Care Home: Bethany House Care Home

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What the care home does well The home has a specially adapted van that relatives can use to take people out at no cost to them. This is used quite often by relatives to take their families out for shopping trips and visits to local places of interests. Daily records show good examples of how the home works with other healthcare professionals in meeting the needs of the residents. There were examples of prompt referrals to GPs and tissue viability nurse. As the home provides palliative care, they have established good working arrangements with McMillan nurses, a local GP with specialism in palliative care and the local hospice staff. The nursing staff have had training in palliative care with the local college. Care staff have also received training in "end of life" training. The care plans are computerised and show details of regular reviews and updates to the plans to reflect the current care needs of the residents. The home is good at making links with the local community and they are supported infund raising activities for the home. The home has a good computerised system in place for carrying out regular audits of the residents accounts. During the inspection visit the inspector spoke with a number of residents and their relatives and their comments and those made in the residents surveys include the following: "I am very happy with the care that my mum receives at Bethany House. She is respected and treated with dignity". "The staff are always helpful and happy". "Nothing seem to be any problem to the staff". "Thanks for your hard work and excellent care and dedication, mum`s health has greatly improved since being here". "Have never heard anyone being cross with the patients". "This place is really very clean and there is never a smell in the home". The home has a good computer system for managing the home`s records and the day to day running of the home. There are good infection control measures in place. The staff are well trained and they continue to receive updated training to improved on their skills and knowledge. What has improved since the last inspection? There were no reqirements for improvements made for the home to improve on. What the care home could do better: The manager should provide one-to-one supervision for the care staff. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bethany House Care Home Village Close Woodham Way Newton Aycliffe Durham DL5 4UD The quality rating for this care home is: three star excellent 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 assessment of the service. We call this full assessment a ‘key’ inspection. Lead inspector: Sam Doku Date: 1 0 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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 Copies of the National Minimum Standards – Care homes for older people 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 21 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 Care Homes for Older People Page 3 of 21 Information about the care home Name of care home: Address: Bethany House Care Home Village Close Woodham Way Newton Aycliffe Durham DL5 4UD 01325300950 01325308897 susanfoster_25@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Object Quest Limited Mrs Susan Forster care home 29 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration Category(ies): old age, not falling within any other category physical disability Additional conditions: Number of places (if applicable): Under 65 0 7 Over 65 29 0 The maximum number of service users who can be accommodated is: 29 The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 29 Physical Disability - Code PC, maximum number of places 7 Date of last inspection: Brief description of the care home: Bethany House is a registered residential care home providing nursing and personal care for up to 29 older persons. The home can also provide care for up to 5 persons with physical disabilities within the overall registered number. The home is owned by Woodham Christian Centre Ltd. which is a charitable organisation managed by a Board of Trustees. The home is located in the town of Newton Aycliffe. The home was opened in 1992; it Care Homes for Older People Page 4 of 21 D D M M Y Y Y Y is a purpose built building providing residential and communal living space on two floors and the second floor can easily be accessed by the lift. There are 29 single bedrooms 7 of which have en-suite facilities. The home has an easily accessed conservatory, garden and courtyard area for the use of the residents and visitors. There are good public transport links to the local towns of Darlington, Shildon and Bishop Auckland. Local amenities including, a community centre, post office and a church are located nearby. The fees charged at the time of this inspection were between 436.60 and 614.25 Pounds per week. These fees do not include hairdressing, newspapers and private transport. Care Homes for Older People Page 5 of 21 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: three star excellent service Care Homes for Older People Page 6 of 21 How we did our inspection: The quality rating of this service is 3 Star. This means the people who use the service experience excellent quality outcomes. The inspection was unannounced and commenced on 5 June 2009 and completed on 10 June 2009. Before the visit the inspector looked at: Information we have received since the last inspection visit on 7 June 2007. How the home dealt with any complaints and concerns since the last inspection. Any changes to how the home is run. The providers view of how well they care for people, as highlighted in the details provided in the Annual Quality Assurance Assessment (AQAA). The views of the people who use the service. The comments made in the residents and relatives surveys that we received. The comments made by the staff in the five staff surveys that we received. During the visit the inspector did the following. Talked to the people who use the service, the manager and the care staff. Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff have the knowledge, skills and training to meet the needs of the people they care for. Looked around the home to make sure it is safe and secure. Checked what improvements have been made since the last inspection. The inspector told the manager what he found. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use the services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: The home has a specially adapted van that relatives can use to take people out at no cost to them. This is used quite often by relatives to take their families out for shopping trips and visits to local places of interests. Daily records show good examples of how the home works with other healthcare professionals in meeting the needs of the residents. There were examples of prompt referrals to GPs and tissue viability nurse. As the home provides palliative care, they have established good working arrangements with McMillan nurses, a local GP with specialism in palliative care and the local hospice staff. The nursing staff have had training in palliative care with the local college. Care staff have also received training in end of life training. The care plans are computerised and show details of regular reviews and updates to the plans to reflect the current care needs of the residents. The home is good at making links with the local community and they are supported in Care Homes for Older People Page 7 of 21 fund raising activities for the home. The home has a good computerised system in place for carrying out regular audits of the residents accounts. During the inspection visit the inspector spoke with a number of residents and their relatives and their comments and those made in the residents surveys include the following: I am very happy with the care that my mum receives at Bethany House. She is respected and treated with dignity. The staff are always helpful and happy. Nothing seem to be any problem to the staff. Thanks for your hard work and excellent care and dedication, mums health has greatly improved since being here. Have never heard anyone being cross with the patients. This place is really very clean and there is never a smell in the home. The home has a good computer system for managing the homes records and the day to day running of the home. There are good infection control measures in place. The staff are well trained and they continue to receive updated training to improved on their skills and knowledge. What has improved since the last inspection? What they could do better: 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 on page 4. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Care Homes for Older People Page 8 of 21 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 21 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have their needs assessed before they are admitted to the home. This ensures that the needs of the prospective residents have been identified and arrangements can be made to provide the care that the person needs when they are admitted. The home provides information about the service, including invitation for prospective residents to visit the home, which enable them to make informed decisions about whether to live at Bethany House. Evidence: Residents files contained pre-admission assessments carried out by the home and also by the social worker or nurse assessor. The registered manager confirmed that it is the homes policy for the nursing staff to carry out pre-admission assessments or obtain a copy from the nurse assessor or a social worker. These assessments are then used to prepare the initial care plans for the person so that all staff would know what care and support the person needs when they arrive in the home. A visiting relative confirmed that when her husband was coming to the home, the staff visited him in hospital and carried out an assessment. They also spoke with her about the care needs of her husband. The manager and staff described the effort they make to ensure that people visit the home and see it for themselves before they decide to come and live at Bethany House. A number of residents and relatives who were spoken with confirmed that they had the Care Homes for Older People Page 10 of 21 opportunity to visit the home. The manager confirmed that all residents have copies of the service user guide which provides information about the home and the service that the home provides. Relatives who were spoken with also confirmed that they have copies of the guide. The guide contain a sample copy of the contract and also of the complaints procedure. Care Homes for Older People Page 11 of 21 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 the 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 residents receive care that is consistent with their personal and healthcare needs. Furthermore, the home has good procedures in place for administration and safe handling of medication which safeguard the health of the residents. The residents are treated with dignity and their right to privacy is upheld. Evidence: The inspector spoke with a number of residents and he used the opportunity to speak to them about the arrangements that are in place to make sure that their healthcare needs are met. They all said that they have access to healthcare facilities including visits from their GPs and other healthcare professionals. The electronic files for the residents provide details of the healthcare support that each individual resident gets. The electronic care notes also show entries of visits to or from healthcare professionals. The home provides palliative care and there are good working arrangements between the home and the McMillan nurses, a local GP with specialism in palliative care and the local hospice staff. Good palliative care training has been provided to the nursing. The care staff have also received training in end of life care. Staff gave examples of good care practices for people who are approaching the end of life. The Care Pathway for End of Life care system is used when someone is approachng death. There is great emphasis on ensuring that the person is comfortable and free from pain. Their spiritual needs are also also provided for. The trained nurses have also received training in verification of death. Care Homes for Older People Page 12 of 21 One relative described the excellent personal and medical care with the words, the doctor has asked for him to go into hospital for treatment but I always say he is better off here. The electronic care plans are well written and provide good information for staff to follow when providing specific care tasks. The electronic care plans provided details of how staff should support the residents and these are regularly reviewed and changes made to them to reflect the current care needs of the individuals. The home shares parts of residents records with residents GPs which makes it easier for GPs to view certain records remotely, thus facilitating quicker response to the medical needs of the residents. The inspector spoke to staff about specific care plans and they were aware of how the person should be cared for. The staff were able to access the care plans and stated that they found the system to be good and easy to use. Care staff said that they often read the care plans and are regularly informed by the nursing staff when any changes have been made to any of the care plans. The home has detailed written policies on the storage and administration of medicines. The manager confirmed that the nursing staff who are responsible for the administration of medicines have received up to date training on safe handling of medicines, and they follow the homes medication policies. A random check of the medicines administration system was undertaken by the inspector. There were no discrepancies noted, and the administration sheets have been signed and dated as required. The residents repeat prescriptions are maintained on the computer system and allow easier monitoring of the stock of medicines in the home. The interaction between staff and residents was good. Staff showed respect to the residents and this was commented on by a number of residents. The service user surveys that were received indicated that the residents are treated with respect and dignity. The five people who responded to the questionnaire were very complimentary about the staff and the care that they receive. Most residents and relatives described the medical and personal care provided by the staff as excellent. Care Homes for Older People Page 13 of 21 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using the 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 social, recreational and spiritual needs of the residents are fully met. This promotes the residents sense of wellbeing. Evidence: The dining room is spacious, pleasantly decorated and furnished to a good standard. The inspector observed that during meal times, the tables were appropriately set and residents had their meals in a pleasant and comfortable setting. The residents were given plenty of time to enjoy their meals and people who require help from staff with the meals were given that support in ways that preserved their dignity. Residents said they like the food and that there is always plenty to eat. They described the food as excellent and they commented positively on the choice of menus that they get. The store room was well stocked with brand-name food items and there was good selection of food items to provide for individual preferences. In discussions with staff, residents and relatives it was evident that the home has strong links with the local community. Social activities often involve the local community and there are frequent charity fund raising events in the home and within the community. The residents commented that they always look forward to organised activities and praised the staff for their commitment. The spiritual needs of the residents are provided for by frequent pastoral visits from the local churches. Residents confirmed that they get up and go to bed when they want. All the residents said that they are able to go to bed when they want and rise when the want. One visiting relative confirmed that, very often her husband has a lie-in and arrangements are made for him to have his breakfast in bed if he wants. Care Homes for Older People Page 14 of 21 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and relatives have information about how to make a complaint and are confident that any concerns raised would be acted on by the home, thus promoting their right to express their views about the service. Staff are aware of safeguarding adults procedures and have received suitable training which safeguards the welfare of the residents. Evidence: The comments in the surveys show that the residents and their relatives are aware of the complaints procedure and would know how to complain. The complaints record on the computer system shows that five complaints have been received since the last inspection and all these complaints have been appropriately addressed. Details in the complaints record show that the home takes complaints very seriously. A summary of the complaints procedure is contained in the service user guide. Then manager indicated that the home has a open door policy and this allows residents and relatives to express their views readily and freely. One visiting relative commented that if she has any concerns she would approach the manager and she is confident she would address her concerns immediately. Staff have had training in safeguarding adult (POVA) procedure, and this is reflected inthe staff training log. Staff who were spoken with were aware of the homes whistle blowing policy and staff were confident that if they saw any bad practice, they would feel comfortable in bringing it to the attention of the manager or any senior staff member. Care Homes for Older People Page 15 of 21 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, 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. This is what people staying in this care home experience: Judgement: People using the 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 home provides safe, secure, clean, warm and pleasant environment for the residents to live in. Evidence: The home is clean and maintained to a good standard. The bedrooms that were seen were clean and personalised, reflecting individual tastes and preferences. Residents have been encouraged to furnish their rooms with personal items which enhanced the homeliness of their rooms. All rooms are single occupancy and some have en-suite facility. Individual rooms have good ventilation and natural lighting. Residents and relatives described the bedrooms as comfortable and homely. Window restrictors have been fixed to all windows for safety, and all radiators have suitable covering to prevent any accidents to the residents. Checks of hot water at randomly selected bathing outlets confirmed that hot water did not exceed the safety level of 43 degrees centigrade. There are good arrangements in place for regular maintenance work in the home. The maintenance book shows that the handyman has kept on top of any maintenance and safety work that is needed to maintain a safe environment. These include fire safety checks and fire drills. The home has suitable infection control policies in place. Staff have had training in infection control and the records show that the home has adhered to effective infection control procedures. The kitchen was noted to be clean and maintained to a good standard. There is a cleaning rota showing how the domestic staff keep up with the cleaning activities in the kitchen. Records relating to food temperatures and other food hygiene measures are maintained. The laundry was found to be well ordered, and appropriate COSSH notices are in place. The laundry machines are suitable for cleaning foul linen. Care Homes for Older People Page 16 of 21 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using the 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 staffing numbers are satisfactory and promote the safety and welfare of the residents. The registered manager follows the homes policy on staff recruitment and training procedures, which promote the welfare of the service users, by ensuring that unsuitable carer are not employed. Evidence: There is a registered nurse on duty at all times including night duties. Staff were spoken to about the staffing levels in the home. They all said that the staffing levels are always adequate. Staff records show that the staff have received training in moving and handling, first aid, protection of vulnerable adults, fire safety, food hygiene and health and safety training. The nursing staff continue to receive refresher training to update them on nursing practices. The files for the most recently employed staff were examined to check on the recruitment process by the manager. The files show that the home has been following good recruitment procedures. All the files contain completed job applications, copy of job description, appropriate references, evidence of CRB checks and record of induction and training. Information in the AQAA shows that, apart from two who are currently doing their NVQ training, all the care staff have NVQ Level II or above. The manager confirmed that the nurses continue to update their skills and knowledge in current nursing practices. Staff record show that the home has extremely low turnover of staff. The residents and relatives commented positively on the well established staff team and said that this provides a stable setting for the residents. Care Homes for Older People Page 17 of 21 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using the 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 home is managed by a qualified and experienced person, and runs the home for the benefit of the residents. However, the home has no system in place to provide supervision for staff of all grades. This, potentially compromises the quality of the service that the residents receive. The safety and welfare of the residents are protected by the regular servicing of electrical and mechanical equipments and the safety arrangements that are in place. Evidence: The registered manager has long experience of managing a residential care home and she has been managing Bethany House for a number of years. Staff commented positively on her management qualities as being excellent, approachable and very supportive of the staff and the residents. The inspector spoke with the manager about the system for managing the residents monies. The manager confirmed that checking the financial system is part of the regular audit that she carries out. The system is computerised and there is regular auditing of each residents personal allowance. Examination of staff records show that there is no system in place for providing formal supervision for the staff. The manager indicated that because of her open door policy, it had not been necessary to undertake any formal supervision as staff are able Care Homes for Older People Page 18 of 21 to approach her at any time if they have any concerns. However, the inspector referred her to the national minimum standards which requires her to provide each staff member with formal supervision. The homes Health and Safety policies remain in place. These cover policy areas such as fire prevention and Care of Substances Hazardous to Health (COSHH), protection of vulnerable adults, infection control, dealing with violence, disposal of clinical waste and record keeping. There is evidence that staff adhere to the policies as set by the company. Servicing records confirm that all portable appliances have been tested. A record is maintained of regular water temperature tests in the home. Regular servicing of fire equipment, passenger lift, bath lifts and hoists, gas and electrical appliances have been carried out by the contracted companies. All the servicing records that were examined were up to date. These included servicing of passenger lift, hoists, water treatment, electrical installation and gas servicing. Care Homes for Older People Page 19 of 21 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 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 36 The manager should provide formal supervision for the staff in line with the national minimum standards. Record of such supervision should be maintianed for each staff member. Care Homes for Older People Page 20 of 21 Helpline: 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 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. ©This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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