Inspection on 06/06/08 for Bulmer House

This is the latest available inspection report for this service, carried out on 6th June 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bulmer House 10/10/06

Bulmer House 23/03/06

Bulmer House 08/08/05

Bulmer House 08/02/05

Bulmer House 12/07/04

Bulmer House 05/03/04

Bulmer House 02/02/04

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Bulmer House 4 Ramshill Petersfield Hampshire GU31 4AP Lead Inspector Christine Bowman Unannounced Inspection 6th June 2008 10:30 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 Bulmer House DS0000037250.V365277.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. Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bulmer House Address 4 Ramshill Petersfield Hampshire GU31 4AP 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) 01730 261744 01730 261 752 tony.rocks@hants.gov.uk Hampshire County Council Mr Anthony Francis Rocks Care Home 44 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 44. Date of last inspection 12th June 2007 Brief Description of the Service: Bulmer House is a purpose built residential home providing accommodation and personal care for up to 44 older persons, 23 of whom may have dementia. The home is part of a resource centre and a day service is located at one end of the complex. The residential area is made of a two-story building that is separated into four units within the building. The kitchens, laundry area, small library area, large reception area, hairdressing room and treatment room are located on the ground floor together with two of the residential units. All of the residential units have their own sitting rooms, kitchen dining area and communal bathrooms. All of the bedrooms are for single occupancy. On the ground floor one of the units is for ten beds and the other for eleven. On the floor above are three units; two with eight beds the other with seven for the residents with dementia. Four of the beds within the home are designated for respite care, two on the ground floor and two on the first floor. The current fees charged is between £392- £434. Bulmer House DS0000037250.V365277.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 1 star. This means the people who use the service experience adequate quality outcomes. This unannounced site visit was conducted as part of a key inspection using the Commission’s ‘Inspecting for Better Lives’ (IBL) process. The site visit took place over seven hours commencing at 10.30 am and ending at 17.30 pm and was undertaken by Ms Christine Bowman, Regulation Inspector. The Registered Manager, Mr Tony Rocks and other senior staff, employed at the home, were available throughout the day and assisted with the inspection process. Staff from several departments were spoken with and a partial tour of the premises was undertaken. A number of residents’ bedrooms were viewed and some residents were spoken with as they relaxed in their bedrooms. Other residents were observed as they took part in a reminiscence session and as they socialised over lunch. Outcomes for residents under the key inspection standards for older people were assessed and resident’s files including assessments, care plans, medication administration records and risk assessments were sampled. Staff personnel files, including recruitment, induction and training records were also sampled. The home’s quality assurance system, complaints and compliments, policies and procedures and maintenance certificates were viewed. The service had completed an Annual Quality Assurance Assessment (AQAA) and information recorded in this and on the inspection record since the previous site visit has been taken into consideration in the writing of this report. After the previous site visit, an improvement plan had been sent to the home because a number of requirements had been made for the health, safety and protection of the residents and the home had responded to inform us of the action they would be taking. Six residents, a social care professional and a staff member completed surveys and comments from these sources have been included in this report. Thanks are offered to the management and the staff of Bulmer House for their assistance and hospitality on the day of the site visit and to those who completed surveys for their contribution to this report. What the service does well: The home had employed an activities co-ordinator since the previous site visit and a range of regular social activities was provided in groups and on a one to one basis. During the morning of the visit a reminiscence session was in Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 6 progress in the shared foyer area. A resident spoken with thought the gardening was marvellous and had enjoyed planting tomatoes and sweet peas in pots. Another resident had enjoyed the ‘Mystery Tours’ and the library, the live entertainment, playing bingo and appointments with the visiting hairdresser. Some compliments received by the home and recorded in the complaints and compliments file included, ‘We are very impressed by the kind and gentle approach you all have’, ‘exceptional kindness and care’, and ‘I am impressed and reassured by your sympathetic and professional care and believe you gave mum a secure and happy life. All the bedrooms were single occupancy ensuring privacy for medical examinations and visit from other health care and social care professionals as well as visitors. Interaction observed between the staff and the residents was good. It was clear that the staff knew the residents and their needs well and they supported the residents in a caring and respectful way. What has improved since the last inspection? What they could do better: Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 7 Advice should be sought with respect to the storage of controlled drugs in care homes to prevent misappropriation, and a list of the staff responsible for the administration of medication should be kept, alongside their signatures, to identify the recordings on the Medication Administration Records, for the protection of the residents. Record keeping with respect to staff recruitment could be improved by ensuring that information from the organisation’s human resources department is recorded on the personnel files held at the home to confirm initial safety checks have been carried out to protect the residents. Staff must be provided with more training such as in induction, food hygiene and infection control to ensure that they have the range skills to support the residents safely. A long-term solution to the call bell system must be resolved to ensure that people using the service have a fully operational system to call staff with at all times. The manager confirmed that this requirement had been complied with within the timescale 12/09/07, after the previous site visit, but the call bell system was not working again at this site visit. Although the situation had been risk-assessed, a temporary plan was in place and the necessary items had been ordered. After the site visit, the manager sent a copy of an email from the Hampshire County Council Property Services Officer stating that a new system had been identified, was currently on trial and that the budget had been identified for Bulmer House to have one installed as one of the highest priorities. 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. Bulmer House DS0000037250.V365277.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 Bulmer House DS0000037250.V365277.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): Standards 3,6 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Prospective residents individual needs are assessed prior to the offer of a placement to ensure the home is able to meet them. The home does not provide intermediate care, so Standard 6 does not apply. EVIDENCE: The assessment documentation of two residents, admitted since the previous site visit, was sampled, confirming that sufficient information with respect to the individual needs of prospective residents was collected prior to admission. The individuals’ personal care needs had been identified to help the manager to decide if the home was able to meet their needs and to enable initial care plans to be produced. Details were recorded under a number of headings including, general health/medical history, medication, communication, Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 10 cognitive functions, dietary requirements, mobility, personal care, continence, social support network and hobbies and interests. The assessment form recorded some information identifying the individuals’ needs with respect to equality and diversity including their religion, cultural and special dietary needs, nationality, and place of origin. On the subject of equality and diversity, the manager wrote, ‘we shall undertake a Race & Equality Impact assessment whenever necessary, as a systematic way of finding out whether an existing or proposed policy or strategy of our service will affect different groups differently. In this way we are able to challenge and eradicate any residual institutional discrimination” in this home, and ensure that policies, services and strategies do not, and will not, impact in a discriminatory way. The AQAA recorded that, ‘All new residents are admitted by referral from a care manager whether funded or self funding. The manager receives a copy of the preadmission assessment’. Residents spoken with confirmed that someone had been to see them prior to being admitted to the home. Four of the six residents who completed surveys confirmed they had received enough information about this home before they moved in so you could decide if it was the right place for them. A resident spoken with said they had chosen to live at the home, although it was some distance from where they had lived for many years, and continued to have friends. They stated they were happy living at the home and would not want to change. Bulmer House DS0000037250.V365277.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): Standards 7,8,9,10 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs were planned and met appropriately, medication was handled safely, and residents’ right to be treated with respect and have their privacy upheld was promoted. EVIDENCE: Care plans sampled were comprehensive and set out the resident’s health, personal and social care needs. Improvements had been made since the previous site visit when a requirement had been made that detailed care plans must in place including risk assessments to demonstrate how the residents’ health and care needs are to be met. Since the previous site visit, the staff had received training in care planning and recording to support the changes. Care plans viewed included a personal history, important relationships and social contacts, interests, activities and spiritual/religious/cultural practices and plans Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 12 were recorded alongside a risk assessment tool used to ascertain the level of risk involved in putting the plans into practise. The AQAA confirmed that, ‘all residents are allocated a ‘key’ worker. In consultation with the resident and with contribution from carers where appropriate, key workers prepare care plans for each new resident on admission. We ensure that residents are in agreement with the plan, that they understand it is a living document and they sign their agreement’. Assistance required in completing personal care needs was recorded, risks identified, and clear guidance was given to the care staff on how the support was to be given, taking into account the personal preferences of the residents. Falls risk assessments were in place for susceptible residents and preventative measures recorded. A full moving and handling risk assessment was included and equipment identified with respect to the activities undertaken. Care plans sampled had been reviewed on a monthly basis and signed by the resident or a representative to confirm agreement. Four of the six residents who completed surveys stated they always received the care and support they needed and two that they usually did. Access to healthcare professional was promoted. Residents spoken with confirmed they had access to a General Practitioner and that their dental and optical needs were met and one resident stated they received treatment from a chiropodist. The manager wrote in the AQAA that the home had a good liaison with community services, that a General Practitioner visited regularly and there was good support from the nurse advisor and the service manager. The six residents who completed surveys confirmed they always received the medical support they needed. A secure ‘professionals’ medication room’ contained the residents’ medication stored in locked cabinets. The home held controlled drugs and appropriate systems were in place to audit these, however, the cabinet in which they were stored was not secured to the wall as required to prevent misappropriation. The manager stated that this would be attended to promptly and later confirmed that the work had been carried out the following morning. The staff training matrix confirmed that medication training had been accessed by the staff responsible for administering the medication, but a list of allocated staff and their signatures was not kept to identify the recordings on the Medication Administration Records. Following the site visit, the manager confirmed that specimen signatures had been obtained and are now on file. The manager confirmed that, ‘residents may undertake self medication where appropriate and they wish to do so, following a suitable risk assessment’. The AQAA recorded under the heading of personal choice and dignity that, ‘the care we provide is client centred and staff are encouraged to remember that they are working within someones home. Residents are entitled to privacy and dignity in their care and to receive visits from whom they choose’. A care manager, who completed a survey confirmed that residents were treated with respect, their right to privacy and dignity was always upheld and that residents Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 13 were supported to make their own choices. All the residents could receive treatment from medical professionals and entertain other visitors in the privacy of their own bedrooms. A mobile pay phone enabled them to make private telephone calls. The home had not incorporated the Skills for Care ‘Common Induction Standards’, which offer new carers a good introduction to the caring role highlighting the importance of promoting the residents’ privacy and dignity and other important values fundamental to the development of professionalism, but the manager confirmed that he would be looking at incorporating this into the organisation’s own induction. He wrote in the AQAA that, ‘staff are trained around these principles, which are underpinned by our policies and procedures.’ Observations made on the day of the site visit of staff knocking on residents’ doors and waiting to be invited in, and respectful interactions between the staff and the residents, confirmed these principles underpinned the care practise at the home. Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 14 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): Standards 12,13,14,15 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Residents are supported to exercise some choice and control over their individual lifestyles, maintain social contacts and receive a balanced diet. EVIDENCE: The home had employed an activities co-ordinator since the previous site visit, who stated that residents are individually assessed with respect to their level of capability and according to their personal care needs. She stated that time was spent in one to one sessions completing a preference sheet to find out initially what residents liked to do, and that families often offered social history details to enable a deeper understanding of individual residents. A day–to-day record sheet was completed to confirm the resident’s involvement. The ‘Weekly Activities’ schedule, which was posted on notice boards, showed that a variety of sessions took place between ten o’clock and noon and between one thirty and two thirty. Sessions included exercises, craft session, cookery, flower Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 15 arranging, indoor gardening, bingo, poetry session, current affairs, sing-along, church service, men’s social afternoon and afternoon film shows. This was varied over two weeks and a mystery tour, magnetic darts, scrabble and other board games, music making, sewing and knitting were also offered. Holy Communion was available at the day centre on Sundays and resident were sometimes taken to local church services. A resident spoken with thought the gardening was marvellous and had enjoyed planting tomatoes and sweet peas in pots. Another resident had enjoyed the ‘Mystery Tours’ and the library, the live entertainment, playing bingo and appointments with the visiting hairdresser. The manager stated that a visiting farm had been popular with some residents and that plans were in place for a summer bar-be-cue and raffle, which relatives and friends were invited to. The activities room contained many interesting games, and materials for creative work and works of art produced by residents were displayed on the walls. Of the six residents who completed surveys, four confirmed there were always activities organised at the home that they can take part in and two that there usually were. The AQAA recorded that plans for improvement in this area, over the next twelve months, included intensive ‘Activity’ training for five staff to develop the activity programme further. The AQAA recorded, ‘We actively encourage the involvement of carers, family, friends and community groups in the daily life of the residents’. A resident spoken with stated they could receive visitors at any time and that if they wanted to speak on the telephone in private, the pay phone could be brought to their bedroom. The menu on the day of the site visit was a choice of sausage casserole with potatoes and vegetables or chicken salad. One resident interviewed thought the food was all right and that when suggestions had been made in the residents’ meetings with regard to the tea menu, they had been followed through. One of the residents, who completed a survey, always liked the meals at the home, four said they usually liked them and one sometimes did. The AQAA recorded that, ‘as a result of listening to the people who use the services, we have reviewed and changed our menus to reflect the likes and dislikes of the residents and improved our activities programme in line with the recommendations for healthy living and residents’ requests.’ A staff member was in the process of compiling a colourful, photographic version of the menu to make it more accessible to all residents. Plans were in place to introduce a series of “Festival Days” which will influence the menu and activities for those days to reflect different cultures. The AQQA recorded that improvements over last twelve months included vegetarian and soft food options and changing the bread supplier to meet resident’s requests for a particular loaf. Two kitchen/dining areas were viewed on the two units visited. Efforts had been made to make them domestic and homely and more improvements were planned. Access to the kitchen/dining areas of the units was by keypad to Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 16 ensure that those residents whose risk-assessments showed them to be at a high risk of harm from using the kettle and the microwave could only use this area when a staff member was present to protect them. The staff-training matrix showed that the kitchen staff had received training in basic food hygiene, but the care staff, who serve the food and support the residents at meal times had not. (A requirement has been made under the staffing section of the report) Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 17 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): Standards 16,18 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Policies, procedures and training ensure the staff are informed on how to safeguard the residents from abuse and safe recruitment ensures that only suitable staff are employed. The residents are confident that their complaints will be listened to and that they will be protected from abuse. EVIDENCE: The Residents Information Pack contained the complaints procedure to inform them of how to raise issues. Four of the six residents who completed surveys, always knew who to speak to if they were not happy, one stated they usually knew and one that they sometimes did. Five of the six confirmed they knew how to make a complaint. A care manager who completed a survey recorded that the home had always responded appropriately if they or their client had raised issues. The AQAA recorded that one complaint had been received over the previous twelve months and this had been dealt with appropriately and resolved and the Commission for Social Care Inspection had not received any complaints over the same period. Some compliments received by the home and recorded in the complaints and compliments file included, ‘We are very impressed by the kind and gentle approach you all have’, ‘exceptional kindness and care’, and ‘I am impressed and reassured by your sympathetic and professional care and believe you gave mum a secure and happy life.’ The Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 18 manager wrote in the AQAA that, ‘residents and their families are encouraged to raise any concerns with the staff and manager at any time. The manager ensures that he or the duty manager, has daily contact with all residents and time is made to have individual discussions with residents, their families and friends. In this way we are able to be proactive about any concerns the residents and their families have over their care, and to gather information about needs, wishes and preferences’. The home had an up to date copy of the local authority safeguarding procedures to inform the staff of action to take should a safeguarding issue be raised. Over the previous twelve months, the staff-training matrix recorded that the staff, from all departments, had received up-dated training on the Protection of Vulnerable Adults. No referrals had been made since the previous site visit. Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 19 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): Standards 19,23,24,26 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a comfortable, safe, pleasant, well-maintained environment, which is clean and hygienic. EVIDENCE: The entrance to the home was also the entrance to the Day and Resource Centre and a receptionist was on duty all day to sign visitors in. The space was light and airy and provided a waiting area for visitors. The home was to the right and the other services to the left, both accessed by corridors. The entry to the home was by keypad and immediately inside was a large foyer area where a group of residents were enjoying a reminiscence session with the activities co-ordinator. In this area was a huge 42-inch widescreen television, a Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 20 DVD player, a fish tank containing colourful fish, and a bar from which residents could partake of a glass of wine in the evenings, free of charge. An activities room, a separate library room and a hairdressing room led off from the foyer. Adjacent to the activities room was a room, which had been the smoking room, but was no longer in use for the original purpose and was currently being used as a storeroom for equipment. An enclosed courtyard garden with raised flowerbeds was planted with small shrubs and potted plants and also contained a water feature and seating for the residents’ enjoyment. A member of staff stated that this area was safe for residents with dementia and that some residents really enjoyed working in the garden. Residents from all of the four units, Elm, Ash, Beech and Oak accessed the shared facilities, a member of staff stated. The kitchen, laundry, medication room, staffrooms and staff changing facilities were centralised on the ground floor also. Two units were visited, one on the ground floor and one on the first floor. Improvements had been made with respect to the lighting and the manager commented that, ‘the corridors are much brighter.’ Some redecoration had taken place and a kitchen/dining area had been completely refurbished. The manager had plans to instigate further improvements with respect to the dining tables, pictures and the use of tablecloths. Another area of the garden was accessible from the kitchen on the ground floor and the manager stated that it had only recently been created and that some residents enjoyed walking in this area. Communal space included a separate shared lounge on each unit, adequately furnished with armchairs, lit with domestic lighting and provided with entertainment in the form of television and compact disc players. Bedrooms were compact and contained the required storage facilities. Some residents had personalised their bedrooms with photographs, pictures and ornaments and one resident had a vase of fresh flowers. Due to the restricted size and uniform shape of the bedrooms, the possibility of creating a home form home was limited as the space did not promote the possibility of residents bringing items of furniture of any size to individualise their bedrooms. The AQQA recorded that, ‘within the restrictions of health and safety requirements, residents are encouraged to bring special pieces furniture with them’. Residents seen in their bedrooms had comfortable armchairs, but there was no seating for visitors, should they wish to entertain in the privacy of their own bedrooms. A staff member commented that the bedrooms on the top floor could reach high temperatures in the summer due to the flat roofing and another staff member thought the bedrooms were rather small. One of the bathrooms on an upstairs unit was not in use and had become an area for the storage of equipment. The manager stated that, ‘plans are in place to make some bathrooms into wet rooms to offer more choice to the residents.’ All the bathroom areas were not inspected, but the manager confirmed there were sufficient facilities and that all the baths had shower attachments. Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 21 The laundry, which was located on the ground floor, was shared by the four units and contained industrial washing machines and dryers. Staff especially recruited to work in the laundry provided this service. The home was clean and there were no unpleasant odours, but there was little evidence of infection control training to ensure the staff had been kept up-to-date with current practise for the protection of the residents. The staff-training matrix showed that several care staff had received this training but not currently and that no staff in the housekeeping or laundry departments had been trained. Four of the six residents, who completed surveys, confirmed the home was always clean and fresh and two that It usually was. Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 22 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): Standards 27,28,29,30 People who use the service experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The home had overcome some drawbacks in staff retention and maintained sufficient staff to satisfy the residents’ needs. Improvements are needed in the provision of some essential training and in the recording of staff recruitment information to promote the safety of the residents. EVIDENCE: ‘Over the previous twelve months, there had been a significant turnover of staff, and temporary/agency staff had been used’, the manager stated. The AQAA recorded that twelve part-time staff had left the employment of the home in the last twelve months, but, the manager stated, there was a core of reliable and loyal staff to maintain continuity and consistency for the residents. Two of the six residents, who completed surveys recorded that the staff were always available when they needed them, and four that they usually were and they all confirmed that the staff listen and act on what they say. One resident commented, ‘the staff are very kind’. A recent recruitment drive had been successful and several newly appointed carers were waiting for preemployment checks to be completed before they could commence in their posts. The AQAA confirmed that ‘The Residential Matrix’ had been applied to ascertain the number of staff required with respect to the dependency levels of Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 23 the residents and this had been used in compiling the staff rota. In addition to the care staff, an activities co-ordinator was employed, a cook and kitchen assistants, housekeeping and laundry staff. Although the manager stated that a key worker system was in operation, he also stated that, ‘the staff are not specifically attached to particular units’. Despite the turnover of staff in the last year the number of staff with National Vocational Qualification (NVQ) or working towards them, as recorded in the AQAA remained well above the 50 level and plans were in place to register the recently recruited staff as soon as possible. The manager stated that the department employed two NVQ Assessors to support this process. The staff personnel files of two staff, recruited since the previous site visit, were sampled and records showed that three senior staff had been involved in interviewing them and that selection had been in keeping with equal opportunities principles. The application form did not require the applicant to complete a full employment history and fully explain any gaps to confirm they were suitable to work with vulnerable adults. The necessary information was however included on a separate sheet of loose paper and the manager confirmed that Hampshire County Council had recently updated the application form to include the required information. Written references had been received prior to the confirmation of employment. The organisation, which provided the service, took responsibility for carrying out the Criminal Record Bureau (CRB) checks and informed the manager by e-mail of the individual’s CRB number and that the check was clear. The manager stated that if a decision was necessary with respect to the information supplied, he would be consulted about the suitability of the applicant to work at the home. One staff member had started work before the results of the CRB check had been received and evidence to support the fact that a Protection of Vulnerable AdultsFirst check had been applied for, to enable them to work under supervision in the meantime, could not be located. The manager stated that the organisation carry out this part of the process and inform the home by e-mail when the results have been received. Following the site visit, the manager informed us that the missing documentation, confirming that this check had been carried out in a timely manner had been found and included in the employee’s file. A staff member, who completed a survey recorded that their employer carried out checks, such as CRB and references before they started work. Staff training records sampled showed that a wide range of training courses were available to the staff and some of the certificates viewed included specialist training to support the individual needs of the residents dementia awareness, risk assessment, palliative care, wound care, conflict management, supervision, catheter care, record keeping, diabetes care, Multiple Sclerosis and arthritis in addition to the mandatory training of fire safety, emergency aid, the administration of medication and infection control. However, the stafftraining matrix revealed gaps in Health and Safety, food hygiene for carers and that infection control training was in need of updating for the majority of the Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 24 staff. The manager confirmed, after the site visit, that food hygiene for non catering staff and infection control training has been planned for completion by December 2008 and that Health and Safety modules had been completed by all staff involved in NVQ training. There was evidence that the organisation’s own induction had be completed by some staff, but the home had not yet incorporated the Skills for Care ‘Common Induction Standards’, which offers new carers a good introduction to the caring role highlighting the importance of promoting the residents’ privacy and dignity and other important values fundamental to the development of professionalism. However, the manager confirmed that he would be looking at incorporating this into the organisation’s own induction. The AQAA recorded that the home had in- Unit training on issues such as ageism and the residents’ right to express their sexuality to support the staff in promoting the residents’ needs with respect to equality and diversity. Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 25 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): Standards 31,33,35,38 People who use the service experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Residents benefit form living in a home, which is managed by an experienced person of good character, who has been limited in discharging some of his responsibilities due to drawbacks outside of his control. Systems are in place to ensure the residents have input into the decisionmaking process with respect to the running of the home, and their financial interests are safeguarded. Improvements had been made with respect to staff access to supervision in their support of the residents. EVIDENCE: Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 26 Since the previous site visit, the appointed manager, who holds both a relevant care and management qualification, had applied and been accepted as the registered manager for the home. Unfortunately, due to a period of unplanned absence, there had been a delay in completing all the changes he had planned. Over the previous twelve months, the AQAA recorded that ‘the barriers to improvement had been that the management team had been depleted because of sickness absence, and that the home had been reliant to some extent on the use of agency staff.’ The manager confirmed that this period of disruption had come to an end and that continuity in the care provision had been established. The impact of the barriers to improvement had been reduced because ‘the management team was committed and staff worked extra shifts to minimise the disruption to the residents,’ the AQAA recorded. The management structure consisted of the registered manager, a part-time deputy manager and three assistant managers, each with specific areas of responsibility. Systems were in place to ensure the views of the residents, their relatives and representatives and the staff contributed to the running of the home. Quality assurance questionnaires had been completed over the previous year to gather the views of residents, their relatives and representatives and plans were in place to review this document. Results confirmed that residents and their relatives and representatives expressed a high level of satisfaction with the service. The AQAA recorded, ‘Questionnaires are completed anonymously wherever possible, analysed within house and results are posted on the residents notice board. Results are also provided to residents individually if required’. Staff and residents’ meetings were also held to enable their views to be sought to contribute to the continuous development of the service. Residents were encouraged to retain financial independence whenever possible. Valuables and money held on behalf of residents were stored securely and records completed. Standard 36 was not fully inspected, but staff supervision records were sampled, confirming that improvements had been made in the support the staff received from the management in supporting the residents’ needs. Records confirmed that the Health and Safety audit for all the units was up-todate and that a full fire risk assessment had been completed in June 2007. A visit from the Hampshire Fire and Rescue Service carried out in August 2007 showed satisfactory outcomes. ‘The fire officer had sanctioned the use of some door wedges in busy parts of the building until automatic door closures could be fitted’, the manager stated. The majority of doors, including the residents’ bedroom doors, had already been supplied with these devices, which ensure the doors close at the sound of the fire alarm to prevent the spread of fire and to protect the residents. The manager did not have any written documentation from the Hampshire Fire and Rescue Service with respect to the use of door wedges and later confirmed that the wedges had been removed. Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 27 Two requirements had been made at the previous site visit with respect to a working system for residents to call the staff in case of emergencies to be in place. One was that, ‘the temporary call system fully operates and is consistently used by staff, that the residents must have a working system to call staff in an emergency and that a long-term solution to the call bell system is resolved to ensure that people using the service have a fully operational system to call staff with’. Since the previous site visit the manager had provided details of action taken. However, on the day of the recent site visit, the manager stated that the system had failed again. A risk assessment had been carried out and a temporary plan was in place, providing an extra staff member to complete a non-stop patrol of all the units between the 5th and 13th June when the eight new pagers were due to be delivered. After the site visit, the manager sent a copy of an email from the Hampshire County Council Property Services Officer stating that a new system had been identified, was currently on trial and that the budget had been identified for Bulmer House to have one installed as one of the highest priorities. The staff-training matrix showed that most of the training with respect to safe working practices had been appropriately up-dated. This included moving and handling, fire safety and first aid. Access to training in infection control was limited and those working in the laundry and housekeeping had not accessed this training. Kitchen staff, who prepare the food for the four residential units, had received food hygiene training, however, the majority of the care staff had not, although the evening meal was prepared on the units and some residents required support when eating. A senior staff member stated that moving and handling refresher training, fire training and food hygiene had been planned for October/November 2008. The Annual Quality Assurance Assessment, completed by the manager confirmed that policies and procedures with respect to health and safety had been kept under review, and that the essential maintenance of equipment had been carried out according to manufacturers’ recommendations. A sample of certificates were seen on the day of the site visit confirming that maintenance checks had been carried out in a timely fashion for the safety of the residents and the staff. The risk assessment with respect to the Control of Substances Hazardous to Health had not been reviewed for some time and the manager stated the reason for this was that the same substances continued to be used at the home. He confirmed they would be updated to reflect any changes in the future. Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 28 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 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? 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 OP30 Regulation 18(c)(i) Requirement Staff must be provided with more training such as in induction, food hygiene and infection control to ensure that they have the range skills to support the residents safely. The management must ensure that a long-term solution to the call bell system is resolved in order that the people using the service have a fully operational system to call staff with. Timescale for action 06/09/08 2. OP38 23(2)(c) and (n) 06/09/08 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. Refer to Standard OP9 Good Practice Recommendations A list of the staff responsible for administering medication and their signatures should be kept to identify the recordings on the Medical Administration Records and advice should be sought with respect to ensuring the controlled drugs cabinet is secured to prevent the misappropriation of drugs. DS0000037250.V365277.R01.S.doc Version 5.2 Page 30 Bulmer House 2. OP29 Better methods of recording staff recruitment checks should be employed to confirm that applicants are suitable to work with vulnerable people prior to the commencement of employment. Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Bulmer House DS0000037250.V365277.R01.S.doc Version 5.2 Page 32 - 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. 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