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Inspection on 24/06/05 for Berengrove Park Nursing Home

Also see our care home review for Berengrove Park Nursing Home for more information

This inspection was carried out on 24th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is quick to respond to changes in service users conditions, and reassesses to ensure they can meet any change in need. Reviewing the plan of care and ensuring staff are aware of the changes. The home provides good home cooked food using fresh produce when in season.

What has improved since the last inspection?

The recording in the daily log has improved with more detail and no abbreviations. The care plans are now being signed by the family and or the service users. The home has responded to the need to get 50% of its care staff up to the NVQ Level 2 in Care or above, and are set to improve upon that number.

What the care home could do better:

The home does not currently arrange outings for the service users, whether to the local shops, the park or further afield. Families are relied on to do this. The manager stated that the service users did not wish to go out. However the home needs to show that encouragement is given to all service users to increase their community presence.

CARE HOMES FOR OLDER PEOPLE Berengrove Park Nursing Home 43 - 45 Park Avenue Gillingham Kent ME7 4AH Lead Inspector Sally Hall Unannounced 24 June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Berengrove Park Nursing Home Address 43-45 Park Avenue Gillingham Kent ME7 4AH 01634 850411 01634 840046 Nil Berengrove Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Carole Frances Godden Care Home with Nursing 36 Category(ies) of Old age - 24 registration, with number Dementia - 12 of places Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Service Users to be aged 60 years or over. Date of last inspection 31 January 2005 Brief Description of the Service: Berengrove Park Nursing Home is home to 36 Older People who mainly have nursing and high care needs. The home also has 12 beds designated for dementia care. The home itself is a large older property, which means a lot of the bedrooms are of a large size. There are a high number of shared rooms in this home but the owner has added another six en-suite bedrooms to reduce the shared rooms. The home has a small garden to the rear and to the side of the property, which can be accessed by service users, and there is off road parking to the side of the home. The home is opposite a large park, which, during the summer months is very pretty with all bedding plants, and it is a nice area to walk in. The home is situated within walking distance of a main bus route and there is main line railways station approximately a mile away. Gillingham also has a High Street with many main High Street stores in, and is not far from the Historic Chatham Dockyard. Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 24th June 2005. The Inspector found that most of the National Minimum Standards had been met and that the overall quality of care provided was good. In some instances the judgment of compliance was based solely on verbal responses given by those spoken with. Not all the standards were assessed at this inspection, and some standards were not inspected fully and therefore were not included in this report. What the service does well: What has improved since the last inspection? What they could do better: The home does not currently arrange outings for the service users, whether to the local shops, the park or further afield. Families are relied on to do this. The manager stated that the service users did not wish to go out. However the home needs to show that encouragement is given to all service users to increase their community presence. Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 6 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. Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2-5 Service users can be confident that they will be issued with a contract/terms and conditions of their stay at the home. Service users benefit from having a comprehensive assessment before they are offered a place at the home to ensure it can meet their individual needs. All service users and or families are encouraged to visit and are offered a trial period to satisfy themselves that the home would be suitable to meet the service user’s needs. EVIDENCE: Six service users care files were seen to contain comprehensive assessments. Three of the files sampled were for service users admitted recently. They contained the assessments completed prior to admission and further assessments completed after admission for mobility, lifting assessment, and the risk of pressure sores. The registered manager who is a RGN and has the NVQ level 4 Registered Managers award had completed these assessments. Social Service assessments had also seen been completed for Local Authority funded service users. The home’s assessment process enables it to prepare comprehensive nursing plans of care. Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 9 The Registered Manager explained that following her initial assessment a place is only offered if she considers the service user’s needs can be met by the skills of the staff at the home. The plans of care, nursing plans and risk assessments seen reflected the information gathered at the assessment stage. Daily records indicated the care that the Service users are receiving on a daily basis. The home does not offer intermediate care Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7-10 All service users benefit from having a care plan which includes their nursing needs as well as their social care needs. Service users can be confident that their health care is monitored and action taken when required. Service users are protected by the home’s robust medicine administration policy and procedure. Service users can be confident that they are treated with dignity and respect. EVIDENCE: The care plans and nursing plans in the files sampled indicated the care required by the service users and cross-referenced with the assessments. These plans are reviewed monthly by staff and before if there is a change in the service user’s condition/needs. Service users/family are encouraged to have input into the plans. The service users or their family had signed plans seen. Daily records covered most of the care provided as detailed in the plans of care and nursing plans. The registered manager agreed that these would be improved if more detail were available in the daily recording. During the inspection process service users were receiving a high standard of care and special needs were being provided for. Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 11 All accidents are followed up and further action taken when appropriate. Documented permission was seen on individual service user files where bed rails were used. Service users’ health is documented in daily records. These records also indicated when the GP had been called in to give treatment or advice. The care plans detailed the care required for a service user with pressure areas as well as the preventative care for another service user who was deemed at risk. The home arranges for health professionals such as chiropodists, opticians, dentists and community psychiatric nurses to visit. The storage and administration of medication met the required standard and was clean and well organised. All medication is locked in cupboards and the controlled medication was stored in another locked cupboard within. The Medication Record Sheets had been completed fully; any medication in stock at the end of the preceding month had been brought forward. Only the qualified nurses in the home administer medication to service users. There are no service users able to administer their own medication at this time. Records are kept of all medication that is returned to the pharmacy and signed for by the pharmacist. The registered manager explained that medical examinations and consultations take place in the service users own room. In bedrooms, which are shared, there are adequate curtains to ensure privacy. The home does not have a visitors room so visits in private take in place in bedrooms or a lounge that is not often in use. There is a public telephone in its own little room so service users can take calls in private. Staff treated the service users with respect and took care when enquiring about personal issues. They were seen knocking on bedroom doors before entering and responded quickly when help was called for. Service users spoken to confirmed that the staff at the home respect their privacy and dignity. Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12-15 Service users benefit from a programme of activities within the home though would also benefit from the opportunity to go on outings outside the home. Service users are offered a varied and balanced diet and are encouraged to make choices to stay in control of their lives as much as possible. EVIDENCE: The registered manager and owner said that they have various entertainers coming in to the home on a regular basis. The home’s staff also undertake activities or help with what is going on in the afternoon. Some service users talked about a lady who comes to the home twice a week and encourages them to do exercises to music. Some of the more able service users spoken to said that they enjoy some of the activities and also confirmed that they do as they want through the day getting up and going to bed when they are ready. The owner and manager explained that as well as entertainers coming on a regular basis schools are also involved with the home, particularly around Christmas. Service users spoken to confirm this. Outings to the park and shopping trips have yet to be arranged. Service users are encouraged to go out more but some refuse. Others go out with their family and friends. Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 13 Service users said they are being offered a choice of meal at meal times and the quality and size of the meals provided are good. The care plans indicated the amount of help service users need with eating their meals. Some take their meals in their bedrooms either by choice or necessity. Meals were taken individually to each service user and staff checked that they were happy with the meal and had everything they wanted before they left the room. Meals taken and the amount eaten was seen recorded in the daily record for each service user. The owner confirmed that fresh produce is used when in season. The registered manager confirmed that on admission service users are asked their likes and dislikes and this, along with any dietary needs, are given in writing to the cook and evidence of this was seen. Staff asked service users what they wanted to do and where they wanted to be and daily records show the choices that service users make as well as when they refuse what is offered. Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) these standadrs were not assessed during this inspection but were met during the inspection in January 05. Not inspected on this occasion EVIDENCE: Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) these standards were not inspected during this visit. Not inspected on this occasion. EVIDENCE: Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,30 Staff are rostered in sufficient numbers with the necessary skills to meet the care and social needs of the service users. The care of service users is being promoted because the home is working towards having more than 50 of staff with an NVQ. EVIDENCE: Staffing levels have increased since the last inspection. The manager said this is because the needs of the service users have increased. The staff said they feel supported by the way the manager keeps the home covered and staff morale has been boosted because training is seen as a priority and they are encouraged to develop within their role and progress. The owner and manager are aware that 50 of the care staff are required to have an NVQ level two or above by April 05. Of the 14 care staff, six now have the award and 5 have just started. The registered manager is now an assessor at the home, which will makes witnessed observation easier for the staff. The home also ensures that their nurses remain current and make suitable courses available to them. This was confirmed by a member of nursing staff. The staff confirmed that they are having formal supervision every 2-3 months and that their training needs are part of the discussion. Staff spoken to listed Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 17 the training they have done as a result and future training identified for them. The manager confirmed that all new staff now attend TOPPS induction training. Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32, 34,35,36,37. The service users benefit from having a manager who is qualified and brings a breadth of experience to managing the home and from leadership in the home which is open and positive with good lines of communication throughout. Robust financial procedures protect the service users. Staff benefit from regular supervision and service users’ rights are safeguarded by the systems in place and security of all documentation. EVIDENCE: The registered manager is a qualified RGN level 1 & 2 and has recently completed her NVQ level 4 registered managers award and NVQ level 4 in care. She is an NVQ assessor and mentor. The registered manager and owner work closely together and their management approach within the home is open and positive. The lines of Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 19 communication between them, staff and the service users appears good. The owner and registered manager were fully aware of the Codes of Practice for Care Staff issued by The General Social Care Council. Copies of the booklet were available in the office. The home has a business plan for the coming year; it set out new goals with the predicted changes of the National Minimum Standards taken into account. The plan looked at market forces and other issues that could affect the business in the future. The cash flow predictions appeared reasonable given current market trends and the past history of the home. A letter from the bank confirming their approval of the plan and the financial viability of the home was seen. The business plan was well written and easy to follow looking at the year ahead and the long-term future of the home. It showed the commitment not just to the business but to its staff and their long term development. The home does not now get involved in any of the service users financial affairs and does not hold personal money for the service users. It is preferred that anything the service users request is paid for and responsible people invoiced on a 6 monthly basis. The registered manager explained that she tries to ensure that supervision is booked in every two months for all staff and delegates some of this task to the nursing staff and senior carer who she is developing with in the role. Staff spoken to confirmed they are having formal supervision every 2-3 months and that their training needs are part of the discussion. Records were up-to-date and securely kept within the home. Staff spoken to knew who was able to access the service users files. The registered manager confirmed that all policies and procedures in the home are being reviewed annually or before if necessary. Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 3 x 3 3 3 3 x Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP13 Regulation 12, 16,23 Requirement Service users must be able to have visitors at any reasonable time and links with the local community must be developed and/or maintained in accordance with service users’ preferences. Outings must be faciliated for individual service users or in groups. Timescale for action 1st July 05 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 Good Practice Recommendations Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent, ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Berengrove Park Nursing Home H56-H06 S26149 Berengrove Park V235104 240605 Stage 4.doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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