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Inspection on 16/01/07 for Bafford House Rest Home

Also see our care home review for Bafford House Rest Home for more information

This inspection was carried out on 16th January 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Prospective residents or their relatives/representatives can visit the home prior to admission to see the home, its facilities and the staff. They have all their care requirements fully assessed before they are admitted to ensure that the Home is able to meet their needs. The Home has the benefit of an experienced Manager who is greatly involved in the home on a day-to-day basis. There appears to be an open, friendly approach to the running of the home, whereby resident`s needs are paramount and this is reinforced to staff. This results in the home being run safely and efficiently with residents` rights and choices being safeguarded and protected. On this visit to the Home the inspector selected for inspection the care records relating to four residents, one being new to the home. In each case thorough care plans had been prepared and developed, based on a full assessment ofeach person`s care needs. Care records seen were well documented on this visit with all information written in an understandable format. Five residents 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 reported that they were addressed in a polite manner and that all care was carried out privately and respectfully. They told the inspector that there were no restrictions put on them. One goes out alone regularly. The inspector observed those residents who were unable to discuss their care due to confusion, inability to communicate or short tem memory loss. Interactions and responses of staff with residents were appropriate, sensitive and kind, residents were observed being treated with respect and dignity.

What has improved since the last inspection?

Management systems are now well implemented and information and evidence is now readily available for the inspection process. Care records are complete, concise and appropriately reflect the care being given to residents and demonstrate resident involvement. Staffing continues to remain stable and they appear to enjoy working at the home and have good team support and respect for one another. The procedures for the recruitment of staff are more robust and provide the safeguards necessary to offer protection to the residents.

What the care home could do better:

The medication records need improving so that they are always complete and accurate. Regular audit checks must be in place to demonstrate that service users always have their medicines correctly. Some storage arrangements for medicines need improving. Staff need more formal training and assessment about the safe handling of medicines. The medicine policy and procedures used by staff must be updated. Training of staff is mainly verbal/informal by the Manager backed up by video training and this is not always delivered in a timely manner. The Registered Manager must ensure that her knowledge and skills are up-to-date to deliver training programmes within the home and that this can be evidenced. It is also essential that the staff are exposed to a variety of formal training to ensure they have the knowledge, skills and abilities to care for the residents at the home. Further work needs to be undertaken to ensure a comprehensive, continuous self-monitoring system is 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 and for staff training.

CARE HOMES FOR OLDER PEOPLE Bafford House Rest Home Newcourt Road Charlton Kings Cheltenham Glos GL53 8DQ Lead Inspector Mrs Helen James Key Unannounced Inspection 16th January 2007 09:15 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.V331127.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.V331127.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.V331127.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th December 2005 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.V331127.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 nine and a half hours on one day in January 2007 and was completed by one inspector. Twenty-nine Care Standards for Older People including all twenty-two Key Standards were assessed on this occasion. Of these twenty-two met the standard, three almost met the standard, three did not meet the standard and one was not applicable. Time during the inspection was spent speaking with the Registered Manager Mrs Ramnial, the deputy Manager Gill Didcot, Mr Ramnial, staff and residents, examining documentation, management records and the environment. One visitor was spoken with on this occasion. Those residents who were able to converse with the inspector discussed the admission process, care, food, lifestyle, activities and relationships with the staff at the home. The information gained in relation to care and welfare from these discussions and observations were then cross-referenced with residents individual care records and other appropriate documentation. Questionnaires were sent out prior to the inspection and analysed prior to the site visit. The six responses from residents were all very positive about the care, food, activities and staff. The five responses received from relatives / visitors were again very positive about the management of the home, care, food and attitude of the staff. One respondent commented that they felt more staff were needed and referred to issues with food and activities. The inspector could find no evidence to support that more staff were required and could find no issues relating to food, albeit that residents didn’t always like the choice of the day. Activity issues are addressed in the body of the report. What the service does well: Prospective residents or their relatives/representatives can visit the home prior to admission to see the home, its facilities and the staff. They have all their care requirements fully assessed before they are admitted to ensure that the Home is able to meet their needs. The Home has the benefit of an experienced Manager who is greatly involved in the home on a day-to-day basis. There appears to be an open, friendly approach to the running of the home, whereby resident’s needs are paramount and this is reinforced to staff. This results in the home being run safely and efficiently with residents’ rights and choices being safeguarded and protected. On this visit to the Home the inspector selected for inspection the care records relating to four residents, one being new to the home. In each case thorough care plans had been prepared and developed, based on a full assessment of Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 6 each person’s care needs. Care records seen were well documented on this visit with all information written in an understandable format. Five residents 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 reported that they were addressed in a polite manner and that all care was carried out privately and respectfully. They told the inspector that there were no restrictions put on them. One goes out alone regularly. The inspector observed those residents who were unable to discuss their care due to confusion, inability to communicate or short tem memory loss. Interactions and responses of staff with residents were appropriate, sensitive and kind, residents were observed being treated with respect and dignity. What has improved since the last inspection? What they could do better: The medication records need improving so that they are always complete and accurate. Regular audit checks must be in place to demonstrate that service users always have their medicines correctly. Some storage arrangements for medicines need improving. Staff need more formal training and assessment about the safe handling of medicines. The medicine policy and procedures used by staff must be updated. Training of staff is mainly verbal/informal by the Manager backed up by video training and this is not always delivered in a timely manner. The Registered Manager must ensure that her knowledge and skills are up-to-date to deliver training programmes within the home and that this can be evidenced. It is also essential that the staff are exposed to a variety of formal training to ensure they have the knowledge, skills and abilities to care for the residents at the home. Further work needs to be undertaken to ensure a comprehensive, continuous self-monitoring system is 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 and for staff training. Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 7 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.V331127.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.V331127.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, 3,4,5 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available for prospective residents and their relatives/representatives to enable them to make an informed choice before moving into the home. The home’s admission procedure ensures that residents are admitted to the home on the basis of a full assessment of their needs, ensuring that they can receive the care that they require. EVIDENCE: Prospective residents or their relatives/representatives can visit the home prior to admission to see the home, its facilities and the staff. They have all their care requirements fully assessed before they are admitted to ensure that the Home is able to meet their needs. Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 10 The statement of purpose and service user guide is available to all prospective residents and their representatives. A yearly review has been carried out to ensure that residents and their families receive accurate information about the home and services provided. A copy was given to the inspector during the inspection. A copy is given to prospective residents/representatives with service users guide and complaints policy and procedure and is available in the entrance of the home. Every resident has a contract either private or social services and terms and conditions of residency, Mr Ramnial is to check that they comply with the Office of Fair Trading standards. All private fee paying residents receive a contract which includes the Homes terms and conditions of residency. Those receiving funding contributions sign a contract, which is between the Home, the funding authority and themselves, they also receive separate terms and conditions of residency from the Home itself. A sample copy was given to the inspector during the visit. The home must ensure that a ‘timeframe’ is included in the contract, where it mentions annual fee increases to indicate when it comes into effect. ie; within one month of notification Bafford House Rest Home DS0000016378.V331127.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. Residents have individual plans of care for staff to follow to meet their health and social care needs, though significant improvements are required in the recording and administration of medication to ensure medication is administered safely to residents. Care is offered in such a way as to promote the privacy and dignity of residents. Residents are addressed in an appropriate manner at all times. EVIDENCE: On this visit to the Home the inspector selected for inspection the care records relating to three residents, two of whom were new to the home since the last inspection. Thorough care plans had been prepared and developed, based on a full assessment of each person’s care needs. Care records were well documented on this visit with all information written in an understandable format. Reviews are undertaken monthly. Day and night reports were written Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 12 consistently. There were no records relating to the resident’s wishes on death this was discussed with the Manager and needs inclusion. There is good liaison with the Community teams and the home has excellent relationships with local Gps. Residents who are being visited by the district nurse for specific nursing care have community care records which are kept at the home, and reference to the district nurse visiting is made in the homes’ care record. All equipment needed for residents’ health care is supplied appropriately by the Community Services. Several residents have health care needs met by the Continence Nurse, the Community Psychiatric Nurses (CPN) and the Community Nurse. The Community Nurse is seeing two residents but there are no wounds or pressure sores at this time. Risk assessments are well documented and moving and handling requirements are clearly recorded. Some records examined appeared to have the care plan and review completed with the resident/relative, as indicated by their signature, this should be done with all residents or reason stated why this was not possible. All information required is kept in one file including the activity/hobby assessment. On discussion with one lady she told the inspector that she needed new glasses. This was discussed with the Manager; the Manager informed the inspector that they are waiting for the optician to visit the home. Three other residents 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 reported that they were addressed in a polite manner, by the name they wished to be called and that all care is carried out privately and respectfully. They told the inspector that they could do what they wanted and ‘the care staff were wonderful and very caring.’ Residents discussed with the inspector the fact that staff were from Poland and whilst their English was not perfect the residents felt that they were always able to understand them and they understood the residents. All the staff are having English lessons at a local college. Residents explained that they were never told what to do. Those residents who were unable to discuss their care with the inspector due to confusion, inabilities to communicate or short tem memory loss were observed by the inspector. Interactions and responses of staff with residents were appropriate they talked to residents told them what they were going to do, guided them, talked with and supervised residents with respect and dignity. Daily routines are ascertained from residents, relatives and friends and these are recorded and maintained as much as possible. Accident records are comprehensive and the home was advised to audit these as part of the Quality Assurance within the home for number of accidents/trends/advice given /taken and outcome of analysis. During the Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 13 inspection a system was devised by the Manager and implemented this met the requirement. Pharmacist Report Some issues about medication identified needed urgent action. These were notified on an immediate requirement form left at the end of the inspection and are included in the requirements in this report. The registered provider responded by letter dated 5 March 2007 confirming he has taken the necessary action. The home is supplied with medicines by a local pharmacy that dispenses mainly in a monthly monitored dose system (MDS) and provides printed Medication Administration Record (MAR) charts. The home has recently changed from a weekly supply system to a monthly system. The manager trains designated staff to administer medicines. There are no records of this training with assessments of staff competence in the various tasks involved. This training does not meet this standard. We have published guidance about training staff to safely handle medicines on our website and the manager was given details of this. Observations from this inspection show that more training is needed. There is medicine policy and this was due for review in November 2006. A review is needed as the medicine system has changed recently. It would be useful to include more specific information rather than broad policy statements so that staff have a template as to exactly what is expected of them when dealing with medicines. There are arrangements to record medicines received administered and returned to the pharmacy but these records are not always kept. There were examples of no records for medicines received into the home. Records on the medicine administration charts are poor and incomplete so are not reliable records of what medicines service users have received. There are many gaps on the charts for most service users where staff have not signed that they have given a medicine or written a code letter if a dose is missed. There are only records for medicines given orally so for example there are no records for medicines applied or used externally, eye drops instilled or inhalers used. Some dose instructions for eye drops said ‘to be used in affected eye’ so it is not known in which eye to use, how many drops and how many times a day. Another medicine is given regularly although the directions say ‘as required’. Where the doctor prescribes a variable dose (one or two tablets for example) the actual dose given is not recorded. There were no records of doses of an antibiotic course apparently started at 5pm on 23 February 2007 as a printed chart had only recently come to the home from the pharmacy. When a new medicine is prescribed if the pharmacy does not immediately provide a printed chart the new medicine details must be immediately written on to a medicine chart with a double check that the details Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 14 are correct so that records of doses given can be made correctly. Spare labels from the pharmacy must not be stuck on the charts, as this can be dangerous. No controlled medicines were used at the time of the inspection and the use of these medicines appears infrequent. There is a small notebook record the receipt and disposal of these medicines. Using a proper bound and printed controlled medicine record book is strongly recommended if these medicines are used again. We have published guidance about handling controlled drugs on our website and the manager was given details of this. Checks and audit counts were made on seven recently prescribed antibiotics courses. Poor records of doses given or counts of remaining doses indicate mistakes on each of these with doses possibly not given as the doctor prescribed. One service user was vomiting during the course so the doses were stopped, but the doctor had not yet been contacted. Medicines were signed on the charts as given but the tablets were still in the blister packs. Medicines were not signed as given although the tablets had gone from the blister packs. Designated staff administer medicines to residents and nobody is able to look after their own medicines at present. One resident apparently looks after an inhaler medicine that is prescribed to use regularly twice each day. This was not noted on the medicine record and there was no risk assessment that this person is using and keeping the medicine safely. The inspector watched one carer giving out some medicines at lunchtime. The trolley with the medicines and the medicine charts were taken to each resident. Several of the medicine records were already signed (indicating the medicines were taken) before the medicine round began. The carer did not always wait to see that the medicines were properly taken before moving to the next person. The medicine charts were not referred to until after the doses were given – apparently relying on memory or the MDS packs. In one case a 5ml dose of liquid antibiotic medicine was measured to give and said that a 5ml dose twice daily was given. The pharmacist inspector pointed out the dose was actually 10ml three times daily. The intervals between doses of medicines must be carefully considered. An antibiotic prescribed with doses three times daily was given at 8am, 12 noon and 5pm which does not properly space out the doses throughout the day and could lead to ineffective treatment. The blister packs of tablets were on the open top of the trolley and there was nowhere to lock these away quickly in the event of an emergency arising. The locks on the two drawers on the trolley were broken so these medicines were not secure. Medicines are kept in various locked cupboards in the office and storeroom. To prevent cross contamination medicines applied externally need segregated storage from those medicines that are swallowed. This could easily be achieved by rearranging some of the stocks so that one of the smaller cupboards is used just for external medicines. Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 15 There is a small safe to use when controlled medicines are used. This safe is standing on a shelf so must be securely fixed to a solid wall to provide improved of security. Some creams and liquids applied externally were seen in a bedroom. It is best if all medicines are stored in the medicine cupboards as there can be risks to service users or others with this arrangement. If particular barrier creams or emollients that are used regularly are needed in bedrooms a safe arrangement can be made based on an individual risk assessment. Better arrangements are needed for keeping medicines secure in a fridge. Daktacort cream and Xalatan eye drops were not correctly stored in a medicine fridge. Three bottles of antibiotic syrup were in a domestic fridge. Writing the dates on medicine containers when they are first opened to use helps with making sure medicines are not used beyond specified time limits after opening. The pharmacy already provides space to write the date on some labels. This also helps provide a method to check that medicines are given correctly. Checks can be made of the amount of medication remaining and comparing to see if this is in agreement with the record of the medicine given. Prescriptions are ordered through the pharmacy and not directly with the various surgeries. Some copies of the original prescriptions are kept in the home (a good practice) but the routine monthly prescriptions are not seen to check before the pharmacy dispenses these. Copies of the prescriptions are not kept. Although the manager has enquired about this arrangement as being acceptable from our customer service helpline there is some evidence from this inspection of poor outcomes as one medicine (eye drops) was not in stock to use and some directions were incomplete or not current. The home still has a duty of care to make sure the prescriptions are correct and medicines are always available in the home when needed even though they have asked the pharmacy to order. The home is in a much stronger position to deal with issues like this if they deal directly with the surgery and see all prescriptions before they are sent to the pharmacy for dispensing. Some of the references in the home about medication were not up to date. It is strongly recommended to obtain the latest edition of the British National Formulary (due March 2007), professional guidance sheets about various aspects of handling medicines from the CSCI website and the June 2003 guidelines from the Royal Pharmaceutical Society. Bafford House Rest Home DS0000016378.V331127.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. Residents experience a stimulating and varied life at the home with visitors and community links encouraged. There are activity sessions available that aim to suit all abilities and preferences within the home. Daily routines are managed as flexibly as possible to enable the residents to exercise choice and control over their daily routine and to lead as independent/interdependent life as possible at the Home. Residents continue to be able to exercise choice and control over their lives within the individual ability to do so and maintain contact with family and friends. Visitors are encouraged and links with the community are maintained where possible. The meals at the home are wholesome and nutritious with choice at each meal. EVIDENCE: Residents at the home are free to spend their day as they wish those spoken with confirmed this. There is no formal daily entertainment programme but Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 17 activities are arranged as and when and seasonal activities take place. Residents confirmed that they could participate in things going on at the home but those spoken with were quite happy to pursue their own hobbies/interests. The Manager takes responsibility for arranging an ‘Entertainment Programme’ to suit the residents and where possible they are consulted on what they would like to do. The following are popular and done regularly watching video films, music, sing-along, and skittles, exercise sessions to exercise videos and talking. A documented ‘activity/ hobby/ lifestyle history’ is recorded for all residents which increases the personal knowledge of individuals and assists in the planning of activities/one to one sessions with residents at the home. Care staff get involved on a ‘one to one’ basis with residents. Activity sheet records are kept for each residents and this forms part of the care record and demonstrates patterns of participation and activity. Residents and staff confirmed that there is the opportunity to exercise choice in relation to daily routines and participation in activities within the home although several spoken with liked to do their own thing watch TV/ read/ watch sport/ go to have a smoke in the smoking room or talk to care staff. The lay preacher visits the home every two weeks and provides communion and talks with residents. She gives feedback to the Manager on any issues, concerns etc. No one goes out to church this is residents’ choice and many are unable to. There is access to advocacy services if required. Visitors are welcomed into the home at any reasonable time and residents spoken to were able to confirm this. One visitor told the inspector, “that they were always welcomed by the staff and always provided with a warm drink”. Meals can also be provided if required by visitors. All residents spoken to stated they enjoyed the food and the quality and quantity was good. Staff were aware of the specialist dietary requirements of residents and ensured their needs were catered for at each meal. A choice of food is available at all meals and the menus provided demonstrated a varied and balanced diet. Snacks and drinks were available as required. Meals seen were well cooked and well presented. The Kitchen was clean and in good order. Three residents need assistance and prompting is given to several at the dining table. Some choose to eat in their room but most enjoy the social occasion of the dining room, which is set well. There are no specific dietary needs at the present time. Weights are monitored monthly for all residents and those identified with nutritional problems evidence was seen. Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 18 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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. The home is making every effort to ensure service users are protected from abuse but the absence of local safeguarding procedures means the home cannot demonstrate training provided to staff meets the requirements of the local adult protection procedures. EVIDENCE: There is an Equality and diversity policy in place. The complaint procedure, is clearly stated in the service user guide given to residents / representatives on admission and is available in the foyer of the home. All residents spoken with stated that they ‘had no concerns about the care or the home and they always felt able to discuss concerns with the Manager, deputy and staff’. No formal complaints have been received by the home. The Manager reports that all concerns/grumbles are dealt with as and when they occur. The home has its own policy on abuse. The Manager and Deputy need to ensure that they attend the ‘enhanced adults at risk training’ and the new safeguarding adults policy and procedure when they are introduced in Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 19 Gloucestershire. Staff who have completed their NVQ Awards will have completed a unit on abuse but as few have at the home. The Manager confirmed that staff are instructed in abuse awareness /adult protection/whistleblowing on induction and this is followed up with video training and a knowledge paper test. Staff spoken with confirmed they knew what abusive practice was. The Manager is required to provide accredited Adult at risk training for the staff team. A copy of the ‘Alerters guide’ produced by the local adult protection team must be available in the home and displayed. The registered manager needs to be aware of the implications of the Mental Capacity Act and should arrange training for all staff as soon as it is available. There is a resident/relative suggestion sheet in each room this is to encourage them to record concerns/issues and compliments so that the manager can follow them up. These have not been used well to date. The Manager looks at the sheets monthly to audit concerns there was no recorded evidence of this audit. It was suggested that the Manager dates and signs even when nothing is written to evidence this auditing. There is a staff suggestion/concerns/ and issues relating to care practice etc form, again this is informally audited monthly it was suggested that a more formal audit is undertaken. Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 20 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, 25 & 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 good with residents having a pleasant, clean and well-maintained environment to live in. . The standard of décor within this home is good and no maintenance issues Heating, lighting, water and ventilation all meet the Health and safety standards and the needs of residents. The home complies with infection control standards EVIDENCE: A tour of the building was carried out and all areas visited were well maintained and decorated. The home has been redecorated throughout this year. The home benefits from the constant attention of the proprietors who Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 21 are at the home each day and address issues relating to decoration and maintenance. Gardens are accessible, attractive and well maintained and the residents take particular pride in awards the homes garden has received in the past. One resident helps clear and tidy the garden and enjoys this. The domestic staff keep the home very clean, tidy and odour free. The laundry has been upgraded and now provides good hygienic facilities for the laundering of clothes, which complies with infection control standards. At the time of the inspection the home was clean and tidy. There was evidence that staff are provided with personal protective equipment which is accessible throughout the home. Washing machines have sluicing facilities. All staff are responsible for overseeing the laundry and good practice was observed to be in place. Infection control training is covered in the health and safety course that all staff have attended recently (the home is waiting for the certificates). Hazardous products are locked away and data sheets/risk assessments are available in the home. All maintenance issues are recorded in the maintenance book on daily basis and these are addressed each day and signed off when they are completed to ensure an audit trail. The manager would like to convert the ground floor bathroom to a walk in wet shower room and also wants new furniture throughout the home especially in the lounge. This will go into the development plan for the new financial year. Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 22 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. The skills and abilities of these staff is variable the Registered Manager needs to ensure staff have knowledge and skills to care for people living at the home. Staff must receive all the mandatory training continuously via formal systems. Improvements have been made in the recruitment process which if sustained will protect people from possible harm. Training to NVQ level is being encouraged to ensure that residents are in safe hands at all times. EVIDENCE: Staff spoken with felt that staffing was sufficient to meet the needs of residents and that they had time to do their job. There are good support staff that deal with domestic chores and catering and during the evening shift staff are involved in preparing and heating the tea. They receive good support from the Manager and Deputy and receive regular ‘one to one’ supervision. The Manager confirmed that monthly team meetings are to be implemented. Most staff working at the home are from ethnic minority groups and whilst there were not specific concerns from the residents relating to language Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 23 difficulties it is essential that the manager monitors this. The Manager confirmed with the inspector that all staff whose English is not fluent are attending English lessons at the college and they are all progressing. Staffing has been a bit stretched recently on night duty and Mrs Ramnial has been undertaking the duties herself whilst a member of staff is trained. This will resolve as the member of staff is trained. A handover is given at each shift change. The care staff write the daily records and feedback any changes to the Manager or Deputy. They all have access to the records and know all about the residents and how to meet their needs. Staff said that it was a good supportive team at the home and it was a happy place to work, ‘like an extended family’ said one. They feel there is enough time to give care to the residents and that residents are given choice. Residents spoken with confirmed that the staff were very caring and met their needs. One new carer has been recruited and this file was inspected. The inspector saw the Criminal Record Bureau (CRB) disclosure and POVA First for this staff member. It contained evidence that all the pre-employment checks had been appropriately undertaken prior to employment to comply with regulation 19. There was an interview record and induction training record on the file seen at inspection but there was no signatory evidence to confirm what had be done. New staff work alongside another staff member for two weeks for their induction. Formal supervision begins at three months and the Induction Standards are completed. Where there are gaps in the employment history there was evidence that the registered manager is questioning this during the interview process. Training of staff is mainly verbal by the Manager backed up by video training and this is not always delivered in a timely manner. The Manager needs to ensure that her knowledge and skills are up-to-date to deliver training programmes within the home and that this can be evidenced. It is also essential that the staff be exposed to a variety of accredited training to ensure they have the skills and abilities to care for the residents at the home. Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 24 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, 35, 36, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, safety and welfare of the people using the service are in the main protected and safeguarded. People live in a home which is run in their best interests offering them choice, respecting their wishes and keeping them safe. There still does not appear to be a clear development plan in place for the home and in areas such as training. The system for service user consultation is improving but must be continued and developed. There are processes in place to safeguard the financial interests of residents. Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 25 EVIDENCE: The Registered Manager has many years of experience running a care home but has not completed the NVQ level 4 in management, although the Deputy Manager is completing the NVQ level 4 at the present time. Although mandatory training is being given by the Manager with video material and this is evidenced through signed records, the Manager needs to ensure that her knowledge and skills are up-to-date and accredited if she is to continue this. It is also essential that training be undertaken in a timely manner to ensure that staff have the knowledge and skills to undertake the work they do, especially as only one member of staff has the NVQ Qualification. Staff and residents were observed having positive interactions with the manager. Evidence was seen of the staff supervision and appraisal system and the records that are kept. This now appears to be established and well coordinated by the manager and deputy. Staffing now appears to be more stable and there appears to be a happy working environment with only one staff vacancy on night duty. Accident records are checked and audited to monitor patterns in the home. All accidents and incidents are now recorded appropriately and notification sent to the Commission. Residents’ personal finances are not managed by the home it is all done through the billing system. The home supplies most of the residents with personal toiletries and then sends the bill to the Relatives/representatives quarterly or half yearly. Records were seen pertaining to this. Evidence displayed confirmed that the Home is fully insured. A Residents feedback sheet has been implemented. This is kept in the residents’ room for completion by the resident/visitors or relatives to ensure that there is satisfaction with the home and its staff. To date no one has completed one they have all tended to talk to the Manager or the deputy about issues, concerns, compliments or queries. Further work needs to be undertaken to ensure a comprehensive, continuous self-monitoring system is 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. Since the last inspection evidence has been seen of the Portable appliance testing, Gas safety checks and the Hoist maintenance undertaken in 2006. The Hot water temperature valves have been tested and Legionella testing has been undertaken. The water outlet temperatures have not been being monitored but the Manager set up a documented system during the inspection. Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 26 All radiators are guarded and window openings restricted. The lift was service in September 2006 and is regularly maintained. All the required weekly and monthly Fire checks are being completed. 2nd January 2007 a Fire drill, evacuation and training was done with day and night staff. The Homes Fire Risk Assessment has been documented and is displayed in the home with a nominal role and plan of the home displayed at each exit. The resident call system is checked weekly and recorded. Catering records are maintained in line with ‘Safer Food Safer Business’ guidelines. First aid and COSHH risk assessments are displayed around the home. Policies and Procedures are reviewed and updated yearly or as needed and staff sign to say they have read them. Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 27 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 3 3 Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 28 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 OP9 Regulation 13(2) Requirement Records of all medicines received and administered must be complete and accurate with regular checks made to monitor this is the case. Immediate requirement left at inspection. Obtain a supply of Xalatan eyedrops for a particular service user so that treatment can be administered as doctor has prescribed. Immediate requirement left at inspection Write the date of opening on eye drop containers so that they can be replaced after 28 days in use. Immediate requirement left at inspection. Store all medicines at the correct temperature and provide lockable storage in the fridge. Immediate requirement left at inspection. Repair the broken locks on the drawers on the medicine trolley. Immediate requirement left at inspection. Registered manager must make sure that medicines are always given in accordance with the doctors’ directions and regular checks are recorded to confirm this. Registered manager must review and update the medicine policy and DS0000016378.V331127.R01.S.doc Timescale for action 23/04/07 2. OP9 13(2) 23/04/07 3. OP9 13(2) 23/04/07 4. OP9 13(2) 23/04/07 5. OP9 13(2) 23/04/07 6. OP9 13(2) 30/04/07 7. OP9 13(2) 30/04/07 Bafford House Rest Home Version 5.2 Page 29 8. OP9 9. OP9 10. OP9 11. OP9 12. 13. OP18 OP29 14. OP29 15. OP30 procedures so as to provide all staff with precise direction about the way medicines are managed and handled in this home. 18(1) Registered manager must make sure that all staff handling and administering medication receive accredited training and ongoing assessment of competence in this task. 13(2) Registered manager must introduce risk assessments with safe recording and storage arrangements for any medicines a service user self-administers. 13(2) Registered person must make sure that there are safe arrangements for transporting medicines around the home and accepted safe procedures are always followed when medicines are administered to service users. 13(2) Registered person must review the storage arrangements for medicines and in particular to make sure that: • The safe used for storing some medicines is bolted to a solid wall; • Medicines that are swallowed are stored segregated from those applied externally; • Risk assessments are in place if any medicines are stored in bedrooms and that the arrangements are safe for everybody in the home; 13(6) Ensure all staff attend accredited Adults at risk training Schedule 4 The induction record for all new (6g) staff must be fully completed, signed and dated. (this is a previous requirement repeated) 19 The interview checklist must be completed for newly recruited staff. (this is a previous requirement repeated) 18(1ci) Ensure that staff receive appropriate accredited training in a timely manner to underpin their knowledge to care. 30/06/07 30/04/07 30/04/07 30/05/07 30/06/07 30/06/07 30/06/07 30/06/07 Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 30 16. OP31 10(3) 17. OP33 24 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. • Development of the selfmonitoring 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. 30/06/07 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 1 2 3 4 Refer to Standard OP2 OP2 OP9 OP9 OP9 OP9 Good Practice Recommendations Ensure a ‘timeframe’ is included in the contract, where it mentions annual fee increases to indicate when it comes into effect. ie; within one month of notification. Mr Ramnial is to check that they comply with the Office of Fair Trading standards Provide a proper printed and bound controlled drug record book to keep records when these medicines are next used. Writing the date on medicine containers when they are first opened and use stock within the time periods recommended by the manufacturer or pharmacist. Arrange to see and check all prescription forms in the home before they are sent to the pharmacy for dispensing. Update the medicine references as identified in the report. Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bafford House Rest Home DS0000016378.V331127.R01.S.doc Version 5.2 Page 32 - 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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