Care Home: Bethany

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What the care home does well The home provides a spacious, pleasant and personalised environment for people to live, with a variety of social and recreational activities being provided regularly. One resident comment card stated "there are plenty of activities arranged I feel too much on occasions!!" The spiritual needs of the residents is a priority as the home is specifically for people from the Christadelphian community, the lifestyle provided by the home matches the preferences and values of residents. One relative comment card stated the home "provide the much needed spiritual atmosphere ... conducive to the professed faith of the residents. The residents living in this home receive good level of care to meet their individual needs and have a good quality of life. The residents treat the home as if it were their own and are well supported by staff as to how they spend their day. All residents who completed comment cards for the Commission stated that they felt they received the care and support they needed and many were complimentary of the staff. One resident said "staff are really good" and "staff are first class". One relative comment card stated, "it provides a caring, friendly and supportive atmosphere, whist encouraging independence as far as possible, the staff are good humoured in spite of being very busy". Comment cards returned to us from relatives all stated that they were satisfied with the overall care provided and were kept informed of important matters affecting their relative. The home has exceeded the standard for 50% of care staff to achieve a National Vocational Qualification II in Care. This training helps staff to provide more effective care to the residents. What has improved since the last inspection? The home now write to residents following their assessment to confirm they can meet their needs. Care plans have been reviewed and paper records are now available in addition to computerised records which allows for easy access to records by staff. A review of menus has been undertaken following a consultation with residents about the food and menus have been changed accordingly. The activities provided have increased and this matter is continually revisited to make sure residents are able to access social activities they enjoy. A newer minibus has been purchased to enable residents to enjoy a more comfortable journey when outside visits are undertaken. Accidents and incidents are now being reported to us as required so we know when these are happening in the home and what actions are being taken to safeguard residents. Some areas of the home have been redecorated including new carpets to the landings and stairways to improve the environment for the residents. What the care home could do better: The Service User Guide needs to be reviewed to ensure this includes the Statement of Terms and Conditions for the home as well as a summary inspection report. The document also needs to contain information specific to Bethany so that prospective residents have all the information they need to make a decision to stay at the home. Daily records and task sheets linked to care plans need to show the staff support being provided and be signed to demonstrate care needs are being addressed consistently. The fall risk assessment tool needs to be reviewed, as this does not show residents at increased risk of falling. This will help to ensure suitable actions are taken by staff to manage risks associated with falling. Hot water in resident`s bedrooms needs to be kept warm enough for residents to wash in. Induction training records need to show that new staff are completing the "Skills for Care" common induction training standards. This is so the home can demonstrate they have suitably trained staff to care for the residents. An outcome report should be devised following any quality monitoring exercise and this should be provided to residents and interested parties to show that comments have been listened to and acted upon. Regular assessments and competency checks need to be carried out for those residents self-medicating to ensure they can continue to do this safely. CARE HOMES FOR OLDER PEOPLE Bethany Clarendon Place Leamington Spa Warwickshire CV32 5QN Lead Inspector Sandra Wade Unannounced Inspection 17th March 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 Bethany DS0000004211.V352092.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. Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bethany Address Clarendon Place Leamington Spa Warwickshire CV32 5QN 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) 01926 423661 01926 433041 bethany@cch-uk.com www.cch-uk.com Christadelphian Care Homes Mr Alan Taylor Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th January 2007 Brief Description of the Service: The home provides places for up to 21 individuals or couples who are members of the Christadelphian Church and who may be drawn from all parts of the country. The home provides residential care for older people and does not provide nursing care, any nursing care required is accessed via the nurses within the community. There are care staff on duty 24 hours a day to provide personal care. Accommodation is spacious with 19 bedrooms, which are equipped with an en-suite bathroom and small kitchenette. There is an attractive garden to the back of the home, which can be accessed by steps or a lift. Parking spaces are provided to the front of the home but these are limited. The home supports residents to have breakfast and supper within their own rooms and the main meal of the day is served in the dining room. Social activities and in particular bible readings are provided both in the home, the local community and with regard to church services, at a nearby sister home. At the time of this inspection the fees for the home were £400.00 - £520 per week. These fees are detailed in the Service User Guide for the home. Extra charges are made for hairdressing and toiletries. Bethany DS0000004211.V352092.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 focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection took place from 9.00am to 5.15pm. Before the inspection the manager of the home was asked to complete an Annual Quality Assurance Assessment (AQAA) detailing information about the services, care and management of the home. Information contained within this document was considered as part of this inspection and is included within this report where appropriate. Two people who were staying at the home were ‘case tracked’. The case tracking process involves establishing an individual’s experience of staying at the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Records examined during this inspection, in addition to care records, included staff training records, the Service User Guide/Statement of Purpose, staff duty rotas, kitchen records, accident records, complaint records, health and safety records and medication records. Service users were observed during lunchtime to ascertain choices and view meals made available. A tour of the home was undertaken to view specific areas and establish the layout and décor of the home. What the service does well: The home provides a spacious, pleasant and personalised environment for people to live, with a variety of social and recreational activities being provided regularly. One resident comment card stated “there are plenty of activities arranged I feel too much on occasions!!” The spiritual needs of the residents is a priority as the home is specifically for people from the Christadelphian community, the lifestyle provided by the home Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 6 matches the preferences and values of residents. One relative comment card stated the home “provide the much needed spiritual atmosphere … conducive to the professed faith of the residents. The residents living in this home receive good level of care to meet their individual needs and have a good quality of life. The residents treat the home as if it were their own and are well supported by staff as to how they spend their day. All residents who completed comment cards for the Commission stated that they felt they received the care and support they needed and many were complimentary of the staff. One resident said “staff are really good” and “staff are first class”. One relative comment card stated, “it provides a caring, friendly and supportive atmosphere, whist encouraging independence as far as possible, the staff are good humoured in spite of being very busy”. Comment cards returned to us from relatives all stated that they were satisfied with the overall care provided and were kept informed of important matters affecting their relative. The home has exceeded the standard for 50 of care staff to achieve a National Vocational Qualification II in Care. This training helps staff to provide more effective care to the residents. What has improved since the last inspection? The home now write to residents following their assessment to confirm they can meet their needs. Care plans have been reviewed and paper records are now available in addition to computerised records which allows for easy access to records by staff. A review of menus has been undertaken following a consultation with residents about the food and menus have been changed accordingly. The activities provided have increased and this matter is continually revisited to make sure residents are able to access social activities they enjoy. A newer minibus has been purchased to enable residents to enjoy a more comfortable journey when outside visits are undertaken. Accidents and incidents are now being reported to us as required so we know when these are happening in the home and what actions are being taken to Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 7 safeguard residents. Some areas of the home have been redecorated including new carpets to the landings and stairways to improve the environment for the residents. 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. Bethany DS0000004211.V352092.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 Bethany DS0000004211.V352092.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): Standards 1,3 and 4 were assessed. Quality in this outcome area is adequate. Information about the home is provided but this is not sufficiently detailed to ensure residents can make informed decisions on whether to stay. Prospective residents are assessed prior to their admission to ensure their needs are identified and can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A generalised Statement of Purpose and Service User Guide is available for the home, which contains some information about the care and services provided. These documents were limited in regard to information specific to Bethany Care Home, which is one of a number of homes within the Christadelphian Care Home organisation. The Service User Guide did not contain a Statement of Terms and Conditions for the home or a copy of the summary inspection report. This information needs to be available to prospective residents so that they can make an informed choice on whether to stay at the home. Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 10 A resident spoken to said that a member of their family had been a resident at the home and they had chosen to also put their name on the waiting list so they could also live in the home. They commented how happy they were with the care provided to their relative previously. Detailed assessment records had been completed upon admission, which consisted of allocating a scoring for each need to identify the resident’s dependency. Records on care plan files viewed showed that the assessment of residents’ needs is ongoing with at least monthly reviews of care and changes in care plans where necessary. The manager advised that this process allows them to identify where dependencies of residents are increasing and to decide if the home can still effectively meet the residents needs. The manager has taken action since the last inspection to write to residents following their admission to confirm the home can meet their needs. Bethany DS0000004211.V352092.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): Standards 7,8,9 and 10 were assessed. Quality in this outcome area is good. Service users have care plans to support their care needs and residents look well cared for. Some attention to records is required to ensure the home can demonstrate the care planned is actually received by residents to maintain their health. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was evident from discussions with staff and residents that the home continues to care for residents, which in the majority are of a low dependency. This means that many of the residents are able to independently do things for themselves and only need occasional support from staff. Residents looked well cared for and felt they were receiving the support they required to meet their needs. One resident said “I am happy here” and “it has been a blessing to be here” then went on to say how relaxed they felt since living in the home. Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 12 Another resident explained how staff helped them and how staff were “friendly” and “very nice”. Since the last inspection action has been taken to review care plans to ensure health care needs of residents are more clearly identified. This is so that staff are aware of all care needs and any support the resident may need to meet them. There has also been action to develop paper records in addition to the computer records so that if the computer system fails staff can continue to work with the paper care plans. The process of reviewing care records for residents was very time consuming as there are some records held on the computer that are not in the paper care plan file and vice versa. It was found that reviewing care plan files solely on the computer in particular took a long time which would mean it would also take staff sometime to use these files if accessing care records for several residents. Care plans had been completed for each area of need including personal care, mobility, nutrition etc and staff instructions had been detailed to show the support that the resident required from staff. Care plans for mobility listed equipment that resident’s needed to help them mobilise around the home and to help prevent them from falling. Risk assessments had been undertaken in regards to falls but it was evident some of these showed residents were at “low” risk from falling even when the residents had experienced several falls. This could result in staff not managing the risk of falls effectively as they would consider the resident to be of low risk from this happening. It was evident from records received by us that some residents have had several falls. This matter was discussed with the manager with a view to reviewing the falls risk assessment tool being used. Daily records are completed for each resident and one record viewed showed that a resident had a “pink” area to the skin. It was not evident from reading the daily records that this was being monitored to show if it was improving or had healed. The senior carer felt the pink area had been caused by using too much of a product on the skin and stated she had asked staff to use less. Records did indicate that staff should use a minimal amount of the product but it was not clear that this was because of the reaction caused on the skin. A separate file has been developed for daily tasks that staff are required to carry out for each resident. Staff are then required to sign this on a daily basis to confirm the tasks have been done. This includes the application of creams prescribed by the doctor, checking blood pressure and assisting the resident to the toilet. Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 13 It was found that some of the tasks had been signed and some had not making it difficult to be sure that the task listed had been done. The Senior Carer had identified this was happening and had written a note on the file for staff to record any refusals of help from residents. One resident was identified to have a stoma and daily records showed the resident frequently attempted to manage this them self but they were not doing this very effectively. It was evident that staff support was needed but records were not clear how the stoma was being managed. For example the care plan for the stoma did not contain clear instructions on how to change the bag, how often it would need changing/checking or what staff should do if a sore area should develop. On some days there were no daily records completed to show what staff had done to support the resident with this. It was noted from daily records completed by staff that there had been occasions when the stoma bag was full and had leaked suggesting the way this was being managed needed to be revisited. Care records showed that doctors, chiropodists, opticians and district nurses were being contacted when needed. Of the eleven comment cards received by us from residents, nine of them stated that they “always” receive the care and support they need. Two stated they “usually” did. Of the ten comment cards received from relatives, eight of them felt the care home “always” met the needs of their relative, two did not give a response. One person stated, “X is very happy at Bethany and they care for her extremely well” another stated, “so far all her needs have been met”. Relatives also responded positively to the question “does the care home give the support or care to your relative/friend that you expect or agreed”? Nine responded “always”, one did not respond. One person stated, “the care is excellent”, another stated, “the staff do their utmost to provide excellent care though they are often pressurised due to staff shortages”. A review of medication was undertaken. This was generally found to be managed well. Records showed that medications received, given and remaining was correct. Tablets were counted for selected residents to confirm this. For those residents self-medicating provision had been made for them to store their medication in a secure place within their room. Other medications were stored in a medication trolley in a locked room. It was not clear that those residents who were self medicating had been recently assessed to confirm their competence to continue to do this safely. It was advised that compliance checks are undertaken periodically to confirm this. Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 14 In some instances codes used on the medication administration record (MAR) had not been defined so that it was clear whether a resident had taken their medication or not. Controlled drugs were kept in a suitable lockable cupboard within another locked cupboard. A controlled drugs register was in place and this had been completed appropriately. The privacy and dignity of residents was observed to be maintained throughout the inspection. Care staff were seen knocking on doors before entering and all residents spoken to were very complimentary of the staff and the way their care is managed. Bethany DS0000004211.V352092.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): Standards 12,13,14 and 15. Quality in this outcome area is good. Residents are supported to maintain a lifestyle, which matches their preference and enhances their quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Christadelphian Care Homes (CCH) were set up by the Christadelphian community specifically to accommodate members of the Christadelphian Ecclesia. All of the current residents are Christadelphians and are able to benefit from a lifestyle, which supports the Christadelphian ethos. Residents were seen to be happy and contented living in the home. Each home has a Welfare Committee, which is made up of local Christadelphians who visit the Homes residents and arrange various activities and outings. Outings that had been undertaken during 2007 included a visit to Pinfields House, Stratford mini bus/boat cruise, Leamington Spa Fraternal and Supper, Ryton Garden Centre and Wyevale Garden Centre. All outings had been well attended by the residents. The home also has a planned programme of activities and entertainment. Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 16 Records showed that residents had participated in a slide and talk on Namibia, Christian book shop, coffee mornings, music and movement and had received a visit from residents at the sister home Peacehaven. During the inspection it was observed that board games and large print books are available and one person was observed to be doing a jigsaw puzzle and said they also did some painting. Residents are able to attend bible readings in the evenings in the main lounge unless they choose to go the church located at ‘Peacehaven’, which is close by. Residents are supported to attend church on Sunday morning and evenings and also on Wednesday evenings. The manager advised they were in the process of organising Spring and Summer Trips with the Welfare Committee. Some residents are able to independently leave the home on and continue with their day-to-day life in the community. Residents spoken to were happy with the level of social activity provided. One said they felt happy that they could “make friends with some others”. Another resident said that they participated in the music and movement sessions and Bible readings which they found “enjoyable” and they confirmed there were mini bus outings once a week or two weekly in the Summer. During the day residents were observed to receive visitors who were made to feel welcome by staff in the home. Resident choices are respected and as most have some independence, they are able to make choices for themselves, which staff support. Residents can get up when they wish and are provided with food to make themselves breakfast when they want. As each room has a kitchenette residents can make themselves drinks and snacks when they wish. Drinks can also be provided through the day by staff for those residents who need assistance. Each resident has a supply of cutlery and crockery and at suppertime they are again supplied with food to make a meal. Alternatively residents can choose a hot snack, which staff will prepare for them. If residents are unwell or do not wish to make their own snacks staff will do this for them. The Annual Quality Assurance Assessment (AQAA) document completed by the home and forwarded to us states that the home has a nutritious and varied menu and they regularly encourage feedback from the residents about the food. This document also states that families and friends are welcome to stay for meals and the home can be flexible with meal times dependent upon individual needs. Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 17 At lunch time residents were observed to have their meal in the dining room and a choice of liver or lasagne was offered with carrots, sprouts and mashed potato. One resident was given liver and they said “I never had liver” and the member of staff changed it and gave them lasagne. Staff served each resident individually so they could choose what they wanted and how much. The lunchtime was clearly a social event with many residents chatting to one another. Each table had a bottle of blackcurrant and orange squash and they were set with tablecloths, mats and condiments. Meals were well presented and appetising and residents spoken to following their meal said they had enjoyed it. One resident said the food was “very nice, homely” and “what they expect”. Another resident said there was always a choice for lunch and “so much food comes round at tea time” and the home was “very generous”. Of the eleven comment cards from residents, six said they “always” liked the meals in the home, two stated they “mostly” liked the meals - one commented “very good standard” and two stated they “usually” liked the meals. One did not respond. Bethany DS0000004211.V352092.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): Standards 16 and 18 were assessed. Quality in this outcome area is good. People living in the home are confident that their concerns will be listened to and acted upon. Systems are in place to help prevent residents being placed at risk of harm from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A detailed complaints procedure is available and accessible to residents, staff and visitors to the home. The procedure was on display on the wall although this did contain our old address and needs to be updated. The home states in their Annual Quality Assurance document that they aim to discuss any issues as they arise and also at resident meetings so they can resolve any issues of concern in the early stages. All residents spoken to were very complimentary of the care and services they receive. One resident said they had “no complaints” and “staff are first class”. Another resident said they had “no complaints what-so-ever” they said that if they were concerned about something they would “go to the head” and stated there was “usually a very nice person on duty” if they needed to speak to someone. We have not received any complaints since the last inspection. Records in the home showed that they had received one complaint regarding an odour in one Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 19 of the bedrooms. It was evident that actions had been taken to address this although it had taken a period of time due difficulties in locating the route of the problem. It was later identified to be a problem within the pipework, which the manager stated had been addressed to the resident’s satisfaction. Questionnaires forwarded to the Commission from residents showed that seven of the ten people who responded “always” knew who to speak to if they were not happy, three people felt they “usually” knew who to speak to and one did not respond. One person stated “but I am happy” and “you can speak to anyone who is not busy”. The manager confirmed in the Annual Quality Assurance Assessment document forwarded to us that staff continue to receive training in regards to abuse and have access to the procedures related to reporting this if needed. There have been no allegations of abuse for this home and staff spoken to at previous inspections were clear on what was expected of them should they observe abuse or if this should be reported to them. Bethany DS0000004211.V352092.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): Standards 19, 25 and 26 were assessed. Quality in this outcome area is adequate. Residents enjoy a comfortable and homely environment, which is well maintained although some actions are required address infection control so this is managed effectively to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was generally found to be clean, tidy and well maintained with period items to provide homely and comfortable accommodation for the residents. The home has a large pleasant communal lounge, which is decorated in pink and green with footstools available for those residents who need them. There is a large table, which residents can use to do jigsaw puzzles or board games and there is a cassette recorder, which can be used for music or quizzes and a television. In addition to the lounge there is an attractive conservatory with Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 21 houseplants, which overlooks the garden. The garden had been well maintained and has a chair lift to enable residents to easily access this if they are unable to use the steps. There is a small greenhouse in the garden which was donated to the home and which residents can use if they wish. Resident’s accommodation is provided on three floors with all floors accessible by using a lift or stairs. Since the last inspection some decoration works have been undertaken. The manager stated that this included new carpets to the stairways and landings. The wooden stairs down to the dining room do not have a non-slip surface so residents using them would need to be wary of this to ensure they do not fall. The home has two communal bathrooms for residents. One has a parker style bath for easy access and the other has a walk in shower. Several bedrooms were viewed and it was evident that the residents had been able to personalise them with their own possessions and furniture to make them comfortable and homely. Fridges were available in each of the bedrooms to allow residents to store their own items of food as well as that provided by the home. Arrangements were in place for the temperature of these to be monitored to ensure food was being stored safely. Residents confirmed they were happy with their rooms and had everything they needed. Rooms viewed were bright and warm and had a pleasant outlook through the large sash windows. Each room viewed had a radiator cover in place to prevent burn risks to residents. One room viewed had a stained carpet and this was brought to the attention of the manager who agreed to address this. It was also noted that the carpet in the dining room was stained and some of the tablecloths were marked with food. The Annual Quality Assurance Assessment completed by the manager states that residents rooms are decorated as necessary. It also states that there is a programme of upgrading rooms which is reviewed annualy when the budgets are set. All bedrooms are fitted with thermostatic mixing valves, which control the temperatures of the hot water to prevent burn risks to residents. Hot water records viewed for bedrooms showed that many taps were running below the recommended 43°C, which would mean the water, would not be very warm for residents to wash in. One resident confirmed that the water “did not always get hot”. This was brought to the attention of the manager. The home has systems in place for the management of dirty laundry in that residents place items they want to be washed in a bag and provide a list to staff of the items they have put in the bag for cleaning. Staff can also assist with writing the lists if needed. When the laundry has been completed, this is Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 22 checked off against the list provided to ensure the resident gets everything back. Residents in regard to the laundry service reported no concerns. The laundry area is based on the lower ground level of the home and is jointly used as a staff room. This had two washing machines and two driers to support the laundry needs of the home. There was a sink with drainer being used to soak clothing but no specified hand washbasin for staff to wash their hands. Staff confirmed they washed their hands in the room next door. As the laundry is classed as a “dirty” area staff should have access to a hand wash sink with soap and hand drying facilities to promote good infection control procedures. Gloves and aprons were located in the food store; these should also be available in the laundry again to promote good hygiene. Systems were in place for sorting laundry and sufficient baskets were available to store laundry so that it was not left on the floor as found at the last inspection. Bethany DS0000004211.V352092.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): Standards 27,28,29 and 30 were assessed. Quality in this outcome area is good. There are sufficient trained and knowledgeable staff available to support the needs of residents. Recruitment checks are being carried out to safeguard residents but records do not always demonstrate they have been done as required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Senior Carer confirmed that the dependency levels of residents within this home continue to be low so they require minimal support and are able to be independent in many areas. From speaking with residents, reviewing their records and observing them during the day, it was evident that residents have varying levels of independence and some only require help with specific tasks. There were residents in the home that required increased support and a review of their records confirmed they were receiving this. The manager advised that continuing assessments of those more dependent residents are carried out to ensure the home can continue to meet their needs. The manager confirmed that they aim to have one senior carer and one carer on the early shift as well as a carer/domestic who does some of both roles. On the afternoon shift from around 3pm they aim to have one senior and two carers up to 10pm. Duty rotas show that these staffing levels are generally being maintained. Those viewed over a four-week period showed there were Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 24 two occasions when a senior carer was not on duty for the morning shift although the manager was on duty. In addition to care staff there are specific staff to undertake cleaning, cooking and laundry services. Duty rotas show that domestics do not work at weekends. It was evident that a member of staff works a long shift from 8am to 2pm and then on the same day 10pm to 8am in the morning. This does not allow for a sufficient rest period in between and could impact on the effectiveness of the member of staff. Comments cards received by us show that all residents feel that staff listen and act on what they say. Of the eleven comment cards received from residents, five felt that staff were “always” available when they needed them, five felt they “usually” were available and one responded by saying “I never need a lot of help”. Relatives were asked in the comment cards “Do the care staff have the right skills and experience to look after people properly? Of the ten comment cards received, five stated “always” three stated “usually”, one did not answer and one responded by saying “yes as far as I am aware”. One relative stated “This home is very suitable for my mother as it is run in line with Christadelphian principles and so she feels comfortable with likeminded people and attending services etc”. Another relative stated, “The care staff at Bethany are very professional and always make appropriate use of other professionals if required”. The home employ fourteen carers and the manager confirmed that nine of these have attained a National Vocational Qualification (NVQ) II in Care to help them provide more effective care to the residents. This exceeds the care standard for 50 of care staff to achieve this and is to be commended. In addition to this training staff also undertake statutory training including Food Hygiene, First Aid, Manual handling and Fire Safety. Training records are in place to confirm training undertaken and it was evident this is ongoing. New staff undertake an induction to the home and records were available to show areas covered. It was not clear from records that the induction training provided incorporates the Skills for Care Common Induction Standards. These standards require staff to complete training over a period of weeks to enable them to build up competences in a range of skills. The manager advised that they had started to implement this training and records would be updated to show areas covered. Two staff files were viewed to confirm recruitment practices carried out. Recruitment checks had been carried out prior to staff employment but there was limited information in regard to applying for and receiving criminal record Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 25 bureau checks. The manager receives a notification from the organisation on their headed paper stating that a criminal records bureau (CRB) check has been received. As there was no original paperwork in regard to the application to the CRB, it was not possible to check that the reference numbers originated from the Criminal Records Bureau. The home also does not keep copies of the original emails sent to the organisation on the outcome of staff checks made on the Protection of Vulnerable Adults Register (POVA First), which would also confirm the reference numbers of the CRB checks. The manager agreed to address this matter. Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 26 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): Standards 31,33,35 and 38 were assessed. Quality in this outcome area is good. The manager is able to discharge his duties fully to ensure the home is safe and is managed in the best interests of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post at the home since 2002. He has achieved a City & Guilds Advanced Certificate in Care Management and the Registered Managers Award so is suitably qualified to manage the home. Since the last inspection a new Senior Carer has been employed to help maintain senior support available as well as enable more effective management of the home. The Annual Quality Assurance Assessment produced by the manager stated Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 27 that he encourages an open and transparent culture within the home. Christadelphian Care Homes (CCH) has a Quality Assurance Policy and procedure to ensure the quality of the service is continuously monitored. Six monthly inspections are carried out by a Trustee who compiles a report on how well the home are achieving the care standards. Monthly visits are also undertaken to monitor issues such as any complaints, accidents and any decoration required. Copies of the reports seen showed positive outcomes in all areas. One report highlighted that at a residents meeting it was requested there be occasional visits between the two Christadelphian homes in Leamington. It was evident that this suggestion had been followed up and records showed visits were happening. Resident meetings are held on a two monthly basis by the manager and homes trustee to discuss matters relating to the home and any concerns residents may have. Notes of the meetings are kept to show issues discussed and any actions taken. Sometimes issues from these meetings are fed back to the Welfare Committee who meet every quarter. It was not evident that there had been any recent relative meetings held. The manager advised that they usually communicated any necessary information to relatives when they came into the home. A quality survey about food had been developed and forwarded to residents. Some requests were made in relation to the food such as having mushroom sauce with chicken more often and one person felt there could be a better selection of cakes. It was not evident that the manager had compiled a report of the outcomes of the surveys including actions taken to make it clear their comments had been acted upon. Comment cards received by us from relatives contained many positive comments about the home. One person stated “Bethany Care Home provides a caring and friendly atmosphere”, “the home is always clean and welcoming and carers are always available if required”. Another stated, “Everything that the staff and management put their hands to for the benefit of all residents they do well” and another “This home is a beacon of excellence and mother and I am very satisfied with her care”. One of the relatives has commented in that in the areas of health and appointments they are “a little vague” in regards to how much independence is expected and how much the home will take care of. The person has commented that this is not made clear to relatives. Those residents spoken to during the inspection were happy with the care and support they received and no negative comments were recorded in comment cards received. The monthly visits undertaken by the provider include a check of any petty cash or monies held by the home for residents to ensure records and money Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 28 available are correct and are being managed appropriately. Suitable procedures are in place for the management of resident monies and no concerns were identified. A review of health and safety records was carried out to confirm safety checks completed. This showed the following: Landlords Gas Safety check – 29.2.08 – this showed that action was required in regards to a gas pipe and the manager advised this was being carried out this week. Bath hoists check - 6.2.08 Portable Electrical Appliances – 14.1.08 Legionelleas Water check – 5.8.07 The Annual Quality Assurance Assessment (AQAA) document completed by the manager showed that checks had been done as follows: Lift Service – September 2007 Fire detection equipment October 2007 The manager has also confirmed in the AQAA that there are written assessments in place in regards to staff using hazardous substances in the home. This is so staff can use these safely. Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 29 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 Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 30 CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 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 3 X X X X X 2 2 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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. 1. Standard OP9 Regulation 13(2) Requirement Regular assessments and competency checks are to be carried out for those residents self-medicating to ensure they can continue to do this safely. The fall risk assessment tool needs to be reviewed to ensure this indicates accurately those residents at high risk of falls. This is so staff can take appropriate actions to manage those risks associated with falling appropriately to help prevent injuries to residents. Timescale for action 30/04/08 2. OP7 13(4) 30/04/08 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 The Service User Guide needs to be reviewed to ensure this includes the Statement of Terms and Conditions for DS0000004211.V352092.R01.S.doc Version 5.2 Page 32 Bethany 2. OP7 the home as well as a summary inspection report. Information provided in this document should also be specific to Bethany so residents are clear on care and services provided by this home. Daily records need to show the staff support being provided to demonstrate care needs are being addressed consistently. Daily task sheets need to be signed consistently to demonstrate the tasks detailed have been carried out to meet the needs of residents. 3. 4. OP25 OP26 Hot water in resident’s bedrooms needs to be kept warm enough consistently to allow residents to wash in. Hand washing facilities need to be made available in the laundry so that staff can maintain effective infection control practices. (Outstanding from previous inspection) All carpets and tablecloths within the home need to be maintained in a clean condition at all times. It is advised that a review of any long shifts worked by staff is undertaken. There should be sufficient breaks provided between shifts to reduce the risk of staff becoming tired when caring for residents (issue from last inspection). Action needs to be taken to ensure there is a clear audit trail to confirm Criminal Record Bureau and Protection of vulnerable Adult checks have been obtained as required. Induction training records need to show that new staff are working through the “Skills for Care” common induction training standards. This is so the home can demonstrate that staff are suitably trained to care for the residents. It is advised that an outcome report is produced following any quality monitoring exercise and that this is made available to residents and interested parties to show that comments have been listened to and acted upon. 5. 6. OP26 OP27 7. OP29 8. OP30 9. OP33 Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 33 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. Extracts may not be used or reproduced without the express permission of CSCI Bethany DS0000004211.V352092.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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