Care Home: Harpenden Bethesda Home

What the care home does well Harpenden Bethesda provides if not a unique service, certainly a distinctive one that fully meets the physical and spiritual needs of those people who live in the home. It has an strong Christian ethos that accords with the wishes and beliefs of those who are either resident or working in the home. Care, activities and every detail of the home are specifically in line with the tradition and practice of the Gospel Standard Bethesda Organisation and this was clearly precisely what the people living in the home wanted above all else and was appreciated in some of the most uniformly positive and glowing testimonies given in response to both surveys and in person to the inspector. "I cannot praise this home enough, kindness reigns every step of the way", "Standard of care is very high" "I can`t fault them in any way" and " We are very thankful for God`s provision for us while we wait for him to call us home to glory" were only some of the comments received. The atmosphere in the home was pleasant and calm throughout this inspection and the standard of care observed was never less than very good, with easy and appropriate interaction between the staff team and those people who live in Harpenden Bethesda. "I would like to say that as a family it is a great comfort to us that we know that our mother is cared for well and with compassion... all aspects of care are well-managed" sums up the comments made to us by the relatives of people living in Harpenden Bethesda. Staff indicated that the home tries to be `person centred` in everything it does and this was supported by the care records seen and in the way that care was given. People living in Harpenden Bethesda benefit from the home`s pleasant and well- maintained environment, and virtually everybody spoken to mentioned how clean and well kept the premises and grounds are. As well as being consistently praised by people living in the home, the staff team under the manager were very positive about the work they do and the support they receive. This means that people living in Harpenden Bethesda benefit for a well trained and motivated staff team. What has improved since the last inspection? The two requirements made following the last key inspection in September 2006 have been fully met and the carpets in communal hallways that were commented on have been replaced. Beyond that, the good and excellent standards recorded in the report of that inspection have been at least maintained and this explains why the people living in the home and those associated with them have been so positive in their comments and appreciation of the care experience. CARE HOMES FOR OLDER PEOPLE Harpenden Bethesda Home 201 Luton Road Harpenden Hertfordshire AL5 3DD Lead Inspector Jeffrey Orange Unannounced Inspection 2nd September 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harpenden Bethesda Home Address 201 Luton Road Harpenden Hertfordshire AL5 3DD Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01582 761 359 01582 460 790 Gospel Standard Bethesda Fund Rachel Susan Verweij Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th September 2006 Brief Description of the Service: Harpenden Bethesda Home, provided by the Gospel Standard Bethesda Fund, is a purpose built residential home accommodating up to twenty-three service users over the age of 65 years. The organisations head office is on the same site in a separate building. There are ample parking spaces within the grounds. The home is situated on the outskirts of Harpenden town centre, within easy reach of public transport and the local shops. There are nineteen single bedrooms and two shared double bedrooms. All the bedrooms have en-suite washbasins and toilet facilities. In addition there are an appropriate number of assisted bathrooms for the use of people living in the home. There is a large communal lounge and a separate dining room, together with kitchen, laundry and administrative offices. The home has a large and attractive garden bordered by mature trees, with seating provided for people who live in the home and their visitors. All the rooms and the garden are accessible to wheelchair users. A copy of the most recent CSCI inspection report is available in the home, together with information about the home, including a Service User’s Guide and Statement of Purpose. Current charges range from £427 to £468 per week. Service users pay for other services such as hairdressing or chiropody privately. Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This unannounced inspection took place over approximately 6 hours beginning early in the morning, which gave us an opportunity to see the experience of people living in the home as they were helped to get up, have their breakfasts and generally get ready for the day ahead and also to observe the morning and lunchtime routine in the home. During the inspection it was possible to speak to people who live in the home about their experiences and to speak to members of the staff team and the home’s administrator and senior care staff in charge about their roles and their views on how the home operates and is managed. We also looked at some key records, including those for medication, staff recruitment and training and care plans for people living in Harpenden Bethesda. This report also draws on information received from surveys completed by people living in the home, from members of the staff team and from health care professionals who have experience of the home. Where we receive surveys after this report is finalised, we will record and assess them and take any action indicated as necessary by them. We have also made use of information provided by the home in their Annual Quality Assurance Assessment or AQAA. The AQAA is a self-assessment document that focuses on how well care outcomes are being achieved for people living in Harpenden Bethesda and also includes some useful statistical information about the home. What the service does well: Harpenden Bethesda provides if not a unique service, certainly a distinctive one that fully meets the physical and spiritual needs of those people who live in the home. It has an strong Christian ethos that accords with the wishes and beliefs of those who are either resident or working in the home. Care, activities and every detail of the home are specifically in line with the tradition and practice of the Gospel Standard Bethesda Organisation and this was clearly precisely what the people living in the home wanted above all else and was appreciated in some of the most uniformly positive and glowing testimonies given in response to both surveys and in person to the inspector. “I cannot Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 6 praise this home enough, kindness reigns every step of the way”, “Standard of care is very high” “I can’t fault them in any way” and “ We are very thankful for God’s provision for us while we wait for him to call us home to glory” were only some of the comments received. The atmosphere in the home was pleasant and calm throughout this inspection and the standard of care observed was never less than very good, with easy and appropriate interaction between the staff team and those people who live in Harpenden Bethesda. “I would like to say that as a family it is a great comfort to us that we know that our mother is cared for well and with compassion… all aspects of care are well-managed” sums up the comments made to us by the relatives of people living in Harpenden Bethesda. Staff indicated that the home tries to be ‘person centred’ in everything it does and this was supported by the care records seen and in the way that care was given. People living in Harpenden Bethesda benefit from the home’s pleasant and well- maintained environment, and virtually everybody spoken to mentioned how clean and well kept the premises and grounds are. As well as being consistently praised by people living in the home, the staff team under the manager were very positive about the work they do and the support they receive. This means that people living in Harpenden Bethesda benefit for a well trained and motivated staff team. What has improved since the last inspection? What they could do better: The shared faith and ethos of the home leads to a very informal atmosphere and method of operation and this can sometimes lead to a level of formal recording, for example in terms of staff supervision, that struggles to meet the requirements of the National Minimum Standards. The home have indicated that they are willing to make changes to address this and whilst it is hoped that this can be done in a way that does not compromise the ‘special’ character Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 7 of the home, it is important that an appropriate standard of recording is achieved in order to demonstrate that the well-being of people living in the home is being safeguarded. Where people self-medicate, this should be supported by an appropriate risk assessments to ensure that any risks to the person concerned have, with their involvement, been identified and as far as is possible eliminated. This process should explicitly not lead to any person being unable to self-medicate where it is assessed as safe for them to do so. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5 (Standard 6 does not apply to Harpenden Bethesda) Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People being assessed with a view to moving into Harpenden Bethesda can be assured that they will only be admitted if their care needs can be met in a way that reflects their personal requirements and wishes following a thorough and robust process of assessment. People who live in Harpenden Bethesda can be confident that their particular faith requirements are fully understood, catered for and met in a way that reflects and accords with them. EVIDENCE: The home’s AQAA identified the way that consultation with, and the involvement of people living in the home makes sure the way care is provided reflects their views and needs, and this is borne out in what people living in the home told us. “The care is never other than excellent” and “you won’t find a better home” were comments received during the inspection visit. Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 10 Relatives of people living in the home tell us that they have been able to visit the home before any decision was made about admission. This is important as in many cases the individuals concerned leave the choice of home to other people, often family carers, and they need to be confident that they will be able to see what the home is like and whether they think the person for whom they are making the decision will be happy there and that their needs will be met. We looked at some pre-admission assessments for people who had recently moved into the home, these were very full and detailed and provide confidence that only those people whose needs can be met appropriately are being admitted. When we spoke to people living in the home, the thing they valued most was the absolute focus of the home on meeting people’s spiritual and physical needs in line with their specific faith outlook. When we looked at the home’s Statement of Purpose and Service User’s Guide we found that it contained detailed information about the home including very explicit and clear details of fees payable and what is and is not included in the basic fee. This should make sure that people considering Harpenden Bethesda as their home can make a well-informed decision. Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in Harpenden Bethesda can be certain that they will receive effective personal and healthcare support and will experience a person centred approach from staff that recognises their rights in respect of dignity, equality, fairness and respect. Those people who live in Harpenden Bethesda that rely on staff to assist and support them with their medication can be assured that the home has effective medication policy, procedure and practice guidelines which are routinely monitored to ensure that they are carried out in a way that protects them and maintains their health and safety. However, where people are supported to self-medicate in order to encourage independence the process is not always supported by specific risk assessments. EVIDENCE: Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 12 During this inspection we saw staff consistently treating people living in the home appropriately, with respect and involving people living in home in decisions about their care and how it was to be given. When we asked people living in the home in the surveys whether staff listen to them and act on what they say, they all replied either “always” or “usually”. When we looked at care plan documentation, we found evidence of people living in the home being able to access community health services such as hospitals and clinics and those that require a visit in the home have received them. One comment from a healthcare professional suggested that the home was “the best in the world” When we checked medication records and procedures we found that they were of a good standard, accurate and well maintained. This helps to maintain the health, safety and welfare of those people who need help with their medication. Healthcare professionals associated with the home told us that in their experience medication was always administered correctly. We found that controlled drugs that need to be stored in a controlled drugs cupboard were correctly stored, however the home did not have a controlled drug register that meets current requirements as the pages were not numbered. When we looked at care plans for those people who self-medicate we were not always able to find risk assessments recorded to ensure that this could be safely achieved. It is however very positive that people are encouraged to look after their own medication wherever possible and safe for them to do so. Because people in Harpenden Bethesda do not believe it is right for them to be cremated, they all indicate clearly on admission their wish to be buried in accordance with their religious beliefs. Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who live in Harpenden Bethesda can be assured that they will be supported and encouraged to enjoy a lifestyle that meets their social and spiritual needs, with a variety of options to choose from. People living in Harpenden Bethesda can be assured that they can have meals at flexible times and in a variety of locations according to their wishes each day EVIDENCE: The home informed us in their AQAA that “In matters great or small, all staff are in agreement that the residents should be offered choice and their wishes respected” That this is a reality was confirmed by observation during this inspection and from what people living in the home told us. The AQAA confirms what people told us, namely that “residents are asked their food preferences and are cooked separate meals if they do not like the food offered” Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 14 Survey returns were very positive about food in the home. “I can be a bit fussy at time – the meals are good” was one typical comment. We found that the activities programme was very distinctive and centred around the religious beliefs and practices of the people living in the home, for example there is no television. All surveys received and everyone spoken to indicated very forcibly that the activities available met their needs and were exactly what they enjoyed and wanted. Some examples apart from a wide range of religious activities and services were trips out by minibus to garden centres, free lunches and picnics, concerts and visits to private homes of people associated to affiliated churches. During the inspection the birthday of one resident was celebrated with a special hymn chosen by them and gifts were prepared for presentation later in the day. A number of people living in the home went out to a friend of the home during the morning and when spoken to later said how much they had enjoyed it. Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who live in Harpenden Bethesda and those who are responsible for them can be confident that the home provides a safe and understanding environment in which they can freely express their views and any concerns they may have, without repercussions for themselves or those they are responsible for. People living in Harpenden Bethesda can be assured that staff working in the home are supported through training to be able to recognise actual or potential abuse and to know what action to take if it is seen or suspected and this should safeguard the well being of people living in the home. EVIDENCE: When we spoke to staff, they told us about the training they had had in safeguarding adults and the current Hertfordshire County Council policy was on display, training records were seen to confirm training given and staff induction includes whistle blowing. The home has a complaints policy and procedure that is displayed in the home and included in the Service User Guide, along with contact details for both the CSCI and the Local Authority and Health Services so that people have clear information about where they could take any concern or complaint if they felt they needed to. Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 16 All relatives and carers spoken to or from whom surveys were received confirmed that they knew how to make a complaint although they all indicated that they never had felt the need to. Surveys received from people living in the home, relatives and carers, staff and healthcare professionals all described the ethos of the home as open and protective and described the standard of care in exceptionally positive terms. The home informed us in their AQAA that there have been no complaints received in the past year. No complaints, concerns or allegations have been communicated to the CSCI in that period either. Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in Harpenden Bethesda can be assured that they will experience a physical environment that provides for their individual requirements appropriately and is clean, safe, comfortable and well maintained. They can be confident that they will have access to a range of communal areas, both inside and outside of the home, which will provide them with a real choice when deciding where they would like to sit and relax or join in activities if they prefer. EVIDENCE: Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 18 When we talked to people in their own rooms, the rooms were seen to be personalised with their own possessions to reflect the interests and life history of the individuals concerned. The bathrooms seen were well presented and provide the kind of environment that people living in the home told us they found attractive and pleasant to use. The home’s AQAA has identified areas where further development and improvement may be possible including extending the dining room and modernising the rear entrance. The home was free of any unpleasant smells on the day we visited and people living in the home we spoke to told us that this was usually the case. “It is kept very clean” one person commented. Surveys returned by people who live in the home, members of the staff team, visiting healthcare professionals and relatives were all very complimentary about the built environment of the home and the standard of cleanliness and hygiene. “It is exceptionally so” was one answer received to the question ‘Is the home fresh and clean’. There were seen to be indoor and outdoor seating areas and people who live in the home told us that they like to walk round outside or to sit in the sunshine, although most commented that this year, this had been in short supply! Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in Harpenden Bethesda can be assured that any care they require will be provided by well trained and supported staff, in the numbers necessary to achieve good care outcomes for them and who have been subject to a robust recruitment process to ensure that they are fit to do so. EVIDENCE: When we spoke to members of the staff team they told us about the training they had received, including at level 2 and 3 NVQ in care. This, together with records of training given and due in future that were seen, demonstrates that staff have the skills they need to provide care to the people who currently live in Harpenden Bethesda. Staff told us that whilst supervision is undertaken regularly, it is more informal than formal and may not involve six one to one sessions each year, with notes taken of the things discussed, signed by both parties. This was discussed with the staff at the time of the inspection and with the manager subsequently and it is hoped that, without losing the benefits of an informal approach, nonetheless some more formal supervision as detailed above, in line with the National Minimum Standards will be put in place. Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 20 It is accepted that staff felt strongly that they receive the support that they need to be able to identify any training or development needs, to reinforce good practice and provide them with an opportunity to discuss the changing needs of people living in the home. One survey from a relative suggested that it might be helpful to introduce a ‘key worker’ system, so that each care worker had a special interest in and responsibility for a small group of people living in the home. This was discussed with staff at the inspection visit and subsequently with the manager as it can work well in some care settings. It is however a matter for each home to determine. When we spoke to people living in the home about the staff, they were extremely positive “ they are very caring and kind” and “nothing is too much trouble for them” were only some of the comments made. Recruitment records were seen to include evidence of the checks needed to protect people living in the home from receiving care from people who may not be suitable or safe to do so. When we spoke to staff in private, they were significantly very supportive of the home, its manager and their experience of working there. “One of the few jobs I can say I look forward to going to work and enjoy being part of a hard working team” was one quite typical comment. It follows that people living in the home benefit from receiving care from staff who want to be there and enjoy what they are doing and who are given the training and support they need to help them care effectively and efficiently. Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living in Harpenden Bethesda can be confident that they live in a well managed home where their wellbeing and best interests are paramount in decisions made. Staff working in the home can be confident that they will be well supported to help them meet the care needs of people living in the home although the majority of supervision, if not all, is informal rather than formal. EVIDENCE: Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 22 When we spoke to staff they told us that the manager and her senior staff are open and supportive and that they welcome suggestions as to how the standard of care might be improved. The Manager completed the AQAA adequately and it included analysis of how various areas of the home’s activity might be further improved. This demonstrates a genuine commitment to improvement that can only be to the benefit of people living in Harpenden Bethesda. When we spoke to people living in the home, they confirmed how active the manager in particular is, and rotas seen indicate that she still carries out some care duties as a way of monitoring the quality of the care experience of people living in the home. Care plans that we looked at included a robust framework of risk assessment to identify most risks to the health, safety and well being of people living in the home and how they can be reduced or eliminated. They did not however always include specific risk assessments relating to self-medication and this should be addressed. However, overall people living in the home can have confidence that their health and safety is being safeguarded. When we spoke to staff and looked for any records of formal, one to one supervision we found that whilst regular and routine supervision of staff does take place, this is within an informal ‘working family’ framework, rather than a formal one. This was discussed with the manager after the inspection and it is suggested that without losing the benefits of the current system, some more ‘formal’ supervision sessions be introduced, which will then better meet the requirements of the National Minimum Standards. The exceptionally positive feed back received throughout this inspection, tributes paid to the manager and her staff together with almost universally high praise for the standard of care provided tells us that the home is well managed and run and that this leads to a high standard of care being experienced by people living in Harpenden Bethesda. When we looked at the records for financial transactions carried out on behalf of people living in the home we found that they were accurate and supported by receipts. They could perhaps be even more robust with periodic external audit and this was discussed with the home’s administrator. Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 4 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations In order to show that where people self-medicate it has been assessed that it is safe for them to do so, risk assessments should be carried out, recorded and put in their care plan documentation. Where controlled drugs are to be recorded in a controlled drug register in accordance with best practice, the home should obtain an appropriate controlled drug register for this to be done. This will be bound and will have numbered pages. Formal staff supervision, at least six times a year should be introduced in such a way that does not detract from the special ethos of the home. 2. OP9 3. OP36 Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Harpenden Bethesda Home DS0000019406.V370858.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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