Inspection on 06/09/07 for Bethany House

This inspection was carried out on 6th 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 found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bethany House 22/08/06

Bethany House 22/11/05

Bethany House 07/06/05

Bethany House 21/02/05

Bethany House 03/08/04

Similar services:

Thorndene

Sutton Lodge Nursing Home

Wingham Court

Bethany Lodge

17 John Street

Red Oaks

Clare House Nursing Home

Broad Oak Manor Nursing Home

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

CARE HOME ADULTS 18-65 Bethany House 30 Eastbridge Road Dymchurch Kent TN29 0PG Lead Inspector Susan Hall Key Unannounced Inspection 6th September 2007 09:45 Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 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 DS0000023355.V348496.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 Adults 18-65. 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 DS0000023355.V348496.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bethany House Address 30 Eastbridge Road Dymchurch Kent TN29 0PG 01303 875199 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) bethanylodge@btconnect.com Mrs Rosemary Jean Mills Mr Robert Shaun Bowden Mills Mrs Susan Anne Urquhart Care Home 15 Category(ies) of Physical disability (15) registration, with number of places Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents over the age of 65 are restricted to one (1) whose date of birth is 15.12.1936. 22nd August 2006 Date of last inspection Brief Description of the Service: Bethany House provides accommodation for 15 younger adults with Physical Disability who require either nursing or personal care. The home is a purpose built, detached house on two floors, which became operational in 1997. The Providers also run Bethany Lodge, which is adjacent to Bethany House, and is a home for older people with nursing needs. The home is located on the outskirts of the village of Dymchurch, surrounded by attractive gardens and overlooking the countryside. Accommodation is provided in single rooms with en-suite facilities. A passenger lift provides easy access between floors. As it has been purpose built, the design is suitable for use by residents with complex needs, and has wide corridors for easy wheelchair access, and other equipment. The premises are light, airy and spacious, providing a well-equipped but homely environment for the residents. The facilities include a hydrotherapy pool, and a sensory room, and there is a minibus and two other vehicles to be used for outings. There are car-parking facilities in the forecourt and the home is close to bus services. The fees currently range between £950 and £1050 per week, depending on the assessed needs of residents. This information was provided by one of the Providers on the day of the inspection visit. There are additional charges for optional newspapers, chiropody, hairdresser and holidays. Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key Inspection, which incorporates all information gathered about the service since the last inspection. This includes formal notifications, letters and phone calls to the inspector; survey forms for residents, relatives, care managers and health professionals; and a visit to the home, which lasted 6.5 hours. All of the key standards were assessed, and most of the other national minimum standards. The inspector received 14 completed CSCI survey forms from relatives, care managers and health professionals, and without exception, these all contained very positive comments about the high standards of professionalism, friendliness, caring attitudes of staff, and cleanliness of the home. During the visit, the inspector met 10 residents, and had some limited communication and responses from them; and observed how staff were interacting with them. Most residents have highly complex needs, and have different forms of communication. One was able to give the inspector verbal responses. The inspector also talked with 2 relatives, and 7 staff, as well as one of the providers. Neither the manager nor her deputy were available, but the inspector was assisted throughout the day by the staff nurse on duty, and by one of the providers. (For the purposes of this report he is referred to as “the provider” for ease of reading the report). They were very helpful with supplying information, and records for viewing. The inspector read documentation which included care plans, medication charts, staff recruitment and training records, and some policies and procedures and servicing records. The inspection included looking around the home in all areas, except for bedrooms where residents were having personal care given. The home had received one formal complaint during the past year, and this had been thoroughly investigated and dealt with appropriately. No other concerns or complaints were brought to CSCI during the year. The inspector found that the premises are clean, light, and well maintained. There is a good staff team, who are thoroughly committed to providing good levels of care, and work hard to enable residents to have as high a quality of life as possible. Although the manager and deputy were unavailable, the home was running smoothly, and staff clearly knew their levels of responsibility. A resident said they were “happy living here”, and a relative spoke highly of the dedication and caring attitude of the staff. Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The home is running well, and provides good standards of care. The inspector identified a few areas which need to be addressed, and others where further change could be implemented. These include: Amending the Statement of Purpose, to ensure that it includes all points in Standard 1 and Schedule 1 of the Care Homes Regulations. Ensure there are complete risk assessments for all residents, including risk assessments for going out of the home, using the home’s transport, and in relation to taking medication out of the home. Care plans for specific needs (such as care of epilepsy, gastric bleeds, wound care), would be improved with a format allowing for more details, and showing a clear pathway for progress or deterioration. Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 7 Some issues concerning medication storage and administration need to be addressed. Staff files must contain all items required as per Schedule 2 (amended 2004) of the Care Homes Regulations, including a photograph of each staff member, and written, available documentation to confirm nurses’ PIN numbers. Application forms should specify that a full employment history is required. It is recommended that minutes are taken and recorded for any formal meetings with relatives or staff. 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 DS0000023355.V348496.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 People who use the service experience good quality outcomes in this area. Detailed pre-admission assessments are carried out, ensuring that the home can meet the needs of prospective residents. EVIDENCE: The inspector reviewed the current statement of purpose, and found that it did not contain all aspects required in Standard 1, and Schedule 1 of the Care Homes Regulations, and this needs to be amended. The inspector did not view the Service User Guide at this visit, but the previous inspection indicated that this was satisfactory. The provider stated that this document includes a large number of pictures and photographs, so that when pre-admission assessments are carried out for prospective residents who live at long distances, they can be shown pictures of the home, and have some idea about it before going there. Most residents are unable to have the mental capacity to make the decision themselves about where they wish to live. It is usual for a relative or care manager to visit the home first, and if they think it may be suitable, the provider or manager arrange to carry out a preadmission assessment. The provider is a registered nurse, and he retains a day to day oversight and participation in the life of the home. Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 10 The inspector viewed the pre-admission assessment for a recently admitted resident, and noted that it contained detailed information. A joint assessment by the Social Services and Health departments had also been obtained. Preadmission assessments are usually carried out by two staff, and including either the provider or registered manager. They check that the room available will be suitable for providing for the person’s needs, and also that the home has all necessary equipment in place prior to admission. All residents are admitted for a trial period of three months. This is longer than for many care homes, but because these residents have very complex needs, more time is required to ensure that the placement is suitable before it is considered permanent. The home does not admit residents who have a history of aggressive or abusive behaviour. Client funding is arranged with either Social Services or the Continuing Care Primary Care Trust. All Social Services funded residents have a contract supplied by Social Services, but those funded by Continuing Care do not currently have formal contracts. However, their placement is reviewed 4 times per year. The home provides each resident (or their representative) with a copy of the home’s own Terms and Conditions of Residency, and these are agreed and signed between them. Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6-10 People who use the service experience good quality outcomes in this area. Staff enable residents to make decisions where possible, and to take part in the life of the home. There is a need to ensure that all risk assessments are up to date, available to staff, and reflect all aspects of risk for each resident. EVIDENCE: Care plans are initially based on the pre-admission assessment, and further assessments on admission. They are discussed with the resident (where possible) and with their representative. The inspector did not see evidence of the next of kin or representative having signed agreement to the care plan, although the provider stated that this is the usual practice. Evidence for this could be made clearer. A relative commented that staff “ always keep them up to date with any important issues”. The inspector viewed 3 care plans – one in detail, and two for specific aspects of care. The home uses the “Standex” system, and it was evident that care plans, risk assessments and goals are reviewed every three months. Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 12 Staff make every effort to enable residents to make decisions where possible. This is difficult to accomplish, as most have complex needs which include communication difficulties. However, staff said that they get to know residents gradually over time, and learn to interpret their particular methods of communication. These may be facial expressions, head movements, eye movements or verbal communication. In this way, staff are able to give choice in relation to getting up/staying in bed; use of different facilities; going out or staying in etc. Care staff are allocated different residents for whom they are key workers, and they can give extra concentration to the specific residents allocated to them. This includes talking with relatives and friends about residents preferred choices, such as types of food, and social activities. Speech and Language Therapists assist in determining if communication aids are effective, and if there are any new products on the market which may be of help. None of the current residents are able to manage their own finances, and the home does not manage any of these except for small amounts of personal pocket monies. Residents’ personal financial management is agreed at admission, and a relative or advocate is required to take responsibility. Pocket monies are held individually and are safely stored. Details of all transactions are recorded, and receipts are retained for all payments. The records for these are always available for the allocated relative or advocate to view, and the accounts are regularly checked and audited. Residents have limited ability to participate in the day to day running of the home, but staff try to enable them to have their own choice of clothes each day, and to have their rooms decorated and furnished according to choice. The home provides survey forms each year for residents to complete with help from those who know them best. Day to day feedback is obtained about items such as menu and activities – so that the relevant staff are informed if it is clear that someone did not enjoy their meal, or were upset by a particular activity. A health professional wrote: “The home treat the residents with dignity and respect, but it is also a fun place. It is probably the best care I have come across.” Risk assessments were viewed in care plans, and were mostly filed under “maintaining a safe environment”. These included data such as ensuring the person has a wheelchair strap or shower strap in place for their safety. The inspector did not see risk assessments specifically for risks associated with going out, using the home’s transport, or management of medication when going out. Details for these are available in care plans, but not specifically identified under risk assessments. However, staff were able to identify risks, and talk about how they are managed. There was particular discussion with the provider and a carer in regards to the storage and management of buccal midazolam – a drug which is needed very quickly to prevent epileptic fits. There is a recommendation to ensure that all risk assessments are up to date, easily available to staff, and reviewed at frequent intervals. Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11-17 People who use the service experience good quality outcomes in this area. The home provides residents with opportunities to maintain and develop their skills and interests. EVIDENCE: Most residents have very complex needs relating to both physical and mental ability. Staff concentrate on assisting residents to maintain skills, and to develop new ones wherever possible. This may be very small skills, such as an improved facial response, or developing small motor skills. Residents are unable to take part in employed work, but may be able to develop in small ways in terms of education and cognitive ability. Each one is treated as an individual, and their own skills and abilities are assessed and monitored, working towards small day to day goals. Many have progressive illnesses. The inspector introduced herself to 9 residents in the lounge, and 1 who was resting in bed. One was able to have limited verbal conversation, and said he “liked living here”. Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 14 The home has good links with the local community, and enables residents to carry out activities such as pub visits, bowling, cinema, church attendance, shopping trips and theatre visits. Several residents regularly go for home visits at weekends. Relatives and friends are invited for special occasions such as birthday parties, summer barbecues and Christmas/Easter parties. Every two weeks, a “Music Hall” night is held at the nursing home next door, and residents can join in with this, and always thoroughly enjoy these occasions. Two relatives commented on survey forms that they would like to see an increase in the availability of activities and stimulation during the afternoons. There was a recognition that additional staff would be needed for this. Families are mostly very supportive, and are encouraged to visit the home at any time. A Social Worker wrote in a survey that “staff are always open to suggestions to try things which will broaden the resident’s outlook”. Holidays are arranged after discussions with family and care managers, to ensure that going away elsewhere will be an experience which will enhance the person’s life, and not something that will upset them, or make them feel de-stabilised or frightened. The home has their own transport vehicles, which includes 2 smaller ones for transport of up to 2 residents and 2 staff (with space for 1 wheelchair user); and a larger minibus for up to 6 wheelchair users, with other residents and staff. All residents have 1-1 care on outings. All staff are trained in management of epileptic seizures and administering emergency medication if needed when the residents are out of the home. Parents are also given training if needed. The inspector observed that staff constantly interact with residents, and do not speak over them or ignore them if talking to each other. They learn to understand when residents wish to join in with an activity or not, and if they need to rest or have time de-stressing. The home has a sensory room, which is very good for calming residents if they become upset for some reason, and this is used as part of planned activities as well as for calming residents down. There are walkways and a pond in the rear garden, and this is another pleasant area in good weather. The home has a hydrotherapy pool, which is mostly used on two days per week, when the Physio Aide is on duty, and he will carry out therapy with residents with a carer alongside. Many residents are limited in being able to eat normal meals, as many are PEG fed, and may be unable to have any food by mouth, or only very small tastes of food. The care plans contain good details in this respect. Those who can have normal meals are provided with a good choice of menus. A relative said that “the staff will always offer different food if he/she does not like what has been provided.” The cook provides a varied menu, and retains a record of what residents eat, and ensures they have fresh cooked meals, and fresh fruit and vegetables. The kitchen was seen to be clean and well organised. The cook ensures that special diets are strictly adhered to, and that portion control is suitable for each resident. Pureed meals are well presented. Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18-21 People who use the service experience good quality outcomes in this area. The home provides good standards of personal and health care. Some aspects of medication management could be improved. EVIDENCE: Care plans provide sufficient information, and include all aspects of daily living (e.g. nutrition, mobility, continence, personal care, maintaining a safe environment, medication, communication, breathing, social activities). There are also specific care plans in place for items such as wound care, management of enteral feeds, management of epilepsy, and management of frequent gastric bleeds. These specific care plans contained adequate information, especially when read alongside daily reports. However, the system in use does not easily allow for as much information as could be included on a different format. For example, wound care plans did not clearly show the dressing of choice, and the size and state of the wound at each dressing change; and they were not accompanied by body maps, or photographs (and consent for photos). Care plans for management of gastric bleeds did not provide sufficient space for ongoing evaluation of the situation, and information had to be squeezed in, in small writing. There is a recommendation Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 16 to review how these care plans are formatted, so that the progress or pathway/deterioration can be easily verified at any time. There is good detail itemising personal care, with attention to detail such as specific care for hair (re style/hairdresser etc.); face (face creams, make –up); teeth (oral hygiene, input from dental consultant); same gender care, and choice of clothes. A relative stated that the resident is “always clean, and there has never been any problem with care. The staff do a brilliant job”. There were many comments on survey forms about how well personal care is given. Daily records are very well completed. Fluid charts and turn charts are only completed if someone is really ill. Positional changes are carried out automatically throughout the day and the night as part of basic care. Staff rely on good handovers with each other, and a “white” board in the office. The inspector pointed out the importance of ensuring good records for positional changes for anyone admitted with a pressure ulcer, and good wound documentation. Medication is stored in a small clinical room. The home uses a monitored dosage system where possible, but many drugs need to be given in liquid form. Storage cupboards and the medication trolley were found to be in good order, and there was no out of date medication. The room and drugs fridge temperatures are recorded daily, and showed that the room temperature is consistently high (24-26 degrees C). This need to be kept under review, and addressed if the temperature is consistently above 25 degrees. Oxygen is stored in the clinical room. There was a small notice stating “compressed gases” on the clinical room door, but this was not very visible. The clinical room is also sited within another room, and the outer room door should have a clearly displayed hazard warning sign to show where oxygen is stored, in case of fire. The deputy manager oversees all medication ordering. A record is kept of medication for disposal. The BNF was out of date (2003), but the staff nurse said there is a more recent one on the premises. Medication Administration Records (MAR charts) are basically well completed, but some handwritten entries had not been signed by 2 nurses, and this is important for clarity of any written entries or altered instructions. Drugs had not been receipted in on the MAR charts. This is important for auditing purposes. Sticky labels were seen on some MAR charts, and this is unacceptable as the writing underneath is covered up. A letter from a GP states that nurses can “administer simple analgesics as required”. This is unsatisfactory, as it does not specify the analgesics, or the names of individuals they can be administered to. Observations of seizures are recorded, and directions for medication administration for individual clients is retained alongside the MAR charts. The inspector discussed her concern with the provider and the staff nurse on duty about the storage and administration of buccal midazolam. This is a drug Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 17 which needs to be given very quickly to prevent seizures, and is sometimes stored in bags on the back of individual wheelchairs where it is quickly accessible. There must be a clear risk assessment in place in regards to this practice and visitors (e.g. small children) coming into the home. A recent concern in regards to a drug error had been well investigated, and protocols in regard to taking verbal messages from GPs in relation to changed dosages have been changed. Nurses are now required to obtain a signature on the MAR chart from a doctor, before administering an altered dose. The nurses keep a record of infections for individual residents, and antibiotics used for treating these. This is good practice. Some staff are trained in palliative care. The provider said they are looking to extend this training for other staff. Family and friends are able to visit at any time as required. The inspector read the procedures for management in the event of a death, and clear directions are in place. Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People who use the service experience good quality outcomes in this area. Complaints are taken seriously, and are dealt with appropriately. Residents are protected from abuse. EVIDENCE: There had been one formal complaint since the last inspection, and this had been given proper consideration, and thorough investigation. Changes in protocols were brought about as a result. A care manager stated that “any issues are dealt with quickly, and with sensitivity”. Day to day concerns are recorded in a small hardback notebook, and include details of follow up and any action taken. Communication difficulties make it very difficult for residents to voice concerns or complaints, but staff are quick to interpret their changing moods and preferences, and constantly monitor if the residents are content. Complaints are documented separately, and records are retained individually. Formal meetings will be arranged for any relatives or visitors who express complaints, and if this is appropriate. The inspector recommends that minutes are taken for any meetings such as this, and not just recorded afterwards. This would enable assistance to both parties. Staff are trained in the recognition and prevention of adult abuse. Personal care needs in relation to same gender care are discussed prior to admission Most personal care is given with two staff in the room. Same gender care is given as requested for female residents, but this is not currently possible for male residents, as there is only one male carer employed. Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 19 Recruitment practices include checking POVA First and Criminal Record Bureau checks prior to commencing employment, and this is a protective measure for residents. There are good training records to confirm adult protection training for all staff. The manager is trained as an Adult Protection trainer, and so delivers this training. Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24-30 People who use the service experience good quality outcomes in this area. The premises provide a safe, comfortable, and homely environment. EVIDENCE: The premises are a purpose built detached residence on two floors, with a passenger lift linking the ground and first floors. The home is well presented throughout - spacious, light and airy, with good décor, and suitably wide corridors and door ways. This provides good access for wheelchairs and other equipment. There is a large lounge/dining room on the ground floor, and a sensory room on the ground floor. The hydrotherapy pool is situated down a linked corridor, and there is easy access to front and rear gardens. The home has a large quiet room on the first floor, and this is useful for relatives to meet quietly with residents, and for meetings. There is a guest bedroom available by a separate entrance if a relative should wish to stay overnight. The premises have a call bell system. Bedrooms are sensitively personalised according to residents’ preferences. Each bedroom has an en-suite toilet and shower, and equipment for individual Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 21 residents was evident in bedrooms and toilet areas. Bedrooms and communal areas are fitted with overhead hoisting facilities, and there is a mobile hoist in case of need. There is a shared bathroom on each floor, and these contain specialised bathing equipment and shower trolleys. The sluice room includes a sluice disinfector. Hot water temperatures are checked monthly, and radiators are covered. The home is appropriately fitted with specialist equipment, and provision of additional aids is arranged in association with Occupational Therapists, Speech Therapists etc. There is a small laundry room on the ground floor, which was seen to be well organised, and has one large washing machine and one tumble dryer. A red alginate bag system is used for soiled items of clothing. Laundry is managed by the cleaning and laundry staff on duty each day. Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31-36 People who use the service experience good quality outcomes in this area. There is a stable staff team, who are well trained and efficient, and deliver care sensitively and effectively. EVIDENCE: Staffing levels are determined according to the dependency levels of residents. Most are high dependency, so staffing levels are quite stable. The residential forum has been used to help work out the levels. There are usually 1 nurse and 5 care staff in the mornings; 1 nurse and 4 care staff in the afternoons and evening; an additional carer from 6-10.30pm; and 1 nurse and 1 carer at night times. There are sometimes 2 nurses on duty in the mornings, and there were 2 on the day of the visit. There are always some day staff commencing duties at 07.00, to help with residents who may wish to get up early. A Physio Aide is employed on weekdays, and he ensures that physiotherapy is carried out on a daily basis, and also oversees hydrotherapy. He carries out instructions provided by a Physiotherapist, who visits from the local GP surgery, and gives directions for individual care. Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 23 The care staff are assisted each day by ancillary staff comprising 1 cook and 2 cleaners – who also manage the laundry. On the day of the visit, there was only 1 cleaner, as the other was off sick. The cleaner was working additional hours to cover this shortfall. There is a maintenance man and a gardener, who work between the two homes of Bethany House and Bethany Lodge. Care staff are named as key workers for two to three residents, and they carry out specific duties in relation to caring for their clothes, and ensuring there are sufficient toiletries, buying birthday presents etc. They check that the rooms and drawers/cupboards are kept in good order, and inform the nursing staff of any specific changes noted. The inspector chatted with 3 different care staff, and found that they were conversant with their different duties, roles and responsibilities. Most of the care staff have completed NVQ 2 or 3 training, and the current percentage is approximately 80 , which is excellent. All staff have a detailed induction, using “Skills for Care” induction booklets. The inspector viewed one of these, and the induction had been excellently completed. There is an initial five day induction, with a following three month probationary period. Mandatory training is carried out alongside NVQ training, and the staff training matrix showed which training had been carried out during the year. Needs for training updates are usually identified during one to one formal staff supervision sessions. The home ensures that staff carry out yearly moving and handling updates, and yearly fire training. As well as mandatory training, staff have training in related subjects such as epilepsy and PEG feeds. The Inspector viewed three staff files, including one for a nurse. Confirmation of the PIN number could not be evidenced on this file, but the provider said they obtain written confirmation from the NMC. POVA first and CRB checks are carried out prior to confirmation of employment, and two written references – with one from the last employer. The application forms do not specify that a full employment history is requested, and this should be amended. Recruitment files did not contain staff photographs, and the provider stated that he would arrange this. The provider stated that all staff receive formal one to one supervision, and this is delegated down to different staff to carry out. There are usually two to three staff supervisions each year, and a yearly formal appraisal. There is a recommendation to increase this to six times per year, as written in the NMS. Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37-42 People who use the service experience good quality outcomes in this area. The home is well managed, and staff are confident in the leadership and direction of the manager. EVIDENCE: The manager is supported by a deputy manager, and has daily input from the providers, who maintain a day to day interest in the running of the home. The manager has suitable managerial and nursing experience. The deputy manager is in the process of completing the Registered Managers’ Award. Neither the manager or deputy were available on the day of the site visit, but the inspector was able to see that the home was running smoothly, and that different staff knew their areas of responsibility. Staff meetings are held at regular intervals, but these are not recorded. The inspector recommends that minutes are taken and passed on to other staff who are unable to be present. Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 25 Quality Assurance processes are difficult to carry out with residents, but surveys are carried out twice yearly with assistance from family or staff. Relatives are also invited to complete survey forms. The provider stated that most feedback is obtained on a day to day basis, and as most residents have very supportive families, there is lots of contact with relatives and friends. Visitors are invited to events in the home – such as parties and barbecues – and these are good opportunities for feedback. There are also a number of residents who go home at weekends, and this provides another opportunity to find out if relatives have any concerns, or have noticed any changes in the behaviour or health needs of the resident. The home has policies and procedures in place for all aspects of life in the home, and these are reviewed yearly, or amended as needed. Staff always have access to these policies and procedures. The inspector read the policies and procedures for medication storage and administration, and for confidentiality. Record keeping in the home was seen to be well managed, with up to date records, properly signed and dated, and with appropriate storage. All staff have mandatory training in safe working practices. An independent health and safety consultant carries out a review of the home four times per year, and completes a yearly audit – which includes accidents and incidents. A trained Fire Officer carries out fire training twice yearly. This includes fire drills; use of training video and questionnaires; how to evacuate a smoke-filled room, and use of fire extinguishers. All doors are fitted with self closures, linked to the fire system. Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 4 33 3 34 2 35 4 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 1 3 3 3 3 3 3 3 X Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 27 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. 1 Standard YA1 Regulation 4 and Schedule 1 13 (2) Requirement Timescale for action 31/10/07 2 YA20 To amend the Statement of Purpose, ensuring that it includes all points in standard 1, and Schedule 1 of the Care Homes Regulations. 06/10/07 To ensure that medication management complies with relevant legislation, including guidelines from the Royal Pharmaceutical Society, in respect of: Drugs must be receipted in on to the MAR charts. All handwritten entries on to MAR charts must be signed by 2 nurses. No sticky labels may be stuck on to MAR charts. To request clarity from GPs regarding homely remedies which may be given to residents. This includes the name and dose of any drug which may be given without specific prescription, and the name of the resident to whom it may be given. Directions must be in writing, and DS0000023355.V348496.R01.S.doc Version 5.2 Bethany House Page 28 clearly signed by the GP. The clinical room temperature must be kept under review, and appropriate action taken if the temperature consistently exceeds 25 degrees Centigrade. Protocols regarding the storage and administration of buccal midazolam must be reviewed, and clear risk assessments drawn up. There must be clear hazard warning notices in place for any areas where oxygen is stored or in frequent use. 3 YA34 19 and Schedule 2 Staff recruitment files must 31/10/07 include a recent photograph of the staff member. Application forms must state that a full employment history is requested. Staff files must confirm that nurses’ PIN numbers have been checked and are up to date with NMC. 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 2 Refer to Standard YA9 YA19 Good Practice Recommendations To ensure that risk assessments are drawn up for all aspects of risk for residents, and that these are easily accessible to staff. To produce a different format for specific care plans (such as wound care, epilepsy management, gastric bleeding), to ensure that details and directions can be clearly followed. DS0000023355.V348496.R01.S.doc Version 5.2 Page 29 Bethany House 3 4 5 YA22 YA36 YA38 To record minutes for any meetings in relation to formal complaints. To increase formal staff supervision sessions to 6 times per year. To record minutes for staff meetings, and make them available to staff who cannot be present. Bethany House DS0000023355.V348496.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 DS0000023355.V348496.R01.S.doc Version 5.2 Page 31 - 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. 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