CARE HOMES FOR OLDER PEOPLE
Batchfoot Country House 181 Church Street Upwey Weymouth Dorset DT3 5QE Lead Inspector
Trevor Julian Unannounced Inspection 31st July 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Batchfoot Country House DS0000026763.V306305.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. Batchfoot Country House DS0000026763.V306305.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Batchfoot Country House Address 181 Church Street Upwey Weymouth Dorset DT3 5QE 01305 812143 01305 812143 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) Mrs M C Taylor Mrs Jacqueline Johnson Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Batchfoot Country House DS0000026763.V306305.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th January 2006 Brief Description of the Service: Batchfoot Country House residential home is established in a large detached Georgian listed building set in its own grounds and mature gardens. It is situated in the village of Upwey, half way between the seaside town of Weymouth and County town of Dorchester. The home is close to the local church, wishing well and other village amenities. The home is registered to accommodate a maximum of 16 service users in the category of old age. The service users accommodation is arranged over three floors, with three bedrooms at ground floor level, six at first floor level and four bedrooms on the second floor. For service users with limited mobility there is a stair lift fitted to the back staircase, which accesses the first and second floors. There is a large communal lounge and separate dining room on the ground floor. At basement level there is a storage area, office, laundry room and a staff toilet/shower room. A driveway leads to the home and a car parking area is available to the side of the house. The home is set in its own grounds with large landscaped front and side gardens which boast mature trees and shrubs and is abundant with wildlife, deer, foxes, badgers, squirrels and birds. The weekly fees range between £353 - £450. Batchfoot Country House DS0000026763.V306305.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Monday 31st July 2006 between 09:00 and 16:15. The owner Mrs Taylor and the manager Mrs Johnson were on the premises throughout the visit. The purpose of the visit was to monitor compliance with key standards and to check on progress made with requirements and recommendations from previous visits. Before the visit the manager had supplied general information on needs of the residents and the management of the home. Residents and visitors returned a total of 14 comment cards giving their views of the home. It was the inspector’s first visit to the home information for this report was gathered through discussion with the residents, staff and management examination of records and a tour of the premises. At the time of the visit, there were 12 residents and no rooms were shared. What the service does well:
The comments cards returned showed that the residents and visitors were very satisfied with the services offered by the home and no issues were identified in the responses. The records seen showed that the home operated a pre-admission assessment to ensure that they had the skills and resources to meet the identified needs. Several residents confirmed that they had been visited at their previous address for the assessment. Care Plans contained good levels of information relating to health and social care needs. However, improvements in the recording social, religious and spiritual interests were suggested. The home maintained good links with the community healthcare teams. Residents said that the staff arranged for GP and community nurse visits as needed. Medication was well managed within the home. Items were safely stored and the medication records were kept up to date. The staff managing the medication were trained and assessed as competent. Batchfoot Country House DS0000026763.V306305.R01.S.doc Version 5.2 Page 6 Residents in the home said there was normally enough activity in the home to keep them occupied. The residents seen all stated that they spent most of their days in their rooms but this was their own choice. The home arranged regular church services in the home and many of the residents took communion. The food in the home was described as good, traditional and home cooked. Residents said they were able to have a choice. Meals were served in the dining room or the residents’ own room. The home had a system for investigating complaints and allegations of abuse. None of the residents spoken to had made a formal complaint, if there were problems they felt comfortable enough to discuss with the staff or management. Staffing levels were appropriate to the needs of the residents. The home benefits from a loyal workforce with a number of people working at the home for several years. The home was not involved with financial management for any service users. Several residents and their families deposit a personal allowance with the home’s management. This was used for personal expenditure e.g. hairdressing. Records of income and expenditure were kept. The home was well managed and operated by experienced individuals. What has improved since the last inspection? What they could do better:
Care plans were generally well documented. However, it was noted that the care planning for social, spiritual and religious needs could be improved by clearer information about how the assessed need would be met. Batchfoot Country House DS0000026763.V306305.R01.S.doc Version 5.2 Page 7 Medication was well managed in the home although when handwritten amendments and additions were made they were not checked by a second person which could result in transcription errors. The home was continuing to look for a suitable training provider to offer refresher training in core topics. The home’s Quality Assurance system was being developed to gain the views of services linked to the home and the staff group. Once the data gathering was completed, the home would need to develop an annual improvement plan. 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.
Batchfoot Country House DS0000026763.V306305.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 Batchfoot Country House DS0000026763.V306305.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were only offered a placement once an assessment had been completed to that the identified needs could be met. EVIDENCE: The file of a new resident showed that a pre-admission assessment was completed before being offered a placement. This ensured that the staff were aware of and could manage the identified care needs. A letter of confirmation was sent following the assessment. Residents confirmed that the owner or manager had visited them before being offered a placement. Information about the services offered within the home was available in the main entrance lobby.
Batchfoot Country House DS0000026763.V306305.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans were in place giving staff detail of how identified needs were to be met. The home maintained links with the community health services to ensure that health needs were addressed. The home had good procedures in place for the safe handling of medicines in the home. People living at the home are treated with respect for their privacy and dignity. EVIDENCE: The care records for three people were checked each covered the required topic and had been developed from the pre- admission assessment. Suggestions were made about how improvements to the recording of social and spiritual needs could be made. One person’s file showed a keen interest in
Batchfoot Country House DS0000026763.V306305.R01.S.doc Version 5.2 Page 11 gardening but this was not addressed in the care plan although the manager had clearly considered how the need could be met. Since the last inspection, the home had introduced an agreement document to show that the resident, or their representative, had been involved with and had agreed the plan of care. The daily reports showed good levels of detail and included any visits by GPs and social activities. Weight checks were in place to assist in basic nutritional monitoring. The home used a monitored dosage system for the management of medication. Medication was administered by staff who had completed accredited training and assessed as competent. Items were correctly stored there was a secure fridge for temperature sensitive item. The community nurse visited the home to manage insulin for one person who was diabetic. There were photos on the medication records should staff need to check someone’s identity. The record charts were checked and appeared in order. It was noted that hand written amendments or additions were not checked by a second person which could result in transcription errors. During the visit it was noted that the home had a homely family atmosphere there was friendly dialogue between staff and residents. The residents said the staff were always kind and attentive and they were treated with dignity and respect. Batchfoot Country House DS0000026763.V306305.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents were encouraged to maintain as much independence and to exercise as much choice as their own circumstances allow. The home provided a varied and nutritious diet allowing good levels of choice and encouraging good nutritional intake. EVIDENCE: The residents at the home tended to stay in their own rooms during the day but came to the dining room for lunch. One resident said she took all her meals in her own room as she preferred not to leave her room. She enjoyed the view from her bedroom window. She said she had all she needed in her room and enjoyed regular visits from her family and took monthly communion. The people spoken with said there was enough to keep themselves occupied. Each room had access to satellite TV. The rooms visited had been personalised by the occupant with photographs and pictures, some had their own items of furniture.
Batchfoot Country House DS0000026763.V306305.R01.S.doc Version 5.2 Page 13 Staff said that the current residents were encouraged to join in with activities in the home; a recent coffee morning was attended by some of the residents but a number remained in their rooms through choice. A visiting library service provide a book exchange at the home. Residents said that their family and friends were welcomed into the home at all times and they were offered refreshments. The food was described as very good with plenty of choice. Records were available showing the items requested for individual residents for each meal. The catering manager said the home operated a four week menu but there was flexibility within the programme. The home manages specialist diets for people with diabetes. Residents praised the standard of the food provided. They described it as traditional home cooking with items freshly prepared and cooked. One Cornish resident was treated to a monthly pasty. During the tour of the premises there was a good supply of hot and cold drinks in evidence. Batchfoot Country House DS0000026763.V306305.R01.S.doc Version 5.2 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had systems in place for residents and visitors to raise concerns and to respond to allegations of abuse. EVIDENCE: The home had a system in place for managing complaint within the home. Records showed just one complaint which, had been appropriately handled. Some guidance was offered regarding the management of policies to ensure that following revisions the earlier policies should be removed to avoid confusion. None of the residents spoken to had made any formal complaints each saying they were able to speak to staff in order to address any concerns they might have. Adult protection was discussed individually with two members of the staff. Both were clear about their responsibilities to respond to signs or allegations of abuse; they were also aware of when they should refer to external agencies for advice. Batchfoot Country House DS0000026763.V306305.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provided the residents with a safe and clean environment. EVIDENCE: The home was found to be clean and well presented there were no unpleasant odours noted during the visit. Bedrooms were redecorated as they were vacated. A stair lift operates to the first floor and to two of the bedrooms on the second floor. The other bedroom on the second floor was accessed by a staircase only; making the room only suitable for people with good mobility. The home employed a maintenance person who carries out routine repairs and maintenance. There is also a gardening contractor who tends the large grounds. A patio area at the front of the home provides a pleasant seating area for the residents. Sun shades were provided to protect the residents from the risk of sunburn.
Batchfoot Country House DS0000026763.V306305.R01.S.doc Version 5.2 Page 16 Communal lounge and dinning rooms were located on the ground floor and were used by a few of the residents. The stair carpet looked “tired” but remained in reasonable condition and did not present a tripping hazard. The bedrooms seen were well laid out and several residents commented that their beds were comfortable. One resident had a new electrically operated adjustable bed; she said that it had helped her to get comfortable and she had been able her to get a good night sleep. Some of the radiators were covered in padded cloth protectors to guard against knocks and burns, the remaining radiators had been risk assessed, the assessments were not seen during this inspection. Batchfoot Country House DS0000026763.V306305.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was appropriately staffed by suitable individuals. The training programme identified staff training needs to ensure the staff remained up to date with current practice. However, some refresher training in core skills was overdue and had been booked. EVIDENCE: The home is staffed by at least two carers throughout the day, at night there is one waking and one sleep-in carer. Night time needs were described as light the residents seen said they rarely used their call alarms during the night. In addition to the care staff there were staff employed for cleaning and catering duties in the home. The home benefits from a loyal workforce which helps provided good continuity of care. Vacant shifts are picked up by other members of the team and so no agency staff had been used. The home had a training file detailing the training completed by individual members of staff. The home had identified that some of the staff needed training updates in first aid, food hygiene and manual handling training; arrangements had been made for the training to be delivered.
Batchfoot Country House DS0000026763.V306305.R01.S.doc Version 5.2 Page 18 The home had not employed any new staff since the last inspection. A check of two files showed the required checks and clearances were in place. All the residents spoken to said the staff were kind and helpful. Batchfoot Country House DS0000026763.V306305.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed and operated by experienced individuals for the benefit of the residents. The views of the residents are sought in order to ensure that the home is run in their best interests. The system was being developed to fully meet the standard. The home’s systems help to ensure that the residents are protected from the risk of financial abuse whilst in the home. Health and safety systems were in place to provide the residents and staff with a safe environment. Batchfoot Country House DS0000026763.V306305.R01.S.doc Version 5.2 Page 20 EVIDENCE: The home’s owner and the manager both have a wealth of experience running the care home. The manager was well advanced in obtaining her NVQ level 4 however due to circumstances beyond her control she had been unable to complete the full programme and was looking for an alternative training provider. As a small home the residents and staff described the management as approachable and accessible. Staff felt they could make suggestions about any ideas they had. Files seen showed that staff receive regular supervision and appraisal meetings. There were residents’ forums and surveys to help identify any areas for improvement. The quality assurance system was being developed and some advice was offered. The home did not manage the finances for the any of residents however a number of people did deposit personal allowances with the management to cover personal expenditure e.g. newspapers, chiropody and hairdressing etc. The home had a accident reporting system which was used to monitor for trends and risks. The home had recently reviewed their fire risk assessment. There were systems in place to regular check and service fire safety systems and equipment. Fire drills had been completed twice in 2006. Batchfoot Country House DS0000026763.V306305.R01.S.doc Version 5.2 Page 21 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 X 11 3 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 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Batchfoot Country House DS0000026763.V306305.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP33 Regulation 24 Requirement The registered persons must develop the quality assurance system based on the views of service users and their representatives and which includes an annual development plan. Timescale for action 31/12/06 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 Refer to Standard OP7 OP9 Good Practice Recommendations The care plan should include information on social, religious and spiritual needs, and how they are to be met. When hand written amendments or additions are made to the medication administration records they should be checked by a second person in order to reduce the risk of transcription errors. The registered person should ensure that the staff have refresher training in manual handling, first aid and food hygiene. 3 OP30 Batchfoot Country House DS0000026763.V306305.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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