Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 26/01/09 for Bethany Francis House

Also see our care home review for Bethany Francis House for more information

This inspection was carried out on 26th January 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The environment has been greatly improved. Communal areas have been painted in light, sutle colours. Pictures and ornaments have been purchased and individual bedrooms upgraded. The expert by experience spoke to many residents and found on the whole residents to be content and enjoying each others company. Residents felt that the care they received was of a high standard and had nothing but praise for the care staff. Residents were observed maintaining their own independence, but staff support was available as required. The expert by experience said, "The manager and staff were very helpful. She said she found it to be "a very happy establishment, a comfortable and appealing home with staff who cared."

What has improved since the last inspection?

This home was registered as a new service in October 2008 after the previous owners sold it as an ongoing business. The registered manager remained in post and there has been very little in the way of staff turnover. A registered manager from another home owned by the same provider is proactive in supporting the manager and has carried several internal audits. This is required under regulation 26. These have been sent to us at our request. Records indicate that some improvements are being made, but as a new service it is difficult to assess. Improvements include: changes to the environment, the decor and purchasing of new fixtures, fittings and soft furnishing. The home have employed a maintenance person. There is now a full time compliment of ancillary staff, which includes administration support shared by all the homes but based at Bethany Francis. The manager has introduced residents meetings and has asked relatives to formally comment on the standards of care being provided at Bethany Francis. The staff records indicated gaps in staff training but these were being addressed and the manager said she was being given alot more opportunity to attend training herself and would ensure that senior staff receive appropriate training to their job role. She said seniors now carried more responsibilities. The staff duty rotas have been changed creating only three shifts, morning, afternoon and evening. The home use to have different start times across the day for staff, which meant shift hand overs could be fragmented.

What the care home could do better:

At the last inspection a requirement was made regarding the care plans which were felt to be inadequate. As a newly registered service alot of the paperwork has changed and there is a new care plan format. These did not adequately describe a persons needs or how best to meet them to ensure staff are working in a consistent way. In response to the draft inspection report the manager stated that the care plans are very much work in progress. She said all the staff have been given extensive training to enable them to complete the care plans clearly and comprehensively. We were concerned that although routines are flexible there was insufficient evidence that residents social care needs were being met. Activities were being provided in theafternoon and residents had asked for activities in the evening. There was no evidence that residents can continue to pursue interests outside the home. The home do not have a budget for activites or transport to escort residents. This means residents who are unable to travel independently are reliant on relatives.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bethany Francis House Bethany Francis House 106 Cambridge Street St Neots Cambridgeshire PE19 1PL     The quality rating for this care home is:   one star adequate service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Shirley Christopher     Date: 2 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Bethany Francis House 106 Cambridge Street Bethany Francis House 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 Additional conditions: 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. 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. Care Homes for Older People Page 4 of 30 Brief description of the care home 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 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We carried out an unannounced inspection on the 26 January 2009. As part of this inspection we used several different methods to try and accurately capture the experiences of residents living at the home. We carried out a two hour observation, known as a (SOFI) short observational framework for inspection. This tries to identify aspects a good quality person centred care and is a tool which uses observation to make a judgement about quality, It is widely used by the Commission and is designed to assist inspectors in capturing peoples first hand experiences of those who have dementia, or difficulty with verbal communication. We also used an expert by experience who through their own personal experiences as a carer or user of care services are able to bring a wealth of experience into the Care Homes for Older People Page 6 of 30 inspection process. We also considered other information we had prior to the inspection including a self assessment form completed by the manager, the contracts and monitoring report completed by the local authority and any service history, including notifications. During the inspection we looked round the home, spoke briefly with staff and a visitor, observed care practises and interactions. Spoke at length with residents and looked at some records including, medication, care plans, staff records, maintenance records and minutes of meetings. What the care home does well: What has improved since the last inspection? What they could do better: At the last inspection a requirement was made regarding the care plans which were felt to be inadequate. As a newly registered service alot of the paperwork has changed and there is a new care plan format. These did not adequately describe a persons needs or how best to meet them to ensure staff are working in a consistent way. In response to the draft inspection report the manager stated that the care plans are very much work in progress. She said all the staff have been given extensive training to enable them to complete the care plans clearly and comprehensively. We were concerned that although routines are flexible there was insufficient evidence that residents social care needs were being met. Activities were being provided in the Care Homes for Older People Page 8 of 30 afternoon and residents had asked for activities in the evening. There was no evidence that residents can continue to pursue interests outside the home. The home do not have a budget for activites or transport to escort residents. This means residents who are unable to travel independently are reliant on relatives. 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are well informed about the home before they move in and are invited to spend time at the home so they can make an informed decision about moving there. Evidence: The manager confirmed that the statement of purpose and service user guide have been updated and re issued to residents and relatives using the service. This would have been inspected as part of the new registration of the service. We spoke to the manager at length about changes in the home and the effect that it has had. The home currently has 7 vacancies and has a mix of privately funded and publicly funded residents. The manager confirmed that she completes a pre admission assessment as do the Local Authority. The local authority have carried out statutory reviews for the majority Care Homes for Older People Page 11 of 30 Evidence: of residents they fund. The manager completed a self assessment form in which she stated that potential residents are invited to look round and spend an extended period in the home to ensure they get the opportunity to meet staff and other residents. They are given all the information they need to help them settle in such as the statement of purpose, service user guide, complaints procedure and terms and conditions. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Written evidence of how residents health, personal and social care needs are being met needs to improve to accurately reflect the high standards of care being provided by the home. Evidence: There are two versions of the care plans in the home. The newer ones contain much more individualised information and if they continue to be built on then they will provide good and pertinent information to meet the care needs of those living in the home. However at the moment only few have been completed and the majority still have the old style which only provide information to meet basic needs of people in the home. Two files were seen for people living in the home and the following issues were found. The health and safety risk assessments are corporate and do not address specific individual issues. This was discussed with the area manager and she agreed that they Care Homes for Older People Page 13 of 30 Evidence: should be personalised and will see that it is done. None were dated or had details of when they were to be re-assessed. The falls risk assessment for one person showed they should be hoisted at all times but there were not details of the type of hoist or how many people were needed to assist. The same person had an assessment of daily living skills that showed she needed full assistance with personal care but no details as to what this meant for this particular lady. There was information that she had disturbed nights which can resolve and then X sleeps well again. There was no information as to what staff should do to help her when the sleeplessness occurs. There was a blanket statement that this lady prefers not to take part in activities, but does enjoy sitting in the dining room for meals. It was disappointing that there was nothing to show how to encourage and engage her, what her interests were/are and if they can be incorporated into anything. In the care plan there was more detail about mobilisation with details of the sling and number of staff, and in communication it showed she should be listened to and encouraged to form relationships with other residents and staff. This was one lady who was observed as part of SOFI and her chair was further back than everyone elses so did not encourage talking to other people. Staff were very task orientated but did engage well when they were hoisting her and explained what they were doing. There were details of GP and District nurse visits. There was a report from the Speech and Language department showing they were unable to provide a service to residential homes, although staff could contact if they wanted advice. An eye test was to be booked for February. Another file seen was of the old type and had limited information which would not have made it easy for staff to meet the needs of that person. The care plan had been updated in August 2008 and contained information such as appears muddled at times, can be agitated in her bedroom but is fine when brought downstairs. This was another lady observed as part of SOFI and although she was initially very calm and sleepy she became more agitated as more people and more activity took place in the lounge. There was no information on file on how to handle her agitation, what helped, what hindered etc. She had seen the GP, Community Psychiatric Nurse and Chiropodist recently. Her medication had been changed and this was shown on the MAR sheets. The manager stated that there were at least nine residents who have a diagnosis of dementia. The home are supported by the community psychiatric nurse, but have no links with the Alzheimers association. There is literature around the home and staff Care Homes for Older People Page 14 of 30 Evidence: have received basic training in dementia care. The home has a chapel which was under utilised and now has been converted into a library come treatment room. The manager confirmed that they had a good relationship with the primary care services and the doctors and nurses come to the home at their request. The manager confirmed that there are regular visits from the chiropody service. There had been 6 incidents so far in Jan 09 which had been recorded appropriately. Medical staff had been contacted where necessary and notes for the person to be observed were detailed. Two people were case tracked and their medication checked. All was found to be in order. There are two medication trolleys, one upstairs and one downstairs. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents should have sufficient opportunites to socialise within the home and the wider community. Residents spent alot of time inactive and this is against their choice. Evidence: We carried out an extensive piece of observation, which involved observing the interactions between staff and residents for a period of two hours. This was done in one lounge and five people were observed. There was evidence that staff were caring and explained to people what they were going to do (when they needed to hoist), but staff were task orientated and lost opportunities to engage with other people in the room. Between 10:15 and 10:55 the five people being observed had no interaction with staff, although other people were being brought into the room, seated and spoken to. One lady could hear talking in the corridor and got up and walked to look out and then went out of the room. Someone not part of the SOFI was heard to be referred to as a good girl when she moved her legs as requested by staff and the same staff member used this phrase on more than one occasion. This is not a positive way of referring to people and the manager has been made aware. No-one was given anything to do. One lady (not part Care Homes for Older People Page 16 of 30 Evidence: of SOFI) had a paper delivered and sat with it. She said to staff it was difficult to read and was told to look at the pictures and the staff walked away. One of the people who were part of the SOFI was eventually given her paper and she sat and talked about it with a lady sitting next to her. One lady who became quite agitated had a bowl of water and flannel brought and a staff member sat and wiped and massaged her hands. This was not detailed as a method of calming her in her care plan. A visitor/volunteer came into the room and when speaking to people who were confused used childish phrases to them. It was discussed with the manager that people need to understand dementia and how to talk and engage with people in a positive way. As part of this inspection we used an expert by experience. She was asked to look round the home and comment on her observations. She also observed care practises, routines and observed the lunch being served. She spoke to staff, residents and visitors. She made these comments. There was no real evidence of activities apart from a photo album which showed some residents doing craft and some dancing at a former time. There is a lady who is employed as a carer and is allotted 10 hours per week to devote to activities; This would seem totally inadequate in a home of this size. The home did not have a mini bus or any means of transporting residents to any events or shopping. The manager stated in response to the draft inspection report that activities are arranged throughout the year, including a summer fete. She stated that most residents are either unwilling or unable to go out, but those who want to go out are assisted to use taxis or dial a ride. She stated some residents go to whist drives and quiz nights.Entertainment depended on voluntary help. A man does a quiz twice a week for those who are able to enjoy it . When asked about entertainment the manager said they were offered tickets for the pantomime but nobody wanted to go. Videos and DVD films could no longer be shown due to recent legislation. An entertainments licence is now necessary. Several residents said they spent alot of time throughout the day just sitting, with limited activities being provided. Residents stated that routines are flexible and staff offer choices to them. One lady was concerned that her nails were long and dirty, and there was no one to do them. On the day of inspection someone was doing nails. The expert by experience stated, My overall impression of the activities and entertainment areas was that it was very poor and residents were not involved much in this area. Care Homes for Older People Page 17 of 30 Evidence: We were unable to speak to the activities co-ordinator as she was on leave, but the manager stated that they have a religious service monthly for residents and she has recently contacted a local minister with the view of setting up a discussion group. We spoke to the chef who showed a good understanding of residents dietary requirements and specific needs. The kitchen was well organised and there were systems in place to ensure foods were stored and cooked at correct temperatures. When we first entered the kitchen it had been left unoccupied only for a few minutes. This is unsatisfactory given the potential risks to residents. Staff/visitors did not and were not asked to wear protective clothing when entering the kitchen. The cook had relevant qualifications in catering, health and hygiene and first aid. There were a few books in a bookcase situated at the top of a flight of stairs in a very dangerous position for anyone let alone an older person who may be unsteady on their feet. The manager informed us after the inspection that this bookcase has been removed. Residents spoken to were very pleased with the laundry facilities The expert by experience stated Lunch was served to 17 residents in the dining room and 5 residents had lunch in their bedrooms. There was a choice of main course, vegetables and desert. They could have omelettes or a meat dish a selection of 4 veg. cauliflower, broccoli,carrot , tomatoes plus potato followed by either jelly and cream or yogurt, or fruit sponge and custard or fruit. Each person was asked what they would like. The servings were more than ample and the meal was thoroughly enjoyed by most residents. There was quiet appropriate music being played, there was fruit juice on all the tables. Serving was slow, some people were finished before others had been served. One lady who was 100 years old said her bottom was sore because she had to wait so long. The manager stated in response to the draft report that residents were served their meal at a pace that was appropriate to them.Staff were good and talked to residents and encouraged them to eat and drink. There was an incident with one of the dementia residents. She was screaming and crying but staff coped extremely well with the situation and even another dementia resident helped to calm her telling her she would be alright and the they(the staff)were very nice. I found this very touching. There was plenty of conversation at the table between residents and the staff joined in. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has adequate systems in place to safeguard people living and working at the home. Evidence: The manager stated there had been one complaint since the last inspection. This had been refered to the local authority to investigate. The manager had responded appropriately within the timescales. New policies and procedures have been introduced to the home and these were easily accessible. Local practise guidelines and adult protection protocols were in place. The home has suitable staff vetting procedures and the majority of staff had completed training in the protection, (safeguarding of vulnerable adults,) although some gaps were identified. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a hight standard of accomodation, which is well decorated and maintained to a high standard. Evidence: The environment has been improved and positive comments were received from relatives about changes that had been made to the home. The expert by experience said, Lounges, dining room, hallways and corridors were well furnished and recently redecorated very tastefully. Furniture was suitable and coverings matched carpet and decor. Bathroom and toilets were in need of redecoration and refurbishment, while there were hoists the furniture and fittings were old fashioned. All the bathrooms have chair hoists. The manager stated that these were regularly maintained and suitable forthe needs of the residents. Toilet rolls were well placed. One toilet had a left hand facility and the toilet next door had a right hand facility. The dining room was newly decorated and pictures were in process of being hung. This was happening in many areas and was certainly adding charm and interest to the Care Homes for Older People Page 20 of 30 Evidence: home. There were 17 people seated at 4 tables.This took up a lot of space. Five residents were having their lunch in their bedrooms. The room was quite full and certainly could not accommodate the full compliment of 34 residents even one more table would be too many. The tables were nicely presented with lace cloths, fresh flowers and blue napkins to match the decor with plastic bibs for those who needed them. Unfortunately all the tables were too low to accommodate wheelchairs without having to remove the foot rests. Even one table of correct height would save carers straining shoulders and back muscles if they have to lift the feet off and on the pedals. In many cases round tables can be easier for the manipulation of wheelchairs. The manager stated in response to the draft inspection report that the tables were the same height supplied to other care homes supplied via specialist care home furnishing companies. The home had received no complaints about the height of the tables. I was shown several empty rooms which were unoccupied and had recently been redecorated. The decor was different in each and very tasteful. They were overlooking the garden, had nice big windows and were of adequate to good size. I also visited two occupied rooms which had evidence of personalisation with items of furniture, pictures ornaments and photographs These rooms were awaiting redecoration. All rooms had a wash hand basin in the bedroom and some had an ensuite toilet but none had a complete en-suite. Beds were mostly divan type,when I asked the manager about hoists she said they had some beds with legs suitable for hoists. The standards of cleanliness through out the home were high and the home employs adequate numbers of domestic staff. Staff receive training in infection control. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a low staff turn over and the majority of staff are experienced and have completed a national vocational course in care. Evidence: We inspected the staffing rotas and were told staffing levels were adequate to meet residents needs. The staffing rota must include the surnames of all the staff as this is a legal document. The manager works Monday to Friday 9-5 and is supported by senior staff and a number of part time administrators. The home has a full compliment of ancillary staff and an activities coordinator who works ten hours a week. There are two night staff on duty and there is an on call system which is shared by a number of registered managers. The manager commented on improved training opportunities and said she had recently completed a course on dementia care mapping, deprivation of liberties and was doing a two day course on safeguarding vulnerable adults. A number of newer staff have places on the safe guarding courses. We looked at three staff files which were satisfactory. They provided evidence that staff receive regular supervision, although all staff are currently being supervised by the manager as senior staff have not been appropriately trained to supervise staff. The Care Homes for Older People Page 22 of 30 Evidence: home intend to introduce annual staff appraisals. Gaps in the existing application form included: no where to put down length of employment at previous posts which should include months and years, so the home can check any gaps in employment. Interview notes were not seen to support a robust staff recruitment and vetting procedure. A new application form has been introduced. References and protection of vulnerable adults, (POVA) checks were in place before new staff had been employed. Evidence of staff induction was provided. New staff are shadowed for about three days and complete a basic in house induction and mandatory training. Staff go on to do an national vocational course, (NVQ.) The basic induction check list was completed and signed off but there was no evidence of a probationary period or review of staffs performance. Some evidence was provided of staffs competence following training, such as the use of questions to test staffs knowledge, but other training had not be evaluated and it was not clear what had been covered during the training. Some mandatory training such as safeguarding and food hygiene had not been completed for staff employed within the last seven months. The training matrix showed that training was mostly up to date. The home exceeds the national minimum standard which recommends that 50 of care staff hold an nationally recognised qualification. This home has a low staff turn over and staff are experienced. The home do not rely of agency staff. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further evidence of how residents are enabled to participate in the decision making processes of the home would raise the standards of care further. Health and safety in the home is good, but some areas of weakness were identifed. Evidence: We asked about the new organisational structure and whether the manager felt sufficiently supported. She told us that she is supported by the new owners who are situated on site. She has a full staff compliment of staff, with the exception of a deputy manager but stated that the new shift structure meant there was no longer the necessity for a deputy.There are three senior staff, one is currently on long term sick leave. Senior staff either hold an National vocational course level 3 or are studying for it. The manager is supported by another home manager. This manager, carries out audits of the service. These should be monthly. The manager of Bethany Francis is experienced and holds the registered managers award. Care Homes for Older People Page 24 of 30 Evidence: The manager stated that residents meetings have been re instated, and the first one took place this month. A grand opening was planned for the end of January 2009 and a cheese and wine party had taken place to give relatives a chance to meet the provider. The manager had circulated a number of questionnaires to relatives and had received 12 responses. The range of responses ranged from very satisfied to dissatisfied. Most relatives were satisfied. We were concerned that feedback from residents apart from the residents meeting had not been sought and the information collected, some of it dating back to December had not been collated and there was no evidence that feedback had been given to relatives. One relative had raised a formal concern and this had been dealt with appropriately. A maintenance person has been employed and most records inspected were up to date. The home had been audited by the local authority who produced a report dated 25 November 2008. The manager stated that they had made good progress against the required action. The local authority had visited a week earlier to monitor the homes progress, for which a report will be made available. The local fire authorities had also audited the service in November. A report from this visit was not seen. We saw evidence of recent fire training and staff participation in drills. Fire alarms are tested weekly but we did not see records for the emergency lighting. Regular servicing of equipment such as hoists and lifts were seen. The fire risk assessment had not been reviewed. it was dated 01/04/ 2007 and must be updated. Employees details was dated 2007. This must be updated. We also asked for evidence that uncovered radiators had been risk assessed. this was not provided. Thermostatically controlled valves had not been fitted on each individual residents handbasin or in one of the communal bathrooms. Temperatures were being monitored and the manager stated risk assessments were in place. We did not request a copy of these. The night staff had raised concerns in one of the staff meetings that they couldnt hear the telephone whilst upstairs. It was also realised in discussion that staff have no means of communicating with each other whilst on shift when working in different areas of the home. This should be looked at to improve both the safety of residents and staff. We asked about residents finances and were told that the home do not hold any money on residents behalf. Those who lack capacity to manage their own money would either appoint someone on their behalf or entrust it to a family member. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 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, Care Homes 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 7 15 The care plans must be 30/03/2009 robust and give care staff sufficient detail to enable care staff to know how to meet residents needs. They must be supported by other appropriate documentation including risk assessments, mental health care plan, and manual handling records. They must be kept under review and provide evidence that they are working documents. They must show that they have been implemented and reviewed in discussion and involvement of the resident and significant others. This will ensure that staff know how to meet residents needs and do so in a consistent way. Regular review will help staff identify accurately where residents needs are met, changing or unmet. Care Homes for Older People Page 27 of 30 2 12 16 The home must ensure that the activites they provide are suitable and reflect residents expectations, preferences and capacities. This is to ensure that the home are identifying and recognising residents social needs. And are creating a stimulating envirorment where residents continue to have productive lives. 30/03/2009 3 30 18 New staff must complete a 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. 30/03/2009 4 37 17 Staff rotas must include staff 30/03/2009 surnames. This is a legal document and may be used as evidence. 5 38 13 The home must ensure that 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. 30/03/2009 Recommendations Care Homes for Older People Page 28 of 30 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 19 The home should ensure that the layout of the home is suitable for residents. This refers to the current layout of the dining room which is adequate. If the home was fully occupied the seating arrangments would not give sufficient space for residents to eat safetly. Equpitment provided in the dining room should be suitable and provide the maximum comfort and independence for residents. The home should demonstate how the home is run in the best interest of residents and should develop strategies to enable residents to contribute to the decision making processes. Staff supervision should be at least six times a year and include a clear induction/probationary period. 2 32 3 36 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - 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!