CARE HOMES FOR OLDER PEOPLE
Badgers Wood Care Home 29 School Road Drayton Norwich Norfolk NR8 6EF Lead Inspector
Mr Jerry Crehan Key Unannounced 16th May 2006 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 Badgers Wood Care Home DS0000065307.V295849.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. Badgers Wood Care Home DS0000065307.V295849.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Badgers Wood Care Home Address 29 School Road Drayton Norwich Norfolk NR8 6EF 01603 867247 01603 261114 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) Ashbourne (Eton) Limited Position Vacant Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Badgers Wood Care Home DS0000065307.V295849.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 22nd September 2006 Brief Description of the Service: Badgers Wood is a care home providing residential care for up to 45 older people. It is situated in a residential area of Drayton, which is approximately four miles from the city of Norwich. There are local shops, pubs and other amenities within the immediate vicinity of the home. Badgerswood was purpose built in 1986. The accommodation is provided on two floors serviced by stairs and a shaft lift. There are 31 single rooms and 7 shared rooms. There are enclosed patio areas and grounds, which are visible from service user bedrooms. Badgers Wood is one of several homes in Norfolk owned by the proprietors. Badgers Wood Care Home DS0000065307.V295849.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 7.5 hours. Opportunity was taken to tour the premises, look at care records and policies, and communicate with the home’s service users in addition to visiting relatives and professionals, staff and the manager. The inspection report reflects regulatory activity since the last inspection and evidence from inspection of Key Standards. Three comment cards were received prior to the inspection from service users and relatives, which gave broadly favourable responses about the home. What the service does well: What has improved since the last inspection?
The home is increasingly well managed by a new manager who has had a positive impact on the home. They are evidently well regarded by service users and staff alike. There are notable improvements to aspects of practice to meet the health and personal care needs of service users, and despite several omissions (that are described in this report) record keeping to support safe care has greatly improved. There was evidence of regular (monthly) reviews of care plans, an increase in the availability of social history or ‘life story’ work to support good individualised care. Care staff spoken to stated that they felt they received good supervision from senior staff, and staff files looked at showed evidence of their supervision being carried out on a regular basis.
Badgers Wood Care Home DS0000065307.V295849.R01.S.doc Version 5.2 Page 6 There are several areas where redecoration has improved the interior environment, and the manager has clearly been considering how to make the best use of the space available to service users and visiting relatives. What they could do better: 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. Badgers Wood Care Home DS0000065307.V295849.R01.S.doc Version 5.2 Page 7 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 Badgers Wood Care Home DS0000065307.V295849.R01.S.doc Version 5.2 Page 8 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&6 The assessment process for admission to the home is satisfactory. EVIDENCE: A review of a sample of service user files provided evidence of satisfactory assessments completed by the manager. A visiting professional spoken to at the time of the inspection confirmed that the home carries out pre-admission assessments where possible. The home does not provide intermediate care. Badgers Wood Care Home DS0000065307.V295849.R01.S.doc Version 5.2 Page 9 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 & 10 There are notable improvements to aspects of practice to meet the health and personal care needs of service users. However, there is also evidence of practice that is failing to protect and promote health and personal care. EVIDENCE: A sample of care plans was reviewed. These set out service users health, personal and social care needs in reasonable detail and reflected the care provided. Despite some confusion associated with the introduction of a new format for care planning and risk assessment, improvements were noted in several areas. There was evidence of regular (monthly) reviews of care plans, an increase in the availability of social history or ‘life story’ work to support good individualised care, and there was evidence of some (though limited) involvement of service users in aspects of their care plans. A care plan reviewed for a service user with a pressure area did not contain information for care staff about appropriate intervention or treatment. It was agreed that this might have been due to the introduction of new care plans referred to above. Badgers Wood Care Home DS0000065307.V295849.R01.S.doc Version 5.2 Page 10 The home maintains good accident records. Records for a service user liable to falls were reviewed, however there was no record of appropriate interventions to be carried out to minimise or reduce the risk of falling for this service user. The home currently accommodates a service user with significant cognitive deterioration, and (it appears) a diagnosis of dementia. It is recommended that monthly reviews for this service users considers the need for a wider review of their care and health (including mental health) needs, to consider the need for more specialist care. An inspection of medication records and practice was undertaken. Following requirement at the last inspection, there is evidence of the completion of risk assessments for service users who are responsible for administering their own medication. These service users have also been provided with suitable storage facilities for this medication. Medication administration records were satisfactory, however, records for the morning of the inspection had not been signed though medication apparently given. On investigation this was due to a departure from the home’s procedure that morning, as two members of staff had participated in the administration of medicines. Controlled drugs were appropriately stored and records corresponded with stock held. However, it was evident that some staff members who are not appropriately trained witness the administration of controlled drugs. On further investigation, the home’s medication policy for the administration of controlled drugs does not support the National Minimum Standard (9.7) required. When asked whether care staff listen and act on what they say, service users gave favourable responses. Service users spoken to stated that their right to privacy is respected at the home, and that visitors are made welcome and can be seen in private if they wish. The privacy of service users is compromised by the absence of locks to bedroom doors, and by the practice of staff of not always locking bathroom doors when assisting service users with bathing. Badgers Wood Care Home DS0000065307.V295849.R01.S.doc Version 5.2 Page 11 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 The social and recreational options available satisfy the needs of service users. Contact with relatives is supported and the home supports choice for service users. Meals at the home are adequate, though the availability of fresh fruit could be improved. EVIDENCE: A dedicated activities coordinator is available on a part time basis (15 hours). Service users spoken to made favourable comments about the provision of activities at the home. Some service users spoke about undertaking trips into the local community, including a visit to a garden centre and a meal at a local pub. There is a published programme of activities and events that includes an activity within the home on a daily basis, and occasional bigger events or activities, such as the home’s forthcoming summer fete, proms in the garden, a boat trip and pub lunch. Service users who are more confined to (or prefer to remain in) their own bedrooms spoken to stated that the activities coordinator makes time to speak with them, and to find out what their preferred activities are. The home supports choice for service users and control over their lives in many areas. Examples of this include supporting contact with relatives and friends, enabling service users to manage their own affairs and to bring and keep their own possessions with them.
Badgers Wood Care Home DS0000065307.V295849.R01.S.doc Version 5.2 Page 12 The majority of service users spoken to stated that they usually like the meals at the home, and that there is choice available. Comment cards received prior to the inspection indicated that meals are usually or sometimes liked by service users. Meals seen at lunchtime on the day of the inspection were reasonable, though served in modest portions. The teatime menu on offer included soup, sandwiches or a ‘mini mixed grill’. Supper is available if service users request it. The home uses a combination of fresh and frozen produce. Fresh fruit is available to service users who request it. Badgers Wood Care Home DS0000065307.V295849.R01.S.doc Version 5.2 Page 13 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 There are satisfactory arrangements in place to deal with complaints that service users are aware of. Service users are protected from abuse by appropriate policies and training. EVIDENCE: Service users both spoken to at the inspection and those who sent comment cards prior to the inspection indicated that they know how to make a complaint. Those spoken to stated that they felt confident that they would be listened to. The manager keeps a record of complaints, investigation findings and responses to complainants, each of which were satisfactory and provided within 28 days. Records of staff training included training on induction and ongoing training in adult protection. Staff spoken to were aware of basic issues connected with adult protection and were aware of the home’s ‘Whistle blowing’ policy. Badgers Wood Care Home DS0000065307.V295849.R01.S.doc Version 5.2 Page 14 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, 24 & 26 A comfortable and safe standard of accommodation is provided for service users. Further measures are required to support service user privacy. EVIDENCE: The home provides a well-maintained and safe environment; its grounds and gardens are particularly well presented. There was evidence of some internal redecoration to dining areas. A visitors room has been established within one of the dining areas. There remain a significant number of bedrooms that are not lockable. This work should be carried out as soon as possible to support service user privacy as indicated in Standard 10 of this report. Every service user should have access to lockable storage space within their bedroom for money and valuables. Service user bedrooms are evidently personalised, in many cases with service users own possessions and furniture. The home appeared clean and hygienic, with cleaning in progress at the time of the inspection.
Badgers Wood Care Home DS0000065307.V295849.R01.S.doc Version 5.2 Page 15 Badgers Wood Care Home DS0000065307.V295849.R01.S.doc Version 5.2 Page 16 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 Although significantly reduced, there remain concerns about staff recruitment practices that may put service users at risk. There are minimal numbers of staff on duty each afternoon to meet service user need. EVIDENCE: There were forty-two service users accommodated at the home at the time of the inspection. Six care staff were deployed to work during the morning, five staff during the afternoon and four staff from 6pm onwards. The Commission requires that the system operated by the home for calculating staff numbers required is provided. Although there was evidence at the time of the inspection that service users needs were being met, the ratio of care staff to service users from 6pm is of concern. The senior person on duty will also have other responsibilities from 6pm onwards, in particular the administration of medication that further reduces the availability of staff to service users. The care requirements of service users indicated by the home in information provided prior to the inspection states that there are 16 service users who require assistance with dressing/undressing, the same number who require help with washing/bathing, and 9 service users who require help/supervision or prompts to eat meals (which would include supper). There is currently one member of care staff (or 5 of the care staff compliment) at the home who has completed NVQ 2 (or above) training. However, a further 6 staff are currently undertaking NVQ 2 training. The successful completion of this training by these staff will bring the compliment
Badgers Wood Care Home DS0000065307.V295849.R01.S.doc Version 5.2 Page 17 of NVQ 2 trained care staff to 37 . The manager stated that a further group of staff will then be identified to complete the training, which will bring the compliment to over the required 50 of care staff with training to this level. Staff files looked at demonstrated evidence of that service users are not fully protected by good recruitment practices, although evidenced improvement from previous inspection. On this occasion it was evident that written references had not been taken up until after appointment. Staff training records seen provided evidence of appropriate induction and ongoing training for care staff. There are only two care staff who currently hold a first aid certificate. Consequently there is not always a first aider on duty at the home. Badgers Wood Care Home DS0000065307.V295849.R01.S.doc Version 5.2 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): 31, 33, 35, 36, 38 The home is increasingly well managed by a new manager who is well regarded by service users and staff alike. However, there remain management deficits that could compromise the health, safety and welfare of service users. EVIDENCE: The manager has two years management experience and is currently in the process of applying to the Commission to be Registered. The manager stated that she will be undertaking NVQ 4 training shortly before the end of 2006. Both service users and staff spoke in very favourable terms about the manager and the impact she has made on the home since her appointment last year. The home has some processes for ensuring and monitoring of the service it provides. This includes quality assurance questionnaires that cover different aspects of the homes practice, and feedback cards that are promoted by the home. These and other quality assurance processes need to be developed further.
Badgers Wood Care Home DS0000065307.V295849.R01.S.doc Version 5.2 Page 19 Service users financial interests are safeguarded by the home; their relatives manage the vast majority of service users financial affairs. Care staff spoken to stated that they felt they received good supervision from senior staff, and staff files looked at showed evidence of supervision being carried out on a regular basis. The health, safety and welfare of service users are compromised by a number of problems with the homes practices, including, risk assessment, medication practices, and staff recruitment. Badgers Wood Care Home DS0000065307.V295849.R01.S.doc Version 5.2 Page 20 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 2 8 2 9 2 10 2 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 X X X 2 X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 Badgers Wood Care Home DS0000065307.V295849.R01.S.doc Version 5.2 Page 21 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 OP7 Regulation 15(1) Requirement The registered person must prepare written care plans with the involvement of service users. This Requirement Is Repeated The registered person must ensure that appropriate intervention for service users at risk from pressure sores is recorded in individual care plans. This Requirement Is Repeated The registered person must ensure that appropriate intervention for service users identified at risk from falls is recorded in individual care plans. The registered person must ensure that appropriate procedures are followed for the administration of medicines, including controlled medicines. The registered person must ensure the home provides suitable locks to support the privacy of service users. This Requirement Is Repeated The registered person must
DS0000065307.V295849.R01.S.doc Timescale for action 16/05/06 2 OP8 12(1)(a) 16/05/06 3 OP8 12(1)(a) 16/05/06 4 OP9 13(2) 16/05/06 5 OP24 12(4)(a) 30/06/06 6
Badgers Wood Care Home 16(2)(l) 30/06/06
Page 22 Version 5.2 OP24 7 OP27 18(1)(a) 8 OP28 18(1)(a) 9 OP29 19(1)(b)( 1) 10 OP30 18(1)(a) 11 OP33 24 ensure that all service users are provided with a place where money or valuables may be deposited. The registered person must provide the Commission with the system it operates to calculate staff numbers required. The registered person must ensure continued progress toward meeting a minimum ratio of 50 NVQ 2 (or above) trained staff. The registered person must ensure that new staff are confirmed in post only following satisfactory checks set out in Schedule 2 of the Care Homes Regulations 2001. This Requirement Is Repeated For The Second Time The registered person must ensure that persons employed to work at the care home receive training appropriate to the work they perform. The registered person must establish and maintain a system for ensuring the quality of care provided at the home, and supply the Commission a report of any review undertaken. 30/06/06 30/11/06 16/05/06 16/05/06 31/08/06 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 Refer to Standard OP7 Good Practice Recommendations It is recommended that monthly reviews for a service user with cognitive deterioration considers the need for a wider review of their care and health needs (including mental
DS0000065307.V295849.R01.S.doc Version 5.2 Page 23 Badgers Wood Care Home 2 OP15 health), to consider the need for more specialist care. It is recommended that the home consider ways of better promoting the availability of fresh fruit for service users. Badgers Wood Care Home DS0000065307.V295849.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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