Inspection on 23/07/08 for Bakers Court Nursing Centre

This inspection was carried out on 23rd July 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bakers Court Nursing Centre 25/03/10

Bakers Court Nursing Centre 07/05/09

Bakers Court Nursing Centre 28/02/08

Bakers Court Nursing Centre 25/04/06

Bakers Court Nursing Centre 19/01/06

Bakers Court Nursing Centre 18/04/05

Bakers Court Nursing Centre 06/09/04

Bakers Court Nursing Centre 13/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Bakers Court Nursing Centre 138-140 Little Ilford Lane Manor Park London E12 5PJ Lead Inspector Anne Chamberlain Unannounced Inspection 23rd July 2008 8:30 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.V368939.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. Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 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 stringch@bupa.com www.bupa.co.uk BUPA Care Homes (ANS) Ltd Mr Christopher Stringer Care Home 78 Category(ies) of Dementia (78), Mental disorder, excluding registration, with number learning disability or dementia (78), Old age, of places not falling within any other category (78), Physical disability (78) Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to residents of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (of following age range: 55 years and over) Dementia - Code DE (of following age range: 55 years and over) Mental disorder, excluding learning disability or dementia - Code MD (of following age range: 55 years and over) Physical disability - Code PD (of following age range: 55 years and over) The maximum number of residents who can be accommodated is: 78 2. Date of last inspection 10th July 2008 Brief Description of the Service: Bakers Court Nursing Centre is registered with the Commission for Social Care Inspection to provide care to for up to 78 people with general nursing needs, physical disability, dementia or/and a mental health diagnosis. The centre is situated in the 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 purpose built and all the bedrooms are single with en-suite facilities. They are equipped with the nurse-call system, television and telephone point. The ground, first and second floor are connected via 2 lifts and the staircases. Each floor is run as a separate 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 Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 5 dementia), while the second floor unit provides continuing care. The premises are fully wheelchair accessible. The designated catering team provide 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. Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this home is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was undertaken on behalf of the Commission for Social Care Inspection (CSCI). The terms we and us will be used throughout the report. The service submitted an Annual Quality Assurance Assessment (AQAA) before the site visit. This document was well completed and provided a great deal of useful information about the service. The site visit was conducted by two inspectors and the duration was eleven hours, on one day. We were assisted by the registered manager of the service, a quality and compliance officer, and various staff members. We spoke with a number of residents and one of us had lunch in the dining room with residents. As part of the inspection we looked at the files of six residents in some depth, cross checking documentation. The site-visit included a tour of the environment of the home. In addition three random inspections of this home have been undertaken since the last key inspection, on 21/04/08 by the CSCI pharmacist inspector, on 01/07/08 by the CSCI pharmacist inspector and on 10/07/08 by the lead inspector in response to a complaint. Two statutory requirement notices were issued on 02/06/08 following the inspection of the home by the pharmacy inspector. The home’s compliance with these notices was assessed both during the inspection by the pharmacist inspector on 01/07/08 and during this inspection. The inspectors found that the statutory notices had been complied with. At the random inspections on 21st April 2008 and 1st July 2008 the commission’s pharmacist inspector found further areas for concern regarding the arrangements for recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. A warning letter was issued to the provider on 13th August 2008 because of those concerns. We would like to take this opportunity to thank the residents, registered manager and staff of the home for their assistance and co-operation with the inspection. Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: This inspection resulted in three statutory requirements and three good practice recommendations. Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 8 Medication administration practice needs further improvement and more vigilance by senior staff responsible for auditing it. Care plans must carry all necessary detail, i.e. normal ranges for blood sugar monitoring, and unsound medical advice must not appear in them. Plans for wound management must be properly carried out. The values of privacy, dignity and respect should be evidenced at all times by managers and staff. 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. Bakers Court Nursing Centre DS0000007352.V368939.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 Bakers Court Nursing Centre DS0000007352.V368939.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5 and 6. Residents experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. No resident moves into the home without having their needs thoroughly assessed first. There is an opportunity to visit and an early placement review is always undertaken. EVIDENCE: The home has an assessment tool for assessing the needs of prospective residents. It is called QUEST and the registered manager states on the AQAA that it has been developed to ensure high levels of person centred care. We examined six residents files and were pleased to note that there were preadmission assessments in place for all six residents. Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 11 We checked most assessments to see if they included information on whether residents had any allergies or not, and if so what these allergies were. Four people had allergies/adverse reactions. They did. The assessments were looked at in depth and were of a satisfactory standard. They were clear and comprehensive. Assessments are drawn up on a pro forma, with various sections, for example around health and personal care, mental state and cognition, eating and drinking and medication. A scoring system is used in each section to denote the level of support that is required, with a space for further information on this. There is also a section to provide details of what further action needs to be addressed through the care planning process. For example, one assessment stated that the resident was at high risk of pressure ulcers, and went on to say that a pressure ulcer risk assessment must be put in place. The same assessment stated that the resident was at risk from falls from their bed, and that bed rails should be used, but that a risk assessment needs to be in place for this. Other assessments examined were of a similar standard, setting out the needs of the resident, and what level of support they would require. The manager states on the AQAA that prospective residents are given the option of a trial in the home. In discussion he acknowledged that many of the residents admitted to the home come straight from hospital and are not able to take up this opportunity, but pointed out that all placements are reviewed after six weeks. If a person is not happy at the home they can move out at that point or before. The AQAA states that regular mystery shops are conducted to ensure that the home is providing the correct information to enquirers. This is excellent quality assurance practice. The home does not accept residents for intermediate care. Bakers Court Nursing Centre DS0000007352.V368939.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. People experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Care plans are good and health and care needs are met. Medication practice is flawed. Respect, dignity and confidentiality are not always upheld. EVIDENCE: We examined six individual care plans. These were found to be based upon the pre admission assessments, and were subject to regular review. So for example, as mentioned earlier in this report, the assessment for one resident stated that a pressure ulcer risk assessment must be in place, along with a risk assessment around the use of bed rails, and both of these documents were in place as part of their care plans and were of a satisfactory standard. Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 13 Plans checked included risk assessments around eating and drinking, with action plans linked to the degree of risk present. All residents have their weight checked, and for those at low risk this is done monthly. For those at medium or high risk this is done weekly. Records were in place to indicate that residents’ weights were been checked appropriately. Likewise, comprehensive records were maintained of food and fluid intake for residents. Daily logs are also maintained to record any significant events on a particular day. Care plans contain information around end of life care. All but one of the care plans seen were of a satisfactory standard. However, the inspector had serious concerns around the information contained on a care plan for one resident around their diabetes. The plan states that they are at high risk and that blood sugar levels should be checked twice a day. There was evidence that these checks are taking place but the care plan gave no indication of what are safe upper and lower blood sugars levels for this individual. The inspector discussed this with the nurse on duty, who said that the diabetes nurse was supposed to help draw up individual guidelines for managing residents with diabetes. It was positively noted that there was evidence that this resident has had involvement from the diabetes nurse but there were no guidelines in place as to what were the safe levels for blood sugar. It is required that care plans are comprehensive, and contain sufficient information to enable the home to provide appropriate and safe support to residents. It was further noted that the care plan on managing diabetes stated, “Report any hypo and hyper glycaemia and take necessary action, i.e. give a glass of milk with sugar and check blood sugar again.” We contacted Newham Primary Care trust on the diabetes issue and spoke with the Director of Nursing. They contacted their diabetic nurse who said that sugar and milk should not be administered, as the milk slows down the absorption of the sugar into the blood stream, and that a high energy fizzy drink should be administered. They said the diabetes nurse had phoned the home to provide this information, and that she would be visiting the following week to ensure that the home’s guidance had been amended. They said that if it had not the they would get back to us. At the time of writing we have not heard any more from them. The three floors at the home all have a registered general nurse in charge. The six residents whose files we inspected had a variety of complex health needs. These are met at the home through a well-structured system of monitoring. Residents all have a General Practitioner (GP) who is consulted appropriately for treatment and advice. Records evidenced that residents have access to a variety of health care professionals including GP’s, consultant psychiatrists and dental care. In addition, the home itself provides nursing care to residents. Routine health related checks are carried out, for instance on weight and blood pressure. Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 14 Staff informed the inspector that a resident on the ground floor unit currently has a pressure ulcer. We were pleased to note that the home has involved the tissue viability nurse in the provision of care to this resident. There was a risk assessment in place for managing the ulcer. The assessment dated the 18/06/08 states that the dressing on the pressure ulcer should be changed every three days. However, records indicated that the dressing had not been changed for a five day period between the 28/06/08 and 3/07/08, and again, that the dressing had not been changed over a four day period between the 19/07/08, and the day of inspection the 23/07/08. There was a random inspection on 10/07/08 in response to a complaint about pressure sores and the requirement was made under 13 (4)(c ) The registered manager must ensure that all steps are taken to reduce any risk to the health of residents. It had a compliance timescale of 31/08/08 and is therefore ongoing. The same resident uses a PEG tube for feeding. The home has involved the dietician in the provision of care to this resident. The risk assessment dated 27/10/07 states that the PEG tube dressing needs to be changed daily to prevent cross infection. Records indicated that this had not been done on the 30/06/07 and the 2nd, 17th and 22nd of July 2007, four days within the past month. In order to promote the health, safety and welfare of residents, it is required that nursing support is provided as appropriate, in line with residents assessed needs. We noted that charts were not always perfectly maintained. There were some errors in the monitoring of fluids etc. where figures were ambiguous and millilitres of fluid were not correctly added up, but the systems are good and there are inbuilt triggers which escalate actions should deterioration occur. There is an ongoing requirement in place about medication procedures that is not due to be assessed until after 31/08/08. There were no discrepancies identified in medication procedures on this inspection. It was however impossible to count tablets loose in bottles because the nurse was unable to provide us with a tablet counter (a device for counting tablets without touching them) We believe this an essential piece of equipment for this home and we have recommended that three tablet counters are acquired, one for each floor. As mentioned earlier in this report, we checked the allergies section on the majority of pre-admission assessments. Four of these indicated that the resident had an allergy to a medication or medications. The inspector checked the Medication Administration Record (MAR) charts for these four residents. Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 15 Three of them included the information on allergies that was detailed within the pre admission assessments. However, for one resident, their pre admission assessment clearly stated that they have an allergy to Beta blockers. The current MAR charts for this resident dated between the 04/07/08 and the 15/08/08 stated “None known” under the heading allergies. The inspector brought this to the attention of the homes registered manager, who was unable to offer an explanation for the discrepancy. Later on during the inspection, the quality and compliance officer at the home produced a Clinical Data sheet that had been faxed to the home from the resident’s GP that day. This states “ALLERGIES: 22/02/2008 Adverse reaction to beta blockers: due to poor glucose control for diabetes. The quality and compliance officer said that as it was an adverse reaction and not an allergy, this information would not necessarily need to be included on MAR charts. The registered manager has not taken the opportunity of the AQAA to tell us much about how the home ensures privacy and dignity for residents. It does state that resident care is focussed on being person centred, supported by the Person Best programme. We noted that in care plans, carers were instructed to approach the resident and explain to them whatever procedure was about to happen. Much of the interaction between staff and residents was respectful and pleasant. However there were seven negative incidents observed some of which raised considerable concerns in us. On one occasion we were with a nurse who was undertaking personal care with a resident. This resident was laying in bed, very sleepy. She was blind and able to communicate very little verbally. The nurse seemed very kindly and well meaning, but she did take a hairbrush out of a drawer and brush the residents hair without warning in her in any way. We mentioned that the resident had grazed her leg at one point and the carer raised the sheet to show the inspector the graze without any reference to the resident. On another occasion we were talking with a carer who was working with a resident. A jar of cream was on a side table and the inspector enquired about this. The carer raised the sheet and pulled down the residents net pants to show the inspector where the cream is used. Again this was with no reference to the resident. We had a discussion with the registered manager about complaints. We were interested in whether a negative verbal comment from a relative might be treated as a formal complaint or not. An example from a residents file was given. The registered manager gave us a lot of information about the residents background and about his family and the perceived family dynamics. Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 16 We tried to make it clear to the registered manager that it was the procedure regarding complaints which we were interested in rather than the background to a particular comment or complaint. This did not have the desired effect of restricting the flow of information. A member of the administrative staff contributed to the conversation, freely giving their view that the resident was very manipulative. Later this same person was heard by the inspector joining in a discussion about a resident which was taking place in the reception area. She was heard to say whatever you do he aint going to be happy is he. The sixth incident concerned an observation which we made in the residents lounge on the ground floor. In this room standing on two chairs pushed together was a very large very full box of files. The files on the top were pink and quite fat with elastic bands around them. They all bore the names of previous residents and had the word deceased written very clearly in black. This is a breach of confidentiality and also insensitive towards the current residents of the home. The seventh incident occurred in the dining room where the nurse was working with residents, bringing them in to lunch. She turned the radio on without asking any of the residents if this is what they wanted. There will be further discussion of these concerns later in the report under the heading of Ethos. We observed on the residents’ files which we viewed, documentation to show that the wishes of the resident or their relatives regarding their death and dying had been sought and recorded. Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 17 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 and 15. People experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. It is the our judgement that residents are supported to live valued lives, with a varied activities programme, and that food provided is of a satisfactory standard. EVIDENCE: The home employs a full time activities coordinator, who is supported by a member of staff who works two days a week on activities, the rest as a care assistant. There was an activities programme displayed within the communal areas of the home, this indicated various activities are provided, including movement to music, arts and crafts and a film club. Photographs were on display around the home of residents engaging in the various activities. On the day of inspection a bingo session was arranged, which ten residents chose to take part in. The inspector sat in for part of this session, and Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 18 residents were observed to be enjoying this. It was positively noted that staff support was provided in a way that encouraged participation. Other activities provided include music, television, painting, cooking and beauty treatments such as manicures. The home holds occasional parties, for example to celebrate birthdays, and recently held a garden fete. About ten residents visit a weekly social and luncheon club. The home has a designated activities room, and also a library. Daily newspapers are available to residents. We noted that some residents who are quite poorly and spend a lot of time resting in beds had televisions playing in their rooms. We were told that this was to provide background music. The TVs were quite loud and delivered inappropriate programmes with talking rather than music. This was pointed out to the registered manager. A priest visits the home and gives Holy Communion, while a vicar visits weekly to provide a Church of England service, helping to meet residents’ equality and diversity needs. We noted one resident had a palm cross in her room, such as are handed out in the Christian church at Easter, and also a crucifix evidencing that this resident was able to enjoy expression of her religious views in her own room in the home. The home also arranges for outside professionals to come in to provide activities. One resident commented “A guy comes in with a guitar, we do exercises with him and sing.” and “We have the music man on Fridays, we all join in.” A daily menu planner was on display. Staff and residents informed the inspector that residents are asked a day in advance to choose their preference for the next days meals. On the day of inspection the menu indicated that for lunch there was a choice of turkey salad, liver and onions or breaded chicken. There was also a set list of various items residents could choose from if they did not want any of the meals from the daily menu. Residents are offered a cooked breakfast twice a week, and a cooked meal for lunch and dinner daily, along with drinks and snacks throughout the day. Food served on the day of inspection appeared appetising and nutritious, and residents spoken to said they enjoyed their lunch. One resident spoken to said the food is very good. A choice of deserts was offered. We asked a resident if drinking water provided was nicely chilled and she said it always is. The kitchen was clean and tidy, and food was appropriately stored. Records are maintained of fridge and freezer temperatures. Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18, People experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Complaints are considered seriously and residents are safeguarded by the protection policy and procedure in place. EVIDENCE: The registered manager stated in the AQAA that BUPA has a clearly defined complaints policy with agreed timescales for managing complaints. The information that accompanies the policy is prominently displayed in the home. The policy includes a three tier framework including the home, the regional management team and the national quality and compliance department. We examined the complaints log and noted that the complaints are clearly listed and given a number. The supporting evidence is contained in a plastic wallet and as complaints are concluded this in indicated in the log. We spoke to the registered manager about whether a complaint has to be written down to be a complaint or whether verbal comments which are negative would be dealt with as complaints. The registered manager said that things which can be easily dealt with verbally and at the time, would probably not be treated as formal complaints. Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 20 We were satisfied that residents and relatives have clear guidance as to how to make complaints and their complaints are dealt with in a structured and timely manner. Since the last key inspection the CSCI has received one complaint regarding the home. The complaint was received on 16th July 2008 a relative regarding the care of a resident. A random inspection was undertaken the next day and a statutory requirement was made. We asked a resident who was sitting in the garden if she knew what to do if anything was amiss. She said she had made a verbal complaint once and it had been attended to promptly and effectively. We asked if she knew who the manager is and she said she did and would feel quite happy about approaching him if she felt she needed to. The AQAA states that BUPA care homes has robust allegation of abuse and neglect policies, allowing staff to raise concerns within the home to senior staff outside of the home. We spoke to the registered manager about how adult protection issues are handled. He said that ultimately they are complaints and would be recorded through that system. Whilst this is not technically incorrect it is a very unusual way to file adult protection issues which are handled quite differently from complaints and can be of a more sensitive and intimate nature. We would recommend that adult protection recording is kept separate from complaints even if from the point of view of confidentiality and access to the material. We discussed with the registered manager the procedure which would be taken should a suspicion or allegation of abuse be made. We were satisfied that he is quite clear that social services must be informed and the CSCI. He also understood that social services will take the lead and through strategy discussions will identify what actions need to be undertaken by whom. Two significant safeguarding concerns have been brought to the attention of the Commission and relevant agencies. The Commission is liaising with these agencies who continue to make enquiries at the time of publishing this report. Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The environment is safe, clean, pleasant and well maintained. EVIDENCE: We made a tour of the home including some residents rooms, the kitchens and garden. The home is clean and hygienic. It is generally in a good state of décor and repair. There are some minor décor issues, like chipped paint, but we understand that there is a cyclical decorating and refurbishment plan and these will be dealt with in due course. Residents rooms are en-suite. They are pleasant and personalised. Bathrooms and toilets are clean and safe and there are sufficient numbers of them. The corridors are pleasant and the communal areas are well furnished and homely. On the day of the inspection however the Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 22 floors on the first floor felt very sticky underfoot and through bedroom doors we noticed the fronts of wardrobes on that floor looked sticky and unpolished. The dining rooms are cheerful and welcoming. The gardens were looking very well cared for with lots of colour. A resident stated that her room is kept tidy for her. The AQAA states that the home has comprehensive policies and procedures for controlling infection and handling clinical waste. There was no evidence of any breaches of infection control procedure. A resident stated that she has clean linen delivered to her room and that her clothes are laundered and ironed as well. Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. People experience good quality in this outcome are. This judgement has been made using available evidence including a visit to this service. It is our inspector’s judgement that the home is staffed in sufficient numbers, and that staff have the appropriate qualifications to carry out their duties. EVIDENCE: The home provides 24-hour support, including waking night staff. All three units have at least one nurse on duty 24-hours a day. On the first floor unit it was noted that it was staffed in sufficient numbers to meet the needs of residents. Staff were seen to react promptly to residents, for instance a resident was observed to inform a passing member of staff that they had put on the wrong glasses, and he staff immediately brought out the correct pair. Staffing levels on the second floor were low at the beginning of the day. The registered manager informed the inspector that four staff had called in sick at very short notice. An agency carer arrived around mid morning, and a staff member from another floor came up to help. The manager made an appropriate response to resolve the staffing shortage on that floor on that morning. Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 24 Through observation and discussion there was evidence that staff have built up good relations with residents, and were seen to interact with them in a friendly and respectful manner. During the course of the inspection there was instances of sensitive and appropriate staff support, for example around mealtimes and activities. Residents spoken to expressed satisfaction with the staff, one commented of the staff “I get on well with them.” While another said “We are being looked after.” All staff are provided with a copy of their job description. The inspector checked several staff employment files at random, and apart from one instance these were found to contain all necessary documentation. There was evidence that all staff have undertaken CRB checks, and provided the home with proof of identity. For all but one of the staff files checked there were two written references in place. For one staff member, there was only one reference in place. This person has worked at the home for a number of years and appropriate documentation was in place for them. We therefore do not intend to take any action at this point. The AQAA indicated that the home has appropriate employment procedures in place, including on equal opportunities and recruitment. Records are in place for staff training. These indicated that staff have access to appropriate training. Recent training has included care planning, safeguarding adults, fire safety, violence and aggression and manual handling. The AQAA supplied by the home indicates that well over 50 of care staff employed in the home have a relevant care qualification. We checked the training records for approximately twelve staff members. We were satisfied that they had received training as appropriate including for nursing staff, on the administration of medications. Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 and 38. People experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The home is well organised and run. However the ethos, leadership and best interests of residents, need to be critically reviewed. The health, safety and finance of residents are promoted. EVIDENCE: The registered manager of the home has qualifications and experience to run the home. He has worked there for many years. He is currently being supported by a home relief manager. Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 26 As discussed previously there were seven incidents where inspectors found that the values of privacy, dignity and respect were compromised and the ethos of the home is not always expessed in in practical ways. The registered manager must communicate a clear sense of direction and leadership to staff, modelling good practice himself. The organisation has a number of mechanisms in place to assure the quality of service. We learned about these through the AQAA and through speaking with the quality and compliance officer who was in the home on that day. There is a regional management team for the home and a national quality and compliance department. Monthly audits are conducted by the regional manager assessing many aspects of care through an early warning audit tool (EWAT). Monthly audit visits are undertaken by regional managers. There is a system of Key Operating Guidelines KOGs to support standards of care. The home invites relatives to the reviews of residents and has a scheme called Resident of the Day where relatives are invited in for a special tea or the resident chooses an activity they would like to partake in. Satisfaction surveys are conducted annually. There are systems in place to assure quality, for example the quality and compliance inspectors. However some of the notifications to CSCI indicate that errors are still not being identified sufficently early. The organisation should give consideration to how they can cross reference audit systems more effectively. Residents may handle their own money and there are lockable facilities in the rooms. The doors to the rooms lock and residents can have their keys. A few residents choose to handle their own money and other have relatives or advocates who assist them with their finances. The home offers safe facilities for the storage of valuables, but does not assist residents to manage their money or hold it for them. Over the course of the day we viewed a great deal of paperwork. We felt that generally the record keeping in the home is good. There were some charts which appeared to be hastily filled in, where figures were ambiguous and the addition of fluids consumed was incorrect, but this was exceptional. The AQAA provided by the home indicates that the home has appropriate health and safety policies in place, including food safety and nutrition, fire safety and first aid. Staff undertake health and safety training, including moving and handling and food hygiene. Fire exits around the home were clearly signed, and free from obstruction on the day of inspection. Fire extinguishers were located around the home, these were last serviced in January 2008. Fire alarms were last serviced on the 14/05/08. The home carries out its own health and safety checks around fire, for example holding Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 27 fire drills and weekly testing of fire alarms. There was evidence that other mechanical equipment in the home is routinely serviced, including lifts and the emergency call point system. The home had safety certificates for gas safety, PAT testing and electrical installation which were in date. The home had employer’s liability insurance cover was in date. Hot water and fridge/freezer temperatures are regularly checked. COSHH products were stored securely on the day of inspection. Bakers Court Nursing Centre DS0000007352.V368939.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 x x 3 x 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 x 3 x x 3 Bakers Court Nursing Centre DS0000007352.V368939.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 OP7 Regulation 15 Requirement The registered person must ensure that comprehensive care plans are in place for all residents, that provide sufficient detail in order for the home to be able to meet the resident’s assessed needs in an appropriate and safe manner. Timescale for action 31/08/08 2. OP9 13 (4) (c) The registered manager must 01/08/08 ensure that all steps are taken to reduce any risk to the health of residents. This is a previously made requirement with a compliance timescale that had not elapsed by the time of this inspection. In order to secure the safety and 31/08/08 wellbeing of residents, the Centres Registered Persons must ensure that the appropriate procedures for dealing with medication (including records) are implemented at all times. The previous targets for compliance with this requirement expired on 30/4/05, 31/01/06 and 31/12/06. The final 3. OP9 13 (2) Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 30 compliance timescale of 31/08/08 had not elapsed by the time of this inspection. On 01/07/08 the pharmacist inspector assessed medication procedures at the home and made the further specific requirements within this overarching requirement • • • Audit of medicines available in the home are required to agree with medication records. All medicines are to be stored in accordance with temperature direction. 4. OP32 12(4)(a) Where an allergy is indicated for a resident, it is required to make correction to the medicines administration record (MAR) chart where the dispensing pharmacist has entered a default allergy status of none-known. The manager must ensure that the ethos of the home benefits the residents, in order to support privacy, dignity and respect. 01/09/08 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 OP9 OP12 Good Practice Recommendations The home should acquire three tablet counters, one for each floor, to count tablets without touching them. If a resident needs some soft background music to be played in their room a radio should be provided rather than using a television set. DS0000007352.V368939.R01.S.doc Version 5.2 Page 31 Bakers Court Nursing Centre 3. OP18 Safeguarding recording should be kept separately from general complaints. Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Bakers Court Nursing Centre DS0000007352.V368939.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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