Inspection on 20/06/07 for Bethel House

This inspection was carried out on 20th June 2007.

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

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

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

CARE HOMES FOR OLDER PEOPLE Bethel House St Bees Road Whitehaven Cumbria CA28 9UB Lead Inspector Nancy Saich Unannounced Inspection 20th June 2007 7:00 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 DS0000068669.V334861.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 DS0000068669.V334861.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bethel House Address St Bees Road Whitehaven Cumbria CA28 9UB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01946 695 557 01946 695 559 Haven Care Centres Limited Ms Karen Crewdson Care Home 62 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (52), Mental disorder, excluding learning of places disability or dementia (2), Mental Disorder, excluding learning disability or dementia - over 65 years of age (10) Bethel House DS0000068669.V334861.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home with nursing - Code N, to people of either gender whose primary care needs on admission to the home are within the following categories: Dementia over 65 years of age - Code DE(E), maximum number of places 52 Mental disorder, excluding learning disability or dementia - Code MD(E), maximum number of places 10) Dementia under 65 years of age - Code DE, maximum number of places 2 Mental disorder, excluding learning disability or dementia under 65 years of age - Code MD, maximum number of places 2. The maximum number of people who can be accommodated is 62. The maximum number of people requiring nursing care who can be accommodated is 31. 2. 3. Date of last inspection Brief Description of the Service: Bethel House provides residential and nursing care to older adults with dementia or a mental health problem. One part of the home has nursing care provision and the other provides residential care. The home is situated on the outskirts of Whitehaven and is set in its own grounds. The home is a Georgian House that has been extensively adapted and extended to provide mainly purpose built accommodation. The two areas of the home are separate but shared a main kitchen, laundry and office space. All accommodation is in single ensuite rooms. The home has been operating for a number of years but was sold in January 2007 to the current provider. Weekly costs range from £326 to £567 to depending on need. Further information can be obtained from the home at the above address. Bethel House DS0000068669.V334861.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of the home since it came under new ownership. The lead inspector, Nancy Saich sent out surveys some weeks before the inspection and received a good number of mainly positive replies. She also asked the registered manager for information about the service. This was returned promptly with enough detail to help the inspector to reach the conclusions in the report. On the day of the visit the lead inspector arrived just after seven and met with both night and day staff. She spoke to residents in both parts of the home and observed the care and attention they received. A second inspector arrived at 10 a.m and spent most of her time in the nursing unit. She undertook a special observation using what is called the Short Observation Framework for Inspection (SOFI) where she sat for two hours, watched and recorded how the residents responded to the staff and to each other and whether they were involved in what was happening around them. She also checked on clinical nursing procedures through observation, discussion and checking files. Both inspectors checked on a wide range of documents that backed up what they saw and what was said to them. What the service does well: This home makes sure they only take new residents that they know they can care for and who will be suitable for the specialist service they give. The residents are well cared for in terms of personal and nursing care support. Health care provision is good. The home is very good at caring for people who have complex needs because of dementia or enduring mental health problems. They provide residents with suitable activities and lifestyle choices so that residents can contribute as much as they can. The home gives very frail and damaged people good opportunities to live as ‘normal’ a life as possible. They are good at listening to complaints and to protecting residents from harm. The home provides a safe, warm and homely environment where residents feel relaxed and comfortable. As one survey said: • ‘This home is now a really pleasant and happy place to reside’. The home is staffed with a very committed, open and enthusiastic staff team. The management ensure that staff have the right kind of training to help them deliver the kind of care and services people want. The home has a manager who is very capable of running this large home for the benefit of individual residents. She has the support of owners who are planning to make changes and improvements so that the home will become even better at giving people as much support and opportunity as possible. Bethel House DS0000068669.V334861.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The 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 DS0000068669.V334861.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bethel House DS0000068669.V334861.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home is good at making sure they only take new people who they know they can care for and who will fit into the existing group of residents. EVIDENCE: The inspectors checked on a number of records and found that the manager or one of the senior staff went out to visit people and that there were social work and health assessments on file. New residents have had psychiatric assessments and, where necessary, nursing assessments. There was also evidence to show that this process continues when people come into the home to make sure the best care is given to residents. The inspectors also met residents who could talk about how they came to look around and made a decision to come in. Surveys from relatives also showed Bethel House DS0000068669.V334861.R01.S.doc Version 5.2 Page 9 that they were given enough information to help them support older people who need care. Bethel House DS0000068669.V334861.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. This home is good at giving residents with mental health needs suitable health and personal care to allow them to be as well as possible. EVIDENCE: The inspectors read a number of the written plans that help staff understand the needs of the residents. These ‘care plans’ were detailed and up to date. They showed a marked improvement from the last inspection. These gave good directions for how to give personal care, how to meet medical needs but also gave other insights about personal preferences that improved the quality of peoples’ lives. The inspectors saw evidence that showed that in the main staff do follow the written plans. The SOFI observations did show that one person didn’t get the attention that was detailed on the care plan but that four people did. The inspectors think that the management may want to check on this as part of their quality monitoring. Bethel House DS0000068669.V334861.R01.S.doc Version 5.2 Page 11 One of the inspectors checked all of the medication and this was in order. This home is careful to only use sedatives wisely and on the instruction of a psychiatrist. The SOFI observation and the general observations of how staff interact with residents showed that staff do give people good levels of intervention and that they treat people politely and respectfully. Residents responded warmly to both day and night staff and showed by their body language that they trusted and liked staff. Surveys were very positive about the staff group, saying they were: • • • ‘calm, kind and thoughtful’ ‘patient and caring’ ‘work well even when people are very damaged by advanced dementia’ The inspectors received surveys from social work teams and G.Ps that gave a lot of detail about how well staff worked with residents. Bethel House DS0000068669.V334861.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,14, 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has suitable arrangements in place but might want to make some changes that will improve things even more for the frailest people in the home. EVIDENCE: One of the inspectors arrived at the home at just after seven in the morning. Only a handful of people on both sides of the home were up at this hour. These people all said they were ‘early risers’ and this was shown on their care plans. Some people got up much later. Some residents spend a lot of time in their rooms and others like to spend time in the shared areas. Staff respected and supported these choices. One or two people went out during the inspection and residents said that they could go out on trips in the home’s transport. These local ‘run outs’ were organised at least weekly. A volunteer was coming to entertain later in the afternoon. Staff spoke about activities they did with groups and individuals. People were quite satisfied with what was on offer. The surveys showed that relatives and friends were made ‘very welcome’ and that relatives were given support when visiting was emotionally challenging for them. Bethel House DS0000068669.V334861.R01.S.doc Version 5.2 Page 13 There was lots of evidence to show that local groups (including church visitors) were encouraged to come to the home. These things help residents get the kind of social, emotional and recreational input that they need. The care plans and the approach of staff show that residents are encouraged to have as much control over their lives as is possible. The inspectors saw the resident have nicely prepared and presented meals. There are new menus in place and residents got enough choice. The inspectors did think there was some scope for improvement in terms of things like special activities, ways to improve on giving choice and providing suitable nutrition for people who are challenged by the symptoms of dementia and other illnesses. They recommend that the provider support the management team to access this research and put it into practice. Bethel House DS0000068669.V334861.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home is good at listening to residents and their families and protecting people from harm. EVIDENCE: There were copies of complaints procedures around the home and the manager was working with relatives on two separate concerns during the visit. She always contacts the inspector if there are any issues around and the lead inspector judged that she takes a lot of time and effort to listen and act upon concerns. Residents had some small ‘niggles’ on the day but staff dealt with these things promptly and appropriately. It was nice to see that residents felt able to voice their opinions. There had been one or two concerns about the protection of residents who may display challenging or uninhibited behaviour. The manager always refers these to social services so that they can be dealt with to protect all parties involved. There were no problems with potential or actual abuse from staff. Staff were very sure about how they would report anything that caused them concern and would have no hesitation to contact outside agencies if they thought something was amiss. Bethel House DS0000068669.V334861.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home gives residents a safe, homely and comfortable environment that allows them both freedom and privacy. EVIDENCE: This home has two separate areas. One is for people who need residential care and the other for people who are more unwell and who need nursing care. The nursing wing is new and purpose built and is bright, airy and spacious. The residential part is an older building but is also purpose built. The inspectors walked around both parts of the building and checked on lounges and bedrooms. They found that all areas were tidy and orderly, clean and hygienic – even at 7 a.m. They were pleased to see that a number of bedrooms had been redecorated and refurbished to a very high standard. The provider said that she planned to Bethel House DS0000068669.V334861.R01.S.doc Version 5.2 Page 16 upgrade all the bedrooms slowly so not to upset residents lives too much. She also has plans to upgrade the dining room and improve the outside area outside. There are also plans to upgrade the internal, secure gardens and change the ‘smoking room’ into a garden room. All of these plans will take time but will eventually give the residents a very much improved environment. There were a number of things seen during the day that showed that staff were careful about preventing the spread of infection. Any linens or disposable items were being securely bagged by the night staff and removed discretely for treatment. There were no foul odours even early in the day. Bed linens were clean and fresh, residents’ clothes were clean and well pressed. Carpets were being washed during the visit and all bathrooms and toilets were clean and fresh. Bethel House DS0000068669.V334861.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home has a well-trained and committed staff group who have residents’ needs at the heart of everything they do. EVIDENCE: The inspectors saw the current staff rosters and spoke to staff about the ratios of staff to residents and the workload. This showed that there was always a trained nurse on duty in the nursing wing and an experienced and trained person in charge of the residential wing. There were suitable numbers of staff on duty by day and night. Staff said that sometimes they were ‘a bit hard pressed’ but that was only if a team member went off sick. Management could show that they work very hard to keep absence levels down. Staff in the home are qualified – either as nurses or as social carers and the levels of qualification at for example National Vocational Qualifications at levels 2, 3 and 4 were above the required minimum. Staff said they got lots of training in all the basics they needed to do their jobs. The inspectors saw records showing that staff had training in things like fire safety, manual handling, managing medication and caring for people with dementia. Nurses complete courses that help keep them up to date and confirm they are competent practitioners. Bethel House DS0000068669.V334861.R01.S.doc Version 5.2 Page 18 The inspectors also looked at the paperwork for new recruits. This was all in order. The manager makes sure she only takes people on when they have been checked as having no criminal record and haven’t been dismissed from another care setting for anything abusive. She also tries to involve residents in recruitment. Surveys were all very positive about the staff. Here are two examples: • ‘My relative had a fall…. and the staff have been marvellous with her and have got her mobile again…I have no complaints at all…they are helpful and friendly…’. ‘The domestic staff work well showing consideration for privacy, the teams of carers show great kindness, cheerfulness and affection, while carrying out work to a high standard…supervisors and managers demonstrate their considerable experience and expertise…’. • Bethel House DS0000068669.V334861.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. This home’s manager has really good systems in place that allow a large number of residents to have care and services that are as individual as possible. EVIDENCE: This home has been operating for a number of years. The nursing side of the home is a fairly recent addition. The home was bought by the new owners in January of this year but all of the management team have been in their posts for some years. A number of surveys thought that the change of ownership had been done smoothly and that the home continues to improve. Bethel House DS0000068669.V334861.R01.S.doc Version 5.2 Page 20 The manager is a trained nurse with a lot of experience in managing both nursing and residential settings. She is liked and trusted by staff and residents and has a good understanding of how important it is to work with families and other professionals. There was evidence to show that she manages this complex operation very well. The home has a quality monitoring system that is used all the time. There hasn’t been an audit of the system since the change of ownership but one is planned. There was evidence to show that the manager checks on quality and that she talks to the provider about any changes needed. There was evidence to show that any money kept on behalf of the residents is managed properly. The inspectors checked that the staff are properly supervised. They saw that senior staff by both day and night were careful to give staff support and make sure that each shift was managed to give residents the best care and services possible. The inspectors saw files that showed the home was maintained properly and that things like food hygiene, fire safety and general health and safety were given high priority. There were no hazards seen on the day and the home was orderly and well cared for. The new owners have made sure that they have done a thorough check on all the health and safety matters and have very good plans in place for the future. Bethel House DS0000068669.V334861.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 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 2 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 4 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 3 X 4 Bethel House DS0000068669.V334861.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations It is recommended that the registered person help the management team to introduce some new research into the way they care for their residents. Bethel House DS0000068669.V334861.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bethel House DS0000068669.V334861.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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