Inspection on 18/09/07 for Bethany House

This inspection was carried out on 18th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bethany House 09/02/10

Bethany House 20/06/06

Bethany House 08/12/05

Bethany House 07/06/05

Bethany House 03/03/05

Bethany House 04/10/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bethany House 20 Front Corkickle Whitehaven Cumbria CA28 8AA Lead Inspector Nancy Saich Unannounced Inspection 9:30 18 and 20 September 2007 th th 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 House DS0000052971.V346005.R01.S.doc Version 5.2 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 House DS0000052971.V346005.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bethany House Address 20 Front Corkickle Whitehaven Cumbria CA28 8AA 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) 01946 695556 Bethany House Limited Miss Kathryn Lisa Taylor Care Home 17 Category(ies) of Dementia - over 65 years of age (15), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (2) Bethany House DS0000052971.V346005.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 17 service users to include: up to 15 service users in the category of DE(E) (Dementia over 65 years of age) up to 2 service users in the category of MD/E ( Mental disorder excluding learning disability or dementia over 65 years of age) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 20th June 2006 2. Date of last inspection Brief Description of the Service: Bethany House is situated in Whitehaven’s conservation area. It is near to all the amenities of the town. The property is a converted Victorian vicarage that has been extended and adapted to accommodate up to seventeen older people with dementia. Two people may be older people with mental health problems. Accommodation is in single ensuite rooms. The company is owned by Mr and Mrs Ditchburn who also own a domiciliary care company in the area. Kathryn Taylor manages the home on their behalf. The charge for all residents is £434 per week. Bethany House DS0000052971.V346005.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the main or ‘key’ inspection for the year. We did this by gathering information from the provider, by sending surveys to residents, relatives and visiting professionals and by checking on other information about the home. We received prompt replies to our request and we had a good number of surveys returned. These were generally very positive. We quote from them in this report. The lead inspector also went to the home unannounced and met with the staff team and all of the residents on 18th September 2007. She returned to the home on 20th September where she spent two hours observing how residents were in the home. To do this she used what is called a Short Observation Framework for Inspection (SOFI). This measures how residents are in themselves, how they interact with each other and how well staff approach and deal with residents. In this home the outcomes of the observation were very positive and showed a very alert group of people who got good attention from staff. What the service does well: The home makes sure they only take new people they can care for and who will fit into the existing group of residents. The home is good at giving care to people with dementia. The staff are able to understand and work with the difficulties the disease brings. Residents are respected and treated with dignity. They are good at getting the right kind of medical help –for both physical and mental illness - and are good at managing medicines. The residents were happy with the way they spent their days and felt there were plenty of activities – no one said they were bored and we saw people participating in a lot of different activities. Residents said they had plenty of choice at mealtimes and we saw people enjoying well-prepared meals and snacks. The home is good at listening to complaints and in protecting older vulnerable people from harm or abuse. The house is clean, warm and comfortable. This home has a settled, competent and very caring staff team who are well aware of the strengths, needs and difficulties of people who have dementia or other mental health problems. The home is well enough staffed to give people good levels of care and attention. Bethany House DS0000052971.V346005.R01.S.doc Version 5.2 Page 6 The home has a competent manager who residents, relatives and staff trust and respect. 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 report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bethany House DS0000052971.V346005.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Bethany House DS0000052971.V346005.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home is good at making sure they only admit new people who will fit into the home and who they think they can care for properly. EVIDENCE: We were given an updated document called the Statement of Purpose. This explains what the aims of the home are and how the team meet this. We judged that this gives a good explanation of what anyone can expect from the service and gives plenty of detail. We checked residents’ files and looked at what people told us in postal surveys. We found that new residents had proper diagnosis of mental ill health and had social work assessments about their needs. We had evidence to show that the manager or the provider went out to see prospective new residents and that they in turn were invited to visit the home. Relatives told us that they were shown around the home and could ask staff Bethany House DS0000052971.V346005.R01.S.doc Version 5.2 Page 9 about the arrangements in place. We saw the checklists the staff do to make sure they settle new people into the home well. We thought these were a good idea and staff said they found them useful to make sure residents settled well. Bethany House DS0000052971.V346005.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The staff team are extremely good at meeting the needs of people who have very challenging needs due to dementia. EVIDENCE: We used the Short Observation Framework for Inspection (SOFI) to judge how well people are cared for. The lead inspector spent two hours observing what residents did and how they interacted with staff and other residents. We found that all five people we looked at were busy with activities, spoke to each other and were generally very content in the home. We also judged that the staff interacted very well with them and showed they understood their needs and treated them with kindness, respect and high regard. We read all of the written plans that help staff to give residents the right kind of care. These contained a lot of information that helped staff to work properly with residents. We found them to be up to date and to contain all the basic facts that everyone needs to give good standards of care. We judged that they Bethany House DS0000052971.V346005.R01.S.doc Version 5.2 Page 11 had improved since our last visit and were pleased to note that the home planned to improve them even further. We saw in the notes that residents have good levels of health care. Doctors, nurses and specialists visit the home and residents go out to appointments when necessary. These include consultations with people who are specialists in the care of older people with dementia or mental health problems. Surveys from health professionals were positive. We checked on the medicines kept on behalf of residents. We also watched staff giving these out to people. We found that medicines are being managed correctly. We were pleased to note that the home doesn’t rely on the use of sedatives or strong medicines. We learnt from surveys that residents and their visitors find the staff team to be ‘kind’, ‘dedicated’ and ‘caring’. A survey from the local social work team showed very high levels of satisfaction with the way residents improved once they came to the home. When we visited we also saw staff treating people with respect and dignity. This was measured very precisely during the SOFI observation. We judged that the staff team do this very well and they do this with a special awareness of the needs of people with mental health needs. Visitors also think they do this well. Here is what one person told us: • “ The staff are all dedicated to the residents and are fantastic with them…treating them well and attending to all their needs…in an attentive way…”. Bethany House DS0000052971.V346005.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported and helped to have as fulfilling a life as possible by a staff team who work well with them to lessen the effects of dementia. EVIDENCE: During both visits we saw that some people spent time in their own rooms but that generally residents enjoy each others company and spend time together in the two sitting areas. We found that people were consulted about their preferences in a way that suited their needs. We saw people doing artwork, listening to music, doing the crossword and reading local and national newspapers. Residents were having manicures and having their hair attended to. More importantly we saw that staff used these activities to interact with residents and make them feel important and to help them understand where they were and to make sure they knew what was going to happen during the day. These things are vital to keep people with dementia feeling safe and secure. No one showed any distress or confusion during the course of both visits. On the contrary lots of people showed a great deal of humour, fun and happiness. Bethany House DS0000052971.V346005.R01.S.doc Version 5.2 Page 13 Surveys from visitors showed they confirmed this and that visitors were made very welcome in the home. We met some visitors and they were content with the way the home cared for their friends and relatives: • “My relative is very settled in the home and I am always made very welcome …that means I got back to a normal life after she was admitted…we have a good relationship because the staff help me to enjoy my time with her…” We spoke to residents who said they had ‘plenty to do’ and that they ‘rubbed along together nicely’. We learnt that they had visits from local clergy and enjoyed services in the home. We also learnt they went out locally but that not everyone felt comfortable with this. Some people said they just preferred to be ‘at home, here with my friends’. We judged that they way staff behaved with residents meant that they had as much control and choice as is possible given their mental ill health. Staff were observed helping residents to make suitable choices and being encouraged to be part of the running of the home. They said they were consulted about everything. We judged that the way residents were asked about food preferences was very good. We saw breakfast and lunch being served and the food was nutritious and well presented. Residents ate well and enjoyed the social side of the meals. Some people had breakfast in their rooms so they could get up at their own pace. The kitchen was orderly with a good range of food available. People were given help at their own pace and with discretion. The home prefers visitors not to come at meal times to prevent some people feeling embarrassed about needing this kind of help. Bethany House DS0000052971.V346005.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home protects these vulnerable people well and is able to listen to their views and understand their needs. EVIDENCE: The home has a good complaints procedure. Surveys told us that residents or their relatives knew who to complain to. There had been no complaints received since the last inspection. Residents said they would go to the manager and talk to her privately. She and the providers were seen with residents and it could be seen that they know residents very well. Residents are comfortable talking to them. The staff had received training in how to protect vulnerable people from abuse and one of the owners was in the process of updating all the staff training in this. Surveys told us that no one had any concerns about anything abusive in the home. There was evidence available to show that the manager was aware of how to report anything of concern. Several residents said nothing unpleasant went on and they reassured us they would ‘make a big fuss’ if there was any ‘bullying’ going on – either between residents, from visitors or from staff. Bethany House DS0000052971.V346005.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Bethany House is a clean, comfortable and homely house that residents felt met all their needs very well. EVIDENCE: The home is set in a residential area of Whitehaven. It is on two floors accessed by a stair lift. Every resident has his or her own single room with a toilet and wash hand basin ensuite. There are two lounges downstairs and one upstairs that is currently used for people who smoke. Different parts of the home are kept secure with a push pad security system. There is a call bell system that has special adaptations to help staff know if a person is restless and moving around at night. These things are important to keep people with dementia safe and are being handled correctly. Bethany House DS0000052971.V346005.R01.S.doc Version 5.2 Page 16 In the last few months the owners have completely refurbished the main kitchen and have installed a new central heating system. They plan to continue with other improvements to the home. They say they are going to upgrade the stair lift and build a small smoking room that will look out into the garden. A lot of rooms, including the lounges had been redecorated and more work was underway during the visits to the home. All areas of the home were clean and fresh during our visits. There was evidence to show that staff understand how to control infection. Residents clothing and bed linens were freshly laundered and ironed. Residents said they were happy with their home. One survey said the home: • “…gives the residents a safe, friendly and welcoming environment to live in during what is a difficult period in their lives…”. “ Bethany House DS0000052971.V346005.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home is suitably staffed by a competent and understanding team who know how to deal with the individual challenges that residents face on a dayto-day basis. EVIDENCE: We learnt that there are usually three staff on duty during the day for the seventeen residents. The home also employs domestic and catering staff. At times the manager delivers care and at other times she is extra to the three staff on duty. There are two staff on at night. Most of the surveys said that the staffing levels were fine. A number of staff were asked about this and they too thought there were enough staff on duty. We judged that given the dependency levels of residents the staffing levels were suitable. Staff are experienced and competent and a good proportion of them have National Vocational Qualifications at levels 2 or 3. One of the owners was giving staff ‘refresher’ training on the first day of the inspection. The home has an ongoing training plan that ensures that staff get training on all the basic things they need to know to do their job properly. The owners provided us with a training plan for next year and a record of training undertaken. These were of a good standard. Bethany House DS0000052971.V346005.R01.S.doc Version 5.2 Page 18 The owners said there has been no recruitment for a number of years as staff like working as part of the team. The home has good policies and procedures for taking on new staff. The manager and the provider said they were aware of how they needed to complete recruitment so that residents were protected. During the visit we saw and heard staff who had good working knowledge of how to care for people with dementia. They could talk with confidence about how to help and support people. They said they had some recent updates on working with people who had mental health problems other than dementia. We saw them working competently and had surveys and residents views to confirm that the staff are doing a good job. • “ Nothing is too much trouble for these lasses”. • “The staff team work well with people during a difficult period of their lives. They are kind, patient and considerate.” • “Very good team who call on us to help them get things right for the residents”. Bethany House DS0000052971.V346005.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33,34, 35, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home is managed so that residents feel safe and well cared for by the staff team and the services provided. EVIDENCE: Kathryn Taylor has managed the home for a number of years. She is experienced and trained in the care of older people with dementia. She is very much a ‘hands on’ manager of this relatively small home. Residents and their relatives saw her as the person to contact if anything troubled them. We judged that she was very much in control of the day-to-day management in Bethany House DS0000052971.V346005.R01.S.doc Version 5.2 Page 20 the home, knew her residents and staff very well and had earned their respect and trust. It was clear that the manager is very much the key person who promotes the very good ethos of this home and this allows people with dementia to feel they are important and valued. The owners were happy with the way the home was operating. This home has a very robust quality assurance system that covers all aspects of the operation of the home. The manager had sent out questionnaires to relatives and visiting professionals. The providers had been reviewing how things were going in the home and were able to provide the inspector with a plan for developing and improving the home in the next twelve months. They now need to pull all this information together in a more formal way. We checked residents’ money and this was kept correctly. We also saw and heard evidence that showed the owners are financially viable and plan to invest even more money in the home. We were also given a simple but effective business plan for the coming year. We also saw that they had completed everything they planned in the past year. We looked at general health and safety. We spoke to the local environmental health department and to the cook about food hygiene. We looked at records about all of this. We found evidence to show that good systems are in place, that the home was clean, orderly and hygienic and that staff were aware of their own responsibilities. Food hygiene was good and the new kitchen makes things much easier for staff to keep doing this well. They showed a good understanding of the need to protect people who are disorientated and may not be aware of risk. We did find the records of health and safety a bit hard to follow so we judged that they need to make these simpler and clearer. We recommend that the owners look at their records organisation to make sure they always have the paperwork right that backs up the good work they do. Bethany House DS0000052971.V346005.R01.S.doc Version 5.2 Page 21 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 2 3 3 X 2 3 Bethany House DS0000052971.V346005.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 OP33 Good Practice Recommendations It is recommended that the registered company complete a full quality assurance audit of how the home operates. They should prepare a report of this audit and make it available to residents and their families and to the lead inspector. It is recommended that the registered company review and update they way they keep all types of records in the home. 2 OP37 Bethany House DS0000052971.V346005.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 House DS0000052971.V346005.R01.S.doc Version 5.2 Page 24 - 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. 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