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: 0 2 0 7 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 12 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 12 What we found:
We, The Commission For Social Care Inspection carried out an unannounced random inspection to Bethany Francis House on the 2 July 2009. The purpose of our visit was to check the current management arrangements at the home. We had been informed by the registered manager that she no longer worked at the home. In response to this draft report the acting manager stated that the home notified the CQC in writing about the manager leaving. We checked on a second visit to the home and saw a completed notification to that effect. Since the last key inspection to the home on the 26 January 2009, we have received four complaints from staff working at the home, several were ex employers and two complaints from relatives. The complaints from relatives were being addressed through the care managers from Social Services. We spoke with the care manager who was satisfied with actions taken by the home. The home were aware of a number of issues and were in the process of having people reassessed where they felt they were unable to meet their needs. Concerns included: inadequate numbers of staff on shift, staff without sufficient skills or experience, language barriers, poor supervision of residents. Examples of this were food and fluid charts not being completed, residents losing weight and residents not being assisted to the toilet frequently enough. Other concerns included: poor personal hygiene, residents with dirty nails, and hair and clothes not being laundered satisfactorily. We also had reports of the medication trolley being left open and unattended and the cupboard where chemicals are kept left open. We were told that issues which potentially could be adult protection issues were not being reported to us by the home. This has since been explored with the home and we are satisfied that the home are reporting issues required under regulation 37. On the day of inspection, we looked at four outcome areas which were: health care, complaints and protection, staffing and management. We have reported our finding under the separate headings: Health Care We observed lunch to ensure residents were appropriately supervised and that their dietary requirements were being adequately met. It was a hot day and there were fans and jugs of water and juice throughout the home. Lunch was served from 12.30. The dining room was adequately staffed, but some staff were not aware of the dietary needs of residents. Staff were asked which residents were on food and fluid charts and not all staff knew this. We checked a number of fluid charts and in one instance the chart was completed incorrectly. One residents care plan stated they needed assistance and encouragement with their meal. We did not observe this being offered. One resident spoken to stated they did not get enough to eat and another gentleman felt the food standards had gone down. The area manager explained that they had recently changed supplier and complaints increased,so they had reverted back to the suppliers used before. Meat and vegetables are sourced locally. We looked at weight records and found one resident had lost weight and the home had contacted the GP but no further action had been taken although the residents weight remained unstable and had dropped further. The manager stated that residents receive adequate nutrition and only one resident has an issue with weight loss and this has been reported to all the relevent health care
Care Homes for Older People Page 4 of 12 professionals. We case tracked three residents files and noted there was good recording of accidents, incidents and communication with other agencies. The district nurses were regularly visiting to dress wounds/skin tears. We saw evidence of medication review and input from psychiatric services. One residents notes indicated that they had gained weight recently after some un-intentional weight loss. They had a risk assessment in place and they had a number of recorded falls. The home had put movement sensors in their room. Their care plan stated how they liked to be dressed and said they liked to wear perfume and make up. We spent some time with this resident. However their mouth was dirty and their eyes looked gluey. Staff said thats how it was sometimes and made no attempt to clean them. Records showed residents were checked hourly and appeared to be toileted at regular intervals. We looked at one residents records. This resident was generally actively mobile but had recently had two falls, which had been discussed with their relative. Their care plan and risk assessment had not been updated. One of the falls had been at the top of the stairs. On the day of inspection there was a discussion about moving them downstairs. The risk must be assessed because they may still be at a similar risk if they were moved downstairs. The residents son raised concerns about his relatives personal hygiene. The care plan had not been updated to reflect a change in need. The residents life history and family tree was poorly recorded. Their care records refered to previous issues with their behavior but does not state what they were. Their mental health needs were poorly described and the actions to be taken by staff were poorly explained. We looked at accident records and identified a few residents who were having frequent falls. Some actions had been taken as discussed with the area manager, but the home should consider having a falls register and clearly showing how they were monitoring falls and what action they should be taking. We observed medication being given out and it was given out safely and the trolley was locked when unattended. We did not do an audit of medication. Complaints and adult protection We asked to see records relating to staff where there have been performance and management issues. These were not available. The area manager stated that the providers had been dealing with staff performance issues. We were concerned that the home had failed to notify us of a number of alleged events, which if did take place put residents at risk. The manager stated in response to the draft inspection report that any concerns they had were raised at the time with the care manager David Watts, who was the lead POVA practitioner. He looked at concerns and was satisfied that the home were taking the appropriate actions. During the inspection a relative asked to speak to us regarding his concerns. A meeting took place between the relative, the manager and area manager and ourselves. Minutes were taken. The relative expressed concerns about changes in staffing levels and felt the standards of care had dropped. He gave a number of examples. He was reassured that staffing levels had not dropped since the providers took over and noted that his relative
Care Homes for Older People Page 5 of 12 had some unmet or changing needs. The manager agreed to update the care plan and to look into an event which occurred at the weekend. The relative felt that the home did not run as smoothly at the weekend. The manager stated that she would be working some weekends and she told the relative she is always on call and would be expect to be informed of any events affecting residents welfare. Staffing On the day of inspection the home was adequately staffed. There were two permanent members of care staff and two members of staff who ordinarily work at Hill House, a similar service owned by the same providers Mr and Mrs Rudd. These staff had experience in care and we were told that they had completed the same induction as staff working at Bethany Francis House. The area manager said that it was preferable to use their own staff rather than agency or bank staff. She said staff from the other home were paired up with permanent staff from Bethany Francis House. We spoke to the temporary staff and asked them the name of particular residents. They did not know. It was evident through observations that the temporary staff did not know the routines of the home or the needs of the residents. The manager stated in response to the draft inspection report that temporary staff are shadowed by more experienced permanent staff and permanent staff would be responsible for completing records such as fluid charts. Another residents care plan stated they needed assistance and encouragement with their meal. This was not offered. The inspector asked the temporary staff which residents were on food and fluid charts. They did not know. The home are in the process of employing a number of new staff, some from oversees. They are waiting for protection of vulnerable adults, (POVA) checks to come through. We asked to see the files of two new staff. The first file was incomplete. Only several pages of the application form could be found. There was a pova 1st in place and references. There was no documentary evidence of the persons identification, immigration status or current address. We were told that Mrs Rudd conducted the interview and had the necessary paperwork. We spoke to a second member of staff who had relevant experience and training in her previous position, but had not received any training since working at Bethany Francis House, four weeks ago. We asked to see her file but this was unavailable. Management arrangements the home. On the day of the inspection we were met by a new manager who had been in post for a few days as the manager, but had been at the home since May 2009, deputizing in the absence of the registered manager. She was being supported by the area manager, who was also at the home of the day of inspection. The manager has previous experience in elderly care and is studying for the Registered Managers Award. The providers were on holiday. They have an office at the home and Mrs Rudd provides administrative support and had been dealing with staff performance and disciplinary issues. The area manager stated they had notified us in writing regarding the manager leaving. What the care home does well:
Care Homes for Older People Page 6 of 12 We looked at a number of outcome groups, where concerns had been expressed. We did not look at the environment or social activities specifically but these are areas where the home has improved. There has been a major refurbishment programme and the home was cleaned to a high standard. The home are looking at their social activities programme and with the help of an activities coordinator and a volunteer met on the day of inspection they are increasing the social opportunities for residents. Staffing levels appeared to be maintained to an appropriate level as evidenced on the day of inspection and from the duty rotas. The feedback we received on the day of inspection was mixed. One relative made a verbal complaint about the standards of care. His concerns were listened to and actions agreed. Another relative praised the home. Some residents said the home had gone down hill and said residents did not receive the care they use to. Some staff stated that there had been alot of changes but these were for the better. The management team were seen as approachable and visible. Staff said hygiene standards had been improved. Care records had improved and there was a new style care plan in place. What they could do better:
The home had adequate records but they are not always completed correctly, or reviewed when residents needs change. Care plans should be a tool for staff to ensure they know what residents needs are and how they should be met. The home must be more proactive in the management of falls and actively assess those most at risk from falls. Hazards from the environment should be clearly documented. Residents weights must be clearly monitored where there is unintentional weight loss and food and fluid charts must be completed properly. We have received a number of reports of the medication trolley and chemical cupboard being left unlocked and have made a requirement regarding this. The home have adequate safeguards in place to protect residents. Staff performance and management issues have been dealt with by the providers but we were not able to see any records. We have been told that there have been incidents at the home that should have been reported to us, but without access to the records or discussion with the providers we are unable to validate this. We are proposing to go back to the home and look at staff records. We have no evidence that the home do not have sufficient staff, but were concerned that some staff on duty did not know what the residents needs were and were unfamiliar with the homes routines. Some of the residents at Bethany Francis house would be unable to tell staff what their needs were and familiarity of routine would be important. We saw evidence of staff induction but were unable to see records relating to staff who were employed at another home and were just providing temporary cover. We asked to see staff files. The home have made a number of recent appointments but were waiting for all the appropriate checks to come through before staff were offered a start date. The file for a staff member recently employed in the kitchen could not be
Care Homes for Older People Page 7 of 12 produced and a second staff file for someone recently employed was incomplete. We have made a requirement about this. The home has appointed a new manager who has only been in post a short while. The providers must enclose an application to register her with the Commission for Quality Care as soon as possible. The management arrangements were satisfactory. We asked to see some records which were not available and these must be made available. They included staff records, and recruitment checks. 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 8 of 12 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 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. 2 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 9 of 12 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 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 37 17 The home must have records 30/07/2009 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
Page 10 of 12 Care Homes for Older People 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 available. This is to ensure the home have robust procedures in place and are able to demonstrate that they are following their own procedures. 4 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. 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 11 of 12 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 12 of 12 - 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!
