CARE HOMES FOR OLDER PEOPLE
Bakers Court Nursing Centre 138-140 Little Ilford Lane Manor Park London E12 5PJ Lead Inspector
Seka Graovac Unannounced Inspection 12:10p 19 January 2006
th 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 Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 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. Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Bakers Court Nursing Centre Address 138-140 Little Ilford Lane Manor Park London E12 5PJ 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) 020 8514 3638 020 8553 2603 ANS Homes Limited Mr Christopher Stringer Care Home 78 Category(ies) of Dementia (0), Mental disorder, excluding registration, with number learning disability or dementia (0), Old age, not of places falling within any other category (0), Physical disability (0) Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. MINIMUM STAFFING NOTICE The home can admit anyone under the above category from the age of 60 years or older. 18th April 2005 Date of last inspection Brief Description of the Service: Bakers Court Nursing Centre is registered with the Commission for Social Care Inspection to provide care to up to 78 people with general nursing needs, physical disability, dementia or/and a mental health diagnosis who are over 60 years old. The centre is situated in Manor Park area of Newham and is easy to access by public transport. There is ample parking available for visitors within the grounds of the Centre as well as on the surrounding roads. The premises are purposly built and all the bedrooms are single with en-suite facilities, equipped with the nurse-call sytem, television and telephone point. The ground, first and second floor are connected via 2 lifts and the staircases. Each floor is run as a seperate unit. The ground floor caters for people with general nursing needs, physical disability and mild to moderate dementia. The first floor is for people with a mental health diagnosis (including dementia), while the second floor unit provides continuing care. The premises are fully wheelchair accessible. The designated catering team provides three meals a day and also tray service for people who prefer to eat in their own bedrooms or are unable to leave their beds. Renault People Carrier is also available. Bakers Court Nursing Centre is owned by Bupa. Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and lasted approximately five hours. The main aims of the inspection were to check the Bakers Court Nursing Centre’s progress towards achieving full compliance with the requirements that had been made at the previous inspection and also to assess the service against the key National Minimum Standards that had not been covered in the April’s visit. The Bakers Court Nursing Centre together with the other services belonging to ANS Homes Limited have been bought by BUPA since the previous inspection. The inspector spoke to the Registered Manager and his Deputy, two Registered Nurses and a number of service users, including a short individual interview with one of them. The inspector saw all communal areas on the first floor and went to one bedroom with the service user. She viewed two files containing information regarding the individual service users and other records such as: staff training records, records of one-to one meetings, records of the individual service users’ money, etc. The inspector also checked a sample of the medication records and the related medicines kept on behalf of the service users on the top floor. What the service does well:
The Bakers Court Nursing Centre was well rmanaged and in best interest of service users. The service users seemed comfortable and well cared for. Their care needs assessments and related care plans also indicated that their health care needs were met. The service users’ individual files contained evidence that the Centre had good liaison with other health care professionals in order to maintain and promote service users’ health. Service users’ independence was promoted and their choices were respected. No protection of vulnerable people (POVA) issues were raised during the inspection. The service users made only positive comments about the service in their conversations with the inspector. The first thing that the service users told the inspector when asked about the service was how nice the staff were: “Really nice”, “Great staff”, “Always kind”, “Very pleasant staff”. Wherever the inspector went during her visit to the Centre, she saw staff being engaged with the service users. It was evident that the Management regularly
Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 Page 6 reviewed the staffing levels and was in consultation with the Commission regarding possible changes. One service user on the continuing care unit had an additional staff that provided one-to-one care every day for six hours. Another service user from the mental nursing care unit had one-to-one care at all times. This was provided by the Primary Care Trust. Staffing levels were adequate. Staff training was appropriately planned. The environment was safe, well maintained and clean on the day of the inspection. What has improved since the last inspection? What they could do better:
Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 Page 7 The inspector was concerned that the requirement regarding the Centre’s dealing with medication had to be restated. In order to secure the safety and wellbeing of service users, the Centre’s Registered Persons must ensure that the appropriate procedures for dealing with medication (including records) are implemented at all times. The inspector also noted that some of the examined service users’ individual records did not contain all required information and discussed the improvement needed in with the Management of the Nursing Centre. The Registered Persons must ensure that the required individual service user’s records are kept. This includes risk assessments and care plans regarding use of lifting aids and also evidence of the centre’s reasonable attempts to obtain Next of Kin information and facilitate the contact. 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. Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 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 Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 0. Not assessed on this occasion. EVIDENCE: All key standards relating to Choice of Home were assessed as met at the previous inspection conducted in April 2005. The Bakers Court Nursing Centre did not provide intermediate care. Some service users were placed short-term. Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8, 9 and 10. Although the Centre provided good nursing health care, this was compromised by failure to implement the appropriate procedures for dealing with medication at all times. EVIDENCE: The service users seemed comfortable and well cared for on the day of the inspection. Their care needs assessments and related care plans also indicated that their health care needs were met. The service users’ individual files contained evidence that the Centre had good liaison with other health care professionals in order to maintain and promote service users’ health. The inspection process indicated that service users’ privacy and dignity were respected. However, the inspector was concerned that there were still gaps in service users’ medication administration records. Some other issues regarding medication were identified at the inspection, for example: what was the correct daily dose of the certain medication (the instruction on MAR sheet and the staff
Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 Page 11 signatures following the administration were conflicting), was the particular cream discontinued or did the staff fail to apply it as prescribed. The requirement regarding the Bakers Court Nursing Centre’s dealing with medication had to be restated. In order to secure the safety and wellbeing of service users, the Centre’s Registered Persons must ensure that the appropriate procedures for dealing with medication (including records) are implemented at all times. Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14. Service users’ independence was promoted and their choices were respected. EVIDENCE: The inspector spent some time on the first floor unit that caters for people with mental health diagnosis, including dementia. The service users moved freely through the communal areas and spent time in their bedrooms when they wanted to. The inspector witnessed a service user asking a staff member to leave their bedroom and their wish was respected without questioning. The inspector was told that all the bedrooms were lockable and one person was given a key as he wished. Some service users had particular ways of dressing that they themselves chose. Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18. Service users were protected from abuse. EVIDENCE: No protection of vulnerable people (POVA) issues were raised during the inspection. The service users appeared well and comfortable. They made only positive comments about the service in their conversations with the inspector. The management of the Centre was experienced and appropriately dealt with the allegations that had been made in the past. The inspector was informed that fifteen staff have attended POVA training since the previous inspection and more staff were due to attend the related training. BUPA policies and procedures arrived on the day of the inspection. Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. The environment was safe, well maintained and clean on the day of the inspection. EVIDENCE: The areas of the Centre that the inspector saw were well maintained, clean and safe. The inspector was informed that since the previous inspection, new flooring has been fitted to some bedrooms and lounges, new chairs have been bought for lounges and bedrooms and two raised flower-beds in the garden have been made available to wheelchair users who enjoyed gardening. Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30. Staffing levels were adequate. Staff training was appropriately planned. EVIDENCE: Wherever the inspector went during her visit to the Centre, she saw staff being engaged with the service users. It was evident that the Management regularly reviewed the staffing levels and was in consultation with the Commission regarding the possible changes. More hours for activities-coordinator have been approved and one of the carers (in addition to the activities-coordinator) would be focusing a half of her working hours on arranging the activities for service users. The care hours have not been reduced. One service user on the continuing care unit had an additional staff that provided one-to-one care every day for six hours. Another service user from the mental nursing care unit had one-to-one care at all times. This was provided by the Primary Care Trust while more appropriate placement was being arranged for this person. Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 Page 16 The first thing that the service users told the inspector when asked about the service was how nice the staff were: “Really nice”, “Great staff”, “Always kind”, “Very pleasant”. The staff training plan for the Bakers Court Nursing Centre was available. Staff training records were appropriately kept. The Deputy Manager was keen to see the positive outcomes for service users after the training had been attended. She also encouraged registered nurses to expand their knowledge in specific areas of nursing expertise. Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 36, 37 and 38. The Bakers Court Nursing Centre was well run and in best interest of service users. However, some aspects of recording must be improved. EVIDENCE: The Registered Provider conducted regular monitoring visits and produced reports on the conduct of the Care Centre. The reports were available in the Centre and were also sent to the Commission for Social Care Inspection as required. Monitoring of use of the nurse-call system has improved as it was fitted with a print-of device. Bakers Court Nursing Centre had the “Investors in People” award. Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 Page 18 The inspector was told that the annual satisfaction with the service survey was conducted in December 2005 by an external company. The Centre was awaiting the results. The staff received formal supervision on a regular basis. The inspector viewed the records of the meetings held. The Deputy Manager supervised all the Registered Nurses and two Sisters supervised care staff. Some of the meetings included being on the floor, observations and discussions regarding care provision. The service users’ money was pooled. The appropriate records were held that made clear how much of this money belonged to the individual service users at all times. The receipts that evidenced the expenditure and the signatures were kept as well. Although the inspector saw many examples of good recording during the inspection, she also noted some instances where the staff have failed to maintain the appropriate records. For example: the inspector observed a staff member safely assisting one service user to use a standing hoist, but this was not recorded anywhere in his notes, neither assessment or care plans. The inspector also read that a service user who according to his notes did not have any contact with his family or Next of Kin, was visited by the family before Christmas, but no further details were recorded. The Registered Persons must ensure that the required individual service user’s records are kept. This includes risk assessments and care plans regarding use of lifting aids and also evidence of the centre’s reasonable attempts to obtain Next of Kin information and facilitate the contact. Since the previous inspection, the fire-doors have been fitted with the doorguards that meant enhanced fire-safety while respecting the service uses’ choices or needs to have their bedroom doors open. Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTExCTION Standard No Score 16 X 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 3 2 3 Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes, one. 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 In order to secure the safety and wellbeing of service users, the Centre’s Registered Persons must ensure that the appropriate procedures for dealing with medication (including records) are implemented at all times. The previous target for compliance with this requirement expired on 30/04/05. The Registered Persons must ensure that the required individual service user’s records are kept. This includes risk assessments and care plans regarding use of lifting aids and also evidence of the centre’s reasonable attempts to obtain Next of Kin information and facilitate the contact. Timescale for action 31/01/06 2 OP37 17 28/02/06 Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bakers Court Nursing Centre DS0000007352.V255071.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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