Inspection on 09/01/07 for Bethany

This inspection was carried out on 9th January 2007.

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.

Other inspections for this house

Bethany 26/01/06

Bethany 14/09/05

Bethany 08/02/05

Bethany 12/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Bethany Clarendon Place Leamington Spa Warwickshire CV32 5QN Lead Inspector Sandra Wade Unannounced Inspection 9 January 2007 09:10 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 Bethany DS0000004211.V313556.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. Bethany DS0000004211.V313556.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bethany Address Clarendon Place Leamington Spa Warwickshire CV32 5QN 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) 01926 423661 01926 433041 bethany@cch-uk.com Olivet@cch-uk.com Christadelphian Care Homes Mr Alan Taylor Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Bethany DS0000004211.V313556.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th January 2006 Brief Description of the Service: The home provides places for up to 21 individuals or couples who are members of the Christadelphian Church and who may be drawn from all parts of the country. The home provides residential care for older people and does not provide nursing care, any nursing care required is accessed via the nurses within the community. There are care staff on duty 24 hours a day to provide personal care. Accommodation is spacious with 19 bedrooms, which are equipped with an en-suite bathroom and small kitchenette. There is an attractive garden to the back of the home, which can be accessed by steps or a lift. Parking spaces are provided to the front of the home but these are limited. The home supports residents to have breakfast and supper within their own rooms and the main meal of the day is served in the dining room. Social activities and in particular bible readings are provided both in the home, the local community and with regard to church services, at a nearby sister home. At the time of this inspection the fees for the home were £345.00 - £440 per week. Extra charges are made for hairdressing and toiletries. Bethany DS0000004211.V313556.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key inspection to Bethany for this inspection year. The inspection process consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. This inspection took place between 9.10am and 7.10pm. Two residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (if possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Records examined during this inspection, in addition to care records, included, staff recruitment records, training records, social activity records, staff duty rotas, health and safety records and medication records. Before the inspection, a random selection of residents and relatives were sent questionnaires to seek their independent views about the home. Comments received are included where appropriate within this report. A pre-inspection questionnaire was received from the home on 16 October 2006; some of the information contained within this document has also been used in assessing actions taken by the home to meet care standards. What the service does well: The home provides a spacious, pleasant and personalised environment for people to live, with a variety of social and recreational activities being provided. The residents living in this home receive good care to meet their individual needs and have a good quality of life. The residents treat the home as if it were their own and are well supported by staff as to how they spend their day. All residents who completed comment cards for the Commission stated that they felt they received the care and support they needed in the home. The spiritual needs of the residents is a priority as the home is specifically for people from the Christadelphian community, the lifestyle provided by the home matches the preferences and values of residents. One resident commented, “we meet together each evening to read the Bible and discuss it, we visit other homes and they visit us”. Bethany DS0000004211.V313556.R01.S.doc Version 5.2 Page 6 All residents spoken with were positive about the staff and the care they receive at the home. One resident said, “the staff always listen and act” and “the managers are always ready to listen and are very friendly and kind”. Comment cards returned to the Commission from relatives all stated that they were satisfied with the overall care provided and were kept informed of important matters affecting their relative. What has improved since the last inspection? What they could do better: The manager needs to ensure that following the pre-assessment process of a resident, a letter is written to them to confirm the home can meet their needs. Care plans need to clearly identify the health care needs of residents and the staff actions required to address these to ensure the home can demonstrate consistently that the health and wellbeing of the residents is being maintained. Some actions are required in regard to the management of medications to ensure this is being managed safely for residents. This includes returning medication no longer in use and ensuring clear records are kept of all medications received and carried forward so that medications can be appropriately audited. Bethany DS0000004211.V313556.R01.S.doc Version 5.2 Page 7 A review of infection control management is required to ensure practices and procedures are effective in maintaining hygiene within the home to safeguard residents. The deployment of staff is not clear from duty rotas in place. Staffing arrangements need to be accurately reflected on duty rotas to confirm there are sufficient staff available at all times to meet the needs of residents. Record keeping is in need of review to ensure the home can demonstrate they do what they say they do. This includes the reporting of accidents and incidents to the Commission so that actions taken by the home can be confirmed as safe and appropriate. It also includes the completion of all recruitment checks as required for staff prior to them working in the home to ensure the manager can deem them safe to work with the residents. Some actions are required in regard to the safe storage of food including that fridges are maintained at suitable levels consistently. 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. The summary of this inspection report can be made available in other formats on request. Bethany DS0000004211.V313556.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 Bethany DS0000004211.V313556.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4 Quality in this outcome area is good. Residents are assessed to ensure their needs can be met and are able to have a trial stay in the home to confirm it is suitable for them although they do not receive written confirmation that the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A Statement of Purpose was available in the home giving details about the care and services provided to help potential residents make an informed choice about moving into the home. This document did not contain up-to- date information about the manager or current staffing arrangements in the home, the manager agreed to address this. Those residents spoken to said that they had either had a trial visit in the home to decide if they would like to stay or knew the home because they had been regular visitors. Bethany DS0000004211.V313556.R01.S.doc Version 5.2 Page 10 Detailed assessment records had been completed upon admission, which consisted of allocating a scoring for each need to identify the resident’s dependency. Additional space on these forms allows staff to add any further important information relating to the residents care needs. The manager informed the inspector that the assessment of residents’ needs is ongoing with at least monthly reviews of care and changes in care plans where necessary. There was evidence of this in residents’ care plan files viewed. Records viewed did not show that a pre-assessment had been undertaken but the manager gave an acceptable explanation for this and explained that preassessments are always undertaken using the same forms as used when a resident is admitted. It was not evident from files that a letter had been written to residents following their assessment to confirm the home can meet their needs as is required. Bethany DS0000004211.V313556.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. The health and personal care needs of residents are being met but records do not demonstrate this consistently. This judgement has been made using available evidence including visits to this service. EVIDENCE: It was evident from discussions with staff and residents that the majority of residents in this home are of a low dependency and therefore were independent in managing many aspects of their care. Residents looked well cared for and felt that they were being well looked after in the home. One resident said that they were happy in the home and it was “very good”. Another resident said there were “quite happy” and confirmed they had no complaints regarding their care. Holistic assessments had been undertaken for each resident living at the home to show how their health and safety could be maintained. Bethany DS0000004211.V313556.R01.S.doc Version 5.2 Page 12 Care plans focused mainly on areas in which residents required assistance such as changing their bed, bathing or applying creams to skin. There was minimal emphasis on their health care needs although entries in daily records suggested these were being managed. Daily records are computerised and it was not clear that if the computers were to fail how staff would be able to follow up issues written into the daily records or what backup systems were in place to ensure daily records could be completed. It was also not clear how confidentiality could be maintained and how the manager could ensure that records could not be tampered with once completed. These matters will need to be addressed within a risk assessment and policy for the home. Daily records were not being completed for each resident on a daily basis and did not always confirm that the care prescribed was being given. For example for one resident it was suggested in the care records that the resident needed to regularly exercise their stiff shoulder. It was not evident from the daily records this was being done. One resident spoken to was noted to have a hearing aid and had swollen ankles. They said that the ankles usually became more swollen when they were up and moving around. The resident also said that they had heart problems and were therefore taking medication to help this. The resident said they had been receiving help from the district nurse in regard to ongoing problems with their feet. There were no care plans in place showing these medical problems and how they should be managed although the resident was very aware of what needed to be done. It was evident from daily records that staff had followed up issues with the doctor and the resident had been supported to attend hospital appointments in relation to these health problems. Daily records also showed that the resident had seen the doctor in regard to problems with dizziness, as they were concerned they could fall over when these episodes occurred. The records suggested this could be due to high blood pressure and a test had been arranged. If care plans do not contain sufficient information on health care needs and how these are to be managed, this could result in an oversight in care for the resident. Care plans should be devised for each identified care need with clear staff actions on what assistance should be given to the resident to support these needs. As a good practice measure, all specialist appointments should be recorded on a specific sheet so there is a clear medical history available at a glance as opposed to having to read numerous daily record entries to gain this information. One resident had a medical condition requiring medication to be given at specific times. It was evident that the condition at times made the resident unhappy. There was no care plan in place on how this medical condition should be managed or other needs that had been identified by a consultant Bethany DS0000004211.V313556.R01.S.doc Version 5.2 Page 13 including an arthritic limbs and shortness of breath. It was evident however during discussion with this resident that they were able to function well with the medical condition providing they took their medication at precise times. An inhaler had been provided for the shortness of breath and painkillers were available to the resident for any arthritic pain. A review of medication was undertaken. It was evident that most of the residents in the home were self medicating and the manager had undertaken appropriate risk assessments for residents to support them in being able to do this safely. Stock checks were being carried out regularly to confirm residents were receiving and taking their medication. For those residents self medicating provision had been made for them to store their medication in a secure place within their room. Residents spoken to said that they were happy to be able to manage their own medication and showed the inspector they were able to store these safely. Other medications were stored in a medication trolley in a locked room. Controlled drugs were kept in a suitable lockable cupboard within another locked cupboard. A controlled drugs register was in place and this had been completed appropriately. The Medication Administration Record (MAR) had not been completed to show the administration of the controlled drugs and the manager agreed to address this. The amount of tablets available were checked and were correct in accordance with the register in place. Some MAR charts continue not to show the amount of medication received and carried forward for each prescribing period. This makes it difficult to audit resident’s medication to check that the amount received, given and remaining is correct. For one resident capsules were in the medication trolley that had been prescribed in December 2003 and these had expired in November 2004. The manager advised that the resident was no longer taking these and they should therefore have been returned to the pharmacist. Another medication (Simvastin) was also found in the cabinet that was not longer in use. This had been prescribed in 2005 and was not listed on the MAR for the resident whose name was detailed on it. The manager said that this had been stopped and also should have been returned to the pharmacist. A gap was found on the MAR relating to the administration of Ramitidine, which meant a member of staff either did not administer the medication or did not sign the record to confirm it had been given. The manager had noted this and had put an asterisk on the chart to remind him to speak to the member of staff concerned when on duty. Bethany DS0000004211.V313556.R01.S.doc Version 5.2 Page 14 The manager said that many of the staff had attended medication training but they needed a refresher and he was awaiting the confirmation of a date from the pharmacist for this to take place. The privacy and dignity of residents was observed to be maintained throughout the inspection. Care staff were seen knocking on doors before entering and all residents spoken to felt they were treated with respect, and that the staff were very good and helpful. Bethany DS0000004211.V313556.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. Individuals are supported to maintain a lifestyle, which matches their preference and enhances their quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Christadelphian Care Homes (CCH) were set up by the Christadelphian community specifically to accommodate members of the Christadelphian Ecclesia. All of the current service users are Christadelphians and are able to benefit from a lifestyle, which supports the Christiadelphian ethos. Residents were seen to be relaxed and happy to be living in the home. Each home has a Welfare Committee, which is made up of local Christadelphians who visit the Homes residents and arrange various activities and outings. There is a planned programme of activities and entertainment in the home. This includes bible readings each evening in the lounge unless residents choose to go the church located near to their sister home ‘Peacehaven’. Bethany DS0000004211.V313556.R01.S.doc Version 5.2 Page 16 Residents are supported to attend church on Sunday morning and evenings and also on Wednesday evenings. There is music and movement held in the home each Thursday, which is carried out, by volunteers and an art class is held every other week. Artwork carried out by residents was of a high standard and was on display in the home. The home has the use of a minibus to attend prayer meetings and social outings and this gives them an opportunity to also meet up with people from other Christadelphian homes. One resident said she went to home to do flower arranging recently which she enjoyed. Trips are arranged on a monthly basis in the summer and have included visits to the Christadelphian Supply Shop, Jephson Gardens and the Cotswolds. A comment card received by the Commission from a resident states “there are outings to local places regularly in the summer” and “there are visits by people to show slides etc of places of interest”. “We meet together each evening to read the Bible and discuss it”. An “Events and Outings” book held in the home showed that during November 2006 there was a visit to Kingsleigh House, Leamington coffee morning, Fraternal and tea, Coventry Market Trip, Sainsbury’s and coffee, Trip to the Christmas lights and a Coffee morning at the Ecclesia Hall. Some residents are able to independently leave the home on their own and continue with their day-to-day life in the community. During the day residents were observed to receive visitors who were made to feel welcome by staff in the home. Resident choices are respected and as most have some independence, they are able to make choices for themselves, which staff support. Residents can get up when they wish and are provided with food to make themselves breakfast when they want. As each room has a kitchenette residents can make themselves drinks and snacks when they wish. Each has a supply of cutlery and crockery and at suppertime; residents are again supplied with food to make themselves a meal. Alternatively residents can choose a hot snack, which staff will prepare for them. If residents are unwell or do not wish to make their own snacks staff will do this for them. The inspector ate a meal with the residents at lunchtime. A choice was given of quiche or fish with vegetables and cheese sauce followed by apple pie with ice cream or custard. Staff served each resident individually so they could choose what they wanted and how much. Meals were well presented, appetising and enjoyed by all residents and the inspector. The lunchtime was Bethany DS0000004211.V313556.R01.S.doc Version 5.2 Page 17 seen to be a social event and it was evident that the residents enjoyed getting together in small groups to socialise. All residents spoken with were very positive about the quality of food provided by the home. Questionnaires received by the Commission showed that out of eight people, who responded, five were “always” happy with the food and three were “usually” happy with the food. Bethany DS0000004211.V313556.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. People living in the home are confident that their concerns will be listened to and acted upon and they are protected from the risk of harm from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A detailed complaints procedure is available and accessible to residents, staff and visitors to the home. Residents felt confident that the staff in the home would deal with any concerns raised. The Commission have not received any complaints since the last inspection and records in the home showed that the home had not received any complaints. Questionnaires forwarded to the Commission from residents showed that all but one person out of the eight that responded knew how to make a formal complaint if they needed to. A procedure for responding to allegations of abuse was available in the home and records showed that training in regard to abuse is provided on an ongoing basis. Staff spoken to were clear on what was expected of them should they observe abuse or if this should be reported to them. Bethany DS0000004211.V313556.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25, 26 Quality in this outcome area is adequate. Residents enjoy a comfortable and homely environment, which is well maintained, but some actions are required to ensure infection control is managed effectively to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was found to be clean, tidy and well maintained with period items to provide homely and comfortable accommodation for the residents. The home has a large pleasant communal lounge and an attractive conservatory with houseplants, which overlooks the garden. The garden had been well maintained and it was observed that a chair lift is available to enable residents to easily access this if they are unable to use the steps. Bethany DS0000004211.V313556.R01.S.doc Version 5.2 Page 20 Resident’s accommodation is provided on three floors with all floors accessible by using a lift or stairs. Some residents were observed during the inspection to opt to use the stairs for exercise rather than use the lift. The stairs down to the lower ground floor, where the dining rooms is based, were dark wood with no non-slip surface. The inspector questioned whether some of the partially sighted residents would be able to easily see the steps and also questioned whether these steps would be slippery particularly if residents used the steps after being outside in wet weather. The manager acknowledged the concerns raised and advised that they had improved the lighting on these stairs to help residents see the steps. The last two steps had black and yellow tape applied to the end of them as apparently some residents had struggled to see the last two steps. Several bedrooms were viewed and it was evident that the residents had been able to personalise them with their own possessions and furniture to make them comfortable and homely. Fridges were available in each of the bedrooms to allow residents to store their own items of food as well as that provided by the home. Arrangements were in place for the temperature of these to be monitored to ensure food was being stored safely. Residents confirmed they were happy with their rooms and had everything they needed. Rooms viewed were bright and warm and had a pleasant outlook through the large sash windows. Each room viewed had a radiator cover in place to prevent burn risks to residents. Residents said that the rooms were cleaned once a week by staff. The home has systems in place for the management of dirty laundry in that residents place items they want to be washed in a bag and provide a list to staff of the items they have put in the bag for cleaning. When the laundry has been completed, this is checked off against the list provided to ensure the resident gets everything back. Residents confirmed they were happy with the laundry service and confirmed their laundry is returned promptly. The laundry area is based on the lower ground level of the home. This area is also used as a staff room. On viewing this area it was evident that dirty laundry was being sorted on the floor and there was no hand wash sink or dedicated sluice sink for the cleaning of commode pots. Staff confirmed that there was a resident who used a commode and this was usually cleaned within the resident’s room. Commode pots should be cleaned in a dedicated area not used by residents to maintain good infection control practices. Staff confirmed that they should be using baskets for sorting the laundry and advised they used gloves and aprons to handle soiled items. Red bags were being used to wash heavily soiled items, which disintegrate during the wash cycle. Bethany DS0000004211.V313556.R01.S.doc Version 5.2 Page 21 It was evident from discussion with staff that one of the carers also worked in the laundry during the afternoon. She confirmed that she changed her uniform before changing over shifts to maintain good infection control practice. It was however established that sometimes she was called upon to assist as a carer during the time she was on laundry duties although for short periods of time, if a carer was not available. It was not evident that there was an infection control policy and procedure in place showing how this practice could be managed safely to maintain good infection control practices in the home. It was also not evident that a risk assessment had been completed in regards to using the laundry – usually classed as a “dirty area” as a staff room. The kitchen was viewed and was found to be clean and tidy. Fridge temperatures were being maintained at safe levels. It was noted that the soap dispenser at the staff hand-wash sink was empty and did not appear to have been used for some time. Staff must have access to suitable hand washing facilities to maintain hygiene. Bethany DS0000004211.V313556.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. There are sufficient competent and knowledgeable staff available to support residents but records were insufficient to demonstrate this consistently. Not all recruitment checks are being carried out as required to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Senior Carer was on duty during the morning of the inspection up to 3pm. She explained that the majority of the residents in the home were of low dependency and therefore required minimal support with their care. From speaking with residents, reviewing their records and observing them during the day, this was confirmed. The main exception was that two residents in the home were in need of increased support. The manager advised that they had been assessed as needing nursing care and arrangements had been made for the two residents to be transferred to another Christadelphian home. The manager said he had increased staffing particularly over the weekend to allow for these residents to receive extra support. Staffing arrangements for the home have been set taking the dependency of the residents into consideration. The home aim to have 7 staff on duty in the morning. These consist of the manager, one senior carer, one carer, two cleaners, one cook and one kitchen assistant. Bethany DS0000004211.V313556.R01.S.doc Version 5.2 Page 23 In the afternoon, this changes to five staff, which includes two carers. At nighttime there is one waking carer and one who sleeps-in who can be called upon if required. Comments received by the Commission in regards to staffing confirmed that all eight residents who responded felt they received the care and support they needed. Six residents said staff were available when they needed and two felt that staff were “usually” available when they needed them. From discussions with the manager and staff, it was clear that the duty rotas in place do not accurately reflect how staff are deployed in the home. This makes it difficult to assess that sufficient staff are available in the home consistently. One person is indicated to work an 8am – 2pm shift followed by a 10pm to 8am shift, this does not allow for a sufficient break between shifts and contravenes the Working Time Directive. Staff training is being provided on an ongoing basis although it was noted from training records viewed that some are due to update their training in moving and handling. The manager confirmed that some staff had missed the training organised for them, which had meant this was now overdue. Additional training dates had been arranged to enable staff to update this training. The manager confirmed that nine out of the fifteen care staff employed had completed a National Vocational Qualification (NVQ) II in Care to assist them in providing more effective care to the residents. Three staff had also completed an NVQ III in Care. New staff complete a detailed induction to the home and records are kept to show their competence in accordance with the National Training Organisation standards. Two staff files were viewed to confirm recruitment practices carried out. All of the appropriate recruitment checks had been carried out with the exception that a Criminal Records Bureau check and Protection of Vulnerable Adults (POVA) check had not been carried out prior to the person starting in the home as required. This must be undertaken to ensure staff are deemed safe to work with residents in the home and not place them at risk from abuse. Bethany DS0000004211.V313556.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37,38 Quality in this outcome area is good. The manager is able to discharge his duties fully to ensure the home is safely managed and in the best interests of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post at the home since 2002. He has achieved a City & Guilds Advanced Certificate in Care Management and the Registered Managers Award so is suitably qualified to manage the home. Four relative comment cards received by the Commission showed they all felt they are kept well informed about their relatives care. All residents spoken to were positive about the management of the home. Bethany DS0000004211.V313556.R01.S.doc Version 5.2 Page 25 Comments received by the Commission from residents included “the managers are always ready to listen and are very friendly and kind” and “the staff and managers always try to meet any requests made”. Staff meetings are held on a two monthly basis and notes of these meetings confirmed that staff always discuss the welfare of the residents and issues requiring attention in the home. Christadelphian Care Homes (CCH) have a Quality Assurance Policy and procedure to ensure the quality of the service is continuously monitored. Six monthly inspections care carried out by a Trustee who compiles a report on how well the home are achieving the care standards. Monthly visits are also undertaken to monitor issues such as any complaints, accidents and any decoration required. Copies of the reports seen showed positive responses in all areas. Resident meetings are held on a two monthly basis by the Welfare Committee to discuss matters relating to the home and any concerns residents may have. Feedback is also encouraged from residents by completing questionnaires about their care and the service provided. These cover a range of areas including catering, personal care, health care, choices and the home itself. It was evident from records in place that positive responses had been received. Where minor issues had been raised these were discussed with the manager who confirmed they had been acted upon. Results from the questionnaires or quality audits are not currently published for the benefit of residents and visitors and this matter was discussed. The majority of residents in Bethany manage their own finances and the home holds monies for only a few residents. Records viewed accurately reflected the money available and showed details of money spent as well as money received. It was not evident that receipts were in place for all transactions carried out to demonstrate the financial interests of residents are being fully safeguarded. The manager carries out formal supervision with staff and a schedule was seen showing dates that had been arranged for staff to attend these sessions. A supervision record seen identified areas discussed as well as training needs. The training schedules in place demonstrated that training is being organised on an ongoing basis to address any needs arising from supervisions carried out. Details of accidents had been recorded in the home and had been acted upon but it was not evident accidents were being reported to the Commission as required. Advice was given in regard to this matter. Bethany DS0000004211.V313556.R01.S.doc Version 5.2 Page 26 A review of health and safety records was carried out to confirm safety checks completed. The following was confirmed:Fire alarm and emergency lighting – 4.1.07 Electrical circuits – 13.10.06 Electrical Portable Appliance Testing – 9.3.06 Legionella – 26.7.06 Landlords Gas Safety Record – 5.1.07 Environmental Health Visit – 23.01.06 – this identified that the home has been awarded the “Heartbeat & Safe Food Award” which recognises the home has good standards of food hygiene. Fridge temperatures in resident’s rooms were viewed, these ranged from 0.8 up to 10.8. The recommended temperatures are 5°C to 9°C and it was not evident that when temperatures read outside of this range, actions were being taken to rectify these. Temperatures of hot water in resident areas ranged from 38°C to 55.8°C. The recommended guidelines state these should be close to 43°C to ensure the water is warm enough to wash in as well as prevent scald risks to residents. The manager said that temperatures could vary according to where the rooms were located in the home. As the residents in this home are in the majority independent, the temperature of the taps was not considered a risk. The storage of food was viewed in the kitchen. Dried foods that had been opened were in the majority stored in sealed containers but cereals that had been opened had been closed with a tie. Dried produce should be stored in airtight containers to keep them fresh as well as ensure they are pest proof. A jug of jelly in the fridge was not covered, labelled or dated so that it was clear when this needed to be used and disposed of. Bethany DS0000004211.V313556.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 3 X 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X X 3 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 2 2 Bethany DS0000004211.V313556.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 14(1)(d) Timescale for action The registered person must write 28/02/07 to residents following their admission to confirm the home can meet their needs. The registered person must 28/02/07 ensure that care plans reflect the health care needs of residents and the actions required to address them to prevent any possible oversight in care. The registered person must ensure the quantities of all medicines carried over from previous MAR are recorded to enable audits to take place to demonstrate medicines are administered as prescribed. (Above outstanding from January 2006 inspection). The registered person is to review medication management in line with the comments in the body of this report. 4. Bethany Requirement 2. OP7 15 3. OP9 13(2) 28/02/07 OP26 16 The registered person must DS0000004211.V313556.R01.S.doc 31/03/07 Version 5.2 Page 29 ensure that effective infection control practices are maintained in the home. A review is to be undertaken in regard to the cleaning of commodes, how laundry is sorted, the availability of staff hand-washing facilities in the laundry and the use of this area as a staff room. Advice of the Environmental Health Officer is to be sought as appropriate. 5. OP27 17,18 The registered person must be able to demonstrate that sufficient staff on duty at all times. The duty rotas must accurately reflect the staffing arrangements for the home. A review of staff shifts is to be undertaken to ensure the home does not contravene the Working Time Directive. 6. OP29 19, Sch 2 The registered person must ensure satisfactory preemployment checks such as Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (PoVA) are obtained prior to the person commencing employment at the home. The registered person must ensure accidents and incidents in the home are reported to the Commission as required. The registered person is to review health and safety matters relating to temperature checks, and food storage as detailed in the body of this report. 28/02/07 28/02/07 8. OP37 37 28/02/07 9. OP38 12 28/02/07 Bethany DS0000004211.V313556.R01.S.doc Version 5.2 Page 30 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 OP1 Good Practice Recommendations It is advised that the Statement of Purpose is updated to show up-to-date information regarding the manager and staffing arrangements for the home. It is advised that the pre-admission documentation includes a section of the medical history of the resident so that care needs can be fully considered when devising care plans. It is advised that a policy be devised on how computerised records are managed within the home. This should include: • • • Procedures for using IT to record information and the maintenance of backup records. A risk assessment to ensure that tampering with records is reduced to an absolute minimum. Procedures for accessing records if there is an enquiry by a relative or resident including details of how this information can be shared within the principles of data protection. 2. OP3 3. OP7 4. OP19 It is recommended the home consider a non-slip, easily identifiable surface for the stairs leading down to the kitchen or floor covering to assist residents in using these steps safely. It is advised that any references obtained for staff make it clear in what capacity they knew the applicant and provide clear name and address details so that there is a clear audit trail. It is advised that individual receipts are kept for all financial transactions carried out on behalf of residents. 5. OP29 6. OP35 Bethany DS0000004211.V313556.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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