Inspection on 11/12/07 for Bafford House Rest Home

This inspection was carried out on 11th December 2007.

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

Bafford House Rest Home 23/03/09

Bafford House Rest Home 16/01/07

Bafford House Rest Home 05/12/05

Bafford House Rest Home 10/05/05

Bafford House Rest Home 13/12/04

Bafford House Rest Home 12/07/04

Bafford House Rest Home 02/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Bafford House Rest Home Newcourt Road Charlton Kings Cheltenham Glos GL53 8DQ Lead Inspector Mr Peter Still Key Unannounced Inspection 09:15 11th December 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 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 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) ramnial@aol.com Mr Manmohun Ramnial Mrs Rosa Calvo Ramnial Mrs Rosa Calvo Ramnial Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2007 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 DS0000016378.V345022.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key Unannounced inspection took place over ten hours on one day in December 2007 and was completed by one inspector. The inspector met with the registered manager and her husband who is joint provider and the deputy manager. The inspection focused on the Requirements and Recommendations made in the last inspection. A number of records were examined including the care of residents, medication and staffing. Unfortunately the provider had not been able to send the Commission their pre inspection Annual Quality Assurance Assessment due to a computer problem and some information to help with this inspection will be considered at the next inspection. A number of questionnaires for residents, relatives, staff and outside professionals had been circulated and some were returned to the inspector. Professionals returned no questionnaires. A number of residents and staff were spoken with and the inspector also observed residents’ care. What the service does well: The providers take good steps to assess residents prior to admission, for example a visit is made to see the prospective person. The management team communicate a strong commitment to putting the needs of residents first and of helping people to feel at home and of offering choice to meet individual wishes and needs. The providers are fully involved in the running of the home and promote an open and happy atmosphere and staff said they were well supported by the deputy manager and the registered manager and her partner. Residents said they got on well with the management team. The home has undergone a full refurbishment and the environment is in very good order, homely, clean and fresh. The care staff team do not speak English as their first language, however residents were observed to communicate easily and there was praise for their caring approach from residents. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 6 The management team demonstrated commitment to wanting to address issues raised at this inspection. What has improved since the last inspection? What they could do better: The Statement of Purpose for the home and Service User Guide need to be brought up to date. The Registered manager must ensure all staff have read and understood the revised medicine policy and procedures, to ensure staff are clear about the way medicines are managed and handled. All staff that handle and administer medication are currently completing accredited training in this task and this training must be completed. Staff induction documentation must be completed and signed by staff and their manager. There should be a review of activity and ways of providing further stimulation for residents to enhance their lives. All staff must be exposed to external accredited training to increase their knowledge base, including the protection of vulnerable people and the Mental Capacity Act 2005. Staff must have easy access to the ‘Alerters Guide’ for reference if staff feel they needs to take steps to protect residents. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 7 All staff must receive formal and recorded one-to-one supervision at a minimum frequency of six times a year. The home must have a registered manager who is qualified to a minimum of National Vocational Qualification Level 4 in management and any future management arrangements must be put to the Commission. The Registered manager must ensure that the Annual Quality Assurance Assessment document is sent to the Commission in time for it to be used to support an inspection. The home must establish an ongoing self-monitoring assessment quality assurance system to enable analysis of feedback about the home and to consider what needs to be done to make improvements and to support a formal development plan for the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service User Guide must be reviewed to ensure prospective residents have up to date information. People who are admitted to the home have their needs assessed so that important information is known and the home can be sure it can meet prospective residents’ needs. EVIDENCE: The Statement of Purpose and the Service User guide were out of date with some information. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 10 The Nursing and Midwifery Council (NMC) is now the responsible body for protecting the public through professional standards and has a code of professional conduct. The National Care Standards Commission has also been replaced by the Commission for Social Care Inspection. There should be mention of fees charged by the home. Both providers are not also registered as managers of the home since Mrs Ramnail is the Registered Manager and this needs to be clarified. The providers said this was due to a mistake by the current Commission for Social Care Inspection on transfer of registration from the previous Commission. The providers agreed to review and update the documentation and to send a copy to the Commission. Mr Ramnail considers that the Home’s contract of residency with residents to be in compliance with the Office of Fair Trading standards. The Registered manager ensures prospective residents are assessed prior to admission so that they can be sure the needs of people can be met. One person recently admitted had moved from another care home and a Transfer Sheet was seen, which gave detail on key points of information. An assessment was also completed by the home on the day of admission. The admission documentation for another person recently admitted, showed that there was a risk of choking. A risk assessment was seen and the detail was also included in the care plan. The providers had visited this person to aid the assessment. The evidence reviewed indicated that the home had ensured they had the key information to make a good judgement about initial admission for the trial stay. Contracts of residency were in place for residents. Short-term respite care is provided but not Intermediate care. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made to the medication system and when the outstanding requirements, including staff training have been met, people who live at the home will have better protection. Pharmacist random inspection 26/09/07. Time of inspection: 1215 – 1450 Quality in this outcome area regarding medication is adequate. This judgement has been made using available evidence including a visit to this service by a pharmacist inspector. People living in this home are now generally protected by the policies and procedures for dealing with medicines. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 12 EVIDENCE: Residents care plans were well documented and daily observation records supported this. Case tracking of a resident found a good care plan record concerning a risk to their well being, which would enable staff awareness and medication details were up to date. The providers say they have a good relationship with District Nurses. The management team said that only two residents have District Nurse support currently and the staff team work hard to ensure good practice, which promotes effective skin care. The management team said they had tried to gain continence training recently for their staff and will continue to pursue the training through the specialist continence nurse. One person was seen being helped by two staff in a corridor and there was good contact and banter between them, the resident was seen to be very happy with the support provided. Staff knocked on residents’ doors before entering and staff were observed to respect people’s dignity. Residents spoken with said they did not have to wait to have their personal care needs met and the inspector also observed this. The Commissions Pharmacist, David Jones, had made a number of requirements at the last inspection following an inspection and he made a further random inspection on 26/09/07. The following is his evidence from the inspection: I observed safe practices being followed when a care assistant was giving medicines to a few people living in the home at lunchtime in different parts of the home. When medicines were prescribed ‘as required’ or with a variable dose the care assistant asked what each person needed and also explained what the medicines were. A new medicine trolley is now in use and this has helped to improve the procedures for safely administering medicines around the home. I found improvements in the medication records since the last inspection and I saw evidence that records are kept of all medicines received, administered to people in the home and where necessary, disposed of. Sample checks of medicines in stock agreed with the administration records and this helps to show that people in the home are receiving their medicines correctly. I pointed out to Mrs Ramnial an incomplete medicine record for one person so that she could look into the reason for this. To help make sure each person has the correct amount of medicine the actual dose administered needs recording where the doctor has prescribed a variable dose (5 –10ml for example). This was not always done. There was an example where one tablet daily alternates with two tablets daily. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 13 The pharmacy had dispensed this in the monitored dose system (MDS) pack so the person is having the right number of tablets but the records are not clear about what is given each day. Sometimes medicine details are handwritten on the medicine chart. It is good practice for the person writing this to sign and date the entry and to ask a second authorised staff member to check and sign that the entry is copied correctly. There was an example pointed out where the strength of two medicines had been missed on the first medicine chart used. Most medicine containers now have dates when they are first opened to use so that they are used or replaced within the time periods advised by the pharmacy or manufacturer. This good practice could be extended to boxes or bottles of tablets as this makes audit checks possible and easier for medicines remaining in stock. I saw records in place that are used when emollient or barrier creams are applied to people in the home. Staff need to make sure they state on all such records what cream is used and also that this same information is defined in the care plan rather than just stating ‘cream’. The arrangements for storing medicines have improved and all medicines are now stored safely. I discussed with Mrs Ramnial about keeping the medicines in the fridge in a locked cash box in place of the unlocked container used at present. (The fridge is in a locked room but the security of the medicines will depend what staff have access to the fridge). There is a medicine policy so staff have some written information about the way in which you expect them to handle medication. The manager has recently updated this information so needs to add the review date. There is also a list prepared (which needs completing now) for staff to indicate when they have read and understood the policy. The policy is taken from the Croner manual so I left some information about items you should consider including in some local procedures so that all staff have specific information about the management of medicines in this home. Staff who administer medicines to people living in this home have begun a formal course of study about the Safe Handling of Medicines and this will be assessed by the college on completion. I saw some training records, which indicated a staff member, had completed induction training about medication. I spoke to two carers who administer medicines and they demonstrated an understanding of safe handling of medication. To fully meet this standard the full training course needs completing by all staff that handle medicines. I have extended the timescale on this requirement as you have begun a training programme. There is now an updated medicine reference book and I explained about access to this book that is available via the Internet, which may be useful. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 14 The inspector for this current inspection, Peter Still also reviewed the points made by the pharmacist above to check progress: The management team have taken on board the matters raised previously and have responded to most of them. The new medicine trolley was being used and was seen chained to the wall in the locked food stock cupboard, during the day when it was not in use. One member of staff spoken with said they had got used to the trolley and its weight. Drugs were observed being given out in the living room and the member of staff was signing the medication administration record (MAR) immediately after a person had received their medication and before medication was given to the next person. One person was having difficulty holding a cup with medication in a drink this was immediately noticed and responded to. The trolley was looked at and found to be tidy and well organised. Where a doctor prescribes a variable dose, this is recorded. Where medicine details are hand written on the medicine chart, the person writing this signs and dates the entry. The last inspection had required that the registered manager must introduce risk assessments with safe recording and storage arrangements for any medicines a service user self-administers. This had not been fully complied with; only one resident was self-administering. There was no locked cupboard for the medicine and the risk assessment reviewed was not detailed enough. However on the day of inspection the deputy manager discussed this with the resident, who agreed not to continue to self-administer their medication as it was considered that there was a risk. As with all such decisions, which affect a persons’ life a full record will need to be made in the care plan so an explanation of the decision can be recorded. Medicine containers and also boxes or bottles of tablets were seen to have dates of when they were first opened, on them, to help with auditing. Where creams are used, the name of the cream is used and entered in the medication care plan. The Pharmacist had talked to the manager about keeping medicines in the fridge in a locked cash box in place of the unlocked container, which was being used. This has not been responded to and the Requirement will be repeated. The medication procedure and policy had only been signed by one member of staff to indicate that they have read and understood the policy and a requirement will be made about this. Staff are still currently completing an assessed college course on the Safe handling of medicines and the inspector was told it will be completed by the end of January 2008. The pharmacist had already extended the timescale for this training and it is understood it will now be completed by 01/02/08. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 15 A Copy of the British National Formulary (BNF) for 2006 was seen and the provider said he would register with BNF on line to ensure the home has up-todate information in future. The deputy manager sees the prescriptions in the home before they go to the pharmacy for dispensing and the new arrangements were said to be working well. The registered manager said that the deputy manager was responsible, under her, for the medication system now. The deputy manager was spoken with and was clearly working responsibly to ensure that all proper steps are taken to keep residents safe in the way medication is handled. An audit of the drugs and including disposals is undertaken every four weeks and the MAR sheets every two weeks. The inspector saw evidence of a mistake by the pharmacy, which was well recorded, where one tablet was missing from a sealed blister pack. The pharmacy record gave a total of 56 tablets and there were 55 and the inspector was shown the unopened blister with one and not two tablets. The deputy manager used this example to show that the system is now much tighter. The deputy manager talks with staff individually to ensure medication record keeping is maintained properly and gives each member of staff who handles medication, an individual training session. Since there was no evidence of staff supervision notes being recorded, it was not possible to check the discussions with staff. Medication is discussed at staff daily handover meetings where any issues are raised. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Whilst more activity and stimulation Should be explored to make life more interesting for the less active residents, some activity is provided and there is involvement in the local community. Residents have a varied diet, which is nutritious and well balanced. EVIDENCE: The home has done very well over a number of years to win Cheltenham in bloom awards and residents enjoy the many flowers and colour in the gardens. The home has no formal activities programme or record; activities are run by care staff and include bingo, chair skittles, music and a variety of games. During the inspection one member of staff was observed encouraging a person to do some art work with a magnetic board, using shapes, unfortunately the resident didn’t wish to be involved at that time. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 17 Another person who was not able to communicate had a radio near, playing music. At one time the very young granddaughter of the proprietors was in the lounge communicating with residents, who were seen smiling and happy with the contact. Staff were also observed to frequently communicate individually with residents. Seasonal festivals are celebrated at the home and this is a time when external people come to the home to entertain residents. The home was very festive on the day of inspection. One member of staff spoken with said they were a qualified physiotherapist, in Poland and sometimes provides residents with an exercise session. One resident spoken with said they go out to the shops and into town and another said they have an allotment across the road from the home, which they really enjoy. This person showed the inspector photos of their allotment. There had been a request for the resident to give up the plot when they moved into the care home, but Mr Ramnial advocated for the person, who was able to keep it and it clearly means a great deal to the individual. This person also goes out into the local community regularly for example the local working mens club to play pool. They also said they like to sweep up the leaves at the home. Two other people spoken with said there was activity at the home and one said they played bingo and that there could be more activity. One relative responding to a questionnaire survey said there could be more activity at the home for residents and indicated that more priority could be considered. A member of staff was observed changing the television channel in the living room since it was a childrens’ show and felt it odd that the resident wanted it turned back, but didn’t find out the reason. The resident told the inspector that they wanted it left on the channel because snooker was about to come on. There was discussion about activity for residents with the management team since the inspectors view is that more could be done to provide interest and stimulation and the providers agreed to consider ways of making improvements. One member of staff was seen having a walk near the living area with a resident, who was enjoying the communication with the staff member. This was seen as an example of staff being proactive and in a small way to be supporting individual residents to enjoy their lives. During the inspection, no visitors to residents were seen, though the home encourages people to visit. Two residents spoken with talked about members of their family who visit them. Five residents were spoken with about the food they have. One said there was choice of food at breakfast and for the evening meal but no choice for the lunchtime meal. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 18 Another said “there was choice but no choice”, the food was all right and it is eaten but the presentation could be better as well as the way ingredients are used, the food was “rough and ready”. The inspector unfortunately missed the residents’ mealtime and did not experience this important part of their day, so this will need to be considered at the next inspection. The providers said there is choice of food and gave an example of a resident that enjoys particular meals and the ingredients for this are kept separately in the stock cupboard. It may be helpful to build in a survey around food and meal times into the quality assurance work for the home. Comments from other residents included: “the food is absolutely marvellous and there is choice”. “The food is good and different”. There is too much food and they have to leave some of it. “I have a small appetite and there is often too much.” A good record of the menu and menu choices being made was seen, the record was up to date. The tea menu had a cycle of 49 days. The breakfast choice record was also seen and the one for 10/12/07 was reviewed. The stock cupboard had plenty of food and fresh vegetables. Fruit is offered to residents twice a day and fresh meat is normally used. Mr Ramnial is the main cook for the home and has a kitchen assistant. Both have attained the food hygiene qualification. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents feel safe and listened to. However all staff need exposure to an accredited form of external training concerning the protection of vulnerable people. Staff will be in a better position to protect residents from abuse if they have easy access to a guidance document called the ‘Alerters Guide’. Staff will be able to support residents with their rights more effectively if they have training about the Mental Capacity Act 2005. EVIDENCE: No formal complaints have been made about the home. Details of how to make a complaint were held in residents’ files and included the contact details for the Commission. Five residents were asked whom they would talk to if they had a concern. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 20 Three said they would talk to the deputy and one said the deputy would listen and does sort things out. Another said that they would also talk to the providers. Another resident said they didn’t want to say anything. The inspector felt this person may have had difficulty in understanding the question and that it would cause worry to pursue it. Another said they would talk with their daughter that lives locally. One of the five residents spoken with said: “You couldn’t wish for better staff – any issues and the deputy would sort it out and I have no complaints”. Another resident said the registered manager liked to “be in charge” but that they got on well with the providers and the deputy manager but would talk with the deputy about issues of concern. Recording of staff training in relation to the protection of vulnerable adults was not in place. The inspector was told that staff watch a video every three months concerning abuse. The provider considered that this met the standard for compliance, however the inspector said that this did not go far enough and that staff need to have accredited external training. It is good practice for a senior member of staff who has responsibility for adult protect at the home to attend the enhanced training too. It was agreed at the inspection that the deputy would go on the next training available and contact details of the Adult Community services coordinator were given to the providers. It was also agreed that the registered manager would attend the training after the deputy manager. The inspector said that all staff must attend accredited training and there needs to be a programme for this. The last inspection made a requirement that all staff attend accredited Adults at risk training. This will be repeated. The inspector asked to see the ‘Alerters Guide’ and the management team had great difficulty in finding it. The inspector said it should be on display so that staff could gain quick access if they needed to remind themselves of steps to take if they had a concern about the possibility of abuse. It was agreed that this would be done and a requirement will be made. The provider had a copy of the Department of Health publication of the Mental Capacity Act but had not taken any steps to ensure staff have training to help them to understand its implications and responsibilities. He agreed to respond to this and a requirement will be made. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment in this home is comfortable and residents have a pleasant, clean and well-maintained environment to live in. EVIDENCE: A tour of the home was made. During the previous year, the home was fully refurbished and since the last inspection, new furniture provided. The home was in very good order throughout and also festively decorated. The home was warm and comfortable throughout and had a range of equipment for residents. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 22 No offensive smell was found anywhere at the home and the whole home was clean and fresh; the home employs a cleaner for 37 hours a week. Liquid soap was seen in bathrooms and individual hand towels were available for people to use; these would be used once only before being washed. The kitchen was very clean and tidy, with excellent work surfaces. The fridges had temperature checks and open food was dated. The fire officer had visited the previous week and it is understood that a report/letter will be provided. Apparently the only issue concerned the upstairs lobby, which has furniture in it and this was of concern. The deputy manager thinks there is an issue about the type of furniture. It was agreed the inspector would use the Annual Quality Assurance Assessment provided by the home, to gain information about the various checks required, such as electrical, heating, hoists and the homes lift. Unfortunately it was found that this information had been lost due to a technical hitch with the document. These areas were not inspected and will need to be a focus for the next inspection. The home has a room adjacent to the building and accessed by a covered area, which is used for residents who wish to smoke. It looked tidy and comfortable but the work place risk assessment will need to be checked for this room at the next inspection. The laundry was seen and it was tidy, and it was noted that washing machines have a sluicing facility. Residents’ laundry is marked to ensure people have their own clothes. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is adequate staffing to meet the needs of residents and good management support, keeps residents safe. Staff recruitment practice is satisfactory to protect people who live at the Home. The lack of a fully completed induction record may put residents at risk if it were later found that staff had not received a full induction. Staff must be exposed to external training to ensure they have the skills and knowledge to care for people living at the home. EVIDENCE: Staffing levels were seen to be satisfactory on the day of inspection, although one member of staff responding to the survey questionnaire considered that more care assistants would be beneficial. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 24 Residents were spoken with in their rooms and communal areas during the day and also observed. There was no rush evident and people were having their needs met promptly. One resident spoken with said, “I don’t have to wait” in relation to personal care being provided. Staff were seen to interact well with residents and were gentle in their approach and proactive in encouraging and engaging with residents. The home had a positive atmosphere and both staff and residents were smiling and happy. One resident said, “You couldn’t wish for better staff, and, all staff have beautiful English”. Staff files were checked for three staff, which contained recruitment information with employment history and references. CRB and POVA First checks were completed. Care assistants who work at the home are mainly from Poland. The files of staff reviewed had a Boarder Immigration Section work permit on file. The induction file for one member of staff had been signed off, as completed by the deputy manager and member of staff on 10/09/07. All staff have an Induction and there were records for all staff, however they had only been completed for one member of staff, the rest of the records were blank. It was understood that there were records but they had been lost in the Homes system and so not available on the day of inspection. A requirement in relation to this had already been repeated and will need to be repeated again. This has now become a very serious matter. The registered manager said she would attend to it. The providers consider that their use of a significant number of up to date videos, ensures the home is in compliance with the training needs for staff. The inspector said that whilst this is a very good way to support staff with the information they need about key aspects of care, it does not go far enough and staff need to be exposed to formal accredited external training. This training would underpin staff knowledge of care practice. The last inspection had required that the registered manager must demonstrate that her knowledge and skills are up to date and can be evidenced, to continue delivering training programmes within the home. This has not been complied with and at this inspection, the registered manager said she would no longer provide the training and instead would use external training providers and would also provide a staff training matrix as a management tool to ensure all staff receive the training the management team require and that they are up to date with their individual training programme. 50 of staff should be qualified to a minimum of National Vocational Qualification (NVQ) level 2 to ensure staff have sufficient knowledge to meet residents’ needs. The inspector was shown the staff certificates for mandatory training, such as first aid and moving and handling, which staff had attended. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered manager of the home must have qualifications, which support their knowledge in caring for residents. Record keeping and systems must be put into use so that necessary information can be accessed and used to support and protect residents. People live in a home which is run in their best interests offering them choice, respecting their wishes and keeping them safe. All staff must receive a minimum of six formal and recorded supervision sessions a year so that they can be supported in their work with residents and there must be a programme produced to ensure it happens. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 26 The providers must ensure a self-monitoring quality assurance system is put in place to support the development plan for the home, which can be available in the home and submitted to the Commission. EVIDENCE: Since the last inspection there has been a reworking of some of the administration systems and recording in a number of areas has not been properly completed recently. The registered manager said the issues would be responded to. The registered manager said she would not now undertake the (NVQ) level 4 in management to continue in her current role as registered manager of the home and that when the deputy manager has completed her training, she will make an application to the Commission to seek registration to become the homes registered manager. The deputy manager spoke of significant difficulties with her training in that her assessor had left and there had been a long delay in moving her NVQ forward, the syllabus had now changed and she will have to start her work again. The providers must ensure that the home; is managed by a person who has the necessary level of qualification, to include NVQ Level 4 in management. The management team are very committed to ensure the home is run in the best interests of the residents. They made this clear in a response about what was the best achievement for the home and they said: “The residents are the most important aspect at the home, they come first, it is a home for the residents, no one else”. “There are no short cuts”. “There are good relationships with families”. Members of staff responding to the survey questionnaire were positive about the support they have from the deputy manager and providers and one said: I “would not have stayed at the home for 5 years if I did not like the management. Other comments included: “Everyone does the job of caring great and I think residents have good care – it is a friendly environment to work in”. The staff records for one member of staff showed that their induction was signed off on 10/09/07 and this was seen as a supervision record for a new member of staff. The record for another member of staff showed no evidence of formal supervision. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 27 The providers accepted that they were not providing formal one to one staff supervision and a requirement will need to be made that they provide all staff with a minimum of six supervisions a year. Their argument was that there is a daily handover, where staff can and do raise any issues. One member of staff in their Survey response said, “I think my manager is aware how I work that she did not feel that the one-to-one supervision is needed. But if I have any questions, I feel free to ask”. The analysis of staff survey feedback forms also gives an indication that staff are not always fully aware of the way they should work. This is one reason why staff supervision is so important. The providers have not produced a quality assurance self-monitoring system with analysis of information, which would lead to a development plan for the home. The requirement made at the last inspection will be repeated for these documents to be produced. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 2 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X X Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4; 5. Requirement The Registered Person shall produce a Statement of Purpose and Service User Guide, which is up to date. The Registered manager must ensure all staff read and understand the up dated medicines policy and procedure. Timescale for action 29/02/08 2. OP9 13(2) 01/02/08 3. OP9 18(1) The Registered manager must 01/02/08 make sure that all staff handling and administering medication receive accredited training and ongoing assessment of competence in this task. (This is a previous requirement repeated) Ensure all staff attend accredited Adults at risk training. (This is a previous requirement repeated) The ‘Alerters Guide’ must be easily available to staff for reference. 31/03/08 4. OP18 13(6) 5. OP18 13(6) 01/02/08 Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 30 6. OP18 13(6) All staff must have accredited training in the Mental Capacity Act 2005. 31/03/08 7. OP29 Schedule 4 (6g) The induction record for all new 01/02/08 staff must be fully completed, signed and dated. (This is a previous requirement already repeated once before) Ensure that staff receive 30/05/08 appropriate accredited training in a timely manner to underpin their knowledge to care. (This is a repeated requirement) The Home must have a Registered Manager that has completed NVQ level 4 in management. The Registered Manager must ensure that all staff receive formal one-to-one supervision at a minimum frequency of six times a year and that a supervision programme is produced. There must be development of the self-monitoring systems in place in the home to ensure that the home can produce a Quality Assurance report for the Commission with their Annual Development plan for the home. Ensure within this that external stakeholders views are sought. More formal auditing of residents, relative and staff views to be undertaken. (This is a repeated requirement) 30/05/08 8. OP30 18(1ci) 9. OP31 9(2)(b)(i) 10. OP36 18(2) 29/02/08 11. OP33 24 31/03/08 Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations There should be a review of activity and ways of providing further stimulation for residents to enhance their lives. Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Regional Office Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bafford House Rest Home DS0000016378.V345022.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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