Care Home: Belmont House

What the care home does well People do not move into the home without having their needs assessed. People`s health care needs are met and their is evidence to show that they receive regular visits by health professionals. One relative told us, "My mother is always clean well fed and cared for very well". The medication system is well managed and there are monitoring systems in place which identify any shortfalls quickly. One relative told us, "The meals appear to be excellent I have eaten with mum on a couple of occasions and enjoyed the meal on both occasions". People are able to maintain contact with family and friends and are able if they wish to be part of the local community. There were some examples of people being encouraged to have control over their lives. For people who were less able to make choices for themselves staff said they made an effort to to make decisions based on what they knew about them. People told us that in the main they were happy with the food provided and choice was offered. Complaints were taken seriously and investigated. Where allegation regarding safeguarding were made there was evidence to show that these were referred to the appropriate agencies and action taken to protect people. The home was reasonably maintained and some refurbishment and replacement had taken place since the last inspection. There were procedures and practices in place to maintain standards of hygiene and infection control. Recruitment procedures were safe appropriate checks were made to make sure people were protected. There has been a new manager appointed since the last inspection who is an experienced manager. People told us the home was well managed and the staff felt the home was run in the best interest of the people using he service. There were safe working procedures and staff understood their responsibility for promoting the health safety and welfare of themselves and the people they supported. What has improved since the last inspection? Since the last inspection their has been some refurbishment, replacement of carpets and tripping hazards and the staff tell us that some training has taken place. What the care home could do better: In the main people using the service and their relatives spoke positively about the staff. From observation on the day of the visit their were some shortfall regarding staffing levels at mealtimes to make sure people were supported and supervised appropriately and in a dignified way. There was examples of the same comb being used for different people and not making sure people had slippers or shoes on. This shows that practice could be improved to better promote people`s right to dignity.There are some shortfalls in a small number of staff transferring knowledge gained from training into practice. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Belmont House Belmont Drive Stocksbridge Sheffield South Yorkshire S36 1AH     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: Shirley Samuels     Date: 2 3 0 2 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 26 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 26 Information about the care home Name of care home: Address: Belmont House Belmont Drive Stocksbridge Sheffield South Yorkshire S36 1AH 01142831030 01142830641 enquiries@redrosecare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Redrose Care Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 52 Number of places (if applicable): Under 65 Over 65 52 dementia Additional conditions: 0 52 beds are registered for personal care (PC), only 25 of the 52 beds are registered for nursing (N). Three service users from the age of 60 years may be accommodated at the home. Date of last inspection Brief description of the care home Belmont care home is a 3-storey part converted old building with modern additions, which provides care for service users with dementia who require either nursing or personal care. The home is situated overlooking the Stocksbridge valley and the hills beyond, and has easy access to Sheffield, Manchester and the motorway network. The home is situated in a residential area, however there are no shops within the immediate vicinity. Care Homes for Older People Page 4 of 26 Brief description of the care home Copies of Service User guides were available to service users and stored in their rooms. The manager advised the inspector that the fee range is between 368.00 pounds and 490.00 pounds including third party top up fees. Any further information about the home can be obtained by contacting the manager. Care Homes for Older People Page 5 of 26 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 was an unannounced inspection carried out by Shirley Samuels on the 23/02/09 from 9:AM-5:PM. The previous inspection at this service took place on the 01/03/07. As part of the visit we sought the views of the people using the service, their relatives, professional visitors and staff. Some people completed questionnaires before the inspection, others were spoke to on the day of the visit. We checked a selection of documents regarding peoples care and support, staff records and records that showed evidence of compliance with regulations and standards. Before the inspection the manager completed a annual quality assurance Care Homes for Older People Page 6 of 26 assessment(AQAA). This information provided by the manager tells us how the service has developed since the last inspection and what is planned to further develop the service over the next 12 months. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into the report as recommendations- but only when it is considered that people using the service are not being put at significant risk of harm. In future if a requirement is repeated, it is likely that enforcement action will be taken. We would like to thank everyone for their help and co-operation. What the care home does well: What has improved since the last inspection? What they could do better: In the main people using the service and their relatives spoke positively about the staff. From observation on the day of the visit their were some shortfall regarding staffing levels at mealtimes to make sure people were supported and supervised appropriately and in a dignified way. There was examples of the same comb being used for different people and not making sure people had slippers or shoes on. This shows that practice could be improved to better promote peoples right to dignity. Care Homes for Older People Page 8 of 26 There are some shortfalls in a small number of staff transferring knowledge gained from training into practice. 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 26 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 26 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. People were assessed before moving into the home but there were some shortfalls in gaining a copy of the assessment. Evidence: The manager told us that assessments were carried out by the home before people were admitted. These assessments were seen on the three files checked . Assessments were also carried out by social workers and the manager said these were also used to make a judgement about whether the home could meet peoples needs or not. Assessments carried out by social workers were found on two of the three files checked. This showed that the home did have the information they needed to decide if the service was appropriate but that they did not always make sure the written assessment was obtained prior to admission. Care Homes for Older People Page 11 of 26 Evidence: The home does not provide intermediate care Care Homes for Older People Page 12 of 26 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. There are some shortfalls in the quality of care plans and the maintenance of peoples dignity however peoples health care and medication needs are met. Evidence: Each person had a plan of care. There was evidence of gaps in information and the care plans needed to be further developed. The manager told us care plan information was being transfered to a new format. In the main the information in the care plan had been taken from the assessment carried out prior to admission. Staff told us care plans were further developed as they got to know people and as further information was obtained from the person using the service and their relatives. On each care plan it was recorded that an evaluation had taken place each month. Often all that was recorded was care plan remains the same. For some people whos care plan was written 12 months ago, no changes in their needs were recorded. This Care Homes for Older People Page 13 of 26 Evidence: means that care plans did not reflect peoples changing needs. Records of care given were made and in the main gave basic information. about sleep, meals, activities, visitors and personal hygiene. The records however lacked details about the outcomes for people. For example what impact doing activities made on the mood of the person, what did they say about the meal, what was peoples mood and interaction like and what difference did it make to them. The manager told us that only senior care staff write in the records of care given. Other staff providing care tell the senior or the nurse what they have done or what they have observed and the nurse or the senior care records this. This means that some information may get lost in translation and may heighten the risk of details not being recorded. Records were kept of health care needs and records of visits and appointments with health care professionals. The records showed that staff obtained support and treatment from outside agencies when needed and carried out any instructions to promote peoples health. The home had procedures in place for administering medication. Staff responsible for administering received training and there were monitoring systems in place. Records were kept of medication received administered and disposed of. Controlled drugs were stored appropriately and the medication system is monitored by the community pharmacist. This shows that people were protected by the medication procedures. People told us they were treated with dignity and respect a professional visitor told us in a survey peoples independence and dignity is promoted people in their care or their priority. Relatives spoken to on the day of the visit were in the main positive about how their relative were treated. On the day of the visit people were observed with no slippers. When asked staff said some people only had one pair and they were being laundered. However some staff were able to find slippers for people when they looked for them. One member of staff was observed using the same comb for everyones hair. The member of staff was approached about this and questioned about the implications of this as well as it being undignified to treat people in this way. Care Homes for Older People Page 14 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities were provided. People were able to maintain contact with friends and family and exercise choice over their lifes. There were some shortfalls in peoples mealtime experience. Evidence: Activities were provided and people were given the choice to take part if they wished. In the AQQA the manager told us that pampering sessions,nail painting,going out for walks and in house patio games took place. On the day of the visit observation were made of people receiving very little stimulation. Even when staff sat in the lounge observing people they failed to utilise the opportunity to engage with people. Relatives told us they were able to visit and were encouraged to keep in touch with the person living at the home. People who were able told us they were able to choice how to spend their day and to choice their own company. They were able to make choices about meals, what time they went to bed and got up, when to have a bath and added they were able to generally please themselves. Staff told us, for people who were less able to make Care Homes for Older People Page 15 of 26 Evidence: choices they made choices for them based on the information they had and consultation with the person using the service wherever possible and from relatives. This promoted choice and some say over their lives. people told us they enjoyed the food ,they were offered choice and they were able to have drinks and snacks in between meals. Dining tables were nicely set on the residential unit and in general people observed to have a pleasant mealtime experience. On the dementia care unit tables were not set,there were insufficient staff to assist people to have their meal in a dignified way and to offer the support and encouragement needed. Care Homes for Older People Page 16 of 26 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. Complaints were taken seriously and there were procedures in place to protect people from harm and for reporting allegations of abuse. Evidence: The home does have a complaints procedure. The records show and the manager confirmed there had been two complaints since the last inspection. These were appropriately recorded and managed. People told us they knew how to make complaints and were in the main satisfied with how these were handled. Staff told us they had received training on safeguarding people and for reporting any concerns. However some staff needed refresher training in this area. Since the last inspection there has been one safeguarding issue reported to us and to the Sheffield social services. This resulted in one member of staff at the home being dismissed. However the manager told us the matter was not fully concluded. This showed that where allegations or problems were identified the manager responded appropriately to make sure people were protected. Care Homes for Older People Page 17 of 26 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. The home was reasonably maintained clean and hygienic. Evidence: In the main the environment was reasonably maintained. In the AQAA the manager told us families are encouraged to personalise bedrooms. Any problems with odour are addressed and monitored and that redecoration and replacement of furniture is ongoing. People told us they were happy with their bedrooms and the communal lounge space was reasonable. Some bathroom areas had been refurbished but others remained below standard. In one bathroom there were plumbing problems and a damp wall. The manager told us arrangements had been made for this to be sorted out. There were procedures in place to promote good hygiene standards and staff were able to tell us the action they took on a daily basis to maintain standards of cleanliness and to prevent cross infection. Care Homes for Older People Page 18 of 26 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. Staffing levels met the minimum required but were not always sufficient to meet peoples needs. The recruitment procedure was safe and in the main staff were trained to do their job. Evidence: The rotas showed that the minimum staffing level was being maintained. There was evidence that there were insufficient or ineffective deployment of staff to provide the support and supervision of people at mealtimes. In the AQAA the manager told us twenty seven staff were employed at the home she said eight of them were trained to national vocational Qualification level 2 in care. The home has a robust recruitment procedure. Three staff files were checked and there was evidence that all appropriate checks had taken place. They included, application forms, criminal record checks, references, identification checks and interviews. This made sure that people were protected by the recruitment procedures. Staff told us they had received induction training and those who had received National vocational qualification in care at level two demonstrated a sound level of understanding of the needs of the people they were caring for. Care Homes for Older People Page 19 of 26 Evidence: There were some shortfall in transferring what they had learned into practice and there were examples of a small number of staff having very basic understanding only. Care Homes for Older People Page 20 of 26 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 home was well managed and there were procedures in place to promote peoples health safety and welfare. Evidence: Since the last inspection there has been a new manager appointed to the home. The manager is experienced in managing a service similar to Belmont. In the AQAA the manager told us she plans to undertake the Registered managers award. This will ensure she develops further the skills to develop the service and manage the day to day running of the home. People using the service and relatives spoken to told us they felt the home was in the main run in the best interest of the people. Visits by a representative of the organisation were made and the involved asking people living at the home and the staff to comment on the service and their overall experiences. There was some evidence that comments were taken seriously and acted upon. This shows that people Care Homes for Older People Page 21 of 26 Evidence: using the service are able to influence the way the service is run. There were procedures in place for the recording and safe storage of peoples money. people told us they were satisfied with the arrangements in place. This made sure peoples financial interests were safeguarded. Staff were observed using safe moving and handling procedures. The records showed that fire fighting equipment was checked and staff were able to tell us the action they would take in the event of a fire. Staff told us they had received fire training although in some cases the records did not support this. In the AQAA the manager told us that health and safety checks are carried out within the required timescales such as gas, electrical appliances, hoists and call system. Staff understood their responsibility for monitoring and reporting hazards and faults,for their own safety and the safety of the people they supported. Care Homes for Older People Page 22 of 26 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 23 of 26 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 7 15 Care plans must be further 26/06/2009 developed to make sure they clearly identify the care and support that people need. The care plan must be kept under review and updated to reflect any changes. To make sure peoples needs are met. 2 10 12 People must be provided with enough footwear to make sure they are not forced to be without. To make sure people are treated with respect and their dignity maintained. 26/06/2009 3 15 13 People using the service must be supported in a dignified way to eat their meal. To make sure people have a pleasant mealtime experience. 26/06/2009 Care Homes for Older People Page 24 of 26 4 27 13 There must be enough staff 26/06/2009 on duty at all times, who are effectively deployed. To make sure that peoples needs are met. 5 30 13 Staff must receive training appropriate to the job they are to perform. Training must be recorded and available for inspection. To make sure staff are competent to do their job. 26/06/2009 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 1 2 3 7 The home should obtain a copy of the assessment prior to people moving into the home. Records of care given should be recorded to reflect not just the physical tasks carried out with people but the outcomes for them and observations about what difference the action staff have taken has had on their quality of life. All staff should receive the training support and the supervision they need to allow them to write their own observations and the actions they have taken. 3 10 Each person should be provided with their own comb and/or hairbrush and this should be used for them exclusively. Staff should receive further training regarding engaging with people who are living with dementia. This will make sure people have equal opportunity for activity and stimulation. 50 of care staff should be trained to National Vocational Qualification level 2 in care. 4 12 5 28 Care Homes for Older People Page 25 of 26 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). 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. 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