CARE HOMES FOR OLDER PEOPLE
Bonaer 17 Station Hill Hayle TR27 4NG Lead Inspector
Diana Penrose Unannounced Inspection 13th January 2006 09:30 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 Bonaer DS0000043280.V276602.R01.S.doc Version 5.1 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. Bonaer DS0000043280.V276602.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Bonaer Address 17 Station Hill Hayle TR27 4NG 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) 01736 752090 Anthony Joseph Metalle Sarah Jayne Metalle Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability (7), Terminally ill over of places 65 years of age (5) Bonaer DS0000043280.V276602.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th June 2005 Brief Description of the Service: Bonaer is situated next to Hayle railway station, which is very close to the local amenities. It is a big adapted house with an extension and a large conservatory. There is limited car parking space in the grounds but there is additional free parking nearby, on the roadside. The home provides residential and nursing care for up to thirty-one elderly people. The registration allows for five people with a terminal illness and seven with a physical disability. Accommodation is on two floors with a shaft lift provided. There are hand washbasins in all bedrooms and there are adequate toilet and bathing facilities. Meals are prepared in the kitchen on the ground floor and served in the three lounges or individual bedrooms if preferred. There is no dedicated dining room in the home. To the front of the home there is a veranda and a garden with a large fishpond and seating that is accessible to service users. The garden at the back of the home is not as accessible but a raised flowerbed is going to be built for service users to use. The Registered Providers have owned the home since May 2003 and are still in the process of upgrading and refurbishing. They are very involved in the running of the home; Mrs Metalle is the Registered Manager and also works as part of the nursing team. Qualified Nurses and Care Assistants provide care within a friendly atmosphere. Bonaer DS0000043280.V276602.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Bonaer Nursing Home on Friday 13 January 2006 and spent five hours and twenty minutes at the home. This was an unannounced visit. The purpose of the inspection was to gain an update on the progress of compliance to requirements identified in the last inspection report dated 09.06.05. In addition the inspector focused on the following key areas of care: care planning, leisure, adult protection, some of the environment, training and quality assurance. On the day of inspection 24 service users were service user in the home. The methods used to undertake the inspection were to meet with a number of service users, staff and the registered providers to gain their views on the services offered by Bonaer. Records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. What the service does well:
The home provides a warm, clean, safe environment for service users, staff and visitors. Each service user has a well written care plan, which is reviewed monthly and relevant risk assessments are undertaken, for example in respect of pressure sores, continence and falls. Daily records are kept for each service user and they are informative. Service users spoken with said their health needs are met and they have access to their GP or other health professionals when required. Relevant equipment is provided for moving and handling purposes and pressure-relieving equipment is supplied as required. A mattress audit takes place every 6 months. The home endeavours to provide activities and entertainment to suit the service users accommodated. There is a variety on offer and service users said they know what is happening and can choose what to be involved in. Service users said they could receive their visitors in private and at any time. Visitors spoken with said they are always made welcome in the home and can call whenever they like. Service users said the telephone arrangements in the home are good. Staff are offered appropriate training and care staff receive NVQ training. The Registered Manager keeps records of all staff training. Staff are encouraged to write articles for inclusion in the training manual. The registered providers are keen to ensure a quality service is on offer, they hold regular staff meetings and there are meetings with representatives from Bonaer DS0000043280.V276602.R01.S.doc Version 5.1 Page 6 the staff, service users and relatives. Quality assurance surveys take place annually and the results are positive. There is a suitable system for dealing with service users money. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bonaer DS0000043280.V276602.R01.S.doc Version 5.1 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 Bonaer DS0000043280.V276602.R01.S.doc Version 5.1 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): EVIDENCE: None inspected on this occasion. Bonaer DS0000043280.V276602.R01.S.doc Version 5.1 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 and 8 Individual care plans are generated for each service user that inform and direct the staff in their care provision; religious and cultural needs must also be included. Service users have access to health care services as necessary to ensure their assessed needs are met. EVIDENCE: Each service user has a detailed written care plan, which is reviewed monthly. Service users cultural and religious needs must be recorded and addressed; the religion was not recorded in the files inspected. Risk assessments include Waterlow scoring, nutrition, moving and handling, falls and Barthel scoring. The care plans are compiled with and signed by the service user or their representative whenever possible. Daily records are maintained and the care staff keep records of personal care provision. The Registered Manager has worked hard to ensure the documentation is comprehensive and informative. Service users spoken with said their health needs are met and they have access to their GP or other health professionals when required. Pressure relieving equipment is supplied and a mattress audit takes place every 6 months. Equipment for moving and handling is used and staff receive appropriate training. There are link nurses for several specialities. Bonaer DS0000043280.V276602.R01.S.doc Version 5.1 Page 10 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): 12, 13 and 14 The home provides a range of activities and aims to offer a lifestyle that meets individual service users needs. Links with family, friends and the community are good and allow service users the opportunity to socialise. Service users are helped to maintain control over their lives and staff respect their individual preferences and choice. EVIDENCE: Activities and entertainment are on offer and posters are displayed. Activities include singers, entertainers, an organist, story telling, massage, nail painting and Holy Communion. Trips out are organised and a summer fete takes place. One service user helps with the cooking and another made her own birthday cake. The care staff are responsible for the activities and records are maintained. There is a record of visitors to the home and there were visitors in the home during the inspection. Service users said they could receive visitors in private and at any time. Visitors spoken with said they are always made welcome in the home and can call whenever they like. Service users said there are suitable telephone arrangements in the home. There are choices on the menu and service users said the daily routines are flexible. One service user said he does not always sit in the same lounge he moves about as he wishes. Service users’ rooms are personalised with their own belongings and furniture.
Bonaer DS0000043280.V276602.R01.S.doc Version 5.1 Page 11 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 Arrangements are in place for the protection of service users safeguarding them from harm or abuse. EVIDENCE: The home has an adult protection policy and a copy of the alerters flowchart. The Registered Manager said she is endeavouring to obtain a copy of the local inter agency procedures. The Registered Manager has been trying to get staff onto the local training days but the days get filled very quickly. In house training takes place, the Registered Manager has a training video. There is a secure facility for the storage of money in the home. Bonaer DS0000043280.V276602.R01.S.doc Version 5.1 Page 12 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): 19,20 and 26 The home and grounds are well maintained and refurbishment is taking place. There is sufficient indoor and outdoor communal space for service users to be comfortable and choose where they would like to be. The home is clean and free from offensive odours making it a pleasant place to live in. EVIDENCE: The home is warm, homely and clean with no offensive odours. A refurbishment programme is in progress and a significant amount of work has already been done. More rooms including the sun lounge have been decorated and some carpets have been renewed since the last inspection. All strip lights must be fitted with covers for safety, the registered provider said this is in hand. The taps in the bedrooms of independent service users have been fitted with thermostatic regulators. The grounds are tidy and the fishpond has been completed. A wall has been built in the back garden and it is hope to have a raised flowerbed for service users to enjoy some gardening. All laundry is dealt with in house and service users are happy with the service. Staff receive infection control training, one member of staff has compiled a very good article on infection control for inclusion in the staff training file.
Bonaer DS0000043280.V276602.R01.S.doc Version 5.1 Page 13 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): 29 and 30 Recruitment procedures are robust and offer protection to the service users. The home provides appropriate training for staff to help them be more competent in their roles. EVIDENCE: Three personnel files were inspected one was lacking a reference but the Registered Manager was sure that two were obtained, the member of staff had worked on the bank prior to having a contract. Not all of the files contained interview records but the Registered Manager said they were written. The Registered Manager said she would collate the files and devise a check sheet to be completed to ensure all forms are included. Relevant CRB and POVA checks are undertaken and nursing registrations are checked with the NMC. The Registered Manager has obtained the Skills for Care information on induction. Induction training at present takes place over a 4-week period. Individual training records are maintained and there is a training matrix for all staff. There is information on courses available to staff. Training needs are identified at interview, appraisal, and supervision and during meetings. A carers training and instruction manual is being compiled. Members of staff are writing articles for the training file. Bonaer DS0000043280.V276602.R01.S.doc Version 5.1 Page 14 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 and 35 The home is run in the best interest of the service users and they benefit from the Quality Assurance systems in place. There is a suitable system in the home for dealing with service users’ money that ensures that the service users’ financial interests are safeguarded. EVIDENCE: A quality assurance survey is undertaken annually. The results of the last survey undertaken in December 2005 are positive. At present the survey includes service users and relatives. Staff meetings take place regularly and a comfort committee meets monthly, this committee comprises of two staff, two relatives and two service users. Minutes are maintained for all meetings. A newsletter is circulated bi-monthly. Records of power of attorney are maintained; the list is being updated. The registered provider is appointee for one service user; her money is kept in a separate account. There is a safekeeping policy with a form for service users to sign as agreeing to the policy. The registered provider has checked the
Bonaer DS0000043280.V276602.R01.S.doc Version 5.1 Page 15 insurance cover for the safe. Records are maintained of all transactions and receipts are kept. Bonaer DS0000043280.V276602.R01.S.doc Version 5.1 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X 3 3 X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X X Bonaer DS0000043280.V276602.R01.S.doc Version 5.1 Page 17 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 2 Standard OP7 OP19 Regulation 12(4) (b) 12 (1) (a) Requirement Timescale for action 27/03/03 Service users cultural and religious needs must be recorded and addressed All strip lights must have covers 27/03/03 fitted 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 OP2 OP28 Good Practice Recommendations All service users should be issued with a copy of the homes contract 50 of care staff should be qualified to NVQ level 2 Bonaer DS0000043280.V276602.R01.S.doc Version 5.1 Page 18 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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