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 9 0 1 2 0 1 0 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): Name of registered manager (if applicable) ADR Care Homes Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : 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 1 4 1 0 2 0 0 9 Care Homes for Older People Page 2 of 14 Brief description of the care home This home was sold in October 2008 to ADR care homes, who bought it as an ongoing business. They own several other homes. 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 accommodation 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 accommodate 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 ensuite 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 reader should check what the current fees are for the service. At the last key inspection in January 2009 they were 358.00 to 550.00 a week. There are additional charges for personal items. Care Homes for Older People Page 3 of 14 What we found:
We, The Care Quality Commission carried out an unannounced inspection of the home on the 19 January 2010. We last did a key inspection to the home on the 9 December 2009. The home had just appointed a new manager who had been in post for approximately two and a half weeks. We were notified at the end of December 2009 that the manager had been dismissed following an allegation of gross misconduct. This was fully investigated by the home and the manager was dismissed on the 28 December 2009. We were notified in writing. At the time of the managers dismissal the providers were on holiday. We received an anonymous complaint on the 23 December 2009 about poor care standards and insufficient numbers of staff employed at the home. The person making the complaint suggested that a number of staff had recently left. We asked the home to respond to the complaint and also passed on our concerns to the local safeguarding team. The purpose of this unannounced inspection was to check that the home had adequate management arrangements in place and that there were sufficient staff on duty, with the necessary skills and experience to meet the needs of people living in the home. We also wanted to review the homes staff recruitment and selection procedures. We did not look at the requirements made at the last key inspection because the providers had only recently received the draft inspection report. They have twenty eight days to comment on the draft inspection report in terms of any factual inaccuracies. We are planning to go back to do a further random inspection when we will look at the outstanding requirements in full. Any further breeches identified may result in us taking enforcement action against the home. We have sent the providers a warning letter and have requested an improvement plan. We received a written response from the operations manager to the complaint we received about the home on the 23 December. We were satisfied with the response, but some elements of the complaint and subsequent concerns received will be looked at under the local safeguarding adult procedures. Current management arrangements We arrived at the home and were met by the provider, Mrs Rudd and the newly appointed operations manager who has been in post since October 2009. They are providing day- to- day management in the home until a new manager is appointed. Interviews were being held that afternoon. The operations manager stated she will play a key part in appointing a manager as she has a specific care background. We have received a copy of her curriculum vitae. Mrs Rudd stated that there is a senior on every shift during a 24- hour period. Current Staffing situation We looked at the staffing rotas. It was produced in a slightly different format and was
Care Homes for Older People Page 4 of 14 now colour coded to show the designation of staff on duty. It showed there were sufficient staff on duty and numbers had increased to five staff in the morning. Four staff were on in the afternoon and two staff at night. Over the last three to four weeks different rota formats had been produced giving an overall confusing picture of how many staff were on duty at any one time. Despite assurances from the provider that staffing levels were being maintained, care staff stated that this was often not the case due to staff sickness and staff not turning up for work. The home employ one domestic and this person was off this week due to personal circumstances. The laundry person retired last month. There were no firm arrangements in place for covering their hours. The management told us that care staff were picking up these duties as additional shifts outside their normal working hours. This was not shown on the staffing rota. As a consequence of staffing shortages staff we spoke to said they were working long shifts. They felt this could lead to mistakes being made. They said morale was low and several staff had felt like leaving. This would exacerbate the problems the home are currently facing. Care staff also told us they were doing additional tasks like laundry and cleaning as part of their care shift. We were satisfied that a number of staff had worked at the home for many years and were familiar with residents needs, compromised only but insufficient numbers of staff. Recruitment We looked at the homes recruitment procedure and audited 6 staff files. We were concerned that references are taken up but give very brief information and did not help to determine if the candidate was suitable. For one person references from their last employer just confirmed employment dates. A second was a personal reference. The person had their previous employment terminated and there was no record that this had been followed up. Details on the application forms were poor. There was no evidence that unsatisfactory criminal records checks had been followed up and in one instance the person had been employed with inadequate references and on the strength of a POVA 1st. We were concerned that the home were employing staff on the basis of need and not suitability. Contact with GPs and Care issues Mrs Rudd stated that the home has contact with two surgeries and she has been reporting care issues regularly. It was recommended that the home would benefit from organizing a weekly in house surgery, with a visiting GP, so that residents could receive regular ongoing monitoring advice and treatment. Mrs Rudd agreed that this would be beneficial and they stated that they would approach the surgeries to set this up. Issues regarding pressure care for one resident were discussed and Mrs Rudd stated that district nurses had been involved in their skin pressure care and had been visiting her daily for a number of weeks. We were told no one else had pressure sores. One persons skin had been identified as fragile and the home had provided them with an air flow mattress. We raised a concern in respect of the under reporting of incidents. The home were not always notifying us of events affecting the safety and wellbeing of residents. We asked to see a regulation 37 for one person who had sustained an injury after a fall. One had been completed but did not include a date. We spoke about the prevention of falls and the home were not able to show us a clear audit trail of who was at risk of falls, apart from individual risk assessments and accident
Care Homes for Older People Page 5 of 14 records, there was no falls register and no contact had been made directly with the falls prevention co-ordinator. We were concerned that a number of people were underweight and the home were not able to tell us directly how many residents were on dietary supplements or special diets. We asked if residents were being offered finger foods and were told yes in the evening. They were also being given chocolate. Management said how difficult it was to make a referral to a dietician and were not aware of the service being offered locally. We had been told that only one resident had pressure sores, but we looked at the diary which had an entry from the previous month of a resident with pressure sores, we saw a daily entry for another resident who had a blistered heel. Quality Assurance We asked about quality assurance and the home produced a survey they had completed in August 2009 which looked at participants satisfaction in a number of different areas including health and personal care, environment, complaints, staffing and management. The Care Quality Commission has sent out surveys to people using the service and their relatives. And hope to have information back before the next planned, unannounced inspection. The home are planning to hold relative/residents meetings within the next couple of weeks and will complete an annual audit on their service. What the care home does well: What they could do better:
From our general observations and discussions with staff, residents and a visitor we were made aware of their concerns about staffing levels, staffing turnover and management. Staff expressed concern about raising issues with management because they stated they feared for their jobs. This was discussed with the management team in relation to everyones responsibilities under safeguarding protocols. One relative said they had raised a number of recent concerns with management and they had dealt with their concerns. We looked at the complaints log and nothing had been recorded. We revisited one bedroom which we found in a poor state at the last inspection. The
Care Homes for Older People Page 6 of 14 window pane remains cracked. There was still a malodorous smell detected in the room. The bed was dry and clean. An outstanding requirement about radiator covers had almost been met and workmen were there on the day and planned to fit the last cover at the weekend. As a result of this random inspection we will be making one requirement about staff recruitment and selection. We will make a further requirement about staffing levels at the home. There are seven outstanding requirements from the key inspection carried out on the 9 December 2010. These are not included on the report. There are a further three requirments carried over from the previous random inspection report. These have been carried forward to this report. We expect the home to report any incident affecting the well-being and safety of residents at the home and to ensure that they properly record the number of falls, whos at risk and what steps they have taken to reduce the risk. We advised the home to contact Jenny Moran with the view of providing some safeguarding of vulnerable adults training in-house. 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 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 7 15 Care plans must reflect 30/12/2009 changes in residents needs and agreed actions to be taken to continue to meet those needs. Particular attention must be paid to the reduction in falls. The home must evidence what actions they have taken and draw up individual risk assessments. This is to ensure that residents have their needs met and they are kept as safe as possible without imposing on their independence. 2 9 13 Records made when 31/03/2010 medicines are given to people must be accurate and complete. This will demonstrate that people receive the medicines prescribed for them. This requirement has not been met in full by the given timescale of 31/12/09 3 9 15 Where people are prescribed 31/03/2010 medicines on a when required basis, there must be clear guidance in care plans of the circumstances
Page 8 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 they are used and staff must follow this guidance. This will protect people from harm and ensure medication is not given inappropriately. This requirement has not been met in full by the given timescale of 31/12/09 4 9 12 Medicines must be given to people in accordance with the prescribers instructions. This will ensure people receive their medicines as intended by the prescriber. This requirement has not been met in full by the given timescale of 31/12/09 5 12 12 The home must demonstrate 30/01/2010 how residents choices are promoted in relation to all aspects of the home. Routines of daily living must reflect the wishes of residents and not be driven by the staffing culture. This is to ensure the home matches the cultural, social and dietary needs and wishes of residents. 6 26 23 The home must be 30/01/2010 maintained to high standards of cleanliness and adequate arrangements in place to control the spread of infection. 31/03/2010 Care Homes for Older People Page 9 of 14 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 This is to ensure residents are safe. 7 27 18 The home must ensure that 30/10/2009 their staff are suitably qualified, competent and experienced. The home must have a clear audit trail of staffs training and induction received. Training records in themselves are insufficient. The home must evaluate the effectiveness of the training provided. This is to ensure that staff have the neccessary skills to meet the requirements of the job. 8 37 17 The staffing rotas must comply with schedule 4, which states that the duty rota must include the position staff hold, the work they perform and the number of hours they work. This is to ensure that there is a clear audit trail and the home are able to clearly evidence that care hours are sufficiently covered. 9 38 23 The home must be free from 30/11/2009 hazards. Unguarded radiators must be covered and hot water temperatures regulated so they do not exceed 43 degrees. This was a previous requirement but the home have taken steps to minimise the hazards but have not eliminated them.
Page 10 of 14 30/10/2009 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 This is to ensure residents are fully protected. Care Homes for Older People Page 11 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 27 18 The home must have sufficient care staff on duty to meet the assessed needs of the residents. The home must employ sufficient numbers of domestic and catering staff. This is to ensure residents care needs are met. And to ensure the home meets the standards relating to food, meals, nutrition and hygiene. 10/02/2010 2 29 19 Staff must not be employed at the home until all the required information is in place regarding their suitability for employment. This is to ensure people using the service are properly protected. 10/02/2010 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 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!
