CARE HOMES FOR OLDER PEOPLE
Bessmount House 1 Rose Hill Kingskerswell Newton Abbot TQ12 3PP Lead Inspector
Judy Hill Unannounced 24th August 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. Bessmount House D54-D07 S3652 Bessmount House V239095 240805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Bessmount House Address 1 Rose Hill, Kingskerswell, Newton Abbot, Devon, TQ12 3PP 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) 01803 872188 Mr David George Simpson & Mrs Jaqueline Sheila Simpson Mr David George Simpson Care Home 11 Category(ies) of Old age - not falling within any other category registration, with number (11) of places Bessmount House D54-D07 S3652 Bessmount House V239095 240805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th April 2005 Brief Description of the Service: Bessmount House is a detached care home that is registered to provide accommodation and care for an maximum of eleven people who need residential care for reasons of old age. It is situated in the village of Kingskerswell and is close to the vilage shops, churches and other amenities. The registered service providers, David and Jackie Simpson, live on the premises. David Simpson is the registered manager and both he and Jackie work at the home on a full-time basis. There are eight single bedrooms and two double bedrooms, all but one benefit from having en-suite toilet facilities. Each of the bedrooms is connected to a call system and has telephone and television points. There are two communal lounge/dining rooms, both of which are exceptionally well presented. There are two bathrooms, one on the ground floor and one on the first floor but the bath in the ground floor bathroom is currently out of use. There is a terrace and a large garden to the front of the house and an enclosed patio garden to the back. Bessmount House D54-D07 S3652 Bessmount House V239095 240805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and was carried out by one inspector from 10.50am to 1.40pm on Wednesday, 24th August 2005. The information contained in this report was gained in conversation with the registered service providers, Mr & Mrs Simpson and two of the residents. Additional information was gained from a partial tour of the premises, an observation of working practices and from records included in the Statement of Purpose. As very few policies, procedures and records were available for inspection, a further announced inspection will be carried out in November to inspect the records, policies and procedures. What the service does well: What has improved since the last inspection? What they could do better:
The residents do not have copies of a Service Users’ Guide containing their individual statements of terms and conditions or contracts between them and the service providers. Comprehensive needs and risk assessments have not been carried out with each of the residents and individual care plans are not being used to inform service delivery. Bessmount House D54-D07 S3652 Bessmount House V239095 240805 Stage 4.doc Version 1.40 Page 6 The storage arrangements for controlled medicines and for medicines requiring refrigeration are not sufficiently secure. There are no policies and procedures on adult protection and the prevention of abuse and the staff have not received any training on these issues. The bath is the ground floor bathroom has been out of use for some time and so only one bath, which is on the first floor, is available for the residents to use. The residents do not have lockable facilities in their bedrooms in which to store their money and other valuables and individual risk assessments have not been carried out to assess if suitable door locks could be fitted to their bedroom doors. The laundry facilities are sited in a room that can only be accessed through the kitchen and where food is stored, this arrangement unsatisfactory on hygiene grounds. The registered service providers both said that they work excessively long hours on a regular basis. This is unsustainable and demonstrates that not enough staff are employed. Although some staff training has been provided, training programmes have not been drawn up to identify the staff’s individual training needs and achievements and the staff do not receive individual one to one supervision. Although the home has a policies and procedures file, very few written policies and procedures have been drawn up for the management and staff to follow. 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. Bessmount House D54-D07 S3652 Bessmount House V239095 240805 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 Bessmount House D54-D07 S3652 Bessmount House V239095 240805 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) 1, 2 & 3 The Statement of Purpose is very good but no other written information is available to enable prospective service users and their representatives to make an informed choice about where to live. EVIDENCE: The Statement of Purpose was seen to well written and informative. Service Users’ Guides, resident’s contracts, needs and risk assessments were not available for inspection so no evidence was provided to enable standards 1, 2 & 3 to be fully inspected or for the requirements from the last report to be checked for compliance. Bessmount House D54-D07 S3652 Bessmount House V239095 240805 Stage 4.doc Version 1.40 Page 9 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, 9 & 10 The quality of the care provided is good, but written assessments and care plans are not used as guidance and this could place the residents at risk if the experienced staff are not available for work. The resident’s privacy and dignity is respected. The residents are protected by the safe administration of their medication by trained staff but the storage of some medicine is not secure. EVIDENCE: No written assessments, reviews or care plans were available for inspection although the two residents spoken with said that they were happy with the care provided and that their needs were being met. Conversations with the service providers and residents and an observation of the way staff and service providers interacted with the residents demonstrated that their privacy and dignity is respected. The medication administration sheets were seen and demonstrated that the staff handle the resident’s medication safely and conscientiously, but the storage arrangements for controlled drugs and medicines that require refrigeration do not comply current guidelines. Bessmount House D54-D07 S3652 Bessmount House V239095 240805 Stage 4.doc Version 1.40 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 None of the above standards were inspected on this occasion as they were all assessed as met in the report of the last inspection. EVIDENCE: Bessmount House D54-D07 S3652 Bessmount House V239095 240805 Stage 4.doc Version 1.40 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The home has a very good complaints procedure, which should ensure that any complaints are dealt with appropriately. To ensure that the residents are fully protected from abuse, policies, procedures and staff training need to be provided. EVIDENCE: The complaints procedure contained in the Statement of Purpose is well written and provides good information on how to make a complaint and the process that the management need to follow to deal with complaints. The complaints procedure contained in the homes policies and procedures file does not meet the required standard and should be replaced with the procedure from the Statement of Purpose that does. A record book is kept to record complaints. No entries had been made in it and no complaints have been made to the Commission about the quality of care provided at Bessmount House. The homes policies and procedures on abuse were not available for inspection. Staff training on how to recognise and respond to incidents or suspicions of abuse has not been provided. Bessmount House D54-D07 S3652 Bessmount House V239095 240805 Stage 4.doc Version 1.40 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 23, 24 & 26 This is a beautifully presented home that provides the residents with a comfortable and homely living environment. EVIDENCE: The home is very well located being within walking distance of the village shops, churches and other amenities. The premises have been upgraded by the current owners and, with the exception of the ground floor bathroom, provide a very attractively decorated and comfortably furnished home for the residents. There is an attractive walled patio garden to the back of the house and a large, naturally landscaped garden to the front. A large terrace provides the residents with a pleasant outdoor recreation area. The two lounge/dining rooms were seen to be exceptionally attractive and to provide a very comfortably furnished and homely environment for the residents. There are eight single and two double bed rooms, all but one of which have en-suite toilet facilities. One of the residents showed the inspector her bedroom and this was seen to be clean and beautifully presented. The resident’s do not have lockable facilities within their bedrooms to store their valuables in and the
Bessmount House D54-D07 S3652 Bessmount House V239095 240805 Stage 4.doc Version 1.40 Page 13 resident’s bedroom doors have not been fitted with suitable locks. The kitchen is attractively presented and adequate for the needs of the home. There are two bathrooms, one on the first floor and one on the ground floor. The bath in the ground floor bathroom has been out of use for some time and needs to be restored to a serviceable standard. The laundry facilities are in a room that can only be accessed through the kitchen and in which food is stored. This arrangement is not satisfactory. The standards of cleanliness maintained throughout the home were seen to be good. Bessmount House D54-D07 S3652 Bessmount House V239095 240805 Stage 4.doc Version 1.40 Page 14 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, 29 & 30 The residents are being well cared for but this is largely due to the service providers working excessively long hours which is not sustainable over a period of time. EVIDENCE: Both of the residents who were spoken with said that the home was meeting their needs and that they were very happy with the standard of care provided. No assessments of the residents needs were available for inspection and no staff records, training records or rotas were available for inspection. In conversation with the registered service providers it was established that both of them work at the home on a full time basis and that four care assistants are employed. There are no separate cleaning or catering staff, although an outside catering firm is employed to provide some meals ready made. Both of the service providers said that they were working excessively long hours, which would not be sustainable over a prolonged period of time and this demonstrates that their not enough staff are employed to run the home effectively, to meet the needs of the residents and to enable both the manager and staff to attend to the administrative duties that are required of regulated registered homes. Some additional support is provided by a professional management consultancy firm that has been commissioned by the service providers to bring the homes policies, procedures and records up to the standard required by the Care Homes Regulations and recommended in the National Minimum Standards, but progress has been slow. The manager said that the requirements made in the report of the announced inspection to update
Bessmount House D54-D07 S3652 Bessmount House V239095 240805 Stage 4.doc Version 1.40 Page 15 recruitment procedures and to provide a staff training and development programme which meets National Training Organisation workforce targets have not been dealt with, but some additional staff training had been provided, including Basic Food Hygiene, Manual Handling and COSHH. Bessmount House D54-D07 S3652 Bessmount House V239095 240805 Stage 4.doc Version 1.40 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 36, 37 & 38 The quality of the care provided was observed to be good but the management of the business, in terms of record keeping, policies and procedures and staffing levels is poor. EVIDENCE: The home has used questionnaires as part of a quality assurance/quality monitoring system but the outcomes were not inspected on this occasion. The staff are supervised on a day to day basis but the manager said that regular one to one supervision is not being carried out. The service providers have acknowledged that their record keeping and paperwork does not conform to the requirements of the Care Homes Regulations and the recommendations contained in the National Minimum Standards. A professional management consultancy firm has been commissioned to bring the policies, procedures and records up to the required standard but progress has been slow. Very few records were made available for inspection and because of this a further announced inspection has been arranged.
Bessmount House D54-D07 S3652 Bessmount House V239095 240805 Stage 4.doc Version 1.40 Page 17 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 2 1 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 3 3 2 x 3 2 x 2 STAFFING Standard No Score 27 1 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 x x 3 x x 2 1 1 Bessmount House D54-D07 S3652 Bessmount House V239095 240805 Stage 4.doc Version 1.40 Page 18 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 1 Regulation 5 Requirement Provide each of the residents with a Service Users Guide that contains all of the information listed in regulation 5. Previous timescale 7/7/05 - not met. Include individual statements of the terms and conditions and contracts in the Service Users Guides. Timescale for action 1.11.05 2. 2 5 1.11.05 3. 3 14 Previous timescale 7/7/05 - not met. Undertake full assessments of 1.11.05 prospective residents and include assessments undertaken from revelant professionals. Previous timescales 31/10/04 & 7/7/05 - not met. Ensure that there is available in the home for each of the residents a Service User Plan that is generated from a comprehensive assessment. This should set out in detail the action which needs to be taken by the care staff to ensure that all aspects of their health, personal and social care needs
D54-D07 S3652 Bessmount House V239095 240805 Stage 4.doc 4. 7 15 1.11.05 Bessmount House Version 1.40 Page 19 are met. Previous timescales 31/10/04 & 7/7/05 not met. Bolt the controlled medication storage container to a fixed surface and provide a locked facility for medicines kept in the fridge. Previous timescale 7/6/05 - not met. Keep policies and procedures on adult protection and the prevention of abuse at the home and provide staff training to ensure that the residents are safeguarded from possible abuse. Repair the existing bath on the ground floor or provide a new bath or shower facility on the ground floor. Previous timescale 7/10/05 not yet reached. Provide each of the residents with a lockable facility in their bedrooms in which to store their money and other valuables. Previous timescale 7/6/05 - not met. Employ sufficient staff to meet the assessed needs of the residents and to ensure that noone works excessively long hours. Draw up a training programme with each member of staff to identify their individual training achievements, gaps in the provision of training and any additional training needs and arrange for them to attend suitable courses.
D54-D07 S3652 Bessmount House V239095 240805 Stage 4.doc 5. 9 13 1.10.05 6. 18 12, 13 & 18 1.11.05 7. 21 23 7/10/05 8. 24 23 1/10/05 9. 27 18 7/10/05 10. 27 18 7/10/05 Bessmount House Version 1.40 Page 20 11. 29 19 Previous timescale 7/10/05 not yet reached. Update the recruitement 1/11/05 procedures to ensure that the records kept on staff comply with Schedule 2 of the Care Homes Regulations. Previous timescales 7/6/05 - not met. Ensure that there is a staff training and development programme which meets National Training Organisation Guidelines. Previous timescales 30/9/04 & 7/6/05 - not met. Each member of care staff must be given formal supervision at least six times a year. Previous timescales 30/9/04 & 7/7/05 - not met. All records listed in schedules 2, 3 & 4 of the Care Homes Regulations must be kept at the home. Previous timescale 7/8/05 - not met. All policies and procedures identified in the regulations must be kept at the home. Previous timescale 7/8/05 - not met. 12. 30 18 1/11/05 13. 36 18 1/11/05 14. 37 17 1/11/05 15. 38 12, 13 & 23 1/11/05 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 24 Good Practice Recommendations Unless it can be demonstrated through individual risk
D54-D07 S3652 Bessmount House V239095 240805 Stage 4.doc Version 1.40 Page 21 Bessmount House 2. 26 3. 38 assessments that it would not be safe to do so, fit suitable locks to each of the residents bedroom doors. Either resite the laundry facilities or create a separate entrance to the laundry so that soiled linen and clothing is not carried through the kitchen and find an alternative location for food storage. The staff should read each of the policies and procedures and sign and date a record stating that they have done so and understand their contents. Bessmount House D54-D07 S3652 Bessmount House V239095 240805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton Devon, TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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