CARE HOMES FOR OLDER PEOPLE
The Bell Memorial Home 164 South Street Lancing West Sussex BN15 8AU Lead Inspector
Mrs K Leppard Announced Inspection 29th November 2005 10:00 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.V258597.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. The Bell Memorial Home DS0000014768.V258597.R01.S.doc Version 5.0 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.V258597.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 46 persons in the category OP (over 65 years) Date of last inspection 24th June 2005 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 home has recently been successful in achieving its second Investors in People review. The registered manager is Mrs. Condick and the recently appointed Responsible Individual for the home is Mrs. Gillian Rodway. The Bell Memorial Home DS0000014768.V258597.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was announced and was carried out on Tuesday 29th November 2005 between 10am and 5pm. Prior to the inspection two relative/visitor comment cards were received. The content of these was shared with the registered persons during the inspection. Twenty residents also completed a comment card with the assistance of a member of staff from the home. Throughout the day the inspector spoke with ten residents sitting in communal areas about their experiences of living at The Bell Memorial Home and spoke with two staff individually. Feedback and comments have been used in this report. The registered manager and her deputy assisted the inspector throughout the day. What the service does well: What has improved since the last inspection?
Through the process of the inspection the following improvements were noted: The outside of the home has been painted over the last few months and this has made a substantial difference to the look of the home.
The Bell Memorial Home DS0000014768.V258597.R01.S.doc Version 5.0 Page 6 Internally work has been done to replace some ceiling tiles that were noted to need attention at the last inspection. Assessments of prospective residents are undertaken and support to meet residents’ mental health needs is being sought. The storage of substances that are hazardous to health protects the health and safety of residents and staff. Residents who spoke with the inspector indicated that their care plan is being shared with them. Monitoring of resident’s weight is undertaken regularly and those at risk of poor nutrition have an assessment in place. Residents indicated that the routines in the home allow them to make choices. Some hand rails have been fitted on ground floor corridors that are used frequently by residents. 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.V258597.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 The Bell Memorial Home DS0000014768.V258597.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, 3 & 5 The Statement of Purpose has been reviewed to reflect changes. Prospective residents needs are assessed before they come to live in the home and opportunities are available to visit the home. EVIDENCE: Due to changes in the home’s committee the Responsible Individual has recently changed and the Statement of Purpose has been amended to reflect this. Residents who spoke with the inspector about the process for deciding to live at the Bell Memorial Home indicated that opportunities had been available to visit the home. Some residents had stayed at the home short term prior to making a decision to live there permanently. One resident said that the registered manager had visited her before her admission and documentary evidence was provided that assessments of need are obtained and conducted by the home’s staff prior to admission. Records also indicated that social services reviews are facilitated and initiated by the
The Bell Memorial Home DS0000014768.V258597.R01.S.doc Version 5.0 Page 9 home if the resident’s needs change such as deterioration in a resident’s mental health. The Bell Memorial Home DS0000014768.V258597.R01.S.doc Version 5.0 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 & 10. Care plans set out the health, personal and social care needs of residents. Health care input for residents is good. Resident’s privacy and dignity is respected. EVIDENCE: A sample of care plans were looked at. They contain comprehensive information about the needs of residents and are updated regularly. Residents asked, were aware of their care plan and the deputy manager provided evidence of a care plan that has been shared and agreed with a resident’s representative. This feedback indicates a positive improvement in the home’s practise. Evidence was available that where poor nutrition is a risk to residents a nutritional assessment has been introduced. Residents are weighed regularly. Residents who spoke with the inspector said they could see their GP if they needed to and one resident said that community nurses are currently visiting her regularly.
The Bell Memorial Home DS0000014768.V258597.R01.S.doc Version 5.0 Page 11 Comment card responses indicate that the vast majority of residents feel that their privacy is respected and those residents asked responded positively when asked if staff knock on their bedroom doors. Staff too gave good examples of how they respect resident’s dignity when they are providing support with personal care. The Bell Memorial Home DS0000014768.V258597.R01.S.doc Version 5.0 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): 14 & 13. Routines in the home allow residents to make choices. Residents feel that their visitors are welcomed into the home. EVIDENCE: Responses on relative/visitor comment cards indicate that staff do not welcome visitors into the home, one comment received was ‘some staff could be friendlier and more welcoming, like offering a drink and a chair to sit on in relative’s room’. From discussion with residents the inspector concluded that they feel their visitors are welcomed into the Bell Memorial and this includes being offered a drink if morning coffee and afternoon tea are being served when they arrive. The inspector observed that most residents were out walking or sitting in lounges during the morning, this is in part due to the fact that residents are asked to allow cleaning staff to clean bedrooms before they return to them. From discussion with residents this does not appear problematic and those spoken with preferred to be in communal areas with the company of other residents during the morning. The Bell Memorial Home DS0000014768.V258597.R01.S.doc Version 5.0 Page 13 When asked about the routines in the home residents commented “They don’t tie me to rules and regulations’ and ‘it’s very free and easy here’. Residents said they are offered the choice of joining in with activities and similarly their choice to spend time alone is respected. The Bell Memorial Home DS0000014768.V258597.R01.S.doc Version 5.0 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 The home has a complaints procedure and residents know who to speak to if they are unhappy with their care. EVIDENCE: Responses on relative/visitor comment cards indicate that the respondents are not aware of the complaints procedure. The registered persons should consider how this could be addressed to ensure the complaint procedure is well publicised. However, the majority of residents who completed a comment card said they do know who to speak to if they are unhappy with their care. One resident talked about resident meetings they are held and explained that these are used to raise issues, one resident said ‘there’s always someone to talk to’. The Bell Memorial Home DS0000014768.V258597.R01.S.doc Version 5.0 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, 22 & 26 The environment is subject to ongoing improvement, which is needed to maintain and raise the standard of accommodation. The provision of equipment has been reviewed. The home is clean, hygienic and safe. EVIDENCE: The building is large and old and décor and lighting need to be kept under constant review in order to promote a homely environment. Since the last inspection the external paintwork has been renewed, which has made a substantial difference to the initial impression given by the home. Since the last inspection some ceiling tiles have been replaced where this was noted as needed. The home has had a fire officer report and the registered manager said that works to ensure fire safety would be complete within the timescales set by the fire officer.
The Bell Memorial Home DS0000014768.V258597.R01.S.doc Version 5.0 Page 16 The registered manager said that the provision of equipment has been reviewed since the last inspection. The main improvement is the installation of a handrail along a main corridor on the ground floor. This will also need to be kept under constant review in order to meet the needs of residents. The home employs cleaning staff and the home is clean to a satisfactory standard. Practises for storing substances hazardous to health ensure the health, safety and welfare of residents. The Bell Memorial Home DS0000014768.V258597.R01.S.doc Version 5.0 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 Staffing levels should ensure that the home is satisfactorily staff consistently. The Bell Memorial has exceeded the National Minimum Standard in relation to the percentage of staff with a National Vocational Qualification at Level 2. The recruitment practises in operation are not satisfactorily robust to protect residents. A comprehensive programme of training is provided to staff. EVIDENCE: Visitors/relatives who completed a comment card indicated that in their opinion staffing levels are not always sufficient. Residents who spoke with the inspector did not raise this as a concern and those residents asked about the response from staff to call bells said that this is satisfactory. The inspector noted that staff were present in lounge areas more so than on previous occasions and this is a good use of staff to provide reassurance and stimulation to residents. The staff rota for the week of the inspection shows that early shifts are covered by between five and nine staff, late shifts are covered by between four and six staff and three or four staff cover night duties. Some shift times vary but most morning and afternoon duties overlap between 2 and 4pm when up to ten staff can be on duty. The lack of consistency in staffing levels may
The Bell Memorial Home DS0000014768.V258597.R01.S.doc Version 5.0 Page 18 account for relatives/visitors views that the home is not always sufficiently staffed and it is recommended that this be addressed. In addition to care staff the registered manager and her deputy work full time and kitchen, laundry, domestic, maintenance and reception staff are employed by the home. Two staff recruitment records were inspected and found to be lacking the necessary information to meet the requirements of the Care Homes Regulations 2001. Specifically, staff had begun supervised employment prior to receipt of a satisfactory Criminal Records Bureau (CRB) and PoVA check or PoVA First check. These practises do not protect residents and must be addressed. Twenty one care staff have achieved an NVQ at Level 2 or equivalent and this represents 70 of the care staff employed by the home. Staff have been given opportunities to train as NVQ assessors and a member of staff is responsible for providing induction training to meet the new Skills for Care Common Induction Standards. Induction training workbooks were not available for inspection. The Bell Memorial Home DS0000014768.V258597.R01.S.doc Version 5.0 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, 33, 35 & 38 A qualified and competent manager manages the home. A quality assurance system is in operation. Resident’s financial interests are safeguarded. Health and safety is promoted and protected by the home. EVIDENCE: The registered manager and her deputy are trained nurses and have also achieved the NVQ at Level 4. The registered manager has also achieved the registered manager’s award. Staff feedback indicates that systems for support and supervision are operated and residents talked about meetings that they are invited to participate in. One resident commented ‘Mrs. Condick is very nice, very considerate’.
The Bell Memorial Home DS0000014768.V258597.R01.S.doc Version 5.0 Page 20 A quality assurance system that ensures all aspects of the home are regularly reviewed is in operation, this includes resident surveys. The end of year report is due to be compiled in December 2005 along with budgets for the coming year and these will take into account the changes that have occurred in the reorganisation of the home’s committee recently. These results should be published and made available to interested parties including the Commission for Social Care Inspection as they have been previously. Some residents have money stored by the home for safekeeping and the registered manager is appointee for one resident. Records are made of transactions and the balance. These records are satisfactorily maintained. Equipment in the home is regularly serviced and accidents are recorded and monitored. Staff who spoke with the inspector said they receive regular training in health and safety topics such as moving and handling, first aid and food hygiene. Records of fire induction training were also seen. The registered manager must ensure that these are completed when training has been provided. The registered manager has been provided with guidance on the safe use of bed rails to support her to ensure that the use of bed rails in the home is appropriately assessed. The Bell Memorial Home DS0000014768.V258597.R01.S.doc Version 5.0 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 3 X X 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 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X 3 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 X 3 X 3 X X 3 The Bell Memorial Home DS0000014768.V258597.R01.S.doc Version 5.0 Page 22 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 OP29 Regulation 19(1) Requirement Staff records must include the information and documents specified within Schedule 2. Timescale for action 29/12/05 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 Refer to Standard OP27 Good Practice Recommendations It is recommended that consistent staffing levels be achieved that meet residents needs at all times. The Bell Memorial Home DS0000014768.V258597.R01.S.doc Version 5.0 Page 23 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
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