Inspection on 09/05/06 for The Bell House

This inspection was carried out on 9th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Bell House 01/11/05

The Bell House 14/07/05

The Bell House 29/11/04

The Bell House 24/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Bell House 61 Wilshaw Road Meltham Huddersfield West Yorkshire HD7 3DX Lead Inspector Karen Summers Key Unannounced Inspection 9th May 2006 01:17 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 DS0000026265.V290634.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. DS0000026265.V290634.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Bell House Address 61 Wilshaw Road Meltham Huddersfield West Yorkshire HD7 3DX 01484 850207 01484 852101 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) Mr Parvaiz Ahmad Dr Shireen Qureshi Ahmad Mrs Lynda Margaret Quinn Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places DS0000026265.V290634.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 1st November 2005 Brief Description of the Service: The Bell House provides personal care for up to 24 older people over the age of 65 years. The property is an extended bungalow, with two dining rooms and two lounges. All bedrooms are for single occupancy, with eight having en-suite facilities. A well-ventilated smoking area is provided for those service users who smoke. Maintained garden and grounds are provided for the use of service users in the warmer weather. Disabled/ wheelchair access to the building is also good. The home is situated in a rural area on the outskirts of the village of Meltham, with panoramic views over the surrounding countryside. Public transport is accessible with a bus stop directly outside the home. Fees at the home start at £360 - £405 per week. DS0000026265.V290634.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report refers to a key inspection, which included an unannounced site visit on the 9th and 12th May 2006, and the duration of the site visit was 9.5 hours. There were 21 service users in residence on the day. Dr Ahmad, proprietor and Mrs Lynda Quinn, manager, were present throughout the inspection. The following areas were looked at and have been used in the production of this report; a sample of records, care plans, individual discussion with three service users, one relative, three members of staff, tour of the premises and document reading. To reflect the views of those who use the service, satisfaction questionnaires were sent to: 6 service users, 3 were returned; 6 relatives, 4 were returned, 2 GP practices, 1 was returned. None were returned from the district nursing team. What the service does well: What has improved since the last inspection? What they could do better: The statement of purpose, and service user’s guide should contain all the information that is listed in the standards and regulations. DS0000026265.V290634.R01.S.doc Version 5.1 Page 6 In relation to care documentation; the care planning is not detailed enough to provide staff with the information they need to meet service users needs in a satisfactory way, or ensure that their health and social care needs are maintained. The care plans should also be updated monthly, and as the needs of the service user change. There should be a detailed procedure for self-administration of medicine, and a register for the recording of controlled drugs. Service users whom were spoken with said that no activities take place on a daily basis and very few activities had been recorded in the care records. Service users should be consulted about the programme of activities, and activities should also take place on a daily basis. Service users also commented that it would be nice if the home routinely provided daily newspapers, as presently papers are only purchased if they have been ordered and paid for by the service user. The owner has started to improve the environment, however a number of areas are still in need of redecoration and refurbishment. The guarding of radiators in service users areas has commenced and should be completed as per schedule, by the end of June 2006. To prevent the risk of scalding, the pre-set valves on hot water taps in baths and showers should be set no higher than 43 degrees centigrade. The results of service user surveys should be published and made available to current and prospective service users, their representatives and other interested parties. 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. DS0000026265.V290634.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 DS0000026265.V290634.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): 3&4 No service user moves into the home without having had his/ her needs assessed and been assured that they will be met. Until the statement of purpose and service user’s guide contains the relevant information, service users do not have all the information they need to make an informed choice about where to live. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Prospective service users and their relatives are encouraged to have a look around the home, and spend some time there before deciding to move in, and service users are admitted following an assessment of their needs. The statement of purpose and service users guide does not contain all the information that is requested in the National Minimum Standards for Older People, or The Care Homes Regulations. However, the service users’ questionnaires said that they do receive enough information about the home DS0000026265.V290634.R01.S.doc Version 5.1 Page 9 before they moved in, so that they could decide that it was the right place for them. DS0000026265.V290634.R01.S.doc Version 5.1 Page 10 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 -10 The care planning is not detailed enough to provide staff with the information they need to meet service users needs in a satisfactory way, or ensure that their health and social care needs are maintained. Service users are not protected by the home’s policies and procedures for dealing with medicines. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during the before the visit to this service. EVIDENCE: The care plan did not identify all the needs of the service users, including their health care needs, and the daily record did not reflect the care that had been given to the service user. In one instance the daily record referred to a service user’s asthma, but there was no reference in the service users care assessment or care plan that the person had asthma. The care plans should also be reviewed monthly or as the needs of the service user change. One of the service users questionnaires said that they always receive the care and support they need, and that was also reflected in what the two service users said when spoken with. The remaining questionnaires said that they DS0000026265.V290634.R01.S.doc Version 5.1 Page 11 usually receive the care and support that they need. A service user also wrote, “The staff are very helpful, pleasant and caring.” “I have made quite a few friends here and I no longer feel isolated.” “I feel settled.” A questionnaire returned from a doctor stated that staff demonstrate a clear understanding of the care needs of service users. The weighing scales were not working properly. The provider said that she would look into purchasing sit on scales, as a number of service users are unable to use the stand on ones. Since the stand on scales had become faulty, new service users had not been weighed, and existing service users weight had been estimated against their previous weight and the reading of the faulty scales. Replacement stand on scales were provided during the inspection. In relation to medication, all staff that give medication to service users have had training. There were inconsistencies in medication stored in bottles, and the recording on the drug administration sheet. Staff are advised to record and check the medication administered and that what should be remaining in the drug bottle. A risk assessment had not been carried out for a service user who wished to self-administer her medication, and it became apparent that the service user was not able to take responsibility for her own medication. As previously identified, there should be a self-administration of medicines risk assessment and procedure/ policy to follow should a service user wish to administer their medication. A controlled drugs register should be purchases so that the medication can be properly recorded. DS0000026265.V290634.R01.S.doc Version 5.1 Page 12 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 Contacts with family, friends and the local community are encouraged and maintained wherever possible. Service users lifestyle in relation to activities does not match their expectations, preferences, and social needs. The needs of those service users who have a visual, or hearing disability are supported. A variety of meals are offered that take into account the likes and dislikes of the service users. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Service users are encouraged to maintain contact with their family and friends and they are always made welcome. Main events that take place in the community and inside of the home were recorded however; the service users’ questionnaires stated that there are activities that the home arranges they can only sometimes take part in, and service users whom were spoken with said that no activities take place on a daily basis. Very few daily activities had been recorded in the care records. Service users should be consulted about the DS0000026265.V290634.R01.S.doc Version 5.1 Page 13 programme of activities, and they should also take place on a daily basis. The activities that service users take part in should also be recorded. Service users also commented that it would be nice if the home routinely provided daily newspapers, as presently papers are only purchased if they have been ordered and paid for by the service user. The home has a supply of large print books, and offered to provide audiotapes for people who have a visual impairment however, at this moment in time service users choose not to use this service. One of the service users spoken with confirmed that they did not wish to use these services. Staff offer to read the service users mail to them, and this was also confirmed by the service users. The menus offered a variety of food, and the food preferences of the service users had also been taken into consideration. The service user questionnaires stated that they usually like the meals at the home. One service user commented, “Not so much choice at tea times, need a soft option”. Whilst another service user said that, “The food is good, and if you want something different from the menu, staff will always make it for you”. DS0000026265.V290634.R01.S.doc Version 5.1 Page 14 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 Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon in a timely manner. Service users are protected from abuse. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The home has a complaints procedure, and service users receive a copy of the procedure on admission. There is also a whistle blowing policy, and all staff have training in adult protection procedures. Questionnaires stated that two out of three service users and the two out of three relatives knew how to make a complaint. Since the last inspection the Commission investigated a complaint, which was proven in some areas, in relation to the weekly maintenance of light bulbs in the lounge. Dignity, in relation to a service user who is no longer resident at the home removing her clothes in public, and the need for all personal clothing to be correctly labelled to ensure no service user wears someone else’s clothing, and that all toilets have a supply of hand towels. The issues continue to be monitored by the manager to ensure that the same mistakes do not happen again. DS0000026265.V290634.R01.S.doc Version 5.1 Page 15 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 & 26 Service users continue to live in a homely environment. Until the radiators and hot water pipes in service users areas are appropriately covered service users are potentially at risk of being burnt. And until the work identified in the Fire Safety officers’ report is also complete, there is also a potential risk. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The redecoration of the premises has commenced, and parts of the home had been tastefully redecorated. A service user who had recently had her bedroom repainted commented on how happy she was with her room. The main lounge/ dining areas and corridor have also been decorated and new curtains have been ordered. There are a number of areas that are still to be decorated, and the owner should inform the Commission with a date when the work will DS0000026265.V290634.R01.S.doc Version 5.1 Page 16 be complete. A service user was sat on a damaged chair, and the chair was removed and disposed off. The Environmental Health Officer has also visited and made a number of recommendations, one of which was the purchase of a new kitchen, and the staff are in the process of ordering a replacement. The registered provider is working with the fire safety officer regarding the work that is outstanding from his report, and the proprietor confirmed that the work is near completion. A programme of replacement/ guarding of radiators/ hot water pipes in service users’ areas has commenced and due to be completed by the end of June 2006. In order to prevent the risk of scalding, the pre-set valves on hot water taps in baths and showers, currently set at 45 degrees centigrade, should be set no higher than 43 degrees centigrade. DS0000026265.V290634.R01.S.doc Version 5.1 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 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 - 30 Staff are trained and competent to do their jobs. Service users are supported and protected by the home’s recruitment practices. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Seventy percent of care staff have achieved an NVQ level 2, or equivalent, and a further four staff, including the manager have an NVQ level 4 in management and care. The staffing levels and skill mix were sufficient to meet the number and needs of service users. One-satisfaction questionnaires stated, that there were sometimes enough staff on duty, and the remaining two said that there were usually enough staff on duty. The registered person operates a thorough recruitment procedure ensuring the protection of service users. DS0000026265.V290634.R01.S.doc Version 5.1 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 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, 33, 35 & 38 Quality assurance and quality monitoring systems are in place based upon seeking the views of service users to ensure that the home is run in their best interest. Service users’ financial interests are safeguarded. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Satisfaction questionnaires are sent annually to staff, service users/ visitors, and visiting profession, and the comments that were received were most favourable. Unfortunately the results of the questionnaires are not published and made available to current and prospective users, their representatives and other interested parties. The audits of service users’ finances were correct. DS0000026265.V290634.R01.S.doc Version 5.1 Page 19 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 2 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X 1 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 DS0000026265.V290634.R01.S.doc Version 5.1 Page 20 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 OP1 Regulation 4.-(1)(c) &5 Schedule 1 15.-(1) Requirement The Statement of purpose, & Service user’s guide shall contain the information requested in the Regulation. The service user’s plan shall show how the service user’s needs are to be met. You are requested to confirm in writing when this will be addressed. Medication - The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. A Controlled Drugs register shall be used to record Controlled Drugs. You are requested to confirm in writing when this will be addressed. Consult service users about the programme of activities, and provide facilities for recreation. The registered provider ensures that - all parts of the home are kept reasonably decorated. (Identified at a previous inspection, dated 14/7/05) A reDS0000026265.V290634.R01.S.doc Timescale for action 30/06/06 2. OP7 12/06/06 3. OP9 13.(2) & (4)(b) 12/06/06 4. 5. OP12 OP19 16. – (2)(n) 23.-(2)(d) 12/06/06 12/06/06 Version 5.1 Page 21 decoration programme of the areas that are showing signs of wear have been received – please confirm in writing when all the work will be completed. 6. OP19 23.-(4) The registered provider is working with the fire safety officer regarding the work that is outstanding from Schedules 1 & 2 of his report. You are requested to confirm in writing by 12/6/06 when the work will be completed. 13. -(4)(c)unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. Standard 25.5 – Unprotected HOT WATER PIPES and RADIATORS in service users’ areas must be guarded or, in the case of the radiators be guarded or have guaranteed low temperature surfaces. (Identified at previous inspections.) The provider has identified the work to be done in order of risk to service users, and has agreed to complete the work by June 2006. 12/06/06 7. OP25 13.-(4)(c) 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations 7.4 – The service user’s plan should be reviewed at least once a month, and updated to reflect their needs. DS0000026265.V290634.R01.S.doc Version 5.1 Page 22 The daily record should show that the needs of the service user have been met. 2. 3. OP8 OP9 8.9 – Nutritional screening should include weight gain or loss, and be undertaken on admission and periodic intervals. 9.1 - There should be a self-administration of medicine risk assessment and procedure to follow should a service user wish to administer their medication. The medicines policy and procedure should also be written in greater detail. Recording and auditing of medication in bottles should take place. 12.3 - The activities that individual service users take part in on a day-to-day basis should be recorded. 25.8 - To prevent scalding, the pre-set valves on hot water taps in baths and showers should be set no higher than 43 degrees centigrade. 33.4 – The results of service user surveys should be published and made available to current and prospective service users, their representatives and other interested parties. 4 5. OP12 OP25 6. 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