free from hazards, as far as possible. The home had a recent routine health and safety inspection from the local authoritys environmental health office. It had identified that the floor in the laundry room was uneven and did not have a non slip surface. We saw that some work had been done by the manager to ensure that the floor was safe and an undertaken had been given to the local authority to action the issues raised in a timely manner. Care Homes for Older People Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Prospective residents must have a detailed assessment of their needs completed prior to their admission. This is so the persons needs can be clearly identified and the home can assess if these can be effectively met. 31/12/2009 2 8 13 Falls risk assessments must clearly identify the action staff must take to minimise any potential risk of the person falling. This will help to reduce the risk of the person being harmed through injury. 31/12/2009 3 18 37 All accidents and incidents that affect the well being and safety of people must be reported to us. This is so that any accidents or incidents affecting the well being of people are managed appropriately. 31/12/2009 Care Homes for Older People Page 27 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 18 13 Staff must be aware of the procedure to follow if an allegation or suspicion of abuse is reported to them, or if they are concerned abuse may have occurred. This is to protect the people living in the home from potential harm. 31/12/2009 5 18 19 Full and satisfactory 31/12/2009 information must be secured for all potential employees before they commence employment. This must include the outcome of a Criminal Records Bureau check, two references, one of which must be from their most recent employer. There must be evidence to show that any identified gaps in employment history has been explored. This will ensure that people who use the service have their health safety and welfare protected. 6 28 18 Records must be available to 14/01/2010 demonstrate that staff receive appropriate training. This is so they have the skills and knowledge needed to support people who use the service and people Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action benefit from having their needs met from suitably qualified and trained staff. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care plans for the management of peoples challenging behaviour should include specific details of the type of assistance they will need. This will ensure staff have guidance on how to handle the situation in an appropriate and consistent way. Care plans should be updated to show the changing needs of people living in the home. This will make sure that people have their current care needs met. Provision of activities should be further reviewed so that it can be evidenced that all people can benefit from stimulation on a regular basis. This will promote their health and well being. A life history of each person living in the home should be developed so that carers understand and can talk with them about their life experiences The complaints procedure should be reviewed to include our updated address and be available in large print. This is so that people have all the information they need should they wish to have their complaint investigated outside of the home. Clear recording systems should be in place to allow staff to record any concerns or complaints raised by people living in the home. This is to ensure that any complaints can be easily identified and the home can demonstrate appropriate action has been taken to address concerns and safeguard people. All areas of the home should be free for hazards, in particular broken light switches and light bulbs should be replaced. This is to ensure the health and safety of people 2 7 3 12 4 12 5 16 6 16 7 19 Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations who live in the home and staff. 8 19 The home should continue the refurbishment programme for those areas needing attention, for example, worn carpeting in the conservatory and bedrooms, chipped paintwork to stairs, door frames and skirting boards. This will ensure that people who use this service live in clean and pleasing surroundings. The carpets in the bedrooms must be maintained in a good state of repair to prevent people from tripping and falling where this is worn or poorly fitted. The home should action the requirements and recommendations of the health and safety inspection, of the laundry area in particular, by the environmental health office in a timely manner. This will ensure the health and safety of the staff and people living in the home. It is advised that an at a glance training schedule is devised showing all staff training completed and planned each year. This is so that it is clear all staff have completed the required training to provide safe care and services to the residents. The training schedule should be kept updated and show the dates when refresher training should be undertaken by. This will ensure that staff get their skills and knowledge updated regularly. Systems that will effectively monitor and audit working and care practice in the home should be introduced. These procedures must be ongoing and should include obtaining the views of stakeholders regarding the quality of service at the home. All issues that relate to the health and safety of staff and service users detailed in the main body of this report are addressed as a matter of priority. This is to ensure the health and safety of people who use the service. 9 24 10 26 11 28 12 33 13 38 Care Homes for Older People Page 30 of 31 Helpline: 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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