CARE HOMES FOR OLDER PEOPLE
Bethany Homestead Kingsley Road Northampton Northants NN2 7BP
Lead Inspector Linda Preen Unannounced 04 April 2005 10:00 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 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 Version 1.10 Page 3 SERVICE INFORMATION
Name of service Bethany Homestead Address Kingsley Road Northampton Northants NN2 7BP 01604 713171 01604 716315 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Trustees of Bethany Homestead Mrs Kathleen Margaret Coxhill CRH 50 Category(ies) of DE(E) 5 registration, with number OP 50 of places PD(E) 10 Bethany Homestead Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 25.01.05 Brief Description of the Service: The home is registered to provide care to 50 service users in thre category of OP , five of whom may also be in the category of DE (E). It is situated in a purpose built facility close to the town centre and local ammenities. It has been modernised and refurbished in recent years in to bring it up to modern standards and the expectation of service users. 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 Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 4 hours, and was carried out as part of the annual programme of inspections. A limited tour of the environment was undertaken and we looked at the experience of three service users in the home. This involved looking at their records, talking to them and also to the staff responsible for their care. In addition to this staff files and training records were seen and safety records in the home were inspected. Four service users were spoken to and three members of staff interviewed. In addition to this comment cards were received from three service users in the home. What the service does well:
The home has is fully staffed and most of these staff have been employed in the home for several years. It is unnecessary to employ any agency staff at the current time. This ensures that staff are familiar with the service users and their needs. There is a commitment to staff training, with a training manager employed in the home. A varied programme of activity is provided and service users commented on their enjoyment of the activities in which they participated. Service users have a monthly newsletter to which they are encouraged to contribute, and welcome to new service users is included in this, to ensure that they feel part of the home. Birthdays and special anniversaries, as well as outings and activities are also reported in this. The environment of the home is maintained to a high standard, giving service users a bright, pleasant place to live. Bethany Homestead Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bethany Homestead Version 1.10 Page 7 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 Standards Statutory Requirements Identified During the Inspection Bethany Homestead Version 1.10 Page 8 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 standard(s) 3. Standard 6 does not aply in this home. Service users have their needs assessed prior to admission to the home in order to confirm that these needs may be met and that they comply with the categories of Registration. 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. There was, however no evidence of service user or their advocate having input into this assessment. Bethany Homestead Version 1.10 Page 9 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 standard(s) 7.8,9 and 10 Health and personal care needs identified are not always met. Medication systems were organised in a manner, which ensures service user safety. EVIDENCE: There was no written evidence of the service user or their advocate being involved in the assessment or care planning process. Plans had been provided for all three of them but these plans did not always reflect needs identified in the assessment or mentioned in the daily records. For example one service user had the entry” pad changed “ in her night record, but there was no mention of incontinence or the use of pads in her elimination care plan. A second service user had been identified as having lost 1.5 stones between March and December 2004, but there was no instruction to staff on how to deal with this weight loss or any evidence of referral for specialist advice, which the assessment stated should be made. This was made the subject of a Requirement. Medication records and systems were seen to be well organised with a separate pre-dispensed system in use for those service users who choose to self medicate.
Bethany Homestead Version 1.10 Page 10 Service users spoken to and observation of practice confirmed that they are treated with dignity and respect and that relationships between service users and staff were relaxed and friendly. Bethany Homestead Version 1.10 Page 11 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 standard(s) 12,13,14 and 15 Social activities and meals are both well managed, and provide daily variation and interest for people living in the home. Family and friends are welcome in the home and service users are able to have choice in their daily lives. EVIDENCE: An extensive activity programme was on display in the entrance hall. One service user who returned her comment card stated that she was on the entertainment committee and was happy with the programme provided. Another service user spoken to showed her Easter Bonnet that she had won second prize with at the recent competition. All of the service users come from the congregation of local churches and one service user said that it was nice to live in a community with like-minded people. Visitors were observed to enter the home freely and were greeted in a friendly manner by staff members. One service user had been out for lunch with her daughter during the previous weekend. Service users were observed to be sitting in their rooms or in the communal lounges according to individual choice. Choices concerning daily activities and routines were recorded in the case files seen. Bethany Homestead Version 1.10 Page 12 Lunch served during the inspection was observed to be served in pleasant surroundings with choices offered. Service users spoken to confirmed that the standard of food was good. Bethany Homestead Version 1.10 Page 13 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 standard(s) 18 Service users are protected from abuse in the home. EVIDENCE: The manager has a commitment to ensuring that staff are aware of the types of abuse, which may occur, and of the reporting procedures to be followed if such an occurrence arises. Staff spoken to were aware of the types of abuse, which may occur, and of their responsibility in reporting any actual or suspected abuse. They confirmed that they had received recent training on the subject. Policies and procedures for staff guidance on Protection of Vulnerable Adults were available in the home. Bethany Homestead Version 1.10 Page 14 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 standard(s) 19,20,22,23,24,25 and 26 Service users live in an environment that is safe, secure and well maintained, and that meets individual and communal needs in a homely manner. EVIDENCE: A limited tour of the environment was undertaken. All areas seen were well maintained and decorated in a homely manner. A continuous programme of redecoration is in place, evidenced by the standard of décor in the home, and maintenance records are available to demonstrate that safety checks are in place for hazardous equipment and the environment. Service user rooms were bright and airy with evidence of personalisation in the form of pictures, ornaments and small items of personal furniture. The home was clean and tidy. Bethany Homestead Version 1.10 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,and 30 A stable well trained staff group are employed in sufficient numbers to meet the needs of the current service user group, however, recruitment procedures are not sufficient to protect service users from potential harm and do not meet the requirements of the Regulations. EVIDENCE: Duty rotas seen demonstrated that staffing was provided in sufficient numbers to meet service user needs. Staff training records demonstrated an induction programme compatible with Training Organisation for Personal Social Services standards. 29 staff are trained to at least National Vocational Qualification level 2 standard, out of the 50 staff employed. Staff spoken to confirmed that training and induction takes place. A training manager is employed two days per week to ensure that training is kept up to date. In conversation, staff demonstrated that they were aware of service user needs even when these had not been identified or recorded in case files. Staff files seen demonstrated that the information required by Schedule 2 of the Regulations in order to protect service users was not complete. This was made the subject of a Requirement. Bethany Homestead Version 1.10 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,and 38 The home is run by an experienced manager with the skills required to ensure that it is run for the benefit of service users and that their needs are provided for in a safe environment. EVIDENCE: Service users and staff were happy and relaxed in the presence of the manager. Those spoken to confirmed that she is approachable and freely available to discuss any problems or concerns, which may arise. A residents committee is in operation and service users contribute to the monthly newsletter. Records of the testing of fire alarms and emergency lighting were seen and found to be satisfactory. Staff spoken to were aware of the procedures to be followed in case of fire. Bethany Homestead Version 1.10 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 3 3 3 x x x x 3 Bethany Homestead Version 1.10 Page 18 No Are there any outstanding requirements from the last inspection? 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 7 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. The records required by Schedule 2 of the Regulations must be in place for all staff employed in the home. Timescale for action 5/5/05 2. 29 19 Schedule 2 5/5/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Bethany Homestead Version 1.10 Page 19 Commission for Social Care Inspection 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
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