CARE HOMES FOR OLDER PEOPLE
Bings Hall Chelmsford Road Felsted Dunmow Essex CM6 3EP
Lead Inspector Jane Greaves Final Announced 2nd June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Bings Hall Version 1.10 Page 3 SERVICE INFORMATION
Name of service Bings Hall Address Chelmsford Road, Felsted, Dunmow, Essex CM6 3EP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01371 820544 01708 501804 Imccar7434@aol.com Family First Residential Care Homes Limited Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Bings Hall Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: There are no conditions of registration for this service at this time. Date of last inspection 1st December 2004 Brief Description of the Service: Bings Hall is a detached two storey property located in the charming Essex village of Felsted. Residents private accommodation consists of 13 single bedrooms and two double rooms, all of which have en-suite facilities.The home is owned by Family First Residential Care Homes Limited and the acting manager, Judith Pretty, is currently going through the process of becoming registered with the Commission for Social Care Inspection. The home is registered for 17 Older People over the age of 65 years. The village of Felsted has shops, public houses and a restaurant. The nearest larger towns are Chelmsford and Great Dunmow. Bings Hall Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place on 2nd June 2005 over 7½ hours. 14 of the 38 National Minimum Standards were assessed, 11 were met and one was nearly met. During the inspection process the inspector spoke with 8 residents, 5 family members, one prospective resident and family, the manager, deputy manager and 5 care staff. A tour of the premises was undertaken including the gardens. For the purpose of this report the service users stated that they would prefer to be referred to as residents. The level of assistance and participation from all concerned in the inspection process on the day was greatly appreciated by the inspector. What the service does well:
All of the residents spoken with at this inspection were very happy to be living at Bings Hall. One resident said “I don’t think you will find anywhere better to live, the staff are wonderful” A relative spoken with on the day said “ This was the best move possible for mum, the key thing is that she’s happy. She feels confident and well looked after” Residents praised the home for the feeling of safety and security that all said they experienced at Bings Hall. One lady remarked “ At night it is a wonderful feeling to have the buzzer to call someone if you are not feeling well” Each resident had a ‘plan of care’ detailing actions required by care staff to maintain their physical and spiritual health and well-being. The care plans were comprehensive and kept under constant review to reflect changes in residents’ needs and aspirations. The home appeared very welcoming and was clean, fresh and free from any offensive odours. Bings Hall Version 1.10 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bings Hall Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Bings Hall Version 1.10 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 standard(s) 1 and 5 The home’s Statement of Purpose and Service User Guide provided prospective residents with the information required to make an informed choice about where to live. Prospective residents and relatives were encouraged to visit the home on a trial basis to assess the facilities and suitability of Bings Hall as a future domicile. EVIDENCE: The original document combining the Service User Guide and the Statement of Purpose had been revised and separated into two documents to meet with regulatory requirements and to ensure the information required by prospective residents of the home is easily accessible to them. Prospective residents were encouraged to visit the home on a ‘trial’ basis prior to making a decision to stay. A prospective resident and family visited the home during this inspection. During conversation with the inspector it was confirmed the resident had been offered a free trial period by the home. Bings Hall Version 1.10 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 standard(s) 7 and 9 Residents’ health personal and social care needs were clearly detailed in individual care plans enabling care staff to deliver appropriate care. Residents were supported to be responsible for their own medication administration, where appropriate, in order to retain independence and were protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Three care plans were sampled at this inspection, these contained good and clear information detailing actions to be taken to deliver care tailored to the specific needs of individual residents. There was a strong medical element of the plan, however personal and spiritual needs were addressed in a similarly enthusiastic manner. The home had a good system of communicating any changes in residents’ individual needs. In each resident’s file there was a daily record of activities undertaken and any issues, including health care, arising from the day. All staff members coming on duty were involved in receiving a ‘handover’ from the previous shift giving information of any changes in care regimes, personal demeanour and physical or spiritual well being of residents.
Bings Hall Version 1.10 Page 10 Three residents self medicate at Bings Hall. There was a lockable cupboard in each bedroom so that medication may be stored safely. There was a policy for residents who wished to self medicate and corresponding risk assessments were on file. Medication procedures were generally good and all staff administering medication had received appropriate training. The acting manager and the deputy manager of the home are qualified nurses with current registrations. The home had a new medications trolley that was kept in the manager’s office. There was no method of securing the trolley to the wall, the manager was aware of this and intended to address the situation. The home maintained supplies of controlled medications for some residents. These were stored in a locked metal cupboard secured to the external wall of the manager’s office. There was only one lock fitted however, instead of the required double locking mechanism. The home’s medication supplies were provided by the GP pharmacy locally. This system was cumbersome and outdated with the medications being supplied in their original boxes for dispensing and a hand written Medication Administration Record sheet. The home had a good relationship with their GP practice and pharmacy. The manager was aware that there are more appropriate systems for the control of medication available but wished to maintain the excellent working relationship with the local surgery. There had been two medication audits in the past 9 months undertaken by a pharmacy from a neighbouring town; there had been no major areas of concern identified. The register of returned medications was not available for scrutiny at this inspection as it was with the pharmacy following a recent coroner’s inquest. As part of the inspection process the Medication Administration Records were scrutinised, there were gaps where initials or reasons for non-administration should be entered. Bings Hall Version 1.10 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 standard(s) 12, 13 and 15 Residents were satisfied their lifestyle in the home matches their expectations and satisfies their cultural, religious and recreational interests and needs. Residents were able to enjoy unlimited contact with family, friends and the local community as they wished. Residents received a wholesome, nutritious diet in pleasant surroundings in a congenial atmosphere however the ‘choices’ were limited. EVIDENCE: Residents at Bings hall have the opportunity to exercise their choice in all aspects of their daily life. Each of the 8 residents spoken with stated that their involvement with the decision making processes at the home was ample and they felt their voices were heard. Residents at Bings Hall were encouraged to maintain contact with family and friends. Visitors were permitted at any time of the day and were made immediately welcome with a cup of tea and a piece of home made cake. The relationship between the manager, care staff and visiting family members was warm but professional and family members praised the home for the care and support provided for the residents.
Bings Hall Version 1.10 Page 12 The home had developed a 6-week menu rota offering such meals as Beef in Guinness, Roast Beef with all the trimmings and Chicken Supreme. A daily option was offered but this was always ‘salad of the day’. Supper consisted of home made soup daily with alternatives offered such as Kippers, Cheese on Toast or Jacket potatoes. One resident said “ The meals are alright and well cooked but it would be quite nice if we were consulted more about the menu” Another resident stated “Oh yes, I enjoy the food. If I don’t like what they are cooking they’ll give me something else” On the day of the inspection the mealtime was a happy and relaxed affair with the staff, manager and inspector joining the residents in the dining room. Staff had their meals with the residents and offered discreet assistance where required. The residents chatted happily with the inspector whilst they ate their lunch and sipped sherry. The kitchen was clean but the cupboards and work units were in need of some refurbishment. The appliances were all in working order and replaced as and when necessary. The cook had been employed at the home for 11 ½ years and had a part-time kitchen assistant 4 days per week. Stocks of food held at the home were ample and of good quality. Bings Hall Version 1.10 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 standard(s) 16 Residents and families were confident that any complaints would be listened to and taken seriously. EVIDENCE: The home had a robust complaints policy and procedure in place including the stages and timescales for the process. The contact details for the Commission for Social Care Inspection were included. The home had received no complaints within the twelve months prior to this inspection. Family members and residents were all aware of the staffing roles within the home and who to complain to if the need arose. Bings Hall Version 1.10 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 standard(s) 19 and 26 Residents live in a safe and well-maintained environment. The home appeared clean, very pleasant and hygienic. EVIDENCE: Bings Hall is accessible, well-decorated, nicely furnished, safe and well maintained, meeting residents’ individual and collective needs in a comfortable and homely way. The gardens are maintained tidy safe and attractive. A ‘walk in’ shower had been installed in an upstairs bathroom. A carpet grip was in place to secure the edges of the shower tray and the flooring. There was a resulting ‘lip’ that could potentially cut feet and harbour bacteria beneath it. The home employed a dedicated cleaner five days per week. Laundry facilities were sited away from food preparation and storage areas. The laundry room was small with a door to the outside. The home did not have a sluicing facility; the washing machines did have a programme to control the risk of infection.
Bings Hall Version 1.10 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 and 30 Residents were supported and protected by the home’s recruitment policy and practices. Care staff had not received training in all areas required to meet this standard and to protect the health and safety of the residents. EVIDENCE: The manager was able to demonstrate that the home adhered to strict and robust recruitment procedures. Prospective staff members were interviewed face to face, two references were obtained and any gaps in employment records explained. An enhanced Criminal Record Bureau disclosure had been obtained for each staff member before they started work at the home. All new staff members completed a comprehensive period of induction training before being able to work with residents unsupervised. The care staff had received training in Moving and Handling, Administration of Medication and NVQ2 training in the past twelve months. Training courses are scheduled in Infection Control, Palliative Care, Risk Assessments, 1st Aid and Wound Care. The manager was in the process of developing a matrix to identify training requirements for the home. Individual staff member’s training requirements were being identified at annual appraisals and supervision sessions. Bings Hall Version 1.10 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 38 Bings Hall was run in the best interests of the residents living there. The health safety and welfare of residents and staff at Bings Hall were promoted and protected. EVIDENCE: Bings Hall had achieved ISO 9001 accreditation and was committed to monitoring the quality of the service it provided for those living there. A questionnaire was produced and sent to families/representatives and given to residents in January of this year. The results of this survey had been put into a graph format and a report was to be forwarded to the Commission for Social Care Inspection. A summary of the findings of this survey will be published and made available to residents and their families/representatives including prospective residents to the home. The home holds residents’ meetings at three monthly intervals; these are minuted and open to families and friends of the residents.
Bings Hall Version 1.10 Page 17 A poster was prominently displayed announcing this inspection and the residents were very happy to discuss their experiences with the inspector and to provide material for inclusion within this report. The acting manager had arranged training for care staff in some mandatory areas however some was still outstanding. An infection control course had been arranged prior to the inspection but had been postponed. 4 staff members were trained as first aiders and the manager is a first aid trainer and assessor. All kitchen staff and those that prepare suppers had been trained in Basic Food Hygiene. Water temperatures were checked monthly and regulators were fitted to all hot taps, a certificate was produced to evidence that the home’s water system had been tested and found clear of Legionella. Window restrictors were seen fitted to a downstairs bedroom window. The garden area had some shallow steps, a ramp is planned to make this more accessible for residents. Handrails are fitted around the garden and the steps are clearly outlined with white paint. Bings Hall Version 1.10 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 x 15 2
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 3 x x x x 3 Bings Hall Version 1.10 Page 19 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13(2) Requirement The registered person must ensure the safe administration and storage of medicines in the home. The registered person must ensure that care staff receive training appropriate to the work they are to perform. Timescale for action 31st August 2005 31st August 2005 2. 30 18 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 15 15 Good Practice Recommendations The kitchen at Bings Hall would benefit from some refurbishment. The home should consider other daily menu choices instead of the daily salad alternative. Bings Hall Version 1.10 Page 20 Commission for Social Care Inspection 1st Floor Fairfax House Causton Road Colchester CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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