CARE HOMES FOR OLDER PEOPLE
The Belmont Schools Hill Cheadle Stockport Cheshire SK8 1JE Lead Inspector
Kath Oldham Unannounced Inspection 27th February 2007 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 The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 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 Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Belmont Address Schools Hill Cheadle Stockport Cheshire SK8 1JE 0161 428 7375 0161 428 7374 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) The Belmont Care Homes Ltd Janet McManus Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home is registered for a maximum of 40 service users to include: *up to 40 service users in the category of OP (Old age not falling within any other category). The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 23rd May 2006 Date of last inspection Brief Description of the Service: The Belmont is a large, two-storey house set in its own extensive grounds. In the past, the home belonged to the Kendal Milne family, although its history extends further back. The home provides a service to 40 older people. The home has four lounge areas and two dining rooms on the ground floor. Stairs and a passenger lift are available to enable service users to access the upper floors. The home is situated near to the village of Cheadle and is well placed for access to a large retail-shopping outlet. The home has a statement of purpose and service user guide which were reported to be given to prospective service users or their families when they visit the home to look round. The fees for staying at the home were reported to be between £337 and £450 per week. The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the report of the key inspection of The Belmont, which included an unannounced visit. The Belmont was previously inspected on 23rd May 2006, when all the key standards that must be inspected each year were assessed. There were 30 requirements issued on that inspection in addition to six good practice recommendations. A further unannounced inspection was undertaken on 13th October 2006, where the focus was to look at what the home had done since the key inspection of 23rd May 2006. At that inspection 12 of the requirements had been met. This inspection concentrated on the outstanding requirements and much of the inspection was taken up in conversation with the acting manager and in the examination of paperwork, which needs to be in place to ensure compliance with the regulations. Comment cards were given to the acting manger to distribute to service users, relatives and visitors, and to staff. The comments received are included in this report. Comment cards received after the writing of this report will be used as part of the next inspection. In addition to the examination of paperwork, a partial inspection of the home was undertaken, lunch was also taken at the home with the service users. The case files of three service users were looked at in detail, looking at their experiences in the home from their time of admission to the present day. The inspector spoke with several members of staff who were on duty. The registered manager is on long term sick and an acting manager has been appointed to develop the home. The acting manager was on duty and verbal feedback was given to her on conclusion of the site visit. The registered person attended the home during the site visit and spent some time with the inspector. Since the last inspection the Commission has received a number of concerns in relation to the staffing arrangements at the home. The registered person addressed this and a response to these comments was forwarded to the Commission. The response identified that all the areas of concern had been dealt with. The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection?
The decoration and furnishings in the home have been improved upon and the majority of the public areas of the home have benefited from having new carpets fitted and being redecorated. Service users commented that it had enhanced the appearance of the living and dining room and the corridors and hallways look bright and well lit. One service user said the home was always clean but now looked much brighter. A number of bedrooms have been redecorated and, where needed, new carpets fitted. This has again improved the comfort for service users. The care plans have received attention and the majority of service users now have the new care plan format in place. This goes some way to ensure that the needs of service users are written down and staff are clear what support and help individual service users need. There was evidence that the care plans had been reviewed and changes made when service users need more or differing help or assistance. Risk assessments are in place which goes some way of supporting service users to be independent and identifying any difficulties which may affect their health or safety. The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 7 The three care plans examined gave a clear indication of service users’ abilities and their past lives which enables staff to support them and understand their background and health problems. The acting manager said that all service users would have an up to date care plan in place within one month. A requirement, which has been outstanding for some time, has, in the main, been complied with. The requirement was in relation to the installation of radiator covers to minimise the risk to service users of having an accident. A risk assessment has been undertaken on the radiators that continue to need the guards fitted. The maintenance man said that the ones that did need replacing were not near to service users’ beds or chairs. It is the registered person’s responsibility to ensure the health, safety and wellbeing of service users. The remaining radiators do need to be guarded or be low surface temperature as an additional safeguard to service users. One radiator within a service user’s bedroom had been turned off, so there was no chance of this becoming too hot. This was due, the maintenance person said, to there being two radiators in the room and the service users commenting that they were too hot with both operational. Medication training has been scheduled and was due to commence on 2nd March 2007. Ten staff are to attend this 16-week training course to ensure they have the knowledge they need to administer medication safely to service users. The acting manager has a format, which she is to amend to suit the home, to enable her to monitor the competency of staff periodically when giving out medication. All newly appointed staff files examined contained evidence that a police check had been requested and a POVA first confirmation received before they commenced working at the home. This provides some protection to service users. A fire risk assessment has been compiled and it was reported that this had been forwarded to Greater Manchester Fire Officer for agreement. Records required by regulation must be available for the purpose of inspection. On a previous visit, maintenance records were not available to confirm that identified work had been undertaken. All records requested on this visit were available and those seen were in order. The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 8 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 summary of this inspection report can be made available in other formats on request. The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 9 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 Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: Standard 3 was assessed on the inspection undertaken in May 2006. Readers should refer to that inspection report to get a full picture of that assessment. The standard was met at that time. Intermediate care is not provided at The Belmont. The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7&9 Quality in this outcome area is good. care, which are regularly reviewed to they have access to medical services This judgement has been made using this service. Service users have individual plans of ensure they reflect current needs and to ensure their health needs are met. available evidence, including a visit to EVIDENCE: Examination of the care files identified that the format used to record service users’ needs and abilities was informative and gave staff details of their care needs and abilities and preferences. There was evidence that service users’ needs were assessed and that risk assessments were in place to highlight any risk and the action taken to minimise the risk. Not all service users have this updated care plan in place. The acting manager gave assurances that all service users would have a detailed care plan in place within the month. The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 12 The care files also detail service users’ nutritional assessment, a moving and handling assessment and for service users who are at risk of developing pressure sores, an assessment of this. Examination of the daily and night-time reports identified that, in some cases, staff entries were judgemental and patronising. There were also some occasions when entries were not made daily. Staff need guidance and support in completing these reports to ensure the entries are accurate and reflect the care and support service users receive. Ten staff are scheduled to commence medication training on 2nd March 2007. It is a 16-week course, which should assist staff to understand and have increased knowledge in the correct way to administer medication. The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Quality in this outcome area is adequate. The provision of social activities is insufficient and leaves service users feeling unfulfilled and lacking in stimulation. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Service users are, in the main, without regular activity and stimulation during the day. The acting manager said that staff will do the occasional quiz and entertainers come to the home periodically. Service users commented that they felt that there was no focus to the day except for meal times and the days seemed long due to lack of stimulation. The full time activities co-ordinator has been away from work for a few months. A small group of service users who were used to going out with the co-ordinator are missing this. The acting manager said she would look into developing the activity and stimulation for service users and arrange for some structured activities to be arranged which meet service users’ needs and requests. The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. The complaints procedure ensured that all interested parties were aware of how to complain and the process that would be undertaken. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: A complaints procedure is in place. Service users commented that they were aware of who to complain to and felt that their complaint would be listened to and acted upon. The complaints record did not include any comments or complaints since September 2006. The comments and complaints from service users and their representatives are an integral part of a home’s quality assurance and should assist in the development of the home. The recording of comments and complaints needs to be further developed. The regularity of residents’ meetings has not been kept up and a meeting has not been arranged since October 2006. Service users felt that the meetings were a good thing and gave them an opportunity to discuss any ideas, worries or concerns. These need to be reinstated to provide service users with an opportunity to influence the service they receive at the home. The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 15 The home has a procedure for responding to allegations of abuse. A number of staff have attended in-house training on the subject to increase staff’s awareness of adult protection. Some staff had not had this training. This will provide all staff with the skills and knowledge to identify signs of abuse and be aware of what actions must be taken if abuse is alleged. The acting manager said this training would be arranged. There has been one complaint made to the Commission for Social Care Inspection which was passed to the home to investigate. There have been no safeguarding issues since the last inspection. The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. The home is appropriately maintained, decorated and cleaned to enable service users to live in a pleasant, safe and hygienic environment. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: During this visit a tour of the building was undertaken. This included communal areas and a selection of service users’ bedrooms. There were several communal areas where service users could spend their time, or they could access their rooms when they chose. The building presented as appropriately maintained and decorated throughout. No items requiring remedial maintenance were identified. The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 17 Since the previous visit, the main hall, lounges and dining rooms had been refurbished. The areas looked clean and fresh and comfortable. Service users commented that the home was a good place to live. Service users’ bedrooms showed clear signs of personalisation. The acting manager confirmed that, subject to space and health and safety requirements, service users were encouraged to bring their own possessions into the home. The home presented as being clean and tidy throughout. This was confirmed as the usual state of the home by service users and staff spoken to. One visitor described the home as “beautifully clean” and another said the home was “always nice and clean”. One service user said they had a “very nice room” which was always kept clean and tidy. The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. Recruitment procedures are in place and appropriate to ensure that only suitable staff are employed. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: There have been a number of new staff appointed since the last inspection. The staff rota was examined and demonstrated that staffing was predominantly maintained at a level of between four and five carers from 08:00 and 20:00, and three carers between 20:00 and 08:00. There were occasions throughout the week when staffing levels were higher than this. The acting and deputy managers’ hours were in addition to those identified above. Additionally, the home employed cooks, domestic staff and a maintenance man. There continue to be some staff vacancies. The deputy said that these were in hand and they were waiting for all the checks to be received before appointment. The acting manager reported that difficulties identified in relation with staffing levels had now been resolved. The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 19 The home employs two cooks; one has basic food hygiene training, the other has not. The attendance to training keeps cooking staff up to date with changes in legislation and best practice guidance and safeguards service users. Examination of a sample of newly appointed staff files found that criminal record bureau checks or POVA first checks had been obtained prior to staff commencing employment. This goes some way to protecting service users. All staff files examined contained a completed application form. Advice was given to ensure that staff complete the whole of the form and clearly indicate their employment history and the dates they were employed. Though new staff complete an induction/orientation programme, the acting manager informed the inspector that induction and foundation training had not commenced to the levels set by Skills for Care. There was evidence of staff taking part in mandatory training. However, this did not include all staff and updates for some training were necessary. It was reported that all staff had received moving and handling training. Six staff have obtained NVQ levels 2 or 3, with other staff hoping to commence study for this qualification. The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 38 Quality in this outcome area is adequate. In the main, the health and safety arrangements in place provide for the home to be a safe place to live and work. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The registered manager is on long-term sick leave and has been for some months. An acting manager has been appointed and is beginning to have an effect on the service provided to service users. Additional staff have been employed to cover the resignation of some staff and to improve on the staffing levels at the home. The acting manager is currently studying the Registered Manager’s award. The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 21 A representative of the registered person attends the home on a monthly basis and undertakes a report of that visit which is routinely sent to CSCI, in line with regulations. The visit is to ensure that the registered person is aware of how the home is running. Service users had not had a residents’ meeting since October 2006 when the opportunity is used by them to comment on the care and support they receive. A number of bedroom doors continue to be wedged, propped or kept open; this increases the risk to service users and staff. The acting manager said she had spoken with staff repeatedly in regard to this and debates have been taken place in relation to service users’ choice to have their bedroom doors open. The acting manager should liaise with the fire authority to find solutions to this practice, as the responsibility for ensuring the safety of services users, staff and visitors remains with the registered provider. It is the registered person’s responsibility to ensure the health, safety and wellbeing of service users. A fire risk assessment for the building was available on the visit. It was reported that the Greater Manchester Fire Authority had been sent a copy for agreement. The requirement to produce a fire risk assessment is complied with. Examination of up to date health and safety certificates in place included servicing of the lift and hoists. The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 22 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 STAFFING Standard No 27 28 29 30 Score X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 9 10 11 3 X X X X X X 3 X 3 X X 3 2 2 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 2 The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 23 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 OP12 Regulation 12 Requirement The registered person must develop the type and routine of activity and stimulation provided to service users. (Timescale of 31/10/06 not met). The registered person must provide staff with the training they need to undertake the position they are employed to do which must include, at a minimum, first aid, infection control, basic food hygiene and health and safety. (Timescale of 31/10/06 not met). Timescale for action 30/04/07 2 OP28 18 30/04/07 The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 24 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 OP16 Good Practice Recommendations The registered person should develop the recording in the complaints record and follow the procedure when investigating complaints, ensuring the process is thorough and safeguards service users and staff. The registered person should provide all staff with training in what constitutes abuse and how to recognise the symptoms. The registered person should fit covers to all the radiators in the home. The registered person should ensure that the recruitment and selection procedures are robust and that staff complete application forms fully and copies of ID are held on file. The registered person should confirm that the homes induction and foundation training complies with NTO standards and details which staff are currently undertaking such training. The registered person must arrange for all staff who have the responsibility of preparing or cooking food with basic food hygiene training and for full-time cooks, advanced level training. The registered person should reinstate service user meetings at an increased regularity to provide an opportunity for service users to comment on the care and support they receive. The registered person should amend the fire safety policy to reflect actual practice for an emergency situation. The registered person should liaise with the fire authority to find solutions to the practice of bedroom doors being wedged open, or develop their own practice to ensure that fire safety is promoted at all times within the home. 2 3 4 OP18 OP23 OP28 5 OP30 6 OP30 7 OP33 8 9 OP38 OP38 The Belmont DS0000060734.V329661.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashton-under-Lyne Area Office 11th Floor, West Point 501 Chester Road Old Trafford Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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