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: 2 8 0 9 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): 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 0 2 0 7 2 0 0 9 Care Homes for Older People Page 2 of 11 Brief description of the care home This home was sold in October 2008 to ADR care homes, who bought it as an ongoing 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 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 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 11 What we found:
We, The Care Quality Commission (CQC) carried out a random inspection on the 28 September 2009 at 10:30. The purpose of this visit was to follow up requirements made at the last random inspection on the 11 August 2009. Some of these requirements had been carried forward from an earlier random inspection on the 2nd July 2009. We did not look at medication requirements which were made at the last inspection. These will be followed up by the pharmacy inspector at a later date. The home was under new ownership and they had just appointed a new manager at the time of the first random inspection. We agreed we would give them time to meet the new requirements and to get their record keeping in order. After the second random inspection we found some continued breeches of regulation and issued the home with a warning letter and told them to forward us an improvement plan by the 17 September 2009. This was forwarded to us within the specified time and stated what actions they would take to meet the requirements. They did not include timescales which we require. During the inspection we met with the manager and the registered provider Mrs Rudd. We looked at staff records, 4 for staff who had been employed since the last random inspection. These were mainly satisfactory and provided us with evidence that the home had improved their recruitment practices. Staff were only employed after the home had received a protection of vulnerable adults (POVA 1st check.) The home must take note of the information on the POVA 1st check and not employ staff where requested not to until further information is received. There were two satisfactory written references on the staff files looked at. On all the files looked at criminal record checks had been applied for but not received. Written job references were in place on staff files and the manager had followed references up with a telephone call to check there authenticity. On one staff file two personal references were given and the reason for this had been explored at interview. We would expect to see at least one professional reference and where this cannot be obtained from employment it should be sought from a professional person. Another application form only included one referee although there were two references on file. The home are required to keep a copy of their staffing rotas for a period of three years. At the last inspection previous staffing rotas could not be produced and a requirement was made. At this inspection the rotas were available and produced in triplicate. The rotas did not make it clear who was working on a particular day and in what capacity. All staff employed are put on one rota, some are care staff, some are domestic staff, some have duel roles and we were unable to see from looking at the rota how many staff were on duty specifically to meet the care needs of the residents. This made it difficult to establish if staff on an induction period were appropriately supervised and supernumerary to the rota. We asked how many staff were on shift and were told it depended on the number of occupants but generally there were four care staff on in the morning and three full time and one part time staff member in the afternoon. The half shift covered the busiest part of the afternoon. The deputy manager was included in this number but was given one administration day. There are two night staff. The manager is supernumerary to the rota. The manager stated there was an activity person who works twenty hours a week. One
Care Homes for Older People Page 4 of 11 cook and a kitchen assistant working at peak times 4-6 pm and an additional person in the morning because the home had now started offering a cooked breakfast if residents want it. There is domestic support, a laundry person and a cleaner who works seven days a week. The home has a gardener and have just filled the maintenance position of 15 hours. The home have improved their induction process and all staff are now completing a skills for care induction. Staff keep their induction books so we were not able to see these. On employment staff complete a lot of the mandatory training through watching a series of videos. We asked how the home ensure that staff have understood the information and are able to put it in to practice. The manager stated that questionnaires are completed to test staffs knowledge and understanding. We would expect to see this information on staffs files. We looked at the staff files for the manager and the deputy manager, both had initially been recruited to different posts. The manager had first applied for an assistant managers post at Hill House, owned by the same providers. The deputy manager had first applied for a post of senior carer. Both had since been promoted to the positions they now hold. Neither of them had an up to date job description or contract or evidence of interview for the job applied for. The provider stated that the deputy manager would share responsibility for staff supervision. This is currently done by the manager. We would expect the deputy manager to complete training which is relevant and specific to their role. The manager had completed training in supervision of staff. The provider stated that they would soon be completing annual staff appraisals. The staff supervision matrix was seen and staff supervision was being provided at regular intervals. We saw evidence of resident, relative and staff meetings. The manager stated that she/he had just completed a quality assurance review and questionnaires had been circulated to people using the service and their families. We did not ask to see this. We asked to see the complaints record. None have been recorded since the last random inspection, but the home have received a number of compliments about the service provided. There have been two safeguarding issues, one has been discussed under local safeguarding procedures, within a multidisciplinary team. The other the home followed their own internal disciplinary procedures and informed outside agencies. We made a requirement at the last key inspection in January 2009 stating that the home must assess the risks from uncovered radiators and hot water, exceeding 43 degrees and to make these areas safe. The home have put in place a risk assessment and are in the process of getting quotes for radiator covers which would remove the risk altogether, given that the covers were fitted properly. Most of the hand basins have individually thermostatically controlled valves but a few still do not. We looked at the environment in relation to the risk of hot water and uncovered radiators. The risk assessment stated that beds and chairs would be away from uncovered radiators. This was true in four out of the five bedrooms we inspected. In one room a chair was against the radiator. The risk assessment stated water temperatures would be tested weekly and if the temperature exceeded 43 degrees a hot water sign would be in place. We checked the toilets and bathrooms and found the hot water temperatures to be 43 degrees or less. In one upstairs toilet the temperature of the water exceeded 50 degrees and there was no warning sign in place. We noted that bathrooms and toilets were being used as storage areas which is unacceptable and one of the two bathrooms down stairs could not be used. One bathroom upstairs had the bath panel removed, peeling window frames, scuffed door loose carpet tiles and personal toiletries left on the side rather than being locked away.
Care Homes for Older People Page 5 of 11 One bedroom smelt strongly of urine. All other areas of the home were free from clutter and were cleaned to a high standard. No outstanding maintenance or hazards to safety were identified. The gardens were beautifully maintained. What the care home does well: What they could do better:
We noted that staff recruitment practices had improved but felt that this was an area which was still poor and potentially compromised by difficulties recruiting and retaining staff. The provider told us that this was a hugh challenge for the home. Staffing levels must be maintained given the frailty and levels of dependency of residents, many of whom have dementia. The home is very beautiful but because of its layout it makes supervision of residents more difficult as there are a number of lounges and sitting areas. Record keeping is still poor. Examples included the staffing rotas which did not give us enough information about who is working and in what capacity. It was difficult to see if staff were on induction period, care or domestic duties. The manager had recorded staff start dates, shadow shifts and dates for working on their own. These dates did not tally. We have made a requirement about this We were concerned that staff did not have criminal records checks, particularly in one instance where the POVA 1st was unsatisfactory. The manager agreed to wait for staffs CRBs in future The manager was recruited to her position without a CRB in place, although the POVA 1st was clear. Staff do not have contracts, or job descriptions and it was not easy to audit if staff have sufficient skills to carry out their job where there are no job descriptions. Staffs competency is still not sufficiently tested, particularly when staff complete a lot of training by watching videos. How does this learning then relate to practice? Staff induction has improved, but the home have not yet introduced staff
Care Homes for Older People Page 6 of 11 appraisals and it is not clear if staff have a full appreciation of their roles, as some staff have duel roles. The home do not use agency staff which means that staff are familiar with residents needs. 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 11 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 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 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. 2 29 19 Staff must have a 30/10/2009 satisfactory protection of vunerable adults, (POVA) check before they are employed. Criminal records checks must be applied for at the earliest opportunity. This is to ensure residents are protected from potentially unsuitable staff. 3 37 17 The staffing rotas must comply with schedule 4, 30/10/2009 Care Homes for Older People Page 9 of 11 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 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. 4 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. This is to ensure residents are fully protected. 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 10 of 11 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 11 of 11 - 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!
