Inspection on 09/06/05 for Badgeworth Court Care Centre

This inspection was carried out on 9th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 30/10/05

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 HOMES FOR OLDER PEOPLE Badgeworth Court Care Centre Badgeworth Cheltenham Gloucestershire GL51 5UL Lead Inspector Kathryn Silvey Announced 09 June 2005 10:00am 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Badgeworth Court Care Centre D51_D03_16377_Badgeworth_v228708_090605_stage4_AI.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Badgeworth Court Care Centre Address Badgeworth Cheltenham Gloucestershire GL51 5UL 01452 715015 01452 859985 Telephone number Fax number Email 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 PD Physical Disability (14) registration, with number DE (E) Dementia - over 65 (24) of places OP Old Age (27) Badgeworth Court Care Centre D51_D03_16377_Badgeworth_v228708_090605_stage4_AI.doc Version 1.30 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. 2) To accommodate a named service user under the age of 65 in the Dementia Care Unit. Date of last inspection 13 December 2004 Brief Description of the Service: Badgeworth Court Care Centre D51_D03_16377_Badgeworth_v228708_090605_stage4_AI.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors were at the home for 6.30 hrs. All four units were visited and staff and service users were spoken to and observations were made on all the units. Four relatives were spoken to and two telephoned the inspectors. The registered manager, head of care and training co-ordinator contributed to the inspection during the day with formal discussions Two care plans were looked at/tracked in the younger adults unit, and four in the dementia units. Wound care records were seen in the elderly persons unit. A pre-admission inspection questionnaire had been completed and was handed to the inspectors on the day of the inspection. What the service does well: What has improved since the last inspection? The new care plan format and recording seen in two units was excellent and was a vast improvement. The home invests in the care staff training, which is managed well by the training co-ordinator resulting in 77 of care staff trained to NVQ level 2 or above. Badgeworth Court Care Centre D51_D03_16377_Badgeworth_v228708_090605_stage4_AI.doc Version 1.30 Page 6 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 D51_D03_16377_Badgeworth_v228708_090605_stage4_AI.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Badgeworth Court Care Centre D51_D03_16377_Badgeworth_v228708_090605_stage4_AI.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None EVIDENCE: Not inspected. Badgeworth Court Care Centre D51_D03_16377_Badgeworth_v228708_090605_stage4_AI.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 8 The records in the new care plan format used were excellent, however there was some room for improvement in the residential dementia unit and the wound care in the older persons unit. The service users looked well cared for, the units were calm and staff communicated well with the service users. The health needs of service users are well met with evidence of good multidisciplinary working taking place. EVIDENCE: Care plans were seen and tracked in two units and wound records were seen in the older peoples unit. Younger adults unit. The new style care plans were in use and were very clear and detailed. The evaluation sheet for each care plan was recorded daily therefore replacing the daily records, which ensured that each care need was reported on daily. Risk assessments were recorded and monthly reviews were well recorded on the six monthly general assessments. Badgeworth Court Care Centre D51_D03_16377_Badgeworth_v228708_090605_stage4_AI.doc Version 1.30 Page 10 A monthly dependency profile graph was completed so the service users change in needs can be identified easily. Some service users require total care including percutaneous endoscopic feeds and a sample care plan for the feed was well recorded. Healthcare professional visit the service users and good records were maintained. One service user had a new computerised communication unit, which he found helpful, but required some further adjustments. Many service users were spoken to, some had profound difficulties in communication, however, the care staff said they were able to tell their mood and desires by careful observation. Dementia units. The nursing unit had adopted the new style care plan and a new service user had an excellent care plan with detailed actions including risk assessments and a meaningful daily record. There was an activities care plan, continence pathway and multidisciplinary records. Care plans were reviewed monthly. Personal profiles were recorded. Staff were observed communicating with the service users in a kind and unhurried manner. The residential unit were using the old style care plans, which were confusing in some instances where outcomes were mentioned in two places. Generally the care plans had sufficient detail, some were better than others. The registered mental nurse from the nursing unit had written one care plan, and looks at all plans weekly to support the unit. A care plan was written for any risks identified. Care plans were only reviewed every three months, which is insufficient, particularly for one service user with nutritional requirements. Detailed personal profiles were recorded, and it was evident that the care staff on duty were able to relate activities to the service users life pleasures. Staff were observed engaging service users in conversation and activities and the unit was calm and pleasant. Wound care. The wound care records seen were incomplete and there were insufficient regular recordings. Photographs were not used to record and there was little evidence of what state of healing each wound was in. Badgeworth Court Care Centre D51_D03_16377_Badgeworth_v228708_090605_stage4_AI.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 &14 Service users enjoy the varied activities programme in the home. The service users are able to make lifestyle choices, and the staff make every effort to ensure service users with limited communication are responded to appropriately. EVIDENCE: A number of service users were seen in the two “dementia units”, the older persons unit and the younger persons unit. Three visitors were also seen and spoken to and a service users friend telephoned the inspector to make positive observations on the way care staff treated the service users in a calm and kind manner. The service users and visitors praised the care in the home and felt they lived in a caring, comfortable and stimulating home where their needs and wishes were met. Some of the specific comments from the younger persons Unit were “, I am able to decide how I spend the day”, I am able to get up and go to bed when I wish”. and “ “I am able to ask for specific meals which meets my wishes”. Such choices were in addition to the written menus, which also contain alternatives. Badgeworth Court Care Centre D51_D03_16377_Badgeworth_v228708_090605_stage4_AI.doc Version 1.30 Page 12 Clearly the comments received were from the “more able” however those who required help felt staff were sensitive and supported them to ensure some choice could be achieved Service Users were able to exercise flexibility over when they get up and go to bed, and have choice over what they eat, and where they are able to eat it. The ability to choose extended to the “dementia unit” (residential) where they were able to have their meals in their bedroom if they wished. Staff told the inspectors that the “secure garden” was popular for many of the service users in the dementia unit. Some of the older people seen in the older person units and the majority of people in the “dementia units” were only able to offer limited verbal comment The visitors seen were complimentary about the service provided in the home and felt it was caring and that staff were kind and competent. One service user said that they had problems with eating so the home arranged for a dietician to offer individual advise and the problem has been resolved. The activities programme is available to all service users and gives them details of the daily events. It was seen as varied and appropriate and the majority of the service users seen were involved in and enjoyed the activities provided, Badgeworth Court Care Centre D51_D03_16377_Badgeworth_v228708_090605_stage4_AI.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home has a satisfactory complaints procedure with evidence that service users feel that their views are listened too and acted upon, however, some service users did not have a copy of the formal procedure to hand. EVIDENCE: A recent service users questionnaire in the home highlighted the issue of the complaints procedure, and there is now a 24-hour reporting system from all of the Units that is passed to the registered manager. This conveys issues and events of the previous day from all of the Units and keeps her up to date about what has happened. A number of service users were not aware of the formal complaints procedure. It is appreciated that Barchester has a policy and procedure but for this to be effective service users will need to have the procedure at hand, or their relative/advocate where this is appropriate. The manager agreed to give all service users another copy of the complaints procedure, which was issued to all service users on admission. Service users confirmed that staff were approachable, good listeners and they felt comfortable about raising any concerns. It was evident after speaking to the service users that the majority of concerns are brought to the attention of staff and dealt with promptly and informally without any need to use the complaints procedures; this was the outcome of what was seen as a positive relationship between staff and service users. Badgeworth Court Care Centre D51_D03_16377_Badgeworth_v228708_090605_stage4_AI.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None EVIDENCE: Not inspected. Badgeworth Court Care Centre D51_D03_16377_Badgeworth_v228708_090605_stage4_AI.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30 The home has many highly dependent service users and a staff review is required to ensure that there is no shortfall in the staffing levels and skill mix. The investment in training care staff is good resulting in a high level of staff trained to NVQ level 2 or above EVIDENCE: A detailed assessment of staffing levels had not been completed as required at the last inspection. The registered manager said she was unsure what was required. This was explained at some length by the inspectors who had some concerns at the previous inspections about adequate staffing level and skill mix in the separate units. The manager agreed to complete a formal written review calculating how many hours each service user required care and how many staff were involved. It was evident that service users nursed in bed, in a persistent vegetative state, with considerable physical and mental health needs would often require the assistance of two staff. Most service uses in the dementia units also had high needs due to the constant engagement required by the staff. The rotas were seen, and indicated the number of staff on duty, and the preinspection questionnaire had calculations of dependency levels and numbers of care hours provided. Badgeworth Court Care Centre D51_D03_16377_Badgeworth_v228708_090605_stage4_AI.doc Version 1.30 Page 16 The units although busy were calm and the service users looked well cared for, however, many service users were unable to comment on their needs being fully met at all times. Staff skill mix was discussed with the manager and the training coordinator. The rota indicated that there were times when the condition of registration for the nursing dementia unit was not upheld and the need to ensure more staff were adequately trained for the dementia units was currently being explored by the manager. The training coordinator had produced records detailing all the training undertaken by and planned for the care staff month by month. Individual records were kept for each carer detailing their training goals and copies were provided by the home. It was evident that the staff were receiving appropriate training and an emphasis had been made on delivering the Memory Lane dementia care within the last year. Care staff spoken to on the dementia units felt able to manage the service user in their care and were engaging well with them. The training coordinator said the training budget provided by Barchester was good, and she was able to access lots of free training, some of it accredited. The home had 77 of staff with NVQ level 2 or equivalent. The training coordinator was enthusiastic and committed ensuring that all overseas staff were able to use good English for the benefit of the service users. The new resource centre for staff contained lots of information and advice and was seen as helpful for staff. A spreadsheet detailing that all staff had completed a Criminal Records Bureaux check was seen. Badgeworth Court Care Centre D51_D03_16377_Badgeworth_v228708_090605_stage4_AI.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The home is well maintained and the service users live in a safe environment. EVIDENCE: The pre inspection questionnaire was completed and it was evidence that the necessary servicing and maintenance had been done to provide a safe environment for the staff, visitors and service users. Lose handrails identified on the day of the inspection were immediately made safe by the maintenance person on site at the home. Policies and procedures were in place, according to the questionnaire, for staff to follow to promote service users health, safety and wellbeing. Staff spoken to were aware of their responsibilities for reporting any matters which may effect the safety of everyone in the home. Badgeworth Court Care Centre D51_D03_16377_Badgeworth_v228708_090605_stage4_AI.doc Version 1.30 Page 18 Badgeworth Court Care Centre D51_D03_16377_Badgeworth_v228708_090605_stage4_AI.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 x COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x 3 Badgeworth Court Care Centre D51_D03_16377_Badgeworth_v228708_090605_stage4_AI.doc Version 1.30 Page 20 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 7 Regulation 15 Requirement The registered manager must ensure that care plans on the dementia residential unit are complete and reviewed monthly. The regsiered manager must ensure that wound care is recorded appropriately. Timescale for action 31/07/05 2. 3. 4. 7 15 31/07/05 27 18 5. 27 18 A detailed assessment of staffing 11/08/05 levels in the home must be achieved in a formal report allocating time spent on care practices. A copy must be sent to the Commission. (This was a requirement from the last inspection for 28/02/05) The registered manager must 11/08/05 ensure that the Condition of Registration for the nursing dementia unit is met at all times. (This was a requirement from the last inspection for 30/01/05.) 6. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Badgeworth Court Care Centre D51_D03_16377_Badgeworth_v228708_090605_stage4_AI.doc Version 1.30 Page 21 No. 1. Refer to Standard 16 Good Practice Recommendations The registered person must ensure that all service users or their representatives have a copy of the complaints procedure. Badgeworth Court Care Centre D51_D03_16377_Badgeworth_v228708_090605_stage4_AI.doc Version 1.30 Page 22 Commission for Social Care Inspection 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. 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