CARE HOMES FOR OLDER PEOPLE
Five Bells Residential Care Home 28 Market Place Folkingham Lincs NG34 0SF Lead Inspector
Julie Western Unannounced Inspection 24th November 2005 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 Five Bells Residential Care Home DS0000002440.V268519.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. Five Bells Residential Care Home DS0000002440.V268519.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Five Bells Residential Care Home Address 28 Market Place Folkingham Lincs NG34 0SF 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) 01529 497412 Mr Ronald Bruce Bridle Mrs Barbara Mary Bridle Mrs Della Graham Care Home 25 Category(ies) of Dementia (2), Old age, not falling within any registration, with number other category (22), Physical disability (1) of places Five Bells Residential Care Home DS0000002440.V268519.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The part of the home identified as Unit 2 is used for couples only when used as a shared room. 27th July 2005 Date of last inspection Brief Description of the Service: The Five Bells is a Grade II Listed former coaching inn, originally built in 1629 and located in the centre of the village of Folkingham, which is a conservation area. Folkingham is of equal distance from the towns of Grantham and Sleaford and has a shop, restaurant, pub and post office. The home is registered as a care home and mainly provides care for older service users; it is also registered to provide care for service users with those needs associated with dementia and for one service user who falls within the category of physical disability. On the day of the inspection 20 service users were being accommodated. The home comprises a main home, the coaching inn, which was extended in 2001, four modern terraced properties in Tannery Lane, which is adjacent to the main building and, more recently three bungalows within the grounds of the home. These provide self-contained accommodation for less dependent service users. These properties have also been built in keeping with the village setting and form part of the homes registration. The home has a courtyard garden where residents can sit out in good weather. Across the road from the main home there are offices from which a domiciliary care service is operated. Accommodation in the main home is provided on ground and first floors, which are accessible via stairs or a stair lift. Access to the first floor flat of one of the self-contained houses in Tannery Lane is via an external staircase. The owners of the home now live in Scotland; one of the owners is in touch with the home by telephone on a daily basis and visits the home fortnightly. Five Bells Residential Care Home DS0000002440.V268519.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 3 ½ hours. A partial tour of the premises took place and care records were inspected. The main method of inspection used was called ‘case-tracking’; this involved selecting three residents and tracking the care they received through the checking of their records, discussions with residents and care staff and observation of practices. Some policies and procedures were examined and records concerning the safety of the home were also seen. Four of the 20 residents and three of the 15 care and ancillary staff were spoken with. The Manager, who is awaiting registration, was absent and the inspection was conducted with the assistance of senior staff. What the service does well: What has improved since the last inspection?
Recent refurbishment and redecoration has included the complete refurbishment of the main lounge including the removal of a partition, new carpets and curtains and the purchase of a wall-mounted television set The conservatory has been redecorated and the furniture re-arranged to provide an improved sitting area for residents. There has been an increase in staffing numbers and care plans have been improved. Five Bells Residential Care Home DS0000002440.V268519.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. Five Bells Residential Care Home DS0000002440.V268519.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 Five Bells Residential Care Home DS0000002440.V268519.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): 1-5 The home clearly sets out what it intends to do for its residents and this information is freely available to residents. Contracts set out clear terms and conditions and initial documentation demonstrates that the home is able to meet residents’ needs. Prospective residents are encouraged to take time before making the decision to move into the home on a permanent basis EVIDENCE: The statement of purpose and the service user guide were comprehensive; it was suggested that the service user’s guide was kept in residents’ rooms. The Manager usually carried out the pre-admission assessment, either in the resident’s home or a care setting such as hospital or another care home. Some residents had been to the home to spend a day and have coffee or meals in the home; one resident said she had previously stayed at the home for a week’s respite care and had liked it so much she had said to her family afterwards ‘If I’ve to go anywhere it’ll be to Five Bells’. Five Bells Residential Care Home DS0000002440.V268519.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10 The home’s records give a clear indication of the needs of residents and enable staff to meet their needs with sensitivity and regard for their privacy and dignity. EVIDENCE: The three care plans looked at in depth contained assessments and were signed where possible by the service user or relatives/advocates. Care plans had improved since the last inspection and were more clear about the needs of the resident. One resident commented ‘It’s wonderful – I couldn’t wish for better care’. The home has a key worker system and four residents had regular visits from a District Nurse. The staff team were observed carrying out their duties with kindness and sensitivity towards the residents, especially when attending to their personal needs. Five Bells Residential Care Home DS0000002440.V268519.R01.S.doc Version 5.0 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): 12-15 A wide range of events and activities is available for residents. The residents exercise choice about which activities, if any, they wish to participate in and what meals they want to eat. EVIDENCE: The home has an activities organiser who works two days a week. On the day of the inspection she was having one-to-one conversations with certain residents and was making arrangements for the Advent coffee morning and carol singing. The notice board and various posters displayed a range of activities and events taking place, including a visiting theatre company and regular singing entertainers. Recent events included a Hallowe’en party and a trip to a local garden centre for the Christmas display. One resident spoken with said she had no wish to participate in any of the events and preferred to stay in her room. Others said they still went to the village pop-in club and lunch club. The activities organiser had developed a library for the home, with an extensive range of books. Residents were observed eating the mid-day meal; one said ‘the food’s very good’ and another said ‘It’s adequate – they do a very good tea’. One resident had diabetic meals and one had a liquidised diet. The new cook had developed a new four-week menu, which was balanced and used more fresh vegetables; she had a basic food hygiene certificate. Five Bells Residential Care Home DS0000002440.V268519.R01.S.doc Version 5.0 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): 16-18 The home’s complaints procedure is clear and gives residents and their relatives the confidence that comments and concerns will be listened to; there is a robust adult protection procedure. EVIDENCE: Residents all said they did not wish to complain but knew how to make a complaint. The home had a ‘compliments, comments and concerns’ book for the use of residents and visitors and the only entry in it read ‘All the Lord’s angels work here’. Residents spoken with said they preferred to go directly to the management if they had any issues. There was a clear adult protection procedure, which was linked to the Local Authority procedures. Staff members spoken with had received training on adult protection and demonstrated that they knew what to do in the event of an incident concerning adult protection issues. Five Bells Residential Care Home DS0000002440.V268519.R01.S.doc Version 5.0 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): 19,20,21,26 The residents live in a comfortable and pleasant environment with both private and communal space, which is generally safe and suitable for their needs; some parts of the building had not been checked for risks. EVIDENCE: The standard of decoration internally was generally good and afforded residents a good degree of comfort. The gardens were well tended with flowers and a water feature in the courtyard area. The home has a rolling maintenance programme and recent improvements included the complete refurbishment of the main lounge including the removal of a partition, new carpets and curtains and the purchase of a wall-mounted television set The conservatory had been redecorated and the furniture re-arranged to provide an improved sitting area for residents. Risk assessments should be carried out on a convector heater in the conservatory, which had a trailing lead and an armchair in the main lounge, which had nails protruding where the arm pads had been ripped off. The first floor bathroom and toilet door locks were difficult to operate. Five Bells Residential Care Home DS0000002440.V268519.R01.S.doc Version 5.0 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): These standards were not inspected. EVIDENCE: Although the standards were not fully inspected, the staffing rota showed that there were enough staff numbers on paper to care for the needs of the residents. Staff members said that staffing had recently increased. There was one permanent vacancy for a handyman. Five Bells Residential Care Home DS0000002440.V268519.R01.S.doc Version 5.0 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): 31,32,38 The home is managed competently and the staff are supported and supervised in carrying out their respective roles. The views of residents are listened to and they are involved in decisions affecting them. EVIDENCE: The Manager, who was appointed to the post in February of this year is unregistered at present and is applying to become the Registered Manager. She has worked in a hospital setting for 21 years and in a management position within this for 6 years. She is currently progressing towards the NVQ Manager’s award at Level 4. Residents spoken with said they were constantly asked for their views on matters concerning the running of the home. Quality assurance was carried out with letters sent to relatives/advocates; any issues from these and from the residents’ meetings were addressed as they occurred. Five Bells Residential Care Home DS0000002440.V268519.R01.S.doc Version 5.0 Page 15 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X X X 2 Five Bells Residential Care Home DS0000002440.V268519.R01.S.doc Version 5.0 Page 16 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 Standard OP19 Regulation 23[1] 23[2](b) Requirement The registered person must repair or remove the armchair in the main lounge with damaged arms. Bathroom and toilet door locks must be easy for older or disabled people to operate. The registered person must ensure that risk assessments are regularly carried out on the environment. Timescale for action 19/01/06 2 OP38 13[4](c) 19/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Five Bells Residential Care Home DS0000002440.V268519.R01.S.doc Version 5.0 Page 17 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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