Inspection on 08/03/10 for Bethany Francis House

This inspection was carried out on 8th March 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bethany Francis House 15/06/10

Bethany Francis House 24/02/10

Bethany Francis House 19/01/10

Bethany Francis House 09/12/09

Bethany Francis House 14/10/09

Bethany Francis House 28/09/09

Bethany Francis House 11/08/09

Bethany Francis House 02/07/09

Bethany Francis House 26/01/09

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

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 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 full review a ‘key’ inspection. Lead inspector: Andy Green     Date: 0 8 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 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): ADR Care Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 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 ongoing business. They own several other homes. Bethany Francis House is a listed building, set back from the main St Neots to Care Homes for Older People Page 4 of 26 Over 65 0 34 34 0 0 9 1 2 2 0 0 9 Brief description of the care home 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. Care Homes for Older People Page 5 of 26 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, the Care Quality Commission, carried out an unannounced key inspection of Bethany Francis House on 8th March 2010. We inspected a number of documents including; the Statement of Purpose, assessment documents, care plans, activities, staff rotas, recruitment, training and supervision and health & safety records. A tour of the building and grounds was also conducted. Surveys were received from staff and residents. We also spoke with residents and staff during the inspection to gather their opinions regarding the services provided in the home. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: 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 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 7 of 26 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 8 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides information to prospective residents. However, improvements need to be made to the assessment process to ensure that care and support needs can be met. Evidence: There is a statement of purpose and residents guide that give information about the home, its staff and the facilities available for prospective residents and copies of both these documents are in the entranceway to the home. Residents are also issued with a contract that states the terms and conditions of their stay and we viewed copies of this contract on the files that we checked. Residents we spoke to told us either they, or their families, had visited to the home before they moved in to check it was suitable for them. One relative told us she visited the home a couple of times and that someone from the home had visited her mother in a local hospital to assess if her mothers needs could be met there. However Care Homes for Older People Page 9 of 26 Evidence: we checked the files of two recently admitted residents and the pre-admission information for both of them was poor. One person had been admitted from a hospital in London and the only information the home had was from the persons daughter-inlaw. The other person was admitted as an emergency following a telephone call and full information about their needs was only received from social services the day after she had been admitted. Admitting people without a thorough assessment of their individual needs does risk the placement breaking down and people not receiving appropriate care. Care Homes for Older People Page 10 of 26 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. There have been a number of improvements made to the care planning process but further development is required Evidence: We looked at four care plans during the inspection. The majority of the care plans remain in the same format as seen at the last inspection and need to be in greater detail regarding the specific care and support that is to be provided. However, the manager has implemented a new person centred care plan which details the care and support that is required with guidelines for staff regarding the individual residents preferences and wishes. Risk assessments are also incorporated in the care plan. The manager has completed three care plans in the new format and she stated that all care plans will be re written within the next few months. Examples seen in the new care plans included ; a new front sheet stating This Care Plan belongs to and Likes to be known as. There are clearly identified objectives, a new social and cultural assessment which gives detailed information about the persons background . interests and preferences. The new care plans are divided in to clearly labelled sections examples included; Care Homes for Older People Page 11 of 26 Evidence: personal care, continence, mobility, night care assessments, tissue viability, communication, activities, end of life details, medical needs (which are cross referenced to specific information in the file eg stroke). If a residents care changes due to a medical or other reason, the manager stated that an additional sheet would be added to the care plan to ensure this need was appropriately met. It was noted that falls prevention has been improved and clear assessment forms are being implemented in conjunction with the local falls prevention team. Nutritional screening has also been incorporated in the care plans. Daily notes are recorded and kept in individual care plans instead of a separate file. The care plans are no longer kept in the office and are now stored securely in an area which is more accessible to the staff throughout the day. Healthcare needs are met and residents receive care from from a range of care professionals. The manager is currently negotiating with a local GP surgery to provide a regular surgery in the home on a weekly basis so that residents have access to medical care. Since the last inspection the manager has taken on a new contract with a local pharmacist who will also provide staff training. The operational manager has implemented nutritional screening (MUST) and contact has been made with the local dietitian to provide further input. Monthly weights are recorded in the Nutritional section in the new care plans. The manager has worked hard to make positive changes to the care planning processes in the home but she agreed that it is work in progress there are still improvements to be made which we will assess at the next inspection. We did not inspect standards regarding medication on this occasion as the Commissions pharmacy inspector had recently carried out an inspection and he will follow up any requirements separately. Care Homes for Older People Page 12 of 26 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 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 range of activities for residents. Evidence: There is an activities coordinator employed by the home who organises something for residents to do every afternoon. Activities include music and movement, baking, bingo, arts and crafts, and sensory stimulation. On the day of our visit we observed residents playing with a ball for exercise and also a musical entertainer singing to them. A PAT Pets as Therapy dog visits twice a month and a volunteer also comes in twice a week to help run a quiz. One resident told us she particularly enjoys the quizzes as they keep my brain alive. Residents told us they rarely felt bored although one reported that there was a lack of people he could meaningfully talk with and that he found this frustrating. One lounge contained magazines and CDs for residents to access, but in the other two lounges there werent many items of stimulation easily available for them. Residents we spoke to told us their families visited them often and were made to feel welcome by staff. We talked to one visiting relative during our inspection who also confirmed this. Care Homes for Older People Page 13 of 26 Evidence: We took lunch with the residents so we could observe how staff interacted with them and to check on the quality of food. Lunch consisted of Shepherds Pie with broccoli and cauliflower, or sausages and chips, followed by apple crumble. It was generally a relaxed and pleasant affair tables were nicely set and residents were given plenty time to eat. Plate guards were available for those that needed them and gravy was served separately so that residents could choose if they wanted it. However, the gravy was put on the tables 15 minutes before the main dish arrived and was consequently cold when poured. We observed one member of staff help a resident to eat their lunch. The level of communication between this staff member and the resident was poor the staff member failed to explain to the resident what the lunch was or ask if she was ready for another mouthful etc. Care Homes for Older People Page 14 of 26 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 a complaints process in place so that any issues of concern can be addressed. Evidence: There has been one complaint raised with the home since the last inspection. The operational manager showed us correspondence which evidenced that appropriate action has been taken. The home is still involved in a number of concerns which have been reported to the local safeguarding team. The outcome of these concerns are awaited. The home has displayed a willingness to respond to concerns that have been raised and it is clear that the manager and operations manager are proactively working towards improving care in conjunction with a range of care professionals. Care Homes for Older People Page 15 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and well furnished. However, improvements need to be made to so that residents have a more homely and comfortable place in which to live. Evidence: We undertook a tour of the premises to check on cleanliness, and health and safety. The home was generally clean, furnishings and fittings were of good quality and there were no strong smells. During our last inspection we noted serious problems with the quality and cleanliness of the bed linen, however during this visit we noted considerable improvement.There were some improvements still needed: Keys were not available for residents to lock their bedroom so they could maintain their privacy and security. One resident told us other residents frequently enter her room to take her fruit and use her toilet The gardens are not easily accessible to residents and once in them they are not secure for residents who may wander Some woodwork around the home was badly scuffed and marked Room 29 was exceptionally cold. The resident in this room sat in her chair under a blanket and her hands were very cold to the touch. All three lounges were set up with all the chairs set against the walls therefore making it very difficult for residents to communicate easily with each other There were few orientation aids around the home to help residents and their visitors Care Homes for Older People Page 16 of 26 Evidence: find their way around. We met one resident walking up the corridor who couldnt find the main lounge. We noted communal toiletries in one bathroom Care Homes for Older People Page 17 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are needed in the recruitment process s to ensure that residents safely receive care and support from appropriately recruited staff Evidence: There are 4 care staff on duty during the day and two staff on at night to meet the needs of 24 residents currently. The rotas have been redesigned in a clearer manner showing the designation of each staff on shift. We received mixed views about staffing levels. Two residents we spoke to felt there were enough staff available when they needed them and that they rarely waited a long time for help. However, another resident told us that she likes to go to bed between 10 and 10.30 pm but one evening last week she had to wait till 11.50pm. She also stated that she usually asks for her commode at 8pm but that staff often tell her she has to wait until the evening medication is done and sometimes this is not until 10pm. Two staff told us that staffing levels had improved: that there were now enough on duty to meet residents needs, that they had time to spend with residents and didnt feel rushed. However another member of staff stated that, about once a fortnight, there were not enough staff in the evening and as a result residents were not given their supper time drink and biscuit and that staff didnt have the time for their tea break. Residents we spoke talked highly of the staff and told us that staff treated them well and always spoke nicely to them. A key worker system has recently been introduced Care Homes for Older People Page 18 of 26 Evidence: so that staff have specific residents they take a particular interest in. There has been a high turnover of staff at the home recently and both staff and relatives told us this had been unsettling for them. One resident reported: all the old staff I like have been sacked and they never tell us anything about the changes. Survey s received also confirmed this view. We checked training files for the night staff. Although two had completed NVQ level 3 in care their fire training was out of date and there was no evidence that one had undertaken food hygiene training. Neither had received supervision as frequently as recommended by the standards. We checked the personnel files for three recently appointed staff. We noted the following shortfalls: The date on which staff had started working had not been recorded and therefore we couldnt check if the home had received their CRB in good time There was no evidence that any of the staff had received an induction to their job All 3 references for one member of staff were from the same home where she had previously worked Both references for another member of staff were from the same hospital abroad and no checks had been completed to verify them Staff had started working at the home before a full CRB had been received and no risk assessment had been completed for working with just an ISA first in place. The manager stated that a full audit of training is being undertaken to identify training updates that are required. She showed us evidence of training that has been booked including; falls prevention, medication update, fire training, stress management and team motivation, Alzheimer Society training and palliative care via a MacMillan nurse. The manager and operational manager also stated that the recruitment process is being overhauled to ensure that appropriate procedures are followed prior to the commencement of employment. Care Homes for Older People Page 19 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are improved management arrangements in the home to ensure that residents receive a safe and well coordinated service. Evidence: Since the last inspection a new manager has been appointed in the home. She has had previous care and management experience in the care of the elderly. In the short time time that the manager has been in post she has actively commenced an audit of a range of processes in the home with regular support from the operations manager. Examples included care planning, training and recruitment, supervision and appraisal. A deputy manager has been appointed to provide a clearer management structure in the home. It is anticipated that the deputy will also supervise the cleaning arrangements including the ordering and stock control of cleaning items and equipment. There are two cleaners in post each day with one working at weekends. The handy man currently works three days a week and the manager stated that she would like to increase his hours so that he can spend more time undertaking tasks in Care Homes for Older People Page 20 of 26 Evidence: the home. Health and safety records were inspected and it was noted that water temperature tests and emergency light checks had not been kept up to date. The manager stated that she would take this up with the handy man and devise a more efficient recording system. Work, to cover all radiators, has now been completed. Care Homes for Older People Page 21 of 26 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 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 2 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 31/03/2010 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 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 Care Homes for Older People Page 22 of 26 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 been met in full by the given timescale of 31/12/09 Care Homes for Older People Page 23 of 26 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 3 14 Thorough assessments of prospective residents care and support needs must be carried out prior to admission To ensure that the home can safely meet assessed needs 31/05/2010 2 7 15 Improvements need to be made to all care plans to ensure a consistent approach So that a person centred approach is in place in the home 31/05/2010 3 19 13 The grounds need to be safe 30/06/2010 and secure for residents So that residents can use the grounds without any hazard to their safety . 4 24 12 Arrangements must be in 30/06/2010 place for residents to have a key to their room Care Homes for Older People Page 24 of 26 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 To ensure residents security and privacy 5 28 19 Satisfactory recruitment checks must be in place To ensure that residents safely receive care and support 6 38 13 Health and safety records regarding water temperatures and emergency lighting must be regularly recorded To ensure the safety of residents in the home 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 31/05/2010 31/05/2010 1 37 The health and safety recording systems need to be stored in a more accessible and efficient manner Care Homes for Older People Page 25 of 26 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. 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