Care Home: Bethany House

Similar services:

• Maple Lodge
• Heathlands
• Aston Court Nursing Home
• Breme
• Ravenhurst
• Bank House
• Inspirations
• Ashcroft Hollow Nursing Home

What the care home does well The home continued to provided a good level of comfort in a homely and wellmaintained environment. People living in the home and their representatives told us that they were happy with the food provided and the records indicated that there were a variety of meals being provided for them.There were evident good relationships with friends and relatives visiting the home and they were made welcome in the home. There were a number of staff who had worked at the home for several years and this provided some good continuity of care for the people living there. Some comments received by the commission about the home included: `Since X has resided at Bethany House the staff have always acted in a very professional manner, with cheery smiles and sense of humour. I would imagine this has got to be a difficult job in many respects with looking after many different types of ladies and gentlemen. They (staff) are always hard working and always have a kind word for everyone living there or visiting.` `I`m very well treated by all the staff. The food is very good. I enjoy very much living at Bethany House, I`m a very staunch catholic and as I`m not able to attend church, the home arranges for me to see the parish priest every week and I can receive holy communion, which is very important to me. I am very happy here.` `We as a family feel happy and reassured to have secured a place in Bethany House. X`s care and retaining her dignity is our prime concern and we feel that Bethany House fulfils our criteria.` What has improved since the last inspection? The home has continued to improve the level of detail in the care plans and they were becoming more person centred. Choices at meal times were better evidenced and weights for individuals was monitored more closely. Several improvements had been made to the physical environment including, new inner doors in the entrance to the home, new carpets, new washing machines, new flooring in the dining area, decoration of communal areas and support rails in corridors. What the care home could do better: The home must ensure that there are risk assessments in place for bed rails to ensure that people are not placed at risk from the equipment. Manual handling assessments must indicate the equipment and techniques to be used by staff to ensure that the people living in the home or the staff are safeguarded during these manoeuvres.Staff must ensure that they follow up medical needs to ensure that people living in the home receive the care they need. The manager must ensure that all employment checks are in place before people take up their employment in the home to ensure that only suitable individuals are employed in the home. The home as a rule does not manage the finances of the people living in the home, however it handles some monies on behalf of one person. A tally of the monies on the day of the inspection showed a small surplus. The home must keep accurate records of any monies held on behalf of people living in the home. CARE HOMES FOR OLDER PEOPLE Bethany 434/436 Slade Road Erdington Birmingham West Midlands B23 7LB Lead Inspector Kulwant Ghuman Key Unannounced Inspection 14th August 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000016765.V370348.R02.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. DS0000016765.V370348.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bethany Address 434/436 Slade Road Erdington Birmingham West Midlands B23 7LB 0121 350 7944 0121 624 7311 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) Mr Joseph Alphonse Rodrigues Mrs Helen Rodrigues Mr Joseph Alphonse Rodrigues Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30) of places DS0000016765.V370348.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That one named person, who is under 65 years of age at the time of admission can be accommodated and cared for in this Home. 29th August 2007 Date of last inspection Brief Description of the Service: Bethany House is a registered care home for 30 elderly people and is located North of the City Centre in Erdington and close to the M6. It has easy access to community facilities and public transport that runs directly outside the home. The home was originally four houses that have been tastefully converted into one large care home offering a very good standard of accommodation. Accommodation is offered over two floors with six double and eighteen single bedrooms all with en-suite toilet and wash hand basins. There are three lounges and a large dining room located on the ground floor, toilet, bathing and showering facilities are located throughout the home. There is also a hairdressing room, large kitchen with a small area attached for residents to prepare drinks, medical room, laundry and office space. The front of the home has been block paved and has ramped access and ample parking space. To the rear of the home is a very large patio area that has been block paved to match the front and offers ample space for the residents with a water fountain feature, raised flower beds and seating available. Access to the grounds is via the dining room and three bedrooms on the ground floor have direct access to the grounds. The service user guide states that the current fees were £314 to £346 per week. Social service clients as per existing contract with Birmingham Social Services with top-up. DS0000016765.V370348.R02.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 outcomes. Two inspectors carried out this inspection over one day during August 2008. Prior to the inspection an Annual Quality Assurance Assessment was sent to the Commission that gave some information about the home. During the inspection we spoke with three of the people living in the home, one relative and one professional visiting the home. We received 6 questionnaires that had been completed by people working in the home and 8 questionnaires completed by people living in the home or their representatives. Without exception all the responses were very positive about the home. As part of the inspection process we also looked at the care files of three of the people living in the home and as part of the process of tracking their one inspector observed the three individuals for a period of nearly two hours covering the lunch time period and an activity in the home. We also looked at the recruitment file of someone new on the staff team and two other staff files to sample training records. Other records relating to health and safety were also sampled. A partial tour of the premises was also carried out. Following the inspection four of the staff were contacted by telephone as requested. Their additional comments were about the quality rating of the home last year which they felt was unfair as they felt they provided good care in the home. No complaints or adult protection issues had been lodged with the commission since the last inspection and major issues had been raised directly with the home. What the service does well: The home continued to provided a good level of comfort in a homely and wellmaintained environment. People living in the home and their representatives told us that they were happy with the food provided and the records indicated that there were a variety of meals being provided for them. DS0000016765.V370348.R02.S.doc Version 5.2 Page 6 There were evident good relationships with friends and relatives visiting the home and they were made welcome in the home. There were a number of staff who had worked at the home for several years and this provided some good continuity of care for the people living there. Some comments received by the commission about the home included: ‘Since X has resided at Bethany House the staff have always acted in a very professional manner, with cheery smiles and sense of humour. I would imagine this has got to be a difficult job in many respects with looking after many different types of ladies and gentlemen. They (staff) are always hard working and always have a kind word for everyone living there or visiting.’ ‘I’m very well treated by all the staff. The food is very good. I enjoy very much living at Bethany House, I’m a very staunch catholic and as I’m not able to attend church, the home arranges for me to see the parish priest every week and I can receive holy communion, which is very important to me. I am very happy here.’ ‘We as a family feel happy and reassured to have secured a place in Bethany House. X’s care and retaining her dignity is our prime concern and we feel that Bethany House fulfils our criteria.’ What has improved since the last inspection? What they could do better: The home must ensure that there are risk assessments in place for bed rails to ensure that people are not placed at risk from the equipment. Manual handling assessments must indicate the equipment and techniques to be used by staff to ensure that the people living in the home or the staff are safeguarded during these manoeuvres. DS0000016765.V370348.R02.S.doc Version 5.2 Page 7 Staff must ensure that they follow up medical needs to ensure that people living in the home receive the care they need. The manager must ensure that all employment checks are in place before people take up their employment in the home to ensure that only suitable individuals are employed in the home. The home as a rule does not manage the finances of the people living in the home, however it handles some monies on behalf of one person. A tally of the monies on the day of the inspection showed a small surplus. The home must keep accurate records of any monies held on behalf of people living in the home. 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. DS0000016765.V370348.R02.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 DS0000016765.V370348.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was an admission process that ensured that the home had all the information they needed to ensure the needs of people wanting to move into the home could be met. People thinking about moving into the home were given written information about what they could expect from the home, they were able to visit the home before moving in and there was a trial period during which both the home the individual could decide whether the home was appropriate for them. EVIDENCE: There was a suitable service user guide in place. Relatives told us that they had received a copy when they came to the home. The service user guide included the complaint procedure for the home and the address of the commission but needed to include the telephone number so that the commission could be contacted by telephone if needed. DS0000016765.V370348.R02.S.doc Version 5.2 Page 10 The AQAA stated that people moving into the home all received a contract, surveys completed by people living in the home or their representatives told us that they had received a contract. The completed surveys and one of the visitors to the home told us that they had been able to visit the home prior to deciding whether the home was suitable. One said “ Great care was taken to show us around Bethany and a look at the different areas where X would be living”. The admission process for one person was looked at. It showed that the staff from the home undertook an assessment of need and obtained information from the social workers and hospital. The homes pre-admission assessment was not dated so that it could not be determined when it had been carried out. It did not state where the assessment had been carried. It is recommended that these be indicated on the form to ensure assessments are carried out before individuals are admitted to the home There is a trial period during which the individual can decide whether the home is appropriate and the home can ensure that the individual’s needs can be met. DS0000016765.V370348.R02.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): 7, 8, 9 and 10 Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. The personal and health care needs of people living in the home were usually met well. Risk assessments were in place ensuring that people living in the home were not put at unnecessary risk of injury. The management of medicines was good in the home and ensured that people living in the home got their medicines as prescribed. People living in the home were sometimes addressed with terms of endearment, which is not always appropriate. EVIDENCE: The files of three people living in the home were looked at during the inspection. The care plans included some very good information for staff on how to meet the needs of the people they were caring for and also included details of things that they could do for themselves. For example, ‘ carer to prepare water in basin, collect toiletries, flannels and towels. Then to observe X to ensure X washes themselves properly.’ DS0000016765.V370348.R02.S.doc Version 5.2 Page 12 The care plans could be further improved by including details, for example, for one person it stated that there was broken skin on admission but there was no information available on the assessment relating to where it was or how the staff were to deal with it. For another individual information for staff could be further improved by detailing how their sight impairment affected their daily life and how staff should assist them. Manual handling risk assessments were in place but they stated that if an individual fell and needed assistance the staff needed to use appropriate equipment and techniques. The appropriate equipment and techniques needed to be identified as they could be different for different people and to ensure consistency of approach between the staff. Evidence that this had been addressed was forwarded to us following the inspection. We were told that one of the people living in the home needed to have bed rails in place to prevent them falling out of bed and hurting themselves. There was no appropriate risk assessment in place to indicate how the individual was to be protected from the risks of possible injury from the use of bed rails. The manager needed to acquaint himself and the staff with the information available on the use of bed rails available from the Health and Safety Executive website. Evidence that this had been addressed was forwarded to us following the inspection. During the inspection we observed three people living in the home for a period of nearly 2 hours making recordings at five minute intervals to assess the state of being, level of interactions and engagement for them. For two of the people being observed the individuals were in a positive state of being for three quarters of the time or more but for the third the individual was in a positive state of being for only twenty five percent of the time. The third person also had fewer engagements overall and interactions with staff were all neutral where as with the other two people the staff interactions with them were neutral only 27 and 15 of the time. Staff needed to be mindful that quieter individuals did not get ignored. Questionnaires completed by or on behalf of the people living in the home told us that peoples medical needs were met at the home. One person said “Staff acted quickly when X needed to go to hospital”. Another person said “ X gets all her medical support quickly and easily without having to wait any length of time”. There was evidence that people received attention from the GP, district nurses, chiropodist, dentist and optician. One of the files sampled indicated that an individual had had a problem with the heel of one foot and had seen the GP in respect of this who had said that the district nurses needed to see it over the next few days. It was not clear DS0000016765.V370348.R02.S.doc Version 5.2 Page 13 who was to arrange this and it had been nearly a week since the visit and the district nurses had not been to dress the heel. The staff needed to ensure that this issue was followed up. The administration of medicines was very well managed with no errors identified during the inspection. The medicines were appropriately stored in a medication trolley. Staff administering medicines had all undertaken safe handling in medicines training. There were no controlled medicines in the home at the time of the inspection but there were facilities available for storage and recording if needed. Staff were using the homely remedies in the home. Homely remedies should be for the use of people living in the home for a limited period, with the agreement of their GP and should be recorded on the MAR charts if given. The staff should provide their own medicines and other staff should not be signing to say they have given the medication in case of any reactions. There were privacy curtains in place in shared bedrooms. All bedrooms had en-suite facilities and there were appropriate locks on bathroom and toilet doors. Staff needed to be mindful of how they addressed individuals. During observations it was noted that staff were addressing people as ‘darling’, ‘love’ and ‘good girl’. These may have been terms of endearment however it would be more appropriate to address people by their chosen names. Staff also needed to mindful of how people with dementia were spoken to and that trying to reality orientation was not always appropriate and other techniques may be more appropriate. For example, a member of staff asked one person where they were going and was told that they needed to get to work. The staff went onto to tell them in quite a firm voice that they had retired and no longer worked. This annoyed the individual who continued to be vocal indicated that she believed that she still had a job. Care plans needed to identify how staff should manage these situations on an individual basis. Evidence that this had been addressed was provided to us following the inspection. DS0000016765.V370348.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home were enabled to make some choices. Visitors were welcomed into the home. There were some activities organised in the home and the people living in the home received a varied and nutritious diet. Assistance with eating could be better organised. EVIDENCE: People living in the home told us that they were happy in the home. During the day several visitors were seen to come and go. Some spent time in the dining room and others in the lounge areas. There were evident very good relationships between the home and the visitors and drinks were readily available to people visiting the home. Visitors were welcome in the home and one visitor told us they visited daily at various times. There were a number of activities recorded in the records seen by us during the day. These included visitors, television, listening to music, ball game, hairdresser, sing a long, exercising and bingo. These were the same activities identified during the last key inspection. These can become repetitive and it DS0000016765.V370348.R02.S.doc Version 5.2 Page 15 was recommended that these are varied and include more trips out to local areas of interest or the shops. One of the completed surveys said ‘A tea dance is provided, quite regularly which is very enjoyable for residents and families. We have regular parties too which are really nice. We are always welcome to join in.’ Where specific interests are identified such as watching a particular type of film the plans for that individual should identify how that need is to be met. Religious needs could be met via the visiting priests or by attending local churches. During the inspection we carried out an observation in one of the lounge areas. It was noted that the activity undertaken in the lounge was enjoyed by those taking part and was managed well by the member of staff. The activity lasted for about 20 minutes and came to an abrupt end with the staff saying “I’ll just see how lunch is”. Some people opted not to take part. It was noted that there were lengthy periods of time when the staff where not in the lounge. During the activity people in the other lounge would not have been able to hear the television if they wanted to. People could make choices such as when to get up and go to bed, what to eat, where to sit and whether to get involved in activities or not. People could return to their bedrooms during the day and would be escorted to their bedrooms by staff. Menus seen by us indicated that there were choices available at mealtimes and there was variety. Comments received by use included: “ X receives special care at mealtimes as she needs pureed foods and needs feeding” “What I have seen of them they (the meals) are more than adequate with plenty of choice”. “The food is quite adequate and varied and is very plentiful”. During lunchtime it was seen that staff were asking people if they wanted their food cut up. There were two people who clearly needed help with eating. One member of staff tried to feed both people moving between the two tables whilst still trying to serve meals. The individuals were left for long periods of time without help and this would mean that their food was cold. A different member of staff came into the dining room and encouraged one of them to hold the spoon and she then ate herself. This approach obviously worked better than feed the individual which also took away some of their independence. Where individuals are not able to eat themselves staff should be seated next to them so that they can be assisted appropriately with dignity. DS0000016765.V370348.R02.S.doc Version 5.2 Page 16 The food trolley was brought out and people were asked if they wanted more food. The appropriate cutlery and equipment, such as plate guards were available. Meals for the day are written up on the board in the dining room. There were records in the kitchen to show what people had eaten. Fresh fruit and nuts were available in a bowl in the kitchen. There was a list in the kitchen of people who needed a soft diet but no list of people who were diet controlled diabetic. The member of staff said that there were no diabetics in the home but during examination of files one of the people being case tracked was a diabetic. The member of staff later clarified that they were thinking of people who were on medication for their diabetes. It is important that there is a list of people who need any kind of special diets in the kitchen so that the person who is working in the kitchen is aware of this. This is even more important as different staff work in the kitchen and there is not one or two cooks who deal with meals all the time. DS0000016765.V370348.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home were safeguarded and listened to and actions taken to remedy any dissatisfaction. EVIDENCE: There had been no complaints or issues of adult protection raised with the commission since the last key inspection. The home’s logbook recorded four minor issues that were raised and these had been resolved appropriately. This showed that peoples concerns were listened to and acted on. People received information about how to make complaints in the service user guide and this included the address of the commission. The telephone number for the commission needed to be added to ensure anyone wishing to contact the commission had all the relevant information. One of the completed questionnaires returned to the commission said “I am sure that if X is unhappy then the staff would know and deal with it immediately”. The AQAA told us that there were policies and procedures available in the home to guide staff in issues of adult protection. DS0000016765.V370348.R02.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean, comfortable and safe and met the needs of the people living there. EVIDENCE: During the inspection communal areas were seen and the bedrooms of the people whose care we were tracking were seen. The communal areas were clean and comfortable and accessible to the people living in the home. There were appropriate adaptations in the home including adapted baths, emergency call systems, pressure mats and passenger lift. The home was accessible to people with limited mobility. DS0000016765.V370348.R02.S.doc Version 5.2 Page 19 Bedrooms seen were clean, comfortable and personalised to the individuals liking. The home was safe and well maintained. Comments made by the people living in the home and their relatives included: “The home is very fresh and clean and is always kept at the very high standard we have come to expect. X’s bedroom is extremely welcoming and is kept tidy”. “The home is always clean and fresh. There is always some improvements been made. After visiting other homes Bethany House always smells fresh and nice”. Improvements that have been made since the last inspection include new inner doors in the entrance to the home and new carpets. There is an induction loop in the lounges, two washing machines have been replaced, grab rails installed in the corridor, communal areas redecorated and free view provided in the lounges. Birmingham City Council had rated the home as having excellent hygiene standards. DS0000016765.V370348.R02.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were adequate numbers of staff on duty with the skills and knowledge to safely meet the needs of the people living in the home. The recruitment process did not always evidence that people did not start their employment before all the appropriate checks were in place. EVIDENCE: Examination of the staffing rota showed that there were 5 care staff on duty during the early shift, 3 during the evening shift and 2 at night times. The manager was supernumerary. These staffing levels appeared to meet the needs of the people living in the home. Staff took on a multi-task role that included cleaning and laundry. One of the staff on the early and late shifts was identified on the rota as being assigned to the kitchen. The AQAA stated that a core group of staff had worked at the home a long times. This was good for the continuity of care for the people living in the home. The recruitment file of one new member of staff was looked at. All the required checks were in place in the file however, it could not be determined DS0000016765.V370348.R02.S.doc Version 5.2 Page 21 that the checks were in place before the individual took up employment. One of the references had no date on it and referred to ‘to whom it may concern’ and the second reference was dated after the individual had started work. The first appraisal for the individual was dated before the POVA first check had been received by the home. The manager needed to ensure that all checks were in place before the individuals took up their employment in the home. The individual had undertaken induction training, people handling and first aid training at the home. The training records of two other staff were looked at. This showed that they had received the training needed for them to carry out their jobs. The AQAA stated that all staff had undertaken NVQ level 2 training. Comments included in some of the completed questionnaires returned to us were: ‘The staff at Bethany House are always available when needed. We never have to go looking as they are in attendance all of the time’.’ ‘staff are most helpful.’ ‘Every time I visit there is always someone available to talk to about anything. They are always available for my mother’. DS0000016765.V370348.R02.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in the home could be assured that the home was managed and run with their best interests in mind. Health and safety was well managed. EVIDENCE: The manager had managed the home for several years and it was pleasing to see that improvements continued to be made at the home. It was clear from discussions with the manager that he was very apprehensive about the inspection and some of this apprehension stemmed from comments he had heard from other homeowners. The manager was advised that he acquaint himself with the processes of the commission which are all available on the CSCI website. DS0000016765.V370348.R02.S.doc Version 5.2 Page 23 Several staff spoke with the inspector following the inspection and without exception all expressed their unhappiness at the quality rating given to the home. The inspector spoke about the inspection process and how the quality ratings were arrived at but it is recommended that the manager discuss this with the staff so that they can better understand how the quality rating is arrived at. We were told that the home does not deal with finances for any of the people living in the home. Any items needed by them are bought and the families asked for the money. There was one individual for whom a small amount of money was held in the home. Some purchases had been made for the individual and a record was kept on a small piece of paper. The balance of money in the packet was more than was indicated on the paper. The manager needed to ensure that where monies were held on behalf of people there were proper records that included signatures of the people making the expenditures, and should include the person for whom the purchase was made if possible, otherwise to staff should sign to account for the expenditure. Receipts should be numbered to ease auditing of the system. The AQAA indicated that the home was making improvements that were of benefit to the people living there and these were seen during the inspection. Meetings were held at the home regularly for people living there to make their views known about their meals and another concerns they had and to discuss arrangements for specific celebrations. It was recommended that these meetings fed back to the people living there the actions that or had not taken place since the last meeting. For example, one of the meetings decided that menus would be displayed on the table and choices to be offered the day before. This was not observed to be happening during the inspection and who told the inspectors that this was not put in place but there had been no feedback on why this had been decided and. The home carried out some questionnaires and the comments made were very positive about the home. These had been completed by visitors, people living in the home and a couple of professional visitors to the home. The manager said that further surveys would be carried out. The appraisals for one member of staff were looked at. The appraisals for the individual showed that there had been some areas of performance which had been assessed as poor. The records did not show what actions had been taken to help the individual improve. It was recommended that appraisal records should be more detailed to show the areas discussed and the actions agreed. Staff meetings were held on a regular basis to impart information to staff. DS0000016765.V370348.R02.S.doc Version 5.2 Page 24 The AQAA told us that the equipment in the home was regularly serviced and maintained. There were no issues of health and safety that were seen during the inspection that raised any concerns. DS0000016765.V370348.R02.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 2 X 2 DS0000016765.V370348.R02.S.doc Version 5.2 Page 26 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 OP7 Regulation 13(4)(c) Requirement Manual handling risk assessments must indicate the equipment and techniques to be used when assisting people living in the home. This will ensure that staff can safely assist individuals and provide person centred care. Evidence was provided that this issue had been addressed following the inspection. A risk management plan must be in place for the use of any bed rails in the home. This will ensure that people are safeguarded from the risks associated with the use of bed rails. Evidence was provided that this issue had been addressed following the inspection. The manager must ensure that all the appropriate checks are in place before individuals take up their employment. This will ensure that people living in the DS0000016765.V370348.R02.S.doc Timescale for action 01/10/08 2. OP7 13(4)(c) 21/09/08 3. OP29 19(Sch 2) 01/09/08 Version 5.2 Page 27 4. OP35 17(2) Sch 4(9) home are safeguarded. A record of all money deposited by someone living in the home or received on their behalf should be maintained showing the amounts received and any purchases made on their behalf with the appropriate supporting evidence. 01/09/08 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 OP3 Good Practice Recommendations Pre-admission assessments should record where and when the assessments were carried out. This would ensure that it could be assured that assessments were carried out before people were admitted to the home. Staff must ensure that visits from ancillary medical staff is followed up where needed. This will ensure that people living in the home receive medical treatment as required. Staff should not use homely remedies, these are for the use of people living in the home. People living in the home should be referred to by their chosen names. This will ensure people living in the home are respected and their dignity maintained. It was strongly recommended that the activity records were developed to include comments from the residents on their suitability and include who had declined to take part. The activities could be rotated so that the people did not get bored with doing the same things week in and week out. Individual plans should identify how specific needs would be met at the home 6. OP15 This would ensure that individual needs would be met. Kitchen staff should be alerted to all special dietary requirements of people living in the home. This will DS0000016765.V370348.R02.S.doc Version 5.2 Page 28 2. 3. 4. 5. OP8 OP9 OP10 OP12 ensure that the needs of the people living in the home are made clear to all staff working in the kitchen. Care staff should be seated to enable appropriate support can be provided to people needing assistance at meal times. This will ensure that peoples’ dignity is observed. All staff should be made aware of how each individual is to be supported at mealtimes. This will ensure that support is given without reducing independence for individuals. 7. OP22 The telephone number for the CSCI should be included in the complaints section of the service user guide. This will ensure that people living in the home will be able to contact the commission via the telephone if they wish. The manager must ensure that the training matrix is updated and any gaps in training rectified. Not assessed at this inspection. The manager should discuss with staff in the home the way in which the quality rating for the home is arrived at. This will ensure that the staff have a greater understanding of the inspection process. The actions taken or not taken, between meetings held for the people living in the home should be fed back to them. This will ensure that people living in the home are kept updated about actions being taken. It is recommended that supervision records are developed to include actions taken to support individuals to improve their performance. This will ensure that individuals are given sufficient support to improve and develop. 8. OP30 9. OP31 10. OP33 11. OP36 DS0000016765.V370348.R02.S.doc Version 5.2 Page 29 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 DS0000016765.V370348.R02.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!