CARE HOMES FOR OLDER PEOPLE
Bindon & Elmcroft Residential Homes Bindon 32-42 Winslade Road Sidmouth Devon EX10 9EX Lead Inspector
Anita Sutcliffe Unannounced Inspection 09:00 12 .January 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 Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 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. Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Bindon & Elmcroft Residential Homes Address Bindon 32-42 Winslade Road Sidmouth Devon EX10 9EX 01395 514500 01395 513586 info@bindoncare.com 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) Bindon Care Ltd Katherine Mary Summers Care Home 46 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (46), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (46), Old age, not falling within any other category (46), Physical disability over 65 years of age (46) Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is allowed to admit up to five service users between the ages of 55 and 64 in the category DE Dementia 8th July 2005 Date of last inspection Brief Description of the Service: Bindon and Elmcroft (together registered as Bindon Care) are situated approximately one mile from Sidmouth sea front and town centre. The home is registered to provide care to older people who may have dementia, a mental disorder or a physical disability. Elmcroft, the smaller of the two buildings, provides personal care for up to eighteen older people who have dementia. Bindon, the larger of the two buildings, provides personal care for up to twenty-eight older people who may have a physical disability or dementia. The home may also admit up to five service users with dementia between the ages of fifty- five and sixty four years of age. The buildings each have level access to their front entrance and to all communal areas. Bedroom accommodation is situated on the ground and first floors, with a stair lift between. Some rooms have steps leading to them. The gardens are secure and well tended. Bindon Care domiciliary care agency is run from the premises. The Home and Agency share the same registered manager and administration. Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection began at 9 a.m. and lasted 6 ½ hours. Several key standards were inspected, and progress on requirements and recommendations made at the July visit to the home were assessed. The care of four of the forty service users (residents) was examined. This involved meeting them, reading records of the care provided, visiting their room, and discussing their needs and care with staff. One was joined for lunch. All other residents in Elmcroft were met and many bedrooms visited. The laundries were visited in the company of the registered manager. Staff were met both individually and interviewed in a group. Records of care, fire safety, complaints, medication, the staff rota and menus were examined. What the service does well: What has improved since the last inspection?
Residents have more opportunity to go out into the town since the employment of the activities organiser. Staff said that there is more emphasis on what residents want to do, rather than what tasks staff have to do. There is continual upgrading of the home. Storage was improved, providing safer walking areas for residents; newly decorated areas were lighter. Bright signs help residents with dementia to further understand their environment. The new method for recording information about care needs and care delivery is helping to assure that health and welfare are promoted. Safe handling of medication has been further assured because two staff now check the accuracy
Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 Page 6 of hand written entries on the medicines administration record. Also, staff now understand how to protect residents from abuse more effectively. 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. Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 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 Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 EVIDENCE: The home does not provide Intermediate care and therefore this Standard does not apply. Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Health and care needs are fully met by well-informed staff, but care is not sufficiently planned. Medication management is satisfactory. Residents are treated with respect and with full regard for their privacy and dignity. EVIDENCE: A resident agreed that her care records reflected her true care needs, and expressed confidence in the care staff and management at the home. She said all staff were courteous and polite; staff were observed knocking before entering rooms and using a polite form of address. Health and wellbeing is well monitored, examples being diet, weight, mobility and mental health. Where necessary, external professional help is appropriately sought. Records of the care delivered contained good detail, demonstrating understanding of residents’ individual needs; they were professionally written. The planning of care still needs to be extended. In this
Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 Page 10 case staff had no written information on how to meet the needs of a resident with diabetes, which is a potentially unsafe situation. Staff engage with residents, and were able to demonstrate knowledge in how to provide person-centred individual care. A previous good practice recommendation that two staff should check hand written entries in the mediation administration record has been achieved. This further ensures safety in the handling of medication. Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14 & 15 The diverse and individual needs of residents is recognised and met, but autonomy could be further promoted. Residents receive a nutritious varied diet, which meets individual choice and health care requirements. EVIDENCE: A resident said: “I get up when I want”. Rooms contained many personal items and were homely and comfortable. Some residents choose to use a lock on their door and each has a lockable drawer for items of personal value. The activities coordinator spends one-to-one time with residents as part of her role, and staff assist residents to visit local shops and events. Residents able to look after their own financial affairs are supported to do so. Lunch was served plated; a resident commented that she would prefer to serve her own “to get what she would prefer and prevent having too much”. There was scope for more independence, choice and involvement at lunchtime. A resident also commented that she would like the opportunity to do some baking. Social and life events information collected was impressive and should enable staff to ensure that diverse needs are understood and met.
Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 Page 12 Visitors may visit at any time ‘as long as the resident is willing to receive them’. Many visitors were seen during the inspection and were welcomed by staff. Lunch was very tasty and the meat tender. Vegetarian and diabetic diets were catered for and residents needing assistance received it. The cook said that fresh fruit and vegetables are provided and the quality of meat was good. The menu was varied and interesting. One resident said: “the food is fairly good. If I don’t like it they soon whip it away and give me an alternative”. Others agreed that they liked the food. Dietary needs are assessed and monitored. Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, & 18 Residents benefit from the homes approach to complaints, and are protected from abuse. EVIDENCE: A resident said: “I could go to the staff with anything; they’re very good”. The Commission has not received any complaints against the home in the last six months and those received at the home have been handled with the resident’s best interest as the priority. Residents said that they felt safe at the home. New staff showed awareness of how to protect the vulnerable adults in their care. The manager was aware of what actions to take should any allegation of abuse be received. Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Residents benefit from a home, which is clean, warm and well maintained, but would benefit from further specialist adaptations. Hygienic practice is understood but sometimes compromised posing a risk to health. EVIDENCE: The home benefits from continual investment and improvement. Thought is given to how space can be better used. Redecoration has lightened corridors and all rooms visited were well decorated, personalised, comfortable and homely. The manager has provided bright signs which help residents with dementia to interpret their environment more effectively. It is recommended that these improvements, which are based on current research, be continued. The home is also registered for residents with physical disability but does not accept those who are independent wheelchair users. Those needing wheelchair assistance or with visual impairment would be restricted from using many parts of the home because of its design, especially door widths and steps
Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 Page 15 leading to areas where bedrooms are located. There is a good provision of equipment such as bath hoists, specialist mattresses and handrails, so that safety and independence are promoted. The gardens are well maintained, pleasant and secure. They can be viewed from the lounge in Bindon and some bedrooms in Elmcroft. The home is generally very well maintained. However, one bedroom visited had a tear in the carpet, which was also uneven, thus posing a trip hazard. Two other rooms had door locks which could be deadlocked from the inside; staff would be unable to gain entry in an emergency. The manager said this was a mistake and would be corrected as a priority. A resident said: “my rooms is nice, but I don’t spend a lot of time in it”. Bedrooms visited were comfortable, homely, clean and pleasant. Furnishings are of good quality and in good condition. Previous concerns about the separation of clean from soiled laundry have been addressed, but that of staff having consistent access to hand washing facilities has not, as two laundries and several bedrooms were without hand washing soap for staff use. Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 30 Residents needs are properly met through the numbers and skill mix of staff, but would be further assured through NVQ training. EVIDENCE: Residents said: “you could always do with more staff from time to time”, but generally they felt staff numbers sufficient. Staff said they ‘pull together’ if there are reduced staff numbers, as during the inspection. Residents’ needs were fully met with the help of the manager. Care staff are encouraged to take the NVQ 2 qualification in care, but the home did not achieve the 50 minimum as set in the National Minimum Standards. Although there is no evidence that residents aren’t in safe hands there lacks the further assurance that this NVQ qualification in care would provide. Training continues to be well managed at the home. Staff spoke of induction, moving and handling, first aid, food hygiene, and prevention from abuse and fire safety training. They said that district nurses provide instruction on issues relating to care. Much emphasis has been given to training in the care of residents with dementia. Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 & 38 The home is well managed and run in the best interest of residents. Health and safety is sometimes compromised. EVIDENCE: The strong leadership and commitment of the manager has helped support staff through a time of cultural change. Professional assessment was sought to measure if residents’ needs were being fully met; this led to staff training and changes in approach. It was an important part of quality assurance work at the home. Residents and family are also routinely asked to give their views on the home; recently this has been extended to include admission – ‘what else might we have done to make it easier?’ Health and safety training is managed in a systematic way so that no staff member is missed. The home is generally very well maintained, but some
Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 Page 18 concerns were identified: one bedroom carpet posed a trip hazard (see Standard 19) two rooms had locks which were unsafe because they could be deadlocked, and a freestanding heater was in use which had not been risk assessed, and could lead to injury. Hand washing detergent was not sufficiently available for staff use (see Standard 26). Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 Page 19 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 X 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 X 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 1 Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP26 Regulation 13(3) Timescale for action The registered person shall make 12/01/06 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. [This refers to the need for staff hand washing detergent where ever personal care is delivered or soiled material handled] (Previous requirement of 15/09/05 not fully met) The registered person shall 31/01/06 ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. [This refers to: - deadlocks on 2 bedroom doors - the trip hazard from uneven and torn carpet] The registered person shall 12/01/06 ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. [This refers to risks posed from the use of free standing radiators] Requirement 2. OP38 13(4)(a) 3. OP38 13(4)(c) Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 Page 21 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. Refer to Standard OP7 OP14 OP19 Good Practice Recommendations The service user plan should include all aspects of service user’s health, personal and social care needs. The home should be conducted so as to maximise service users’ capacity to exercise personal autonomy and choice. [This refers to the serving of meals in the dining room] The layout of the home should be suitable for its stated purpose. (The environment should continue to be improved in line with current good practice guidelines in dementia care) A minimum ratio of 50 trained members of staff (NVQ level 2 or equivalent) should have been achieved by 2005. 4. OP28 Bindon & Elmcroft Residential Homes DS0000037575.V272353.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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