Care Home: The Bell House

What the care home does well What has improved since the last inspection? The care documentation has improved and now includes guidelines for staff to follow in the care of people`s medical conditions. Radiators and hot water pipes in areas where people who use the service have access are now covered to ensure that no one is at risk of being burnt. All staff have had fire training. CARE HOMES FOR OLDER PEOPLE The Bell House 61 Wilshaw Road Meltham Huddersfield West Yorkshire HD7 3DX Lead Inspector Karen Summers Key Unannounced Inspection 20th May 2008 08:25 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 The Bell House DS0000026265.V366552.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. The Bell House DS0000026265.V366552.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Bell House Address 61 Wilshaw Road Meltham Huddersfield West Yorkshire HD7 3DX 01484 850207 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) sarahandtojo@ntlworld.com Mr Parvaiz Ahmad Dr Shireen Qureshi Ahmad Mrs Lynda Margaret Quinn Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places The Bell House DS0000026265.V366552.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd May 2007 Brief Description of the Service: The Bell House is a privately owned care home registered to provide accommodation and care for up to 24 older people. The property, an extended bungalow, is generally well maintained to an acceptable standard. All bedrooms being for single occupancy, with eight having the provision of en-suite facilities. Communal areas are spacious and comfortable, and there are well-maintained garden and grounds where people can sit out in the warmer weather. The establishment is situated in a rural area on the outskirts of the village of Meltham, with panoramic views over the surrounding countryside. Public transport is accessible with a bus stop directly outside the home. The provider informed the Commission for Social Care Inspection on 20/05/08 that fees range from £400 to £445 per week. Additional charges include hairdressing and newspapers. Information about the home and the services provided are available from the home in the statement of purpose and service user’s guide. The Bell House DS0000026265.V366552.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 two star. This means the people who use this service experience good quality outcomes. This report refers to an inspection, part of which included an unannounced visit to the home on the 20th May 2008, commencing at 8.25 am, and the length of the inspection was 7.25 hours. There were 20 people living at The Bell House on the day of the visit. As part of the inspection in order to provide information to help us form judgments about how the service is run, the manager was asked to complete an annual quality assessment document. This she did, and the document provided the Commission for Social Care Inspection (CSCI) with a lot of information about the way the home is run, and what they hope to achieve in the future. During the visit we spoke with members of staff and people who receive care to obtain their views. We also looked at a sample of care records, staff recruitment, and training records, quality assurance audits and looked around the home. To enable people who use the service to comment on the care it provides, we sent ten surveys to people living at the home, and five of these were returned, and ten were sent to their next of kin, eight of these were returned. Below are some examples of the feedback we received: • • “Staff always very helpful, give lots of support.” “I have been happy here.” We would like to thank all the people who gave feedback about this home, and would like to thank the deputy manager and staff for their co-operation throughout the inspection process. What the service does well: People have their needs assessed prior to admission to the care home, and are assured that those needs can be met. People living in the home said, “Staff are always very helpful, give lots of support.” “I have been happy here.” The Bell House DS0000026265.V366552.R01.S.doc Version 5.2 Page 6 Staff were seen to respect the residents privacy and dignity by knocking on doors and wait to enter and call residents by their preferred name of address. As a tribute to the standard of food provided the home has received a four stars, “Very Good” award in association with Kirklees Council’s Health Choice Award. “Scores on the doors”. The award is a five star rating scheme providing information about the standards of hygiene and compliance with legislation in food premises within Kirklees. Relatives were asked, “What do you feel the care home does well?” Comments include: • • • • Provide, “Professional, thoughtful kind staff. Pleasant surroundings. Well cared for – very happy with the service.” “Keep the people happy and content.” “They care.” “The home provides a caring, loving and friendly environment to support mum in her final years. It also provides a safe place for mum to be herself.” What has improved since the last inspection? What they could do better: The Law for the storage of controlled drugs (CD) changed in 2007, and as such the provider is required to provide a cupboard for the storage of the CD’s to comply with this Law within the next three months. The provider could make sure that activities take place on a regular basis to ensure that the recreational needs of people are being met. People should be offered a choice of food at meal times. All staff should have safeguarding training, and there should be a copy of the Local Authorities safeguarding procedure to ensure that they know how to protect people from abuse. The Bell House DS0000026265.V366552.R01.S.doc Version 5.2 Page 7 The provider should ensure that all areas of the home are kept clean. 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. The Bell House DS0000026265.V366552.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 The Bell House DS0000026265.V366552.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): 3 Standard 6 – the home does not take people who require intermediate care. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have their needs assessed prior to admission to the care home. EVIDENCE: The care records of three people who use the service were examined, all of which contained a pre-admission assessment carried out by the funding local authority. Each assessment contained information about the person’s current needs, and in addition to this there was evidence that the home had also carried out an assessment of the person’s needs. Although this documentation was not comprehensive it supported the information obtained from the funding authority. The person in charge at the time of the visit also said that people were given The Bell House DS0000026265.V366552.R01.S.doc Version 5.2 Page 10 information about the home and were encouraged to visit and spend some time there before making a decision to move in. People living at the home said that they received enough information about the home before deciding if it was the right place for them, and relatives also confirmed this. The Bell House DS0000026265.V366552.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 - 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The level of care people need, which includes their health, personal and social care needs are recorded within their care plan. People are treated with respect. The recording and administration of medication is satisfactory. EVIDENCE: Three people’s care records were looked at in detail and the documentation identified the care needs, and the level of support the person requires. Risk assessments had also been completed and included the risk of falls. There were also movement and handling assessments, nutritional assessment, and skin integrity recorded. There was evidence that care reviews had taken place, and that the care plans are updated monthly or as the needs of the person change. The Bell House DS0000026265.V366552.R01.S.doc Version 5.2 Page 12 Information provided by the home confirmed that people are consulted on their care plans. Staff were seen to respect the residents privacy and dignity by knocking on doors and wait to enter and call residents by their preferred name of address. Five relatives said that the home helps their relative to keep in touch, and two people said that they visited daily and so were regularly in touch with their relative. Four people said that they are kept up to date about important issues, and one person said that they usually were. People also said that they receive the care and support that they need and one person said that, “Staff are always very helpful, give lots of support.” Everyone said that the staff listen and act on what they say. Three people said that staff are available when they need them, and two said usually. Staff were seen to talk to people by name and respect their wishes. There was also evidence in people’s care records that they are able to access health care services, such as the dentist, chiropodist, optician and everyone living at the home is registered with a doctor. Four people said that they receive the medical support they need and one person said that they usually receive the support. The person in charge on the day confirmed that all staff that gives medication to people have had training and the staff confirmed this. A sample of medication and records were checked, and the administration and recording of the medication were done correctly. There was also evidence that the medication is audited for any errors on a regular basis, however, there was one discrepancy found when checking the medication and the person in change was looking into the reason why it had occurred. The staff plan to continue to monitor and audit the medication to try to prevent further errors occurring. With reference to the storage of controlled drugs, in 2007 the law changed. All care homes, whether providing nursing or personal care, must now keep controlled drugs (CD) in a controlled drugs cupboard. As the home does not presently comply with these requirements, a timescale of three months is given for the ordering and installation of the cupboard. The provider of the service is recommended to contact their local pharmacist should they need further advice. The Bell House DS0000026265.V366552.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 – 15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are offered a range of activities, and are able to make their own choices about how they spend their time. Meals provided are varied and served in a pleasant environment. EVIDENCE: At the time of the visit people were sat in different parts of the home, some people were chatting with each other, and others were sat relaxing. People said that they are encouraged to maintain contact with their family and friends and they are always made welcome. Events and entertainment that take place in the community and inside of the home were displayed in the main corridor, and included; Hoopla, dominos, bingo, skittles, hairdressing, nails and hand massage, arts and crafts, sing along, cards, ball darts, and ball games. In addition to this each month there is live entertainment e.g. “Name that tune”, ”Memories made of this”. People are also registered with the access bus, which assists in providing transport to places of interest. The Bell House DS0000026265.V366552.R01.S.doc Version 5.2 Page 14 People living in the home said that they went to church on Sundays with their family or friends. Three out of five people in the surveys said that there were activities arranged by the home that they could take part in, and two people said “Sometimes.” One of the relatives said, “I would like the care home to provide more regular activities, physical or mental which the owners could meet by employing someone…” The same person said that the staff were too busy providing care to have time to do activities. People spoken with said that sometimes the daily activities did not take place as the staff were too busy. Staff also confirmed in their surveys that sometimes there isn’t time for activities if the shift is a hectic one. This was discussed with the provider of the service at the time, and she agreed to look into the matter. Every two months the home has a visit from the library and they deliver new books, including large print books and audiotapes for the partially sighted. The menus offered a variety of food, and the food preferences and specialised diets of the people, had also been taken into consideration. The main meal of the day is served at lunchtime, and whilst a choice of meal is not offered, staff said that they would offer an alternative if someone wanted something different. Four out of five people said that they usually liked the meals at the home. People who were spoken with on the day said that the quality of the food would depend on which cook was on duty. One person said that they would like to see new potatoes on the menu. The provider of the service agreed to look into offering a choice of food on the menu that reflected the preferences of people living at the home. As a tribute to the standard of food provided the home has received a four stars, “Very Good” award in association with Kirklees Council’s Health Choice Award. “Scores on the doors”. The award is a five star rating scheme providing information about the standards of hygiene and compliance with legislation in food premises within Kirklees. The Bell House DS0000026265.V366552.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 &18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that their complaints will be listened to and taken seriously. People are protected from abuse. EVIDENCE: The complaints procedure is located in the entrance hall of the home, and people and their relatives receive a copy of the procedure on admission. There was evidence that the complaints procedure had been reviewed earlier in the year however, the address of the CSCI needs to be updated. With the exception of one person, all surveys stated that they knew how to make a complaint and that the home had responded appropriately if concerns have been raised. One person said. “The care manager always responds well if we have any concerns about mum and addresses the issues, but they have not been detrimental.” The home has a whistle blowing procedure, and staff that were spoken with were aware of the procedure to follow. Records showed that not all staff have had safeguarding (adult protection) training which provides information on how to protect people from abuse. Those staff spoken with during this visit spoke with confidence about how they would report poor care practice and abuse. The member of staff could not find the Local Authorities procedure on safeguarding. The manager is advised to ensure that the home has an up to date copy of the guidance. Following the inspection the CSCI were informed that two training days on safeguarding have been arranged, and that the The Bell House DS0000026265.V366552.R01.S.doc Version 5.2 Page 16 manager would ensure that all staff have the training. Three staff have also been booked on a course to enable them to train staff in safeguarding people. The Bell House DS0000026265.V366552.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 & 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home offers people a homely and comfortable environment. EVIDENCE: As part of the inspection a tour of the home took place that included the communal areas and a number of peoples bedrooms. Since the last inspection a large plasma screen television has been purchased for the main lounge; new chairs for the lounges, dining rooms and bedrooms, blinds for the sitting room, conservatory and dining rooms, bathroom suites have also been replaced, and floor coverings in a number of area. Externally a patio has been laid where people can sit out in the warmer months of the year. The carpet in the main corridor outside of the staff office was discussed with the provider of the service, as it was starting to wear and lifting in some areas. The Bell House DS0000026265.V366552.R01.S.doc Version 5.2 Page 18 The provider is aware that the carpet may need to be replaced in the near future should there be a risk of someone tripping. The standard of cleanliness has improved since the last inspection however, in several areas the walls of the main corridor outside of the staff office had not been cleaned when drinks had been spilt. One of the cleaners is on sick leave. The staff confirmed that the weekend cleaner and the staff have been covering these duties. The provider of the service said that she would ensure that the cleanliness of the home would be improved. There were no unpleasant odours noted in any part of the home. Three out of five people commented in the surveys that the home is clean and two said usually. The atmosphere on the day of the visit was warm and friendly and people looked comfortable whilst sitting in various parts of the home. The Bell House DS0000026265.V366552.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 – 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are supported by qualified, competent and experienced staff in sufficient numbers and that have had all the necessary checks before working with people so that they are kept safe. EVIDENCE: The information in the annual quality assessment document states, that the home is staffed with people who are trained and competent to do their job. The list of staff on duty showed that there were sufficient staff in number to meet the needs of the people in their care and the person in charge confirmed this. Three people said that there are always staff available when you need them, and two said usually. Discussion was held with the provider of the service regarding the full time cleaner being on sick leave, and who is covering these duties in her absence. The weekend cleaner is temporarily working during the week and the staff are covering the weekend duties. The owner agreed to monitor the situation and ensure that the cleanliness of the home improves. Please also see standard 26. The Bell House DS0000026265.V366552.R01.S.doc Version 5.2 Page 20 With the exception of one relative, everyone commented in the surveys that the care staff have the right skills and experience to look after people properly. One person wrote, “The staff without exception are always attentive and supply any needs my sister requires quickly and with a very pleasant manner always.” “I have been very happy to find such a caring cheerful home.” Seventy eight percent of care staff have an NVQ (National Vocational Qualification) level two or above, and a further three staff are working towards the qualification. It was evident from observation and discussion with people and staff that staff have the skills necessary to support people. The recruitment files of three members of staff were looked at in detail and they contained the required information and employment checks. These checks are necessary to help protect people from potentially unsuitable staff. New staff undertake induction training in accordance with Skills for Care, the National Training Organisation for care staff, and the person in charge confirmed this. The Bell House DS0000026265.V366552.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 & 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People benefit from the management approach of the home and the manager ensures so far as is practicable that the health, safety and welfare of people and staff are protected. The home is run in the best interest of people who live there. EVIDENCE: The manager has a number of years experience in the care of older people, and she has achieved a NVQ level 4 qualification in management and care. For those people who wish, small amounts of personal money are held safely at the home. The Bell House DS0000026265.V366552.R01.S.doc Version 5.2 Page 22 There was evidence in the staff training records that they have regular supervision and staff also confirmed this. Satisfaction questionnaires are sent out annually by the home to staff, people who live at the home/ visitors, and visiting profession, and the comments that were received were most favourable. A book was also seen in the entrance of the home labelled, “Comments and suggestions” but no one had made an entry. To keep people informed of forth-coming events, and topics of interest, the home produces a newsletter four times a year. A sample of records was looked at relating to health and safety within the home and satisfactory records are being maintained. The Bell House DS0000026265.V366552.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 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 3 X 3 3 X 3 The Bell House DS0000026265.V366552.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. 1. Standard OP9 Regulation 13.- (2) Requirement The Law for the storage of controlled drugs (CD) changed in 2007, therefore the provider is required to provide a cupboard for the storage of the CD’s to comply with this Law. Timescale for action 15/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP12 OP15 OP18 Good Practice Recommendations Activities should take place on a regular basis to ensure that the recreational needs of people are being met. People should be offered a choice of food at meal times. All staff should have safeguarding training to ensure that they know how to protect people from abuse. As a reference guide, the home should have an up to date copy of the Local Authorities safeguarding procedure. The Bell House DS0000026265.V366552.R01.S.doc Version 5.2 Page 25 4. OP26 The provider should ensure that all areas of the home are kept clean. The Bell House DS0000026265.V366552.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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