Care Home: Benridge

What the care home does well We felt that he home have managed well the care of one particular resident who has diverse needs around self care and dietary intake. What the care home could do better: We felt that care staff should make fuller notes when receiving feedback from health care professionals such as district nurses as this would provide detail for ongoing review. We would recommend that there is more evidence of family involvement in the care and this could be best facilitated at he time of care plan reviews. Staffing levels need to be maintained at all times so that people in the home can receive a consistent level of social intervention and support. The emphasis placed around the training of staff in terms of awareness of abuse and the reporting procedures for any allegations remains insufficient. We require that all staff receive updates and that the induction program is developed to emphasis safeguarding issues. This will help ensure that residents are kept safe in the home. The requirement to assess any member of staff fully in terms of fitness to work in the home remains an outstanding issue. All staff records must contain evidence of a full risk assessment of any issues that relate to the suitability of staff. The manager should develop a suitable assessment tool. All staff need to be fully trained in moving and handling residents so that they are cared for in a safe manner. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Benridge 53 Queens Road Southport Merseyside PR9 9HB one star adequate service The quality rating for this care home is: The rating was made on: 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. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Michael Perry Date: 1 5 0 1 2 0 0 9 Information about the care home Name of care home: Address: Benridge 53 Queens Road Southport Merseyside PR9 9HB 01704530378 Telephone number: Fax number: Email address: Provider web address: admin@benridge.demon.co.uk Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Benridge Care Homes Ltd care home 27 Number of places (if applicable): Under 65 Over 65 0 dementia Conditions of registration: 27 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of service users who can be accommodated is: 27 Date of last inspection Brief description of the care home Benridge is a privately run residential care home registered for twenty-seven older people. The home has been open for a number of years. Valerie Flint manages the home. Provider is Benridge Care Homes Ltd whose managing director is Paul McLouglin. The home is located in a residential area of Southport on one of the main roads leading from the town centre. As a result the home is close to local facilities and near to public transport routes. The home is operated from a detached building, which has amenities on three levels. A basement level provides bedroom and communal facilities. On the ground floor are further bedrooms as well as kitchen, dining room and two lounges. Further bedrooms are located on the upper floor. A number of bathrooms Care Homes for Older People Page 2 of 12 Brief description of the care home and toilets are also available. All areas are served by stair lifts. The current fees for the service are £450 per week. Care Homes for Older People Page 3 of 12 What we found: We visited the home to check on the progress made regarding the outstanding statutory requirements made following the key inspection on 10th April 2008. We also had some concerns raised more recently by visiting professionals around some of the care standards such as the cleanliness of the home, ongoing health and personal care and staff attitudes towards residents. We looked at each of the outstanding requirements. We had made a previous requirement that care plans for people using the service must be more in depth and include care interventions for all identified care needs so that these can be met effectively and reviewed regularly. We looked at the care of two of the residents in some depth. One has individual needs around diet. This person has been very challenging to care for due to some behaviors that are uncooperative and care staff have to be careful of their approach so that basic hygiene and dietary needs are not neglected. We found that the care plan was very clear around how staff should intervene and it included attempts to include the person in decision making about diet and personal hygiene. There had been appropriate referrals made for health professional input and staff had been careful to monitor closely. The general out come was that the persons overall appearance and hygiene had improved so that the person could feel more dignified as well as continued weight gain evidencing adequate dietary intake. Another resident has had input from health care professionals for the treatment of a leg ulcer. The records clearly record all visits although we did comment that fuller details of health professionals comments would provide a more detail for ongoing reviews. The records also included visits by other professionals such as the persons GP as well as visits to hospital. This shows general good liaison with health care professionals. The care plan seen identified this care need and was up to to date. One resident was showing signs of ill health during the visit and had been referred to the GP who had visited the day previously and prescribed a course of treatment. The care plans were evaluated on a monthly basis and any changes to the care plan could be made. The evaluations lacked detail and were not a review of the previous months progress. This was discussed. We also felt that relatives could be more involved in the care planning and that evaluations were a good time to encourage this. This ensures that families of people in the home are kept up to date and included in the care. We found this requirement to have been met. We made a previous requirement that a fuller program of activities must be made available for people in the home and this should include some access to outside space. We found that the provider and staff have developed a safe garden area at the rear of Care Homes for Older People Page 4 of 12 the building and that this has been used by residents over the previous summer. There is also a new activities room [converted from existing bedroom] that contains examples of art work that some people have been involved in. Each person has an activities file which contain records of an assessment of each persons preferences and any activities undertaken. During the inspection visit we did not observe any activities for residents although noted only three staff were on duty instead of the more usual four staff. There were periods where people were left without regular staff intervention. For example we sat for 15 minutes in one lounge without any staff interventions. The people in the lounge were generally detached for their surroundings with nothing to stimulate them. We spoke to the manager about basic staff numbers and looked at the duty rota. during the week of the inspection there were three care staff in total planned each day. On the previous day there had been only two care staff in the morning [due to sickness]. The manager and staff confirmed that normally there is at east four care staff to cover the day shift. The home do not make use of agency staff and have little flexibility in terms of covering acute shortages of staff. This may have the effect of making care standards inconsistent. A new requirement has been made to ensure that the home has consistent staffing numbers at all times. Staff reported that the provision of activity had improved overall and the manager had arranged for some staff to attend training and had also accessed up to date information around general activities. This requirement has been met. Another requirement made previously was the need for all staff to receive adequate training in how to keep people safe from abuse. In particular this was to be developed in the induction program. We looked at safeguarding training in the induction program. Records seen were not clear. The manager gave us a newly developed staff handbook but there was no reference to safeguarding policy in it. We also saw the induction checklist for new staff but safeguarding was not listed. We were shown a list containing names of staff who had viewed a DVD on the subject but this was not dated and the manager could not recall any details. We felt that there was not sufficient emphasis or organisation around the training of staff who may not therefore be sufficiently aware of how to report concerns that may have around allegations of abuse. The homes policy statement does not reference the locally agreed social service policies and procedures and this should be updated so that all staff can be aware of the policy to follow. This requirement has not been met. A requirement has been made to develop the home environment in line with good practice guidelines for dementia care so that peoples quality of life can be further enhanced. We saw that improvements have been made to the home. The day areas were better Care Homes for Older People Page 5 of 12 lit and had been decorated so that the home was brighter and fresher. The manager has accessed some good practice information and used this to enhance the general environment. For example there were signs for toilets and bathrooms as well as some of the bedrooms. This helps residents to find their way around the home. There was also some easily accessible information in the hall way such as an orientation board and menu board showing what was on offer for dinner. The rear garden has been developed so that people can now access a safe area in good weather. We would recommend that this process is continued. This requirement has been met. On the last inspection the home had employed a member of staff who had issues around previous criminal convictions. A requirement had been made for the manager to update this staff file with full assessment of risk and how this informed the managers decision to employ. We discussed this with the manager who had made a brief record of an interview with the staff member. There were no further records however. The manager discussed a new staff application and was awaiting a criminal records check [CRB] which the manager believed may contain past convictions. The manager did not display a full understanding of the factors and criteria to be used in any assessment of fitness to employ such a staff member. This requirement has not been met. We looked at a previous requirement for all staff to have adequate training in moving and handling so that people can be assisted to move or mobilise safely when needed. It was required that the training has a practical component so that staff can be fully competent. The training records indicate that staff have access to a DVD on the subject but that there is still no practical training in this area. The manager confirmed this and has been trying to arrange for a trainer to come into the home. We observed one staff member assisting a resident to mobilise by holding both hands and leading/ pulling. This is not good practice and compromises the persons dignity as well as being potentially dangerous. Other findings We looked at the concerns raised by visiting professionals. We toured areas of the home and found the home to be clean. There was some maloudour evident but this had improved since the previous visit and was confined to a few areas. The manager is aware of the need to maintain standards in this area. We observed the residents and found them to be dressed appropriately and standards of general hygiene to maintained. Some residents had disheveled hair and this was pointed out to the manager. Care Homes for Older People Page 6 of 12 What the care home does well: What they could do better: 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 2. Care Homes for Older People Page 7 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 9 13 Medicines must be given to 16/02/2009 people correctly and an accurate record of medicines given and disposed of must be made. This is to help make sure the health and wellbeing of people is protected. 2 18 13(6) All staff must receive 16/02/2009 adequate training in particular there must be increased emphasis in the induction programme. This is so that residents can be assured of protection. All staff records must be 16/02/2009 complete with respect to any management decision to employ staff following the consideration of any issues relating to `fitness? to work with vulnerable people. With respect of the staff discussed a full note of the managers interview and risk assessment must be recorded. This helps ensure that residents are protected. 3 29 19(1) 4 38 13(5) All staff must be adequately trained in moving and handling and the training 16/02/2009 Care Homes for Older People Page 8 of 12 must be approved and have a practical component. [See recommendation below regarding he training of a moving and handling assessor]. Care Homes for Older People Page 9 of 12 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 27 18 There must be care staff on 02/02/2009 duty at all times to meet the assessed needs of the residents. To ensure that consistent standards of care are maintained. 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 7 We would recommend that there is more evidence of family involvement in the care and this could be best facilitated at he time of care plan reviews. We felt that care staff should make fuller notes when receiving feedback from health care professionals such as district nurses as this would provide detail for ongoing review. The bathing facilities should be evaluated with respect to resients needs and chioce. An upgrading of the shower facility would be appropiate. The laundry room floor needs repainting to ensure easier cleaning. The residents personal allowance records should contain two signatures for all transactions. Receipts should be Page 10 of 12 2 8 3 21 4 5 26 35 Care Homes for Older People provided and the records be audited by the manager / provider on a routine basis. Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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