Random inspection report
Care homes for older people
Name: Address: Bickleigh Down Care Home Woolwell Road Woolwell Plymouth Devon PL6 7JW two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Michelle Oliver Date: 1 4 0 9 2 0 1 0 Information about the care home
Name of care home: Address: Bickleigh Down Care Home Woolwell Road Woolwell Plymouth Devon PL6 7JW 01752695555 01752696406 bickleigh.down@fshc.co.uk www.fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Four Seasons (DFK) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Name of registered manager (if applicable) Mrs Lisa Marie Maidment Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: The maximum number of service users who may be accommodated is 83. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within
Care Homes for Older People Page 2 of 13 care home 83 Over 65 0 0 15 0 51 32 0 40 any other category (Code OP) - maximum 15 places, Mental disorder, excluding learning disability or dementia (Code MD) - maximum 32 places, Physical disability (Code PD) - maximum 40 places, Dementia (Code DE) - maximum 51 places Date of last inspection Brief description of the care home Bickleigh Down is a 64 bedded, purpose built care home with nursing. It is part of a large national Independent Health Care organisation, Four Seasons Health Care Limited. It is in the suburb of Woolwell, a few miles from the city of Plymouth and close to Dartmoor National Park. The home is divided into three units laid out on two floors. On the ground floor there is an eight bedded residential care unit for older people, and a twenty four bedded unit, called Moorland View, providing nursing care to older people with mental illness or dementia. On the first floor there is a general nursing unit for up to thirty people. There are a range of disabled bathrooms and toilets in the building. The organisation chooses to provide all single room accommodation at this time although four rooms can be used as doubles. There is a shaft lift between each floor and a range of communal spaces in each unit used for lounge and dining purposes. There is outdoor garden space available for peoples use and close to the home is a small shopping complex with a hairdresser, general store and a medical centre. A superstore is one mile away. A Registered Nurse manages the home and there is a registered nurse on duty in each of the nursing units 24 hours a day. Current fees range from GBP287 - GBP739 a week. There is an additional charge for chiropody, hairdressing, personal items, telephone calls and entrance to activity venues. The most recent inspection report, the Statement of Purpose and Service Users Guide are displayed in the entrance to the home. Care Homes for Older People Page 3 of 13 What we found:
This Random Inspection was undertaken following concerns managed by Devon Social Services Safeguarding Adults Team recently and recommendations made following the last Key Inspection. The inspection was carried out by 1 inspector, from 10:30am - 4:30pm on 14th September 2010 to carry out a site visit as part of this inspection. During our visit, we spoke to 8 people who were living in the home that day and to a doctor. We read the care records of 3 people we met and had observed closely, one of whom had recently moved into the home. We case tracked them as a way of helping us find out more about how the home cares for or supports individuals. We looked around the communal areas of the home that they used and at their bedrooms. We also undertook a period of observation of 3 people in the lounge/diner on Moorview unit. We read other information, that would help to tell us how the home is run, including staff training records. We talked with 3 care staff, a registered nurse, the manager, Operations manager and a maintenance person. During this inspection we looked at care plans to establish whether they provide an accurate and accessible assessment of the needs of each individual and whether they identify what interventions are required by individuals and how intervention should be evaluated and when and how completed. This included looking at records including assessments and management of individuals skin, nutrition, fluid intake, activities and assessments of individuals mental capacity to make choices and decisions. We also looked at daily records to check whether they show how and when every intervention has been made. As part of this inspection we looked around the building, spoke to several people living at the home and staff where clarification was needed or specific questions needed to be asked about individuals living at the home or procedures within the home. What the care home does well:
A recommendation was made at the last key inspection that the service user guide should be updated to include the arrangements for those people who choose to smoke, as the home maintains a non-smoking environment, the availability of a bank account for peoples money and the security arrangements such as locked doors or doors with keypads. During this visit we looked at the service user guide which has been updated and includes details referred to in the recommendation. Another recommendation made at the last inspection related to the service ensuring that pre-admission assessments should include all the information gained about a persons care needs. Peoples hobbies, interests and cultural and religious preferences had not
Care Homes for Older People Page 4 of 13 been consistently recorded prior to admission to ensure the home can prepare for their admission and offer them leisure activities that meet their needs and the support to continue to follow their religious beliefs. During this inspection we looked at the care plans for 3 people and noted that staff have begun to gather and record personal information relating to individual personal social history, religious beliefs and preferred social activities. The manager told us that pre admission assessments undertaken for people moving into the home include as much detail as the individuals are prepared to divulge and information is also added to as individuals settle into the home. The manager told us that care plans are currently in the process of being updated and regular reviews of these care plans are undertaken to ensure that current health and social care needs are met by staff to allow the highest quality of care to be provided. We were told that care plans have been taken back to square one and staff are in the process of re writing them to ensure they are more person centred. Family members are being involved with this to ensure likes/dislikes, life stories are implemented. It was obvious when we looked at 3 care plans that staff are working towards continuing improvement in the quality of the information that is recorded so that staff know how to meet individual health and social care needs. As well as recording information about the individuals details of actions taken in response to their needs were also recorded. For example staff had identified that a person was at risk of not taking an adequate diet to maintain their weight and weight loss had been recorded. We saw information relating to the persons doctor being consulted and very detailed information of how the decreased amount of diet was to be supplemented to increase the calorific value. We saw staff encouraging this person to eat lunch which had been supplemented. We also saw evidence on medication record charts of this person being given food supplement drinks. We were also told how the risk of falling had been minimised for one person when staff had reported problems with the persons footwear. As a result they had been referred to a footwear specialist, now wore appropriate fitted footwear and was able to get around the home more safely. The manager told us that staff have been encouraged and supported to review the use of language which more accurately reflects precisely what has taken place and how residents have been affected.This was evident when we reviewed care plans and compared recent entires with those a few months ago. Staff have developed to be descriptive when recording information and not to categorize incidents with one word or sentence.The manager told us that staff were still developing this skill which she continues to monitor.The manager said that the Accident/Incident record within a file was used as part of reviews as a checking device. The manager told us that the incidents of falls on the unit have decreased since the
Care Homes for Older People Page 5 of 13 staffing levels incorporate the need for at least one member of staff to be in the lounge diner at all times, which has reduced the number of unwitnessed falls and related injuries. People who choose to spend time in their rooms are checked regularly and a check chart is maintained for the whole unit. We looked at the homes record of accidents and noted that in the first 2 weeks of September 2 people had fallen. During this inspection we looked at 3 care plans in detail, following a 2 hour period of close observation of 3 people sitting in the lounge/diner of Moorview, which is the unit where people who are diagnosed as having dementia are accommodated. Spending time observing people helps us understand the experiences of people who are unable to tell us themselves and who are most likely to have the greatest care needs. It allows us to get an insight into the general state of well-being of individuals and staff interaction with people who use the service during the observation. The observations were undertaken in the dementia care unit and covered the lunchtime meal. Staff were seen to generally interact well with people in a caring, patient and friendly manner. Two of the people we observed needed to be assisted with lunch.Staff were encouraging and usually told the people they were assisting what food they were being given. Staff communicated more with a person who could respond to them. For example they asked them if they were enjoying their lunch, did they want a drink, if so what would they like, gave them a choice of pudding and told them what staff were going to do, such as remove their apron. At the last inspection two people preferred to stay in their rooms and as they wished to keep their doors open had requested a stair-gate to be fitted across their doorway to prevent other people entering their rooms. The use of these gates was discussed at length at the time as it could be misconstrued as keeping people in their rooms rather than keeping others out, and they could cause injury due to people trying to climb over them. The manager was asked to review the use of these gates with the person, their family and their social worker to ensure everyone was in agreement with their safe use and to document this review. This has been undertaken since the last inspection. Prior to this inspection we received information that during a tour of the nursing wing at Bickleigh Down, an offensive odour had been noted. Although this inspection related to the dementia unit we did visit the nursing wing. On the day of this visit we did not note any unpleasant odours despite the fact that some people were still being assisted to wash and dress and have their beds changed. However, we did note a very unpleasant odour on Moorview unit. The manager was aware of this and took us to a room which was particularly offensive.
Care Homes for Older People Page 6 of 13 We were told that a carpet cleaner had been ordered and was due to be delivered, that the carpets and curtains in the room were to be replaced and all built in furniture was to be removed and replaced. the unpleasant odour from this room permeated the corridor in which the room was situated. However, towards the end of our visit we were asked to visit the room again. The expected carpet cleaner had been delivered that day, the maintenance person had cleaned the carpet in the room and some of the carpet in the corridor and the odour had been significantly reduced. All other areas of the unit were clean and fresh and there was no unpleasant odour. The service is currently recruiting staff and at the time of this inspection the manager interviewed two applicants for a Registered Nurse post. On the day of this visit staffing on the Moorview unit consisted of a Registered Nurse and 5 carer during the morning, decreasing to a Registered nurse and 4 carers throughout the afternoon. The manager told us that the staffing levels on the unit were being maintained as it would be if the unit was fully occupied, even though the unit currently has two vacant rooms. However,although staff confirmed that staff levels have been maintained they also confirmed that there are not always enough staff at peak times to meet health and social care needs of people living on the unit. People in the dementia care unit had significant mental and physical impairments due to their dementia and this unit had a keypad controlled entrance to ensure people do not leave the area unsupervised. Those people who preferred to keep active were seen to wander freely around the unit. The majority of staff have attended a 2 day Dementia Training course, including newly appointed staff and ancillary staff. The manager is awaiting dates of training for those who could not attend. The manager told us that staff undertake E learning and that all staff have undertaken E learning in the Mental Capacity Act and Safeguarding Vulnerable Adults. Staff can undertake E learning at the service or at their own home and manager is able to track all staff training An electronic training matrix is maintained at the service to ensure that training is maintained and that all staff have completed mandatory training. We were told that 10 staff are due to undertake a Nationally recognised qualification[NVQ] Staff confirmed that they have ample opportunities to undertake training and are supported and encouraged by the manager. Care Homes for Older People Page 7 of 13 What they could do better:
Records of the food and fluid intake were in place but improvement in the maintenance of these records is needed to ensure that an accurate reflection of the persons dietary intake is clear. For example it was not clear how much the person had eaten when staff had recorded ate half there lunch or ate all their breakfast. We saw a member of staff encouraging a person to eat their lunch when they were sitting in a chair in the lounge/diner. The person was sat in a position which was not conducive to eating or drinking and did not take much food or drink despite staff being kind and encouraging. We discussed this with the manager who told us that staff were aware of this difficulty and it had been discussed whether the person could be assisted to their bed at meal times, as the person was able to eat their breakfast well when sitting in their bed.However,his had not been followed up as it was thought this could constitute a potential deprivation of the persons liberty. We discussed this in relation to assessing risk presented to the person and reviewing health needs and outcomes. During the time we spent at the unit we saw that staff were busy and some people had to wait to be attended to. For example, one person we were observing became very distraught when they needed to be assisted to the toilet. There were two carers in the room, assisting another person, and other staff were assisting people in their own rooms, clearing the dining room following lunch or assisting people to the conservatory area. We sat in a chair which had been vacated by this person who had been taken to the toilet after they had been calling for assistance for 5 minutes, and the seat of the chair was very wet. We had also sat in a chair when undertaking our observation and had to change the cushion as this was also wet. We were told that staff had just cleaned the chairs.Neither of the cushions indicated that they had been cleaned and had an unpleasant odour. All staff we spoke to were able to tell us about the three people we observed and whose care plans we looked at. Not all the information they told us was included in the care plans. Risk assessments had been undertaken in relation to skin condition, continence and nutrition but not all of these were accurate and some had not been updated to reflect the current needs of individuals. For example a manual handling assessment, which is designed to provide staff with current information relating to individuals mobility and how much assistance they may need or aids they use, stated that the person could mobilise with assistance of an aid and one person, although the person was completely immobile. Staff confirmed this assessment was not accurate. During the time we spent observing 3 people in the lounge/diner we we aware that staff did not communicate well with two people who were not so alert or responsive during our
Care Homes for Older People Page 8 of 13 period. Both people were told that staff were going to assist them with their lunch, they werent told what they were being given, one person was not in a position in their chair to safely eat, neither were asked what they would like for pudding and one person had a drink placed on a table in front of them, which they were unable to see. We noted several instances when staff stood in front of one of the people, speaking to another member of staff and not acknowledging the person. None of the three people we observed over a 2 hour period, had anything to occupy themselves, there were no magazines or objects within reach. However, there were several items around the walls of the room, including musical instruments. One person spent the majority of the 2 hours we were observing, sitting, bent forward, with their eyes closed. Another was withdrawn except when they were being assisted with lunch. We were concerned about a bathroom close to the lounge/diner. This was generally untidy, the raised toilet seat was unstable, a plastic liner in a bin used for the disposal of incontinence pad had not been securely fitted resulting in the bin being dirty and an covering of a length of water pipes had come free from the wall and presented a hazard. Also some equipment, including a wheelchair and hazard signs were being stored in the room. This puts people who use this room at potential risk of harm. We also saw an opened tub of cream in a bathroom next to the lounge /dining room, the prescription label of which had been partially removed making it impossible to note who it had been prescibed for, there was no indication when it had been opened or when it should be disposed. This means that there is a risk of the product being ineffective as it may be past its shelf life and also there is a risk of cross infection if it is being used for several people. 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 set out on page 2. Care Homes for Older People Page 9 of 13 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 10 of 13 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 8 Improvement in the maintenance of records is needed to ensure that an accurate reflection of peoples dietary intake is clear. Records of the food and fluid intake were in place but improvement in the maintenance of these records is needed to ensure that an accurate reflection of the persons dietary intake is clear. Risk assessments should be undertaken to ensure that peoples care needs are met in their best interests. This relates to the difficulty one person eating when sat in a sitting room chair in the lounge/diner. A procedure should be developed to ensure that creams/lotions, when opened are not used past their expiry date and should only be used for the person they are prescibed for to prevent the risk of cross infection. People should be given opportunities for stimulation through recreational activities. This relates to people not being provided with anything 2 8 3 8 4 9 5 12 Care Homes for Older People Page 11 of 13 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 which they could take an interest in or occupy themselves when in the lounge/diner. 6 22 All areas of the home should be kept free of hazards which present harm or the risk of harm to people living at the service. This relates to storage of wheelchair and hazard warning signs and an unstable toilet seat raiser in a bathroom next to the lounge diner on Moorview unit. 7 8 26 27 The service should continue to ensure that the home is kept fresh and free from offensive odour. There should be sufficient staff on duty at all times to meet the health and social care needs of people living at the service. Care Homes for Older People Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 13 of 13 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
