Inspection on 19/02/07 for Badgeworth Court Care Centre

This inspection was carried out on 19th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Badgeworth Court Care Centre 30/10/05

Badgeworth Court Care Centre 09/06/05

Badgeworth Court Care Centre 13/12/04

Badgeworth Court Care Centre 07/06/04

Badgeworth Court Care Centre 05/02/04

Badgeworth Court Care Centre 10/03/03

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Badgeworth Court Care Centre Badgeworth Cheltenham Glos GL51 4UL Lead Inspector Mrs Ellie Fox Key Unannounced Inspection 19th February 2007 09:00 X10029.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 Badgeworth Court Care Centre DS0000016377.V325677.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 and Care Homes for Adults 18 – 65*. 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. Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Badgeworth Court Care Centre Address Badgeworth Cheltenham Glos GL51 4UL 01452 715015 01452 859985 badgewartharchester.com www.barchester.com/oulton Barchester Healthcare Homes Limited 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 Teresa Anne Berry Care Home 64 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (25), of places Physical disability (15) Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A Registered Nurse on Parts 3 or 13 of the NMC Register and in possession of an ENB N.11 Care of People with a Dementing Illness Certificate, or equivalent, must be in day-to-day control of the unit. The minimum qualification of other Registered Nurses shall be Registration on Part 2 or 4 of the NMC Register To accommodate a named service user under the age of 65 in the Dementia Care Unit. This condition will be removed when the service user no longer resides at the home. To accommodate one named service user under 65 years of age in the Dementia Unit This condition will be removed when the service user no longer resides at the home. 30th October 2005 2. 3. Date of last inspection Brief Description of the Service: Badgeworth Court is a grade two listed building, which has been restored and renovated to include a modern wing. It is owned and managed by Barchester Health Care Homes Ltd. The house is set in eighteen acres of formal gardens and is situated on Badgeworth Green, next to the church. The M5 motorway and Cheltenham town centre are only a few kilometres away. The accommodation is arranged on two floors accessed by two shaft lifts. All bedrooms have en-suite facilities and only four bedrooms are for double occupancy. There are a variety of communal rooms. The home comprises four units, • DeClare unit providing nursing care for older people • Norwood providing nursing care for older people with dementia • Selwyn Payne providing personal care for older people with dementia • Conynghame providing nursing care to adults aged 18 to 65, with physical disabilities. Information about the home is available in the Service User Guide, which is issued to prospective residents, and a copy of the most recent CSCI report is available in the home for anyone to read. The charges for Badgeworth Court range from £650.00 to £820.00 per week. Hairdressing, Chiropody, Newspapers, Guest meals and Aromatherapy are charged at individual extra costs. Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Two inspectors carried out this inspection over two days in February 2007. A check was made against the requirements that were issued following the last inspection, in order to establish whether the home had ensured compliance in the relevant areas. Care records were inspected, with the care of eight residents being closely looked at in particular. The management of residents’ medications was inspected. A selection of residents were spoken to directly in order to gauge their views and experiences of the services and care provided at Badgeworth Court. A number of staff were also interviewed. Survey forms were also issued to a number of residents, visitors and staff to complete and return to CSCI if they wished. Twenty-four residents, twentyfour relatives, and eleven members of staff returned their completed surveys; some of their comments are featured in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, training and provision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. What the service does well: Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 6 Badgeworth Court provides a homely safe and well-maintained environment for the residents living there. It offers a welcoming and inclusive atmosphere for visitors. Residents living at the home are treated with courtesy and friendly respect. Many of those people who responded to the questionnaires made positive comments about the staff with one person saying, “The staff are getting to know me well. They are sensitive and respectful”. Respect for residents’ personal choices and preferences was evident throughout. The home is to be commended for the good working relationships, which have been developed between the staff and the residents and their families. People living in the home are given the opportunity to take part in an excellent variety of activities; these have been designed to address their various interests and social needs. A very good standard and variety of food is served in this home. Any complaints or concerns are addressed promptly and, if required, full investigations are undertaken. Employees have the opportunity to attend training appropriate to their work, which includes a good focus on the national vocational training and protection of vulnerable adults. The home has the benefit of strong leadership and committed focussed management. Health and safety, with fire prevention in particular, is addressed well. There is also a good focus on improving the quality of care provided to residents at the home. What has improved since the last inspection? Each prospective resident is now fully assessed before admission to Badgeworth Court is arranged, ensuring that the home is able to meet all his or her care needs. Although the home is in the process of introducing alternative care planning documentation, staff throughout the home are now provided with clearly detailed guidance on the care required by each person; this is normally reviewed and updated in a timely fashion. Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 7 Improvements have been introduced in some of the medication administration processes and storage systems in use at the home, however further work is still required as reported below. Selected areas of the home have been refurbished and decorated during the past year, and maintenance repairs both internally and externally have been undertaken. New flooring has also been provided where necessary. Selected records and policies have been reviewed and updated to ensure that the information provided is current and contains all the required details. Adjustments have been made to the staffing allocations to ensure that an adequate number of personnel are on duty to address all the residents’ needs. 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. The summary of this inspection report can be made available in other formats on request. Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Older People) and 2 (Adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments are carried out on all prospective residents, so that they can be assured prior to admission that the home can meet their needs. EVIDENCE: In each of the eight care records which were inspected as part of the case tracking exercise there were fully completed assessments that identified each individual’s care and social needs prior to admission to the home. In some cases these were supported by information provided by other health and social care professionals previously involved in the care of the individual. Badgeworth Court does not provide intermediate care. Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 &10 (Older People) and 6, 9, 16, 18, 19 & 20 (Adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a comprehensive care planning system in place, which provides staff with detailed information to satisfactorily meet residents’ health, personal and social needs. The systems for managing medications are generally good, with certain exceptions seen to the recognised safeguards in place for residents. Residents are treated with courtesy and respect. Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 11 EVIDENCE: All residents in each of the four units have their own personal plan of care. Eight plans (two from each unit), were selected for a case tracking exercise, and were scrutinised in closer detail. Conynghame Unit: Each of these care plans was directly linked to an assessment of needs, which incorporated health, personal and social issues. Plans were fully detailed, providing clear guidance to staff when caring for the individual. There was clear evidence that due regard should be shown towards individuals’ dignity, choices and preferences, and levels of independence. Documentation demonstrated that the residents concerned were empowered in terms of their autonomy and control over their daily lives. DeClare, Selwyn Payne and Norwood Units: Care plans have been regularly reviewed and updated as necessary. They are personalised, and are reflective of individuals’ choices and levels of independence. Care plans are directly linked to assessments, including risk assessments where applicable; these included moving and handling, falls, nutritional and pressure sore risk assessments. Where relevant, wound care plans were detailed, with wound monitoring charts in progress. Appropriate measures and equipment were in place to support residents as identified on assessment. Care was being delivered in accordance with the care plans, and when interviewed, staff were able to demonstrate their understanding and awareness of individuals’ needs and their planned care. Although one resident’s representative expressed some concern in this regard, there was very good evidence of multidisciplinary working between each of the units and other health care services, with residents afforded regular medical reviews and consultations, and access to a range of health care services, either in the community or in the home. Residents have the benefit of physiotherapy exercises on a regular basis, with physiotherapy assistants employed in the home. A residents in Conynghame Unit in particular, appreciated this, saying that she enjoyed her ‘physio’ very much. Residents themselves were overwhelmingly positive regarding the way in which they were looked after at Badgeworth Court. Each confirmed that staff were caring and kind. One particular resident said that ‘they always make time Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 12 for me, and are always smiling – it means a lot’. A resident in Conynghame unit said that staff had ‘got to know her and her needs very well’. Visitors and relatives were also very happy with the care their relative was receiving. Comments received included, ‘staff show empathy and warmth towards the residents’, and ‘I have complete peace of mind here’. Residents are able to manage their own medications if they wish and are able, and this is done on the basis of a documented risk assessment process. Those currently doing this have safe storage in their rooms. Each of the four units had its own designated medication storage, with associated documentation. Storage was secure, clean and well organised in each unit. Items requiring cold storage were stored in designated refrigerators; temperatures were monitored and recorded regularly. Controlled Drug (CD) storage was provided in DeClare, Norwood and Conynghame units. In order to comply with The Misuse of Drugs (Safe Custody) Regulations 1973 the CD cupboards must be rag/rawl bolted, through two pre-drilled holes in the reinforcing plate at the back of the cupboard, to a solid wall. Each was mounted on a plaster board wall, which is insufficient to mount a CD cupboard in accordance with regulations. The medication cupboard temperature in DeClare Unit was 27 degrees centigrade and in Selwyn Payne Unit was 25.5 degrees centigrade. As these temperatures exceed those which are required for medication storage, the manager acknowledged the need to address this with all due urgency, and indicated the home’s intention to install air conditioning in these areas. Medication administration charts were printed by the supplying pharmacist. In each of the four units there were numerous examples of inadequately recorded directions for the administration of certain drugs. The use of ‘as directed’ was seen repeatedly with no clear instructions for usage available; this was particularly evident in relation to the use of external creams. When interviewed, staff were well informed on the usage of such items however. Other medications prescribed to be given at set times had not been administered, with no recorded reason for the omission. There were examples in Conynghame Unit, in particular, of discontinued items remaining on the medication chart. There was also an example where the prescribed instruction was different from that which was on the pharmacy label. In Selwyn Payne Unit eye drops had been prescribed, ‘several times a day’, with no clearer direction for use recorded. A number of boxed and bottled items had been dated on opening, however this was inconsistent, particularly in Conynghame and Selwyn Payne Units, making auditing arrangements problematic. Four medication audits were carried out and in two cases a slight discrepancy was identified. Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 13 The method of administration of medications in Selwyn Payne Unit involved staff decanting prescribed items into small pots and taking them directly to the resident. This particular practice is not considered to be the most appropriate or safe, and should be reviewed. Staff said that they adopted this method for just one resident at a time. Staff were consistently observed being polite, courteous and sensitive in their approaches to residents. Care was delivered discreetly in the privacy of individual’s bedrooms and bathrooms. At least one resident had elected to keep his room locked when he was not in there. Care planning, the home’s policies, and staff training direct them towards respecting residents’ privacy and dignity at all times. Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 (Older People) and 12, 13, 15 and 17 (Adults 18-65) Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Good opportunities are provided for varied and stimulating activities to occupy the residents and thus improve their quality of life. Residents are facilitated to maintain any links they wish with family, friends and the local community, thus adding interest to their lives through social contact. The meals are nutritious and balanced, offering a good choice and variety to the residents. Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 15 EVIDENCE: The home employs three activities organisers to address the needs of the disparate group of residents at the home. An assessment is undertaken of each person and the staff then aim to address his or her respective wishes and needs. An innovative plan of activities has been arranged, including trips out and the provision of entertainers. Some of the residents were clearly enjoying the Chinese New Year celebrations and photographs showed that they had also celebrated ‘Burns Night’ and ‘Valentines Day’ recently. Four ladies commented on how much they enjoyed these events. Staff were observed undertaking one to one activities with some of the residents; others were involved in a creative activity in one of the lounges. Those people who did not wish to be involved in group activities pursued their own particular interests in their bedrooms or in one of the alternative communal rooms. One resident in Selwyn Payne Unit was fully supported to assist with a light domestic chore, which she clearly wished to do and very much enjoyed. Families and friends are welcomed into the home and the Badgeworth Court Newsletter, ‘The Badgeworth Times’, is provided to visitors to ensure that everyone is fully aware of any planned events or specific news. Responses on resident surveys were all very positive, with comments received such as, ‘The home keeps me in touch with calendar dates and special occasions’. A visitor commented that their relative had shown signs of improvement due to the stimulation and company at the home, which showed due regard to their choices. Residents go out with friends and family when possible. Residents, who spoke to the inspectors, confirmed that they were able to get up and retire when they wished and that they were free to eat their meals and spend their days where they preferred. Residents living in Conynghame Unit sometimes choose to have a ‘take-away’ meal for a change. Individual choices were evident in residents bedrooms, as many had been personalised with the occupants’ treasured possessions. The service of the mid day meal was observed on this visit. The majority of residents sat in one of the dining rooms with a few preferring to remain in their bedrooms. Although the meal had a Chinese theme, the people living in the home were provided with a choice of menu and some residents preferred to have an omelette or other alternative. Some of the staff also ate with the residents, ensuring that the meal was a convivial occasion. One person who needed full assistance to eat her food was observed. This task was completed in a sensitive and considerate fashion; the carer talked quietly Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 16 and encouragingly to the lady and ensured that she ate as much as she wished. Everyone was given the chance to eat their meal in a relaxed unhurried manner. On occasions a finger buffet is provided for residents living in the dementia care units as an additional means of addressing their particular dietary needs. Since the last inspection arrangements have been made for catering staff to deliver the meals to Selwyn Payne Unit, so that the unit care staff may remain with the residents. The majority of those questioned enjoyed the food served; two residents spoken to directly felt that the food could be of a variable standard. The kitchen was seen during the lunch time preparations. Although clearly very busy, it was well organised. The Chef was well informed about the needs of the residents, and had records of individuals preferences, special diets and choices. The kitchen area and storage was clean, with all appropriate catering records well maintained. Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 (Older People) 22 and 23 (Adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints system enables residents and their families to feel assured that their views would be listened to and acted upon. Residents are afforded a good level of protection against abuse. EVIDENCE: A comprehensive Complaints Procedure has been prepared for Badgeworth Court; this has been reviewed and updated since the last inspection. A copy of the document is provided to each prospective resident and/or relatives with other information about the home. The details are also displayed prominently within the home. There have been seven formal complaints about services at Badgeworth Court since the last inspection. All had been addressed promptly, fully investigated and, where necessary, remedial action taken. Completed surveys returned from residents at the home indicated that staff are receptive to concerns and “respond positively”. Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 18 The home provides fully documented policies to address all forms of abuse. The policies are readily available for staff to read. Abuse issues are covered in the Induction Training Programme, which each newly appointed member of staff attends. The home’s in house trainer has also provided detailed mandatory training on the subject to all grades of staff; it was observed that there was a certificate displayed in the Maintenance Manager’s office to indicate that he had attended the course. Information on sourcing advocacy support is provided if the residents require this facility. POVA (Protection of Vulnerable Adults) legislation is correctly followed at Badgeworth Court. Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 (Older People) and 24 and 30 (Adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home is designed, furnished and maintained to suit the special needs of the residents living there. Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 20 EVIDENCE: Badgeworth Court provides accommodation in an old style character filled property, which has been extended to provide good standard, purpose built care facilities in additional wings, catering for a diversity of needs. All areas are light, accessible and well maintained. A committed maintenance team is employed at the home, and meticulous maintenance and safety checks are carried out, with thorough and detailed records kept. Since the last inspection a number of adjustable beds and hoists have been provided. Many areas have been redecorated, and new flooring provided in places. Redecoration in the dementia care units has been sensitively completed, to assist with the orientation needs of the residents living there. The heating system has been upgraded, with new replacement radiators installed where required. One lounge has been refurbished. Major repairs have been undertaken to the roof, and air conditioning has been installed in two of the units. Two new washing machines have also been purchased. The gardens are currently being upgraded to provide a potting shed, a greenhouse and sensory garden for the residents’ use. This area is also being made fully secure so that people living in the home can use it safely. The home is clean, and the air was fresh in the main areas of the home. However, there were significant offensive odours detected in Selwyn Payne Unit, which had not dispersed when the unit was re-visited later in the inspection. There are good infection control measures here, with liquid soap, paper hand towels, hand sanitising gels, gloves and aprons widely available. Clinical waste is safely managed. The laundry room is well organised, and washing machines are capable of disinfecting any foul laundry. The laundry assistant was conversant in the proper infection control procedures for the laundry. Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 (Older People) and 32, 34 and 35 (Adults 18-65) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive care from a competent workforce but improved recruitment would help to ensure residents are fully protected. EVIDENCE: On this occasion there were sixty-one residents living in the home. Rotas for each unit were checked and showed that there were: • Two carers on duty until 12 midnight with one person on duty over night to care for the ten residents in Selwyn Payne • Two nurses and four carers to look after the twenty-five residents in DeClare, with two nurses and two carers in the evening and a nurse and two carers overnight Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 22 • • One nurse and four carers throughout the day to care for the thirteen people accommodated in Conynghame; a nurse and two carers covered the night shift One nurse and three carers on all three shifts to care for the twelve residents in Norwood. The residents from all four units were also receiving treatment from two physiotherapy assistants on four mornings a week. The home employs three people to provide activities for the home. The manager and the head of care were both working in a supernumerary capacity. There were also two members of staff covering administrative duties. Two chefs and two kitchen assistants were on duty throughout the day to cover catering requirements; there was also an additional kitchen assistant from five pm until eight pm. Five members of staff covered cleaning and housekeeping duties on the day of the inspection. There were also three maintenance staff on duty. The majority of people who responded to the questionnaires felt that there was normally an adequate number of staff on duty to care for the residents although there were a few isolated comments that the home is sometimes short of staff. Records showed that there is a commendable focus on National Vocational Qualification (NVQ) training at Badgeworth Court, with the home well exceeding the expectation that at least 50 of staff should be trained to NVQ, Level 2 or equivalent. On this occasion the personnel files relating to eight members of staff who had been recruited in recent months were inspected. In each instance, the prospective employee had completed an application form providing details of his or her employment history; medical information had also been provided. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person. Two written references had been provided for the majority of applicants but in one isolated case, two written references had not been obtained prior to the commencement of employment, as is required. This issue is now being rectified. It is acknowledged that this employee had worked at the home on a previous occasion and was well known to the staff. Staff at this home are provided with the opportunity to attend a commendable amount of appropriate training to assist them to undertake their duties effectively. The home has the benefit of dedicated trainer on site who keeps careful records, ensuring that all mandatory training is provided in a timely fashion. New staff receive structured induction training in line with the Common Induction Standards, and work under supervision during this period. Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 (Older People) and 37, 39 and 42 (Adults 18-65) Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Robust management systems ensure that the financial interests, and the health, safety and welfare of people using the service are safeguarded. Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 24 There is also evident commitment in the Home to improve the services for the benefit of the residents living there. EVIDENCE: The manager, a trained nurse, is well experienced in the care of older people. She has also undertaken additional management training and is well supported in her role by the senior staff team at Badgeworth Court. The home has the benefit of strong leadership and committed focussed management. In addition to the manager there is a designated Head of Care, and each unit has a lead practitioner who is appropriately trained to care for the residents in her unit. There are a number of quality improvement measures undertaken at this home. A residents/relatives satisfaction survey was circulated in December 2006; once the results of this survey have been collated corporately, an action plan will be prepared to address any issues identified. Health and safety, medication administration, infection control, personal care, dementia care, activities and customer service, home environment, nutrition and dining, and management of pressure sores are all monitored closely in the home with completed reports on the assessed performance produced once a month. Senior managers from Barchester Healthcare also audit the home’s performance on a monthly basis. Badgeworth Court was awarded the Company’s 5 Star dining award in 2006. The home takes responsibility for the personal monies for the majority of the residents; the records relating to five residents selected for case tracking were checked on this occasion. It was observed that meticulous records are maintained and that individual secure storage is provided. Residents’ status in relation to ‘Power of Attorney’ is also maintained on file. Records were provided to show that statutory maintenance/inspection of equipment and services is arranged in a timely fashion. Where faults are identified, they are rectified as necessary. Water temperatures are checked at outlets on a monthly basis; in recent months these have remained within safe levels. Fire prevention management and training of staff appears to be addressed extremely well at this home. Records showed that fire drills and training had been undertaken on a very regular basis to incorporate all grades of staff. One member of staff showed that she had a clear understanding of her responsibilities if the fire bells were activated. Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 25 All nursing staff have received First Aid training. An Environmental Health inspection took place in May 2006; issues highlighted for improvement have now been corrected. The building was safe and secure throughout, with coded door entries in higher risk areas and the dementia care units. Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 26 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 x 2 x 3 3 4 x 5 x 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 ENVIRONMENT Standard No Score 19 3 20 x 21 x 22 x 23 x 24 x 25 x 26 2 STAFFING Standard No Score 27 3 28 4 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No Score 31 4 32 x 33 3 34 x 35 3 36 x 37 x 38 4 Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 27 NO 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 OP9 Regulation 13(2) Requirement Timescale for action 31/05/07 2 OP9 13(2) The registered manager must ensure that a review is undertaken of the Controlled Drug storage in DeClare, Norwood and Conynghame Units, in order that each complies with The Misuse of Drugs (Safe Custody) regulations 1973. 31/03/07 The registered manager must ensure that: • The use of ‘as directed’ and ‘several times a day’ instructions on medication administration charts does not continue, and that concise instructions for use of all items are recorded • When medication dosages are omitted, staff record a reason for it, so that it is clear that medications have been addressed in strict accordance with prescribed orders, and to avoid the risk of errors • Prescribed instructions on medication administration charts correspond directly with those indicated on the associated pharmacy DS0000016377.V325677.R01.S.doc Version 5.2 Badgeworth Court Care Centre Page 28 3 OP26 16(2k) labels, so that correct dosages are administered. The registered manager must ensure that Selwyn Payne Unit is maintained free of offensive odours. 31/03/07 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 The registered manager should ensure that: • All boxed medication items are dated when opened, so as to assist with auditing purposes • The medication administration procedures are reviewed in Selwyn Payne Unit. Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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. Badgeworth Court Care Centre DS0000016377.V325677.R01.S.doc Version 5.2 Page 30 - 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. 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