Care Home: Bethany House

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What the care home does well Before people come to live at the home they are told about what is on offer and what to expect.People are fully assessed before they come to stay. This makes sure the service can give them the support and care that they need. The staff we spoke to have a knowledge and understanding of the service users. The care staff on duty talked and interacted with the service users in a respectful and caring way.The home looks after peoples physical and healthcare needs. They see doctors and nurses and other specialists.A relative told us, ` The care here is the best I have come across`.A service user told us ` The care is excellent`People can chooses what they want to do.The premises meet the needs of the people who live in the home. The environment is clean, light, and well maintained. Each person has the equipment and aids they need to assist them to be as independent as possible.There is a range of facilities to support and improve peoples lives. There is a hydro-pool, sensory room, accessible garden and plenty of space for people to move around. The service provides its own transport and drivers to get people out and about. People are encouraged and supported to take part in a variety of activities in thehome and in the community.Each of the service users has their own rooms, which are personalised and reflect their individual tastes and choices.People keep in touch with their family and friends.People told us that the food is good. And all meals made from scratch with lots of fresh ingredients. What has improved since the last inspection? The home now has a statement of purpose which contains the information needed to tell people about how the service works and what its aims and objectives are.They have held more family days which have been well supported. The home is well kept and they get things replaced and changed when it is needed. What the care home could do better: Some of the people living in the home can`t speak and need help to say what they want in other ways. The home is going to provide more training for staff in person centred planning. This will help see people in a holistic way and will help find different ways to provide the means to express choices.The service is not keeping all its care plans and risk assessments upto date. This means things might be missed and people might not be receiving their care in the way that suits them best.Medication policies and procedures are not followed at all times. This means that people may not be receiving their medication when it is prescribed. The service were not disposing of medication in the way that is required. The registered manager is addressing these issues.All the staff are not up to date with the necessary training. This means that staff may not have the necessary skills and knowledge to look after people in the safest and best way. The service have now accessed the necessary training. Staff competencies also need to be checked at regular intervals to makesure they are using their knowledge in a way that benefits the people at the home.Criminal Bureau Checks need to be kept by the service until after the next inspection. This is so we can evidence that all safety checks have been completed before staff work with vulnerable people. This will make sure they are protected.The registered manager is not up to date with current practises and legislation.The management of the service have not identified some of the shortfalls of the service. And have not made sure they are following the Care Home Regulations. The home are not keeping the commission upto date on things that have happened at the service.Water temperature checks need to be done at regular intervals. Key inspection report Care homes for adults (18-65 years) Name: Address: Bethany House 30 Eastbridge Road Dymchurch Kent TN29 0PG The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mary Cochrane Date: 1 9 0 8 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 47 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 47 Information about the care home Name of care home: Address: Bethany House 30 Eastbridge Road Dymchurch Kent TN29 0PG 01303875199 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : bethanylodge@btconnect.com Mr Robert Shaun Bowden Mills,Mrs Rosemary Jean Mills care home 15 Number of places (if applicable): Under 65 Over 65 15 0 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 15 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability - PD Date of last inspection A bit about the care home Bethany House is a purpose Care Homes for Adults (18-65 years) Page 4 of 47 built, detached house on 2 floors. It was opened in 1997. It has a garden. It is by the beach and the village of Dymchurch. It provides accommodation for 15 younger adults with physical disability who require nursing and personal care. The Providers also run Bethany Lodge, which is close by. They homes share some of the facilities. Everyone has their own bedroom and bathroom. There is a lift and has wide corridors for easy wheelchair access, and other equipment. The home is light, airy and spacious, providing a wellequipped but homely Care Homes for Adults (18-65 years) Page 5 of 47 environment for people to live in. There is a hydrotherapy pool, and a sensory room. There is a minibus and two other vehicles which are for people to get out and about. There are car-parking facilities in the forecourt and the home is close to bus services. The fees currently range between £900 and £1100 per week, depending on what people need. Information about the home including the inspection report from the Care Quality Commission are available on request from the home. Care Homes for Adults (18-65 years) Page 6 of 47 Care Homes for Adults (18-65 years) Page 7 of 47 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 8 of 47 How we did our inspection: This is what the inspector did when they were at the care home We did not tell anyone we were coming to visit the home. We spent 6 hours at Bethany House. We spent time with service users and spoke to 2 staff members and a relative. They told us things about the home and the support and care that is given. We had a look around the communal areas of Bethany House and visited some of the people in their rooms. We looked at the documentation kept by the home. We looked at and discussed service users individual support plans and their risk Care Homes for Adults (18-65 years) Page 9 of 47 assessments. We looked at medication procedures and records. We also looked at staff files and training records. We saw how the service recruits their staff and the homes quality assurance systems. An annual service assurance assessment (AQAA) was sent to us by the service. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. Information received from the home since the last inspection was used in the report. The AQAA contained the information we needed to assist in making judgments about the service. We sent 5 surveys to people who Care Homes for Adults (18-65 years) Page 10 of 47 live at the home, 5 surveys to the staff and 3 to care managers and 3 to visiting professionals. Nine surveys were returned 4 from people who use the service (these were completed with assistance from relatives) 3 from staff and 2 from health care professionals. We received no surveys from care managers. We looked at these before visiting the home and used these comments to help with our inspection. We took looked for things that have happened in the service; these are called notifications and are a legal requirement. We had received no notifications. We identified shortfalls in the systems, procedures and practises Care Homes for Adults (18-65 years) Page 11 of 47 within the home, which are reported on throughout the outcome areas. We also found evidence that the outcomes for the service users is good. The provider and the manager have told us they will address these shortfalls and will tell us how they are going to do this. What the care home does well Care Homes for Adults (18-65 years) Page 12 of 47 Before people come to live at the home they are told about what is on offer and what to expect. People are fully assessed before they come to stay. This makes sure the service can give them the support and care that they need. The staff we spoke to have a knowledge and understanding of the service users. The care staff on duty talked and interacted with the service users in a respectful and caring way. The home looks after peoples physical and healthcare needs. They see doctors and nurses and other specialists. A relative told us, The care here is the best I have come across. Care Homes for Adults (18-65 years) Page 13 of 47 A service user told us The care is excellent People can chooses what they want to do. The premises meet the needs of the people who live in the home. The environment is clean, light, and well maintained. Each person has the equipment and aids they need to assist them to be as independent as possible. There is a range of facilities to support and improve peoples lives. There is a hydro-pool, sensory room, accessible garden and plenty of space for people to move around. The service provides its own transport and drivers to get people out and about. People are encouraged and supported to take part in a variety of activities in the Care Homes for Adults (18-65 years) Page 14 of 47 home and in the community. Each of the service users has their own rooms, which are personalised and reflect their individual tastes and choices. People keep in touch with their family and friends. People told us that the food is good. And all meals made from scratch with lots of fresh ingredients. Care Homes for Adults (18-65 years) Page 15 of 47 What has got better from the last inspection The home now has a statement of purpose which contains the information needed to tell people about how the service works and what its aims and objectives are. Care Homes for Adults (18-65 years) Page 16 of 47 They have held more family days which have been well supported. The home is well kept and they get things replaced and changed when it is needed. What the care home could do better Some of the people living in the home cant speak and need help to say what they want in other ways. The home is going to provide more training for staff in person centred planning. This will help see people in a holistic way and will help find different ways to provide the means to express choices. The service is not keeping all its care plans and risk assessments up Care Homes for Adults (18-65 years) Page 17 of 47 to date. This means things might be missed and people might not be receiving their care in the way that suits them best. Medication policies and procedures are not followed at all times. This means that people may not be receiving their medication when it is prescribed. The service were not disposing of medication in the way that is required. The registered manager is addressing these issues. All the staff are not up to date with the necessary training. This means that staff may not have the necessary skills and knowledge to look after people in the safest and best way. The service have now accessed the necessary training. Staff competencies also need to be checked at regular intervals to make Care Homes for Adults (18-65 years) Page 18 of 47 sure they are using their knowledge in a way that benefits the people at the home. Criminal Bureau Checks need to be kept by the service until after the next inspection. This is so we can evidence that all safety checks have been completed before staff work with vulnerable people. This will make sure they are protected. The registered manager is not up to date with current practises and legislation. The management of the service have not identified some of the shortfalls of the service. And have not made sure they are following the Care Home Regulations. The home are not keeping the commission up Care Homes for Adults (18-65 years) Page 19 of 47 to date on things that have happened at the service. Water temperature checks need to be done at regular intervals. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Care Homes for Adults (18-65 years) Page 20 of 47 Mary Cochrane The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 01622724950 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 21 of 47 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 22 of 47 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need in a format they can understand to help them make a decision about this home. Needs are assessed so the home can be sure it can meet a persons needs. Including aspirations in the assessment will encourage consideration for development and making choices. Evidence: Since the last inspection the homes Statement of Purpose has been updated and now contains the information required by the National Minimum Standards. The statement of purpose and service user guide gives details and information about what the home has to offer. The service user guide includes information on how to make a complaint, peoples rights and terms and conditions. The service user guide has colour pictures and photos. It has large print. This gives people the information they need in a format they can understand to help them decide about moving in. We looked at the assessments of the 2 most recent people who have come to live at the home. They give a clear outline of each persons needs and the care plan is based on these. The assessment focuses on current needs and includes health care, personal care, communication and socialisation needs. The families and people who are important to Care Homes for Adults (18-65 years) Page 23 of 47 Evidence: each person are also involved in their assessment. The AQAA told us all prospective clients are shown around the home and the room that is available. Where it is possible a choice of rooms is offered. The AQAA said we do not admit clients if we feel unable to meet their needs and will give our reasons if we are unable to do so. Prospective clients are able to visit and stay for a few days in the home to help them to decide if the placement is right for them. Family and friends are welcome to view the home with the client and to ask any questions that they may have. Care Homes for Adults (18-65 years) Page 24 of 47 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home receive the care that they need. Care plans and risk assessments are not always up to date and do not reflect all aspects of support and risk for each person. Person Centred Planning will assist people to further communicate their wishes and be involved in how they are supported. Evidence: On the day of the visit there was 15 people living at the home. Each person has a care plan in an individual folder. We looked at two plans in detail and two more generally. The majority of the people who live in the home are unable to speak to tell the staff what they want. The staff interpret their needs. Individual needs have been identified and a care plan is written based on the assessments and getting to know the people. There are plans on, eating and drinking needs, communication, personal hygiene care, medical and specialist needs, and individual management. The home arranges reviews for all the service users. Care Homes for Adults (18-65 years) Page 25 of 47 Evidence: We did find that some peoples support needs had changed but their plans had not been updated to show what changes had taken place. The staff were able to tell how they would best support the person but it was not documented. This means that people could be at risk of not having the care they need or receiving care that is not in their best interest. For example we saw that bladder washouts were needed 2 to 3 times a week but there was nothing documented to say this had been done. We also saw that it was identified that someone mood could become low but there nothing written to tell staff how to identify this and what they had to do. The deputy manager did take immediate action to address these issues. Daily records are kept but they are clinical and mainly relate to peoples health. They do not give a clear picture about how service users spend their time and do not relate to all aspects of the person. The registered manager told us that carers do have access to the plans and do read them but the registered nurses write the daily records. This means that some of the support and care given to people may not be documented or missed as the nurses are not involved in all aspects care and support. Staff are passing on information verbally from one to another but information is not recorded. When we spoke to the registered manager she recognised this short fall and told us that she will review and redeveloped the plans. The care plans of the service user are not written or formatted in a way that is person centred and holistic. The registered manager told us that the staff had no training in person centred planning but she had now booked training for September and October 2009. This will improve the level of involvement people have in planning their own care and how they want to be supported. One relative told us The care given to all the clients is very good. We are very pleased with the care my relative receives. A service user said The help I get could not be better. The majority of people at the home do have difficulty communicating. In 2 of the care plans we saw guidance for staff on how people express there choices, preferences and needs but other plans did not explain in detail how the person is able to communicate. The staff and manager told us that they get to know the service users gradually over time. They speak to their relatives and friends and learn to interpret peoples particular methods of communication. These may be facial expressions, head movements, eye movements or verbal communication. In this way, staff are able to give choice in relation to getting up or staying in bed; use of different facilities; going out or staying in. This information was not in the care plans. Each person living at the home has a key worker. This means staff give particular attention to the specific person allocated to them. The home have regular input from the Speech and Language Therapists. Page 26 of 47 Care Homes for Adults (18-65 years) Evidence: We saw that each person does have risk assessments in place to make they are as safe while allowing as much independence and choice as possible. The format that is used for documenting risk is restrictive and information is squashed into a small space. We saw that some risk assessments had not been update to reflect the changing needs of some people. For example a person risk assessment said that they had bed rails in place and there was guidance on how this should be safely managed, but when we looked at the daily records there was an entry that said the person no-longer used the bed rails as they posed a greater risk if they where used. The risk assessment had not been updated to reflect this and there was no up to date guidance in place for staff to make sure the person was as safe as possible without the bed rails. The risk assessments do not identify all areas of risk. The assessments mainly focused on risk within the home but did not contain information on how to reduce risks when people are out in the community. We were told that people are always supported by 2 members of staff if using the homes transport and all precautions are taken if people go out . The staff we spoke to were able to identify risks, and talk about how they are managed. Some of the service users often go out with their family and friends. We saw no risk assessments in place about how this is managed especially with regards the medication they take with them. The service does provide good outcomes in this area for the people who live at Bethany House. And we found this evidence from gathering information and talking to people who use the service or are involved in someway. We also received information from the staff who work at the home. The home is doing themselves a dis-service by not evidencing and documenting clearly how they are supporting people to make decisions and choices about how they want to live their lives. Person centred planning will assist people to do this. Care Homes for Adults (18-65 years) Page 27 of 47 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities to take part in a range of activities at home and in the community. People are supported to keep in contact with their family and friends. Food is nutritious and balanced Evidence: People do not have an individual activities programme in place. Activities are arranged on a weekly basis and the AQAA told us that people have the opportunity to attend in-house and community based activities. Activities provided by the home include hydrotherapy, physiotherapy, reflexology, massage, use of the multi- sensory room, art therapy, craft and sports activity. Some people have regular hydro therapy and physiotherapy sessions throughout the week. Community based activity include; Ten pin bowling, Cinema, theatre and shopping. The service has arts and crafts activities facility which people regularly attend. There is an activities person 4 days per week. At the time of the visit some people went out, we saw people using the hydrotherapy Care Homes for Adults (18-65 years) Page 28 of 47 Evidence: pool. One person was having reflexology and others were playing a game with staff. Some people were having quiet time in their rooms or watching TV. The service employs a person to take people out in the homes own transport. Outings are organised at the beginning of the week and people can choose what they want to do. The AQAA told us, 5 outings are arranged each week and clients are able to go out regularly if they wish. Some clients attend the day care centre at Folkestone resource centre if they wish. The home has their own transport vehicles, which includes 2 smaller ones for transport of up to 2 people and 2 staff (with space for 1 wheelchair user); and a larger minibus for up to 6 wheelchair users. All service users have 1-1 care on outings. The staff do keep a record of the things that people do. But the information is very brief and doesnt give a holistic picture of how people are living their lives. One activities record said up in lounge and this was all the information it gave for several days. Staff were able to give an accurate account of what this meant but it was not documented. Other records said went to the pub, or went to the cinema but there was nothing written to say whether the person had chosen the activity or whether they had enjoyed it not. The registered manager told us she would address this. Families and people who are important to each person are involved in their support in the home. We saw that people have regular home visits and people are encouraged to bring their family and friends into the home. People also go out and about with their families. People can choose when to be in the privacy of their own rooms or in the communal areas. Everyone has the freedom to access all communal areas of the home with assistance from staff. Members of staff were observed demonstrating good body language and communication skills when interacting with the service users. They were seen to talk and interact in a positive way and involved and included service users in conversations. Many of the people living at home are not able to eat normal meals and receive their nutrition through a Percutaneous Endoscopic Gastrostomy (PEG) tubes. There are regular visits from the community dietician to monitor any dietary issues. People with PEG tubes are still given the opportunity to taste small amounts of solid food and drink if it is safe to do so. There is detailed guidance and direction in place for people who are PEG fed. People who have a normal diet have a choice of menus and a record is kept of what people eat. A relative said, the meals are always cooked from scratch and there are plenty of fresh fruit and vegetables. Page 29 of 47 Care Homes for Adults (18-65 years) Evidence: The cook makes sure that special diets are adhered to, and that portion control is suitable for each person. Pureed meals are well presented. The AQAA told us people can access drinks and snacks whenever they want them. Care Homes for Adults (18-65 years) Page 30 of 47 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will receive the support they need to stay healthy. People have the support they need regarding their personal care. Medication policies and procedures have not been adhered to. People may not receive their medication on time and safely. Evidence: We saw that some people did have support plans in place around their daily routines with regards to getting up and going to bed and personal hygiene. They explained the particular way that people like to have things done. Staff have got to know each person well and have found out how they like to be supported with their personal care. Routines have been established for them and guidelines have been written for the staff so that there is a consistent approach. All personal care is given in the persons own bedroom or en-suite bathroom when possible. If people have specific medical needs there are written guidelines on how to support them. We looked at some records for supporting people on a specialist diet and these gave all the information needed to help and support people to remain healthy and have a well balanced diet. At the last inspection it was recommended that the staff develop Care Homes for Adults (18-65 years) Page 31 of 47 Evidence: different formats for monitoring peoples health care needs. For example, wound care plans now clearly show the dressing of choice, and the size and state of the wound at each dressing change. This information is supported by photographs which show how the wound is improving. The home have involved a wound care specialist from the district nursing team in the care of a people. The service also told us they have joined a pilot scheme to promote infection control and awareness arranged by the Improvement Foundation in conjunction with local Primary Care Trust (PCT). Service users health is monitored and if any problems arise they are dealt with promptly and appropriately. All personal care is provided in peoples own bedroom or en-suite bathroom where possible. Some of the service users have complex health needs. The service was able to evidence that these are well managed. The people living in the home are supported to access the local health care facilities. The provider told us that they have a good working relationships with speech and language therapists, occupational therapists, dieticians, community matrons, physiotherapists and reflexologist. The service employs a physio- aid 5 days a week to support people in the hydrotherapy pool. Each service user is registered with a local doctor and any area of concern related to health is referred to them. There is contact with specialist services when needed. Their medication is reviewed regularly. Medication is stored in a small clinical room. The home uses a monitored dosage system where possible, but many drugs need to be given in liquid form. Storage cupboards and the medication trolley were found to be in good order, and there was no out of date medication. The room and drugs fridge temperatures are recorded daily, and showed that the room temperature is consistently high (24-26 degrees C). This need to be kept under review, and addressed if the temperature is consistently above 25 degrees. We looked at the medication procedures at the home. Only trained nurses administer the medication. We looked at the prescription sheets. We found that people had not received their medication when they were supposed to but the prescription had been signed by the nurse in charge. This had happened to three different people during the month of August 2009. There was nothing written to say why this medication had not been given. This means that people have not received their medication when they were supposed to. The drug errors had not been identified and the appropriate action had not been taken. When we discussed this with the registered manager she immediately informed the doctor and reported the error to the appropriate agencies. We also found that when staff are receiving medication in the home and writing on the prescription sheet, drugs had not been receipted on the prescription sheet. This is Care Homes for Adults (18-65 years) Page 32 of 47 Evidence: important for auditing purposes. There are some drugs kept at the home that need to be disposed of in a specialist way. At the time of the visit the service were not adhering legislation and the drugs were being disposed of incorrectly. The provider has told us he has now addressed this issue. Because staff were not adhering to policies and procedures regarding medication we will make a requirement that they review and change their practises to make sure people at the home receive their medication on time and safely. Care Homes for Adults (18-65 years) Page 33 of 47 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are confident complaints will be listened to and dealt with appropriately. They can be sure they will be protected from all forms of abuse. Evidence: The home has a complaints procedure, which meets the national minimum standards. The complaints procedure is available. The AQAA told us since the last inspection there has been 3 complaints made directly to the home these have been actioned and resolved. There was information about the outcomes of the complaints. We saw that complaints are logged together in a hardback note book. This means that the information cannot be separated. This breaches data protection legislation. We discussed this with the provider and he told us he would review and change this practise to make sure that service user information is kept confidentially. When we spoke to relatives they said that they knew how to complain and would have no problem doing so if the need arose. They said that the management would listen to them and act on any complaints or concerns. The home told us that it has policies and procedures relating to safeguarding adults. Some of the staff have received up to date training in safe guarding adults and there is Care Homes for Adults (18-65 years) Page 34 of 47 Evidence: training planned for those who have not yet received it. Staff were able to tell us about abuse and what they would do if they if they suspected or evidenced that someone was not being treated as they should be. Staff told us they knew about the whistle blowing policy. The homes recruitment procedure includes undertaking formal checks to ensure that potential employees are suitable to work with vulnerable adults. The home has policies and procedures in place to assist in and support people to manage their finances. The policies and procedures protect people from financial abuse. We looked at some of the records kept to trail peoples money and found that in 2 incidences the records had not been updated in a timely manner. We spoke to the registered manager and she told us this issue would be addressed. This will make sure any irregularities will be picked up quickly and appropriately dealt with. This will mean that people are protected from any financial abuse. Care Homes for Adults (18-65 years) Page 35 of 47 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are safe, light, airy and welcoming, and provide a very pleasant and homely atmosphere for the people living there. Evidence: The provider and manager have made sure that the home provides for the individual needs of the people who live there. The living environment is appropriate for the particular lifestyle of the service users. it is well maintained and reflects the individuality of the people who live there. The home is well kept and well maintained. The provider has an on-going maintenance plan and has recently replaced carpets on the ground floor and plans to renew carpets some of the in the upstairs bedrooms before the end of the year. All the areas of the home are spacious, light and airy, with good decor, and wide corridors and door ways. This provides good access for wheelchairs and other equipment. There is a large lounge/dining room and a sensory room on the ground floor. The hydrotherapy pool is situated down a linked corridor, and there is easy access to front and rear gardens. The home has a large quiet room on the first floor, and this is used for Care Homes for Adults (18-65 years) Page 36 of 47 Evidence: service users and their relatives. It is also used for meetings. The home has a call bell system so people can alert staff when they need them. All the bedrooms are personalised according to peoples preferences. Each bedroom has an en-suite toilet and shower, and equipment for individual service users needs is available throughout the home. Bedrooms and communal areas are fitted with overhead hoisting facilities, and there is also mobile hoist available when needed. The home is fitted with specialist equipment, and provision of additional aids is arranged with Occupational Therapists, Speech Therapists etc. This means that people can access all areas of the home safely and have the equipment they need to get out and about in the community. One person said, my room is lovely. There is a shared bathroom on each floor, and these contain specialised bathing equipment and shower trolleys. The sluice room includes a sluice disinfector. Radiators are covered. There is a fire assessment which means the service has looked at the fire risks in all areas of the home and have plans in place to make sure the building is as safe as possible. There is a small laundry room on the ground floor, which is well organised. Since the last visit the washing machine and dryer have been upgraded. There is system in place to make sure that soiled laundry is transported and washed safely. This reduces the risk of cross infection. The laundry is managed by the cleaning and laundry staff on duty each day. Care Homes for Adults (18-65 years) Page 37 of 47 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is taking steps to make sure there is enough staff with the skills, knowledge and competencies to undertake their roles effectively and safely. People are protected by the homes recruitment policies and practices. Evidence: Service users and relatives told us that they have confidence in the staff who look after them. One person said, we have watched all staff from the manager to the domestics and the care is outstanding. Another person said, the staff are very caring. A staff survey told us. Bethany House is a place I would be happy form my own relative to live in, if it was needed. We looked at the staff duty rota and spoke to service users, staff and relatives. Care Homes for Adults (18-65 years) Page 38 of 47 Evidence: The home makes sure that there is enough staff on to look after and support. There is always a trained nurse on duty. In survey that we sent staff told us, Bethany House is very good home. I believe all our service users receive good care and get all the support that they need. If we had more staff in the afternoon we could do more individual in-house activities. There are gaps in mandatory training. The manager is aware of this shortfall and is the process of accessing training for staff over the next few months. The staff are also going to receive more specialist training to make sure that they have the skills knowledge and capabilities to care effectively, positively and safely for the people at the home. The manager is developing a training matrix so gaps can be identified quickly. This was not completed at the time of the visit but the service has now sent us up -dated records on their training. We were told that all new members of staff receive an induction into the home and have an induction training programme in place. This programme is linked to skills for care. We saw evidence of this during the inspection. Staff told us, The home does provide training, but often staff have to do training on their days off and are not reimbursed for this. The management could not show us any evidence that staff competencies are checked to make staff do their jobs effectively and in the best interests of the people who live at the home. We were told that staff have regular supervision. Staff said that they would like more staff meetings and they did not think these were frequent enough and often when they happened focused on negative issues. Some registered nurses do the training required by them to make sure they can re-apply for their registration, but we did see that some nurses had gaps in their training. There is extra training in wound care, infection control and feeding people via a PEG devise. The home has an NVQ programme for care staff and the service told us that they have reached the target of more than 50 of care staff with NVQ level 2. To make sure the service users are kept safe and are protected the company has recruitment procedures. We looked at three of the staff files these included 2 of the most recently employed staff. The manager completes a number of safety checks on new care workers. These include things such as confirming their identity, taking up references and doing a Criminal Bureau check. (CRB) The CRBs have been done on those staff employed by the service and a record of the CRB number is kept. The provider did tell us that he was destroying CRB checks after 6 months. We discussed the commissions guidance Care Homes for Adults (18-65 years) Page 39 of 47 Evidence: regarding not destroying checks until the next inspection was completed. The provider has told us he has amended this practise and will keep CRBs and Pova 1st checks on file. The files had not been audited. The provider told us this would now be done. Care Homes for Adults (18-65 years) Page 40 of 47 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is qualified and has the relevant experience to run the home. She is now aware of the areas that need improvement and has plans to do this. There are shortfalls in the quality assurance systems of the service. The majority of health and safety checks are undertaken. Evidence: The registered manager is supported by a deputy manager, and has daily input from the providers, who maintain a day to day interest in the running of the home. The registered manager has suitable managerial and nursing experience. The deputy manager has completed the Registered Managers Award. The registered manager was not available on the day of the site visit, and the deputy manager was only available for a short time. The provider was available throughout. We did have a long telephone conversation with the manager on 21st August 2009 to Care Homes for Adults (18-65 years) Page 41 of 47 Evidence: discuss issues and shortfalls that had been highlighted during the inspection process. The registered manager told us that she is not up to date with current legislation and new guidance. She told us that she does spend a lot of time working directly with the service users. She said that she is going to discuss with the providers about working more supernumerary hours. This means that she will be able to address the shortfalls in the home and make sure everything is up to date. The manager does have has an understanding of the key principles and focus of the service but we did identify shortfalls throughout the inspection process. But we did find that the outcomes for service users are good. The shortfalls should have been identified and addressed by the manager. She is now aware of the shortfalls within the home and told us that these will be addressed. The manager said she will be working to improve the service. The provider has told us he will be supporting her to do this and work has already started. We received an AQAA from the home when we asked for it. However the information in it was not sufficient to assist us with the main parts of the inspection process. The manager had not taken into account the shortfalls identified at the last inspection and did not tell us in the AQAA how these had been addressed. There was little information on how the service had improved and how the were planning to improve further. We spoke to the provider and he told he would make sure the next one contains the necessary information. The service does seek the views of the people who live at the home and their relatives. This needs to extended to include other people who have an interest and contact with the service. Staff and visiting professionals have not been asked their opinions on how the home is doing. The information has not been collated to identify the strengths and weaknesses of the home. People are not informed of the outcomes following the surveys. The provider told us that this would be addressed. The home does have regular audits from and independent company and these identify generic shortfalls within the home. The PCT make regular visits to the home to review care plans. The service are not checking themselves against the Care Homes Regulations and have not embedded this into their quality monitoring systems. We found that the home were not telling us about certain incidences that are happening in the home that are a legal requirement. They are also not auditing their medication and other systems that underpin the service, support and care that people receive. A requirement will be made in the report. At the time of the visit we did find that the hot water exceeded the recommended temperatures and were not being regularly monitored. The temperatures are centrally controlled and the provider took immediate action to reduce the temperatures. He told us Care Homes for Adults (18-65 years) Page 42 of 47 Evidence: that the he would make sure that the temperatures are now checked regularly and kept within the recommended limits. Care Homes for Adults (18-65 years) Page 43 of 47 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 44 of 47 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 20 13 To make arrangements for the recording,safe administration and disposal of medicines received into the home 30/09/2009 To make sure that people receive their medication when it is prescribed. To make sure medication is receipted and disposed of safely according to the law. 2 39 24 30/11/2009 To make arrangements for effective quality assurance and quality monitoring systems, based on seeking the views of service users and people who have an interest in the service. The Care Home Regulations 2001 need to be embedded into the Quality Monitoring process Care Homes for Adults (18-65 years) Page 45 of 47 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action This will measure success in meeting the aims, objectives and the statement of purpose of the home. This will identify the strengths and weaknesses of the service to make improvements for the people who live there. To make sure you are working within the law. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 46 of 47 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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