Care Home: Belton House Retirement Home

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What the care home does well What has improved since the last inspection? Belton House continues to provide high standards of care for the residents. Rooms are refurbished prior to new occupancy. What the care home could do better: There are five good practice recommendations: When next reviewed the Statement of Purpose and Residents Guide (which included the complaints procedure) should be updated to include contact details for Social Services and the area CSCI office. The fridges containing medicines should be kept locked at all times, and the person in charge (or designated person) should hold they keys to the medicine cupboard and medicine fridges to prevent unauthorised access to residents medication. Residents who self medicate should have a written, regularly reviewed assessment to ensure that they are competent and safe to continue to do so. There should be a menu, offering choices of meals in written or other formats to suit the capacities of all residents that is given, or explained to the residents so that they are clear that an alternative is always available. Residents/relatives meetings should be considered to enable regular participation by residents in voicing their opinions on what entertainments they would like and/or any other changes they may feel could improve the service. CARE HOMES FOR OLDER PEOPLE Belton House Retirement Home Littleworth Lane Belton-in-Rutland Rutland LE15 9JZ Lead Inspector Mrs Carole Burgess Unannounced Inspection 8th September 2008 09:50 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 Belton House Retirement Home DS0000006458.V371386.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. Belton House Retirement Home DS0000006458.V371386.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Belton House Retirement Home Address Littleworth Lane Belton-in-Rutland Rutland LE15 9JZ 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) 01572 717682 01572 717552 info@beltonhouse.co.uk Mr David Arthur Salter Ms Julie Elizabeth Flaherty Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Belton House Retirement Home DS0000006458.V371386.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home will limit the service to the following Service User categories: Older People 22 (OP) To include a maximum of 4 within the registration of 22 with category of D(E) 17th October 2007 Date of last inspection Brief Description of the Service: Belton House is a 22-bedded residential care home for older people located in the small village of Belton-in-Rutland. There are self-contained bungalows as part of the site where residents can develop wider social contacts. The home has been the subject of major renovation, which has significantly improved its facilities. The communal areas are well furnished and many of the rooms have en suite facilities. A patio area built with level access enables residents to enjoy the well-kept gardens. A range of facilities has been provided in the grounds - a putting green, croquet and petanque areas, with a pavilion (with inside and outside seating, toilet facilities and small kitchen for residents and relatives to make drinks). There is a frequent bus service that able residents can use, and the home has purchased their own courtesy car for residents to use, alternatively the home can order taxis. The Statement of Purpose, Residents’ Guide & Inspection Report are available on request (these provide information on how the home is organised and what services they provide). The Statement of Purpose and Residents’ Guide are provided for all new residents. At the time of the inspection the deputy manager stated that fees ranged from £460 to £850 per week. Belton House Retirement Home DS0000006458.V371386.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. ‘We’ as it appears throughout the Inspection Report refers to ‘The Commission for Social Care Inspection.’ The focus of the inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who use the service and their views of the service provided. The site visit was unannounced and took place over five and a half hours. We selected three residents and tracked the care they received through a review of their records, discussion with them (where possible), other people who use the service, visitors, the care staff, and observation of care practices. We spoke with staff members regarding training and support. Planning for the inspection included assessing notifications of significant events, a review of the Annual Quality Assurance Assessment (AQAA) sent to the CSCI by the service. Surveys were sent to the service to residents, staff and health professional to provide feedback to the CSCI but none had been returned at the time of the inspection. Both the Registered Manager and Provider were on annual leave at the time of inspection. The deputy manager and other staff spoken with were positive and helpful during the inspection. Belton House Retirement Home DS0000006458.V371386.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Belton House continues to provide high standards of care for the residents. Rooms are refurbished prior to new occupancy. Belton House Retirement Home DS0000006458.V371386.R01.S.doc Version 5.2 Page 7 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. Belton House Retirement Home DS0000006458.V371386.R01.S.doc Version 5.2 Page 8 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 Belton House Retirement Home DS0000006458.V371386.R01.S.doc Version 5.2 Page 9 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): 1, 3 & 6. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with detailed information about the home, and have their health, welfare and social care needs assessed, so that they can be fully met once they move into the home. EVIDENCE: The home provides prospective residents and their relatives with a Statement of Purpose and Relatives Guide (both give information about the home) to help them decide if the home is the right one for them. A copy of the residents guide was provided in residents’ rooms and included details of how to make a complaint. Belton House Retirement Home DS0000006458.V371386.R01.S.doc Version 5.2 Page 10 When next reviewed the Residents Guide (including the complaints procedure) needs to include contact details for local Social Services and the new contact details for the CSCI to ensure residents are provided with the correct information. Copies of residents’ contracts were kept in the home in a separate file and residents, or their relatives, are able to have a copy provided. The three residents’ care plans reviewed contained a detailed pre-admission assessment to show that the home could meet their specific health, welfare, and social care needs. It included personal details, relative and GP contact numbers, past and present medical history, current health care requirements and medications, personal preferences, social interests and hobbies to ensure that the home could meet all of a prospective residents needs and provided and individualised and person centred approach to care. The home does not provide intermediate care. Belton House Retirement Home DS0000006458.V371386.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, 8, 9 & 10. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are well looked after in respect of their health and personal care needs. EVIDENCE: Residents’ care plans are detailed and give carers thorough information about the health, personal and social care needs of the residents. The care staff review all care plans at least monthly so that residents’ care needs continue to be met. Belton House Retirement Home DS0000006458.V371386.R01.S.doc Version 5.2 Page 12 Contact with healthcare professionals such as GP’s, District Nurses, hospitals, and Chiropodists were recorded in separate files to ensure that healthcare needs and treatments were addressed. Medication policies and procedures were generally sound. However, the keys to the drug cupboards were kept in a key cupboard in an unlocked office providing easy access to medicines, including controlled drugs. It was recommended that the small fridge containing medication was kept locked at all times, and that the person in charge should hold/be aware who is holding the keys to the drug cupboards and drug fridges at all times to fully comply with the Misuse of Drugs (Safe Custody) Regulations 1973 and the safekeeping of medicines. Residents are able to continue to self medicate following an assessment to ensure that they are safe to do so. It is recommended that this is a written assessment with periodic reviews to ensure that the resident continues to be considered safe to do so. Medications is administered by carers who receive annually updated training to safeguard the residents, and ensure that they receive their medication as prescribed. Observation during the inspection showed that staff have a good awareness of how to protect residents privacy and dignity. Staff spoke to residents and visitors in a respectful, friendly, quiet and supportive way. One resident who was case tracked was unable to provide meaningful information but looked well cared for, and staff were patient, kind and supportive in their care for her. Three residents, spoken with during the inspection, said that they were very well looked after and that staff were very kind, caring and respectful. Belton House Retirement Home DS0000006458.V371386.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, 13, 14 & 15. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The staff work hard to ensure that residents experience a safe and homely life style. EVIDENCE: The home has a monthly entertainment programme and residents are provided with information, in large print, in their own room and can choose which event they wish to attend. In the warmer months there were outdoor activities such as the barbeques, the putting green, croquet and petanque. Although there was regular movement to music sessions and a member off staff plays the keyboard to entertain the residents, residents spoken with said that additional entertainments such as films and music afternoons, clothes sales and bingo etc rarely happened, as they had done previously. The deputy manager indicated that this was because they were poorly attended. There were no residents Belton House Retirement Home DS0000006458.V371386.R01.S.doc Version 5.2 Page 14 meeting to enable residents to discuss this or to provide general ideas for improvements on a regular basis. Religious and spiritual need are supported; birthdays and festive days are celebrated and shared with the local church and village to ensure that residents are able to remain fully engaged with community life. There was a hairdressing salon and the hairdresser visits twice a week. The home also had a visiting reflexologist and chiropodist to enable residents to maintain their appearance and wellbeing. Residents were able to have their own television and telephone in their room should they choose to do so. Residents said that they were able to have visitors at any time. Staff support residents with making choices in their everyday life. All residents spoken with said they got up and went to bed when they wished and could breakfast in their rooms if they wished, and were well supported by very caring staff. All meals are prepared in the home’s kitchen by the chef. A cooked breakfast is available every day. The chef said that at the main midday meal there was one main course, although an alternative would be provided on request. A choice of three or more puddings was available, and a glass of wine if required. Drinks such as tea, coffee and soft drinks were available throughout the day. Special diets such as diabetic and soft diets were catered for. Residents have a nutritional assessment in their care plan to ensure that their dietary needs are met. Two residents and a regular visitor, who also lunched at the home, said that the food was usually good but was not as good as it used to be. On the day of inspection residents had fish pie at lunchtime. Although there was an alternative to the main meal of the day (on request) residents spoken with seemed unclear that they could have something else if they did not like what was offered. Three residents said that they did not like the fish pie but didn’t like to complain; one resident said she was still hungry. These comments were passed to the deputy manager to address. Belton House Retirement Home DS0000006458.V371386.R01.S.doc Version 5.2 Page 15 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. This judgement has been made using available evidence including a visit to this service. Arrangements for receiving and responding to complaints are sound resulting in satisfactory protection of residents’ rights. EVIDENCE: Residents and staff comments showed that people feel at ease discussing any concerns with the staff. Information regarding advocacy services is available if residents require independent support and advice. The CSCI had received one erroneous and unfounded complaint about the home. This had been well managed in a professional manner by the Registered Manager. The home’s complaints process reflects the Safeguarding Adults policies and procedures and staff are provided with appropriate training and are able to demonstrate the correct procedures for safeguarding the residents from harm. Belton House Retirement Home DS0000006458.V371386.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 excellent. This judgement has been made using available evidence including a visit to this service. A comfortable, clean, safe and high standard of accommodation is provided for the residents. EVIDENCE: The home is clean, safe and well maintained with adaptations to suit residents’ specific needs. It is decorated and furnished to a high standard that creates a comfortable, light, spacious but homely environment. Belton House Retirement Home DS0000006458.V371386.R01.S.doc Version 5.2 Page 17 Many residents’ rooms have en-suite facilities and all have a ‘nurse call’, and were clean and well decorated. Residents are able to bring items of their own furniture and possessions with them to personalise their rooms. All residents’ rooms were highly personalised with some of the resident’s home furnishings. Residents also have access to attractive safe gardens. There are sufficient toilets, bathing and assisted bathing facilities, which have recently been upgraded and included a new, powered bath seat that gently lowers the user into the bath. Residents praised the staff for the high standards of cleanliness and décor in the home. The home’s health and safety arrangements such as regular maintenance and servicing of equipment, regular fire drills and monitoring heat control valves on hot water taps throughout the home show that the Registered Provider (owner) and Registered Manager are mindful of their responsibilities to make sure that residents live in a safe environment. Belton House Retirement Home DS0000006458.V371386.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 good. This judgement has been made using available evidence including a visit to this service. Staff at the home are well trained and sufficient in number to meet the residents’ needs. EVIDENCE: There were twenty residents at the time of the inspection. Staffing levels, at the point of inspection, were in line with those suggested by the Department of Health Residential Forum Guidelines and were sufficient to meet the residents’ needs. During the day there were three care staff and two carers at night. In addition, during the day, there were the chef, cleaners, kitchen and laundry staff and a maintenance person. Residents said that there seemed to be sufficient staff on duty. (The Registered Manager said at the last inspection that she had a small bank of carers who cover for emergencies). Three staff files were checked during the inspection and showed that there is a satisfactory recruitment process to ensure that residents were well protected. Belton House Retirement Home DS0000006458.V371386.R01.S.doc Version 5.2 Page 19 New staff carry out an induction programme and have mandatory, annual updates. Staff undertake training in specific areas such as fire training, first aid, moving and handling, food safety, infection control, and safeguarding adults. The deputy manager said that more than fifty percent of care staff had completed National Vocational Qualification (NVQ) in Care and that the other care staff would also be undertaking NVQ soon. This ensures that staff have the necessary skills to give safe care to the residents. Belton House Retirement Home DS0000006458.V371386.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, 35 & 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The Registered Manager provides strong and supportive leadership to staff, ensuring that residents receive a high standard of care. EVIDENCE: The Registered Manager is an experienced carer and works in a supervisory and management role in addition to the care staff numbers. Belton House Retirement Home DS0000006458.V371386.R01.S.doc Version 5.2 Page 21 Excellent interaction between staff, residents and residents’ relatives ensures that there is a culture of openness and friendliness in the home. The home conducts a yearly quality audit (satisfaction survey) for residents to complete. The results are collated and actioned and written feedback is provided for the residents so that the comments from residents and visitors help to improve the service. The home does not keep money on behalf of residents. Residents manage their own finances or, if they are unable, then a relative will do this for them. Staff are well supervised by the Registered Manager in performing their care tasks. Staff receive regular, recorded supervision (regular review of staff’s personal and training needs in relation to their work) to ensure that they have the necessary skills to provide a good service for the residents. Health and Safety Policy and Procedures, such as regular recorded fire drills and fire alarm tests are completed, to ensure the health and safety of the residents and staff. Belton House Retirement Home DS0000006458.V371386.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 3 X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X N/A X 3 X X 3 Belton House Retirement Home DS0000006458.V371386.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/A 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. Standard Regulation Requirement Timescale for action 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 OP1 Good Practice Recommendations It is recommended that The Statement of Purpose and Residents Guide (including the complaints procedure) be updated to include contact details for Social Services and the area CSCI office. It is recommended that fridges containing medicines are kept locked at all times, and that the person in charge (or designated person) holds the drug keys at all times to fully comply with the Misuse of Drugs Act 1971 & the Royal Pharmaceutical Society Medicines Act 1968. It is recommended that residents who self medicate should have a written, regularly reviewed assessment to ensure that they are competent and safe to continue to do so. It is recommended that there is a menu, offering choices of meals in written or other formats to suit the capacities of all residents which is given, or explained to the residents. It is recommended that residents/relatives meetings be DS0000006458.V371386.R01.S.doc Version 5.2 Page 24 2. OP9 3. 4. OP9 OP15 5. OP33 Belton House Retirement Home considered to enable regular participation by residents in voicing their opinions on what entertainments they would like and/or any other changes they may feel could improve the service. Belton House Retirement Home DS0000006458.V371386.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 © 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 Belton House Retirement Home DS0000006458.V371386.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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