Care Home: Belamie Gables

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What the care home does well Belamie Gables provides appropriate information for prospective service users and all have their needs fully assessed to be sure the home can provide them with appropriate care and support. People`s health and care needs are generally well met and, although there is room for improvement, they enjoy the lifestyle provided by the home. The people who live at Belamie Gables have their complaints listened to and acted upon and they are safeguarded from possible abuse. They live in a safe and generally well maintained environment which is clean, pleasant and hygienic. The home has the necessary number of skilled staff to meet the needs of the people who live there. People are generally supported by staff who are well trained. A large percentage of staff are qualified. The people who live at Belamie Gables benefit from the home being well managed, and run in their best interests. They experience care which is delivered in a safe manner within a healthy and safe environment. What has improved since the last inspection? Two requirements were made following the last inspection. The first one stated that the home must only admit people whose needs it can meet, as documented in its Statement of Purpose. We saw evidence during our inspection that this requirement has been met and the home now only admits people following a full assessment and a decision that they can suitably meet each person`s needs. The second requirement stated that the home must ensure that external areas are appropriately maintained, to ensure the safety and welfare of residents. We saw evidence during our inspection that improvements have been made to the external areas of the property and that it is within the home`s current action plan to improve these areas further. What the care home could do better: We have made one requirement as a result of this inspection to ensure that a suitably trained person is always available to administer medication. This relates to there not always being a person on duty at night who had attended a medication training course. Other improvements that the service needs to make include the need to further improve the outside area of the home and introduce a wider range of activities, including use of the garden, which would improve the opportunities for the people who live there. The home is aware of these improvement areas and already has them as part of their action plan. The proprietor must ensure they undertake monthly reviews of the home in line with regulation 26 of the Care Homes Regulations. This will ensure they are monitoring the performance of the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Belamie Gables 210 Hyde End Road Spencers Wood Reading Berkshire RG7 1DG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Amanda Longman     Date: 2 9 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Belamie Gables 210 Hyde End Road Spencers Wood Reading Berkshire RG7 1DG 01189883417 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : belamiegables@hotmail.co.uk Mr J Parry,Mr D L White care home 20 Number of places (if applicable): Under 65 Over 65 20 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 20 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Belamie Gables is a privately owned care home. The service is registered to provide personal care and accommodation for up to 20 persons. The home is not registered to provide nursing care or care to people with dementia, as this would require additional registration categories. It is situated in a quiet residential area to the south of Reading. The property is a large detached house set back from the main road. There are large front and rear gardens with car parking spaces at the front of the property. There is a passenger lift in the building and accommodation is provided on two floors. Care Homes for Older People Page 4 of 27 Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the service was an unannounced Key Inspection. It was a thorough look at how well the service is doing. We (the commission) received detailed information from the service in the form of an annual quality assurance assessment (AQAA). This provided details of current care provided, as well as plans for the future, details of staff and resident numbers, qualifications and training of staff, and information about the health and safety of the home. A site visit was undertaken on 29 April 2009 by Amanda Longman, regulatory inspector. During this site visit we looked round the home, observed care practices and spoke with people living at Belamie Gables and staff working there. We examined care records and staff records. The service has in place policies and procedures relating to equality and diversity and Care Homes for Older People Page 6 of 27 there was evidence that they could meet a range of different needs and choices. The last inspection of this service was undertaken 29 April 2008. What the care home does well: What has improved since the last inspection? What they could do better: We have made one requirement as a result of this inspection to ensure that a suitably trained person is always available to administer medication. This relates to there not always being a person on duty at night who had attended a medication training course. Other improvements that the service needs to make include the need to further improve the outside area of the home and introduce a wider range of activities, including use of the garden, which would improve the opportunities for the people who live there. The home is aware of these improvement areas and already has them as part of their action plan. The proprietor must ensure they undertake monthly reviews of the home in line with regulation 26 of the Care Homes Regulations. This will ensure they are monitoring the performance of the home. Care Homes for Older People Page 8 of 27 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Belamie Gables provides appropriate information for prospective service users and all have their needs fully assessed to be sure the home can provide them with appropriate care and support. Evidence: Belamie Gables has a detailed Statement of Purpose in place which was reviewed in April 2009. Of the people who replied to our survey, all said they had a contract and 75 said they had plenty of information to make a decision about moving in to the home (one respondent was an emergency admission). Belamie Gables has an appropriate, detailed assessment procedure in place. We looked at the records for four people who have been admitted and they all had a full assessment of their needs. Care Homes for Older People Page 11 of 27 Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and care needs are generally well met. However, the home must ensure that a suitably trained person is always available to administer medication and the home should encourage and promote residents continence care. Evidence: The four records we looked at all had detailed care plans in place which had been reviewed monthly, or more frequently. These showed the care to be provided, personal preferences such as how they like to be addressed and the times they like to get up and go to bed, medical information, including GP visits, and detailed risk assessments and management plans for a variety of activities including handling, bathing, pressure, falls, nutrition, walking and escorting. Risk assessment were personal to each person as their needs dictated. For example there was a risk assessment for oxygen in place because someone living at the home uses oxygen. The surveys that were returned by members of staff stated that they always had up to date information about peoples needs. In the surveys returned by people living at Care Homes for Older People Page 13 of 27 Evidence: Belamie Gables 50 said they always received the support they required and 50 said they usually did. 100 of the respondents said that staff always listened and acted on what they said. 75 of people said they always received the medical support they needed and 25 said they usually did. The people we spoke with on the day of our site visit all said the care they received was very good. Belamie Gables own quality assurance survey for 2009 showed 83 of respondents thought the care provided at the home was excellent or very good, with the remaining respondents saying the care was good. The medical needs of individuals are detailed on their care plans and the staff we spoke with were knowledgeable about individual needs. District nurses visit the home regularly, as required, to administer nursing care where appropriate and relevant records are maintained. The home has in place policies relating to dignity and choice and individual preferences and choices are detailed on peoples care plans. People we spoke with confirmed they are able to get up and go to bed when they wish and can spend their day how they wish. We saw that some people choose to spend their time in their rooms and some people choose to spend their time in the communal areas. We discussed the homes approach to manageing continence with the manager and the need to promote continence care. The majority of people at the home on the day of our site visit were wearing incontinence pads. In the information supplied to us prior to our site visit it stated a minority of people living at Belamie Gables were incontinent. One person we spoke with felt they didnt really need them but was happy to wear them incase she had an accident. The manager stated that pads were only used for people who needed or wanted to use them. One of the care plans we looked at was for a person who uses incontinence pads and the care plan clearly showed that this had been reviewed. The home has a medication policy in place. Medication is approrpiately stored. Records showed that not all staff had received medication training. The rotas showed that this sometimes means that there are no night staff on duty who have attended a medication adminisration training course. The manager explained that these staff have received an in-house briefing but there were no records to show that this had taken place. On the day of our site visit the manager returned to the home in the evening to administer the medication herself to overcome this problem. The manager undertook to ensure there was always some one on duty who was trained to administer medication. Care Homes for Older People Page 14 of 27 Care Homes for Older People Page 15 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Belamie Gables enjoy the lifestyle provided by the home but a wider range of activites, including use of the garden, would improve the opportunities for the people who live there. Evidence: Information received from the manager informed us that people have autonomy and choice about their daily routines and how they spend their time. People we spoke with said they could choose when they got up or went to bed, where they spent their time, for example, the lounge or their room. We saw that personal preferences, including what times people like to get up or go to bed, are documented in peoples care plans. They stated that visitors are always welcome in the home. An activites rota was on display in the home. There are some activites every day except saturday. Examples of activites include quizes, bingo, excercise to music, aromatherapy and local walks. A religious service is held once a month on a Sunday but staff informed us that other arrangements can be made to meet religious needs. For example, in the past someone has come to give communion. The manager stated that in assessing an individuals needs every effort would be made to meet individual Care Homes for Older People Page 16 of 27 Evidence: diverse needs, including those relating to religion. On the surveys received from staff, one of the comments made about how the home could be improved was to give more attention to activities, especially outdoors. Of those people who live at Belamie Gables who replied to our surveys, 50 said always, 25 usually and 25 sometimes there were activities they could join in. Some improvements have been made to the garden but comments were made to us included that it would be nice to use the garden more for activites in the summer. The home has a varied menu and states it caters for individual needs and preferences. An example of this was provided in a comment on one of the questionnaires returned relating to what the home does well. It stated that staff had been given extra training to prepare specialist meals for example diabetic and halal meals. Of the surveys received from people who live at the home 100 said the meals were always good and extra comments included the cook bends over backwards to give me things I like and that the vegetarian meals are very enjoyable. People we spoke with on the day of our site visit said the food is excellent. One person who chooses to stay in their room told us that the cook visits her every day to see what she would like from two or three choices. Care Homes for Older People Page 17 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Belamie Gables have their complaints listened to and acted upon and they are safeguarded from possible abuse. Evidence: The home has an appropriate complaints procedure in place, a copy of which is provided for all the people who live at Belamie Gables. The information provided to us before the site visit showed that one complaint had been recieved which had been dealt with within 28 days. We had also been made aware of this complaint at the time. All the responses we received to our survey stated that people knew who to speak to if they were not happy and that staff always listen and act on what someone says. This was confirmed when we spoke with people during our site visit. There is an appropriate policy in place to safeguard vulnerable adults and all but two of the current staff members attended vulnerable adults training in 2008. One did in 2007 and also has her NVQ level 2 and one member of staff was yet to receive training. The manager agreed to arrange this as soon as possible. 100 of the staff responses to our survey stated that they knew what to do if they had any concerns. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Belamie Gables live in a safe and generally well maintained environment which is clean, pleasant and hygeinic. The home needs to carry through its plans to further improve the outside areas. Evidence: We had a look around the home on the day of our site visit. The people we spoke with liked their bedrooms, said they were comfortable and that they had everything they needed. We viewed some rooms from the doorways and were invited to view other rooms by the people in them. The rooms were small but well equipped and they were personalised with peoples own belongings. One of the people we spoke with, who chooses to stay in their room was very happy with their room which contained lots of personal items. The maintenance of the home has recently been taken over by the owners son and a maintenance log is being maintained. We noticed a few minor maintenance issues, for example one bare light bulb in one of the corridors and one missing handle from a bedroom drawer. The manager confirmed these would be dealt with. We saw that the garden has level paths and benches. Improvement of the garden is part of the homes current action plan. The outside front area has been tidied and the Care Homes for Older People Page 19 of 27 Evidence: appearance of the home has improved. New, matching, net curtains have been put up since our last visit but the bins still need to be boxed in. We spoke to the provider about this during our visit who undertook to ensure this was done. During our visit we observed that the home was very clean and pleasant. 75 of people living at Belamie gables who returned surveys to us said the home was always fresh and clean and 25 said it usually was. This was confirmed by people we spoke with during our site visit. We observed there are appropriate facilities for handling laundry. Staff receive training in infection control and food hygiene. One member of staff commented on their returned survey nice and clean environment. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has the necessary number and skill mix of staff to meet the needs of the people who live there. They need to continue to keep this under review, particularly in regard to night time care needs. People are generally supported by staff who are well trained and a large percentage of staff are qualified. Evidence: The rota for the day of our site visit showed, excluding the manager, four staff on duty from 7.30am, five staff from 8.30am. This reduces to three at 12.30pm and two from 3.30 until 7.30pm. Two night staff work from 7.30pm, one of whom becomes a sleeping-in person later in the evening. This is a new arrangement and the manager explained it was under review. We saw that not all the people who work alone at night have received all of the appropriate training. This was a particular issue in regard to medication and is addressed in outcome area 2, earlier in this report. It was also the case with emergency first aid training. At the time of our site visit no one living at the home needed help from two carers at once but the manager explained, if an unplanned or emergency incident necessitated this the person on night duty wakes the person on the sleep in duty. Likewise if it is a male care assistant on night duty and someone reguring assistance prefers to receive help from a female care assistant, the sleep in person will provide the assistance. 75 of the people who live at Belamie Gables who returned surveys to us stated there were always enough staff on duty to Care Homes for Older People Page 21 of 27 Evidence: meet their individual needs, and 25 said there usually were. Where people are employed at the home in two different capacities, for example admin assistant and carer, or house keeper and carer, the rota did not make it clear which times they were working in which capacity. We discussed this with the manager on the day of our site visit who agreed to ensure this was clear on the rota. The home has an appropriate recruitment procedure in place. No recruitment has happenned since our last inspection. One person had transfered to a caring role and was working through her six month induction course at the time of our visit. The home maintains a training and development plan for each of its staff but at the time of our site visit this was not up todate. However an up to date training matrix provided evidence that the home is providing relevant training for its staff. (The issue of medication training is covered earlier in this report, in outcome area 2.) People we spoke with who live at Belamie Gables said staff were well trained. We saw evidence that the deputy manager has undertaken a train the trainers course and 100 of the staff who returned surveys to us said that training is relevant, up to date and enabled them to meet diverse needs. Approximately 65 of care staff hold an NVQ level 2 in care and the house keeper holds an NVQ 2 in house keeping. Two people were currently doing their NVQ level 2s and on the day of the site visit the NVQ assessor was visiting the home. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Belamie Gables benefit from the home being well managed, and run in their best interests. They experience care which is delivered in a safe manner within a healthy and safe environment. The proprietor must ensure they undertake monthly reviews of the home in line with regulation 26 of the Care Homes Regulations. Evidence: Belamie Gables is managed by a suitably qualified person who has many years experience and is registered with us to manage the home. She is supported by a deputy manager, who also holds the Registered Managers Award, and an adminnistrative assistant whose hours have been increased since our last inspection so that administrative support is now available four days per week. The people we spoke with during our site visit spoke very highly of the manager and the completed surveys we received from people who live at the home stated that the manager is very good. Of the staff surveys we received 100 stated that the manager supports them and Care Homes for Older People Page 23 of 27 Evidence: one quote was The manager is fantastic. We discussed the fact that the monthly self inspection visits required under regulation 26 of the Care Homes Regulations had not been completed since January 2009 and the manager and the owners representative, who was present, undertook to ensure these are completed monthly. Belamie Gables has mechanisms in place to ensure quality assurance within the home. These include a regular review of policies and procedures, a complaints procedure, residents meetings and staff meetings. We saw evidence of residents meetings being held approximately three monthly. The minutes showed that residents are able to raise issues to be resolved, for example maintenance issues, and that activites are discussed and planned for, for example a BBQ and a summer fete. We also saw evidence of staff meetings being held where changes in working practices were discussed with staff. The home also undertakes an annual quality assurance survey. We looked at the results of the 2009 survey. 22 questionnaires had been sent out and 17 had been returned. 71 of respondents rated the care home overall as excellent or very good, with a further 18 rating it as good and 11 as average. From the results of the survey, the manager had drawn up an action plan which addressed shortfalls highlighted in the survey, for example improvements to the garden and activities. The home has in place a range of policies and procedures relating to health and safety which include training in moving and handling, fire safety, first aid and food hygeine. Evidence from the information sent to us prior to our site visit showed electrical and other equipment are mainained in line with manufacturers recommendations. We saw evidence during our site visit that appropriate risk assessments are in place for safe working practices, for example the use of oxygen. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 10 13 All staff must receive 08/10/2009 training in the safe handling, storage and administration of medication. To ensure the safety and well being of the people who live at Belamie Gables. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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