Inspection on 19/07/06 for Benvarden

This inspection was carried out on 19th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Benvarden 13/08/09

Benvarden 13/09/07

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Benvarden 110 Ash Green Lane Exhall Coventry West Midlands CV7 9AJ Lead Inspector Sheila Briddick Key Unannounced Inspection 19th July 2006 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Benvarden DS0000004212.V298705.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. Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Benvarden Address 110 Ash Green Lane Exhall Coventry West Midlands CV7 9AJ 02476 368354 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) Ms Diane Hughes Ms Diane Hughes Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Benvarden may also care for the person named in the application for variation of registration dated 31 May 2006 22nd December 2005 Date of last inspection Brief Description of the Service: 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, 6 with en suite facilities and 2 double bedrooms with en suite facilities. There is a 6-person lift, a laundry and domestic style kitchen. 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 fees are currently set at £340 - £360 per week. Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection took place over one day and commenced at 08.30am on Wednesday, July 19, 2006 and finishing at 3.00pm. A second visit was made on Thursday, July 20, 2006 at 12.30pm to give feedback of the inspection findings to the Manager. The inspection involved: • • Discussions with the Senior Person and care workers in the home at the time. Three service users were identified for close examination by reading their, care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for residents. A tour of the environment was undertaken, and records were sampled, including staff training, health and safety, rotas and fire records. Interactions between service users and staff were observed. The views of two staff were sought at interview. The views of three visiting relatives were sought through informal discussion. The views of service users, including two whose care was being ‘case tracked’ were sought through informal discussion. • • • • • Finally, feedback took place with the Senior Person on duty at the time about the inspection findings. What the service does well: The service is focussed on providing a homely and caring environment in which older people can feel well cared for and safe. Discussions with the people who live in the home and visiting relatives confirmed that this is done well with the following comments being made; • • • ‘Staff are fine’. ‘I can’t fault the place’. ‘There is always plenty of staff’ DS0000004212.V298705.R01.S.doc Version 5.2 Page 6 Benvarden • • • • • • ‘Our things are secure’. ‘We visit regularly and are always happy’. ‘My mother has all the equipment she needs’. ‘I have no concerns I am kept informed and have options’. ‘The staff all know what they are doing’. The manager is good – she has made a difference’. A member of the Health Team involved with the service informed the Commission that ‘It is always a pleasure to visit this home. You should use it as an example’. Staff practice observed was sensitive to older peoples needs and carried out in a manner that respected dignity and promoted independence. What has improved since the last inspection? The admissions process has improved in that service users are now informed in writing as to whether the home is able to meet a prospective service user’s needs or not. Steady progress is being made to improve care planning so that staff have sufficient information necessary to meet identified needs, that this is reviewed with them regularly and that daily records are up to date. Medicine management has improved to a safe level. The registered manager has worked hard to implement good systems in the home and was keen to improve practice further. Service user now have a choice at mealtimes and a record is made of their choice, which supports nutritional assessment. People can hear the front door bell clearly now from all areas of the home and service users can easily locate areas within the home by following signage in place to assist with their orientation. Equipment is in place over radiators to protect people from hot surfaces and hot water outlets are regulated so a safe temperature can be maintained, although this has not resolved water pressure problems. Infection control measures in the laundry area have improved and staff are adhering to changed procedures. The duty rota clearly indicates when care duties are completed by staff and when their hours spent in the home are for cleaning or laundry duties. This demonstrates that sufficient care hours are being provided at all times. Recruitment practice is ensuring that people living in the home are protected from harm by the people caring for them and this includes POVA and Criminal Record Bureau, (CRB), checks taking place prior to employment being offered. Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 7 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. Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people coming to live in this home can be sure that they will not do so without an assessment of their needs taking place and that they will receive confirmation of this in writing. The care staff team however do not always have the necessary knowledge regarding individual and specific care needs. EVIDENCE: The assessment process for this service is based on the Care Management Assessment of needs for Older People and involves the service user and appropriate family members. The process for a recent admission was looked at as part of the case tracking of three service users individual care needs during this visit. A Care Plan Programme Management assessment had been obtained by the home prior to the person coming to live there and this was forming the basis of the care planning being put into place to meet the identified needs. Basic care plans Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 10 were already in place for supporting the service user regarding their personal care needs, mobility and health and social care needs. The service user was met with during the visit and their views were sought about life in the home. They indicated that staff were “fine and felt that they understood their needs and were meeting them adequately. This was confirmed during discussion with two staff who were fully aware of the service users specific health-care needs however, a third staff member spoken with was not fully aware of the specific needs of the service user. The specific care needs of each service user must be fully understood by the people supporting them as without this knowledge service user’s care may not be appropriately, or safely met. The admissions process now includes a format for informing service users whether the home can meet their needs, or not, following their assessment period in the home. This confirmation takes place at the first review meeting and in writing both to the service user and family members. Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of care planning continues to improve steadily with the manager and staff demonstrating a commitment to continuing improvement so that that the assessed and changing needs of service users is be fully understood and met by the staff team. The staff have worked hard to improve the medicine management within the home. Robust procedures have been installed since the last inspection. The majority of the requirements since the last inspection have been met. EVIDENCE: Three care plans were examined on this occasion and progress in the detail on care planning since the last inspection visit has included assessment of risk for individuals and how these are to be managed. Care plans detail individual care needs and there is a section for detailing the staff action required to address specific needs however, further work is necessary to ensure that this is sufficient so that needs can be met safely and consistently. Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 12 Staff spoken with demonstrated that they had a very good knowledge of the individual needs of service users this included an awareness of the risks involved when supporting them with their health and personal care. New staff spoken with however were unaware of the specific mental health care needs of a service user were risks to their health and welfare had been identified as high and specific support was required. Service users spoken with were happy with the care they were receiving and indicated individual and preferred choices were respected. Comments included, ‘we can have a bath or shower’, ‘staff knock before entering our bedrooms’ and ‘our things, (personal), are secure’. Bathroom doors can be locked if the service user requires and alarm cords are easily accessible in bedrooms and bathroom/toilet areas. The relatives of a service user who had recently passed away spoke of the support that had been offered to their relative at the time, they said this had been appropriate and included palliative care support. The family had been able to be with their relative throughout. Care plans examined set out basic guidance for staff on support required for meeting all aspects of health, personal and social care needs of the service user however guidelines were not in sufficient detail to ensure needs would be met consistently or contain specific guidance on what action should be taken in the event of any concern. The staff team and manager recognised the shortfalls and were keen to develop care planning to improve on this. It was noted on one care plan that a service user needs assistance of one carer when using her Zimmer frame as she has become more confused, this statement should then continue to advise staff of the specific support required, i.e. the physical support and verbal prompting that will help the service user stay focussed on the activity. Continence management requirements are recorded on care plans and it was noted that guidance for staff was limited to “ to promote”. This is insufficient and not specific to meet individual requirements. It was noted on one care plan that a service user with oedema to the legs required staff to elevate legs if appear swollen. This information does not supply staff with sufficient guidance regarding how long the legs would should be elevated, how this is to be monitored and whom to contact, and when, should there be any concerns. It was noted on one care plan that the service user should not feel too isolated and during the inspection the service user was seen to spend much of the time alone. The service user said that staff had provided a ‘nice’ area in the garden where they preferred to sit. The care plan however should contain Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 13 sufficient information for staff as to how they could encourage the service user to participate in activities with other people or identify the type of activities that the service user had interests in. Daily records continue to be completed for each service user and it is evident that the home are working with specialist services such as district nurses, mental health services and dentists. Feedback received from the home’s GP indicated that they felt staff demonstrated a clear understanding of the care needs of service users and that the home communicates clearly and works in partnership with them. The GP had not received any complaints about the home. It was noted that following successful treatment of pressure areas the home is not maintaining daily monitoring records as part of the prevention of, or reoccurrence of, skin tissue damage. For example, the records for one service user with a history of skin tissue damage that had occurred during a hospital stay did not record any monitoring for almost a two-week period. A family member visiting at the time however spoke highly of the care given by the home to enable the tissue damage to heal. They said, “ the home has all the equipment necessary for the treatment of sores and staff do monitor. They keep me informed and I have no concerns”. The relative also spoke highly of the personal care given, including mouth care and diet. Care plan reviews are taking place and these are now based on the individual needs of service users and not general however the home must ensure that care plans are updated to reflect changed needs. For example one care plan review dated 1/4/06 stated that bathing was to cease due to the service user having an opened wound on their leg. Staff informed that this was now healed and the service user was having baths again. The change had not been recorded on the care plan. Staff spoken with had a good knowledge of known risks to individuals in the environment and were seen to move people sensitively, respectively and at a pace suitable to the needs of the individual. Risk assessment records are in general good however there are still some identified risks that require recording on the care plan and action taken to minimise the risk. For example, a care assessment identifies management of the risks of alcohol abuse and smoking is necessary. A tour of the environment found that alcohol is easily accessible from the kitchen area, this was discussed with the staff and manger and arrangements made to seek alternative storage facilities. A separate visit was made to the home on 27th July 2006 by a Pharmacy Inspector with the following outcome. Random audits undertaken demonstrated that the medicines are administered as prescribed and records reflect practice. The home accurately records all variable doses of medicines and has installed a “warfarin” chart to make sure Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 14 the changing doses of medication are accurately administered. All dose changes were evidenced. The home does not check the prescription prior to dispensing or check the dispensed medicines and Medicine Administration Record (MAR) chart received into the home against it. However the quantities of all medicines received or balances carried over were accurately documented. Hand written entries on the MAR chart were well documented. Adequate Controlled Drug storage facilities have been installed. Following the requirement from the last inspection the home does not keep any excess medicines on the premise. The home does not have any homely remedies on the premise but the implementation of homely remedies was discussed. One resident had bought in a food supplement to take. Checks had been made with the doctor as to its suitability to take alongside their prescribed medication. This is commended. Staff interviewed had a limited knowledge of what the medicines are for. One member of staff has successfully completed the safe handling of medicines course and the remaining staff that handle medicines are due to start the course within the next six months. The practice of two members of staff undertaking the medicine round is considered high risk. The purchase of a medication trolley was discussed to safely transport the medicines to the service user. Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although activities provided within the home are limited the people living there are satisfied with the activities available to them. Service users are able to maintain contact with family and friends and encouraged to make choices and be involved in day-to-day decision making. The menu provision is well balanced, nutritious and offers a choice each day. The involvement of specialist services in meeting dietary needs for older people would ensure that specific needs were being met safely and according to current best practice. EVIDENCE: An activity schedule was not seen although activities were happening at the time of the visit. In the morning service users were relaxing in the lounge listening to music, talking with staff and with each other. Magazines and newspapers are brought in for service users if they wish. During the afternoon the Volunteer Activities Organiser organised a quiz which at which many people joined in and appeared to enjoy. The activities organiser is now coming into the home on two occasions each week. Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 16 Service users spoken with said that they also enjoy bingo and card games. A church service is held monthly in the home for service users wishing to take Communion. Service users are supported to maintain contacts with their family members and friends and it was evident that visitors are welcome to the home. Visiting relatives met with were happy with the care offered and had positive comments regarding being made to feel welcome and being able to visit when they wished. Service users said that the food provided was ‘good’ and they - ‘did know sometimes what was for lunch each day’. The menu record evidenced that meals are well balanced, nutritious and that an alternative is available. The lunchtime meal was roast pork, stuffing, roast and boiled potatoes, cabbage and carrots with Bakewell Tart and custard for pudding. The mealtime was relaxed and tables were set attractively and it was pleasing to see that aprons provided for protection against spills were of a floral design and not of‘ ‘white disposable plastic’. The meal was unhurried with service users having sufficient time to eat. There is a procedure for monitoring weight monthly and nutritional screening assessments take place. Allergies are recorded on care plans and the cook is aware of the preferred and assessed dietary needs of service users. It was noted however on one care plan, instructions for a service user’s food to be blended and it was unclear if this instruction was following assessment by Speech and Language Therapists or Dieticians Services. Discussion with staff identified that food may not be always offered to the service user as the care plan instructs, i.e. mashed rather than blended. Without a professional assessment by specialist services in meeting dietary needs and inconsistency in staff practice is posing a risk to the well being of the service user. It was noted on one care plan that fluid intake was to be promoted and the service user was receiving their care from their bedroom. A drink was seen to be at hand throughout the day however a record for monitoring fluid intake was not being maintained. Staff meeting minutes indicated that staff have been reminded of the importance of encouraging the service user to drink more. Without records being maintained it will not be possible to identify if fluid intake is sufficient and promoting the service user’s health and well being. Care plans are recording past interests and family history and this is an area the home wishes to develop further. Information is dependent on other family members and when this has happened the record is comprehensive. Ongoing development in this area is recommended and will be beneficial as part of meeting dementia care needs and promoting interaction between staff and service users. Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 17 Resident meetings are not held however staff were observed and heard to promote choice and involvement with lifestyle in the home. Staff spoken with felt that this was something they ‘did well’ and felt it important to ‘support new staff in ways to offer choice’. Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users and family members can be sure that their concerns will be listened to and acted upon. An abuse policy is available however staff must be able, through training, to have an understanding of their role and responsibilities within this. EVIDENCE: There is a complaints policy and procedure and this is available to service users, family and friends. The pre-inspection information requested from the home indicated that two concerns had been raised in the past twelve months and both had been resolved. The record in the home showed that both complaints had been about the laundering of a service users’ clothing when white and coloured linen had been washed together. Instructions for washing white linen separate to coloured linen were displayed in the laundry area and staff meeting minutes identified the concern had been discussed at a team meeting. An abuse policy and procedure is in place but staff have yet to attend training on abuse. It was advised by the manager that training has been arranged for all staff with a date to be confirmed. Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of this environment is good and providing service users with a comfortable and homely place in which to live. The manager is keen to develop effective risk management strategies to demonstrate that the ongoing safety of the people living and working in the home is being managed effectively. EVIDENCE: The environment presents a warm and welcoming atmosphere and was clean and fresh at the time of the visit. The grounds were attractive and tidy and although accessible to service users the uneven paving slabs on the patio area continue to present some risk of falls or trips to service users. The manager advised that quotes have been requested for work to be undertaken to make paved areas safe and a service user had met with a contractor who had ‘been to look at making the slabs safe’. Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 20 The manager discussed action plans that were in place for replacement of carpets and to address the issues around making doors easier to open for service users. The manager has identified these issues as urgent but has yet to forward the maintenance and refurbishment plans to the Commission. A number of environmental requirements however have now been met and this includes ensuring the doorbell to the home is loud enough to be heard throughout the building and fitting radiator covers to all radiators. The manager has ensured that signage so that residents can easily find bathrooms, toilets and lounge areas is in place although is considering more ‘homely’ signing symbols than is currently in place. Involving service users in choosing an alternative was discussed as a good practice issue. Hot water regulators have been fitted to water outlets however the home continues to have difficulty with the current hot water system being compatible with acceptable water flow pressure. The manager advised that further equipment has been purchased to try and address this issue. The manager demonstrated a commitment to making the home free from risks to service users and has some risk assessment documentation in place for individual risks to service users. Risk assessment documentation was not available however to show that all areas of the home and care activities have been assessed for risk including the garden area, risks from hot water surfaces and to service users accessing areas of the home through doors with heavy door closures. Without a robust process for assessing and evaluating risks in the home the manager cannot be sure that appropriate action is being implemented to minimise the possibility of harm to the people living and working there. The bedrooms of the service users who care was being ‘case tracked were viewed and found to be in good decorative order, clean and fresh. A service user who now has care from their bedroom appeared comfortable, the room was fresh and bed linen was clean. A family member visiting said that her relative was now ‘happier in her room – we ask but she doesn’t want to come downstairs. We visit regularly and are always happy. She has all equipment necessary for bed care’. The laundry area was found to be in good order, clean and safe. A laundry procedure is in place which includes instruction to staff how laundry should be sorted, washed and managed. Staff were seen to carry laundry by the identified route which ensures soiled linen is not taken through the kitchen area and baskets are clearly labelled for dirty and clean laundry. The clothing in three service users wardrobes was hung neatly and appeared fresh and clean. All toilets and bathrooms were clean and fresh with sufficient supplies of soap, towels, with gloves and aprons in place for staff use. Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 21 Staff spoken with demonstrated an understanding of the infection control procedures and had completed training in infection control. The manager has taken appropriate action to ensure that services and facilities comply with the Water Supply (Water Fittings) Regulations 1999. Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living in this home are happy with the care they receive from staff although staff’s understanding of service user’s specialist needs must be improved upon so that service users health and wellbeing is protected and maintained. The recruitment of staff is protecting service users from harm by the people caring for them and the manager is keen to amend the selection process to reflect changing legislation in the Care Home Regulations. EVIDENCE: There were sufficient staff on duty at the time of the visit and service users were observed to be having their needs addressed safely and promptly. Interactions between service users and staff were positive and a relaxed atmosphere was evident. Service users appeared happy and staff spoke with them appropriately and sensitively. The views of the service users whose care was being ‘tracked’ were sought about the staff team and they all felt that staff cared for them well. Comments from people who visit the home included; ‘There is always plenty of staff, if they are off sick there is always cover’. (Service User) ‘I have no concerns and staff keep us informed’. (Relative) Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 23 ‘There are enough staff, they all know what they are doing’. (Relative) ‘Staff are good’. (Relative) ‘Staff demonstrate a clear understanding of the care needs of service users’ (Health Professional) it is clear from the staffing rota which hours are given to care and hours allocated to other duties, this includes laundry duties. Separate domestic staff are employed for cleaning duties. Night staff hours are clearly indicated, i.e. one waking night staff and one ‘sleep in’ staff each night. Staff training is being addressed on an ongoing basis and it is expected that the seven staff currently completing an NVQ in Care will achieve this by the end of September 2006. The manager has developed links with a local college for continuing staff development in care practices. An external NVQ Assessor is contracted by the home. Staff confirmed through discussion that they have recently had training in Dementia Care, Infection Control, Equality and Diversity and NVQ. The manager advised that training is arranged for this year in the Safe Handling of Medicines and Moving and Handling. It was noted that five staff working in the home require refresher training in the use of hoists when moving and handling. Staff spoken with said they had discussed their training needs with the manager or a senior member of staff during supervision. There is however no structure to the training and development of staff to include assessment of training needs against service user needs or monitoring of timescales for refresher training needs. Without this the home cannot demonstrate a commitment to ensuring they can meet assessed and changing needs. For example, staff have, and continue to, support district nurses in pressure area care and continence management however awareness training in tissue viability and continence care has not been planned for. It was noted on care plans that a number service users have specific dietary requirements relating to monitoring food and fluid intake and swallowing difficulties. Staff, including kitchen staff, supporting these changing needs should have a full understanding of the nutritional needs of older people as part of maintaining the health and well being of people and dietician and speech and language services would support this. The home is providing care for people with mental health care needs, including Schizophrenia and Alcohol Abuse, and this care provision requires specific knowledge if needs are to be met effectively to maintain a person’s health and well being. Staff spoken with had very limited knowledge and understanding of these specific care needs and one staff was not aware that a person living in the home had mental health care needs. The home has the support of a Mental Health Nurse when necessary and can be contacted when required however mental health deterioration requires prompt attention and staff Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 24 require a basic knowledge in order to recognise these symptoms to make a judgement that specialist support is required. The staff files for three newly recruited staff members were examined and found to be in good order with Criminal Record Bureau and POVA checks having taken place. The application form requests current or most recent employment history and the manager was advised that this information is not compatible with changed legislation. A copy of the amended Care Homes Regulations was given to the manager for reference. Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has a good understanding of the areas in which the service needs to improve and has plans in place indicating how this improvement is to be managed. People living and working in the home can be sure that the manager however has a commitment to ensuring their health and well being at all times. EVIDENCE: The manager continues to work towards achieving her NVQ 4 Registered Managers Award and is confident this will be completed in September 2006. The manager demonstrated a commitment to meeting requirements and recommendations set out in the last inspection and was able to evidence through discussion, and with documentation, the ongoing progress she is making to achieve this. This included improving record management systems and purchasing a facsimile transmission for improved communication. Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 26 The manager has a good knowledge of service user’s individual needs and has a good rapport with them and the staff team. A quality management system has been implemented and this has included sending out a service questionnaire to service users and relatives of which responses are expected. This has been slow and staff will now to seek feedback during care plan reviews. Questionnaires had not been sent out to other professionals involved in the service, i.e. GP’s, District Nurses and Social services. Feedback was sought from health professionals by the Commission as part of this inspection and one was returned. The feedback was positive and the following additional comment was made; ‘It is always a pleasure to visit this home. You should use it as an example’ The Pre inspection questionnaire received from the manager was fully completed and indicated that routine maintenance checks and servicing of equipment is taking place regularly and that fire safety checks are being completed as required. The fire safety records were examined during the visit and found to be in good order and up to date. Staff had all undergone fire safety training on 18th May, 2006 and undertaken a fire drill practice 1st April 2006. A fire risk assessment to address fire risk areas however is necessary and this should include a risk assessment regarding the need for the use of magnetic devises on doors. Policies and procedures are in place and available to staff, who are signing when reading new or amended policies. There are policies and procedures for the protection of service users finances and the home does not act as Appointee for any service user, this is the responsibility of family members. Service users spoken with were happy with their financial arrangements which are recorded on their care plan. All documents and records examined during this visit were in general good order with the exception of those identified in this report as not being maintained up to date. The manager demonstrated a commitment to ensuring safe working practices and discussed strategies for continuing improvement in risk management strategies including those identified in this report. Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 27 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 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 3 3 X X 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 2 Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 28 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 OP4 Regulation 18.1(a) Requirement The registered manager must ensure that staff individually and collectively have the skills and capacity to meet the assessed needs, including schizophrenia and alcohol abuse, of individuals admitted to the home The manager must ensure that care plans contain sufficient and clear guidance for staff to follow when meeting identified needs. This must include mobility, continence management and mental health and pressure area care. Changes in care as identified during care reviews must be reflected in care plans. (Timescale of 22/12/05 remains unmet). Timescale for action 15/10/06 2. OP7 12 & 13 15/10/06 3. OP7 13.4 Risks to service users must be 30/09/06 documented on their care plan and include guidelines for staff to follow so that identified risks are minimised. Risks must be reviewed monthly and amended DS0000004212.V298705.R01.S.doc Version 5.2 Page 29 Benvarden 4. OP8 5. OP9 as needs changed. 14.2(a)(b) Care plans must be in place for the continuing management of pressure area care if there is a history of pressure sores and evidence ongoing monitoring of areas at risk. 13(2) All prescriptions must be seen prior to dispensing, checked and a system installed to check the dispensed medicines and MAR charts received into the home 13(2) The purchase of a medication trolley is required to transport the medicines to the service user in the home. The care assistant who actually administers the medicines must sign the MAR chart. 30/09/06 27/08/06 6. OP9 27/08/06 7. OP9 13(2) 07/08/06 8. OP9 13(2) Protocols for “when required” 14/08/06 medicines must be written to reflect the doctors prescribed directions. Outcomes following administration must be recorded. A Controlled Drug register must be purchased and all CD transactions recorded. The home must write a robust medication policy and staff must be trained following its implementation. The manager must ensure that the dietary needs of service users are assessed by suitably qualified persons and that identified needs are documented on the care plan and met according to the guidance on the care plan. A record of all fluid intake must be documented and kept up to date when there is a risk of DS0000004212.V298705.R01.S.doc 9. OP9 13(2) 14/08/06 10. OP9 13(2) 27/08/06 11. OP15 14.1(a) 15.1 31/08/06 Benvarden Version 5.2 Page 30 dehydration. 12. OP18 13(6) The manager shall make 30/09/06 arrangements, by training staff, to prevent service users from being harmed or suffering abuse or being placed at risk of harm or abuse. (Previous timescale of 31/03/06 remains unmet.) 13.4(a)(b) The manager must ensure that 01/10/06 risks to service users in all parts of the home and garden area are assessed for risk and action taken to minimise any identified risk. The outcome of any risk assessment must be documented and reviewed as needs change or at least annually. 23(1a&2o The manager must ensure that 01/10/06 ) the slabbed area within the 13(4a&c) garden is even and safe for service users to use. An action plan to address this matter is to be forwarded to the Commission. Action is to be taken to address the various doors within the home which were stiff to open including the front door, to ensure these do not compromise fire safety. An action plan with dates to address this matter is to be sent to the Commission. (Previous timescale of 31/03/06 remains unmet) 13. OP19 14. OP19 15 OP19 23 The manager must forward a copy of the refurbishment plan for the home to cover the next 12 months to the Commission for Social care Inspection. Hot water taps must operate DS0000004212.V298705.R01.S.doc 01/10/06 16. OP25 23(2j) 13(4) 01/10/06 Version 5.2 Page 31 Benvarden 17 OP27 18.1©(i) 18. OP27 18.1(a) 19 OP30 18.1 © 20. OP38 23 effectively. Action is to be taken to test the water flow on all hot taps and address any taps where the flow or water pressure is poor. (Previous timescale of 28/02/06 remains unmet) The manager must ensure that all staff are trained in moving and handling people and safe use of hoisting equipment. The manager must ensure that at all times suitably qualified, competent and experienced persons are working at the care home as are appropriate for health and welfare of service users and this must include knowledge and understanding of continence management, pressure area care, and the nutritional needs of older people. The manager must ensure there is a staff training and development programme in place for the staff team and forward a copy of this to the Commission for Social care Inspection. A fire risk assessment must be devised to address fire risk areas within the home and actions required to reduce these risks. This must include the need for fire doors on the ground floor, excluding the kitchen and laundry, to remain open during the day time 15/10/06 30/10/06 30/10/06 30/09/06 Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 32 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 OP9 Good Practice Recommendations Any creams applied to service users within their room should be recorded on an additional monitoring sheet which can be kept in the service users rooms provided this is kept out of view. (This is in addition to the MAR which must be signed to confirm application). It is recommended that the recording of the life history of service users be developed further if this is acceptable by them. It is recommended that the support of to assess the dietary needs of people living in the home. It is recommended that the manager review the information requested from prospective employees is compatible with the amended Care Homes Regulations. 2. 3. 4. OP12 OP15 OP29 Benvarden DS0000004212.V298705.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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