CARE HOMES FOR OLDER PEOPLE
Allison House Swan Lane Sandy Bedfordshire SG19 1NE Lead Inspector
Dragan Cvejic Unannounced Inspection 20th October 2005 08:30 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 Allison House DS0000014875.V260318.R01.S.doc Version 5.0 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. Allison House DS0000014875.V260318.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Allison House Address Swan Lane Sandy Bedfordshire SG19 1NE 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) 01767 682998 01767 690982 BUPA Care Homes (Bedfordshire) Ltd Mr G Michel Care Home 42 Category(ies) of Dementia - over 65 years of age (42), Learning registration, with number disability over 65 years of age (42), Old age, not of places falling within any other category (42), Physical disability over 65 years of age (42) Allison House DS0000014875.V260318.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th August 2005 Brief Description of the Service: Alison House was opened in 1984 by Bedfordshire County Council and transferred to “Care First Bedfordshire Ltd”, part of BUPA Partnership Homes, in July 1998. The house is a purpose built residential home for 42 frail, elderly residents including those with dementia and learning disabilities. The home offered respite care for 2 service users and permanent care for 40,this is based on 24 hour care. The care was provided by experienced and trained staff. The home is a two-storey building and has two units on the upper floor and three on the ground floor. Each unit has its own lounge, dining, and kitchenette area, which are individualised to meet the needs of service users. All the bedrooms are single and the service users are encouraged to bring in their personal belongings to make their rooms as homely as possible. The home has a pay phone,a hairdressing salon and a mobile library that comes to the home once a week. The home has a pleasant garden with a patio area. The home is situated in a residential area in Sandy, near Bedford; the A1 allows easy access for those travelling to the home from a distance. Car parking facilities are also available on site for both visitors and staff. The shops and a bus stop are within walking distance of the home. Allison House DS0000014875.V260318.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. It was carried out early morning, to allow monitoring of the “getting up” process. Case tracking methodology was used as the main method. In addition, 5 service users were spoken to and two of them were case tracked in relation to activities, rights, environment and food. Two staff members provided their comments. Medication sheets for case tracked service users were also checked. The inspection was carried out during a short period of time and only the key standards were inspected. Therefore, this report should be seen together with the previous inspection report. What the service does well:
Service users were just getting up at the beginning of the inspection. The staff were engaged in helping the users to get up, one by one. Three quite independent users got up without assistance. Two service users came in to the main lounge, while a third stayed in her room as she preferred. This was her usual routine. Downstairs, in the dining room, a staff member made a cup of tea for two service users. One of them came into the main lounge where he collected the daily newspapers to read. The other remarked: “I am quite warm here”, she explained her satisfaction with a smile despite the confusion that she suffered from, due to her advanced age. The dining room soon became busier and a lively chat developed between the service users who had been brought in to the room. A service user that stayed in her room had not finished her tea when the inspector went in for a chat. “The staff are very good with me. The maintenance man always responds quickly and repairs things when something goes wrong.” She continued: “They (staff) always inform us of what’s going on. We have activities every day. I do a bit of exercise and I make bookmarks. We do that in a group, you see. This is my wheelchair ready for me. I am waiting for a hairdresser. I like my room”. The kitchen was clean and tidy. A cook became concerned when he was registered blind, but his job that he had done for many years was not affected. Fresh tomatoes and salad were in bowls ready for him to make a fresh salad for that day lunch. “They (service users) told me they wanted fresh salad today, so I have got the ingredients ready to make this for them, I always ask them what they want and try to make food that they like and this way we reduce wastage.” A service user came into the dining room wearing a stained shirt; the staff noticed this and gently and respectfully spoke to him and went back with him to his room. A few minutes later they came back and he was wearing a clean shirt. Allison House DS0000014875.V260318.R01.S.doc Version 5.0 Page 6 As the day progressed, a district nurse came to check on a service user who was taking antibiotics for a chesty cough. She than went on to visit a service user who had been diagnosed with cancer. This person was receiving extra attention from all of the staff. Upstairs, in the unit for people with dementia, 5 service users walked or sat in the lounge. “It is nice to see people’s faces with a smile, isn’t it?” said one of the service users, adding her own smile. Downstairs, a service user helped herself to some fresh grapes from a fridge, which was in each kitchenette unit. There was also milk, butter and bread, fresh juices, mayonnaise and rice pudding; this was available for service users to help themselves whenever they wanted. What has improved since the last inspection? What they could do better:
The statement of purpose described what was offered in the home, but it was not reviewed to illustrate the change in BUPA’s management team: a new operational manager. All doors were marked to help service users with orientation, but there was a dump marking on a bathroom door that needed replacing. In one of the kitchenettes, a lid was missing from the rubbish bin. Despite a wide range of activities offered on a regular basis and the service users being informed in person on a daily basis, the main board was used to remind everyone of the planned activity each day. On the day of the inspection this was not done and a senior staff member noticed and stated: “I must remind the activity person to do it”. Allison House DS0000014875.V260318.R01.S.doc Version 5.0 Page 7 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. Allison House DS0000014875.V260318.R01.S.doc Version 5.0 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 Allison House DS0000014875.V260318.R01.S.doc Version 5.0 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): 1,4 The home had a very well structured statement of purpose that provided all information about the home, but it was not reviewed and updated to illustrate small changes. Service users’ needs were met. EVIDENCE: The statement of purpose still stated that the operational manager was the previous manager, who had left her post. It also contained the NCSC title that needed update to the CSCI, as the commission has changed its title. The content of the statement was appropriate and provided sufficient information what was provided and offered and included in the fee payable. Service users spoken to confirmed that the home was meeting all their needs. The home also took into consideration service users wishes and preferences when a decision on admission and offer of a place was made. Allison House DS0000014875.V260318.R01.S.doc Version 5.0 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): 8,9,10.11 Service users knew their goals that were set in the care plans. They were happy with how their health care needs were met. Administration of medication had improved and was accurate now, ensuring better protection of service users. The procedure and practice of care for service users who are dying was tested in practice and was appropriate. They were treated with sympathy and extra support. EVIDENCE: Service users spoken to, confirmed that staff helped them in anyway that they wanted to be helped and supported. A service user stated: “My leg is now fine, thanks to them (staff).” Another user, admitted for respite care, confirmed that he had explained to staff how he wanted them to assist him and they had created a care plan and used the explained and recorded methods to support him. Three service users stated that the home ensured that their medication was given to them correctly and stated that they were happy with the medication process. The staff were confident in administering medication and they knew the procedure.
Allison House DS0000014875.V260318.R01.S.doc Version 5.0 Page 11 The cleaners were visiting a number of service users rooms in the morning hours to do their job and had been observed knocking on the doors before entering bedrooms and addressing users with full respect. The deputy manager explained the process set for the care of a service user with a diagnosis of a cancer, the procedure demonstrated a dignified, respectful and sympathetic approach with involvement of external professionals to ensure that sensitive care was offered to the user and support for the family. Allison House DS0000014875.V260318.R01.S.doc Version 5.0 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): 12,14,15 Service users were able to express their views and to influence a daily routine in the home to suit their expectations. The catering provisions not only met the nutritional needs of service users, but were also used to make connection with the society in general and follow the expanding food market. EVIDENCE: Service users confirmed that activities organised in the home were meeting their needs and expectations. They were informed of activities for each day in the morning, verbally, and that created an atmosphere where they felt respected, empowered and in control of their lives. At the time of the inspection, the main notice board for activities was not written down for that day. The deputy manager addressed the issue straight away with the activity coordinator. A service user stated that he was getting his favourite newspapers delivered daily by staff. All service users spoken to stated that the food provided was excellent. They said that they had choice, decided on menus and enjoyed the choice of where to eat: in the main dining room or in the small dining rooms within each unit. A staff member brought in a Mango fruit. It was shown to the service users and used for discussion of food and the food market. At the end of the discussion, it was sliced up and tasted by the users that had not had a chance to taste it before. The home planned to introduce other fruit or food products
Allison House DS0000014875.V260318.R01.S.doc Version 5.0 Page 13 to service users in the same way. The presence of drinks and food in small fridges in each unit also demonstrated the independence offered and promoted for service users. All these elements showed that the home exceeded the standards. Allison House DS0000014875.V260318.R01.S.doc Version 5.0 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): 16,17 The home used the company’s complaints procedure that was effective and ensured protection of service users. EVIDENCE: The complaints procedure was visibly displayed in the main hall and was also included in the written pack given to service users and referring agents on admission. The procedure indicated that all serious complaints would be investigated by an independent investigating officer, usually a manger from another home. The statement of purpose stated that service users’ legal rights would be respected. It detailed that legal help and guidance would be provided if needed and that users would be encouraged to take part in the election process. Allison House DS0000014875.V260318.R01.S.doc Version 5.0 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 The building and the environment met the service users needs and expectations. Maintenance was well organised and efficiently carried out. Service users benefited from the well-maintained, clean and homely environment. EVIDENCE: The building was well maintained. A service user praised a maintenance man for being “efficient and handy” and attending to any potential faults without delay. She also stated that the staff prepared a wheelchair for her transfer and kept it close to her when the use of it was planned. Service users’ bedrooms were meeting both standards and users’ needs. The home was exceptionally clean and the cleaners were doing an excellent job. They were showing respect to service users and maintained a friendly relationship. The laundry room was tidy, clean and users’ clothes were kept in separate baskets. A new No smoking arrangement improved the look and the freshness of the main foyer, very much used by service users. A marking sign on one bathroom door was written on a paper and was exposed to dump, that made it look scruffy.
Allison House DS0000014875.V260318.R01.S.doc Version 5.0 Page 16 A lid was missing on the rubbish bin in one of the units’ kitchenettes. Allison House DS0000014875.V260318.R01.S.doc Version 5.0 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): none These standards were fully met on the previous inspection and were not inspected this time. EVIDENCE: Allison House DS0000014875.V260318.R01.S.doc Version 5.0 Page 18 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): none The key standards from this section were met on the previous inspection and were not inspected on this occasion. EVIDENCE: Allison House DS0000014875.V260318.R01.S.doc Version 5.0 Page 19 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 2 X X 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Allison House DS0000014875.V260318.R01.S.doc Version 5.0 Page 20 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 OP1 Regulation 6 Requirement The statement of purpose and service user’s guide must be reviewed and updated to illustrate the current details about the home The rubbish bin in the kitchenette must have a lid. Timescale for action 30/11/05 2 OP26 23 30/11/05 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 OP12 OP26 Good Practice Recommendations The activities board should be filled in each morning, as the normal home’s procedure regulates. The notices for marking doors should be replaced when they show signs of wear, tear and do not look presentable. Allison House DS0000014875.V260318.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 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 Allison House DS0000014875.V260318.R01.S.doc Version 5.0 Page 22 - 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!
