CARE HOMES FOR OLDER PEOPLE
Bonaer Nursing Home 17 Station Hill Hayle Cornwall TR27 4NG Lead Inspector
Diana Martin Announced 09 June 2005 09:30 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. Bonaer Nursing Home D52-D04 S43280 Bonaer V226174 090605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Bonaer Nursing Home Address 17 Station Hill Hayle Cornwall TR27 4NG 01736 752090 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) Anthony Joseph Metalle Sarah Jayne Metalle Care Home with Nursing 31 Category(ies) of Old age, not falling within any other category registration, with number (31), Physical disability (7), Terminally ill over of places 65 years of age (5) Bonaer Nursing Home D52-D04 S43280 Bonaer V226174 090605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 09/12/04 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 seating that is accessible to service users, a large fish pond has been added recently. The garden at the back of the home is not suitable for service users. The Registered Providers have owned the home since May 2003 and are in the process of an upgrading and refurbishing programme. 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 Nursing Home D52-D04 S43280 Bonaer V226174 090605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited Bonaer on the 09 June 2005 and spent the day at the home. This was an announced visit. On the day of inspection 27 service users were resident in the home. The inspector met with 2 service users and 2 representatives, a number of staff and the Registered Providers to gain their views on the service that Bonaer provides. In addition the inspector examined records, policies and procedures and toured the building. This report summarises the findings of this inspection. What the service does well:
The home has a statement of purpose and service users guide that inform prospective service users and their family about the home. Copies were readily available in the home and the service users guide had been issued to all service users living in the home. One service user said her relatives received ample information about the home when they were looking for a suitable place for her to live. All service users have a written contract either from the home or the relevant funding authority. An assessment of needs takes place prior to a service user being admitted to the home, this enables the home to decide if the service users’ needs can be met by the service provided. The registered provider visits prospective service users whenever possible prior to admission. Service users and their relatives can also visit the home and stay for a meal if they wish. Service users spoken with said their families had visited the home on their behalf as they were admitted from hospital. Staff receive training specific to the needs of the service users accommodated, this enables them to provide appropriate care. Each service user has a care plan, which is reviewed monthly and relevant risk assessments are undertaken, for example in respect of pressure sores, continence and falls. Daly 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. There is a suitable medicines policy in place and storage for medicines is safe and secure. Service users said their privacy and dignity are respected at all times. The home endeavours to provide activities and entertainment to suit the service users accommodated. There was a variety on offer and service users said they were involved in the forthcoming fete to be held in the grounds. 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 the telephone arrangements in the
Bonaer Nursing Home D52-D04 S43280 Bonaer V226174 090605 Stage 4.doc Version 1.30 Page 6 home are good. Some service users attend a local day centre and one goes out to church. Nutritional needs are assessed and special diets catered for. There are choices on the menu and further alternatives available on request. Meals can be eaten in the lounges or individual bedrooms and staff are available to assist if necessary. Special occasions are celebrated and there was a list of service users birthdays in the kitchen. There is a suitable complaints policy in the home and the home receives few complaints. The home is warm, homely and clean with no unpleasant odours. The grounds are kept tidy. The room sizes are suitable for the service users accommodated although nine single bedrooms are below the recommendations of the national minimum standards. Staffing levels are appropriate and the registered providers said the skill mix is suitable. There is a qualified nurse on duty at all times and the night staff are waking. The Manager is a qualified nurse and she has acieved the NVQ level 4 in Management. She is very competent to run the home and both staff and service users said she is a good leader. They said she is very approachable, organised and in control. She works shifts alongside the care staff as well as working in the office. There is a person trained in first aid on duty at all times and statutory training is provided for all staff. The fire and maintenance records were all up to date. What has improved since the last inspection? What they could do better:
If all service users were issued with the homes contract of residency they would be more fully informed. The records in respect of medicines need to be
Bonaer Nursing Home D52-D04 S43280 Bonaer V226174 090605 Stage 4.doc Version 1.30 Page 7 improved. Medicines received from the pharmacy must always be recorded on the administration chart with the signature of the staff member. Anything hand written on the medicine chart must be signed by the person writing it and the member of staff witnessing it. Food records must be kept for three years to comply with the regulations. The recruitment records must be improved. Staff files inspected did not contain all of the records required. They did not all contain two written references and the previous employer had not always been contacted for a reference. New staff must have the relevant police checks and the protection of vulnerable adults register must also be checked prior to staff commencing work in the home. The home is working towards training the care staff to at least NVQ level 2. At present 42 are qualified and others are on the course. 50 should be qualified by December 2005. A training and development programme must be devised; the registered provider has started to work out how to put this together. 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 Nursing Home D52-D04 S43280 Bonaer V226174 090605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Bonaer Nursing Home D52-D04 S43280 Bonaer V226174 090605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 and 5 Prospective service users are given information about the home enabling them to make an informed decision. Each service user is issued with a written contract; service users would be better informed if they all received the home’s contract. Service users are only admitted to the home following an assessment of their needs that ensures the home can provide adequate care. The home provides training and specialist services to ensure service users needs can be met. Prospective service users are invited to visit the home prior to moving in, enabling them to make an informed decision. EVIDENCE: The home has a statement of purpose and service users guide that comply with the regulatory requirements. Each service user is issued with a relevant contract, either the home’s or Social Services. It is recommended that all service users be issued with a copy of the home’s contract. The registered provider explained the procedure for the assessment of prospective service users and completed assessment documents were inspected. The home has its own assessment form that complied with the criteria a set out in Standard 3.3. Information from Social Services and
Bonaer Nursing Home D52-D04 S43280 Bonaer V226174 090605 Stage 4.doc Version 1.30 Page 10 hospital staff is also obtained. An individual plan of care is compiled from the initial assessment. Training specific to the needs of service users accommodated has been taking place, for example Parkinsons disiease, the administration of buccal medicines and dementia. Individual nurses have taken on the role of ‘Link Nurse’ for various subjects. Specialist nurses and other healthcare professionals are involved as necessary. The registered provider said that prospective service users and their family are invited to visit the home and stay for a meal if they wish. Arrangements could be made for an overnight stay if required. Service users spoken with said their families had visited the home on their behalf as they were admitted from hospital. The contracts include a months notice period. Bonaer Nursing Home D52-D04 S43280 Bonaer V226174 090605 Stage 4.doc Version 1.30 Page 11 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) 7,8, 9 and 10 Individual care plans are generated for each service user that inform and direct the staff in their care provision. Service users have access to health care services as necessary to ensure their assessed needs are met. There are suitable systems and policies in place for dealing with service users medicines and some extra vigilance in record keeping will help to ensure service users safety. Systems are in place to ensure that service users are respected and their privacy is upheld at all times. EVIDENCE: Each service user has a care plan, which is reviewed monthly. 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 documentation is comprehensive and informative. Service users spoken with said their health needs were met and they had 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 training. Bonaer Nursing Home D52-D04 S43280 Bonaer V226174 090605 Stage 4.doc Version 1.30 Page 12 There is a suitable medicines policy and system in place for the administration of medicines. Storage is safe and secure. All medicines received into the home must be recorded and signed on the medicine administration chart. The arrangements for ensuring privacy and dignity were specified in the statement of purpose. Staff were observed to respect service users privacy during the inspection. Suitable screening is provided in shared rooms and service users are addressed by their preferred name. Bonaer Nursing Home D52-D04 S43280 Bonaer V226174 090605 Stage 4.doc Version 1.30 Page 13 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 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. Dietary needs of service users are well catered for with a varied selection of food available that meets their taste and preference. EVIDENCE: Activities and entertainment were on offer. These include singers, karaoke, an organist, dancing dogs, massage, nail painting, Holy Communion and planting flower seeds. Trips out are also organised and a summer fete was imminent at the home. The activities folder was not kept up to date but details of activities attended were recorded in the individual daily records. 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 the telephone arrangements in the home are good. Some service users attend a local day centre and one goes out to church. Nutritional needs are assessed and special diets catered for. There are choices on the menu and further alternatives available on request. Service users can eat in the lounge or in their bedroom. Appropriate assistance is given when
Bonaer Nursing Home D52-D04 S43280 Bonaer V226174 090605 Stage 4.doc Version 1.30 Page 14 required. Special occasions are celebrated and there was a list of service users birthdays in the kitchen. One service user helps out in the kitchen and she said she really enjoys it; this activity has been risk assessed. Records of the food service users eat must be kept for three years. Bonaer Nursing Home D52-D04 S43280 Bonaer V226174 090605 Stage 4.doc Version 1.30 Page 15 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 The home has a satisfactory complaints procedure that ensures complaints are listened to and acted upon. EVIDENCE: There is a suitable complaints policy in the home. The home has had 10 complaints in the last year, these have been mainly verbal and from two complainants. The complaints have been dealt with appropriately and recorded. There have been no complaints to the Commission. Bonaer Nursing Home D52-D04 S43280 Bonaer V226174 090605 Stage 4.doc Version 1.30 Page 16 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, 20 and 23 The home and grounds are well maintained providing a safe environment for residents, staff and visitors. Residents have access to communal areas and grounds that are safe and suitable for their needs. The home provides suitable sized rooms for service users needs. EVIDENCE: The home is warm, homely and clean. A refurbishment programme is in progress and a significant amount of work has been done. The grounds are tidy and a large fishpond has been added to the front garden. Service users were sitting in the three lounges and they had their meals there or in their bedroom. There have been no changes in room sizes. There are 16 single rooms with at least 10sq.m of space and 9 single rooms below 10sq.m. In addition there are 3 shared rooms with at least 16sq.m of space. Bonaer Nursing Home D52-D04 S43280 Bonaer V226174 090605 Stage 4.doc Version 1.30 Page 17 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) 27,28 and 29 The number of staff available is sufficient to meet the needs of the service users. Service users are in safe hands but not will benefit when more care staff achieve an NVQ qualification. Recruitment procedures must be improved to offer protection to the service users. EVIDENCE: The Registered Manager said the number and skill mix of staff was suitable for the service users needs. The working duty rota was displayed. There was a qualified nurse on duty at all times and there were waking night staff. In addition there were normally 6 care staff in the mornings, 3 in the afternoons and 2 at night. The Registered Manager is a qualified nurse and is included in the care duty rota. Two domestic staff, a laundry worker and a maintenance worker are on duty each day plus a cook and a catering assistant. 42 of care staff are qualified to at least NVQ level 2 and others are studying for their qualification. 50 of care staff must be qualified by December 2005. Induction is in line with the TOPSS guidance and foundation training is to be discussed with the college. Recruitment files inspected did not contain all of the documents required by legislation. Two satisfactory references must be obtained along with a POVA check prior to staff commencing work. All new employees must have an appropriate CRB check. Bonaer Nursing Home D52-D04 S43280 Bonaer V226174 090605 Stage 4.doc Version 1.30 Page 18 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) 31, 32 and 38 The home is well managed with good leadership and direction for staff that promotes consistent quality care. Appropriate training and safety checks are undertaken to ensure the health safety and welfare of service users and staff. EVIDENCE: The Manager is a qualified first level nurse who keeps herself up to date with current issues in respect of her client group. She has acieved the NVQ level 4 in Management and is very competent to run the home. She manages the care and recruitment aspects of the home while her husband manages the maintenance, finance and catering. A significant amount of work has been done since the last inspection. Service users visitors and staff spoke highly of the Registered Providers. One service user said that the Manager is very organised and in control. The Registered Providers endeavour to ensure that working practices are safe. Staff receive statutory training regularly. There is a person trained in first aid on duty at all times. The Manager said she does regular MRSA updates for
Bonaer Nursing Home D52-D04 S43280 Bonaer V226174 090605 Stage 4.doc Version 1.30 Page 19 staff. Accident reporting complies with data protection. The health and safety risk assessments required at the last inspection have been commenced. Bonaer Nursing Home D52-D04 S43280 Bonaer V226174 090605 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2
COMPLAINTS AND PROTECTION 3 3 x x 3 x x x STAFFING Standard No Score 27 3 28 2 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 x x x x x 2 Bonaer Nursing Home D52-D04 S43280 Bonaer V226174 090605 Stage 4.doc Version 1.30 Page 21 yes 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. 2. Standard 29 9 Regulation 17(1)(a) Sch 4 13(2)(4)( c) 13(2)(4)( c) 37 Sch 4 (13) 13(4) (6) Requirement The employment records required by legislation must be maintained The transcribing of medicines onto the MAR charts must be witnessed with two signatures recorded Medicines received must be recorded on the MAR charts and signed for Records of the food service users eat must be kept for three years. The health and safety risk assessments must be completed Timescale for action 09/06/05 09/06/05 3. 4. 5. 6. 9 15 38 09/06/05 09/06/05 26/09/05 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 30 28 2 Good Practice Recommendations A training and development plan should be compiled. 50 of care staff should be qualified to NVQ level 2 by December 2005. All service users should be issued with a copy of the home’s contract.
D52-D04 S43280 Bonaer V226174 090605 Stage 4.doc Version 1.30 Page 22 Bonaer Nursing Home Commission for Social Care Inspection 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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