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Inspection on 23/03/09 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 23rd March 2009.

CSCI found this care home to be providing an Adequate service.

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.

Key inspection report CARE HOMES FOR OLDER PEOPLE Bafford House Rest Home Newcourt Road Charlton Kings Cheltenham Glos GL53 8DQ Lead Inspector Odette Coveney Unannounced Inspection 23rd March 2009 09:00 DS0000016378.V374944.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Bafford House Rest Home DS0000016378.V374944.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.V374944.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th December 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.V374944.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. The key inspection was undertaken in line with the Care Standards Act 2000 and following the Commission’s Inspecting for Better Lives guidance. The purpose of the visit was to review the progress to the requirements and recommendations from the last key visit undertaken by us in September 2007. This visit took place on Monday 23rd March 2009, all of the key standards were inspected the visit commenced at 09:00 am and lasted seven hours. The methods used during this visit included record checks, reviewing the care and associated documents for four people who live at Bafford House, a review of staffing records, and health and safety records such as risk assessments and fire records. We also undertook a tour of the home and had discussion with people who use the service, visitors to the home the registered Manager and staff. What the service does well: There are clear, recorded admissions processes into the home. Prior to admission individual’s needs are assessed in order to ensure that Bafford House is able to support them in all areas of their care and support requirements. There is a stable and consistent team of management and staff at this home. Staff have developed good relationships with those who live at the home and have a sound understanding of individuals needs and preferences Evidence from records and speaking to the people who live at the home indicate that the home creates a safe, friendly and caring environment in which people living in this home feel content and their needs fulfilled. Generally the home was found clean and warm and people within the home looked relaxed, some people were seen accessing the communal area without restriction, we also spoke with people within the privacy of their rooms all of whom spoke favourably of the care they received. Staff were noted interacting with individuals living in the home in an informal and sensitive manner A guide is given to prospective residents to enable them to make an informed choice about living at Bafford House and they are informed on admission of a Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 6 one-month trial to enable them to make an informed decision on if the home is suited to meet their needs and whether to stay. The home has a good care planning system, which is holistic, and this specifies how identified needs are to be met. Care plans are regularly reviewed. Good meals are provided for people living in the home and staff ensure that meals are not hurried and those who have difficulties are assisted in a respectful, sensitive and dignified manner. A robust complaint procedure is in place and all complaints are investigated properly and action taken where required. What has improved since the last inspection? The Statement of Purpose for the home and Service User Guide has been reviewed and the information about the manager has been brought up to date. The Registered manager has ensured that all staff have read and understood the revised medicine policy and procedures; this has ensured that staff have clear information about their responsibilities in respect of the way medicines are managed and handled. Staff induction documentation is completed and signed by staff and their manager to evidence that this area of training has been completed. There has been a review of activities and ways of providing further stimulation for people living in the home in order to enhance their lives; this should be an ongoing priority. Some staff had completed external accredited training to increase their knowledge base in respect of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards; further training is to be arranged for other staff as required. Staff have easy access to the ‘Alerters Guide’ for reference if they feel they need to take steps to protect people who live at the home. The information on how to do this is available to them. All staff receive formal and recorded one-to-one supervision at a minimum frequency of six times a year. The Registered manager has ensured that the Annual Quality Assurance Assessment document was sent to the Commission in time for it to be used to support an inspection. The home have established an ongoing self-monitoring assessment quality assurance system to enable analysis of feedback about the home and uses this Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 7 to consider what needs to be done to make improvements and to support a formal development plan for the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 8 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 9 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.V374944.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is comprehensive information describing the service and facilities available to individuals living at Bafford House. Individual’s needs are assessed prior to admission and these are kept under review. Each person living at the home has a contract which outlines the terms and conditions of the placement. EVIDENCE: Bafford House is registered with The Care Quality Commission to provide a residential care service for 19 older people. Within the homes statement of purpose and service users guide there is comprehensive and clear information for people living at the home and their relatives about the home. These documents also contained information about Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 11 the staff and management arrangements at the home. Information also included how individuals are supported with their admission into the home, the services and facilities provided by the home and other agencies as well as information about how to make a complaint and how individuals needs would be assessed and met. During our last visit to the home a requirement was made that the registered person shall produce a statement of purpose and service user guide, which is up to date, this was because the information contained within these documents was unclear about who was the registered manager and who were the registered providers. Mr M and Mrs R C Ramnial are the proprietors and are also the registered providers. Mrs Rosa Ramnial is the registered manager. Both documents had been ammended to ensure the information contained within these documents was accurate and the requirement had been met. There is a clear process to ensure that the service is able to meet the assessed care needs of prospective people moving to the home. There is an admission procedure, which is included in the statement of purpose and full assessments of need were undertaken. People are able to spend a day at the home free of charge before deciding if they wish to take up residency at the home. The home also has a policy on trial periods; people have between 4-6 weeks in order to decide if the home is able to meet their needs and also for the home to determine if the placement is an appropriate one. We reviewed the care and associated records for the most recently admitted person into the home and saw that a comprehensive care management assessment had been completed prior to their admission to the home. The home had used this information, as well as their own assessment and consultation with the individual in order to develop a care plan for the individual based upon their wishes and choices as well as their assessed need. Each person living at the home has an agreement which outlines the terms and conditions of the placement. The manager confirmed that these contracts are in place for all of the people living at the home. We saw that the contracts outlined the facilities and services, which are provided by the home and the responsibilities of the people residing at the home. We saw that information was also given about visitors, how people would be supported if they were in ill health, insurance details and notice periods. We saw that fees are fully inclusive with the only extras that people would have to pay being hairdressing and chiropody. During our visit staff were observed interacting with individuals, using appropriate language and tone of voice. Intermediate care is not provided at this home. Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual’s personal and health care needs are being met. Individuals are protected by the home’s medication administration and practice. EVIDENCE: We looked at four care files for people who live at this home at this visit. Records showed that one recently admitted individual had pre-admission assessment. There was evidence of individualised care plans, which described how these needs are to be met, and the care plans were recently reviewed. Care plans seen were detailed and explicit and the daily report contained entries of what, when and how care was provided. Information recorded on care documentation corresponded with information told to us by the people we spoke with and the manager about the level and individualised levels of support that people living at the home received. It was clear that support Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 13 provided was flexible and tailored to individuals identified and requested support needs. We spoke to a relative of an individual whose aunt had been living at the home for sometime, they told us about the level of care and support their relative needed and gave a number of examples of how the care was provided. This relative told us that they are very happy with the service given by the home and told us that their aunt’s health, both on an emotional and physical level had improved since her arrival at the home. The home has an equal opportunity policy in place, to ensure that staff provide care to people living at the home, which has been based on individual needs and capabilities. Information about individuals expressed wishes and choices had been well recorded within individuals care records and staff we spoke with were knowledgeable about the preferences and support that individuals living at the home required. People we spoke with confirmed that their privacy was never compromised when staff assisted them with personal care. One individual stated that they were satisfied with their care. “It is a privilege to live here it feels so much like living in your own home”. Staff were noted knocking at bedroom doors and waiting for an answer before going in to assist people with personal care demonstrating that individuals living in the home are treated with respect and that their privacy is maintained. It was evident through talking with people who live at the home that the staff are sensitive to the emotional, physical and health needs of those living at the home and through observation and discussion demonstrated respect to the wishes of individuals living at the home. Furthermore staff were observed going about their duties in a friendly and calm manner and responding to the people living in the home in a friendly, familiar style. A monitored dosage system of medication administration is in place at the home and this appears to work well. All of the people who live at the home are supported with all aspects of their medication. There is no controlled medication in place at this home. Records of medication administration are in place, as are photographs of people who live at the home. During our last visit to the service a requirement was made that the registered manager must make sure that all staff handling and administering medication have received accredited training and ongoing assessment of their competence in this task. At this visit the manager and staff spoken with confirmed that all staff that give medication have received training in this area through the Royal Forest of Dean College. We also saw that staff had received training in this area from the pharmacist who supplies and dispenses medication to the home. We asked staff a number of questions about their training and good clear answers were given when asked about what they would do in certain scenarios Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 14 such as medication refusal and errors. Staff also told us that medication responsibilities are also discussed during individual supervision and during staff meetings. We saw that the home has a detailed medication policy and this covers a number of important areas. During our last key visit to the service a requirement was made that the registered manager must ensure all staff read and understand the up dated medicines policy and procedure. The manager told us that this was responded to immediately after our visit. Within the medication folder we saw a copy of the medicines policy and procedure in place and also saw a record to show that staff had read the policy. Staff we spoke with were aware of the medication policy and procedure and were aware of their responsibility in this area, this requirement had been met. From examination of care plans, and daily records and through discussions with people living at the home and staff who work there, we concluded that people are supported with all aspects of their health. People have access to primary care services, such as the general practitioner, dentist and optician as needed and that specialist services such as oncology, physiotherapists, and community psychiatric nurses can be accessed when a need for this has been identified. Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those living at the home are enabled to maintain contact with families, friends and local communities. Choices are provided in respect of meals and mealtimes. The home provides those living at Bafford House with structured and meaningful activities and they are able to choose whether they wish to participate or not. EVIDENCE: During this visit we saw that staff were friendly, polite and caring in their approach. They were seen to be supportive. We saw them listening to people and answering questions, providing reassurance and information as requested. Staff employed at Bafford House enable those who live at the home to maintain contact with family, friends and community. Within the home’s service user guide it states that one of its main aims is to help residents to retain their links with their community, family and friends. Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 16 During our visit we spoke with people who were visiting their relatives at the home. One person told us about the care and attention given to their relative. They told us that since their relative had been admitted to the home that they had become less anxious and their health had improved. This same relative told us about their relative’s diagnosis of a dementia and how this affected them in their life. They told us that staff knew the needs and wishes of their relative well and supported them with warmth and kindness. Individuals living in the home are provided with a meaningful choice of activities and are able to participate or not, this is dependent on their own choice. During our visit people were watching the local news bulletins, completing the crossword and playing cards. Within the annual quality assurance assessment completed by the home, received by us prior to our visit to the service the home informed us that they encourage links with the local community and that Charlton Kings Community Players entertain residents at the home with their performances in the summer and in the lead up to Christmas. Lunch being service on the day of our visit was cottage pie, served with mixed vegetables with sponge pudding and custard for dessert. People were seen enjoying their lunch and afterwards one person told us “I love the food here, its always tasty and plenty of it!”. We noted in individual’s records food preferences, choices and special diets were recorded. Daily records evidenced that staff knew this information and individual’s needs and preferences were adhered to and respected. Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are responded to at this home and there are clear systems and protocols in place to protect those who live at the home from abuse. The home makes sure that as far as possible those living at the home are protected from harm by having robust policies and procedures, however, staff must receive training in adult protection. EVIDENCE: The home has a comprehensive complaints policy, which had been reviewed and updated in October 2008. The policy states that the homes management welcome complaints and look upon them as an opportunity to learn, adapt, improve and provide better services. We viewed the home’s record of complaints and saw that where an issue is raised it had been responded to promptly and dealt with effectively. We had not received any complaints prior to our visiting the home and no issues or concerns were raised with us during our visit. Prior to our visit to the home the manager had sent us some information about a complaint they were investigating, this was discussed with them during this visit and we found that appropriate action had been taken by the manger to investigate and respond as required to the complainant. Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 18 Records of recently employed staff members were viewed and contained personal information and record of identity. Other information seen included, record of previous employment, references, protection of vulnerable adults checks and satisfactory Criminal Record Bureau disclosures. During this visit we reviewed a repeated requirement, which was, that the registered person must ensure that all staff attend accredited ‘Adults at risk training’. Some discussion took place with the manager about this. We saw within the minutes of the last staff meeting that staff responsibility in respect of reporting abuse and allegations had been discussed, we saw that staff were aware of their responsibility to report through the home’s internal ‘whistle blowing’ procedures and that they should also report allegations to the local authority and if necessary the police. A review of staff training found that only one member of staff has completed training in this area. This repeated requirement had not been met. Some discussion took place with the manager about the difficulties the home has experienced in finding places for staff for this training, however the timescale given for compliance was that training should have been completed by 31st March 2008. The home must arrange this training as a matter of priority and must also confirm to us that this training has been requested and completed for all staff. We made a requirement during our previous visit that the ‘Alerters Guide’ must be available to staff for reference. We saw this document in place and staff confirmed to us that they had read it and were aware of its contents. Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Bafford House is comfortable, clean, tidy and well maintained. EVIDENCE: Bafford House is the sole care home of Mr and Mrs Ramnial. The building is circa 1760 and has been adapted over the years to provide fifteen single rooms and two double rooms, although the double rooms are used for single occupancy. The home is set within impressive grounds and the home has recently won a silver award in the Cheltenham in bloom competition. Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 20 The lounge was comfortable and homely and there was a separate dining room for people to have their meals. The home also has alarge pleasant garden area for residents use. We saw a number of individual’s rooms and saw that these had been personalised with photographs, pictures, plants and soft furnishings, all were well decorated to a good standard. Within the last twelve months two bedrooms have been redecorated. On the ground floor we noted security cameras in the corridor, the deputy manager told us that these did not work. The manager/proprietor Mrs Ramnial also confirmed that these cameras were not in use. When asked why they were there we were informed that they had formally been used in order that staff may respond should someone fall in this area. The home is reminded that use of such cameras is not acceptable and would be seen as an invasion of privacy, if these are not in use then it is suggested that they are removed. Lighting within the home is domestic in style and of a good standard, emergency lighting is provided throughout the home, this is checked on a monthly basis. The home has sufficient toileting and bathing/showering areas for individuals’ use. These areas are close to people’s rooms. The temperature in the home at the time of our visit was warm and comfortable. The home is appropriately adapted to meet the needs of the current group of people who live in the home. Specialist equipment has been obtained for individual’s following identified need; examples of these include mobility aids, sensory aids, continence aids and equipment to assist with manual handling. We also saw a passenger lift and a hoist is in place to support those with limited mobility. The manager confirmed that this equipment is well maintained and serviced by an appropriate contractor on an annual basis. Within an individuals care file we noted that they had a bed rail in situ in order to prevent them falling out of bed at night. We found that there was no risk assessment in place for this aid and also that there was no consent form to evidence that discussion and agreement of this aid had taken place and to further demonstrate that it is not being used as a form of restraint. It is required that a full, recorded risk assessment is completed for the use of this equipment in order to review any potential hazards and where possible, eliminate these and reduce the likelihood of injury to the individual. Also it is required that written consent is obtained in respect of the use of this piece of equipment to evidence that consultation re the use of this aid has been undertaken. At this visit all areas seen were clean, tidy and odour free. Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that all staff have been employed following robust recruitment and selection processes. Staff are trained to support older people, and some core skills training has been undertaken by staff, however training in other core areas such as first aid and manual handling is required. EVIDENCE: There is a well-established staff team at Bafford House. During the visit the manager and staff were able to demonstrate a clear understanding and knowledge of the individuals who use the service, and of their role in the home The manager was able to demonstrate that she and the staff team have developed good relationships with those who live at the home and have a sound understanding of their needs, wishes and aspirations. These are well recorded in individual’s records. We viewed rotas for the forthcoming three weeks and saw that staffing provision appeared to be consistent with levels and skills needed due to assessed care needs of the individual’s. The staff team have a varied range of knowledge and skills, they were observed by us to be good listeners, effective communicators and were interested and motivated in meeting the needs of Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 22 those living at the home. On duty on the day of the visit was the Registered Manager; two care staff, a cook, a general handyperson and domestic staff. Mrs Ramnial confirmed that at night there are two members of staff, who are awake, to support people. Information contained within individual staff files were all of a consistent standard. The files for two staff were reviewed; including the most recently recruited staff member. All of the required documentation was in place in respect of robust recruitment and selection practices. The recruitment files for two members of staff were seen. It was found that all of the checks and records required had been complied with, including two references being taken up, a Criminal Record Bureau check and clearance from the register of people deemed unsuitable to work with vulnerable adults had been checked before the staff started working at the home. At a previous visit we had required that the induction record for all new staff must be fully completed, signed and dated. We reviewed the training for the most recently appointed staff members and saw that the induction training record was detailed. Records in place showed that staff had covered areas within their induction such as the individual care and support of the people living at the home, health and hygiene, policies and procedures, the importance of record keeping, risk assessment processes, security of the home and the protection of vulnerable people. This requirement had been met. A review of staff training at the home evidenced that staff have undertaken training in areas such as the Mental Capacity Act, Deprivation of Liberty Safeguards, Medication competency and Dementia Awareness. During our last key visit to the service in December 2007 a requirement was made that all staff must have accredited training in the Mental Capacity Act 2005. We saw recorded that three staff members have completed this training and a further two more staff are booked to complete this within the next few months. The manager of the home is aware of the significance of this training for staff and that this is an area in which all staff are required to have an awareness of their responsibility. We also noted that kitchen staff have attended a two day course in care catering at the Food Centre in Cirencester. The deputy manager of the home has completed a National Vocational Qualification (NVQ) at Level 4, and has also commenced a Leadership and Management in Care qualification. Four staff have completed an NVQ in care at level two, with a further two staff who have commenced training in this award. During a previous visit to the service a requirement was made that staff must receive appropriate accredited training in a timely manner to underpin their knowledge to care. This requirement has not been met. We noted that three staff have not received training in first aid, two staff completed health and safety training in the workplace in 2006 and only one staff member has a current manual handling training certificate in place. Core training is compulsory for all staff and it is required that staff must Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 23 receive training in both first aid and manual handling in order that they can safely meet the needs of people living at the home, both on a day to day basis and also in the event of an emergency. Furthermore to evidence that training has been completed it is recommended that a training matrix is developed in order to record training achieved and to also identify further training and development required for staff. During this visit we saw that staff were respectful to those who live at the home and their privacy was respected. Staff spoke to people living in the home discreetly and politely, doors were knocked before entering and staff were heard asking permission and did not presume that it was okay to enter. Bafford House Rest Home DS0000016378.V374944.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36, 37, 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home benefits from good management; its practices have offered protection to the health and safety of those who live at the home. The home is run in the best interests of those who live at the home ensuring that individual’s interests and rights are promoted and protected by a committed staff team. Improvements are required within the recording of risk assessments and fire safety instruction. Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 25 EVIDENCE: Bafford House is privately owned and the proprietors are Mr M and Mrs C Ramnial who have owned Bafford House since October 1987. Mrs Rosa Ramnial is the Registered Manager. During our last key visit to the service a requirement was made that the Home must have a Registered Manager that has completed NVQ level 4 in management. The current manager Mrs Ramnial is a qualified nurse, however she has not maintained her nursing registration. Mr Ramnial is also a qualified nurse; he has maintained his nursing registration. The deputy manager in post is National Vocational Qualified at Level four in care management and is also in the process of completing a course in leadership and management in care. Mrs Ramnial believes she is suitably experienced, appropriately qualified and committed to improving the quality of life for the people who live at the home. People living in the home spoke positively of the care provided. Practice observed was of good relationships between those who live at the home, staff and management. Mrs Ramnial is not happy with this requirement and has requested that it be removed. The reasons for this requirement were discussed at this visit and it was suggested that in order that consideration may be made for the removal of the requirement in respect of the managers qualification Mrs Ramnial should put her reasons for this in writing to the local area manager for their consideration. Both Mr and Mrs Ramnial and the deputy manager fully engaged with us during this visit and were able to locate all necessary information and documents easily. This evidences that the home has good systems in place and is well run. During this visit we reviewed a repeated requirement, this was that 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. Prior to the site visit the Commission received from the registered provider a completed annual quality assurance assessment. The annual quality assurance assessment (AQAA) is a process that is being used for all regulated services from April 2007. The AQAA is in two parts: Part one is a self-assessment, part two is a dataset. It is a legal requirement for all services to return an AQAA to the Commission. The document received from the home was fully completed and sufficiently detailed. In response to the question within the AQAA ‘What the service does well’, the response from the home was; “We remain committed in running Bafford House in the best interests of our service users. We do not compromise with care and the day to day running of the service”. We also noted that the home has a low level of complaints, there are regular staff meetings and individual supervision which provides an opportunity for staff to air their views Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 26 about how the home is run. The manager appears to have an open management style, people and visitors that we spoke with told us that the manager is friendly and is always available should there be any queries or questions. During our last key visit to the service a requirement was made that the Registered Manager must ensure that all staff receive formal one-to-one supervision at a minimum frequency of six times a year. During this visit we reviewed a number of staff files. These staff files contained evidence of supervision and positive comments were noted in the feedback to staff. Frequency of supervision was generally good and staff had received the required sessions. Areas of discussion included guidelines and policies of the home, individual’s expectations and an evaluation of their performance and how this can be developed. Risk assessments were in place which identified potential hazards at the home, the people who may be affected, existing controls, the degree of the risk and what actions were required to control the risks, the areas of assessment covered use of cleaning materials, smoking, use of kitchen, electrical and gas equipment. We noted that there is a steep metal, spiral staircase leading from the hall down to the basement area, also one person has patio doors leading out to a balcony on the first floor. It is required that risk assessments must be completed to record that areas of potential risk have been evaluated and where possible eliminated. We noted through examination of an individuals records that they have bedrails on their bed. We were told that this was to prevent them from possibly falling out of bed. It is required that a risk assessment must be completed in respect of the use of bed rails. This is to ensure that all potential risks have been identified and where possible eliminated. Furthermore a consent form should also be in place to evidence that discussion and agreement to the use of this aid had taken place and to also demonstrate that it is not being used as a form of restraint. We viewed the fire logbook for the home. The home was completing the appropriate checks on the fire equipment and the recording of fire drills and the testing of equipment were satisfactory. We saw the fire panel in working order. The home has a fire risk assessment in place, which outlines requirements under the Fire Precautions Act, the assessment identifies potential sources of ignition, structural factors for consideration, current fire detection, equipment and warning systems in place and the recording of the recommended control measures which are in place. We asked about staff fire instruction and were given dates of when drills and instruction had been completed, this information was held in differing places and was unclear. It is required that records of fire safety instruction must be better maintained. This is to evidence that all staff have received sufficient amounts of fire instruction Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 27 and training in order to respond appropriately to support those living at Bafford House should a fire occur. The manager told us that all of the water taps used by residents within the home are thermostatically controlled and are safe. Whilst we did not note any concerns over the temperature of the hot water during our visit it is recommended that the home checks hot water temperatures on a regular basis and that these checks are recorded in order to ensure their continued safe use. Bafford House Rest Home DS0000016378.V374944.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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X 3 3 1 Bafford House Rest Home DS0000016378.V374944.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 OP38 Regulation 13(4) Requirement A risk assessment must be completed in respect of the use of bed rails. To ensure that all potential risks have been identified and where possible eliminated. Ensure all staff attend accredited Adults at risk training. (This is a previous requirement repeated) Timescale for action 31/05/09 2. OP18 13(6) 30/06/09 3. OP38 12(2) A consent form should also be in 31/05/09 place in respect of the use of bed rails. This is to evidence that discussion and agreement of this aid had taken place and to also demonstrate that it is not being used as a form of restraint. Records of fire safety instruction must be better maintained. This is to evidence that all staff have received sufficient amounts of fire instruction and training. Staff must receive training in both first aid and manual handling. The Home must have a Registered Manager that has DS0000016378.V374944.R01.S.doc 4. OP38 17(2) 30/04/09 5. 6. OP30 OP31 13 (4)(5) 9(2)(b)(i) 30/06/09 30/10/09 Bafford House Rest Home Version 5.2 Page 30 7. OP38 13(4) completed NVQ level 4 in management. Risk assessments must be completed to record that areas of potential risk have been evaluated in respect of the spiral staircase and a balcony leading from an individual’s bedroom. 30/04/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP38 OP30 Good Practice Recommendations It is recommended that the home check hot water temperatures on a regular basis and that these checks are recorded in order to ensure their continued safe use. It is recommended that a training matrix is developed in order to record training achieved and to also identify further training and development required for staff. Bafford House Rest Home DS0000016378.V374944.R01.S.doc Version 5.2 Page 31 Care Quality Commission South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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