CARE HOMES FOR OLDER PEOPLE
Bethany Homestead Kingsley Road Northampton Northants NN2 7BP Lead Inspector
Mrs Helen Wilson Unannounced Inspection 26th January 2006 12:45 X10015.doc Version 1.40 Page 1 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 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Bethany Homestead Address Kingsley Road Northampton Northants NN2 7BP Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01604 713171 01604 716315 The Trustees of Bethany Homestead Mrs Kathleen Margaret Coxhill Care Home 50 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (50), of places Physical disability over 65 years of age (10) Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 4 April 2005 Brief Description of the Service: The home is registered to provide care to 50 service users over 65 years of age in the category of OP, five of whom may also be in the category of Dementia DE (E) and 10 people may have a Physical Disability PD (E). It is situated in a purpose built facility close to the town centre and local amenities. Modernised and refurbished in recent years in to bring it up to modern standards, the home is run by a group of trustees and admits service users who are members of non-conformist churches in the town. Service users are accommodated over three floors, with lift access for those with mobility problems. There is a mixture of single and double rooms, all of which have en-suite facilities. The home is set within a complex of sheltered housing and a community centre to which service users have access. Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is on outcomes for Service Users. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. The inspection was carried out over two unannounced visits on 26 January and 3 February 2006 and lasted approx six hours in total. Discussions were held with the Registered Manager on the first visit and with the Assistant Care Manager on the return visit as the manager was on annual leave. Selected records were examined relating to the running of the home and individual service users. Requirements identified at the previous inspection were reviewed and were found still to be outstanding. In addition some serious concerns relating to care planning and medication were identified for remedial action on the first visit as detailed in the following report. The second visit was carried out to assess the progress made. It was useful on both visits to be able to discuss and explain directly the findings of the inspection and have an agreement on the way issues can be resolved and managed. What the service does well: What has improved since the last inspection? Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 6 The home’s environment continues to meet the current standards and the ongoing programme of redecoration carried out by the home’s own employee and contractors as necessary. What they could do better:
A requirement from the previous inspection report with an original compliance date set as 5/05/05 remains unmet and is restated for urgent compliance in this report:- The records required by Schedule 2 of the Regulations must be in place for all staff employed in the home. It was seen from one staff file that the full range of required recruitment documentation including two references, Criminal Record Bureau checks, was not available. In two files it was noted that the staff identification photographs were very dark and indistinct and these should be replaced. A requirement from the previous inspection report with an original compliance date set as 5/05/05 remains unmet and is restated for urgent compliance in this report:- Assessment and care planning must improve to ensure that staff are given the relevant information to meet all of the service users needs, and that the care provided can be demonstrated. Written evidence that input from service users and their advocates should be sought when care is planned and reviewed. During the first inspection visit and checking care files for two service users it was evident that there are lengthy gaps in recording in the service users’ daily log sheets relating to care plans and this fails to evidence that care has actually been given as planned. The home needs to evidence robust methods of initial assessment of care needs, risk assessments of individual service user abilities and of any environmental risks specific to the person, evaluation and revision of care plans and risk assessments at appropriate stages. There needs to be written confirmation and signatures that the service user and/or an advocate/family representative has been involved at each stage. During the first inspection visit on Thursday 26th January 2006 the medication system was checked and the following issues of serious concern were identified: The system for medication handling in relation to two selected service users were examined. For both service users the medication system, including receipt of supplies, administration to service users, and disposal of stock to the dispensing pharmacist was found to be unsafe. An Immediate Requirement was made relating to handling and administration of medication for compliance by 30 January 2006. During the return visit on 3 February 2006 although there had been good progress on most areas of the medication system a staff signature was missing in the Register of Controlled Drugs.
Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 7 During the 26 January 2006 inspection an immediate request was made that the sliding door to the upstairs medication storeroom be fitted with a locking device/padlock to ensure that access was restricted to staff keyholders only. This work was carried out before the Inspector left the premises. The same medication storeroom door swings outwards from its sliding rail into the corridor and is a potential risk to passing service users and staff. The Registered Manager has agreed to have this permanently remedied. It is of concern that many issues are identified for remedial action through these two recent inspection visits. As a result several requirements are made for action and two outstanding requirements from 2005 restated for urgent compliance. CSCI will monitor the progress of the home through future inspection. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4, 5 (Standard 6 is not applicable.) The home has a thorough admission process giving people information about the home’s facilities and service. EVIDENCE: A comprehensive pre-admission tool was seen in the service user files sampled. This demonstrated that all areas of care including physical, emotional and spiritual needs were included. The Assistant Care Manager advised that she had, following this process, been able to identify that a potential admission could not be provided with the level of care necessary. The admission process allows for visits, shared meals, overnight stays and gentle introduction to the home meeting other service users. Many of the service users have lived in sheltered accommodation on site. Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 It is clear that service users are treated with dignity and respect and are seen by community health professionals. The home again has failed to evidence that care planning is thorough and that service users receive the planned care. The medication system is not robustly managed and fails to demonstrate that service users are safe-guarded. EVIDENCE: Service users spoken to and observation of practice confirmed that they are treated with dignity and respect and that communication between service users and staff was relaxed and friendly. Records show that visits are arranged with health professionals such as District Nurses, GPs and hospital consultants and all such consultations are well recorded. On checking care plans for two service users it was evident that a folder has been introduced for each service user that includes some twenty-four standard and wide ranging care plans for potential areas of care need and associated daily log sheets for signing to log that the care has been delivered as directed.
Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 11 In discussion with the Assistant Care Manager it was identified that this method appears to have become over-onerous for staff and has led firstly to staff diligently filling in each type of care plan, whether relevant or not, and secondly then being unable to sustain the task of daily recording. This shows up as lengthy gaps in recording in the service users’ daily log sheets and fails to evidence that care has actually been carried out as planned. In discussion with the Registered Manager during the first visit it was agreed from the case files being inspected that there were lengthy unexplained gaps in daily logs, no signatures of service users/advocates on the care plans examined, no cross-referencing of medication changes onto medication profiles and care plans so therefore care plans were contradictory to other more recent information, no detailed moving and handling plan for one service user requiring hoisting, evaluation of care plans not completed when care needs have changed. The home needs to evidence robust methods of initial assessment of care needs to draw up specific individualised care plans, risk assessments of individual service user abilities and of any environmental risks specific to the person, evaluation and revision of care plans and risk assessments at appropriate stages. There needs to be written confirmation and signatures that the service user and/or an advocate/family representative has been involved at each stage. During the first inspection visit on Thursday 26th January 2006 the medication system was checked with the Registered Manager and the following issues of serious concern were identified: The system for medication handling in relation to two selected service users were examined. For both service users the medication system, including receipt of supplies, administration to service users, and disposal of stock to the dispensing pharmacist was found to be unsafe. An Immediate Requirement was made for compliance by 30 January 2006. The following action was required: 1. The medication system including ordering, receipt, administration and disposal of drugs must be made safe. 2. The Medication Administration Record Sheets for all service users must be checked and cross-referenced to actual supplies held and with each person’s medication profile. 3. Disposal records must be completed for all supplies set aside for return to the dispensing pharmacist. 4. Staff who are delegated the responsibility of administering medication to service users must be deemed competent to do this task and be able to record accurately the administration of medication. A written confirmation by the Registered Manager was received by CSCI on 30 January 2006 stating that the required remedial action had been taken.
Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 12 On 3 February 2006 a return inspection visit was made to the home and medication records again checked. Compliance with items 1, 2 and 3 was confirmed, however a staff signature was missing from the Register of Controlled Drugs to confirming distribution of one tablet to a service user. The Assistant Care Manager called the staff member into the home to account for her error. The Registered Manager must carry out random monitoring checks on the operation of the system for the handling and administration of medication and record her satisfaction that this delegated task complies with guidelines issued by the Royal Pharmaceutical Society. During the 26 January 2006 inspection an immediate request was made that the sliding door to the upstairs medication storeroom be fitted with a locking device/padlock to ensure that access was restricted to staff keyholders only. This work was carried out before the Inspector left the premises. The same medication storeroom door swings outwards from its sliding rail into the corridor and is a potential risk to passing service users and staff. The Registered Manager has agreed to have this permanently remedied. Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Service users’ personal monies are safely accounted for by the home. EVIDENCE: Records relating to the safe-keeping and disbursement of service users’ personal monies were sound and fully receipted. Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed during this inspection. Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25,26 The home is well maintained, clean and provides a homely environment. Service users are potentially at risk due to the medication storeroom being without a lock. EVIDENCE: Communal areas and passageways were seen during this inspection. Lounges and dining rooms are bright and well furnished giving service users a homely environment with choices of various public rooms in which to relax, read, join activities and meet with each other. All areas seen were clean, tidy and had no odours. During the inspection an immediate requirement was made that the sliding door to the upstairs medication storeroom be fitted with a locking device/padlock to ensure that access was restricted to staff keyholders only. On open shelves there had been a partial bottle of surgical spirit and a container for used needles/sharps. This work was carried out before the Inspector left the premises.
Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 16 The same medication storeroom door swings outwards from its sliding rail into the corridor and is a potential risk to passing service users and staff. The Registered Manager has agreed to have this permanently remedied. Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 Although the staff are largely long-term carers and form a well trained and supervised staff team, the home has again failed to evidence in staff files that recruitment procedures have been robustly carried out to protect service users from potential harm. EVIDENCE: A requirement from the previous inspection report with an original compliance date set as 5/05/05 remains unmet and is restated for urgent compliance in this report. The records required by Schedule 2 of the Regulations must be in place for all staff employed in the home. It was seen from one staff file that the full range of required recruitment documentation including two references and Criminal Record Bureau checks, was not evidenced. In two files it was noted that the staff photographs were very dark and indistinct and these should be replaced. Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,37 There is a clear style of management and atmosphere in the home that values and engages with staff, service users and families. Requirements have not been implemented from 2005 and this cannot benefit the service users. EVIDENCE: The home is run by an experienced manager with the skills required to ensure that it is run for the benefit of service users. It is accepted that in a large home of fifty beds that some tasks that are the responsibility of the Registered Manager will be delegated to others. It is of concern that monitoring of delegated tasks such as care planning, recruitment and medication has not highlighted existing problems. As previously referred to in this report, records for care planning and medication are not fully completed or detailed.
Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 19 Financial records for service users’ monies were well maintained. It is of concern that neither requirement made at the April 2005 has been implemented and therefore remains as non-compliance. The Registered Manager must take action to comply fully by 30 April 2006 and must confirm this in writing to CSCI. Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 X 18 X 2 X X X X x 2 3 STAFFING Standard No Score 27 x 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 1 X 3 X 1 x Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Service user plans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet their health and welfare needs. These plans must be regularly reviewed and formulated in conjunction with the service user or their advocate. This is an unmet requirement from the previous inspection with an original date for action by 5.05.05 The records required by Schedule 2 of the Regulations must be in place for all staff employed in the home. This is an unmet requirement from the previous inspection with an original date for action by 5.05.05 The medication system including ordering, receipt, administration and disposal of drugs must be made safe. This was an Immediate Requirement made during the inspection on 26 January 2006 for compliance.
DS0000012601.V279355.R01.S.doc Timescale for action 30/04/06 2. OP29 19 Schedule 2 30/04/06 3. OP9 13(2) 30/04/06 Bethany Homestead Version 5.1 Page 22 4 OP9 13(2) 5 OP9 13(2) 6 OP30OP9 13(2) 18(1) 7 OP31OP9 13(2) 12(1) The Medication Administration Record Sheets for all service users must be checked and cross-referenced to actual supplies held and with each person’s medication profile. This was an Immediate Requirement made during the inspection on 26 January 2006 for compliance. Disposal records must be completed for all supplies set aside for return to the dispensing pharmacist. This was an Immediate Requirement made during the inspection on 26 January 2006 for compliance. Staff who are delegated the responsibility of administering medication to service users must be deemed competent to do this task and be able to record accurately the administration of medication. This was an Immediate Requirement made during the inspection on 26 January 2006 for compliance. The Registered Manager must carry out random monitoring checks on the operation of the system for the handling and administration of medication and record her satisfaction that this delegated task complies with guidelines issued by the Royal Pharmaceutical Society. 30/04/06 30/04/06 30/04/06 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 23 No. Refer to Standard Good Practice Recommendations Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bethany Homestead DS0000012601.V279355.R01.S.doc Version 5.1 Page 25 - 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!
