Inspection on 07/04/05 for Bessmount House

This inspection was carried out on 7th April 2005.

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

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

Other inspections for this house

Bessmount House 29/07/09

Bessmount House 10/05/08

Bessmount House 12/12/07

Bessmount House 20/07/07

Bessmount House 05/07/06

Bessmount House 15/11/05

Bessmount House 24/08/05

Bessmount House 01/09/04

Bessmount House 13/04/04

Bessmount House 23/03/04

Bessmount House 06/01/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Bessmount House 1 Rose Hill Kingskerswell Newton Abbot TQ12 3PP Lead Inspector Judy Hill Announced 7 April 2005 th 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 V214165 070405 Stage 4.doc Version 1.20 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 Jacqueline 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 V214165 070405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 1st September 2004 Brief Description of the Service: Bessmount House is a detached building located in the village of Kingskerswell, it is situated near to local shops and church. The home is registered to take up to 11 residents, male of female who require 24 hour residential care by reason of old age. Bessmount House is built on two floors, with a stair lift servicing the first floor. There are 8 single rooms and 2 double rooms. All of the rooms, bar one have en-suite toilet facilities. Call bell systems are in every room along with television and telephone points. There are two lounge/dining rooms. All of the bed-sitting rooms and both communal rooms are attractively decorated and comfortably furnished. There is one assisted bathroom on the first floor. A second bathroom on the ground floor is currently out of use but there are plans to convert this into a shower room. At the front of the house is a terrace with seating available and a large garden. The registered providers, David and Jackie Simpson, live on the premises and work closely with their staff of five care assistants. Bessmount House D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and carried out over one day. Both of the registered service providers and their management consultant were present throughout the inspection. During the inspection seven residents and three care assistants were interviewed in private. In addition, completed Comment Cards were received from two residents and three visitors to the home. A preinspection questionnaire was completed by the registered providers and a copy of the revised Statement of Purpose was sent to the Commission. A tour of the premises was carried out, a meal was seen being served and a sample of records were inspected. What the service does well: What has improved since the last inspection? The Statement of Purpose has been revised and provides good information about the home for people considering living there and their representatives. Considerable improvements have been made to the premises by the current owners and although further work needs to be carried out to complete the kitchen and to upgrade the ground floor bathroom and laundry facilities, the refurbishment of the bed-sitting rooms and lounge/dining rooms has been carried out to a high standard. A quality assurance/quality monitoring system has been drawn up to enable the residents, their representatives and staff to let the management know if there are any ways in which they feel that the service provided could be made better for them. Bessmount House D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Version 1.20 Page 6 New staff recruitment procedures have been introduced to provide written evidence that the staff employed will be properly vetted before they start to work with the residents. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bessmount House D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Version 1.20 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 V214165 070405 Stage 4.doc Version 1.20 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 & 5 Prospective service users and their representatives will have access to the information that they need to make an informed choice about where to live. However, the information provided following admission does not provide the residents with sufficient information about how their individual needs will be met or about their rights and responsibilities. EVIDENCE: The revised Statement of Purpose was read and found to be clearly written and informative. The Admissions Procedure contained in the Statement of Purpose states that prospective residents and their representatives will be invited to visit the home before making a decision to move in so that they can view the premises and facilities and discuss their care needs with the service providers. This was discussed with the service providers who said that they would not generally accept emergency admissions, as they needed to access the suitability of residents prior to admission. A sample of the resident’s initial assessment forms was inspected and not all of the information required had been recorded on them and therefore they could not provide sufficient information to form the basis of an initial plan of care. Bessmount House D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Version 1.20 Page 9 The Service Users’ Guides were seen to be incomplete and copies containing the individual resident’s terms and conditions and contracts, had not been given to them to ensure that the residents are informed of their rights and responsibilities. Bessmount House D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Version 1.20 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, 8 & 9 The quality of the care provided for the residents is good but could be improved with better care planning and reviews. The handling of resident’s medication is satisfactory, but the storage of controlled drugs and medicines requiring refrigeration needs to be more secure. EVIDENCE: Five of the seven residents spoken with in private were asked if they felt that their care needs were being met by and they said that felt that they were. In addition to this Comment Cards that had been completed by two of the residents and three visitors to the home all contained positive comments about the care provided. However, a sample of the residents care plans was inspected and they did not set out in detail the actions which need to be taken by the care staff to ensure that all aspects of the individual residents health, personal and social care needs were met. There was also no written evidence that regular reviews of the care plans were being carried out with the residents. Bessmount House D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Version 1.20 Page 11 The storage and records of the administration of medicines were inspected. The storage of general medicines was satisfactory but the storage of controlled medicines and medicines requiring refrigeration was not sufficiently secure. The medication administration record sheets were seen to be clear and up to date. Bessmount House D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Version 1.20 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, 13, 14 & 15 The resident’s lifestyle experienced in the home matches their expectations and reflects their preferences. Friends and relatives are encouraged to visit and the service users are supported to maintain contacts in the community. The quality of the food provided is good. EVIDENCE: Most of the residents were seen and spoken with in their bed-sitting rooms. Very positive comments were made about the care provided and in particular the kindness of the management and staff and the good quality of the meals provided. Although most of the residents spoken with confirmed that they choose to stay in their bed-sitting rooms rather than use the communal lounges, some of them said that they felt lonely and isolated at times. It is suggested that they could be given more encouragement to mix, especially at meal times. The service providers said that the home is very much a part of the local community and the residents confirmed that they are taken to the village Bessmount House D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Version 1.20 Page 13 shops and that they attend social events in the village. One of the residents said that the staff escort her to the local church every Sunday and that she is brought home by friends. The completed Comment Cards from visitors indicated that they are made welcome at the home and several residents said that they had maintained close links with their families. Further confirmation of this was provided by the warm welcome afforded to a visitor during the inspection. Lunch was seen being served and it looked well prepared and appetizing and the record of food provided demonstrated that the residents are offered alternatives if they do not want the set lunch. Bessmount House D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Version 1.20 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) 0 EVIDENCE: Bessmount House D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Version 1.20 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) 19, 20, 21, 22, 23, 24, 25 & 26 Both of the lounge/dining rooms and the residents bed-sitting rooms are well presented, clean and comfortably furnished and provide a very pleasant and homely environment for the residents. However, some of the other areas of the home need attention. There are adequate toilet facilities but insufficient bathing facilities to meet the needs of the residents. EVIDENCE: A physical inspection was carried out of the premises. The service users bed-sitting rooms are on the ground and first floor and there is a stair lift between floors. It was demonstrated that when allocating bedsitting rooms consideration had been given to the individual residents mobility to ensure that wherever possible, residents who cannot manage to use the Bessmount House D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Version 1.20 Page 16 stair lift without an escort have ground floor rooms so that they can access the lounge/dining rooms and the patio and gardens. All but one of the service users bed-sitting rooms were seen to have en-suite toilet facilities and there are additional toilets in the bathrooms on the ground and first floor. The bath in the ground floor bathroom has not been in use for some time and the registered provider said that he had plans to convert this into a shower room. Without a bath or shower facility on the ground floor the home only has one bath, which is not sufficient for eleven residents and the first floor bathroom is not easily accessible to some of the less mobile residents. The push button light switch in the first floor bathroom is unsafe and needs to be replaced with a pull cord. There are eight single and two double bed-sitting rooms. All of the residents bed-sitting rooms were seen to be attractively decorated and comfortably furnished. The residents had brought their own possessions into the home with them and some of the bed-sitting rooms had been highly personalised. It was observed that locks had not been fitted to the residents bed-sitting room doors and although the registered provider said that the residents did not want locks, suitable locks, which can be overridden by the staff in an emergency, should be provided and the residents should be offered keys to their rooms, unless it can be demonstrated through a risk assessment that the provision of keys would not be safe. It was also observed that the residents did not all have lockable facilities in their rooms in which to store their money and other valuables. The home has undergone major refurbishments since the current owner brought it as a going concern and the programme of refurbishment is now nearing completion with only the kitchen to be finished off, the laundry and the aforementioned ground floor bathroom to do. The most recent area to be upgraded was one of the ground floor lounge/dining rooms. This room has been sensitively restored and is very attractively and comfortably furnished. The second lounge/dining room is light and spacious and is again comfortably furnished and well presented. On the whole the home was seen to be is clean, pleasant and hygienic. The location of the laundry, which is only accessible through the kitchen and is in an area where food is stored, is inappropriate on hygiene grounds although it is acknowledged that soiled linen and clothing is taken through the kitchen in sealed containers. Bessmount House D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Version 1.20 Page 17 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 staffing levels are sufficient to meet the needs of the residents and the residents have confidence in the ability of the proprietors and the staff to provide a good standard of care. New recruitment policies, procedures and practices are being introduced to ensure that only suitable staff will be employed to care for the residents. The staff are committed to providing a good quality of care and are highly regarded by the residents. There are gaps in their training that when met could further improve their ability to care for the residents. EVIDENCE: The pre-inspection questionnaire that was completed by the proprietors identified that five care assistants are employed. The care staff also have housekeeping duties and assist with the preparation of light meals and snacks. Lunches are brought into the home ready prepared. The registered providers, Mr & Mrs Simpson, live on the premises and the staff rotas show that Mr Simpson, who is also the registered manager, provides waking night care while his wife is on-call throughout the night. The proprietors have recently commissioned a Management Consultancy Company to help them to develop their policies, procedures, practices and record keeping. A director of the management consultancy was present throughout the inspection and was able to demonstrate both verbally, and through the provision of documentation, including the revised recruitment Bessmount House D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Version 1.20 Page 18 policies and procedures, that should provide written evidence that a safe system of staff recruitment is used. In addition to the registered persons, three members of staff were interviewed and each of them demonstrated a high level of commitment to the provision of a good quality service. However, the records of staff training, interviews with the staff and discussion with the registered providers identified that there were gaps in provision of staff training. Seven service users were engaged in conversation and many very positive comments were received about the qualities of the management and staff. This positive feedback was also included in Comment Cards completed by visitors to the home. Bessmount House D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Version 1.20 Page 19 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) 32, 33, 35, 36, 37 & 38 The provision of care is well managed. However, this is not achieved through adherence to written policies and procedures or through good record keeping practices. A commitment has been made to improve this through the commissioning of a management consultancy agency. EVIDENCE: Private interviews with three members of staff and seven service users indicated that they are satisfied with the management style. Conversations with the registered providers and their management consultant, who was present throughout the inspection, identified a commitment to developing an effective Quality Assurance/Quality, the details of which are in the Statement of Purpose. Bessmount House D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Version 1.20 Page 20 Formal one to one staff supervision is not currently provided and should be introduced to enable the management and staff to discuss all aspects of practice, the philosophy of the home and the staffs career development needs. Conversations with the registered providers and their management consultant identified that they were aware that their record keeping practices, including service users assessments, care plans, reviews and staff recruitment, had not been satisfactory and that positive action was being taken to improve this. This was further demonstrated through the inspection of some new policies, procedures and recording forms. This proactive approach to problem solving on the part of the service providers is recognised as good practice. . Bessmount House D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Version 1.20 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 2 3 2 2 3 2 STAFFING Standard No Score 27 2 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 x x x x 3 2 x 3 2 2 2 Bessmount House D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Version 1.20 Page 22 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 service users with a Service Users Guide that contains all of the information listed in regulation 5. Include individual statements of the terms and conditions and contracts in the Service Users Guides. Undertake full assessments of prospective service users and include assessments undertaken from relevant professionals. (Previous timescale 31/10/04 not met) Ensure that there is available in the home a Service User Plan that 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 the health, personal and social care needs of the residents are met. (Previous timescale 31/10/04 not met) Bolt the controlled medication storage container to a fixed surface and provide a locked facility for medicines kept in the fridge. D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Timescale for action 7/7/05 2. 2 5 7/7/05 3. 3 14 7/7/05 4. 7 15 7/7/05 5. 9 13 7/6/05 Bessmount House Version 1.20 Page 23 6. 7. 21 23 23 23 8. 24 23 9. 27 18 10. 29 19 11. 30 18 12. 36 18 13. 14. 15. 37 38 17 12, 13 & 23 Repair the existing bath on the ground floor or a new bath or shower on the ground floor. The light switch in the first floor bathroom must be replaced by a pull cord. (Previous timescale 30/9/04 not met) Provide each of the service users with a lockable facility in their bed-sitting rooms in which to store their money and other valuables. Draw up training programmes with each member of staff to identify their individual training acheivement, gaps in the provision of training and any additional training needs and arrange for them to attend suitable training courses. Update the recruitement procedures to ensure that the records kept on staff comply with Schedule 2 of the Care Homes Regulations and a record of their identified training needs and achievements. Ensure that there is a staff training and deleopment programme, which meets National Training Organisation. (NTO) workforce targets. (Previous timescale 30/9/04 not met) Each member of care staff must be given formal supervision at least six times a year. (Previous timescale 30/9/04 not met) All records listed in schedules 2, 3 & 4 of the Care Homes Regulations must be kept. All of the policies and procedures identified in the regulations must be kept at the home. 7/10/05 30/5/05 7/6/05 7/10/05 7/6/05 7/6/05 7/7/05 7/8/05 7/8/05 Bessmount House D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Version 1.20 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 24 26 Good Practice Recommendations Fit suitable locks to the service users bed-sitting room doors and provide each of the service users with a lockable facility. Either resite the laundry facilities or create a separate entrance to the laundry facilities 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 procedure and to sign and date a record stating that they have done so and understand their contents. 3. 38 Bessmount House D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Version 1.20 Page 25 Commission for Social Care Inspection Unit D1 Linhay Business park Ashburton TQ13 7UP 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 Bessmount House D54-D07 S3652 Bessmount V214165 070405 Stage 4.doc Version 1.20 Page 26 - 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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