Care Home: Bethune Court

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What the care home does well There is good evidence that people interested in moving into the home are provided with comprehensive information so that they are able to make an informed decision. Prospective residents are also able to visit the home to meet with other residents and staff. Detailed pre-admission assessments are carried out so that the manager can make an informed decision in regard to meeting the residents care needs. There is good evidence that residents have a voice in the way the home is managed and particularly in regard to social activities both within the home and in the local community. The food in the home is excellent offering residents a variety of well cooked nutritious meals that are served in relaxing and attractive surroundings. Staff are unobtrusive at mealtimes but are available to give assistance as and when required. Residents were very complimentary about the meals offered in the home, saying that the standard of cooking is excellent. Residents said that they know how to complain should they need to and they know that the complaint will be taken seriously. The home throughout is maintained to an excellent standard, providing the residents with a comfortable and relaxing home in which to live. Residents are able to bring their own furniture and other personal items for their bedrooms if they wish to. All bedroom are provided with en suite facilities and there are more specialised communal bathing rooms on each floor. At the present time care and ancillary staff are employed in sufficient numbers to meet all the residents needs. There is good evidence that staff have the qualifications, skills and experience to meet residents personal, health and social care needs. Recruitment procedures in the home are robust, with all prospective staff being appropriately vetted prior to being offered employment in the home. The home places high priority on fire, health and safety issues by ensuring that regular monitoring and risk assessments take place and maintenance of equipment and the environment is managed in a timely way so that both residents and staff are protected from risk. What has improved since the last inspection? All requirements made at the last inspection have been complied with. Those residents who self medicated or partially self medicate are monitored and risk assessed on a monthly basis to ensure that medication is kept safely in their bedrooms. What the care home could do better: The inspector viewed three care plans and found that not all parts had been completed, and that personal care was given generic descriptions rather than showing that individual needs, preferences, choices and likes and dislikes had been taken into consideration. While medication is generally well managed in the home further improvements could be made in regard to dating eye drops/ointments on day of opening on the bottle/tube to ensure that administration does not go beyond the 28 day opening period. Key inspection report Care homes for older people Name: Address: Bethune Court 30 Boscobel Road St Leonards-on-sea East Sussex TN38 0LX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: June Davies     Date: 2 9 0 1 2 0 1 0 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 25 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 25 Information about the care home Name of care home: Address: Bethune Court 30 Boscobel Road St Leonards-on-sea East Sussex TN38 0LX 01424719393 01424420043 colin.marshall@anchor.org.uk www.anchor.org.uk Anchor Trust Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to ve accommodated is 45 The registered person may provide the following category/ies 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 categories: Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Bethune Court is a purpose built residential home on the outskirts of St Leonards on Sea in East Sussex. The home incorporates single flatlets for all residents which are furnished with residents own furniture, however furniture can be provided if required. There are several communal areas within the home, and a small well maintained garden, which is easily accessible to all residents of the home. Residents also run a Care Homes for Older People Page 4 of 25 Over 65 0 45 45 0 Brief description of the care home small shop and library and hold meetings to decide what activities and outings they wish to take part in. The home holds many parties and photographs of these adorn the walls of the home. All residents can receive help with personal care, and local GPs and community nurses visit the home. Information in relation to fees charged can be obtained on application from the registered manager, this does not include extra services such as hairdressing and chiropody. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home 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: This key unannounced inspection took place on Friday 29th January 2010 over a period of seven hours. During the inspection the inspector spoke with the acting manager, head of care, two staff and four residents. Documentation was viewed relating to the key standards inspected. Observations took place of staff interacting with residents and the environment and a short audit was carried out of medication. Residents spoken to during the inspection were all very happy with the care and the food they receive. Four residents said that staff are very kind and always willing to help them. Staff were positive about the home and the training they receive. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: The inspector viewed three care plans and found that not all parts had been completed, and that personal care was given generic descriptions rather than showing that individual needs, preferences, choices and likes and dislikes had been taken into consideration. Care Homes for Older People Page 7 of 25 While medication is generally well managed in the home further improvements could be made in regard to dating eye drops/ointments on day of opening on the bottle/tube to ensure that administration does not go beyond the 28 day opening period. 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 25 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 25 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. Prospective residents are given detailed information so they are able to make an informed choice in regard to moving into Bethune Court. Pre-admission assessments are carried out, so the manager can make an informed choice in regard to the home meeting the residents assessed needs. Evidence: Statement of Purpose and Service User Guide meet the standard and regulations. Residents spoken to were able to confirm that they had received copies of these documents prior to making the decision to move into the home. Prospective residents are also invited to visit the home prior to making a decision to move in. Four pre-admission assessments viewed showed detailed information in regard to the physical, health and social care needs of the prospective residents. There was evidence that prospective residents and/or their relative/representative had signed the Care Homes for Older People Page 10 of 25 Evidence: assessments. The pre-admission assessment is then used by the manager to assess if the staff have the skills and knowledge to meet residents needs and to ensure that the environment is suitable for their needs. The pre-admission assessment is then used as a basis for the care plan. Bethune Court does not offer intermediate care. Care Homes for Older People Page 11 of 25 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. Care planning and recording need to be improved to show residents are treated as individuals and that their personal risks are assessed. Medication is generally well managed and with minor improvement residents are not placed at risk. Staff respect residents rights to privacy and dignity. Evidence: Three care plans were viewed and it was found that personal care needs are generic, in some cases some information in the care plan had not been completed, this was particularly the case for one resident on respite care. It was found that while preadmission assessment gave detailed information this had not always been carried over into the care plan, for instance on pre-admission assessment stated due to weight loss must be weighed regularly, there was no evidence on the care plan that this resident had been weighed. Another pre-admission assessment said that the resident must be risk assessed for using stairs and going out, there were no risk assessments in relation Care Homes for Older People Page 12 of 25 Evidence: to this in the care plan. For another resident who had fallen, while there was evidence in the Regulation 37 report that this resident had to attend hospital for a fractured wrist, there was no evidence in the hospital visits on care plan that this had happened. This was discussed with the acting manager, who confirmed that Anchor Trust is aware that care plans are not being kept as they should and remedial action is in the process of taking place. Four resident spoken to during the course of this inspection said that the quality of care provided in the home is high, and that they have access to health care professionals as and when required. Medication practises in the home are generally well managed, monthly administration records, controlled drugs and policies and procedures were all in order. It was noted however that eye drops and liquid medications were not dated on the bottle on the day of opening this resulted in a query in regard to eye drops prescribed on 29/12/2009 for one resident and still being used after the 28 day use by period. Staff observed respecting residents rights to privacy and dignity both during personal care being given and at mealtimes. There was a warm friendly atmosphere throughout the home with staff talking to residents in a friendly and professional manner. Care Homes for Older People Page 13 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to live their everyday lives as they choose and are able to make choice in regard to activities, entertainment, trips into the local community and places of interests. Staff in the home encourage residents to maintain their independence. Meals in the home are excellent and provide residents with a choice of well balanced and nutritious meals. Evidence: Residents are able to retain their own personal choices over how they wish to lead their every day lives. There is good evidence within the home that residents have access to a variety of in-house activities, and well as outside entertainment, and contact with the local community. It is through residents meetings that they choose the activities they would like in the home, what entertainers they would like and where they wish to go on outings. Some residents maintain links with local clubs. A local church visits the home once a month to hold a church service and communion for those residents who wish to attend. Care Homes for Older People Page 14 of 25 Evidence: The home operates an open visiting policy, with relatives and friends made welcome at any time. Relatives and friends are also invited to visit for functions held in the home. Each bedroom has its own telephone point and there is a mobile call box for residents who do not wish to have their own private phone. Residents are able to bring items of furniture and personal belongings into the home with them, although the home does provide furniture if required. Meals in the home are of a very high quality. All residents are offered three cooked meals a day. The dining room is a light airy room with attractively laid tables. Residents are offered a variety of food at each meal time. All vegetables are served in tureens directly to the table so residents are able to help themselves. It is planned that in the near future to produce menus in a new format as well as producing daily menus that will be available on each table in the dining room. Snacks and drinks are available throughout the day in the three communal lounges. The home is able to cater for specialised diets as and when required. None of the residents who come to the dining room need assistance with eating at the present time. Care Homes for Older People Page 15 of 25 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. Residents know that their complaints will be listened to and acted upon. Procedures and training are in place to help protect residents from abuse. Evidence: From viewing the complaints policy and procedure and the compliments, concerns and complaints form available to the residents and their visitors it was noted that the Care Quality Commission address needs to be updated and include a contact telephone number.Residents spoken to said that they would know how to complain if they felt it necessary and they would know who to make the complaint to. There has been one complaint made in the last twelve months and there was evidence to show that this had been appropriately investigated and feedback had been given to the complainant in a timely manner. The home has reviewed Safeguarding Vulnerable Adults policies and procedures and this includes the whistle blowing policy and procedure for staff. All prospective staff have the appropriate checks carried out prior to taking up employment in the home. There is evidence via the training matrix and talking to staff that they have completed Safeguarding Vulnerable Adults training (Protection of Vulnerable Adults) although in some cases this training needs to be updated as it last took place in 2006. Care Homes for Older People Page 16 of 25 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. Bethune Court provides its residents with a comfortable, warm and airy home in which to live. Infection control procedures are in place to help reduce the risk of cross infection to the residents. Evidence: On the day of this unannounced key inspection the home was found to be warm, comfortable and well maintained. All communal lounge and dining areas of the home were furnished and decorated to a high standard. Three communal lounges situated on each floor of the home have their own drink and snack making facilities and there was evidence that residents make good use of this area. All communal hallways were bright, warm and airy and provide ample space for wheelchair users. Each floor of the home has its own communal bathroom, toilet and disabled toilet all are provided with specialist equipment to assist with mobility of frail elderly residents. All bedrooms have en suite facilities, residents are encouraged to bring their own furniture into the home with them, but the home does supply furniture when required. The garden area is well tended and provides resident with a pleasant place to sit, there are plans to develop the garden further so that residents have safe access to all the grounds of the home. Care Homes for Older People Page 17 of 25 Evidence: The laundry room is fitted with three industrial washing machines that provide sluicing facilities and three industrial tumble driers. Staff are provided with disposable gloves and aprons for dealing with bodily fluids and spillages. All communal toilets and bathrooms have hand washing facilities with liquid soap and paper hand towels. On the day of this inspection the home was found to hygienically clean with no offensive odours. Care Homes for Older People Page 18 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels on each shift in the home are good at the present time and meet the residents assessed needs. Staff on duty have the qualifications, skills and knowledge to care appropriately for the residents. The majority of staff have received mandatory training and work related training to meet residents needs. Evidence: From viewing rotas and talking to residents at the present time there are sufficient skill mix of staff on duty to meet the residents assessed needs. Residents said that there is always a member of staff available for them if needed. Sufficient ancillary staff are employed to cook, keep the home clean, carry out maintenance duties, keep the garden well tended and to provide administration for the management of the home. At the time of this inspection fifty percent of care staff had obtained their NVQ level 2 or above qualification. From staff personnel files viewed the inspector found that the recruitment process in Care Homes for Older People Page 19 of 25 Evidence: the home is robust ensuring that all staff are appropriately checked prior to taking up employment. All newly employed staff are expected to carry out an initial induction into the home, shadow an experienced member of staff for at least two shifts and to complete a Skills for Care induction package within the first six weeks of their employment. The inspector viewed the training chart and the training matrix and found that the majority of staff have completed mandatory training with some staff needing to update this training in the near future. Many of the staff undertake work related training giving them a more in depth knowledge of ailments of frail elderly. One member of staff said that she along with other members of staff are at the present time doing a dementia care course. She went on to explain that they each have to do an assignment and that she has chosen reminiscence. Care Homes for Older People Page 20 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At the present time there is no registered manager in the home but the administrator has been appointed manager for the time being. Health and Safety in the home is well managed helping to ensure that residents live and staff work in a safe environment. Evidence: The registered manager employed since the last key inspection has now resigned. At the present time the appointed manager is the administrator supported by the head of care until such a time that a new manager can be appointed. The administrator has many years experience of working in the home and is aware of the philosophy of care required by the Anchor Trust. The inspector noted that on the day of this inspection residents made frequent visits to the office to talk to the administrator. The quality assurance system in the home is good with views of residents their relatives/representatives and professionals being sought. There is some evidence that Care Homes for Older People Page 21 of 25 Evidence: systems operated in the home are monitored, more work needs to be done to develop this further and ensure that regular monitoring takes place and is recorded. The inspector was shown that monthly regulation 26 visits take place conducted by the area manager for the Anchor Trust who own the home. There is evidence that fire, health and safety risk assessments are in place. No evidence was available to show that the views of people, monitoring of systems are produced into an annual summary for quality assurance purposes. Residents who request the home to keep their personal money safe and secure for them are protected by good accounting procedures, with all moneys being checked on a regular basis. All appliances and equipment used in the home have an up to date maintenance certificate. Records were seen that fire call points, emergency lighting is checked on a regular basis. Fire drills are held at regular intervals. Hot water delivery temperatures are also checked and recorded. The inspector did note that some temperatures were well below the 43 degree centigrade required. All accidents are recorded into an accident book, and these are then entered onto a falls matrix that is sent monthly to head office. The administrator said that if there is evidence that a resident is falling on a regular basis, referral will be made to the residents general practitioner for further investigation. Care Homes for Older People Page 22 of 25 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 23 of 25 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 24 of 25 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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