Inspection on 07/12/06 for Bethesda House

This inspection was carried out on 7th December 2006.

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

Bethesda House 08/01/09

Bethesda House 08/11/05

Bethesda House 13/05/05

Bethesda House 09/02/05

Bethesda House 09/09/04

Bethesda House 01/03/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Bethesda House Derry Hill Calne Wiltshire SN11 9NN Lead Inspector Alison Duffy Unannounced Inspection 09:00 7 December 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bethesda House DS0000028561.V317763.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. Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bethesda House Address Derry Hill Calne Wiltshire SN11 9NN 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) 01249 816666 01249 758877 The Gospel Bethesda Fund Miss Rebecca Wheeler Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (12), Physical disability (1) of places Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. No more than 12 service users over 65 years of age No more than 1 male service user with physical disability The Registered Person will continue to provide personal care and accommodation to service users, who whilst at the home are diagnosed with Dementia, until such time that their care needs cannot be met. 8th November 2005 Date of last inspection Brief Description of the Service: Bethesda House is registered to provide care to thirteen older people, one of whom may have a physical disability. The home is one of a number of homes managed by the Gospel Standard Bethesda Fund. One of the conditions of residency is the continued attendance at a Gospel Standard chapel unless prevented by frailty or illness. In such circumstances, services are relayed to the home and residents are able to participate, within the lounge or their own room. Miss Rebecca Wheeler is the registered manager. Bethesda House is a purpose built detached property. It has one twin and eleven single rooms on the ground floor. All except one of the rooms have ensuite facilities. There is a comfortable lounge and separate dining room. Pleasant, well maintained gardens surround the property. Staffing levels are maintained at a minimum of two care staff on duty during the waking day. At night one member of staff undertakes a waking night and another provides sleeping in provision. Catering and housekeeping staff are also deployed. Bethesda House is not registered to provide intermediate or nursing care. Fees for living within the home are dependent on individual need and there are three levels. These are, ordinary (£385.95 a week) intermediate (£422.40 a week) and higher (£442.40 a week.) Fees do not include newspapers and periodicals, toiletries, hairdressing, dry cleaning, chiropody or the purchase of clothing or other personal items. Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a period of two days. The inspection initially commenced on the 7th December 2006 between the hours of 9.00am and 12.15pm. On arrival at the home, Miss Wheeler was on duty, with two care staff, three housekeepers and a cook. There were eight residents in the home. Many were getting ready for a trip out to a local garden centre. It was agreed therefore, that while residents were out, time would be spent viewing various forms of documentation. This included care plans, daily records, risk assessments, staffing rosters and the fire log book. An additional day was made to complete the inspection. This was undertaken on the 3rd January 2007. During this time, discussions were held with residents and interactions between staff and residents were observed. A tour of the building was made and the inspector examined the safekeeping of personal monies, medication systems and recruitment information. As part of this unannounced inspection, the quality of information given to people about the care home was examined. Residents were asked if they could understand the information and how it helped them to make choices. The findings are highlighted within main report. The information included the service user’s guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk As part of the inspection process, surveys were sent to the home so that residents could have assistance with completing the forms, as required. Comments cards were also sent to each resident’s primary relative, their GP and social worker, if applicable. The feedback received is detailed within the main text of this report. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Bethesda provides a comfortable, clean, well-maintained environment. Dedicated provision is in place to address residents’ spiritual needs. Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 6 The admission procedure is clear, organised and well managed. Residents are given a detailed introductory brochure before their admission. Interactions between staff and residents appeared attentive and respectful. Residents are able to personalise their rooms and undertake housekeeping tasks if they wish. What has improved since the last inspection? What they could do better: Although care planning is of a good standard, there are some areas, which would benefit from further detail and clarity. Tissue viability is addressed yet greater consistency within documentation would ensure residents are further protected from the risk of developing a pressure sore. Control measures in relation to any potential risk to residents must be clearly evidenced within the risk assessment process. Adult protection training, facilitated by an external trainer would ensure residents are further protected. Further developing the home’s quality assurance systems will enable greater opportunities for additional development. Within this, consultation systems should be further explored, so that strategies of how suggestions can be implemented are established. Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 7 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. Bethesda House DS0000028561.V317763.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 Bethesda House DS0000028561.V317763.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, 2 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a clear well managed admission procedure. While residents receive a high level of information before their admission, developing documentation specifically, in relation to the home, would ensure residents are further informed. Residents benefit from detailed contracts and are fully informed of any fee increases. Standard 6 is not applicable to this service, as intermediate care is not provided within the home. EVIDENCE: The organisation has developed a combined Statement of Purpose and Service User’s Guide in the form of a ‘Bethesda Introductory Brochure.’ The brochure applies to all homes within the organisation and further on, has information specific to individual homes. The information is very detailed and comprehensive. Within the section dedicated to the home, Miss Wheeler’s Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 10 qualifications and details of the environment are stated. Other information however, is written in general terms. Miss Wheeler is currently in the process of developing documentation, which relates more specifically to the home. This will include daily routines and the provision to meet residents’ religious needs. Fees are not stipulated within the brochure, yet Miss Wheeler reported that all residents are given details of fee levels and planned increases in writing, before their admission. To be eligible for a placement within the home, a prospective resident must be a member of the Gospel Standard Churches or have regularly attended Gospel Standard chapels. This criterion is clearly identified at an early stage within the admission process. Prospective residents must complete an application form, which is circulated to members of the Bethesda Fund Committee. Identifying the prospective resident’s church and Minister, forms part of the assessment documentation. As part of the process, contact is also made with the prospective resident’s GP. Information about medication and past and present health conditions is requested. A decision to offer occupancy is then made, taking into account individual need and spiritual aspirations. All residents have a detailed contract. A copy of this is kept on file. The assessment documentation in relation to two new residents was viewed. Both residents had assessments, yet one was dated in accordance with a previous respite stay. Miss Wheeler believed the date was an administrative error, as she had undertaken the assessment. Following discussion at a previous inspection, Miss Wheeler reported that she now visits all prospective residents even if this means lengthy travelling. The style of the pre-admission assessment consists of a tick list. It does not identify significant detail. This was noted to be appropriate in the event of a relatively independent resident. However with greater dependency, the member of staff undertaking the assessment would need to be creative to ensure sufficient detailed information was obtained. Miss Wheeler reported that she undertakes all assessments and adds additional information, as required. The initial page of the assessment is allocated to previous history such as occupation and health. Within the plans viewed, this was detailed and informative. It was noted that, on one occasion the prospective resident had completed their own form. All residents spoken with reported, when needing to make the decision of residential care, they had no hesitation in applying for a Bethesda home. The philosophy of the home was paramount. One resident reported that they would not be happy in an ‘ordinary’ care home. All confirmed they were given a copy of the home’s introductory booklet. They also confirmed that they had a contract and written details of fees. Two residents reported that the fees increase on a yearly basis. Residents reported that they are given written confirmation of this. Within a comment card, a relative reported ‘it was my Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 11 XX’s wish to live at this home as its ethos meets the way of life that XX had always led. I am very happy with the care and attention that XX receives.’ Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 12 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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning is of a good standard, yet greater detail within some aspects of documentation, would ensure further clarity. Residents have access to a range of health care services. Greater consistency with tissue viability assessments and recording would further enhance preventative measures. Medication systems are well managed, which reduces the risk of potential error. Residents are treated with respect and their privacy is upheld. EVIDENCE: All residents have a care plan and additional assessments, addressing matters such as nutrition and manual handling. All care plans viewed contained good detail. For example, within a section of poor appetite, the plan addressed ways to promote eating. This included colour contrast with food, special utensils, ensuring food was cut up or liquidised, offering snacks/supplement high calorie drinks and prompting and assistance to eat. Food and fluid intake was highlighted within daily records. There were also clear guidelines regarding managing a resident’s mobility. This included the potential risks to the resident and staff due to the resident’s unpredictability when moving. Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 13 Risks of developing a pressure sore were identified within some plans. Preventative measures included daily monitoring, special equipment and gaining advice from the District Nurse as appropriate. In one plan however, maintain ‘skin integrity’ was stated yet the process to enable this, was not clear. Another assessment highlighted a resident as high risk, yet in the care plan it was stated ‘no pressure risk at present.’ Greater clarity regarding tissue viability is therefore required. Within some documentation, terms such as ‘needs help with dressing’ and ‘takes medication for pain’ would benefit from further clarity. Greater detail regarding the management of health conditions would also be of benefit. For example, within the daily records of one resident, hospital treatment was evident yet it was not detailed within the care plan. Miss Wheeler reported that this was due to a ‘one off problem’ so details were not recorded. While this is acknowledged, associated aspects such as guidance from the hospital or pain relief should have been documented. A record of weight monitoring and specific health care checks such as blood sugar levels are maintained. Following a recommendation at the last inspection, medical terms are now explained. A number of risk assessments are in place. The risk assessments address tasks such as bathing or showering, using a kettle and eating and drinking. The assessments form a standard format and if a risk has been identified, the topic is ticked. Control measures were not always evident. Within discussion, one resident reported that they used the assisted bath independently. Risks associated with this practice were not evident with the risk assessment. Miss Wheeler was advised to address these areas accordingly. Some assessments identified good practice of residents not being in the bath unattended due to their health condition. Some residents have signed their care plan. However, in the event of a resident not being able to do this through their health condition, there was limited evidence of an advocate’s involvement. At the last inspection, a requirement was made to ensure that all care plans contained an up to date photograph. Photographs have since been taken and are located within a separate file. Miss Wheeler reported that these are kept separately, so that they can be used in the event of a resident going missing. It was recommended that the photographs be kept within the residents’ care plan. Those residents spoken with were satisfied with the care received. Three residents confirmed that they saw their GP as required. Another reported that, “staff are quick to notice any problems although if you are unwell in the night, you need to wait for the night staff to get the on call person up. They will call the doctor if need be.” Within documentation there was evidence of intervention from the District Nurse and specialised services, such as the Diabetic Liaison Nurse. Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 14 Within comment cards, residents confirmed that they receive the medical care they require. Relatives also expressed satisfaction with general care provision. One relative reported ‘I am very happy with the level of care provided to my XX and have never had any cause for complaint. XX is well looked after, physically, emotionally and spiritually. Every effort is made to make XX feel happy, comfortable and occupied.’ Another relative stated, ‘on the whole residents are treated with respect. Staff are very patient, welcoming and offer a drink on arrival. The staff have been good with changing need and give help where help is needed. XX is looked after well.’ A GP reported, ‘as has been the case for the last 10 years at least, Studley Bethesda Home continues to maintain a very high standard of care for the residents. They never transfer their residents, either to nursing homes or to hospitals when they reach the end of life stage and require very heavy nursing input.’ In the event of caring for one resident, the GP confirmed ‘their care could not be faulted.’ Medication is stored in a locked trolley and a locked cupboard. Staff administer all medication from original packaging. Miss Wheeler reported that the current system works well and she does not want to make any changes. Miss Wheeler believes that by following specific instructions to dispense medication, staff become more skilled and errors are minimised. The medication administration record highlighted that staff had signed for all, but one medication. A member of staff had countersigned all handwritten medication instructions. There was a record identifying the receipt of medication. As good practice, staff had recognised that one resident’s pain relief was insufficient. The GP was called and an alternative medication was prescribed. The home has a homely remedies policy. This has been signed by a GP. At the last inspection, a requirement was made to ensure that barrier creams are stored appropriately. There was no evidence of barrier creams being stored within bathrooms during this inspection. A number of residents reported that the staff are very good and they receive the privacy and respect they require. Staff were seen to knock and wait to be asked in, before entering any room. One member of staff asked for confirmation to clean the en-suite and empty the waste paper bin. They also apologised for their disruption. One resident reported that staff are sensitive when assisting with tasks such as personal care. Within one care plan it was identified that one resident is reluctant to call for help or ask for a cup of tea. Documentation highlighted staff should be aware of this and the need to offer support, with this in mind. Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 15 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Significant consideration is given to meeting residents’ spiritual needs, which enhances quality of life for individuals. Residents appear satisfied with the level of activity offered and are able to undertake housekeeping tasks as they wish. Visiting arrangements and the discouragement of visiting on a Sunday are openly portrayed. Meal provision is based on home cooking and fresh produce. EVIDENCE: The home continues to give significant consideration to residents’ spiritual needs. Residents attend a local Gospel Standard chapel on Sundays and during the week. Morning prayer is undertaken in the home on a daily basis and all residents and staff are expected to attend. Male residents are able to undertake readings, if they wish. Alternatively, visiting ministers or male members of the Gospel Standard Churches conduct the services. The lead of a male, rather than a female is identified within the Statement of Purpose. If residents are not well enough to attend, they are able to listen via the relay system in their rooms. All chapel services are also relayed to the home. This focus was reported to be extremely important to all residents. One resident confirmed ‘the Ministers are excellent.’ Another resident reported that they felt they would not be able to continue with their way of life due to their frailty. Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 16 Having the relay system however, enabled this. Within a comment card a relative also reported, ‘all XX’s life, XX has attended a Baptist Church and now that XX is unable to get out, XX very much appreciates the provision of the Ministry in the Home.’ Residents confirmed that other activities are also available. These include craft sessions and exercise groups. One resident reported that many items are made and then sold during coffee mornings. Another resident reported that they enjoyed card making and appreciated the home gaining items required. One relative stated ‘there are plenty of activities for the residents to be involved in (e.g. trips out, cooking craft mornings, carol service etc.) and they are encouraged to get out and about and be independent where possible.’ Some residents confirmed that they enjoy their own company and like to read. Spiritual material is available to residents within the main lounge. The home does not permit televisions within the home. Radios and other forms of personal entertainment equipment are permitted in residents’ bedrooms but not in any of the communal areas. There are also restricted times for their use. Due to the ethos of the home, residents expect this. Such restriction is also identified within the home’s Statement of Purpose. As stated earlier within this report, on the first day of the inspection, the majority of residents went out to a local garden centre. The home has its own transport and Miss Wheeler often drives. At the last inspection, there were requests from some residents about wanting to get ‘out and about’ more. This was not evident during this inspection. Some residents reported that they would prefer not to go out, due to their frailty and the risk of falling. Some residents reported that they walk around the garden in better weather. Residents are encouraged to go out independently if they are able. Visitors are welcomed at all reasonable times, except that visiting is not encouraged on Sundays, because of chapel services and required rests in between. The visiting policy, identifying this restriction is clearly displayed by the visitor’s book, in the entrance area of the home. Residents confirmed that they are able to meet with their visitors in the privacy of their own room. Many enjoy trips out with their families. One resident had visitors while out at the garden centre. Staff were observed to be polite, informative and offered the visitors refreshments. Residents reported that they are able to follow their preferred routines and do as they please. This involves getting up and going to bed as they wish. Within one care plan however, it was reported that a resident does not like getting up. The strategy for staff to manage this was to offer a five-minute lie in. This was discussed with Miss Wheeler, who reported that the portrayal of the written information was not entirely accurate. Miss Wheeler confirmed that the resident did not like to change their position. To address this, with minimal stress to the resident, staff were encouraged to revisit the situation after approximately five minutes. Miss Wheeler reported that all residents are able Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 17 to remain in bed later, if they chose to do so. One resident confirmed they aim to keep their room tidy and do tasks such as dusting and polishing. Residents are also able to undertake their personal laundry if they wish. Residents expressed satisfaction with the food. Within a comment card, a relative reported ‘the food is always well presented, as well as plentiful – if any resident has difficulties with eating a member of staff is always available to help if required.’ Another relative confirmed ‘the dietary needs of the residents is taken into consideration and also, if there is anything a resident does not like, an alternative is offered.’ It was reported that Miss Wheeler devises the menus, as she undertakes all food ordering and has an awareness of the food budget. The menu is generally centred on meat dishes. An established choice of each meal is not available. The cook reported however, that if a resident dislikes a meal, an alternative is always found. The cook confirmed that Miss Wheeler discusses meal preferences with each resident on admission and then informs the catering staff. At present, there are a number of residents who require a diet suitable for their diabetes. Miss Wheeler confirmed that residents are able to suggest ideas for the menu. A recent development includes more fresh fruit. Discussion took place with two members of staff, regarding a resident’s reluctance to eat. Clear strategies were described. One resident confirmed that you can have your meals in your room, but at lunchtime in particular, staff prefer everyone to use the dining room, unless they are ill. Another resident confirmed they have their meals in their room, due to a specific reason. Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a detailed complaint procedure and residents appear clear regarding whom they would speak to if they were unhappy. Further staff training in relation to adult protection would ensure residents greater protection. EVIDENCE: Within the Introductory Brochure there is a section addressing ‘consultation and participation.’ Within this, there are details regarding whom to contact for suggested improvements to the service. The home also has a detailed complaint procedure. Minutes from a residents meeting were displayed on the notice board. Residents reported that they are able to share their views. One resident reported however, that consultation is sometimes lengthy and action may not always be apparent. Of those residents spoken with, all appeared clear regarding whom they would speak to if they were unhappy. One resident expressed a wish to be thankful and reported that they would not want to raise any concern. Miss Wheeler reported that the home has not had any formal complaints. It was advised that a record of all concerns raised, should be maintained. The record should contain details of the investigation, the outcome and the information shared with the person raising the concern. Within a comment card, one relative stated ‘I have always found the staff to be very helpful, willing to discuss, and resolve any concerns the resident or their relatives may have. I consider the standards of care and cleanliness to be excellent.’ Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 19 The home’s adult protection policy is clearly stated on the notice board in the office. Miss Wheeler reported that she is currently in the process of gaining more up to date copies of the summarised ‘No Secrets’ documentation. Miss Wheeler reported that some staff have attended adult protection training that she has facilitated. However, adult protection was not highlighted within the training matrix Miss Wheeler devised during the inspection, following discussion about training. Miss Wheeler was advised to review each staff member’s training needs in relation to adult protection. Arranging an external facilitator to address local reporting procedures would also be of benefit. Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 20 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, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is clean, comfortable and maintained to a good standard. Residents are able to personalise their own rooms as they wish. Systems are in place to minimise potential risks to residents. EVIDENCE: The home is purpose built and all residents’ rooms and communal areas are on the ground floor. The environment is very peaceful and relaxed. There are 10 single rooms and one twin. All rooms have lockable storage space. Rooms are personalised according to individual wishes. The rooms are comfortable, light and benefit from views of well-maintained gardens, containers and bird tables. There is a summerhouse and a greenhouse within the garden. There are two assisted baths and a walk in shower. Toilets contain raised toilet seats as required. Soap dispensers are used in line with infection control guidelines. It was recommended that existing towels be replaced with paper towels, in these areas. Communal areas consist of a comfortable lounge and separate dining Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 21 room. The corridor contains a range of plants within the windowsills. There is a small kitchenette for residents and visitors’ use. A payphone is located in the entrance area although residents may have their own telephone in their room. Radiator covers are in place throughout the home. Hot water temperature regulators have also been fitted. The kitchen and laundry room were noted to be very organised, clean and tidy. Residents expressed satisfaction with their environment. Within a comment card, one relative reported ‘one of the striking features of this home is its homeliness. In my view, it is the nearest thing to a ‘real home’ that a residential home of this nature can be.’ Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 22 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are maintained as required, with an ancillary team supporting the care staff. Positive relationships between staff and residents have been established. Recruitment is generally well managed. Training is available yet exploring further opportunities in relation to older age would be of benefit. EVIDENCE: Staffing levels continue to be maintained with two care staff on duty throughout the waking day. On occasions there is an additional 8.30am-4pm shift. At night there is one waking night staff member. Another member of staff provides sleeping in provision. In addition to the care staff, there are a number of housekeepers and a cook. Miss Wheeler continues to undertake some shifts as part of the working care staff roster. Housekeeping staff are reduced at a weekend. Miss Wheeler confirmed that the majority of work is completed during the week and limited amounts, especially on a Sunday are undertaken. This also applies to cooking, whereby a roast lunch is eaten on a Saturday and a salad or a casserole is prepared on a Sunday. While these factors are in place to compliment the philosophy of the home, Miss Wheeler was advised to document such, within her written documentation currently being devised. Within the inspection, positive, respectful interactions were observed between residents and staff. Residents spoken with reported that the staff are very Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 23 good. Some raised particular favourites. One confirmed that you just ring your bell and they will do anything for you. Within a comment card, a relative reported ‘the staff are helpful, considerate and caring and do all that they can to ensure that my XX’s life is maintained at the highest level possible.’ Other comments included ‘the care and kindness of the staff is excellent. Nothing is too much trouble in their care of the residents’ and ‘in my contact with the Matron and the staff, I have found them most caring and helpful.’ Within the team, there is a deputy manager, two senior carers, five carers, three night carers, two cleaners, two cooks and a general assistant. Two members of staff have NVQ level 3, three have NVQ level 2 and one has a GNVQ. Miss Wheeler is an NVQ assessor. It is anticipated that the new staff will commence their NVQ shortly. The recruitment documentation of two new staff was examined. Both contained an application form and two written references. Although one reference was stated from a current employer, it was not written on headed notepaper. Miss Wheeler reported that she had sent the reference request to the actual work place, so she was sure of its authenticity. Miss Wheeler was advised to keep a copy of all correspondence on file in such instances. Another reference was dated after the staff member’s start date. Miss Wheeler reported that she had initially gained a reference over the telephone due to the length of time it was taking to receive the reference. The written reference then confirmed what had been said. Miss Wheeler was advised to ensure written references before the staff members’ commencement. Both applications contained a POVAFirst check and a CRB disclosure. Miss Wheeler reported that food hygiene training has been booked for January 2007. Manual handling training was cancelled through the trainer’s illness, so this has been rescheduled. All training information is currently detailed within staff members’ individual files, so training sessions could not be easily evidenced. Miss Wheeler was advised to complete a training matrix for this purpose and to easily identify the need for refresher courses. Within the inspection Miss Wheeler completed this although understandably did not include dates of the training. The matrix identified that all, except the two new staff were up to date with first aid. Other topics also covered by some staff were health and safety, infection control and dementia. There was no evidence as stated earlier of adult protection or tissue viability. At the last inspection, a recommendation was made to undertake sensory loss training. Miss Wheeler reported that she had found this difficult to access so, as an interim period, she had gained written documentation regarding various conditions. Such leaflets are displayed on the staff notice board. Bethesda House DS0000028561.V317763.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 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is orderly managed yet clarity regarding the manager’s qualification is needed, to ensure up to date, relevant knowledge. Satisfactory systems are in place to manage small amounts of residents’ money for safekeeping. Further development of the home’s quality assurance system, would enable greater involvement with sharing views and the implementation of suggestions. Potential risks to residents are minimised through various health and safety systems. EVIDENCE: Miss Wheeler has been the registered manager of Bethesda since 1995. Miss Wheeler qualified as a nurse from the University of Surrey in 1992 and has since completed the NVQ level 4 in Management. Miss Wheeler is also an NVQ assessor. Miss Wheeler has experience of working in rehabilitation, long-term Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 25 and terminal care and continues to undertake regular training to maintain her qualification. Miss Wheeler although well qualified, does not have the Registered Managers Award. Consideration is currently being given to this. Miss Wheeler continues to undertake shifts as part of the working roster. Sharing information with staff is therefore a regular occurrence. Miss Wheeler confirmed that there are specific roles and responsibilities, which are clearly delegated. For example, Miss Wheeler does not get involved in financial matters, such as fees and their payment. Within a comment card, one relative reported ‘the home is run extremely efficiently from a business point of view. All in all, a very good home.’ Another relative raised a comment regarding approachability. This was discussed with Miss Wheeler during the inspection. Miss Wheeler reported that she is currently in the process of further developing the home’s quality assurance system. Miss Wheeler is aiming to develop the systems in line with CSCI’s quality tools. She is also planning to meet with another care home provider to share views. Miss Wheeler reported that she has recently sent quality questionnaires out to a range of stakeholders. These included relatives, GPs, District Nurses and the Chiropodist. Miss Wheeler summarised the feedback, which is available on the main notice board. A member of the Committee undertakes monthly Regulation 26 meetings. Within these, discussions are held with residents and staff. Miss Wheeler reported that residents have expressed their satisfaction to various members. Within discussion with residents during the inspection, general satisfaction was confirmed. It was reported however that the organisation of outgoing post could be better organised. At present, residents ask staff to take their post or leave it on the fish tank for it to be collected. It was reported that this is not totally effective and a post box would be more beneficial. This was discussed with Miss Wheeler who reported concern that a post box may be not be emptied appropriately. It was agreed that the responsibility should be agreed and the suggestion should be implemented. It was also reported that at times, when asking the wellbeing of a resident, staff report that they can not discuss another resident’s health. Miss Wheeler explained the need for confidentiality and stated that residents are encouraged to visit the resident they are enquiring about. This ensures information is not divulged. It was agreed that further discussions should be held and in future, general terms could be used rather than disclosing specific information. Residents are encouraged to manage their own financial affairs for as long as they are able. Some have given the responsibility to family members or other representatives. A small amount of money is kept for safekeeping on behalf of one resident. Balance sheets contained two signatures with receipts demonstrating expenditures. Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 26 The environment is very well maintained with radiators covered as required. Following a requirement at the last inspection, hot water regulators have now been fitted to all hot water outlets. Risk assessments are in place although an assessment is required, for the rotary iron in the laundry room. All entries within the accident book are detailed and well written. Such entries are crossreferenced within daily notes. The fire log book was also well maintained with evidence demonstrating regular checks of the fire alarm systems. Bethesda House DS0000028561.V317763.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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 2 3 X X X X 3 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 2 X 3 X X 3 Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Timescale for action Unless it is impracticable to carry 28/02/07 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met. (Care plans must be kept up to date and reflect residents changing health care needs.) The registered person shall 28/02/07 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. (All residents must be assessed in relation to their risk of developing a pressure sore. Preventative measures must be in place and be documented within individual plans of care. The registered person shall make 31/03/07 arrangements, by training staff or other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. DS0000028561.V317763.R01.S.doc Version 5.2 Page 29 Requirement 2 OP7 12(1)(a) 3 OP18 13(6) Bethesda House (Training needs of staff in relation to adult protection must be identified and addressed through formal training sessions. This must be clearly evidenced within written documentation.) 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 3 4 5 6 7 8 9 10 Refer to Standard OP7 OP7 OP7 OP16 OP18 OP26 OP29 OP30 OP33 OP33 Good Practice Recommendations The Registered Person should ensure that identified control measures, to minimise any potential risk to residents is clearly stated within documentation. The Registered Person should ensure that greater clarity within care planning information, is given to some terms, such as ‘needs assistance.’ The Registered Person should ensure that when residents are unable to be involved in the development of their care plan, an advocate is involved and evidenced. The Registered Person should ensure that a record is maintained of all suggestions and concerns. The Registered Person should ensure that all staff receive training on local reporting procedures of adult protection matters. The Registered Person should ensure that towels within communal toilets are replaced with paper towels, in line with infection control guidance. The Registered Person should ensure that documentation demonstrates a robust recruitment procedure. The Registered Person should ensure that a training matrix, which contains dates of various courses, is devised. The Registered Person should ensure that the suggested system for managing residents’ post is implemented. The Registered Person should ensure that on going implemented improvement, which is based on users of the service, is identified through the home’s quality assurance system. Bethesda House DS0000028561.V317763.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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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