Care Home: Bescot Lodge

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What the care home does well We found that Bescot Lodge offers a genuine commitment to care with a professional, yet an open and personable approach, which reflected the homeliness of a confident relationship between carer and people who use the service: "I came here for just a few days but I liked it so much I decided to stay and have been here 4 years and 7 months". Through the process of inspection we considered that the establishment of a detailed care planning and review of resident`s needs were meaningful and robust, formulating a good standard of care. This highly personable attitude and approach to care is appreciated and welcome by residents and visitors alike. The overall management style demonstrated a positive approach in maintaining a social environment conducive to the care of the elderly. We recognised the maintenance of satisfactory staffing levels, with effective staff training and supervision well established in safeguarding the interests of residents. The support services were found to contribute to the team approach, and are recognised for their efforts. We found evidence of a willingness to seek advice from other health professionals in order to maintain a service, which encourages best practice. Overall we consider the attitude in meeting caring and organisational demands is commendable, with forward thinking, planning and application contributing to a good service. What has improved since the last inspection? We found an effective communication record is kept in all care files, confirming that relatives are actively involved in the planning of care. We examined and confirmed that care files have been re-organised to provide a more userfriendly working document. Our discussions with staff confirmed an improvement in the standard of the Induction and training programme. We have recognised the re-introduction of a Key worker system as a meaningful improvement to the organisation of care and services. During the course of our inspection we established that there have been some positive initiatives to the environment, including the provision of a popular memory room, and increased activities. CARE HOMES FOR OLDER PEOPLE Bescot Lodge 76-78 Bescot Road Walsall West Midlands WS2 9AE Lead Inspector Mr Keith Jones Key Unannounced Inspection 26th August 2008 09:00 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 Bescot Lodge DS0000039568.V370500.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. Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bescot Lodge Address 76-78 Bescot Road Walsall West Midlands WS2 9AE 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) 01922 648917 01922 649139 United Care Ltd Mrs Tania Mason Care Home 26 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (26) of places Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th September 2007 Brief Description of the Service: Bescot Lodge provides accommodation and personal care for 26 older people with Dementia care needs. It has 20 single occupancy rooms (some of which have en-suite facilities) and three double bedrooms. There are two lounges, a conservatory and separate dining room, all of which are decorated to a high standard. Parking facilities are located at the side of the home and there is a small-enclosed garden to the rear (not accessible to service users with mobility problems). The home is located in a residential area of Walsall with shops, public transport and a few public houses situated close by. United Care Ltd makes their services known to people who may wish to use the service in The Statement of Purpose and Service Users’ Guide. The Inspection Report is mentioned in the statement of purpose and how a copy can be obtained. The fee chargeable for the service at Bescot Lodge is from £346.00p £415.00p per week, detailed in the service’s Service User Guide’ documents. The fee information applied at the time of inspection, and the reader may wish to contact the service to obtain more detailed and up to date information. Bescot Lodge DS0000039568.V370500.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 2 star. This means the people who use this service experience good quality outcomes. The Registered Care Manager and senior staff on duty were all involved with this unannounced inspection. Our inspection of the building allowed us free access to all areas and open discussion with people who use the service, relatives and staff. There were 25 people in residence on the day of our inspection. We looked at how care is being arranged and supported for a range of people with health care needs. To do this we looked at (case tracked) three people’ files from referral to the present time, and three staff files were examined. We also looked at other information such as complaints, incidents, events and other professional reports. We took the opportunity to speak with a number of people who use the service, relatives and members of staff, who took an active role in the inspection process, and contributed to the subsequent report. We acknowledged receipt of the Annual Quality Assurance Assessment (AQAA), and four survey forms returned by residents. We inspected a sample review of administrative procedures, practices and records, confirming consistent good practice and effective management. We gave feedback, in which we offered an evaluation of the inspection, indicating those recommendations resulting from the inspection. The Registered Provider and his assistant were present for the feedback session. What the service does well: We found that Bescot Lodge offers a genuine commitment to care with a professional, yet an open and personable approach, which reflected the homeliness of a confident relationship between carer and people who use the service: “I came here for just a few days but I liked it so much I decided to stay and have been here 4 years and 7 months”. Through the process of inspection we considered that the establishment of a detailed care planning and review of resident’s needs were meaningful and robust, formulating a good standard of care. This highly personable attitude Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 6 and approach to care is appreciated and welcome by residents and visitors alike. The overall management style demonstrated a positive approach in maintaining a social environment conducive to the care of the elderly. We recognised the maintenance of satisfactory staffing levels, with effective staff training and supervision well established in safeguarding the interests of residents. The support services were found to contribute to the team approach, and are recognised for their efforts. We found evidence of a willingness to seek advice from other health professionals in order to maintain a service, which encourages best practice. Overall we consider the attitude in meeting caring and organisational demands is commendable, with forward thinking, planning and application contributing to a good service. What has improved since the last inspection? What they could do better: We have found that the substantial improvements made in the quality of care and service is not reflected in the adequacy of the environment. More attention is needed in upgrading the furnishing and décor in a number of rooms. We also found evidence of maintenance not keeping pace with demand. Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 7 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. Bescot Lodge DS0000039568.V370500.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 Bescot Lodge DS0000039568.V370500.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): 1,3,4, and 6. The quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The needs of prospective people are appropriately assessed before they are offered a place. They and their relatives can be confident that the service will be able to meet their needs. EVIDENCE: We examined the revised Statement of Purpose and Service User Guide, and found them to provide a very informative description of the Provider’s aims, objectives, and the way the service operated. A separate and well-produced Service User’s Guide serves as readable with valued supporting information, widely used to inform all interested parties. It was agreed that an audio presentation would be advantageous, to complement the large print Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 10 production. It is stated in the service’s AQAA that the Statement of Purpose represents the foundation on which service operates upon, offering potential people and their relatives the opportunity to make an informed choice about where to live. We found this to be true, and acknowledged that the documents were offered to all enquirers, and a copy placed in each bedroom for people to read. We confirmed that the service continues to deploy a statement of contractual agreement, clearly indicates the terms and conditions, which are discussed with people and relatives prior to admission. The agreed choice of bedroom was identified in the contract. Through our case tracking of three people we clearly identified that the Care Manager at the point of reference, conducted the pre-admission assessment. The documentation we examined was found to be comprehensive, providing a solid foundation for progressive care planning. This assessment is produced with the full involvement of residents and family, allowing them to influence the direction of care. The assessment initiates the process of care, each individual having a plan of care, which includes a dependency assessment forming a comprehensive, solid foundation for care planning. The objective is for this assessment to be produced with the full involvement of prospective residents and their family, allowing them to influence the direction of care. During the course of our inspection we had ample opportunity to sit and talk with people who use the service, staff and a number of visitors. We found evidence that attention had been taken in involving people and their families in the admission process. “I came here for just a few days but I liked it so much I decided to stay and have been here 4 years and 7 months.”. “I checked and read through inspector’s reports on many homes in the area and then began visiting them. I chose Bescot Lodge not only because of the favourable comments, but it was able to offer a pleasant, spacious double room for my mother and father to be together which other homes were not able to do. Also impressed with the general decor/furnishings in rooms and friendliness of the staff”, “Information was very forthcoming in talking to staff and many leaflets about home and care”. From our discussions with staff and people who use the service it was evident that prospective people and their relatives are able to visit and assess the quality, facilities and suitability of what is offered at any reasonable time, to meet with staff and management. Staff are aware of the special period of personal anxiety that people have under those conditions. One prospective persons daughter was very impressed with what she had seen that morning, and read about on our website. She told us she was impressed with the activities and general atmosphere of family homeliness, being keen to secure a place for her mum, who had been similarly impressed. Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 11 There were no people assessed and referred solely for intermediary care at the time of inspection. Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 12 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, and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A wide range of needs are addressed through the care planning process, meeting personal and health needs with clear principles of respect, dignity and privacy towards people who use the service. Medicine administration systems are safe and secure. EVIDENCE: We found that the pre-admission assessment represented the foundation for a well-considered and detailed care planning process. Each person’s health, personal and social care needs were found to be carefully assessed in an individual plan of care that is reviewed monthly, to reflect their changing needs supported with an informative daily progress report, and risk assessments. The strength of purposeful planned care lies within the frequency of the review process in monitoring and adapting care. Relatives’ involvement in the process Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 13 was evident. Risk assessments were carried out on an individual basis and frequently reviewed. Case tracking confirmed to us that specialist support and advice are sought as needed, with each person having access to a local Doctor, Dentist, Optician, Chiropodist, and Audiologist as required. Key worker care staff maintain aspects of people’ personal care, overseen by the Care Manager on a daily basis. People using the service appeared to be content, comfortable and happy; complimentary regarding the quality of their lives, and the care they were receiving at Bescot Lodge. The administration of medicines adhered to procedures to maximise protection to people. We saw that storage was secure; although the secure cupboard was not fixed by Rag bolts. We looked at the controlled drug register, and found it to be in order. Random checks of medicine stocks against Medicines Administration Record (MAR) sheets confirmed a consistent and accurate administration. Records were seen to be complete and easy to follow through, with no observed breaches in the system. It is stated in the service’s Statement of Purpose and the AQAA, that ‘independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of residents’. This was confirmed by our inspection findings. People and relatives meetings are held on a three monthly basis, supported with a Newsletter, recently started. We spoke with most of the people using the service, all commented positively about their care, and felt they have everything they need. Several people who use the service stated that: “On the whole, Im very pleased wit the care my mother receives and the home is very comfortable and odour free”, and “I can only add that I personally feel that the home and staff do their best for each patient there. Care plan are always updated regularly”. “the carers are always there to help”. We looked at bedrooms presented to facilitate privacy for the individual, which included medical examinations and personal care procedures being performed in private. Consideration is to be given to facilitate a suitable bedroom door lock for dementia care situations, to enable selective periods of privacy, without prejudicing safety, to complement available lockable facilities. In our discussions with people and staff we confirmed that relatives have freedom of visiting, which emphasised the importance of maintaining social contact, and promotes excellent relationships. From our examination of care records we established that a policy and procedure on care of the dying and death had been carefully constructed to Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 14 meet individual needs, and were in place with the full knowledge of both people and relatives. Individual spiritual persuasions were seen to be documented and respected at all times. We were informed that relatives are welcome to stay as long as they liked in times of stress. We were impressed with the confidence and closeness within the service of staff, residents and visitors, and the mutual respect that prevailed. Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 15 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 and 15. The quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People’s rights to live a meaningful life are central to the service’s aims and objectives. People are offered opportunities to exercise choice and control over their lives. People are offered a healthy, well balanced diet, with choices for every meal. EVIDENCE: Our discussions with people and staff clearly identified a relaxed and informal atmosphere in which the people’s needs were held in high importance. We observed the daily routine to be flexible and non-institutionalised, offering choices for meal times, personal and social activities. We looked at three people’s care notes which confirmed that at pre-admission the person’s personal interests and customs are determined, and where possible accommodated within the routine of the service. We acknowledged Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 16 the practice of preparing individual life histories, which are discussed, and used as a basis for personalised social care offering choice and support. Throughout our inspection we found that people using the service are enabled to enjoy a full and stimulating life style with a variety of options to choose from often by personal requests. There were numerous displays and records of activities participated in, with photographs of major events displayed. We discussed with the manager the potential for recognising a more structured, regular approach to activities linked to socialisation and care planning. We considered that more variety in activities would be beneficial, especially for people with dementia and other cognitive impairments. We were informed of arrangements made for staff to receive appropriate training in meeting the social and leisure needs of people with Dementia care. The Newsletter was also recognised as a valuable point of information and stimulation. We discussed the potential to develop the land around the service to promote a small garden area to enhance outdoor activity facilities. We were informed of plans to provide further reminiscence therapy to complement the popular ‘memory room’, and numerous reminiscence displays throughout. The service continues to operate an established open visiting policy, which was clearly observed during the inspection with our discussion with relatives and friends present at the time. We spoke to several visiting relatives, who stated that: “its fantastic to see dad taking part in activities, and talking to so many different people, he never used to speak to anyone at home, if he could help it”, “Care of my mother is good, to mix with other residents in social activities”, “Activities are there, unfortunately (her) dementia means her time span is very short so she will not always take part”, and “This is one area that I feel there could be more offered, although I realise some of the residents do not wish to partake and participate in activities and display apathy. The staff do try and help and there is a lovely memory room”. Our observations of peoples’ rooms showed a significant influence of personalisation in the inclusion of belongings, furniture and general décor. We did remark on the presentation of the personal bedroom doors to accommodate dementia recognition and familiarity in a more sensitive and positive style. During the course of the inspection we saw that staff interacted with people in a positive and polite manner. We were informed of regular visits by both Church of England and Roman Catholic priests. There are no other religious persuasions at the time of inspection, although a gentleman who has Muslim beliefs recently admitted for respite care was reported to be “very pleased” with his care. Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 17 The manager informed us that each individual is encouraged to be independent with regard to financial affairs with the assistance of their relatives. We found this to be true and saw that each person has a lockable facility available in their rooms if they wished to handle their own accounts. The service offers a good catering service. The menu operates on a four weekly cycle and offers a wholesome, varied choice. Lunch was served during the inspection, we saw it to be an attractive and well-presented meal. Special diets are accommodated with the cook making effort to engage with people who use the service to discuss personal preferences, frequently oversees the delivery of service, and discusses their individual preferences, including the dietary needs of ethnic groups as and when necessary. A discussion we had with the cook clearly indicated her awareness of the wide range of diverse needs she was expected to respond to. Staff were seen to offer discreet assistance to those who required it, with residents agreeing on the quality of preparation and serving. We found the dining area ‘homely’ but very presentable, offering a pleasant ambience for a social meal. A menu sheet was available on each table, although it was felt that a prominent description of each meal would be helpful. Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 18 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 and 18 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a meaningful complaints policy. People are given opportunities to freely express any concerns they are protected from abuse and their human rights are promoted. EVIDENCE: We found that peoples’ legal rights are protected by the systems in place in the service to safeguard them, including their contract, the continual assessment of care planning and policies for example, the complaints procedure. There were a few minor complaints, which we feel would be better dealt with through a ‘record of concerns, complaints and safeguarding’, to record peoples’ and their families’ concerns in a meaningful and effective manner. From our talks with people who use the service, and staff, it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. All people had received information on the procedure to complain, including reference to us. This process was evidenced through the Service User Guide, on examination and case tracking and discussion. We identified that there had been one allegation made to us since our last Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 19 inspection regarding an employment issue, and two dealt with internally - all satisfactory outcomes. Our case tracking confirmed the effectiveness of a Provider, Care Manager and staff sensitive to people’s needs, and a readiness to test the robustness of their information and report structures. We found the policy and procedure for handling issues of abuse (safeguarding) to be effective, and recently updated. We examined four staff records, confirming that staff were suitably checked through Criminal Records Bureau (CRB) disclosure and Protection of Vulnerable Adult (POVA) list. We found staff had received training on abuse at induction; which includes the right to ‘Whistle blowing’, consistent with the Public Disclosure Act 1998. Safeguarding training has been completed for all trained and care staff over this year. Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 20 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): 19,20,24,25 and 26 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although generally the premises are safe, clean and comfortable some work is needed to further enhance the overall environment. EVIDENCE: We looked at the premises and considered that they were fit for purpose, clean warm and tidy, offering a personal and comfortable environment. The surrounding garden is substantial, but the patio areas are small and under utilised. We found the grounds are kept reasonably tidy, safe and are tended regularly, although lacking a designated garden area for people, which would enhance outdoor activities. Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 21 We were informed that on people’s admission the Care Manager assesses each individual’s needs for equipment and necessary adaptations, we found this to be correct, and saw those facilities were available. Efforts had been made to provide a ‘homely’ atmosphere and the décor in most areas was found to be of an adequate standard only, in need of upgrading of furnishings and décor. However none of the people we spoke to felt the rooms were poor, all remarked how comfortable and homely they were. We considered that to improve security service areas and storerooms should be secured when not in use. We found all communal areas were of a good standard, offering social as well as private reflection, as the mood takes. There are two well-furnished communal day rooms where people are able to access at all times via well-lit corridors. The areas were found to be comfortable, welcoming and homely, of a good standard of furnishings, offering social as well as private spaces. We were informed that social, cultural and religious activities tend to take place in the lounges. The dining area was a well-furnished, homely room for a pleasant passing of time over a good meal. We noted that toilets and bathrooms were located on both floors, and were in close proximity to bedrooms and communal areas. Presentation was very satisfactory, although some of the paper towel dispensers and liquid soap dispensers needed filling. A bath thermometer was advised for each bathroom. Most bedrooms we looked at were adequately maintained to meet people’s personal preferences, being highly personalised, with some displaying own furniture, and personal belongings. We were told that it is the policy that on bedrooms becoming vacant that each room is reappraised for redecoration, although we found most rooms showed deteriorating fixtures, and an ‘adequate only’ standard of décor. Nevertheless people we spoke to expressed a sense of belonging and satisfaction in the quality and presentation of their living areas. Numerous floral displays greatly enhance the presentation. We did remark on the presentation of the personal bedroom doors to accommodate people with dementia in recognising in a clearer, more robust style. We advised that personalisation should be a permanent presentation of actual normal usage. We also found that double bedrooms should have ceiling tracked curtains installed. Our inspection found several examples of unfinished, or inadequate attention to maintenance standards, which were brought to the attention of the care manager. Several wardrobes were seen to be unsecured. We tested the effectiveness of the nurse-call alarm system, receiving a positive response, and personal electrical equipment (PAT) were seen to be tested appropriately. We recognised the standard of cleanliness to be satisfactory throughout; there was no evidence of offensive odours in any of the rooms we looked at. We Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 22 were informed that sluices, bathrooms and toilets were cleaned on a routine basis, which we confirmed during our inspection, presented a pleasant and hygienic environment. Disposable gloves and aprons were seen in use, and liquid soap and paper towels were evident throughout, although some dispensers had not been refilled. We looked at the kitchen with the cook and found a well equipped and organised area. All fridges and freezers were checked daily by the kitchen staff, and recorded appropriately. A cleaning schedule was in place, up to date and we confirmed, accurately reflecting the observed standards. The sluices and laundry were found to be well organised and equipped to a good standard, procedures were in place for coping with soiled or infected linen with the provision of alginate bags to minimise handling and cross-infection. We indicated that appropriate laminated information posters Control Of Substances Hazardous to Health (COSHH) would enhance safety in all areas handling chemicals. It was identified that the small stock of ‘lost’ clothing be reorganised. The domestic services were seen to be of a good standard. People and relatives spoken to remarked that they find the environment always very clean and conducive. We found no evidence of unpleasant smells or unsightly debris anywhere throughout the inspection, much to the credit of all staff concerned. The Registered Provider is to provide the Inspector with a development plan for 2008/09, with consideration given to a full risk assessment of the Home. Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 23 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 and 30 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels ensure that suitably trained staff are provided to meet the needs of people who use the service. Recruitment, appointment and training processes are consistent and robust, protecting the people who use the service from harm and abuse. EVIDENCE: Duty rotas were made available at our request from these we saw that staffing levels are satisfactory. We found that the service has maintained staffing to consistent levels to ensure equilibrium between numbers, skills and qualifications, with a solid foundation of long serving, and experienced staff. There were 25 people using the service on the day of our inspection. Agency coverage has not been used during the last three months; overtime and flexible rostering meet shortfalls. The Care Manager works supernumerary contributing to the shift rotas on an ‘as and when, need be’ basis, and is supported by an able team of carers, each shift being led by a team leader. Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 24 The, catering and domestic hours were determined and found to be appropriate for the size of the Home, and the needs of the people who use the service. There is also a part time maintenance person working nine hours a week. We examined three staff files, each providing satisfactory evidence that the process of appointing new staff were well organised, consistent and contributed in safeguarded the interests of residents. Three members of staff on duty were interviewed. Each member of staff spoke well of the training and supervision offered to them, and of the good working conditions that prevail. Our discussions with staff also confirmed their commitment to providing a quality service, and their awareness of the principles of good practice and Code of conduct. There were no problematic issues raised by the staff. There is a satisfactory staff induction programme, which we found initiated a formal in-house training schedule. We recognised that the National Vocational Qualification (NVQ) programmes continues, with good standards maintained. Consideration has been given to enlarge the availability for care staff to the dementia training programme to meet anticipated needs. The programme was examined and found to be a good quality, national award scheme. We accept the continuing commitment to care education as maintained at a much improved standard. A staff comment received indicated: “Training is ongoing to meet the care that each individual receives. At present Dementia Level 2 to deal with the amount of residents we have in our care that have dementia, or Alzheimer’s, to get a better understanding of each individual’s needs”. The supervision programme is firmly established, which involved establishing a shared aspect of responsibility between staff and trainer, with the involvement of mentor trained staff. All staff spoken with felt the benefit, and ‘inclusion’ created by the process. “We have regular supervision and can discuss any concerns with manager”. Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 25 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): 31,32,33,35,36 and 38 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care team promote the health, safety and welfare of people using the service, and working practices are safe. People who use the service can be assured that the service is run in their interests. The ethos of the service is based on openness and respect. EVIDENCE: We found that the Registered Care Manager Tania Mason has demonstrated a commitment and competence in running Bescot Lodge, by establishing a solid Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 26 procedural and policy platform; that has been implemented to achieve a good standard of set aims and objectives. A well-qualified care manager, she has demonstrated to us her wide experience of over 20 years as a carer, and is well qualified in meeting the aims and objectives of the service. She has a Level five NVQ and the Registered Managers Award, and has actively promoted, and enhanced the Key worker team concept. The Registered Provider has demonstrated a high profile and involvement in the smooth running of the service, and delegates a wide range of management responsibility to good effect. We acknowledged the openness and confidence in the observed interactions of staff, relatives and people who use the service. Relationships were seen to be of mutual trust and respect. Evidence was secured to acknowledge achievements, ongoing and planned objectives. Involved within this process are the views of people and relatives, confirmed at case tracking, relatives audit and informal discussion. All requirements and recommendations made at the last inspection have been addressed. We found appropriate risk assessments in place for people through care planning, review and monitoring, staff selection and the general environment, these were found to be up to date and accurate. Health and safety notices were seen throughout the premises. We recognise that quality assurance complements this arrangement, in that we found extensive monitoring in areas as care planning, staff meetings, staff training and residents’ suggestions. Our case tracking reinforced the effectiveness of people’s involvement in their care and environment. We saw records of people and relative meetings that are a recognised feature of quality assurance. Comments from those attending included: “On rare occasions when the need is there, there is always someone to talk to.” “I can only add that I personally feel that the home and staff do their best for each patient there”. Financial records and administrative procedures relating to the handling of monies of three people who use the service were inspected and were found to be well ordered and maintained. We sampled records and servicing reports and found them to be well maintained, accurate and up to date, ensuring that the people’s’ rights and best interests are safeguarded. The procedures manual was examined, and found to offer a useful up to date reference. Relevant legislation was discussed and is fully understood by the management, especially the Mental Capacity Act and its implications. Equality and diversity issues were also discussed covering a wide range of issues, including food, religion and staffing. We found that the health and safety of residents and staff are promoted with safe storage of hazardous substances, regular electrical PAT and servicing of Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 27 electrical and gas appliances and regulation of the water system. Maintenance issues are to be reviewed to keep on track with needs of the refurbishment programme. The accident book was seen and found to be in order for staff and residents, with a three monthly analysis of trends and frequency. An examination of administrative, monitoring, planning and care records showed an organised and professional attitude to effective record keeping. They were generally found to be well maintained in ensuring that the residents’ rights and best interests are safeguarded. The Manager offered evidence of safe working practices including procedures on: - infection control, abuse awareness, challenging behaviour and dementia care. We recognise that the administration and management of the service is efficient, uncomplicated and sensitive to the needs of people who use it. Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 28 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 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X X 2 3 3 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 3 3 3 X 3 3 X 3 Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? None 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 2 Refer to Standard OP9 OP10 Good Practice Recommendations To ensure adequate security of Controlled drugs at all times by fitting with Rag bolts to a secure adjacent wall. Ceiling-mounted curtain tracks should be fitted to replace the unstable wheeled curtain frames this will increase safety and privacy for people who use the service. Consideration should be given to the appointment of an activity coordinator, to facilitate social interaction and stimulation and ensure that the needs of the people who use the service are fully met. Greater variety in activities would be beneficial, especially for people with dementia and other cognitive impairments. 3 OP12 4 OP12.3 Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 30 5 OP19 Full unit risk assessment programmes should be established to increase safety and help keep people who use the service safe. A system should be put in place to ensure that the essential repairs such as those identified in this report are dealt with promptly to increase safety and comfort for people who use the service. To consider the provision of a small garden area for the use of people for their enjoyment and leisure. A re-furbishment plan should be drawn up to address improvements for 2008/09, to offer advance information on the level of development of the service, and enhancement of décor throughout. This is to increase safety and comfort for those who use and work in the service. Bath thermometers should be placed in each bathroom and shower area, to facilitate safe bathing. Liquid soap and paper towel dispensers should be refilled and maintained at all times to minimise any risk of cross infection. Extra hours of maintenance should be considered to maintain a high standard of repair and refurbishment. Freezers in the outbuildings should be maintained and defrosted to prevent any food risk. COSHH posters should be located in areas where chemicals are stored to enhance safe handling of chemicals this to increase safety in the service. 6 OP19 7 8 OP20OP20. 3 OP24 9 10 OP25 OP26 11 12 13 OP27.7 OP38 14 15 OP38 OP38.4 Ensure access to all service rooms be secure to casual entry by people and therefore minimise risk of injury. Bedroom wardrobes should be secured to abutting walls to ensure people’s safety. Bescot Lodge DS0000039568.V370500.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. 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