Inspection on 10/06/08 for Bethel House

This inspection was carried out on 10th June 2008.

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

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Bethel House 28 Beach Avenue Barton-on-Sea Hampshire BH25 7EJ Lead Inspector Jan Everitt Unannounced Inspection 10th June 2008 09:00 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 Bethel House DS0000070976.V365237.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. Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bethel House Address 28 Beach Avenue Barton-on-Sea Hampshire BH25 7EJ 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) 01425 610453 01425 620905 Hartford Care (Southern) Ltd Miss Zoe Victoria Wilson Care Home 31 Category(ies) of Dementia (0), Mental disorder, excluding registration, with number learning disability or dementia (0), Old age, not of places falling within any other category (0) Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) Mental disorder, excluding learning disability or dementia (MD) maximum number 5. The maximum number of service users to be accommodated is 31. 2. Date of last inspection New Service. Brief Description of the Service Bethel House is a large detached property situated close to the cliff top at Barton-on-Sea. The home is registered to accommodate thirty-one residents in the categories of old age, dementia and mental health disorders over the age of 65. The home has an enclosed garden and a number of pleasant communal areas. The home has recently been taken over by new providers and a new manager has been appointed. The current scale of charges range between £469:35 and £584.08. The fees do not include hairdressing/papers/magazines/ chiropody or toiletries dependent on the item. Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 2 star. This means that people who use this service experience GOOD quality outcomes. The site inspection visit to Bethel House was the first visit since the home has been sold to the new provider in December 2007. The visit was unannounced and took place over a one-day period on the 1oth June 2008. The manager, Ms. Zoe Wilson and other members of staff assist the inspector throughout the visit. The visit to the home formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The home sent us their Annual Quality Assurance Assessment (AQAA) back on time, which had detailed information and the focus of this visit to the home was to support the information stated in this document and other information received by the CSCI. Documents and records were examined and staff working practices were observed where this was possible without being intrusive. The inspector visited all areas of the home and spoke to a number of the residents, some of whom, through mental frailty, were unable to communicate with us, staff and visiting relatives in order to obtain their perceptions of the overall service the home provides. Those spoken to were very happy and complimentary about the home and care that is provided. Surveys had been distributed to service users, care managers, GP and other visiting professionals. Four service user survey, eight staff surveys, two care managers, two GP and two district nurses surveys were returned to the CSCI. The outcome of the surveys indicated that there was a high level of satisfaction with the service and that generally residents and health care professionals were very satisfied with the care and other services the home provides. The surveys returned from staff also indicated that they have good training opportunities, are listened to and consulted on changes made in the home and feel very supported by the management. Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 6 What the service does well: Assessments are carried out before a person moves into the home and give a clear account of the persons needs. Plans are developed and reviewed and detail each persons overall needs and gives carers good information on how these should be met. Residents felt safe and secure and happy that staff could look after them properly and treated them with respect. The home’s routines were flexible and it promoted the right of residents to make choices for themselves and exercise personal autonomy as far as was reasonably possible, including dealing with their own finances. Residents were positive about the food that the home provided and were pleased with the range of activities in which they could participate and the condition of the accommodation that they occupied. Management systems and procedures in the home worked well including, dealing with complaints, quality monitoring, and health and safety. Staff were recruited properly ensuring that residents safety and welfare was given proper consideration. There was a strong commitment to staff training and development to ensure that staff were able to fulfil their roles and responsibilities and meet residents’ needs. Comments made on surveys and by service users say: ‘The home is very good and I give the cook a few tips on cooking’. ‘Mum is very happy and everyone is so kind they care for her so well’. ‘Everything is very satisfactory’. ‘There are some excellent senior carers and the staff give a high standard of care’. ‘The staff are very good at caring for clients with dementia, the training we receive is good’. ‘The home responds to different needs’. ‘Strong management has always been a feature with concerns being addressed appropriately’. ‘Good staffing levels, very pleasant care team always in evidence around the home’. ‘I cannot fault the service’. ‘I feel the service user’s needs are met. I think we provide a homely environment and staff work well together’. Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 7 ‘I think the service users are well looked after and that Bethel is a very homely place for them’. ‘The home is a happy and caring environment for the elderly’. 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. Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. 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. Prospective service users have access to sufficient information to enable them to make an informed decision about moving into the home. Service users’ needs are fully assessed before moving into the home to ensure their needs can be met. EVIDENCE: The service has a Statement of Purpose and Service User Guide that contains all the information a prospective service user and their representative would need to make an informed decision about coming to live at the home. These documents reflect the change of proprietors and manager. Service user surveys returned to the CSCI indicate that service users consider they had sufficient information about the home so they could decide if it was the right place for them. Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 10 The home has an admission policy, which ensures that residents are assessed before accepting a place at Bethel House. If the home receives an initial enquiry they send out information about the home. The manager invites the prospective residents to come to the home for a visit but if this is not possible the manager or her deputy will visit and assess the person in hospital or in their own home. A sample of three service user’s records was viewed, these contained the preadmission assessment, and on which the care plans are initially based. These were seen to be fully completed and covered all aspect of the person’s physical, psychological, emotional and social care needs with detailed information recorded in each area. The pre-admission assessments demonstrated that appropriate and comprehensive information is collated prior to the individual moving into the home and that this information is collected with the service user and/or their relative’s involvement. The manager told us that she does receive care assessments from the care managers, if they are involved in the admission to the home. One of the care plans viewed identified that a thorough assessment of needs had been sent to the home from the local authorities. Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 11 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): 7, 8, 9, & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal, social and healthcare needs of residents are met. Policy and procedures are in place to manage the resident’s medication safely and effectively. The home promotes staff working practice to ensure that residents’ privacy and dignity is respected. EVIDENCE: The AQAA told us a comprehensive plan of care is developed for each resident, whilst promoting as much independence as possible in relation to his or her activities of daily living. A sample of three service user’s care plans were viewed and those seen detailed information on personal care, risk assessments for moving and handling, nutrition, pressure sores, and falls. Care plans had been written if risks had been identified. Assessments are also undertaken for mental and emotional heath. Likes and dislikes are recorded including the wishes in the event of a person dying. Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 12 Excellent social histories are recorded for all residents and the manager told us that relatives and service users have compiled these where possible and records of the service users participation in the activities is also recorded. It was noted changes had been recorded on care plans, which were reviewed monthly. We were advised residents are usually involved in the care plans and reviews. Those seen on the day did evidence the service users, or representative’s signature to agree the plan. Daily notes are recorded and were observed to be very detailed in content of how the service user’s daily routine was spent. Service users spoken with and surveys returned by the service users to CSCI say that service users are very happy in the home and they say all their needs are met and they are ‘so lucky to have found such a home’. It’s a lovely home and staff are wonderful”. Staff spoken to had a good understanding of residents needs and staff recently recruited said they were well supported in their roles and were receiving a variety of training to ensure they were able to meet the resident’s needs. Care plans included information on a person’s medical need. The majority of service users are registered with the local GP in Barton-on-Sea. Evidence was seen in care plans that a range of health professional visit the service including, dentist, optician, chiropodist, community psychiatric nurse, district nurse and doctor. Residents, who are unable to attend appointments because of frailty, have domiciliary visits by the optician and dentist. We observed in care plans records being kept of all health professional visits with outcomes of the visits. Surveys received from a visiting health professionals said: ‘The residents health care needs are met by the home and the service respects individual needs and staff are very caring’. ‘The staff at Bethel House maintain a high standard of care to the residents’. Those residents spoken to confirm that they always see a doctor when then need to and this was supported in the surveys returned from service users who say that they receive appropriate medical attention when they need it. The home had a clear medication policy and procedure. The home operates a monitored dosage system for the management of medication that is supplied by a local pharmacist. The blister packs are divided, for ease of giving out, into sections to correspond to the different areas of the home. Samples were inspected and found to be correct. The drug administration sheets were found to be satisfactorily recorded, with no omissions. As well as a locked medication cabinet the home has two drugs’ trolleys, which are taken around the home on each medication round. Part of the medication round was observed and the carer undertaking this was following safe procedures. Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 13 Only staff that have attended a safe handling of medicines course are able to administer medication. The manager said that a number of staff have attended the local college to received training for the safe handling of medicines. She is in the process of ensuring that all staff receive this training eventually. The manager told us that she co-ordinates the ordering, receiving, disposal, and showed us the records for the management of medication and told us that she checks the prescriptions before they are taken to the pharmacist for dispensing. This is seen as good practice and is stated as such in the Royal Pharmaceutical Society Guidelines. Staff spoken to confirmed only staff that have undertaken training are involved with the administration of medication. Staff were observed throughout the visit, providing care to residents in a dignified and respectful manner ensuring their privacy at all times. Staff were seen to knock at bedroom doors before entering and, were responding to residents requests in a discreet and appropriate manner. The communication and interaction between staff and the residents was observed to be good and residents were full of praise for the staff that were familiar with their routines. Residents spoken to say that staff were very kind and that they were always there for them is they needed assistance. Two care managers surveys returned to CSCI indicated that they consider that staff respect individuals’ privacy and dignity at all times. Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 14 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. Each person is treated as an individual and supported to follow personal interests. People keep in touch with family and friends. People have nutritious meals at a time and place to suit them. EVIDENCE: The AQAA states that the home provides a wide range of activities within the home to ensure the residents have mental stimulation. The AQAA states that the home hopes to provide residents with more information regarding menus and activities in the home. The home has a programme of activities that was displayed on the notice board. The service users’ plans detail a social history of their lives and this information is provided for the home from relatives and from service users themselves, if they are able. This includes information on each person’s hobbies, interests and social contacts. People have the choice to join in events Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 15 or not. Events include an entertainer who visits monthly to entertain with music and also recite poetry. The home is also visited three times a week by an external activities person who practices extend exercises. The manager said that there are also one-to-one activities for those residents who choose to stay in their rooms. The manager told us that she is in the process of advertising for an activities co-ordinator for 30hours a week, which she anticipates will formalise and give more structure to the activities programme. The manager said that the outings are limited currently, but his is something she wishes to address in the coming year. Service users, who are able to walk, are escorted on walks to the sea front, which is close by. On the day of this visit, the weather being very fine, a relative was taking her mother for a walk in the surrounding area. Service users told us that they are happy with the activities programme and that they have a choice whether to join in or not. Surveys returned by the service users told us that activities are always arranged by the home if they wish to take part in. Records are maintained of the activities that take place and the level of participation by each resident. The visitor’s book evidenced that the home does have regular visitors. On the day of this visit two relatives were spoken with and they said they are made very welcome and can visit any time and they see their relative in private or in any of the communal areas. Another visitor spoken with said she was taking her relatives out for a short walk in the surrounding area. The care plans identify a person’s religious belief and these are respected. Service users are offered to attend church services, which are held in the home of varying denominations. It was clear from discussions with residents and visitor’s, residents have choices and control over their lives. Residents are asked to join in social events but their choice is respected if they do not want to join in. Care plans record how a person wishes to be addressed and of the preferences of how they wish to plan their activities of daily living. We visited the kitchen, which was clean and well organised. The cook told us that she has been employed at the home for many years and is very familiar with the service users likes and dislikes, which are recorded, and although she has not received any formal training in alternative diets, she is able to provide and understand the dietary needs of diabetics. She said that there is no other alternative diets needed but she described one service user, who has an allergy to fish, which she is very aware of when preparing any foods. The home has a four-week rotating menu; this also demonstrated an alternative choice at each mealtime for service users. The cook confirmed resident’s wishes have been taken into account when the menus are planned. Resident’s surveys received by the CSCI demonstrate a high level of Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 16 satisfaction with the meals and those spoken with at the time of this visit confirmed that the ‘food is very good’. The lunchtime meal was observed and was well presented and looked wholesome. There was evidence of little waste and residents said they enjoyed the beef hotpot followed by apple crumble and custard. Residents have the choice of having their meals in the dining room, which is pleasant and well presented, or in their own rooms. Residents who needed assistance with meals were observed and it was noted this was done in a dignified manner. The manager said relatives could stay to lunch if they request this and it was observed on the day of this visit a relative was having lunch with the residents. All residents spoken with stated they enjoyed their meals and a choice was available. One visitor stated the meals always looked appetising and their relative enjoyed the meals. All surveys from service users confirmed they enjoyed their meals, one person stated “I love my food and I look forward to my meals”. We observed that there were drinks being offered and taken round at regular intervals throughout the day, the day being a particularly hot day, the residents were being encouraged to drink plenty of fluids. The cook said that there were snacks and beverages available at all times of the day. A late supper is offered to those residents wishing to stay up later in the evening. Weights are monitored monthly and recorded in care plans. Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 17 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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People know how to complain and know their concerns will be looked into. The policies and procedures of the home safeguards people from abuse and neglect. EVIDENCE: The AQAA states all residents are issued with a copy of the complaints procedure, which is incorporated into the service user guide. All residents spoken to state they would have no concerns complaining to the manger that they all felt would sort out any problem. Visitors and staff spoken to stated if they had any concerns they would discuss it with the manager who all had confidence it would be sorted out. All surveys received from residents indicated that they would know how to make a complaint and on saying ‘I would inform my family and let them make the complaint for me’. Surveys received from visiting health professionals and care managers said they are confident the manager would respond appropriately if any concerns were raised. The manager showed us the complaints log that recorded one complaint and the action outcome stated. Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 18 The home had copies of a whistle blowing procedure and safeguarding adults and prevention of abuse procedure. All policies and procedures are kept in the office in the home, where staff have access to them. Members of staff spoken to were aware of what action to take and who should be contacted regarding adult protection. Surveys received from staff indicate that they know what to do if a service user or relative has concerns about the home. Currently the abuse training is part of the induction programme and the organisation’s trainer gives further training in-house. Staff say that they have received appropriate training on abuse issues. The manager told us that that it has been planned for staff to attend a refresher training on abuse in the very near future, which will be delivered by the organisation’s trainer. Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 19 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service live in a safe and well-maintained home that is homely, clean, pleasant and hygienic. EVIDENCE: Bethel House has been extended over the years and has thirty-one single bedrooms and one double bedroom, although the home is registered to accommodate thirty-one residents. The home is well maintained and all areas seen on the day were clean and no offensive odours were detected. All bedrooms are personal and have been personalised by the resident. All rooms have views over the homes front and back gardens, which are well maintained. A ramp has been built giving access into the back garden with handrails fitted. Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 20 Communal areas consist of three sitting rooms, a day room and two dining rooms. All were comfortable, well furnished and clean. The manager said that new carpet is being put down in the communal areas imminently. The home has two passenger lifts, giving access for residents to all floors. All radiators are guarded or have low surface temperature surfaces. A number of bedrooms have recently been re-decorated with new curtains and carpets. The AQAA states that the improvement in the coming year is to provide en-suite facilities to all bedrooms. Other redecorated and the relocation of offices is also planned. The home has a separate laundry room, which is situated away from the kitchen and food preparation. The home does not specifically employ a laundry assistant, as care staff is responsible for service users’ laundry. Locks are fitted to all bedroom doors and one service user chooses to hold their own key. One visitor stated, “the home is always clean and tidy”. Residents spoken to stated their rooms are always kept clean and the laundry is well looked after. Infection control training is provided at induction and also the local college are offering a twelve-week distance learning training package that the home is signing up to. Staff were observed to have gloves and aprons available and hand washing facilities were in all bathrooms and toilets. Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 21 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. Staffing levels ensure all service users’ needs can be met. Training is promoted in the home ensuring all staff have the skills and knowledge to be able to meet service users needs. Robust recruitment procedures are followed for all staff ensuring the safety of all service users. EVIDENCE: The AQAA told us that the home is aware that the staff will always play a very important role in residents’ welfare. To maximise this contribution they employ sufficient staff and ensure the relevant skill mix allows the complex needs of residents to be meet. We have a high staff/resident ratio to allow more 1:1 time with residents to address individual needs. From rotas viewed identified that 5 carers were on duty all day until 16:00 and there then 4 care staff on until the 2 waking staff come on duty at 20:00. The manager or deputy manager is also on duty for five days a week and is extra to those numbers. It would appear that the home generally provides sufficient staff to support the needs of individuals accommodated. Surveys returned from staff and staff spoken with say that there is always or usually sufficient staff on duty to meet the service users’ needs and surveys returned from the service users tell us that they receive the support and care they expect. Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 22 Observation of the home and care practices throughout the day would suggest that there is sufficient staff on duty to meet the resident’s needs. Residents, spoken to, were full of praise for the staff. One resident said, ‘The staff are wonderful’. Another commented that “anyone Living here would be happy the staff and management are great”. Staff were observed working well together throughout the inspection and responding to residents’ needs in a respectful and discreet manner. Agency staff are not used in the home. The home employs a separate staff group for cleaning, cooking, maintenance and gardening. We were able to view the staff training records. Many of the staff have worked in the home for some years and twenty care staff have achieved a National Vocational Qualification (NVQ) Level 2 and 3, with five care staff currently working towards their NVQ level 2 in care. A sample of the three more recently recruited care staff personnel files was viewed. It was noted these were well organised and contained the correct checks and documentation required. The AQAA states that the induction programme for newly recruited staff is of a high standard and staff are provided with a mentor during that period. We viewed the induction programme workbook in the personnel files of the staff records viewed. This is based on the Skills for Care induction programme. One staff member told the inspector, that they were currently undertaking their induction and were being appropriately supported. The manager told us that the home has been involved with a pilot scheme for Skills for Care project that is designed to identify training needs and documents outcomes and action to formulate a training plan. This is currently running alongside supervision and appraisal. An example of this was seen in a staff member’s personnel file. The staff training files were viewed. Each file has an analysis at the front of the training the member of staff has undertaken in the past year and certificates for these are kept in this file. The home has core training in manual handling, infection control, health and safety, basic food handling, fire safety, adult protection and various courses obtained through the Alzheimer Society including dementia awareness. The manager told us that most staff have received dementia training and those staff who have not attended are undertaking a distance learning programme currently. Both internal and external training has been provided and is planned in relation to the needs of residents Staff spoken to and surveys returned from staff to Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 23 CSCI indicate that staff feel the training meets their needs and indicated that they receive all the support they need from the manager on a day-to-day basis. The inspector spoke to the chef on duty that indicated that they felt supported by the management team enjoyed working in Bethel House. Staff are paid for training sessions. Surveys received by CSCI from care managers and other visiting professionals commented that ‘The staff have the right skills to care for the residents’. ‘The staff at Bethel House are excellent and liaise with district nurses to ensure continuity of care within the home’. ‘I feel that the staff are the major strength in the home’. Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 24 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, 33, 35 &38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have confidence in the care home because it is well managed. The environment is safe for people and appropriate health and safety practices are carried out. EVIDENCE: The AQAA states the leadership of the home is critical to all its operations. To provide this we ensure the management team have the necessary qualifications and experience to perform the expected role. The Registered Manager has been involved in the care at Bethel House for the last 10 years. Qualified as a Registered Mental Health Nurse with 3 years Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 25 experience in an acute Mental Health Hospital setting. This has resulted in a well-balanced approach to the care needed in this care home setting. The manager has gained her Registered Managers Award. (RMA). The registered manager has a deputy who has been in post for some years and therefore they are familiar with the home and are a strong management team. We spoke to the manager about her new role and managing for the new providers. She said that she was very happy and well supported in her role from both her line manager and her deputy. Residents, spoken to were appreciative of the management team. Staff felt supported by the management structure within the home. All persons spoken to including residents, visitors and staff were full of praise for the manager. All stated he had an open door policy and could be contacted at any time. The AQAA states that the home has an effective quality assurance and monitoring system in place to gain feedback of the service provided. This has helped to highlight areas where there is room for improvement. It was clear the home is run in the best interests of the people who live there. The home has a friendly open atmosphere and residents are consulted on decisions affecting the home. The manager undertakes the internal audit monthly of care plans, medication, general cleanliness of the home and training files. The outcome of these audits was seen. The manager anticipates distributing survey to service users six monthly and generally relatives will support them complete the questions. The manager told us that head office have sent out questionnaires since taking over the ownership and these have to be returned to the head office and to date the manager has not seen the results or outcome of the surveys. The manager held the first relative meeting in March, which was well attended and highlighted many positive areas but also issues around food and that more outings were needed. We were advised the home does not become involved in any of the resident’s money. The manager explained if he has to pay any money out on the behalf of residents’ for example a hairdressing bill this is itemised on the monthly invoice. The AQAA advised us the home has clear policies on health and safety. Regular checks are made on the equipment in the home and professionals service these. A sample of servicing certificates was viewed for Gas safety, bath chairs and hoists and yearly electrical appliance testing. Staff reported they all have the equipment and training they need and there is always a supply of appropriate gloves and aprons. Alcohol dispensers have been placed around the home. Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 26 The Environmental Health Officer visited the home and made two recommendations that have both been complied with. We viewed a risk assessment of the environment that was undertaken by the manager going from room by room. The fire risk assessment evidenced a recent report had been submitted to the home. All hot water taps have thermostatically controlled valves fitted to them. The first floor windows have been risk assessed and window restrictors fitted. Cleaning materials were observed to be stored in a locked environment and not left unattended and information on the cleaning substances has been reviewed. On the day of this visit a representative of a supplier was giving the care staff training in the new cleaning substance the home was going to purchase. The training files evidenced that staff have received the mandatory health and safety training. The accident book was viewed and demonstrated that all accidents are recorded and this information is stored in a confidential manner line with the Data Protection Act Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 27 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 3 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 X 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 X 3 X 3 X X 3 Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? None 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. Refer to Standard Good Practice Recommendations Bethel House DS0000070976.V365237.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone 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. 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