Inspection on 28/02/08 for Bakers Court Nursing Centre

This inspection was carried out on 28th February 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 23/07/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bakers Court Nursing Centre 138-140 Little Ilford Lane Manor Park London E12 5PJ Lead Inspector Ornella Cavuoto Unannounced Inspection 09:15 28 February & 4th March 2008 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.V349996.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.V349996.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 ANS Homes Ltd 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.V349996.R01.S.doc Version 5.2 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. 25th April 2006 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 that 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 purpose built and all the bedrooms are single with en-suite facilities, 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 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.V349996.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 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced inspection that took place over two separate days in February and March 2008. The registered manager was on annual leave the first day of the inspection but was present for the second day of the inspection. The inspection involved speaking to ten service users and two of the care staff. One of the activities co-ordinators was also spoken to and some of the nursing staff were consulted on issues through the inspection. Other inspection methods included a partial tour of the premises and inspection of records. In addition, prior to the inspection relatives’ surveys were sent out but unfortunately there was a poor response with only one survey returned. An Annual Quality Assurance Assessment (AQAA) was also completed and sent to Commission for Social Care Inspection (CSCI). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also provides some numerical information about the service. This will be referred to within the report. What the service does well: What has improved since the last inspection? Bakers Court Nursing Centre DS0000007352.V349996.R01.S.doc Version 5.2 Page 6 The home has drawn up a good quality statement of purpose and service user guide providing all the information prospective and current service users need to know about the home. Care staff have been supported to achieve a relevant qualification to be able to work at a competent level with service users. Improvements have been made in respect to consultation with service users to make sure they are provided with opportunities to give their views of the home. Some improvements have been made in respect to concerns identified at the last inspection about health care but further improvements are required to make sure standards are met. The home was found to be clean and hygienic at this inspection with no offensive odours noted. What they could do better: 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.V349996.R01.S.doc Version 5.2 Page 7 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.V349996.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Standard 6 is not applicable Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective and current service users have the information they need to make a decision about the home. Service users have had their needs assessed prior to being admitted to the home. EVIDENCE: The home has a comprehensive statement of purpose and service user guide in place that includes all the information required by regulation and also provides a break down of fees charged. This meets the previous requirement specified at a thematic inspection held December 2006. The personal files of seven service users across all the floors of the home were looked at. Six of these files belonged to service users that had moved into the home within the last four- five months. All the files included evidence that the home had obtained assessments and reports from the referrer as well as carrying out their own pre- admission assessment, which covered all areas of Bakers Court Nursing Centre DS0000007352.V349996.R01.S.doc Version 5.2 Page 9 health, personal and social care needs. However, this information had not always been used effectively to draw up care plans for service users (See Standard 7 for further details). Bakers Court Nursing Centre DS0000007352.V349996.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, 9 &10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all service users had a care plan in place that addressed all their individual needs and changing needs of service users had not always been clearly reflected in their care plans. Unsatisfactory record keeping in respect to service users’ health care needs and also in the administration of medication has continued to compromise the quality of health care provided to service users within the home. Service users were satisfied with the care they had received by staff. EVIDENCE: Seven care plans were examined from all floors. It was reported by the nursing staff that a new format for care plans had been introduced in October 2007. Five of the care plans that were looked at were comprehensively completed and had addressed the health, personal and social care needs of service users with good detail being provided on individual preferences regarding daily routines, likes and dislikes. There was also evidence within care plans where there had been input from relatives and that attempts had been made to involve relatives in relation to care planning. In respect to the two remaining Bakers Court Nursing Centre DS0000007352.V349996.R01.S.doc Version 5.2 Page 11 care plans these belonged to service users that had been admitted a month prior to the inspection and it was evident from the pre- admission assessments carried out by the home and also for one of the service users the assessment obtained from the referrer that not all areas of need had been covered, for example for one of the service users their needs in respect to personal care and some health care needs had not been addressed. The home should aim to ensure that care plans covering all areas of need are completed as soon after admission as possible and these should be based on assessments in place to ensure service users needs are fully met. In addition, although care plans on the first floor had been reviewed consistently on a monthly basis gaps in reviews of care plans were identified for service users on the other floors. Furthermore, it was identified that service users’ changing needs had not always been clearly reflected in the care plans, for example for two service users changes in respect to health care needs had not been recorded (See Requirements). There was evidence within the files of service users that were looked at that there had been good liaison by the home with a range of health care professionals to ensure that service users’ individual needs in relation to their physical and emotional health were addressed, for example these included a GP, a liaison nurse that had regularly visited the home to monitor service users’ health and to provide advice and guidance to the nursing staff, chiropodists, physiotherapy services, a dietician, community psychiatric nurses and a psychologist. There was also evidence that service users had been supported to attend hospital appointments such as to the diabetic clinic. At a random inspection held at the home in February 2007 following a complaint made to the CSCI regarding the care received by one of the service users at the home, concerns were identified in respect to the management of pressure sores in that despite records belonging to the service user indicating there had been a deterioration in relation to pressure areas this had not triggered staff to take appropriate and timely action with a referral being made to a relevant health care specialist specifically a tissue viability nurse. In addition, it was noted that pressure area turning charts to evidence changes of position specified within the care plan to be undertaken four hourly had not been maintained. As a result requirements were specified in relation to both these matters. At this inspection two of the service users whose files were checked had pressure sores and one service user had leg ulcers. For all service users there was evidence that referrals to the tissue viability nurse had been promptly made and also that the liaison nurse had been involved in monitoring pressure sores this meets one of the previous requirements specified. Furthermore, photographs of wounds had been taken at regular intervals to monitor progress and appropriate aids such as pressure relieving mattresses were used. Pressure area risk assessments had also been completed for all the service users although for one of the service users the date of the risk assessment indicated this had only recently been completed, four months after their admission. Wound care charts and pressure area turning charts were in Bakers Court Nursing Centre DS0000007352.V349996.R01.S.doc Version 5.2 Page 12 place but these had not been accurately maintained. Wound care charts included gaps and changes of position recorded on the turning charts did not consistently comply with the times specified for when this should occur and dates recorded on the charts were confusing, for example for one service who was case tracked one of the turning charts stated two hourly turning was required. The chart was dated to cover five days but times of turning for only two days had been recorded and on both days changes of position had occurred solely within between the hours of 12- 6 it was not clear if this was am or pm as it had not been indicated on the chart. For another service user case tracked the care plan stated two hourly turning but two charts seen indicated turning had not occurred after 6pm. A random sample of other charts was checked and recording for all were irregular and indicated regular turning had not consistently been undertaken. In respect to the previous requirement specified in respect to the home needing to ensure records pertaining to care delivered to service users are maintained this had been met as charts were in place but these need to be completed accurately with turning times being adhered to as specified within care plans and /or the charts themselves (See Requirements). Further concerns regarding poor recording were also identified in respect to weight monitoring and food and fluid charts. It was evident from files seen that monthly weights as specified by NMS had not been undertaken consistently and also not always in line with the nutritional risk assessment or care plans, for example for one service user the care plan stated they should be weighed weekly and at different points the risk assessment also indicated this but weight had only been recorded monthly. For another service user admitted only a month prior to the inspection the nutritional risk assessment had been completed that indicated weight should be done weekly but this had not been carried out having just been done on their admission. For another service user there were gaps for two months where monthly weight had not been done despite the service user consistently losing weight although there was evidence the home had taken appropriate and prompt action by involving a dietician. Weight monitoring charts seen on files had also not all been completed. In respect to food and fluid charts it was reported by nursing staff that the home has a policy whereby all newly admitted service users are placed on food and fluid charts for a period of fourteen days regardless of whether it is identified by pre-admission assessments or referrers’ needs assessments obtained that there are concerns about individual service users’ eating and drinking. In looking at a random sample of charts for service users on the ground floor it was identified that many contained gaps particularly fluid charts, which had not been consistently completed, for example no entries of fluids having been consumed had been recorded on two charts after 3pm and 6.30pm (See Requirements). Finally, although risk assessments had been completed as mentioned in respect to pressure areas, nutrition and also falls these had not been reviewed on a regular basis and attention to this is required (See Requirements). Bakers Court Nursing Centre DS0000007352.V349996.R01.S.doc Version 5.2 Page 13 The last two inspections carried out at the home have identified concerns about the home’s management of medication with gaps identified in medication records. At this inspection the previous requirement that appropriate procedures for dealing with medication such as maintaining accurate records should be implemented at all times was still not met. A sample of medication records from all floors was inspected and an unacceptable amount of gaps were found particularly on the ground and second floors where medication had been given but not signed for or signed for and not given. Also, there were gaps where it was identified medication had not been given but no explanation for this had been recorded by using the code system in place. Medication where gaps were found included insulin prescribed for two service users. In addition, it was noted for one service user that the time for one of their medications to be administered had been changed but the instructions for administration on the medication record sheet had not been altered. This potentially leaves room for errors to be made. In respect to cold storage of medication records monitoring the temperatures of the fridges to ensure that they remain at the recommended level of 2-8c contained gaps not having been done daily as required and on one of the floors the temperature had not been recorded correctly. Furthermore, there were no records monitoring the temperature of the room where medication was stored to ensure the temperature did not exceed 25c and although it was noted that all the rooms where medication was kept had air coolers it would be good practice to monitor this. Finally, records of medication returned to the pharmacist or disposed of had not been maintained. On the first floor medication returns/disposal had been recorded in June 2007 and March 2008 whilst on the second floor returns/disposal of medication had not been recorded since July 2007. A clear audit trail of all medication that is stored in the home must be kept as part of effective stock control. Controlled drugs kept in the home were checked and found to be in order. Qualified nursing staff administers all medication within the home. The last report indicated that the management of the home had liaised with the Nursing and Midwifery Council to secure compliance with legislation and professional nursing standards and training records sent to the CSCI indicated that the nurses working in the home had undertaken some medication training since the last key inspection. However, it was evident at this inspection that these measures had still not resulted in improvements being made to address the unsatisfactory record keeping of administration of medication. The home needs to take further action as; non -compliance to address the requirement in this area will result in enforcement action to be taken (See Requirements). Apart from two service users who were spoken to who stated that they found the attitude of the some of the care staff better than others, feedback from other service users was very positive about the staff and the care and support received. One service user said ‘Staff are all nice, will do anything for you’. Another service user commented, ‘Highest standard of professionalism is here’. Other service users confirmed that their privacy was respected with staff knocking before entering their rooms and observations during the inspection Bakers Court Nursing Centre DS0000007352.V349996.R01.S.doc Version 5.2 Page 14 were that staff treated service users respectfully and service users were overall well dressed and groomed. Bakers Court Nursing Centre DS0000007352.V349996.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities have been arranged to engage service users on both a group and individual basis and they have regular contact with family and friends with links with the local community maintained. Service users can make their own choices and are supported to exercise control over their lives. Meals provided to service users are healthy and nutritious. EVIDENCE: The home has two activities co-ordinators one that works full time and the other that works three days a week. The home has allocated a room on the first floor specifically for activities that has been equipped with various resources to engage service users. Care plans had detailed service users particular interests and how they preferred to spend their time and one service user that was spoken to described how they had been supported to develop an interest in gardening and in particular to grow their own vegetables by giving them a patch in the home’s garden. For another service user there was evidence within their file that their interest in books was to be supported with plans to allow them to catalogue the books in the home’s library being put in place. The home also had a weekly activities schedule in place that included group and individual time to be spent with service users. In addition, there was Bakers Court Nursing Centre DS0000007352.V349996.R01.S.doc Version 5.2 Page 16 evidence on the notice board that a raffle and Easter egg hunt had been organised involving children from the local school and the full time activities co-ordinator who was spoken to reported further entertainment was arranged for April. Service users spoken to confirmed they had been involved in different activities, which included playing bingo and other board games, that they have their nails done, do exercises and they have done some painting. The other activities co-ordinator was observed spending individual time with service users and there was some evidence seen within personal files where one to one time spent with service users had been logged although they acknowledged they did not always note this in service user files. Also, records of group activities, what was done and who was involved, were not maintained and so the regularity of some of the activities such as reminiscence was difficult to determine and also whether all service users were provided with opportunities for social stimulation at regular intervals. As a result, it is advised that the activities co-ordinators try to keep records of activities carried out with service users (See Recommendations). Service users spoken to confirmed that the relatives and friends visited them regularly at the home. There was also evidence that service users’ links with the local community have been maintained. Some service users spoken to stated that they regularly attend a local day centre. Two other service users said they often go out alone; one to attend an external appointment and another who stated they go out almost daily locally to the shops and to see their family on occasions. The home has a representative from a local church that visits the home to do a weekly service and another service user spoken to said they had been supported to attend services at a nearby church. In terms of service users being supported to exercise choice and control there was evidence from service users’ rooms that were seen that they had been supported to bring their personal possessions with them into the home. Also, as mentioned in respect to Standard 13 individual service users where appropriate were supported to go out alone when they wanted to maintaining their independence. At the last key inspection held at the home it was identified that service users and relatives’ meetings were not held to provide an opportunity for service users to provide feedback on issues about living in the home and to be involved in making decisions about aspects of the running of the home that may affect them. However, at this inspection the registered manager reported this was being addressed with a service users’ meeting to be held on the 16th May 2008 and a relatives meeting on 18th April 2008. Meetings will then be held every three months. This will be looked at, at future inspections. Also, it was noted that there was no information about advocacy services available for service users who may need independent advice and representation and it is advised this is obtained and made accessible to service users (See Recommendations). Although feedback about the food did vary with some service users expressing dissatisfaction, the majority of service users spoken to, stated they were happy Bakers Court Nursing Centre DS0000007352.V349996.R01.S.doc Version 5.2 Page 17 with the meals provided at the home and confirmed that a choice of food was available. Comments made included; ‘The food is not too bad, its nice I eat it all’, ‘Food is very good really’, ‘Food – you get a choice. I did not like the choices today but I had an alternative. If I ask for something else, you can get it’. The home has a four- week rolling menu that included a good variety of meals that were healthy and nutritious. The home also provides food to ensure that the culturally specific needs of individual service users are met. Two lunchtime meals were observed on both days that the inspection was held. The meals that were served were as those specified on the menu and the food was well presented including pureed food for service users. Service users were able to eat unhurried and staff were observed providing assistance to service users to eat in an appropriate and respectful manner. Bakers Court Nursing Centre DS0000007352.V349996.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16&18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were aware who to complain to and were confident they would be listened to and their complaints acted upon. The home has acted appropriately where adult protection issues have arisen. EVIDENCE: Service users spoken to said they would speak to either the registered manager or the deputy manager if they had a complaint and they were confident that action would be taken to address their concerns. One service user said ‘If you’ve got a complaint you can talk to the deputy manager or the manager and they will always listen. Its rare (in reference to having to make a complaint) but they deal with it.’ The home’s complaint log was inspected. This included both informal and formal complaints made and all had been investigated and appropriately addressed and complainants had been informed in writing of the outcome. Since the last inspection there have been four adult protection investigations undertaken in relation to the home. Three of these investigations have been as a result of allegations made in respect to poor standards of care received by service users. The fourth adult protection concern arose during the inspection and concerned a service user with unexplained facial bruising. This was identified following a member of the nursing staff attended to the service user after hearing them shouting and distressed whilst they were receiving personal care from one of the care staff. There was no evidence to indicate the care Bakers Court Nursing Centre DS0000007352.V349996.R01.S.doc Version 5.2 Page 19 worker had caused the bruising but the home took appropriate and prompt action and suspended them pending further investigation that included eliminating any medical cause of the bruising and had also promptly reported the incident to the local authority and other relevant persons including the relative ensuring adult protection procedures were adhered to. The matter had also been recorded in the service user’s daily notes. At the time of writing the report the outcome of the investigation was not known. In respect to the other adult protection investigations the registered manager reported the first allegation had been found to be partially substantiated in that it was identified there had been a lack of communication by the home to the service user’s relative about issues concerning their care but other allegations made about poor standards of care were not substantiated. An adult protection investigation was held in relation to the second allegation of poor standards of care shortly prior to the inspection being held and was reported by the registered manager that these were again had been found to be unsubstantiated. The third allegation was made shortly following the inspection and the outcome of the investigation was not known at the time of writing the report. Training records sent to CSCI shortly following the inspection indicated the majority of staff working in the home had received some adult protection training. The registered manager also reported they were in the process of completing a course provided by the local borough specifically for managers. Bakers Court Nursing Centre DS0000007352.V349996.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,24 &26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a pleasant, safe and well-maintained clean environment and individual rooms are comfortable and personalised. EVIDENCE: The home has been purpose built and is suitable for its stated purpose with ample communal spaces on all floors. It has furnishings that are domestic in character to give a homely atmosphere and all parts of the home that were seen were well maintained. Service users’ rooms that were seen contained all required furniture and many of the rooms had been personalised with personal effects and items of furniture that they had brought in with them. One service user had brought in their own double bed. Bakers Court Nursing Centre DS0000007352.V349996.R01.S.doc Version 5.2 Page 21 At a random inspection held at the home in February 2007 strong odours of urine were detected in service users’ rooms and in communal areas. However, at this inspection a slight malodour was noted on the ground floor on the first day of the inspection but this was not detectable on the second day and the home was found to be clean and hygienic in all areas that were checked. The home also had suitable laundry facilities that were sited away from the preparation of food. Bakers Court Nursing Centre DS0000007352.V349996.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were sufficient levels of staff working in the home. Staff had been supported to achieve relevant qualifications to ensure they were competent to work with service users. The home’s recruitment practices have protected service users. There was evidence that new staff had received an induction and other staff had been provided with regular opportunities for training. EVIDENCE: At the time the inspection was held there were a number of vacancies within the home and staffing levels had been adjusted accordingly. Yet, it was observed that there were still sufficient levels of staff on duty to meet service users’ needs. Rotas that were seen confirmed this. Care staff spoken to, confirmed they were involved in handovers and allocated work so they were clear about their duties. At the last key inspection held in April 2006 that was held it was identified that the home had not met the target specified within the National Minimum Standards (NMS) that 50 of care staff should have achieved a National Vocational Qualification (NVQ) Level 2 or be working towards one. At this inspection the registered manager reported that out of forty- seven care staff eighteen had completed a NVQ and two were presently undertaking the qualification. A further four of the care staff were also doing nurse conversion courses which would be a higher level of qualification than a NVQ. Bakers Court Nursing Centre DS0000007352.V349996.R01.S.doc Version 5.2 Page 23 Consequently, in total 24 care staff had done or were due to complete a relevant qualification meeting the target specified within NMS that at least 50 of staff should be qualified. In relation to recruitment five staff files were checked who had commenced working in the home within the last three-four months. The files contained evidence that all documents and checks required by regulation had been obtained including Enhanced Criminal Record Bureau (ECRB) checks, two references and proof of identification. In addition gaps in employment had been addressed and a record of the interview was included in the files although it was noted that only one person had conducted the interviews and it is advised as part of good practice and to ensure the process is line with equal opportunities that two people should be involved in interviewing prospective employees (See Recommendations). At the time of the inspection staff training records were not looked at but records detailing training completed by nursing and care staff since the last key inspection were sent to the CSCI shortly after the inspection. These indicated that nursing and care staff had been given regular opportunities for training in relevant topics including violence and aggression, mental capacity/palliative care, communications, preventions of falls, care planning and the activities co-ordinator had completed training in reminiscence. Records confirmed that some mandatory training had been done, for example staff had undertaken refresher fire training and first aid. There was also evidence within the files of newly recruited staff that they had undertaken basic training in health and safety, manual handling, fire safety and food hygiene as part of the home’s induction and it was reported staff are issued with a work booklet, which was seen that covers Common Induction Standards and in which staff should keep an individual record of the training they do. Bakers Court Nursing Centre DS0000007352.V349996.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager is suitably qualified and experienced to ensure the home is well run. Surveys have been completed as part of self- monitoring and to ensure the home is run in service users’ best interests. Service users’ finances have been safeguarded and their health, safety and welfare has been protected and promoted. EVIDENCE: The registered manager and deputy manager clearly are both experienced and qualified to manage the home. Service users did express that both managers were approachable and helpful. The registered manager has worked at the home for many years and consequently is very familiar with the running of the home. In most areas it was evident that the home was well run but ongoing issues in respect to recording in relation to medication administration and Bakers Court Nursing Centre DS0000007352.V349996.R01.S.doc Version 5.2 Page 25 service users’ health care needs (See Standards 8 & 9 for further details) have compromised the overall quality of care provided at the home. Subject to a previous requirement that the home needed to develop and implement a quality assurance policy that would establish a system for reviewing at appropriate intervals the quality of care at the home and should provide for consultation with service users and their representatives, this was identified as met at this inspection. Evidence was seen of a report that outlined the results of a survey that had been carried out with service users at the home December 2007. Some of the areas that the survey had obtained service users’ views on included the staff, activities and the food. A survey is completed annually as specified within NMS and the results compared with the previous years results. This was detailed in the report that was seen. Any areas for improvement have to be detailed in an action plan, which the registered manager reported they had yet to complete. It was noted that surveys had not been completed with relatives or professionals that have links with the home and it is advised these are included when the home carries out the next survey. The home’s AQAA (Annual Quality Assurance Assessment) had been completed to a satisfactory standard (See Recommendations). The home has robust systems and procedures for the management of service user finances. Service users’ money was pooled but appropriate and clear records had been maintained detailing how much money individual service users had in the account and included details of all transactions carried out and receipts had also been kept. All service users receive interest on their money. It was reported that service users’ finances are subject to both internal and external audits. There was evidence that areas of health and safety had been addressed by the home. The home had an inspection undertaken by the LFPEA (Fire Services) in January 2008. The letter sent that was seen stated that the premises were satisfactory in respect to fire safety and all log books were found to be up to date. The home has adhered to regulation in reporting all relevant incidents as specified by regulation 37 and maintenance certificates such as for gas safety and portable appliance tests had been kept updated as indicated by the home’s AQAA. Bakers Court Nursing Centre DS0000007352.V349996.R01.S.doc Version 5.2 Page 26 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 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 X 3 X 3 X X 3 Bakers Court Nursing Centre DS0000007352.V349996.R01.S.doc Version 5.2 Page 27 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(1) Requirement The registered manager must ensure that all service users have a care plan addressing all identified needs and based on pre- admissions assessments drawn up with them, a relative or a representative where appropriate as soon as possible after their admission to ensure all their needs can be met by staff and changes in need can be effectively monitored. The registered manager must ensure that the care plans for all service users are reviewed monthly as specified within NMS and that any changes in the needs of individual service users are reflected within their care plans to ensure all their needs are addressed. The registered manager must ensure that where pressure area turning charts are in place for service users these are accurately maintained in that dates and times of turning are clearly recorded and that times of turning specified on the charts and within care plans are DS0000007352.V349996.R01.S.doc Timescale for action 31/08/08 2. OP7 15 31/08/08 3 OP8 12(1) 31/08/08 Bakers Court Nursing Centre Version 5.2 Page 28 4. OP8 12(1) 5. OP8 12(1) 6. OP8 12(1) 7. OP9 13(2) 8. OP9 13(2) adhered to as part of ensuring that the health and welfare of service users is upheld and is able to be monitored effectively. The registered manager must ensure weight monitoring for service users is implemented in line with the nutritional risk assessment and individual care plans and this is recorded with weight monitoring charts completed to ensure individual health care needs are met. The registered manager must ensure food and fluid charts for all service users are accurately maintained as part of ensuring that the health and welfare of service users is upheld and is able to be monitored effectively The registered manager must ensure that all risk assessments for falls, pressure areas and nutrition are completed promptly on admission and are kept under regular review as part of ensuring that the health and welfare of service users is upheld and is able to be monitored effectively. 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 31/12/06. The other previous targets on 31/01/06, 30/04/05. The registered manager must ensure that temperatures of the fridges used for cold storage of medication and also the temperature of the room where DS0000007352.V349996.R01.S.doc 31/08/08 31/08/08 31/08/08 31/08/08 31/08/08 Bakers Court Nursing Centre Version 5.2 Page 29 9. OP9 13(2) 10. OP9 13(2) all medication is stored is recorded daily to ensure that these remain within recommended limits as specified within the report in order to secure the safety and wellbeing of service users by ensuring medication remains effective for use. The registered manager must ensure that where times for the administration of medication are altered that clear instructions specifying the changes are written on the medication record sheet maintained in order to secure the safety and wellbeing of service users. The registered manager must ensure that records of all medication disposed of or returned to the pharmacy are maintained as part of effective stock control and in order to secure the safety and wellbeing of service users. 31/08/08 31/08/08 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. Refer to Standard OP12 Good Practice Recommendations The registered manager should try to ensure that the activities co-ordinators maintain records of the different activities carried out with service users specifying what was done and who was involved as a means of monitoring how often different activities are held and that all service users are being provided with regular opportunities for social interaction and stimulation. The registered manager should try to ensure that information on where service users can obtain DS0000007352.V349996.R01.S.doc Version 5.2 Page 30 2. OP14 Bakers Court Nursing Centre 3. 4. OP29 OP33 independent advice and support in the way of advocacy is obtained and made accessible to service users as part of upholding their rights. The registered manager should try to ensure that two staff members conduct interviews with prospective employees in line with equal opportunities. The registered manager should try to ensure that relatives and professionals who have links with the home are consulted as part of surveys carried out by the home. Bakers Court Nursing Centre DS0000007352.V349996.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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. 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