Care Home: Bethesda Home

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What the care home does well The atmosphere in the home was comfortable, homely and relaxed and staff were seen to be kind and caring towards people living in the home. Care planning systems ensure that social, personal and health care needs are identified and met. Residents spoken with said that staff are very good and so were the meals. Wholesome, nutritious and well balanced meals are provided in addition to activities and outings. People moving into the home are able to bring in their personal possessions to personalise their bedrooms and the home has a well maintained garden to the rear of the property and limited parking at the front. There is an open-house policy, which welcomes visitors at all reasonable times and complaints are handled well ensuring that residents feel listen to and their views acted upon. All parts of the home are well maintained and both safety checks and quality monitoring systems ensure any shortfalls are identified and addressed. Staff are well trained and the manager provides good overall leadership whilst remaining aware of residents individual needs. What has improved since the last inspection? Residents and their families are now given access to copies of the homes complaints procedures. The three good practice recommendations in respect of creating a staff training matrix, recording healthcare appointments and updating all policies and procedures have also been fully addressed. What the care home could do better: No significant shortfalls were found as a result of this visit. Key inspection report Care homes for older people Name: Address: Bethesda Home 5 Hove Park Gardens Old Shoreham Road Hove East Sussex BN3 6HN     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 review of the service. We call this full review a ‘key’ inspection. Lead inspector: Gwyneth Bryant     Date: 0 5 0 8 2 0 0 9 This is a review of 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 2 1 0 stars - excellent stars - good star - adequate 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. that people have said are important to them: They reflect the things 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 Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 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 Older People Page 3 of 24 Information about the care home Name of care home: Address: Bethesda Home 5 Hove Park Gardens Old Shoreham Road Hove East Sussex BN3 6HN 01273735735 01273735735 hove-bethesda@surfanytime.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Trustees Of Gospel Standard Bethesda Fund care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 22 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Bethesda is one of three care homes owned by the Trustees of Gospel Standard Bethesda Fund. The home is registered to care for up to 22 older people who require assistance and support in their everyday lives. The home is not registered to provide nursing care. One of the conditions of residency is that residents are members of the Gospel Standard Churches or that they regularly attend their chapels. The home comprises of a large three-storey property, which is set back from the Old Shoreham Road next to Hove Park, the area is quiet and peaceful. All bedrooms have en suite Care Homes for Older People Page 4 of 24 Over 65 22 0 Brief description of the care home facilities and are located on the ground floor. There are also assisted baths and walk-in showers. The home has a dedicated Bethesda library and a very well maintained rear garden area, which is accessible to all residents. The home also has the use of a communal mini bus. The home also has a shop trolley to enable residents to buy small items such as notepads, envelopes and toiletries. Fees currently range from approximately £458.50 to £525.70per week. Additional charges are made for hairdressing and chiropody. Care Homes for Older People Page 5 of 24 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 Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 uses the term service user to describe those living in care home settings. For the purpose of this report those living at Bethesda care home will be referred to as residents. This was an unannounced inspection and took place in just under five hours. The purpose of the inspection was to check compliance with key standards and other standards. There were fourteen people in residence on the day. Six residents were spoken with in addition to discussions with the Registered Manager, the administrator, a senior carer and the cook. The last key inspection was conducted on 6 September 2007 and an Annual Service Review carried out on 21 July 2008. A number of documents and records were viewed; including personnel files, medication charts and care plans and a tour of the premises Care Homes for Older People Page 6 of 24 was also carried out. Eleven bedrooms were visited as were two communal bathrooms and the communal lounge and dining areas. Prior to the site visit we asked the Registered Providers to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. This was completed well and provided when we asked for it and the information included in this report as necessary. Care Homes for Older People Page 7 of 24 What the care home does well: 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 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 Older People Page 8 of 24 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 24 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 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 moving into the home benefit from an admission process that ensures their individual needs and wishes are comprehensively assessed and identified as being able to be met prior to moving into the home. Evidence: As part of the care planning process all people moving into Bethesda have a detailed assessment of their needs which is used as a basis for their individual plans of care. The admission assessments for four residents were viewed and it was evident that a thorough assessment process had been undertaken prior to all four people coming to live at the home. Information is gathered from a variety of sources including social care professionals, in addition to input from family and friends. Information in the AQAA demonstrated that all people moving into the home are encouraged to visit prior to admission. Care Homes for Older People Page 10 of 24 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 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 care planning systems ensure that the health, medical and personal needs of those living in the home are identified and planned for in a consistent and comprehensive manner. Evidence: Four care plans were viewed and it is clear that they have been developed from the information in the pre-admission assessments. The plans were satisfactory in that they included clear information on the care needs of people living in the home and the necessary action to be taken to meet those needs. Two plans included a list of the residents daily routines and the manager said she intends to extend this to all care plans. The manager is also in the process of developing a detailed history of individual residents as part of the holistic approach to care. A sample one was available and found to give a good understanding of the residents past life, including their interests. Residents are encouraged to remain independent within a risk-assessed framework. Risk assessments had been carried out and they clearly identified the hazards and included sufficient detail for the management of risks. Some residents go out alone to shop or to walk in the garden. Risk assessments include details of those residents who Care Homes for Older People Page 11 of 24 Evidence: need staff to escort them when they are outside. There is a daily handover which includes written details of each resident and there are additional notes within the care plans which are used where there has been a change to usual routines, such as GP visit or a need for pain relief to ensure staff can follow up on changing needs. The home has folder to record visits from GPs, district nurses, chiropodists, hospital appointments, dentists and opticians. Although the need for these services are in the care plans, the home maintains separate folders for ease of reference. Some residents living in the home hold and administer their own medication and satisfactory risk assessments have been carried out to ensure they are not at risk. There are policies and procedures on respecting service users dignity and privacy and all service users are offered keys to their bedrooms and staff were seen to knock on doors before entering. Throughout the site visit staff were seen to treat individuals with care and respect and it was evident that comfortable working relationships had been developed. Residents spoken with praised staff for their care with comments such as I cant fault them or they are just wonderful. As part of the homes ethos of encouraging independence each residents medication records are held in a locked cabinet in their own rooms. Staff then give the medication to the resident and the medication chart is marked to indicate medication has been made available. Medication Administration Records for July were viewed and found to be clear, accurate and up to date ensuring that it is clear whether or not medication has been given. Two apparent errors were found but may be due to the homes procedure for administering medication. This was discussed with the manager who agreed to contact the Commission Pharmacist inspector for clarification. Care Homes for Older People Page 12 of 24 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 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 in the home have the opportunity to experience a lifestyle that matches their expectations, choice and preferences in respect of leisure activities and meals. Evidence: The home employed someone to provide activities but the take up was poor as most residents in the home like to provide their own activities or read. Two residents spoken with said they go out into the community independently and good risk assessments were in place for this activity. The manager is keen to provide activities and the day before the site visit, five residents had an outing to a nearby steam railway. The manager has plans to offer more outings and activities when residents request them. Staff spend time with residents on a one to one basis and this needs to be recorded. None of the residents spoken with indicated that they were bored or would like more activities, therefore it appears that they are content with the current activities. Residents are actively encouraged to eat in the communal dining room but have to choice of eating in their rooms if they wish. The weekly menu is displayed on the notice board and a choice is given for each meal. The menu showed that meals are varied, well balanced and nutritious. A discussion with the cook found that she is aware of one person who is subject to high sugar Care Homes for Older People Page 13 of 24 Evidence: levels and has amended their desserts accordingly. The cook has a list of the meals that each person has chosen and each resident spoken with said the food was excellent and they couldnt wish for better. The home has a trolley shop so residents can buy toiletries and small items such as note pads and pens. In the corridor there is also a table of handcrafted items which are sold to raise funds for the home. The homes routines are flexible and residents treated as individuals as indicated in all aspects of the service. Those people spoken with confirmed that they go out into the community and that visitors are made welcome at all times. Daily religious services are provided and there is a relay system to ensure all residents can hear the service even if they in their rooms. Care Homes for Older People Page 14 of 24 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 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 home has a satisfactory complaints procedure with evidence that those living in the home feel that their views are listened to and acted upon. People living in the home are further protected by satisfactory adult protection systems. Evidence: The AQAA showed that the home has policies and procedures on both complaints and Safeguarding Adults. The complaints and incident logs were viewed and the home has not had a complaint since 1997 and no significant incidents since 2003. Residents spoken with said they would be happy to speak to staff if they had any concerns. All staff have had up to date training in Safeguarding Adults, as has the manager. During the site visit it was identified that one person may need a best interest assessment and the manager agreed to raise this with the appropriate agency for advice. Care Homes for Older People Page 15 of 24 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 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 standard of decor and maintenance within the home is excellent, providing people living in the home a safe, homely and comfortable environment Evidence: Eleven bedrooms were visited, in addition to two communal bathrooms, one communal toilet and the lounge and dining room. The home continues to provide a safe and comfortable place in which to live. Residents bedrooms were very well maintained and pleasingly decorated and it was evident that people are able to bring in their own possessions in order to personalise their bedrooms. All bedrooms have en-suite facilities and all were clean and well maintained. Of the vacant rooms, it was evident that one is in the process of being refurbished including the provision of new carpets. One bathroom had a walk in shower and the other had a fully assisted bath to ensure all residents are able to be easily bathed. There are hoists and other equipment provided that fully meet the needs of people living in Bethesda. The laundry facilities are satisfactory and washing machines are able to wash clothes at temperatures that control the risk of infection. Staff are trained in infection control and none were seen to be wearing gloves or aprons in communal areas which indicates that they are disposed of in the room where they are used. This is in line with good practice as is the separate soiled laundry bins. The garden is particularly good, with a wide range of plants, flowers, shrubs and rose Care Homes for Older People Page 16 of 24 Evidence: bushes, thereby providing an excellent view for residents. There is also a summer house and seating areas in the gardens. The gardens are accessible via a ramp and provision of a handrail. The side gardens have been used to plant vegetables for use in the home. One resident remarked how lovely it was to have access to fresh, home grown vegetables. Care Homes for Older People Page 17 of 24 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 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. There are sufficient staff with appropriate skills to meet the needs of those people living in the home and the recruitment practice is also sufficiently robust to safeguard those living in the home Evidence: There are three carers on duty during each daytime shift and another carer is available to bathe residents. There are two night carers of which one is a sleeping duty. In addition there are a cook, two kitchen assistants, two domestics and a gardener/handyman. In employing domestics care staff have ample time to devote their time to residents. Recruitment records for three staff were viewed and it was found that all staff had provided the required information prior to appointment, including Protection of Vulnerable Adults and Criminal Record Bureau checks, two written references and a full employment history. Volunteers are also required to undergo Criminal Records Bureau checks and provide references prior to having contact with residents. There is staff training development programme, which includes both mandatory training and additional training such as dementia care. Of the twenty-two care staff, thirteen have achieved National Vocational Qualification level 2 in care therefore the home exceeds the required 50 of staff with this qualification. The staff induction programme has been implemented and this was confirmed by staff within the staff surveys. In addition, the induction records for two new staff were Care Homes for Older People Page 18 of 24 Evidence: viewed and found to include all aspects of the services provided in the home. Residents spoken with spoke highly of the care given and said they felt safe and well looked after. One person said that it was good that whenever they needed to be hoisted this was done by two carers at all times. Care Homes for Older People Page 19 of 24 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 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. People living in the home and staff benefit from clear leadership and direction and all aspects of their health, safety and welfare are protected and promoted. Evidence: The Registered Manager has the qualifications, experience and knowledge to effectively manage the service. Throughout the site visit there was evidence of her proactive approach to improving all aspects of the service. In parts, such as growing vegetables for the home is particularly innovative and the development of personal histories of residents can only enhance the person centred aspects of care giving. Growing vegetables not only gives residents access to fresh produce, it is also good business practice to enable the home to operate within budgets. The manager is keen to see residents receiving a good level of care whilst maintaining their independence and information in care plans indicated that there is an ethos of respect for individual needs. Throughout the site visit it was evident that staff are comfortable in approaching her with any concerns. The manager convenes meetings for both residents and staff and the minutes of these meetings were viewed. These Care Homes for Older People Page 20 of 24 Evidence: demonstrate that people living in the home are listened to and their suggestions acted upon and that they have a say in how the home is run. Minutes of meetings showed residents had been consulted on menus, outings and other activities. The minutes of staff meetings also showed that staff are encouraged to comment on how the home is run. One member of staff suggested that a picture be pinned to a bedroom door to enable the resident to easily recognise their room, this was acted upon and found to be very effective. The manager remains involved in the day to day routines of the home, by joining the staff handovers and this ensures she remains up to date on the needs of residents and monitor staff practice. As part of the quality monitoring process all policies and procedures are regularly updated and the manager undertakes training to update her skills and knowledge. The home holds small amounts of money for residents, which are held in individual boxes and kept locked in the safe. The records relating to transactions were viewed and found to be in good order, with two staff signatures for each transaction. The AQAA showed that regular checks are made on all electrical and gas appliances and systems and these records were checked on the day and found to be up to date. In addition checks are carried out on call bells, water delivery temperatures and emergency fire systems. All staff have been trained in fire safety and a fire safety risk assessment has been carried out for all parts of the premises. These systems ensure the safety of people living in the home in the event of fire. As part of the fire safety systems a colour code has been developed to ensure both staff and the fire service are clear on the amount of assistance individuals need to evacuate the building in the event of fire. Accident records were viewed and found to be accurate and maintained in line with the Health and Safety Executive guidance. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Older People Page 22 of 24 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 Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 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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