Random inspection report
Care homes for older people
Name: Address: Bethany Francis House Bethany Francis House 106 Cambridge Street St Neots Cambridgeshire PE19 1PL one star adequate service 26/01/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Shirley Christopher Date: 1 1 0 8 2 0 0 9 Information about the care home
Name of care home: Address: Bethany Francis House Bethany Francis House 106 Cambridge Street St Neots Cambridgeshire PE19 1PL 01480476868 01480473799 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : ADR Care Homes Ltd care home 34 Number of places (if applicable): Under 65 Over 65 0 34 dementia old age, not falling within any other category Conditions of registration: 34 0 The maximum number of service users who can be accommodated is 34 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home This home was sold in October 2008 to ADR care homes, who bought it as an on going buisness. They own several other homes. They inherited the current manager and care staff and have implemented a number of changes including a major refurbishment of the property. This was the first key inspection to a newly registered service.
Care Homes for Older People Page 2 of 14 2 6 0 1 2 0 0 9 Brief description of the care home Bethany Francis House is a listed building, set back from the main St Neots to Cambridge road. It has large extensive gardens. It is a victorian property which has been extended and provides spacious accomodation on two floors. The upper floor is accessed by a wide sweeping stair case at each end of the house. There is a lift available. The home can accomodate up to 34 people who fall into the category of older people, with or without dementia. There are three double rooms and 28 single rooms. 21 have en suite facilities. The first floor has two bathrooms with hoists and toilets and two individual toilets and one shower room. There are attractive gardens and a number of the residents help with the garden. They have hanging baskets and raised flower beds. The grounds are enclosed and their are suitable seating areas. The home is situated just a few minutes walk from the market town of St Neots where a range of shops and leisure facilties can be accessed. It is close to public transport; the railway station and bus routes. A copy of the homes statement of purpose and service user guide are made available by the home. The current inspection report is available in the hallway. The current fees for the service are 358.00 to 550.00 a week. There are additional charges for items of personal items. Care Homes for Older People Page 3 of 14 What we found:
We, The Commission for Social Care Inspection carried out a key inspection to Bethany Francis House on the 26 January 2009. The home was sold to new providers in October 2008 and the Commission registered it as a new service. We are required to complete a key inspection within six months of registering a new service. At the time of the key inspection the home was awarded an adequate 1 star rating. On the 2nd July we completed a random inspection to the home because we had been informed by the registered manager that she no longer worked at the home and we had not received anything in writing about the current management arrangements. We had also received four complaints from staff previously employed at the home and staff still currently working at the home. A number of relatives had also raised concerns. During this inspection we looked at four outcome areas including health care, complaints and protection, staffing and management. We were satisfied that the home had adequate management arrangements in place, but the newly appointed manager had only been in her current post for several days. We had asked to see a number of staffing records which could not be located. We agreed to go back to do an announced random inspection to check staffing files. During the second random inspection on the 11 August 2009 we checked staff files of care staff employed since the key inspection. We also followed up the actions taken by the home following a complaint from a relative made on the day of our last random inspection. We looked for evidence that the home had complied with regulations made at the time of the last key inspection and further requirements made at the last random inspection. During this inspection we identifed a number of continued breeches of regulation and we told the manager and the Operations manager that we would follow our enforcement pathway. A warning letter has been sent out with this random inspection report and we shall be asking the providers for an improvement plan. We will do a further unannounced inspection to the home. The random inspection was carried out over four hours and included two regulation inspectors and a specialist pharmacy inspector who made a number of requirements around medication standards. These were new requirements. We found evidence that the home had met a number of the requirements and we identified areas that had improved. These will be discussed in the next two sections. What the care home does well:
On the day of inspection the home was adequately staffed. There are satisfactory management arrangements in place and the new manager has been working a variety of shifts to see how the home is functioning throughout the day and evening. We asked two staff about their opinion of the manager and they said. She is a modern manager, who is hands on and very approachable. We saw improvements both in terms of the environment which has been completely
Care Homes for Older People Page 4 of 14 refurbished. Work is ongoing and some of the bedrooms are being decorated. The home have employed a maintainance person. The home was maintained to a high standard of cleanliness. The home are in the process of recruiting a second activities person, to extend the range of activities on offer. At the moment there is one person employed for a few hours three times a week. Social activities will be extended to the weekend. The manager stated she was trying to establish closer links with the local community with the view of groups, including local schools coming in to the home. They have appointed a volunteer who works at the local day centre and she spends time with residents. There is also a volunteer who does quizes several times a week.The visiting library has been reinstated. The home have restarted residents and relatives meetings. The home circulate a newsletter. The manager stated that she was writing to relatives to ask for their assistance in updating residents social histories where they may be unable to complete this themselves. She is also collecting relatives email addresses as another way of keeping in touch with families and letting them know about whats going on in the home. We looked at a care plan seen at the last inspection and was satisfied that the home had reviewed and updated it to reflect a change in need. We discussed the current care plan format and felt it was good. The manager told us about the changes in residents needs. Some residents had been reassessed and identified as needing nursing care. Other residents had notified improvements in their health status. One example was of a person who was previously nursed in bed. They are now assisted up every day. We are confident that the manager works well with other agencies and is able to quickly identify changes in residents which require intervention. One of the care managers has been actively involved in looking at concerns raised by relatives and is satisfied that the home are taking appropriate action. The home notify the Care Quality Commission of anything affecting the well being and, or safety of residents. The home have introduced a falls register. What they could do better:
We feel that the home are making good progress and we were satisfied that since the last inspection the home are meeting residents health and welfare needs. We were concerned about some staff performance related issues and asked to see records. These were unavailable. At the second random inspection the operations manager was able to explain the processes they had followed in respect to a number of staff and their performance. We are satisfied that residents interests are protected but there must be a clearer audit trail of staffs performance. We looked at one care plan and noted improvements. The life story/history was weak but the manager told us that they were updating these. The care plans could be developed further and include information about promoting emotional well being particularly when there has been a change in residents behaviour. We asked for a specialist pharmacy inspector to accompany us on this inspection because we had received a number of complaints about medication being left unlocked and unsecured and medication being administered by untrained members of staff. The findings of the pharmacy inspection were as follows: We looked at the practices and procedures for the safe storage and use of medicines. The home has a written procedure
Care Homes for Older People Page 5 of 14 for staff to follow, but some aspects are not followed. Also the policy needs to be updated since it refers to the overall responsibility for drug administration will be that of a first level RN [Registered Nurse] and no nurses are employed at the home, and the guidance for the storage of controlled drugs is wrong. The storage rooms for medication on both the ground floor and first floor were secure to prevent unauthorised access to medicines and the temperatures of the rooms were recorded and were satisfactory to maintain the quality of medicines in use. The frige used to store medicines is not lockable but the outer door to the room is. The fridge temperature is recorded but has been recorded above the recommended maximum over the previous 9 days. None of the care staff spoken to were aware of what the correct fridge temperature should be and were not following the homes policy which states The proprietor/manager must be alerted if two or more consecutive temperature readings fall above 7C. The failure to store medicines at the correct temperature may result in people receiving medication that is ineffective. The cupboard used to store controlled drugs does not meet the requirements of the relevant regulations and the cupboard was also used to store jewellery belonging to residents. This is not appropriate storage for residents property. We looked at medication and medication records for several people resident in the home and found some problems with these records: A number of people had had their medication omitted as it was not available, one for a period of 15 days. One persons medication record did not clearly indicate the medication that was given. When medication was omitted, the reason for the omission was not always recorded. When medication is given to residents at a time which is different to that printed on the record form, the actual time it is given is not recorded and this could result in people receiving medicines too close together. Care staff have received training on the safe use of medicines but for some people this training is quite old. We were told that futher training has been planned for the near future and that staff will be assessed as competent to administer medicines when this training is completed. Given the discrepancies found above, we expect this to be managed as a matter of priority without the need to make a requirement on this occasion. At the last random inspection we asked to see files of staff recently employed since the last key inspection. A number of files were incomplete but these related to staff waiting to start employment subject to satisfactory employment checks. We looked at a staff file of a member of staff who had been employed in the last month. There was no proof of identification, immigration status or current address. She had a protection of vunerable adults checks but we did not see a criminal records check. We were told that the appointment of staff was completed by the provider and we agreed we would go back to re examine staff records. During the second random inspection we looked at the same file and found evidence of identification namely a passport and birth certificate. There was a POVA check and CRB check. The latter dated before the person was employed. The original POVA check had been lost and re requested. One reference was received after employment, the other dated beforetheir employment. They had a basic induction record and some training certificates. We asked to see a second staff file which could not be produced at the last inspection. We looked at a further two staff files both had been employed in July 2009. The first included a photograph, a clear CRB check received before the persons employment and identification, birth certificate, and passport. The
Care Homes for Older People Page 6 of 14 application form did not include a full employment history and there were two references on file one received after employment. There was some evidence of induction although the assessor was not identified and they had not signed the induction record. The staff member had been observed whilst giving personal care and lifting/moving residents. They had been given no other training but had previous experience, (training.) for previous employment.The observer made a comment about the staffs performance but there was no evidence of how it was going to be followed up. We were told staff are observed and shadowed by more seniour staff, but there was no evidence that senior staff were suitably competent or had completed a train the trainer course. Most training was being completed by asking staff to watch a series of videos. In one file the staffs understanding and competence had been tested through a series of questions and answers. We do not know how this is audited to ensure staff have sufficient knowledge and understanding. On a further staff file the person was employed before receit of a POVA 1st. We were told they were not put on the rota until after their POVA was received back. We asked for rota from July 1st and were told these had been shredded accidently. Both references were dated after the first date of employment. One reference was a personal reference, but we do not know who the second reference was from. Gaps in employment history had not been explored. There was proof of identifcation. There was an induction record dated on the day of employment and completed within three weeks. There was no evidence of any training with this organisation but they had previous experience/training. The staffing rotas now include the surnames of individual staff members but a requirement about records have been made as copies of rotas were unavailable. We spoke to two members of staff whos files we had inspected. They confirmed that they had been shadowed for the first three weeks of employment and they had received an induction and walk through policies and procedures. They were not aware of the formal induction process. One staff confirmed manatory training would be given in several weeks time. Staff confirmed that staffing levels were being maintained and this was further evidenced by examination of current rotas. We looked at maintainance records and found water temperatures were satisfactory for the last couple of months. The operations manager explained that thermostatically controlled valves had been fitted to individual handbasins. The home had completed a new fire risk assessment. Some of the radiators remained uncovered ,which was said not to be a problem because the heating was off. A risk assessment was not in place. This requirement was considered unmet. We looked for evidence that previous requirements made at the last key inspection on the 26 January 2009 had been met and were satisfied that three out of the five requirements had been. Two were considered outstanding. We made a further four requirements at the last random inspection. We removed one of these as we had insufficient evidence. One was considered met at the second random inspection and two remain unmet. These relate to staffing records. We have made an additional requirement about records. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 14 Care Homes for Older People Page 8 of 14 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 8 12 The home must promote and 30/07/2009 make proper provision for the health and welfare of residents. Staff must be familar with residents needs. These needs must be properly reviewed and recorded. Actions following a fall or other unplanned change in health status must be clearly recorded. This is to ensure residents health is promoted. 2 9 13 The home must ensure that they have safe systems in place for the storage of medication. This is to ensure residents are kept safe. 30/07/2009 3 30 18 New staff must complete a 30/03/2009 thorough induction programme which is linked to skills for care. Systems must be in place to evaluate the effectiveness of any training/induction provided. This is to ensure staff have the neccessary skills and competence to do their jobs. 4 37 17 The home must have records 30/07/2009 required by regulation and
Page 9 of 14 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action these must be open to inspection. Records relating to safe recruitment practices, staff performance and issues affecting the well being of residents must be made available. This is to ensure the home have robust procedures in place and are able to demonstrate that they are following their own procedures. 5 37 17 Staff records must include all 30/07/2009 the information included in Schedule 2 of The Care Home Regulations for Older People 2000. This is to ensure residents are kept safe. 6 38 13 The home must ensure that 30/03/2009 the fire risk assessment is up to date and the risks from uncovered radiators and hot water are fully assessed and measures taken to minimise risks. This is to ensure the fullest protection to residents is given. Care Homes for Older People Page 10 of 14 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 9 13 Medicines must be stored 30/11/2009 under suitable environmental conditions and medicines controlled under the Misuse of Drugs Act must be stored in accordance with the Act and associated Regulations. This will prevent unauthorised access to medicines, ensure the quaility of medicines in use and comply with legal requirements. 2 9 13 There must be accurate 15/09/2009 records of all medicines adminstered, the reasons for any omissions must be recorded. This will demonstrate that people receive their medicines as prescribed. 3 9 13 There must be suitable arrangements in place to ensure that supplies of medication do not run out and that there are sufficient supplies for the continued 15/09/2009 Care Homes for Older People Page 11 of 14 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action treatment of residents. This will ensure people receive their medicines as prescribed. 4 37 17 Staff records must include all 10/09/2009 the information included in schedule 2 of The Care Home regulations for older people 2000. This is to ensure residents are fully protected. 5 37 17 The home is required to keep 10/09/2009 specific records for a period of three years. This includes a copy of the duty rosters of persons working. This is a requirement 6 37 17 The home must have records 10/09/2009 required by regulation and these must be open to inspection. Records relating to safe recruitment practices, staff performance and issues affecting the well being of residents must be made available. Time scale of 30/07/2009 not considered met. This is to ensure residents are fully protected Care Homes for Older People Page 12 of 14 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 9 The written policy and procedures should be updated to reflect current good practice and the practices within the home. Care Homes for Older People Page 13 of 14 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 14 of 14 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
