CARE HOMES FOR OLDER PEOPLE
Bafford House Rest Home Newcourt Road Charlton Kings Cheltenham Glos, GL53 8DQ Lead Inspector
Helen James Unannounced 10 May 2005 09:15 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. Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Bafford House Rest Home Address Newcourt Road Charlton Kings Cheltenham Glos GL53 8DQ 01242 523562 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) Mr M Ramnial & Mrs R C Ramnial Mrs R C Ramnial Care Home - Personal Care 19 Category(ies) of Old Age not falling within any other category registration, with number (19) of places Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 13 December 2004 Brief Description of the Service: Bafford House is situated in a quiet residential area of Charlton Kings, approximately two miles from the centre of Cheltenham. It is easily accessible by public transport and car. It is an imposing detached residence with a large entrance hall where a cage of parakeets is situated. The accommodation has been adapted to provide fifteen single bedrooms and two double bedrooms, although in practice these rooms are used as singles unless occupied by a couple. Eight bedrooms have en-suite facilities, and all other rooms have hand washbasins. There are three communal bathrooms; one with a hoist. The accommodation is provided over three floors, accessed by a shaft lift or the stairs. There are two lounge areas on the ground floor, a sitting area on the first floor and a dining room on the lower ground floor. The two offices, kitchen and laundry are also located on the lower ground floor. The home is set in extensive gardens and the home has won several awards for the Cheltenham in Bloom competition for its floral displays. To the front and side of the house are parking spaces for several cars for staff and visitors to the home Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five and a half hours on one day in May 2005 and was completed by one inspector. Twenty standards for older people were looked at on this occasion five were met, six were almost met and eight were not met and one was not applicable. The inspector spoke to the deputy manager and as well as a number of service users and one visitor. Appropriate records and a selection of care plans relating to the service users spoken with or newly admitted were looked at. The service users appear well cared for and well nourished and all their care needs are met and those talked with confirmed their satisfaction with the care, nutrition and staff. However, one individual who is temporarily placed at the home on ‘respite care’ requires urgent reassessment, as to the appropriateness of the placement at the home. What the service does well: What has improved since the last inspection?
The updating of the Fire measures has been completed. The deputy manager is doing her National Vocational Qualification (NVQ4) in Management Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.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.
Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.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 Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.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) 2 &3. 6 is not applicable. Each service users is reported to have a contract but these were not available for scrutiny due to the absence of the Provider/Manager. Arrangements are in place to ensure that each prospective service user is fully assessed prior to admission, to confirm that all their particular care needs may be met in the Home. EVIDENCE: Service users are assessed prior to and on admission although documentation seen for a service user admitted on respite care had not been completed. Only basic details had been taken and family contact numbers. There was no documented assessment of activities of daily living or baseline information about this service user. The service user is independent and has short-term memory loss and is leaving the home and making his way to a relative’s house. This poses a safety risk for the service user and the home as the home does not have a keypad door entry system and is not staffed sufficiently to deal with service users who wander out of the home. The service user requires an immediate reassessment to find an alternative placement, as this is not an appropriate placement. Whilst this process is undertaken it is imperative that
Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.doc Version 1.30 Page 9 the assessment documentation and risk assessments are completed and staffing levels are improved. Completed signed copies of terms and conditions for admission to the home are reportedly filed in the service users’ records. Service users contracts were not available to be seen by the inspector, as the deputy Manager did not have access to them. It was not evident that service users/advocates are provided with a contract, terms and conditions and details of the breakdown of charges in the Home to comply with the Office of Fair Trading Standards 2004. Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 and 10 There is a comprehensive care planning system in place to ensure that all members of staff have a clear understanding of the care each person requires. Service users who were able to converse with the inspector confirmed that they were treated with respect and that they had choice in their daily routine. They were addressed in a manner that they were comfortable with and were not told what they could do or could not do. EVIDENCE: Six care plans were selected for inspection. Five contained a plan of care based on a comprehensive care needs assessment. Reviews are undertaken monthly although some examined were in need of review. Input from the community nursing team is recorded in the documentation. A fully detailed assessment, care plan or risk assessment, however, had not been prepared for a new service user to cover all identified care needs ie; diabetes, poor short term memory and a tendency to ‘wander’. Staffing was also not adequate on some shifts to meet the identified needs of some service users ie; a service users assessment noted that they required two to transfer and only one carer was on duty, on one shift noted on the duty rota.
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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) 13 and 15 Daily routines are managed as flexibly as possible to suit the individual preferences of service users living at the Home. Visitors are encouraged and links with the community are maintained where possible Nutritious meals are provided and specialist diets catered for. EVIDENCE: Relatives and friends call in to see the service users; they were greeted in a friendly manner by the staff. Some chatted in one of the communal areas; others chose the privacy of their bedrooms. One service user was going out to the supermarket with her son and she told the inspector that she thoroughly enjoyed doing this. Staff were observed always knocking on doors before walking in and speaking to any service user they came into contact with. Three service users confirmed that they are able to choose where they spend their days, what times they get up/ go to bed and what they will have to eat. The meal on the day was gammon with parsley sauce, mash potato and sprouts with ice cream for dessert. Served with juice from jugs. Service user expressed their satisfaction and enjoyment of the meal and shared that the “gammon was extremely tender”. Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.doc Version 1.30 Page 12 However, two liquidised meals were seen after they had been prepared for two service users requiring assistance with eating. The meat and vegetables were liquidised together, not allowing any of the individual food to retain its taste, colour, texture or appearance. This is not acceptable preparation of liquidised food for eating; the meat, vegetables and potato must all be liquidised separately and placed separately on the plate. It was also noted that one carer was assisting two service users and one meal was left uncovered and unheated whilst one service user was assisted. Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.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) 18. Arrangements for the protection of service users are not satisfactory placing them at possible risk of harm or abuse. EVIDENCE: The Home’s Complaints Policy is included in the Statement of Purpose, a copy of which is kept in the front hall, ensuring that it is readily available to anyone visiting Bafford House. Two service users confirmed that they are able to tell the staff if they have a problem and that “they sort it out for me.” Several recent incidents indicate that one particular service user is ‘at risk’, as he has wandered out of the home on several occasions, to the main road and to a relatives house 25 minutes walk away. He was found by the relative at her home. Regulation 37 notices had not been completed and sent to the Commission for the incidents. It was reported that staff from both day and night duty have still to watch the training video on Abuse. For some staff, their English is not good enough to understand this form of training. Also due to only two staff per shift, there is not sufficient time for them to watch this during work time. No specific time has been allocated to address this training need. Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.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) 9,20,23 & 26 Service users live in a homely environment, which is comfortably decorated. Service users rooms suit their needs and are personalised with their own personal possessions. There are outstanding requirements relating to Health and Safety that must be addressed. The ongoing improvements that have previously been identified have not been completed. EVIDENCE: Most of the Home is clean, reasonably well maintained and decorated in a homely style. However, several maintenance issues were identified: The carpet in Room 9 is very uneven and worn, posing a hazard to anyone walking in the room and floorboards are creaky and loose by the door. Room 5 has a radiator protector but this has come adrift and requires mending. The ground floor bathroom has a toilet that is not working. The static bath hoist covering is cracked on the armrests and this is an infection control hazard. No evidence was available of when it was last serviced.
Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.doc Version 1.30 Page 15 The Cleaner has left, so care staff are now cleaning all the communal areas, which is having a negative impact on the time available to spend with service users. Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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) 27,28,29 & 30. Staffing is barely adequate to meet the care needs of the service users living at the Home when the Providers(administrator) and Manager are away from the home. The procedures for the recruitment of staff are still not robust and do not provide the safeguards to offer protection to the service users. Improvements must be made. The training opportunities offered to the staff have been limited to videos and in-house training by Mrs Ramnial EVIDENCE: The Manager has been away eight weeks with no notification to the Commission and Mr Ramnial who provides administration and catering assistance has been away for two and a half weeks. They both are at the home daily. The Deputy Manager reported that she has been working thirteen-hour days and is ‘on call’ when at home. No extra staff have been rostered on whilst they are away this was evidenced by the duty rota. Two staff on each shift to cover care, catering, cleaning and administration tasks is totally inadequate. The commitment of the staff group is exemplary and it is through their efforts that the service users continue to receive a standard of care, the same cannot be said of the providers. Several Polish carers are employed at the home. Two of these staff at least, have limited English and potentially limited understanding, they are registered to learn English here. The induction and training of these staff is questionable. This does question the Providers fitness in leaving the home understaffed and with some staff with limited spoken English and staff not adequately trained.
Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.doc Version 1.30 Page 17 Staff have not completed the mandatory training as there is insufficient time for them to watch the videos during shift and the video recorder is located in the residents lounge. A new carer started yesterday with no completed application form or employment history, no references and no CRB or POVA check, in consultation with the Providers over the telephone from Spain. There was also no shadowing or working with another carer as there were insufficient staff to facilitate this. This is totally unacceptable recruitment practice and a regulation notice will be served as recruitment practice at the home has continually been an issue and previous inspections have made requirements relating to recruitment practice. The deputy manager did give her a basic induction but this was not documented. Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.doc Version 1.30 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) 31,36,37 &38. There is good leadership, guidance and direction to staff from the Deputy Manager to ensure that service users receive consistent quality care. However care records have suffered because she is managing the home in the absence of the Registered Manager and the Providers. Their absence with no increase in the staffing establishment has had a negative impact. EVIDENCE: The provision of staffing, food and basic necessities has not been interrupted and evidence displayed confirmed that the Home is fully insured. A full health and safety check was not completed on this occasion but issues recorded elsewhere in this report regarding staffing, health and safety in the home and inappropriate action taken with regard to employment, accidents and incidents in the home all raise concerns about the health, safety and welfare of service users in the home. Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.doc Version 1.30 Page 19 There were also issues raised concerning the records that should be maintained in the home, for example a visitors book is by the front door but visitors are not encouraged to complete this. Visitors can only access the home by being let in by staff, they must encourage them to sign the book. Photographs of each service user were also not available and neither was there a photo of the service user who kept walking out of the home. Staff do not appear to have contracts or terms and conditions of employment. This is not acceptable employment practice. Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 1 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 2
COMPLAINTS AND PROTECTION 3 2 x x 3 x x 3 STAFFING Standard No Score 27 1 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 2 x x x x 1 1 1 Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.doc Version 1.30 Page 21 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 38 Regulation 13(4) Requirement All radiators to be protected to prevent the risk of accidents. (Previous timescale 30th November 2004). Where heat emitting surfaces are uncovered each service users must have a documented risk assessment on their care file until the risk is addressed. (Previous timescale 28th February 2005) Where portable appliances are used ensure that these are secured to prevent accidents. (Previous timescale 28th February 2005) All staff to receive training on: a) Abuse’ issues. b) Aggression Management. c) Dementia d)Confusional disorders and their management. (Previous timescale 30th November 2004). Deputy Manager to receive updating training in First Aid. (Previous timescales 30th April 2004 and 30th March 2005). A documented supervision and appraisal system must be implemented for all staff. Timescale for action 30th June 2005 16th August 2005 2. 38 13(4) 3. 38 13(4) 16th August 2005 30th June 2005 4. 18 13(6) 5. 18 13(4) 16th August 2005 30th June 2005
Page 22 6. 36 18(2) Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.doc Version 1.30 7. 36 13(4) 8. 9. 38 18 13(4) Schedule 2 10. 27 Schedule 4(7) 11. 29 Reg 19 12. 29 Reg19 & schedule 2 13. 36 18(2) (Previous timescale 30th June 2004). Portable appliance testing to be completed. (Previous timescale 30th November 2004 & 28th February 2005). Water tanks to be replaced to reduce the risk of Legionella. a) The Manager to obtain the updated Gloucestershire Adult At Risk Guidance. b) The Manager to update recruitment policies and procedures to include the new legislation regarding Protection of Vulnerable Adults (POVA). All hours worked by Mr and Mrs Ramnial must be recorded on the duty rota (previous timescale 28th February 2005) The homes recruitment policy/procedures to be amended and updated to reflect current legislative changes with respect to employment practice. Since the introduction of the POVA scheme, and the amendments to the Care Home Regulations on the 26/7/04 for recruitment and pre-employment checks on staff. The Home must ensure that its recruitment practice complies with the leglislation (Previous timescale 28th February 2005) a) An appropriately qualified and experienced member of staff must be appointed to supervise a new worker for the duration of their induction training. b) As far as is practicable the ‘staff member’ must be on duty at the same time as the new worker. c) The new worker must not 16th August 2005 30th June 2005 30th June 2005 16th August 2005 30th June 2005 16th August 2005 16th August 2005 Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.doc Version 1.30 Page 23 14. 29 Schedule 2(5) 15. 16. 8 2 14(2b) 16(1) & 4(1)(b) 15(1) 17. 7 18. 10 12(4a) 19. 20. 15 18 16(2i) 37 21. 20 16(2c) 22. 23. 20 27 & 31 23(2c) 38(1&2) escort any service user away from the care home premises unless accompanied by the ‘staff member’. (Previous timescale 28th February 2005 On employment of staff ensure that two written references are taken. (Previous timescale 30th March 2005) Ensure service user identified at inspection is reassessed for a more appropriate placement For future inspections ensure that service user contracts are available for the Commission to examine A written plan must be prepared detailing how the service users needs in respect of his health and welfare are to be met Take down list displaying personal care and personal routines that are displayed around the home. Ensure that all food is liquidised separately to retain colour, texture and taste. A record must be kept of any accidents/incidents that affect the service user in the care home which is detrimental to the health or welfare of the service user, and notification be made to the Commission via a Reg 37 notice. The following maintenance issues be addressed:a) Mend radiator cover in Room5 b) Replace carpet in room 9. c)Repair toilet in ground floor bathroom. Repair Hoist coating in ground floor bathroom and provide evidence of servicing. Manager to notify the Commission in writing of any 16th August 2005 30th June 2005 30th June 2005 30th June 2005 30th June 2005 30th June 2005 With immediate effect 30th June 2005 30th June 2005 16th September
Page 24 Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.doc Version 1.30 24. 27 18(1a) 25. 38 17(2) schedule 4(6) planned absence from the home in advance of the absence. Ensure that at all times suitably qualified, competent and experienced staff are working at the home in such numbers that are appropraite to the health,safety and welfare of service users. Ensure all employed staff have contracts and statement of terms and conditions of employment. 2005 16th August 2005 16th August 2005 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 2 15 Good Practice Recommendations Ensure terms and conditions of contract comply with the Office of Fair Trading Standards 2004. Ensure food is kept covered and warm whilst a service user is waiting to be assisted with eating Bafford House Rest Home D51_D03_S16378_Bafford House_V227235_100505_Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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