Inspection on 07/06/05 for Bethany House

This inspection was carried out on 7th June 2005.

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 06/09/07

Bethany House 22/08/06

Bethany House 22/11/05

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 Lisbeth Scoones Unannounced 7 June 2005 10.20 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bethany House Address 30 Eastbridge Road, Dymchurch, Kent, TN29 0PG 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) 01303 875199 Mrs Rosemary Jean Mills Mrs Susan Anne Urquhart Care Home with nursing 15 Category(ies) of Physical Disability x 15 registration, with number of places Bethany House H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21.02.05 Brief Description of the Service: Bethany House provides accommodation for 15 younger adults with a Physical Disability who either require nursing or personal care. The home is a purpose built, detached house on two floors, which became operational in 1997. It is close to its sister home Bethany Lodge. The home is located on the outskirts of the small village of Dymchurch, surrounded by attractive gardens and overlooking the countryside. There are car-parking facilities in the forecourt and the home is close to bus services. The home has a hydrotherapy pool and multi-sensory room as well as other services. Residents may use the arts and craft room in Bethany Lodge. The home has a minibus used for trips and outings. All bedrooms are single with en-suite facilities. The home provides a light, spacious, cheerful and bright environment for its service users. Bethany House H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 4 hours on June 7th 2005 and comprised interaction with all residents and discussions with the director Mr P Mills, deputy manager Ms S Savage and other staff. A partial tour of the building was undertaken and records examined. What the service does well: 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. Bethany House H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 6 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 Standards Statutory Requirements Identified During the Inspection Bethany House H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 Residents are only admitted to the home following a comprehensive needs assessment. Residents or their next of kin or legal representative know that that the home can meet their needs. EVIDENCE: There have been no admissions since the previous inspection. The preadmission process was discussed and demonstrates the home’s commitment to ensure that the prospective resident’s needs can be met. In this respect, issues to be considered relate to rehabilitation and therapeutic needs, physical and mental health needs, appropriate disability and communication equipment, suitability of the environment, social activities and education. The funding authorities carry out frequent care reviews. Staff training was discussed in respect of current knowledge of residents’ conditions and it was demonstrated that the staff collectively and individually have the skills and experience to deliver the care the home offers to provide. The registration certificate was on display and the inspection report available to all who wish to read it. Bethany House H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9 There is no clear care planning system to provide staff with the information they need to meet the residents’ needs. Risk assessment tools are not adequately used to inform the care plan. Residents, through their next of kin or advocate, make decisions about their lives. EVIDENCE: Residents have very complex and changing needs and many professionals are involved in providing care. As a result, much information is generated for every resident. Care plans are discussed with residents’ next of kin and key workers contribute on progress made. Whilst care plans seen are very detailed and evidence review, they would benefit from a simpler format whereby risk assessments inform and cross-refer to the care plan. An example was given of the risk of developing pressure ulcers (Waterlow) versus intervention identified in the care plan. It was agreed that wound care recording is in need of review. Daily records should evidence that the planned care has been provided. A lengthy discussion ensued with the deputy manager as to how the care-planning format could best be simplified. Bethany House H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 9 Some senior care staff, following training, could be involved in the care planning process thereby contributing to the most practical way of presenting the information needed for each resident. Such delegation would free up nursing staff’s time for regular care planning audit. See also standard 39 in respect of quality assurance. As was identified at the previous inspection, dates on exercise regimes on display in residents’ rooms do not indicate recent review. See also standards 11 and 19. Bethany House H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 14, 15, 17 Residents are provided with opportunities for personal development and leisure both in-house and through outside activities. Residents are supported in maintaining good family links. Meals in the home are nutritious, varied and balanced. EVIDENCE: On the day of the inspection, several residents enjoyed a session in the hydro pool and two residents went shopping in the afternoon. The home has a multi sensory (snoezelen) room and an art and craft centre. The home employs a physiotherapist. A physio-aid carries out a therapeutic exercise regime. See also standards 6 and 19. The home shares a minibus with its sister homes which is used for trips out to the cinema, ten pin bowling, pub lunches and drives in the country. The home also has a number of other vehicles available. Bethany House H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 11 Many residents spend weekends with their families. It is evident that family and friends are welcomed and encouraged to be involved in residents’ lives. The deputy manager said that the key worker system allows for good communication with residents’ families. Whilst some residents have soft or liquidised meals, some residents are fed through a tube (PEG). It was noted that staff assist the residents with their meals in a patient and dignified manner. Nutritional assessments are carried out. Residents are weighed regularly and if necessary, a dietician is available for advice and review. The kitchen was not visited on this occasion. Bethany House H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 Residents’ health needs are well met with evidence of multi disciplinary input. Residents are provided with personal support to ensure that their physical and emotional needs are met. The home has a safe system for the administration of medication. EVIDENCE: The home cares for residents with either combined nursing/residential or mainly nursing needs. Such needs are determined prior to admission by the funding authority and regularly reviewed during formal assessments whereby other specialists would be invited. District nurses meet the needs of those residents assessed as requiring residential care in accordance with an agreed protocol. Residents receive additional support from a multi- disciplinary team comprising physio, occupational and speech therapists and specialist nurses in respect of continence, diabetes, epilepsy and Huntington’s disease. It is evident that staff know the residents’ likes, dislikes and preferences very well. Staff have excellent communication skills and treat the residents with sensitivity, kindness and respect. Bethany House H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 13 Technical aids and equipment are provided to maximise independence and support. Special toilet chairs are provided and the majority of the bedrooms have overhead hoist. Due to their disability, the majority of the residents are dependent on a wheelchair tailor- made to their individual needs. Wheelchairs are maintained and their suitability reviewed by wheel chair specialists. A senior care worker has devised an in-house system ensuring the correct use of adaptations and safety belts thereby promoting residents’ comfort. It is evident that residents are cared for by a multidisciplinary team, which include physio, occupational and speech therapists, nutritionist and dietician. Medication administration charts were well maintained. Many residents have a complex medication regime, closely monitored and regularly reviewed. As identified at a previous inspection, the manager, in conjunction with the GP and pharmacist, has devised a protocol for the urgent delivery of an epilepsy medication and staff training provided. Bethany House H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 Residents (through their family and advocates) know that their views will be listened to and acted upon Residents are protected from abuse and neglect. EVIDENCE: Since the last inspection, no complaints were received or recorded in the home’s complaints file. From discussions with the deputy manager and other staff, it is ascertained that they speak to relatives regularly and inform and consult with them when any change in condition occurs. Any concerns expressed are dealt with immediately. Staff have excellent knowledge of and are trained in issues of adult protection Bethany House H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29, 30 The home provides a good standard of décor, which is homely, well maintained, spacious and safe. The gardens are well looked after and provided with seating arrangements. Residents’ bedrooms are personalised according to their lifestyle and equipment is provided to promote their independence. The home is clean and hygienic but infection control provision needs to be improved. EVIDENCE: The home has been specially designed for people with physical disabilities in respect of communal and bedroom sizes, corridors and door widths. These were in good decorative order. Bathroom fittings, equipment and overhead hoists are provided to promote independence. Especially adapted en-suite toilets/showers and communal bathrooms are provided. Since the previous inspection, some en-suite bathrooms have been fitted with shelves for toiletries storage. Bethany House H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 16 The home provides a clean, hygienic and odour free environment. The deputy manager is the home’s infection control link nurse and has recently attended training. In respect of infection control, it was noted that several soap dispensers were empty. Bethany House H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35 Staff have a good understanding of residents’ needs and residents benefit from a positive relationship. Staff turnover is low and residents benefit from an effective staff team The home has good recruitment procedures thereby ensuring the safety of the residents. EVIDENCE: Staffing is stable with little changeover. Staffing levels indicate that these are adequate for residents’ needs. Several care staff have achieved the senior carer status with additional responsibilities. See also standard 6 in respect of care planning. Examination of the staff file of a recently recruited care worker demonstrates sound employment practices. These include two reference requests, an enhanced CRB and POVA check. As evidenced on the training matrix, staff attend statutory, NVQ and specialist training. Bethany House H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 42 Residents benefit from a well run home. Residents’ views about the services provided are sought. The health safety and welfare of residents and staff is promoted and protected. EVIDENCE: The manager is supported by the director, a deputy and other staff. The deputy manager is currently undertaking NVQ 4 in management. Residents’ care needs are regularly reviewed both by the funding authority and in-house. Residents’ next of kin and/or advocate are always invited to take part. These reviews are well documented and detailed. Formal satisfaction surveys are undertaken twice a year and the results made available. Whilst the director said that Regulation 26 reports are produced monthly, these are not sent to the CSCI and it was stated that this would be acted upon. Bethany House H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 19 Staff are trained in the undertaking of risk assessments and formal health and safety audits are undertaken every three months. Staff attend statutory training in respect of fire safety awareness, infection control and moving and handling. The fire officer recently visited and inspected the home. Accident records are maintained. Bethany House H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 2 Standard No 11 12 13 14 15 16 17 3 3 x 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bethany House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 3 x H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 21 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 39.1 Regulation 26(5) Requirement that a copy of the report be supplied to the CSCI Timescale for action 30 June 2005 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 6 and 9.3 30.1 Good Practice Recommendations That the care plannning system be simplified and can demonstrate that risk assessments inform the care plan. That universal precautions are practised throughout the home Bethany House H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford, Kent TN29 0PG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bethany House H56-H05 S23355 Bethany House V225619 070605 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!