Inspection on 20/05/07 for Bakewell Cottage Nursing Home

This inspection was carried out on 20th May 2007.

CSCI found this care home to be providing an Good 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

Bakewell Cottage Nursing Home 04/07/07

Bakewell Cottage Nursing Home 06/06/06

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Bakewell Cottage Nursing Home Bakewell Cottage Nursing Home Butts Road Bakewell Derbyshire DE45 1EB Lead Inspector Brian Marks Unannounced Inspection 20th May 2008 09:00 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 Bakewell Cottage Nursing Home DS0000065048.V364786.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. Bakewell Cottage Nursing Home DS0000065048.V364786.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bakewell Cottage Nursing Home Address Bakewell Cottage Nursing Home Butts Road Bakewell Derbyshire DE45 1EB 01629 815220 01629 815330 bakewellcottage@westwickgroup.com Info@Westwickgroup.com The Westwick Group of Businesses Limited 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) Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places Bakewell Cottage Nursing Home DS0000065048.V364786.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th July 2007 Brief Description of the Service: Bakewell Cottage is an extended period home, previously a local community hospital, which is located near to the centre of Bakewell, close to local amenities and services. Bakewell Cottage provides personal care with nursing to a maximum of 38 older people. Accommodation is provided on three floors, which can be accessed at two levels, in 34 single and 2 shared bedrooms; some bedrooms are equipped with en suite facilities. There is a range of lounges and dining areas. The home is well maintained both internally and externally. A large garden area with a patio is provided at the side of the building, which creates a pleasant sitting area for residents. Support services are provided locally with residents having a choice of GP and other support services accessed on request. At the time of inspection the range of weekly fees was £640 - £680. Items not covered by this fee included: Hairdresser, Chiropody, Newspapers/Magazines, Optical treatment (this does not include eye test), Toiletries. Bakewell Cottage Nursing Home DS0000065048.V364786.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 2 star. This means the people who use this service experience good quality outcomes. This was a Key unannounced inspection that took place at the home over one day. Additionally, time was spent in preparation for the visit, looking at key documents such as previous inspection reports, records held by us and the written Annual Quality Assurance Assessment document (AQAA), which was returned before the inspection. For administrative reasons there were no written surveys available from staff or people living at the home but all of the above material assisted with the preparation of a structured plan for the inspection. At the home, apart from examining documents, care files and records, time was spent with the manager of the home, who was in charge during the visit, and the visiting regional manager from the company. We also talked to two of the nurses and seven of the staff working on the day shifts. The care records of four people who live at the home were examined in detail and two of these were interviewed along with six others. Three relatives who were at the home were also spoken to. No other inspection visits have been made to the home since the last Key unannounced inspection on 4 July 2007 and the assessment was made against the key National Minimum Standards (NMS) identified at the beginning of each section of this report, as well as other Standards that were felt to be most relevant What the service does well: Bakewell Cottage is well furnished and attractively decorated to provide a homely environment for the people living there. The communal areas are light, warm and clean, and there is wheelchair access to the garden area, which is attractively and safely maintained. The staff team demonstrate a caring, friendly and respectful approach to residents and comments made by residents and their representatives were positive regarding the care and support provided. Residents confirmed that the standard of the catering is good and that there is choice of menu items provided. Bakewell Cottage Nursing Home DS0000065048.V364786.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Bakewell Cottage Nursing Home DS0000065048.V364786.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 Bakewell Cottage Nursing Home DS0000065048.V364786.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): 3, 5 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People do not come to live at the home without the care they need being properly identified. EVIDENCE: Staff have continued to use the same care records as before and all those looked at were completed to the same good standard. They all contain an assessment completed by the manager before people move to the home and this is then supplemented by information obtained as they move in, which creates a complete picture of the person and the problems they are facing. All the records have additional assessments of the general risks facing people as well as specific areas of risk that are relevant to them individually, such as safe moving and handling, skin breakdown and pressure sores, falls and nutrition. Where there has been specific involvement of Healthcare or Social Services people, their assessments are also included in care records. One person spoken to had a complex arrangement for managing pain and this was based on work carried out by staff in a special hospital clinic. However, none of the records looked at contain life histories of the people concerned, which could Bakewell Cottage Nursing Home DS0000065048.V364786.R01.S.doc Version 5.2 Page 9 describe their lives in terms of positive achievements rather than just the problems they are facing at the present. The AQAA indicates that the home’s management have put in additional work to improve the standard of assessment carried out and that people are welcome to visit the home before making a decision about moving in. Those that did so said that they were immediately impressed and that ‘there was a very nice feel about the place’. All the people spoken to said that all of their needs are met and that ‘they have an eye for the details of caring at this home’. The home does not provide intermediate care so Standard 6 does not apply. Bakewell Cottage Nursing Home DS0000065048.V364786.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 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessment records promote safety and consistency, and they encourage staff to work in ways that respect individuality, privacy and dignity. EVIDENCE: As noted above the care records looked at contain clear and comprehensive descriptions of the areas where people need help or where they experience risk, as well as the areas in which they are independent. Care activities to be carried out by staff are identified and one of the records includes a ‘Right Care Management Plan’ from the Health Service that is used to look after a complex range of health problems and the linked medication programme. There is a section in each care plan that indicates the social and leisure needs of the person but not a detailed background history that would complete the picture. The care plans are looked at regularly to make sure that all information is correct and up-to-date – for example the plan for somebody who had recently moved to the home had been changed to include the outcome of recent doctors’ appointments. The AQAA indicates how the views of people living at the home and their relatives are included and staff spoken to described how Bakewell Cottage Nursing Home DS0000065048.V364786.R01.S.doc Version 5.2 Page 11 the documentation in use allows them to continuously monitor the quality of care being provided. Additionally they said that ‘communication through handovers and diaries is the other thread that makes sure things get done properly’. The care records looked at confirmed that contact with external healthcare services is good; an example of new developments in this area has been the recent visits by a domiciliary dental service to the home. A number of specialist healthcare services are also currently involved with people living at the home. From the written records and speaking to people it was evident that the staff at the home work hard to care for people in sensitive and dignified ways, and of keeping people as independent as possible: ‘I walk up to town from time to time and we’ve all got telephones in our rooms that we can use at any time’. ‘They always find staff to help me get to the bank in a wheelchair and I still go to the Rotary Club every month’. ‘Staff look after me sensitively and carefully; they have an eye for the details and know my routine’. The family members of a recently deceased resident specifically sought us out to comment on the quality of support they had received from the manager and her staff during the last days: ‘Her palliative care was managed perfectly, they couldn’t have done any more and took all the stress away from us’. Examination of the arrangements for the receipt, storage and administration of medicines indicated these to be generally satisfactory apart from a small number of gaps in the written record. Medication is stored securely and the home uses a Monitored Dosage System for administration. The manager regularly carries out an audit of medicines herself and brings any deficiencies to the notice of relevant staff. There are a number of people living at the home who are using controlled drugs and storage and administration arrangements for these are satisfactory. There are also a number of medicines for ‘occasional use’ (PRN) but specific instructions for their administration were not included in the records. Bakewell Cottage Nursing Home DS0000065048.V364786.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People enjoy lifestyles and routines that suit them and have the opportunity to take part in organised leisure and social activities. EVIDENCE: The people spoken to confirmed that are very happy with life at the home and they are able to do very much what they like. A number of people were seen to spend a lot of time in their rooms and this was true of the ones spoken to who had made this a specific choice, or because of health problems. Whilst some of them try and take their meals in the dining room, a number have their meals separately as well. The home had an activities coordinator until a few weeks before the inspection, and she encouraged structured things for people to do and arranged the bigger events such as birthday and fundraising activities. The home is visited by a local voluntary group – First Taste – who promote art, craft and musical activities that are very popular with residents. As noted in the previous section a number of residents try and remain as independent as possible and one expressed his determination to ‘enjoy my own lifestyle and resist being organised’. The care staff spoken to said that they try and support people to do individual things – ‘I’ve just been down to the park with a resident’ – but difficulties with enough staff being on duty limits this. Bakewell Cottage Nursing Home DS0000065048.V364786.R01.S.doc Version 5.2 Page 13 The family members spoken to talked about the homely atmosphere of the home and the welcome they always receive from the staff; a kitchen and small sitting room were available for residents and their relatives to use, although the manager stated that this is generally only used for bigger family occasions. The AQAA described flexible visiting and care that targets the individual needs of people and their families. There are regular visits by the hairdresser to the home. A brief visit was made to the kitchen and the long-established cook described current arrangements. Good standards in the catering service have continued, and a regular 4-week menu is being followed. This indicates a choice at the main meals of the day and a hot option being available for breakfast and teatime, and people spoken to confirmed that supper is available for those that want it. The cook makes arrangements for people with special dietary needs, and these include one whose diet is salt-free, five who are diabetic and a number who need a softened or liquid diet. Bakewell Cottage Nursing Home DS0000065048.V364786.R01.S.doc Version 5.2 Page 14 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home responds to complaints made by residents and their representatives according to a written procedure, and aims to protect them from harm. EVIDENCE: The home has a complaints procedure, which is available to residents and their friends and relatives. The AQAA indicated that the home’s management has recorded two formal complaints since the last inspection and records indicated that these were satisfactorily dealt with and quickly resolved. In addition an anonymous complaint was referred to the Commission just before this inspection and was being looked at by the home’s regional manager. All the people spoken to were clear about getting problems resolved and confident that they would be listened to: ‘If there are any problems I would be confident about approaching the home’s management’. Staff records and the AQAA indicate that the manager has increased levels of training so that staff are clear in their responsibilities to safeguard the vulnerable people living at the home and they know how to make full use of the systems in place. Records indicate that all 25 staff have received detailed instruction since the last inspection and the rest will do so in June 2007. The regional manager is an approved trainer with the local Social Services Department. Bakewell Cottage Nursing Home DS0000065048.V364786.R01.S.doc Version 5.2 Page 15 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a clean comfortable and well-maintained home. EVIDENCE: The layout of the home is suitable for its stated purpose and all communal areas were accessible to the residents, including the grounds. Bakewell Cottage was once used as a cottage hospital and has been well maintained with many of its original features still in place. A homely and comfortable environment for the residents is maintained with views that overlook well-kept and attractive grounds. People spoken to were very positive about the ‘high quality of the home, it’s first class’ and how it is ‘very homely and just right for us. We bought a lot of things in from home’. The manager discussed plans for the refurbishment of the dining room later this year and since the last inspection one bathroom has been converted into a wet room/shower room for residents to access independently or with assistance as required. The AQAA indicates that the programme for Bakewell Cottage Nursing Home DS0000065048.V364786.R01.S.doc Version 5.2 Page 16 improvement will continue. The home employs a maintenance person who ensures small jobs are completed in good time. Housekeepers are employed to undertake laundry and domestic duties and are on duty seven days a week. On the day of the inspection the home was clean, tidy and free from odours and the residents spoken to had no complaints about the laundry service; all residents observed in the home wore clean and wellpresented clothing. Bakewell Cottage Nursing Home DS0000065048.V364786.R01.S.doc Version 5.2 Page 17 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides an adequate level of staffing which supports a safe environment in which people live and work, but shortfalls continue in the key area of recruitment that undermine this. EVIDENCE: During 2008 the home has experienced turnover of staff which has impacted on the ability of the home’s management to always put sufficient staff on duty, particularly during the evenings. The staff spoken to reported that due to short-term illness and lack of flexibility in staffing arrangements there would sometimes not be enough carers available and ‘casual informal working with individual residents has suffered’. The manager and regional manger reported that new staff have recently been recruited and, as a temporary measure, staff from another home owned by the company and agency staff have been drafted in to fill the gaps in the roster. Staff agreed that the situation has been considerably improved over the past two weeks by these measures and that the agency staff that have been coming to the home have been regulars. Comments made by people living at the home however did not particularly reflect these difficulties, and those spoken to said that ‘staff are available when we need them’, that ‘I’m very happy with all the attention I’ve received’ and that ‘staffing has always been available and very responsive to my needs’. The levels of nursing staff have been retained throughout the recent difficult period and there are two nurses on duty throughout the day. Bakewell Cottage Nursing Home DS0000065048.V364786.R01.S.doc Version 5.2 Page 18 The AQAA indicates that the numbers of care staff achieving or currently undertaking the National Vocational Qualification (NVQ) has been increased and the 50 target should be achieved later this year. Additionally kitchen staff have been supported to get an appropriate qualification as well. Records indicate that good achievements have been made across the board for the training of care staff; the staff spoken to confirmed that the manager has been very good for them in this respect. A recently appointed carer described how a proper recruitment system had been followed before she started work, and although the two staff files looked at contained evidence of the proper checks being carried out they did not contain two written references as is required by law. The same member of staff described an extended period of induction training that she had to follow and confirmed that all new starters follow this using a workbook that is provided through a training agency. Bakewell Cottage Nursing Home DS0000065048.V364786.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is a well-managed and safe environment in which to live and work. EVIDENCE: The manager has been confirmed in post since the last inspection and has recently applied for registration with the Commission. She has considerable experience within the management of care homes for older persons, which spans over 18 years and is a trained registered nurse. The regional manager and registered provider are in regular contact with the home and offer additional management support and monitoring of the home’s services. People living at the home and their relatives had a lot of good things to say about the manager, about how ‘she is good with staff and residents’ and how ‘everybody is working better as a team because of her’. Staff in particular said they are well supported and can go to the manager with any problems, but Bakewell Cottage Nursing Home DS0000065048.V364786.R01.S.doc Version 5.2 Page 20 none of the ones spoken to have been given planned meetings with a supervisor on a regular basis. The AQAA indicates that an outside manager regularly completes the monthly visit to the home that is required by law, and copies of reports of these visits were seen on file. The manager has also carried out a survey of the views of people living at the home and their relatives in 2007 and the results of this information was made available to residents, relatives and staff and reported back through the company’s regular newsletter. The manager and regional manager between them carry out a number of internal audits of activity at the home covering such areas as catering, medication and the completion of care plans. The systems for the safe keeping of residents’ personal spending money have been retained and these are satisfactory. The AQAA indicates good standards of health and safety activity and regular servicing of equipment, and the home’s handyman makes sure that any problems are dealt with quickly. Observations made around the building and a sample of fire safety records indicated the home is hazard free. Bakewell Cottage Nursing Home DS0000065048.V364786.R01.S.doc Version 5.2 Page 21 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Bakewell Cottage Nursing Home DS0000065048.V364786.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes Bakewell Cottage Nursing Home DS0000065048.V364786.R01.S.doc Version 5.2 Page 23 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 OP29 Regulation 19(1)(b) Schedule 2 Requirement Evidence that references have been obtained in respect of newly appointed staff must be retained on staff files so that it can be established that a proper staff selection system is being operated and only people suitable to work with vulnerable people are working at the home. (Requirement from last inspection, timescale not met) Timescale for action 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 OP9 Good Practice Recommendations There should be a detailed description of the procedure to be followed for the administering of individual ‘occasional use’ (PRN) medicines to help staff carry this out safely and consistently. Staff supervision should take place every two months and include career development needs, and philosophy of care in the home. 2. OP36 Bakewell Cottage Nursing Home DS0000065048.V364786.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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