Inspection on 30/10/05 for Badgeworth Court Care Centre

This inspection was carried out on 30th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Badgeworth Court Care Centre 19/02/07

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 5UL Lead Inspector Mrs Kate Silvey Unannounced Inspection 30th November 2005 10:00 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.V269250.R02.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 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.V269250.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Badgeworth Court Care Centre Address Badgeworth Cheltenham Glos GL51 5UL 01452 715015 01452 859985 badgewartharchester.com 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) Barchester Healthcare Homes Limited Mrs Teresa Anne Berry Care Home 65 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (27), of places Physical disability (14) Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 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. Date of last inspection 9 June 2005 2. Brief Description of the Service. Badgeworth Court is a grade two listed building, which has been restored and renovated to include a modern wing. 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 ensuite facilities and only four bedrooms are for double occupancy. There are a variety of communal rooms. The home provides care for older people, and has two units to care for people with dementia. One dementia unit has recently opened and cares for service users who have nursing care needs. There are twelve places in each dementia unit. There are 27 places in the home for older people and 14 places for younger adults with a physical disability in a defined area of the home with a separate lounge, café and dining room. Badgeworth Court Care Centre DS0000016377.V269250.R02.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 completed by two inspectors over 6 hours. Thirteen Standards were fully inspected at this second inspection of the year to complete the key standards. These included pre-admission assessment, care planning, management of medication, the protection of service users from abuse, recruitment, the environment and the quality of food provided, to include observation during lunchtime activity. All four units were inspected Selwyn Payne (residential dementia care), Norwood (nursing dementia care). DeClare (older persons unit), and Conyghame (younger adults unit). Service users, visitors and staff were spoken to during the inspection. The administrator, the maintenance man, the activities coordinator, a physiotherapy assistant and the head chef were also spoken to and helped with the inspection process. The registered manager commented on the draft report and minor amendments were made, taking them into consideration, before the report was finalised. A copy of the comments are available from the Commission on request. What the service does well: Some complete and well recorded pre-admission assessments were seen, which enable the staff to identify the service users needs and prepare for their admission. Care in all the units is offered in such a way to promote the privacy and dignity of the service users. Service users spoken to were pleased with the staff in the home and the care they received. Care staff actively promote contact with relatives and visitors in the interests of service users. Catering services are well managed in the home and the service users have varied, nutritious, well presented meals in pleasant surroundings, and are supported by care staff in an unhurried and appropriate manner. The service users spoken to were very pleased with the high standard of food provided in the home. The home is maintained to a good standard and the service users appreciate the clean, comfortable and malodour free environment. The manager operates a robust recruitment system that protects service uses and staff in the home. Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 Page 6 Service users are able to communicate their wishes and preferences by way of the homes regular service users meetings, and evidence was seen of care staff consulting them during the day. The well organised activities benefit all the service users and two carers were able to take a service user on holiday to Weymouth this year. What has improved since the last inspection? 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. Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 Page 7 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.V269250.R02.S.doc Version 5.0 Page 8 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 to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 DeClare The staff complete a detailed pre-admission assessments, which ensures that the home can meet the service users needs before they arrive. Selwyn Payne Unit The admission procedure is variable and evidence was not easily located to ensure all service users had been admitted following a full assessment of their needs. Norwood The admission procedure ensures that service users are admitted to the unit on the basis of a full assessment of their needs, ensuring that they receive the care they require. EVIDENCE: Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 Page 9 DeClare A pre-admission assessment for a service user yet to be admitted to the home was seen. The record was very detailed and identified the problems, equipment required and the family involvement. The senior nurse on DeClare stated that the record was used initially to prepare the care plan. Selwyn Payne A number of care files were examined with mixed results. Some of these contained pre-admission assessments, there were different types of assessment formats used and the inspector was unable to locate three. Subsequently the registered manager wrote to say that the assessments were there but as two care plans for an individual were being used in some instances there was some confusion. The Head of Care has apologised for the muddle of the care plans on the day of the inspection and assures the Commission that there has been considerably progress and all have been completed by the end of December. Norwood Comprehensive pre-admission assessments had been completed and recorded for service users admitted to this unit. Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 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 to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 7,9,10 DeClare and Conninghame units were providing good care to the service users and generally the records supported their actions. Service users and relatives spoken to were satisfied with the privacy and dignity of the home and the good standard of care provided. Conyghame The management of medication was generally well organised, however, there were some shortfalls which could put service users at risk. Selwyn Payne Care plans in this unit were incomplete, potentially compromising the staff in meeting service user’s needs. Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 Page 11 There were shortfalls in the storage and ordering of medication that could place service users at risk. Care is offered in such a way as to promote the privacy and dignity of service users. Norwood Care plans in this unit were good providing clear information for staff in meeting service user’s needs. EVIDENCE: DeClare The unit accommodates 24 service users and there were three care staff, one nurse and a supernumerary adaptation nurse on duty. The new senior staff nurse had been involved in the recent care staff review. by completing a record of all care provided by the staff and how long procedures take each day. The new senior staff nurse on the unit was interviewed and was keen to implement a new care plan system, which the registered manager and the head of care had both agreed on. Three care plans were seen and two were case tracked to ensure complete care and medication was appropriate. The plans had eleven generic care plans for each service user, however all the actions recorded were individual to each service user, additional plans were added as required. The eleven generic plans were Communication, Personal Hygiene, Continence, Nutrition, Manual Handling, Falls and Mobility, tissue viability, Pain, Sleep, Activities and Death and Dying. Any records from healthcare professionals allied to the care plans were stored together giving a clear picture of events and outcomes. An example seen was a letter from the SALT (Speech and Language Therapy) unit. The actions seen were detailed and specific to the individual, reviews in the new system were soon to be completed and it was recommended that the unit continue with writing a formal review comment every month. Personal histories and other care records were well recorded and up to date. Weight records were not recorded regularly and this was due to the scales not working for a while. Healthcare professional visits to support service users were well recorded. Risk assessments were recorded well and reviewed and accidents records were complete. Daily records were informative and addressed the care plan issues. Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 Page 12 A burn wound care record was seen. The PCT tissue viability nurse had visited recently to support the care staff and will return in three weeks. A Polaroid picture was to be taken on the day of the inspection to compare with a hospital picture. Wound care was recorded at every dressing and the wound was described. The description could be more detailed, the chronic wound had showed little improvement so far. A change of position chart was used to ensure that tissue viability was promoted. Suitable equipment was in use to prevent pressure sores. Service users and staff spoken to were content with the staff and said they were treated with dignity and respect. One relative said that there is sometimes a shortage of care staff at the weekends. Conyghame The staff nurse in charge helped with the inspection process and was available during the inspection. Thirteen service users were accommodated. There were three care staff on duty and one nurse. The unit had been short staffed during the morning as normally there are four carers. Every effort had been made to fill the position, without success. The nurse in charge stated that the care staff on duty had been well trained to care for the service users and were experienced, and therefore the morning care had been managed well. Two care plans were seen and all service users were seen, some were able to talk to the inspector about their life in the unit, however, many were unable to communicate and required total care. The care plans were well written with detailed actions, which included a daily record for each problem. Risk assessments were recorded. The service users who required total care had no record of position change. It is essential that care records are maintained when pressure relieving equipment is used and staff do change position. It was evident that healthcare professional support is provided for the service users here as some have many and complex needs. The hospital Multiple Sclerosis nurse and the consultant neurologist had recently seen one service user. Oxygen therapy was being reviewed with the neurologist for one service user in the hope of reducing it. A care review meeting is held every three months to ensure all appropriate agencies are involved and the care is progressing. Recording service users weight was also a problem here as units share the scales that were in need of repair. Medication management was inspected on Conyghame. The nursing staff administer all medication, there were no service users self-medicating. Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 Page 13 The storage was secure clean, well organised and the stock levels were appropriate. A box of rectal diazepam 10mgs should be returned, as it was not in use. All liquid medication had been dated when opened. The medication stored in the fridge in the office was not secure and must be kept locked at all times. Controlled drugs were stored in another unit, which means the nurse in charge have to access it through secure doors and leave the unit. This is unacceptable and the unit must have a controlled drugs cabinet and their own record book. All medication is signed in on arrival and the amount entered on the Medication Administration Record (MAR sheet). Medication is returned to the pharmacy and recorded in a book, which could not be located and it was assumed by the nurse that it was on the adjacent unit Norwood. The home had a medication procedure and a monitored dosage procedure, which was kept with the medication. The record looked worn and dirty and should be replaced. It was recommended that the home has the latest Royal Pharmaceutical guidance in all units, which can be copied from the internet. A March 2005 British National Formulary was in use. The medication is administered using a monitored dosage system, a random check completed was correct. Administration records were generally well recorded. However, there was an error regarding the recording of Rectal Diazepam and there was conflict in the individual protocol for administration in the care plan. This must be clear and it is recommended that the protocol is kept with the administration record. Homely remedies used were recorded appropriately with the doctor’s approval. The nurse in charge stated that all nurses do an administration of medication update every year. The supplying pharmacist completes a three monthly check of the medication and the doctor who visits the home regularly review service users medication needs. Service users spoke highly of the care staff and of the care they received. However, some would like more television channels to watch, and to go out on short trips more often. Selwyn Payne A number of care plans were examined, with some of them there was confusion between the aims of the care plans and the actions that staff needed to carry out to meet the service users needs. There was also a need for more actions on some care plans to guide staff in the service users care. In one case a service user who suffered with epilepsy had no care plans, and another who had continence problems had no care plan to address this need. Some service users only had care plans for sleeping although assessments indicated other needs. Where care plans did exist the person writing the plan did not sign them. Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 Page 14 Although medication was stored safely there were some issues regarding storage temperatures. A record of temperatures for medication stored in a refrigerator had been made although on occasions the record indicated that the temperature was too high. In addition there was no record of the storage temperatures in the medication cupboard. Liquid medications had not been dated on opening. One service user who required pain-relieving medication had not had this administered for several days due to delays in the supply of the medication. Where medication was prescribed on ‘as required’ basis there were no care plans to assist staff with this. Service users were cared for in a way in which their privacy and dignity was respected. Norwood Service users in this unit had individualised care plans based on a full assessment of their needs. The care plans had been reviewed on a monthly basis. Medication was stored correctly and storage temperatures were measured and recorded. It was noted that liquid medications were dated on opening. Medication administration had been recorded accurately although this was not the case for the administration of topical applications such as creams. Where medication was prescribed on an ‘as required’ basis there were care plans to guide staff in administration. Care was provided in a way that promoted the privacy and dignity of service users. Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,15 All units actively promote contact with relatives and visitors in the interests of service users. DeClare and Conyghame Catering services are well managed in the home and the service users have varied, nutritious, well presented meals in pleasant surroundings supported by care staff in an unhurried and appropriate manner. Selwyn Payne and Norwood The dietary needs of service users are well catered for with a balanced and varied selection of meals available to suit service users needs and choices. Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 Page 16 EVIDENCE: DeClare and Conyghame Two visitors were seen and spoken to and other visitors were seen around the home with the service users. The activities coordinator tries to ensure that service users enjoy the local community. Shopping trips to Cheltenham and local garden centres are organised regularly. A boat trip was enjoyed on the Gloucester- Sharpness canal this year. A person provides art therapy from the local community, and the service users enjoy regular Holy Communion from the local rector. Service users are also taken to Badgeworth church if they prefer. The service users from DeClare and Conyghame were spoken to at lunchtime. Service users who required feeding had the individual attention of a carer and were aided in an appropriate an unhurried manner in very pleasant surroundings. The care staff see this time with the service users as a valuable time of communication and individual company for them to enjoy and for this reason a leisurely pace is always adopted. Some service users have an alcoholic drink with their meals provide by the home. Most service users enjoy a drink of fruit squash or water. Fortified complementary food drinks were available for service users who may need additional nourishment. The menus seen were varied and nutritious and the three course lunch was served well and looked appetising. The home presents an attractive desert trolley at every meal. All service users spoken to were very pleased with the food provided. The head chef was spoken to and had recently passed an intermediate food hygiene course completed over three days. The head chef stated that there were sufficient catering staff who Barchester were training to a recognised standard. The Environmental Health Officers report was seen and all the requirements had been completed including repair of the kitchen floor. The head chef stated that there were no outstanding items required for the kitchen and catering facilities. Special diabetics diets are catered for, and four diabetic deserts are provided daily for the service users to chose from. Care staff can access the kitchen at any time when catering staff are unavailable for service users who may require food at any time. Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 Page 17 The issue of care staff from Selwyn Payne collecting meals and food leaving only one member of staff in the unit at a time when service users may require help to get ready for meals was discussed. The head chef agreed that the catering staff could deliver meals to the unit when required. Selwyn Payne Care files gave plenty of evidence of service users contact with relatives. In addition the unit has a system for forwarding messages received via E-mail to service users. Norwood Service users were receiving visitors and it was reported that some visitors maintain contact with relatives through the telephone when they do not live within reach of the home. During the year several events are planned in the home that relatives of service users are invited to, such as a summer barbecue and a harvest supper. Both dementia care units assess service users dietary needs and draft care plans where required. A range of varied and nutritious meals are available for service users. Choice was seen to be respected when one service user disliked the meal provided and an alternative was immediately provided. Staff were seen to be attentive to service users needs during lunchtime, reminding them of the content of the meal. Service users spoke positively about the meals offered. Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17,18 Conyghame The staff had been well trained in identifying and reporting abuse, however the procedure should be modified to contain all information required to ensure the support and protection of the service users and care staff. Norwood There was good awareness of adult protection issues in order to protect service users from abuse. EVIDENCE: It was evident that the registered manger had recently given a copy of the complaints procedure to all the service users and their representatives in the home. This will ensure that they know who to go to with any concerns or complaints. Conyghame Risk assessments were recorded in the service users care plans and care staff on Conninghame stated that service user self-harm would have been highlighted when required and the necessary actions implemented. Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 Page 19 The abuse policy was seen on Conyghame, which was clear but did not mention contacting the local Adults at Risk Team or informing the Commission under regulation 37 requirements. However, it stated that Social Services would be contacted, which was unclear whether it was the ‘contracting’ staff or duty officer. All the staff on Conyghame had received Protection of Vulnerable Adults from Abuse training in July 2005, which comprised of three sessions. The comprehensive training sessions included ‘whistle blowing.’ Norwood It was reported that all staff had received a training session on abuse and there was an awareness of the home’s whistle blowing policy. There was a copy of a locally produced ‘Alerter’s Guide’ in the office, which gives information about adult protection issues. Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,26 DeClare and Conyghame The home is maintained to a good standard and service users appreciate the clean and free from odour environment. Selwyn Payne and Norwood The standard of the environment in this unit is good providing service users with an attractive and generally clean place to live. In both units more could be done to adapt the environment for the needs of service users with dementia. Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 Page 21 EVIDENCE: The home has a rolling programme of maintenance and a daily log is kept by the care staff on each unit of the items that require attention. The homes maintenance team check the logs regularly and ensure that items are rarely outstanding each day. DeClare and Conyghame were well maintained and comfortable with a high standard of décor and furniture provided. No health and safety issues were noted. The units were clean and mainly free from offensive odour. DeClare unit had one room that was odorous, which the care staff thought was temporarily due to circumstances during the day. The domestic staff were seen on both floors and the use of coloured bins for the laundry sorting was evident. The laundry room was secure to prevent unauthorised access and to promote infection control. Selwyn Payne Some minor maintenance issues were noted involving light fittings. These were reported to the maintenance manager on the day and he later reported that the problems had been rectified. One of the bathroom doors was badly scratched and in need of repainting. The unit was clean with the exception of the carpet in the lounge, which required cleaning. Norwood The unit was clean and well maintained. Both dementia units could benefit from some consideration of environmental adaptations for service users with dementia such as coloured doors and pictorial signage for toilets and bathrooms. Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 Selwyn Payne There are times when the lack of staff in the unit may compromise the ability of the remaining staff to meet service users needs. The skill mix appears incomplete in this unit and an appropriately qualified and competent person is required to be in day-to-day control. All units The home operates a robust recruitment system that protects all the vulnerable service users accommodated. EVIDENCE: Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 Page 23 Standard 27 was looked at during the last inspection and the registered manager had identified extra staff for Conninghame in the required staffing review. Selwyn Payne During this inspection a shortfall was identified in Selwyn Payne, and the care plans remain poor. It is obvious that the nursing staff from the dementia nursing unit are not looking at the care plans regularly as reported to the inspector at the last inspection. The minimum requirement for a person managing a residential dementia unit would be the equivalent of an NVQ level 3 in dementia care. The home is specialising in dementia care and it does not appear that the residential unit has the benefit of a competent person in day-to-day control. This situation cannot continue or service users will be at risk. The registered manager must look at the skill mix in the unit and appoint an individual that can effectively implement the required actions to ensure the service users needs are met. The unit was staffed by two care staff and a cleaner, although a cleaner was not in the unit during the inspection. At night there is one member of care staff. Care staff told the inspector that only one member of staff is on the unit during the time that staff take their breaks during the day. A ‘twilight’ carer is sometimes provided to assist during the evening although this is variable. No extra staff are provided at mealtimes. Recruitment (All units) Two new care staff recruitment records were looked at, both were from overseas, one from China and one from Romania. The home operates a robust recruitment, which included the translation of references sent in other languages. Staff have a week long induction before commencing work and are supervised for 3-4 weeks, all POVAFirst checks and Criminal Record Bureaux checks were complete. Previous training certificates were on file and a complete employment history. Two new staff had been accommodated in the home for a very short time, which is unacceptable and must not be repeated as it compromises service users privacy and dignity. Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 The service users wishes are taken into consideration in the home by way of open meetings and discussions, but resources may prevent them being fully implemented. Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 Page 25 EVIDENCE: DeClare and Conyghame The service users in Conninghame said they had regular meetings. Not all service users attended but minutes are kept and distributed to everyone. Staff in DeClare were able to say that service users meeting are held. Music was being played on a compact disc player in the dining room and service users were able to choose which music was played, as there was a selection. It was evident from the activities programme that service users can join in with holy communion if they want to or are offered assistance to go to Church every Sunday in Badgeworth. The activities organiser said that the many trips out to Bristol Zoo. Cribs Causeway, Weston-super-Mare for example were well attended and enjoyed by the service users. Service users in Conyghame have the opportunity to go out but as the mini bus can only take two wheelchairs, and there is a need to ensure sufficient staff, the times are limiting as everyone in the home needs to be catered for. One service user went on holiday to Weymouth this year with two carers. From discussion with the younger adults, who obviously may need additional daily social interaction, it was evident that more regular local trips out would be appreciated. The provision of ‘SKY’ television for some younger adults who enjoy the diversion of watching television, which is enjoyed by younger people in their own homes everywhere today, should be considered by the home. The administrator was unsure if any quality assurance surveys had recently been completed by the service users, which may have highlighted any of their needs and wishes. Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 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 2 4 X 5 X 6 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 2 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 2 23 X 24 X 25 X 26 2 STAFFING Standard No Score 27 2 28 X 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No Score 31 X 32 X 33 3 34 X 35 X 36 X 37 X 38 x Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 Page 27 yes 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 OP7 Regulation 15 Requirement The registered manager must ensure that care plans on the dementia residential unit are complete and reviewed monthly.( This was a requirement from July 05) The registered manager must ensure that a full pre-admission assessment is completed for service users in Selwyn Payne. The registered person must ensure that care records are maintained for service users in Conyghame who require regular pressure care position changes. The registered manager must ensure all units have access to scales in working order to be able to weigh the service users regularly. The registered person must ensure that the medication fridge on Conyghame is locked. The registered person must make provision for the controlled drugs in use on Conninghame and the related records to be stored there. The registered person must DS0000016377.V269250.R02.S.doc Timescale for action 31/01/06 2 OP3 14.1 21/01/06 3 OP7 15 31/01/06 4 OP7 12.1 31/01/06 5 6 OP9 OP9 13.2 13.2 31/01/06 31/01/06 7 OP9 13.2 31/01/06 Page 28 Badgeworth Court Care Centre Version 5.0 8 OP9 13.2 9 OP9 13.2 10 OP18 13.6 11 12 OP19 OP22 23.2 ( d) 23.1(a) 13 14 OP26 OP27 23.2(d) 18.1 (a) ensure that the conflicting protocols identified on Conninghame for rectal Diazepam are rectified. The registered person must ensure that the medicines are stored at the correct temperature on Selwyn Payne. The registered person must ensure the ‘as required’ medication on Selwyn Payne is managed appropriately. The registered manager must ensure that the Protection from Abuse policy has complete information. The registered person must ensure that the bathroom door on Selwyn Payne is repainted. The registered manager must ensure that the dementia units have appropriate adaptations e.g. pictorial signage and coloured doors. The registered manager must ensure the lounge carpet in Selwyn Payne is cleaned. The registered manager must ensure Selwyn Payne is adequately staffed at all times and that meals are delivered to the unit. 28/02/06 31/01/06 31/01/06 28/02/06 31/03/06 31/01/06 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP9 Good Practice Recommendations The registered person should ensure that staff record more detail when describing a wound. The registered person should ensure that soiled and old DS0000016377.V269250.R02.S.doc Version 5.0 Page 29 Badgeworth Court Care Centre 3 OP9 4 5 OP33 OP33 medication procedures be replaced and that the latest Royal Pharmaceutical Society Guidance is available on all the units. The registered person should ensure that copies of any protocols for the administration of rectal Diazepam are kept with the service users medication records as well as in the care records. The registered manager should ensure that the younger adults have the trips out that they need and wish for. The registered manager should ensure that the younger adults benefit from additional ‘enjoyable diversions’, such as SKY television, as requested by a few service users during the inspection. Badgeworth Court Care Centre DS0000016377.V269250.R02.S.doc Version 5.0 Page 30 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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. 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