Care Home: Benthorn Lodge

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What the care home does well There is a stable staff team, and staff are aware of the needs of people in their care. Since the last key inspection a recognised tool has been introduced to formally assess the vulnerability of individuals of developing pressure area ulcers. This had been done with the support and guidance of the district nurse involved in the care of people with the home. Formal risk assessment and monitoring tools have been introduced for people vulnerable to falls and poor nutritional intake. Accidents and incident are recorded and reported to the Care Quality Commission. What the care home could do better: In discussion with the staff they gave detailed accounts of the care required for people intheir care, this level of detail should be included in the individual written care plans. Attention is needed to improving the exterior and interior of the home, the home is looking tired and in need of redecoration and refurbishment. The outside sitting area to the front of the property is in need of weeding, re potting of plants and general tidying up. The implementation of a program of routine repairs and renewals of fabrics and furnishings would ensure that people using the service are provided with a home that is safe, pleasant and well maintained. Regular checks to the quality of the bed linen, towels flannels, pillows and pillow cases provided by the home would ensure that worn items are disposed of and replaced. A cleaning schedule needs to be put into place to include the deep cleaning of bedrooms, communal areas, kitchen and laundry areas. This would ensure that the home is kept clean and free from unpleasant odours. The introduction of set domestic cleaning hours and tasks, factored into the daily staffing ratios, would ensure that there is sufficient staff on duty so that cleaning tasks do not infring on the care support required for people using the service. All bedroom sinks and bathrooms should have the provision of a sink plug, a han towel and a large bath towel, an additional flannel or where necessary disposable cloths within peoples individual bedrooms. This would ensure that people have sufficient facilities to enable them to strip wash with dignity and prevent the risks of cross infection. The recording of weekly fire tests must take place as this evidences that the test has been undertaken and the outcome recorded to ensure that the fire system is operating correctly. The use of door wedges should be avoided, where it is identified that a door is required to be held open, a formal risk assessment needs to be completed and a suitable door hold open device fitted that will automatically close the door upon the fire alarm being activated. Regular checks to wheelchairs would ensure that they are fit for use and footplate`s need to be attached at all times. Random inspection report Care homes for older people Name: Address: Benthorn Lodge 48 Wellingborough Road Finedon Northants NN9 5JS two star good service 29/09/2009 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. 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: Irene Miller Date: 2 7 0 5 2 0 1 0 Information about the care home Name of care home: Address: Benthorn Lodge 48 Wellingborough Road Finedon Northants NN9 5JS 01933682057 Telephone number: Fax number: Email address: Provider web address: benthorn.lodge@ntlworld.com Name of registered provider(s): Name of registered manager (if applicable) Mrs Pam Bennett Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Frank Bennett,Mrs Pam Bennett care home 18 Number of places (if applicable): Under 65 Over 65 18 4 dementia old age, not falling within any other category Conditions of registration: 0 0 No person falling within the category DE(E) can be admitted where there are 18 persons in the category DE(E) already in the home. The Home will limit its services to the following service user categories: No person falling within the category Older Persons (OP) can be admitted where there are already 4 persons of category OP in the home. The total number of service users in the Home must not exceed 18. Date of last inspection 2 9 0 9 2 0 0 9 Care Homes for Older People Page 2 of 14 Brief description of the care home Benthorn Lodge is a home providing personal care and support for 18 Older People, by reason of old age and dementia. Community healthcare professionals meet healthcare needs. The home is situated on a main road leading into the centre of Finedon and is within easy access of public transport and local shops. The home comprises of a three-storey building of which the first two floors are used for residents accommodation. The original frontage of the house has been retained so that the home blends in with others in the road. There is off road parking at the side of the house, and a small paved garden to the front, which is accessible for residents. Accommodation is provided in both single and shared rooms, one of the single rooms has en suite facilities. A copy of the last inspection record is held in the homes office. Current fees range between 355.21 to 381.63 pounds per week. Care Homes for Older People Page 3 of 14 What we found: This inspection was unannounced with the main purpose of checking compliance with requirements set following the previous key inspection of the 29th November 2009 and also to monitor actions taken by the provider following concerns raised about the service in January 2010. Since January 2010 several joint meetings have taken place with the provider, the Local Authority Safeguarding Team, Northants County Council Commissioning Unit and the Care Quality Commission. During which the provider has produced written action plans on how they aim to ensure the health, safety and welfare of people using the service is protected. At the time of this inspection 12 people were living at Benthorn Lodge and we focused our attention on checking how the provider is managing to meet the health, safety and welfare of people using the service based upon the action plans produced at the meetings. We looked at the risk management systems in place and how the provider responds to accidents and incidents. Outcome: There was records of accident and incident reports, and risk assessments in place for people who are vulnerable to falls, injuries and pressure ulcers. Since the last key inspection a recognised tool has been introduced to formally assess the vulnerability of individuals of developing pressure area ulcers. This had been done with the support and guidance of the district nurse involved in the care of people with the home. Records were available of people receiving treatment from the district nurse and visits from their general practitioner. We looked at how the provider meets the nutritional needs of people using the service. Outcome: Since the last inspection a formal nutritional risk assessment has been introduced and the food and fluid intake of people identified at risk is being recorded and monitored on a daily basis. The monitoring records were viewed and seen to be have been completed by staff at each meal time and detailed the food and fluids consumed. Peoples weight gains and losses are recorded monthly and records seen evidenced this. In discussion with the registered manager she explained for one person who finds it difficult to sit for any length of time to eat a meal due to being very mobile and physically active. A decision had been made to bring their meal times forward to enable a member of staff to sit with them, throughout and that this had been successful in that the person was now eating a full cooked meal. The main kitchen appeared clean and tidy, and records of the monitoring of peoples food and fluid intakes over the past week were available to view. We looked at how the provider ensured that specific equipment on loan for individuals use is managed. Care Homes for Older People Page 4 of 14 Outcome: The person in charge on the day of the visit said that all people requiring the use of pressure relieving equipment had their own designated equipment in place, we observed that pressure relieving equipment was in use for the named individual. It was noted that a designated wheelchair for one person was out of use due to the tyres on the front wheels having worn, we also noted that many of the wheelchairs did not have foot plates attached. We looked at the general cleanliness and safety of the home and management of environmental standards and cross infection prevention controls. Outcome: On first impressions of the home outside sitting area to the front of the property was in need of weeding, re potting of plants and general tidying up. The registered manager said that this was due to be completed by the maintenance worker within the week. We carried out a tour of the building and viewed the communal areas, all of the occupied bedrooms, the bathrooms and WCs and the main kitchen and laundry. The decor within the communal areas was satisfactory, although some of the arm chairs were beginning to look worn and in need of replacing. Within some areas of the home there was an unpleasant odour, in discussion with the registered manager she explained that some people using the service have accidents and spillages with their food and drinks. All areas where people take their meals are carpeted and this was thought to be a main contributing factor to the build up of the odours. The registered manager said she was considering replacing some of the carpets with a more practical washable flooring. We found that within many of the bathrooms and bedrooms there was distinct lack of sink plugs. Some redecoration to bedrooms has began, one vacant room was in the process of being redecorated however some of the occupied bedrooms were greatly in need of redecoration. Within one bedroom the wallpaper was peeling off and there was unsightly watermarks to the walls. We were informed that this damage had been due to a water leak from the flat above this room, and the room was soon to be redecorated. The carpet had a slight fray which if left unattended could pose a potential tripping hazard. It was noted that within this room a hand towel hanging on the rail and a flannel over the sink were in need of laundering. We were informed by the senior on duty that the person who occupied the room was independent with washing and dressing, however acknowledged that the care staff need to be mindful of replacing soiled towels and flannels daily within this room. The soiled items were removed and replaced with a clean towel and flannel immediately. Within one bedroom the carpet was badly soiled, we were informed that this carpet was due to be cleaned later in the day, in discussion with the senior in charge she explained that the care staff were responsible for the cleaning of carpets and it was agreed that the cleaning of this carpet would be best left until the following morning, otherwise the carpet would not have dried out in time for the person going to bed. We visited the home the Care Homes for Older People Page 5 of 14 following morning to meet with the provider and took this opportunity to check that the carpet had been cleaned. We were informed that due to a person having sustained an injury and attending the local hospital emergency department that a member of the care staff had escorted the person to hospital. This had resulted in a further delay in attending to the cleaning of this carpet, resulting in it having to be left again until later in the day. We were informed that the care staff attend to cleaning and laundry tasks in addition to performing their care duties, as no designated cleaning / laundry staff are employed at the home. In addition we were informed that the afternoon care staff are expected on occasion to prepare the evening meals and night care staff to clean the carpets in the communal areas. These over arching roles impacts greatly on the availability of when any deep cleaning can take place within the home, and has the potential to leave people using the service with limited care staff presence whilst they are busy performing non caring duties. On viewing a shared bedroom, a person was being cared for in bed it was noted that the bottom sheet on their bed was practically threadbare, and no pillow case was on the pillow. Two foam pillows on the armchair within this room were very lumpy and badly stained with food spillages. Alongside the bed a perspex sheet had been fitted to the wall in an attempt to protect the wall from scuffs, however food and other waste had fallen behind this cover and the wall looked unsightly, this room was in need of redecoration. A new carpet had been fitted and in an attempt to protect the carpet from food spillages, strips of plastic carpet protector had been placed alongside the bed and around the arm chair next to the bed. However this posed a potential tripping hazard for the people occupying the room staff and visitors, due to the plastic rutching. Within the bathrooms and WCs protective gloves and aprons, hand wash and paper hand towels were available, with the exception of the ground floor bathroom, which did not have protective gloves available. We were informed by the senior on duty that the protective gloves were being stored on top of the wardrobe in the persons bedroom next door to this bathroom. That this was due to one person having a tendency to put the gloves down the toilet. The unsuitability of this arrangement was discussed with the senior on duty and the option of providing a lockable bathroom cabinet to store disposable gloves within this bathroom was discussed. Within all of the bedrooms one small hand towel and one flannel was provided and some bedrooms had baby wipes available. It was noted that no additional flannels or bath sheets were available in the bedrooms for peoples use. We looked at the homes fire risk assessment and the generic building risk assessment. The provider has spent a significant amount of time in putting together these documents, however the generic assessments would benefit from more detail, such as the fire risk assessments identifying rooms that have portable audio self closing devices fitted to the doors and having detail on the mobility and cognitive abilities of individuals occupying bedrooms, as this information would be needed in the event of an evacuation of the building by fire fighters. We checked the records of weekly fire alarm tests and the last record was entered as having been carried out on 16th March 2010, in discussion with the person in charge of the maintenance of the home they informed us that the tests had taken place but they Care Homes for Older People Page 6 of 14 had forgot to record when these had been carried out. It was noted that the fire exit to the rear of the main kitchen had some items stored in this area, the items were removed during the inspection, it is important that all fire exits are free from obstructions. The fire door at the top of the stairs leading to the main kitchen had a portable audio self closing device fitted, which was bleeping constantly throughout the whole of the inspection visit, (this is an indication that the battery is in need of replacement). This was brought to the attention of the senior on duty and the maintenance person during the inspection. The door was closed to ensure the safety of people using the service until the battery was replaced and we were informed that this would be attended to. However on visiting the home the following day this door was still closed and the device still bleeping, again we were assured that this would be attended to as a matter of urgency. The office is based in the cellar, at the foot of a steep staircase, of which it was noted that the carpet on the staircase leading to the office was coming loose in places. The office is very small, has no natural ventilation, and computer equipment is in use within this area. The Laundry was viewed which had one washing machine and one tumble dryer available, we were informed that both these items of equipment were in working order. There is no designated laundry person employed at the home, it is an expectation that care staff attend to laundry duties in addition to their caring duties. Items of bedding and towels stored within the laundry room were sample checked, and we found that many looked in need of replacement, due to being worn out, frayed and threadbare. This was brought to the attention of the registered manager at the time of the inspection who said that she would make steps to check the bedding etc. and replace items where needed. Feedback was provided during the inspection to the person in charge of maintenance and building upkeep and also the senior member of staff on duty. We visited the home the following day to provide feedback to the registered manager Mrs Pam Bennett who was not present at the home on the day of the inspection. What the care home does well: What they could do better: In discussion with the staff they gave detailed accounts of the care required for people in Care Homes for Older People Page 7 of 14 their care, this level of detail should be included in the individual written care plans. Attention is needed to improving the exterior and interior of the home, the home is looking tired and in need of redecoration and refurbishment. The outside sitting area to the front of the property is in need of weeding, re potting of plants and general tidying up. The implementation of a program of routine repairs and renewals of fabrics and furnishings would ensure that people using the service are provided with a home that is safe, pleasant and well maintained. Regular checks to the quality of the bed linen, towels flannels, pillows and pillow cases provided by the home would ensure that worn items are disposed of and replaced. A cleaning schedule needs to be put into place to include the deep cleaning of bedrooms, communal areas, kitchen and laundry areas. This would ensure that the home is kept clean and free from unpleasant odours. The introduction of set domestic cleaning hours and tasks, factored into the daily staffing ratios, would ensure that there is sufficient staff on duty so that cleaning tasks do not infring on the care support required for people using the service. All bedroom sinks and bathrooms should have the provision of a sink plug, a han towel and a large bath towel, an additional flannel or where necessary disposable cloths within peoples individual bedrooms. This would ensure that people have sufficient facilities to enable them to strip wash with dignity and prevent the risks of cross infection. The recording of weekly fire tests must take place as this evidences that the test has been undertaken and the outcome recorded to ensure that the fire system is operating correctly. The use of door wedges should be avoided, where it is identified that a door is required to be held open, a formal risk assessment needs to be completed and a suitable door hold open device fitted that will automatically close the door upon the fire alarm being activated. Regular checks to wheelchairs would ensure that they are fit for use and footplates need to be attached at all times. 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 8 of 14 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 26 16 The premises must be kept free from unpleasant odours This is to ensure that people using the service are provided with a clean home that is free from unpleasant odours. 31/12/2009 Care Homes for Older People Page 9 of 14 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, 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 19 23 A program of routine repairs 31/07/2010 and renewals of fabrics and furnishings must be implemented and items of worn out carpets, furniture and fittings must be replaced. This will ensure that people using the service are provided with a home that is safe, pleasant and well maintained. 2 22 23 Wheelchairs must be maintained in good working order and have foot plates available. This will ensure that wheelchairs are available and fit for purpose at all times. 30/06/2010 3 24 16 A timescale for the 30/06/2010 redecoration of bedrooms as identified at the time of inspection must be produced. This will ensure that a programme of routine maintenance and renewal of Care Homes for Older People Page 10 of 14 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 fabrics and decoration is implemented and records kept. 4 24 23 A full audit of the bed linen, towels flannels, pillows and pillow cases provided by the home must be carried out and all worn items disposed of and replaced. this will ensure that people are provided with a good standard of bedding, towels and flannels. 5 26 16 A cleaning schedule must be 30/06/2010 implemented, to include the deep cleaning of bedrooms, communal areas, kitchen and laundry areas. This will ensure that people are provided with a home that is clean, hygienic and free from unpleasant odours. 6 26 16 All bedroom sinks, 30/06/2010 bathrooms and wash hand basins must be supplied with sink plugs. This will ensure that people can use their individual wash hand basins and any of the bathing facilities within the home. 7 27 18 Domestic hours and tasks must be factored into the daily staffing ratios, so as not to infring on the care support provided for people using the service. 30/06/2010 30/06/2010 Care Homes for Older People Page 11 of 14 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 This will ensure that the home is maintained in a clean and hygienic state and free from unpleasant odours and people using the service have access to care support at all times. 8 38 13 Fire exits must be kept free of obstacles. This will ensure the safe evacuation of the building in the event of a fire. 9 38 13 Records must be kept of weekly fire alarm test. This is to evidence that weekly fire alarm tests take place and that the fire alarm is operating correctly. 10 38 13 Where it is identified that a 30/07/2010 door is required to be held open, a risk assessment must be carried out and a suitable door hold open device fitted that automatically closes the door upon the fire alarm being activated. This will ensure that in the event of a fire people are safe behind a fire door. 30/06/2010 30/06/2010 Care Homes for Older People Page 12 of 14 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 19 Attention should be given to tidying the sitting area to the front of the property, to enable people using the service to have a pleasant outdoor seating area. A large bath towel, an additional flannel or where necessary disposable cloths should be provided within peoples individual bedrooms. This would ensure that people have sufficient facilities to enable them to strip wash with dignity and prevent the risks of cross infection. Consideration should be given to relocating the office to an area within the home that is more accessible for people using the service, staff and visitors and provide an office environment with natural ventilation. 2 26 3 38 Care Homes for Older People Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission 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. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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