Inspection on 10/05/06 for The Bell Memorial Home

This inspection was carried out on 10th 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 Memorial Home 25/07/07

The Bell Memorial Home 29/11/05

The Bell Memorial Home 24/06/05

The Bell Memorial Home 04/11/04

The Bell Memorial Home 22/06/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE The Bell Memorial Home 164 South Street Lancing West Sussex BN15 8AU Lead Inspector Mrs Kerry Leppard Key Unannounced Inspection 10th May 2006 07:40 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 The Bell Memorial Home DS0000014768.V289135.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. The Bell Memorial Home DS0000014768.V289135.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Bell Memorial Home Address 164 South Street Lancing West Sussex BN15 8AU 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) 01903 752020 The Bell Memorial Home Mrs Maureen Condick Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46) of places The Bell Memorial Home DS0000014768.V289135.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 46 male and/or female service users over 65 years of age in the category of old age, not falling within any other category may be admitted/ accommodated. 29th November 2005 Date of last inspection Brief Description of the Service: The Bell Memorial Home is a detached building which is set back off the main road, close to local shops, amenities and the sea front in Lancing. The home offers care and support to service users but is not registered to provide nursing care. The Bell Memorial Home is registered to provide accommodation for 46 service users in the category OP (Old age, not falling within any other category). The home offers separate sitting and dining rooms and additional areas where activities take place. A smoking and hairdressing room is provided on the ground floor. Twelve rooms provide en suite facilities. There is a wellmaintained garden at the rear of the home. The current scale of charges is £380-£400 per week, additional charges are made for chiropody, hairdressing and newspapers. The home’s inspection report was on display in the main entrance of the home. The registered manager is Mrs. Condick and the responsible individual for the home is Mrs. Gillian Rodway. The Bell Memorial Home DS0000014768.V289135.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced fieldwork visit was carried out by two inspectors from 7.40am to 4.00pm on Wednesday 10 May 2006. Prior to the visit information was requested and received from the home in the form of a questionnaire. Comment cards were supplied to the home for distribution to both residents and relatives/visitors. Of these 5 completed relative/visitor cards were received and 28 resident cards were received, the majority of which were completed with the assistance of a senior staff member. During the visit the inspectors spoke with twelve residents, three visitors, and a group of seven staff. A variety of records were reviewed including, assessments, care plans, medication administration records, accident forms and resident finance records. What the service does well: What has improved since the last inspection? The Bell Memorial Home DS0000014768.V289135.R01.S.doc Version 5.1 Page 6 Work has continued to improve the internal decoration and the external redecoration has now been completed. New furniture has been purchased for the main lounge. 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. The Bell Memorial Home DS0000014768.V289135.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 The Bell Memorial Home DS0000014768.V289135.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, 5, & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There are procedures in place to assess prospective residents and the registered manager must ensure these are followed for all new admissions to the home. Prospective residents and their representatives have an opportunity to visit and assess the suitability of the home. Intermediate care service are not provided at The Bell Memorial Home. EVIDENCE: Evidence from case tracking indicates that assessments of need prior to admission gather basic information that is sufficient for the home to determine if they can meet the person’s needs. A further assessment of need is carried out on admission. The Bell Memorial Home DS0000014768.V289135.R01.S.doc Version 5.1 Page 9 However, for one recent admission there was no evidence of an assessment prior to the person coming to stay at the home. All prospective residents needs should be assessed in order to determine that the home can meet their needs and assure the individual of that. There was evidence to show that the needs of some residents have changed leading to greater dependency however there was no indication in care plans of ongoing assessment and actions to meet increasing mental health needs. Discussion with relatives did demonstrate that a process of consultation has been carried out with the aim of securing a more suitable placement (see standard 7). Through discussion with residents it was clear that either they or their representative had had the opportunity to visit the home prior to moving in. The Bell Memorial Home DS0000014768.V289135.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, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents’ needs are set out in an individual plan of care however these need to be developed to ensure that they are accurate and comprehensive. Residents’ health needs are met however actions to minimise identified risks to health, safety and well being need to be recorded. Residents are not currently protected by the home’s medication practises. Residents feel they are treated with respect and their privacy and dignity is upheld. EVIDENCE: Care plans had been developed for most residents however for one resident there had been a significant delay in putting together a care plan following admission. The registered manager must ensure that care plans are developed in a timely fashion following admission, to ensure that staff have clear instructions about how they are expected to meet residents needs. The Bell Memorial Home DS0000014768.V289135.R01.S.doc Version 5.1 Page 11 Staff did advise that they felt they are given information about new residents and have access to assessments. Basic information about a new resident was shared during a staff handover meeting. The care plans seen provide basic information on aspects of personal and health care needs and how these should be met by staff. However where a resident’s needs are changing it was found that care plans were not reflective of this. In some cases there were no specific care plans in place, for example in meeting mental health needs. This shortfall could be addressed through a new system of care planning that the registered manager advised she has obtained and plans to implement in the home. Similarly, risk assessments are undertaken in relation to falls and pressure areas however these do not include the action needed to manage and/or minimise the identified risk. It is therefore recommended that all risk assessments be reviewed regularly with evidence that audited accident records have been considered in order that appropriate actions for staff to follow are recorded. Particular attention must be given to falls, pressure area care and relief and mental health needs. Records indicate that health care professionals visit as required. Feedback from residents and relatives shows satisfaction that health care needs are met. Storage arrangements for medication protect residents. Specifically the arrangements for managing controlled drugs were good. However through case tracking it was noted that record keeping on Medication Administration Records (MARs) was inaccurate and therefore poses a risk to resident’s health, safety and well being. In addition to which, the inspector found that staff were signing to confirm administration of one medication that was not in stock. This not only poses a risk to residents but also to staff who could be held accountable for wrongful administration. Residents said that they felt that staff treated them with respect and upheld their right to privacy. Staff were observed knocking on doors to residents private accommodation before entering and speaking to residents in a respectful way. The Bell Memorial Home DS0000014768.V289135.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, 13, 14, & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Routines of daily living can be flexible and a variety of activities are provided. Residents are supported to maintain contact with family, friends and the local community. Residents are able to exercise choice and control. Residents enjoy a balanced and varied diet. EVIDENCE: There is a programme of activities that is provided by the staff team. During the day of this visit a member of staff was observed playing the piano in the main lounge, a game of bingo was held in the activities room and an outside performer played guitar and sang for a group in the main lounge. Residents were seen to participate and enjoy the musical entertainment. It was noted that none of these activities were provided in the small lounge and it was not clear what activities are available to this group of residents. In addition one resident did comment that the afternoon can drag if activities are The Bell Memorial Home DS0000014768.V289135.R01.S.doc Version 5.1 Page 13 not planned. 29 of residents who completed a comment card answered ‘no’ or ‘sometimes’ to the question ‘does the home provide suitable activities?’ One resident told the inspector that she had achieved two specific goals during her time at The Bell Memorial. Church services are held within the home and some residents said they attend services at the local church. Feedback from residents indicates that their visitors are welcome at anytime. Comment card responses from relatives/visitors show that 100 are welcomed into the home at anytime and can visit their relative/friend in private. Discussions with residents indicate that routines can be flexible and some said they are able to make choices about getting up and going to bed. Leaflets about external advocacy services were displayed in the main entrance of the home and residents are able to furnish their private accommodation with their own belongings. Residents said that they enjoy the meals and that they are offered a choice of food at each mealtime. Hot and cold drinks were available to residents throughout the day of this visit. A visitor commented that she is always offered a drink when she arrives. The Bell Memorial Home DS0000014768.V289135.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There is a complaints procedure in place and the home is responsive to issues. Residents are protected from abuse but guidelines for managing challenging behaviour must be included in care plans. EVIDENCE: The homes complaints procedure is displayed in the main entrance of the home and feedback from residents and staff indicates that meetings are held to discuss minor issues. However feedback on comment cards indicates that 50 of relative/visitors are not aware of the procedure and 29 of residents do not know who to talk to if they are unhappy with their care. It is therefore recommended that some work be done to publicise the procedure. Feedback from staff indicates that abuse awareness training has taken place and they are aware of and confident to use the whistle blowing procedure for the protection of residents. Although care plans did not include clear guidance for staff to follow in response to aggressive and challenging behaviour, that daily notes indicate does occur, staff provided good examples of actions they take. The Bell Memorial Home DS0000014768.V289135.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, 21 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is subject to a programme of redecoration and refurbishment, which is needed as the building is large and old. Décor and lighting need to be kept under constant review in order to promote a homely environment. Toilet, washing and bathing facilities are provided to meet the needs of residents however the home would benefit from additional facilities by refurbishing current unused space. The home is clean pleasant and hygienic. EVIDENCE: The home has been subject to redecoration and refurbishment including new chairs for the main lounge and staff are currently raising funds to purchase new furniture for the sun lounge also. However, the building is large and old and décor and lighting need to be kept under constant review in order to The Bell Memorial Home DS0000014768.V289135.R01.S.doc Version 5.1 Page 16 promote a homely environment. One resident commented ‘I’ve got a nice room with some of my own things’. It was noted during the tour of the premises that the home would benefit from another assisted bathroom; the registered manager indicated that this is in the long term plans for the home. Similarly, sluicing facilities are currently only available on one side of the building and the registered manager indicated that consideration has been given to this also. Discussions with staff indicated that staff have been given guidance on hand washing and practises to prevent the spread of infection. One comment received was ‘my clothes have a habit of disappearing in the laundry although they are labelled’ the inspectors discussed this with the registered manager who was confident that she has systems to address this. The visit began at 7.40am and the inspectors noted that the home was clean, tidy and free from offensive odour. Cleaning staff are employed in addition to care staff. The gardens are well maintained and provide an attractive and pleasant environment for residents and visitors to enjoy. Residents confirmed that they enjoy walking and sitting in the garden during good weather. The inspector had the opportunity to speak with the gardeners who demonstrated a commitment to maintain and improve this facility for the benefit of the residents. The Bell Memorial Home DS0000014768.V289135.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, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The registered persons must ensure that residents’ needs are met at all times by providing consistent staffing levels. Residents’ benefit from a trained and qualified staff team. Residents are not protected by current recruitment procedures. EVIDENCE: Feedback from residents did not indicate that any of their needs go unmet due to the staffing levels in the home. However the calculation provided by the home based on Department of Health guidance and the dependency levels of current residents indicates there is a shortfall of three full time staff within the compliment, in addition agency staff are not used to provide cover in the home. Staff however did advise that they work over time to cover planned absence. Rotas indicate that staffing levels are lower over weekends and some nights, this is reflective of findings from the last inspection and suggests that resident’s needs may not be consistently met. The registered manager advised that the home is currently recruiting two new members of staff, which, if successful, may address the shortfall. The Bell Memorial Home DS0000014768.V289135.R01.S.doc Version 5.1 Page 18 From two recruitment records sampled the inspectors concluded that residents are not protected by robust recruitment procedures and practises. Specifically, two satisfactory written references had not been obtained and Criminal Records Bureau (CRB) disclosures and Protection of Vulnerable Adults (PoVA) First checks had not been carried out prior to employment commencing. The Bell Memorial home benefits from having a training centre and training resources on site and as a result the home has exceeded the standard in relation to National Vocational Qualification (NVQ) Awards and has achieved 66 . Some staff told the inspectors that they had recently undertaken an external dementia training course, which they had found useful and had been able to apply. In addition staff have been able to share their learning with other members of staff. Evidence of formal induction for two new members of staff was not available. The person in charge advised the inspectors that both members had undertake shifts identified for induction purposes and formal induction had not started as the person responsible for this was on leave. The registered person needs to ensure that induction is completed within the twelve week timeframe. The Bell Memorial Home DS0000014768.V289135.R01.S.doc Version 5.1 Page 19 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, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The registered manager is qualified and competent to manage the home however she must ensure that other responsibilities do not impinge on the day to day running of the home. The management approach of the home encourages an open and inclusive atmosphere. There are quality assurance and quality monitoring systems in place. Residents’ financial interests are safeguarded. Staff are supported and appropriately supervised. The health, safety and welfare of residents and staff is generally promoted and protected, however work is needed to improve accident recording and auditing and risk management within the home. The Bell Memorial Home DS0000014768.V289135.R01.S.doc Version 5.1 Page 20 EVIDENCE: Information from more than one source indicates that the management approach has changed, with some negative effects, recently. This was discussed with the registered persons during, which the registered manager acknowledged that the change of responsible individual and a recent busy period at the training centre had impacted on her accessibility. On reviewing the training planned for the next six months the inspector were satisfied that the registered manager has sufficient time to carry out her duties as registered manager. Staff said they felt supported and able to approach the management team with any issues. Staff also confirmed that they receive 1-1 supervision. A quality assurance system is in place within the home and an annual management review report was provided to the Commission on 3rd March 2006 in which actions and business objectives have been identified. The home is able to keep small amounts of money safely, for residents if they so wish. A record is kept for these residents, which details any transactions, and receipts are kept for any expenditure. A sample of records was seen and these were accurate and up to date. It is recommended that where larger amounts of money have accumulated this is transferred to the residents own bank account. Information received prior to the visit indicates that all equipment is regularly serviced. Staff confirmed that they receive fire safety training and had recently carried out a practical session, during which they used fire extinguishers. During the visit a test of the fire safety alarm system was carried out. Accidents are recorded but incidents logged in daily notes within care plans had not been transferred to an accident or incident report. The registered manager maintains a log of all falls, however it is felt that a full audit is not carried out and the results of this are not linked to individual assessments of risk for residents, to protect their health safety and well being (see standard 8). The Bell Memorial Home DS0000014768.V289135.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 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 2 17 X 18 2 3 X 3 X X X X 3 STAFFING Standard No Score 27 2 28 4 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 2 3 X 1 The Bell Memorial Home DS0000014768.V289135.R01.S.doc Version 5.1 Page 22 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 OP8OP38 Regulation 13(4 c) Requirement Timescale for action 10/06/06 2. OP9 13 (2) 3. OP27 18 (1 a) 4. OP29 19(1) The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. The registered person shall make 10/06/06 arrangements for the recording, handling, safe keeping safe administration and disposal of medicines received into the care home. 10/06/06 The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. Staff records must include the 31/05/06 information and documents specified within Schedule 2. Previous time scale of 29/12/05 not met. The Bell Memorial Home DS0000014768.V289135.R01.S.doc Version 5.1 Page 23 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 The Bell Memorial Home DS0000014768.V289135.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 The Bell Memorial Home DS0000014768.V289135.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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