CARE HOMES FOR OLDER PEOPLE
Bings Hall Chelmsford Road Felsted Dunmow Essex CM6 3EP Lead Inspector
Jane Greaves Unannounced Inspection 23rd November 2005 11:30 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 Bings Hall DS0000030469.V268007.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. Bings Hall DS0000030469.V268007.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Bings Hall Address Chelmsford Road Felsted Dunmow Essex CM6 3EP 01371 820544 01708 501804 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) Family First Residential Care Homes Limited Manager post vacant Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Bings Hall DS0000030469.V268007.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered provider of Bings Hall may accommodate the married couple, whose names were made known to the Commission in August 2003. This couple may be accommodated in the room agreed with the Commission in August 2003. Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 17 persons) The registered provider must also, at the point of a vacancy arising within the room occupied by the married couple, make an application to the Commission to vary the registered number from 17 to 16 The registered provider must notify in writing and obtain agreement from the Commission of any proposed change in the room to be occupied by the married couple 2nd June 2005 2. 3. 4. Date of last inspection 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. 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 DS0000030469.V268007.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place 23rd November 2005 over 3 ½ hours. 13 of the 38 National Minimum Standards were assessed at this inspection including any shortfalls highlighted in the previous inspection report. 8 standards were met, 3 almost met, 1 not met and 1 standard exceeded. The registered manager had resigned her post since the previous inspection, the acting manager had been in post for one month at the time of this inspection. During the inspection process the inspector spoke with the acting manager and two staff members and gathered views on life within Bings Hall from 6 residents. The inspector undertook an independent tour of the premises and studied documents required to meet regulations. For the purpose of this report the people living at Bings Hall prefer to be referred to as residents. The atmosphere at the home on the day of the inspection was warm and welcoming and the participation and co-operation received during this inspection was appreciated. What the service does well: What has improved since the last inspection?
Some redecoration of bedrooms had taken place since the previous inspection. The medication trolley had been secured to the wall in the manager’s office. A part time kitchen assistant had been employed for fours hours daily resulting in more care staff available to assist the residents with their daily activities. Bings Hall DS0000030469.V268007.R01.S.doc Version 5.0 Page 6 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. Bings Hall DS0000030469.V268007.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 Bings Hall DS0000030469.V268007.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): 3 Residents’ needs and choices were assessed on admission however potential risks to their health, safety and well being were not documented. EVIDENCE: The acting manager was able to demonstrate the assessment process undertaken when a new resident was admitted to the home. The acting manager was able to verbally confirm the risk assessment processes applied however this was not documented with the appropriate actions to be taken to minimize or remove the identified risks. Bings Hall DS0000030469.V268007.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): 8,9 and 10 Residents’ health needs were fully met. The home’s medication administration procedures protected the health and safety of residents however controlled drugs were not stored appropriately. Residents were treated with respect and dignity. EVIDENCE: The acting manager reported that the home had a good relationship with the local GP surgery and the District Nursing team. If an admission assessment identified that a resident was prone to pressure sores the District Nursing team would assess the need for specialist equipment and supply if required. All residents spoken with reported that any health concerns they raised with the staff team were taken seriously and appropriate action was taken. Care plans provided evidence of healthcare appointments arranged and attended. The acting manager had delegated the responsibility for the ordering, receiving and administration of medicines to a shift leader who had attended external competency assessed training. A pharmacy audit had identified that the drug
Bings Hall DS0000030469.V268007.R01.S.doc Version 5.0 Page 10 stocks maintained within the drug trolley were too great. This had been rectified by the storage of any medicines excess to requirements at the time in a locked metal filing cabinet, the acting manager held the key. The previous inspection report identified that the drug trolley must be secured to a wall. It was observed at this inspection that this had been done. A requirement was made as a result of the previous inspection for the cupboard used to store controlled drugs to be fitted with a double locking mechanism as opposed to the single lock fitted currently. This was still outstanding at this inspection. All residents consulted at this inspection voiced the opinion that their privacy and dignity were protected throughout the home. Staff members were observed knocking on doors before entering and announcing themselves. Some residents had a telephone in their own rooms and others were able to use the home’s cordless phone in the privacy of their own rooms if they wished. Bings Hall DS0000030469.V268007.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): 14 Residents were supported to exercise choice and control over their lives. EVIDENCE: Residents’ private rooms were pleasantly decorated and personalised with their own belongings. Most of the people living at Bings Hall had friends and families to represent their interests. Information on independent advocacy groups was available in the reception hall. Residents handled their own financial affairs as long as they wished to and as long as they were able to do so. Residents confirmed they chose when to go to bed and to rise. Bings Hall DS0000030469.V268007.R01.S.doc Version 5.0 Page 12 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): 18 Residents at Bings Hall were protected from abuse. EVIDENCE: Staff members had received training in the Protection of Vulnerable Adults from abuse. The home had robust policies and procedures in place for responding to suspicion or evidence of abuse. The procedures for handling residents’ money were robust. Monies were stored in individual named wallets with receipts documented. Samples audited at this inspection were found to be correct. Bings Hall DS0000030469.V268007.R01.S.doc Version 5.0 Page 13 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): 23 and 24 Residents’ rooms were safe and comfortable suiting their needs. EVIDENCE: As mentioned previously in this report the residents’ private bedrooms were well decorated and observed to contain personal belongings producing homely and individual feel. Radiators were guarded for residents’ safety and well being. Bings Hall DS0000030469.V268007.R01.S.doc Version 5.0 Page 14 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 and 30 Residents could be confident that a staff team with appropriate skills and numbers met their assessed needs. Staff members had not received training in all the mandatory areas. EVIDENCE: Staffing numbers and the skill mix of the staff team at Bings Hall were appropriate to meet the assessed needs of the residents living there. Four care staff members were on duty in the morning and three for the afternoon shift. The residents were supported by two members of night staff, one waking and one sleeping in. A person was employed 20 hours per week to undertake domestic duties. 90 of the care staffing team at Bings Hall had achieved NVQ level 2 in care. This exceeded the desired ratio of 50 staff trained by the end of this year and is to be commended. The previous inspection had identified a shortfall in some areas of the staff training provision. 21 care staff members were employed at Bings Hall. Training records showed that 6 had current infection control training, 3 had Health and Safety training. The acting manager demonstrated the awareness of the importance of training and recognised the shortfall. The acting manager was scheduled to undertake training to qualify her to provide manual handling training ‘in house’ for the staff team. Bings Hall DS0000030469.V268007.R01.S.doc Version 5.0 Page 15 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): 35 Residents’ financial interests were safeguarded. EVIDENCE: All residents at Bings Hall had friends, family or representatives to ensure their best interests were safeguarded. Information about independent advocacy services was available in the reception area. Robust policies and procedures were in place to protect the financial well being of residents at Bings Hall. Where the money of individual residents was handled the acting manager was able to demonstrate that the personal allowances of these residents were not pooled and appropriate records and receipts were kept. Individual funds were stored in clear plastic wallets in a locked cash tin in a locked desk. Samples audited at this inspection were found to be correct.
Bings Hall DS0000030469.V268007.R01.S.doc Version 5.0 Page 16 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X 3 3 X X STAFFING Standard No Score 27 3 28 4 29 X 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X x Bings Hall DS0000030469.V268007.R01.S.doc Version 5.0 Page 17 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 OP9 Regulation 13(2) Requirement The registered person must ensure the safe administration and storage of medicines in the home. This is a repeat requirement with an original agreed timescale of 31/08/05 specifically relates to the controlled drugs cupboard. The registered person must ensure that care staff receive training appropriate to the work they are to perform. This is a repeat requirement with an original agreed timescale of 31/08/05 Timescale for action 28/02/06 2. OP30 18 28/02/06 Bings Hall DS0000030469.V268007.R01.S.doc Version 5.0 Page 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. 3 Refer to Standard OP15 OP15 OP3 Good Practice Recommendations The kitchen at Bings Hall would benefit from some refurbishment. This is a repeat Recommendation of Good Practice The home should consider other daily menu choices instead of the daily salad alternative. This is a repeat Recommendation of Good Practice It is a recommendation of good practice that the registered person should ensure that any risks to residents health, safety or well being are assessed on admission, documented appropriately with actions to be taken to minimize or remove the identified risks and to keep under review. Bings Hall DS0000030469.V268007.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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