Inspection on 19/02/08 for Bamfield Lodge Care Home

This inspection was carried out on 19th February 2008.

CSCI found this care home to be providing an Poor 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

Bamfield Lodge Care Home 02/07/08

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bamfield Lodge Care Home 1 Bamfield Whitchurch Bristol BS14 OAU Lead Inspector Sandra Jones Key Unannounced Inspection 08:30 19 , 20 & 22nd February 2008 th 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 Bamfield Lodge Care Home DS0000070870.V359670.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. Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bamfield Lodge Care Home Address 1 Bamfield Whitchurch Bristol BS14 OAU 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) 01275 891271 Avery Homes Bristol Ltd Ms Isla Joanna Nicholson Care Home 60 Category(ies) of Dementia (28), Old age, not falling within any registration, with number other category (60), Physical disability (16) of places Bamfield Lodge Care Home DS0000070870.V359670.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 service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability aged 45 years and over on admission (Code PD) maximum of 16 places Dementia aged 45 years and over on admission (Code DE) - maximum of 16 places - personal care only The maximum number of service users who can be accommodated is 60. NEW SERVICE 2. Date of last inspection Brief Description of the Service: Bamfield Lodge was purpose built in 2007 to provide nursing and residential care for up to sixty people that are over 45 years old, have physical disabilities, dementia and terminal illness. The property has level access and is arranged over three floors with shared space and bedrooms on each floor. The property is decorated to an excellent standard; all rooms are single and en-suite. The range of fees is stated within the Statement of Purpose, which ranges between £415.00 for residential - £515.00 per week for nursing Bamfield Lodge Care Home DS0000070870.V359670.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 0 star. This means the people who use this service experience poor quality outcomes. This key inspection was conducted unannounced over three days in February 2008 with the pharmacist inspector as a result of serious concerns raised by relatives and social and health care professionals. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedure. During the site visit, the records were examined and feedback sought from individuals, their relatives and staff. The Responsible Individual (for the company) and external operational support managers were present at the inspection because of the serious nature of our concerns. Six people were case tracked. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The home’s policies and procedures were also used to confirm the findings. The views of the assistant manager, staff and people using the service were gathered through face- to- face discussions. What the service does well: The people living at the home were consulted about the standards of care. Individuals made positive comments about the abilities of the staff to meet their needs. Staff respect people’s rights in particular their privacy and dignity. The people consulted are aware of the complaints procedure and knew whom to approach with complaints. The property is decorated to an excellent standard, there is level access into the home, extra wide corridors, bedrooms are single with full en-suites and there are communal areas on each floor. Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are fourteen requirements arising from this inspection and to confirm the safety of the people at the home these requirements must be met. The manager must ensure that the members of staff responsible for undertaking initial assessments for individuals wishing to live at the home are qualified and completed. This will ensure that the needs of the individuals can be met by the skills of the staff. Each individual accommodated at the home must have a care plan. It must be developed with the person to guide the staff to consistently meet the individuals assessed need. Risk assessments must be completed for individuals that have moving and handling needs to ensure that techniques are safe to use and supports the person to be independent. The staffing levels in place must be appropriate to the needs of the people accommodated. Recruitment procedures must be more robust. Where members of staff do not declare any criminal convictions in the application form and it later transpires that the person has a conviction, the manager must then assess their character and integrity before their appointment. Regarding references, the manager must ensure the authenticity of the referee to ensure the person is suitable to work with vulnerable adults. A copy of the monthly reports of the visits undertaken by the external manager must be provided to the Commission. During the monthly visits, the external manager must undertake through assessments on the conduct of the home to make sure that people’s care needs are met and they are protected from harm. Fire risk assessments must include the checks of fire alarm systems and equipment to ensure the property is safe and there are adequate measures to prevent an outbreak of fire. Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 7 Where facilities for safekeeping of cash and valuables exist at the home, records of the transaction must be kept. This safeguards individuals from abuse. Requirements concerning handling of medicines in the home have been made to safeguard the health of the people using this service. 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. Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (3) & (6) Quality in this outcome area is (poor). This judgement has been made using available evidence including a visit to this service. The admissions process must be more effective to enable new people to make an informed choice about moving there. Current practices cannot reassure Individuals that the home will have the skills and resources to meet their assessed needs. EVIDENCE: The Avery Care Statement of Purpose provides information to people wishing to live there, their relatives and placing agencies about the home and facilities. It purports that members of staff can meet the needs of people with nursing needs, dementia, terminal illness and physical disabilities over 45 years. From the case files viewed people with mental health care needs, acquired brain injury and learning disabilities are also accommodated at the home. Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 10 Within the Statement of Purpose the admission procedure is described and specifies the range of needs that can be met by the skills of the staff. The Operational Support manager explained that it is the role of senior nurses to undertake initial assessments, which look at all aspects of an individual’s needs and consider the appropriateness of the admission. It was further stated that there is an expectation that the staff undertake initial assessments for any person wishing to live at the home including people funded by the Local Authority. It is evident from the case files viewed that the staff at the home conducts initial assessments. However, initial assessments are not always consistent with the social workers care plan. The company/manager must ensure that suitably qualified and competent staff assess the needs of individuals wishing to live at the home. This will ensure that the home offers accommodation to individuals whose needs can be met by the skill of the staff at the home. The Operational Support Manager acknowledged that formats that are suitable to the persons needs must be considered so that individuals can make decisions about living at the home. The Terms and Conditions list the facilities and include the fees and room number, which is signed by the person. Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 11 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 (poor). This judgement has been made using available evidence including a visit to this service. The home has failed to provide an effective care planning systems so individuals can benefit from receiving an individualised and consistent service. Poor practice for handling of medicines in the home has put the health of people using this service at risk. EVIDENCE: Each person has an Avery Health Care Group care file sectioned into PreAdmission Assessments, Contact Details, Social Reviews, Day to Day assessments, End of Life Plans, Day to Day monitoring, Daily reports, Personal Effects Inventory and Care Plan Audits. It is evident that a senior manager conducts pre-admission assessments before an admission to the home is arranged and social workers needs assessments are provided for individuals funded by the Local Authority. The assessment should ensure that the home can meet the needs of the individual. However, needs assessments conducted by the home are not consistent with social workers needs assessments. Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 12 For a number of people living at the home, care files have little or no contact details for next of kin and no care plan and for others the information is very basic. One person’s file contained only her name and weight on admission. It is of concern that staff are not provided with sufficient information to consistently meet the needs of people at the home. Care files examined show that people with learning disabilities, mental health, dementia, acquired brain injury, nursing and physical needs are accommodated at the home. The care plans for these individuals are not specific about they way their needs are to be met by the staff at the home. For example, care plans for people with dementia did not include the way it manifests itself along with the actions to be taken by the staff to meet the need. Following the inspection the providers have taken action by deploying senior managers to undertake audits to ensure members of staff have sufficient information to meet the individual’s needs. Standard formats for Moving and Handling, Nutritional Assessments, Risk Taking, Water low, Pressure Sores and Self-Administration of Medications form part of the care file. These formats have not been consistently completed and there are some instances where the information was not documented. For example, the records of risk assessments for individuals with moving and handling needs are either poorly completed or not completed at all. The home have experienced difficulties with registering people with local GP’s and records completed by the staff show that they were not clear about which GP people were registered with. For example, a member of staff recorded that when a GP’s visit was requested, staff were told that the person was not registered with that GP. This resulted in people running out of essential medication, which triggered hospital admission for two people. Feedback about the standards of care was sought from six people at the home. Individuals consulted said that GP’s visit on request and a GP’s visit had taken place since their admission to the home. Regarding health care one person said that staff had attempted to administer the wrong medication and relatives had brought the medication error to the attention of the home. The pharmacist inspector looked at handling of medicines in the home on 20th February. This followed a complaint we received from a visiting doctor that some medicines had not been available for someone living in the home, putting their health at risk. Medicines administration record sheets seen in the home showed that four medicines had not been given for several days, although other medicines had been available and given during this time. The pharmacist inspector visited again on 11th March to look at medication storage arrangements on the first floor of the home. Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 13 Secure storage is available for medicines on both floors of the home. The temperature of the medicine fridges on both floors is recorded daily. Records for the ground floor fridge showed the temperature was –6 degree C at the time of the inspection. This is well below the safe range of 2 to 8 degree C for storing medicines. No action had been taken to address this. At the time of this inspection one medicine was in the fridge. Action is needed to make sure that the temperature of the fridge is within the safe range. The medicine fridge on the first floor contained more medicines and records showed that this was kept at a safe temperature. Four small Oxygen cylinders were kept. These need to be secured so that they cannot fall over causing injury. A large medicines trolley is used to take all the medicines around the home. Medication rounds have been taking a long time, at the time of the inspection lasting nearly three hours. This means that some morning medicines are not given until lunchtime making it difficult to have the correct time between doses that are given three or four times a day. Staff confirmed that medicines administration often took this length of time. On the first day of the inspection the registered provider managed to locate some alternative medicine trolleys, which were delivered the next day. When the inspector visited on 11th March the new trolleys were in place and staff said that they could now give medicines in a reasonable time. In an effort to improve the medication system, the manager has requested that the pharmacy supply medicines in monthly blister packs instead of the standard packs that had been used. This new system had started on the week of the inspection. Some medicines called Controlled Drugs need extra secure storage, which is provided, and also extra records made in a Controlled Drugs register. Staff did not keep the correct records when the home first opened so there is no audit trail to show that these medicines have been used safely. We found that records for administration of medicines since the home had been open were very difficult to follow and did not demonstrate that medicines had been given as prescribed by the doctor. Records for some periods of time had been made electronically and staff were not able to show these to us at the time of inspection. We checked most of the current medicines administration record sheets with the medicines available and found a number of discrepancies, which could result in medicines being missed or given incorrectly. Handwritten records that could be seen had some gaps where it was not clear whether medicines had been given. In a number of cases medicines were not given because they were “out of stock”. Two people living in the home had brought in plastic Dosette boxes containing a week’s supply of medicines. These were not clearly labelled with their contents. This means that nurses cannot check that they are giving the correct medicines, as prescribed by the doctor. Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 14 Many people moving into the home brought in their own medicines with them. In most cases staff made no record of the quantity of medicines brought into the home. This means that it is not possible to check that medicines have been given as recorded. In some cases medicines have been recorded as being out of stock but it is not possible to check whether this was the case. Records have been made of the disposal of unwanted medicines. Requirements concerning handling of medicines in the home have been made to safeguard the health of the people using the service Following the inspection assurances were given by the Responsible Individual that all individuals are now registered with a GP. The registered people must ensure that people at the home are registered with a GP. Records of health care professional visits were not always completed for GP’s, dental and optician visits. The home’s Privacy and Dignity policy is appended onto the Statement of Purpose and confirms that every effort will be taken to retain individual’s rights. People consulted made positive comments about the way staff respect their rights. It was stated that their privacy is respected, staff knock and wait for an invitation to enter, and staff are respectful. Bamfield Lodge Care Home DS0000070870.V359670.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. There are good support systems in place for people at the home to lead active and interesting lifestyles. EVIDENCE: The Statement of Purpose informs individuals about the range activities including outings organised at the home. Individuals living at the home said that an activities coordinator was employed and activities take place. Six people said that they participated in activities and two said it was their preference to stay in their rooms during the day. Individuals that stayed in their bedrooms said that they watched television, read books or went for walks around the home. The visiting arrangements of the home are included in the home’s Statement of Purpose, which stated that visitors are welcome at the home. Individuals at the home said that they their visitors are welcome by the staff and visits can take place in bedrooms for additional privacy. Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 16 Individuals were consulted about the meals served at the home. Generally individuals were satisfied with the meals provided and confirmed that alternatives were provided. One person said, “ Food is very good, likes and dislikes are catered for,” although another said “food is not so good, there is always a choice but there are always sandwiches for evening meals.” Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): (16) & (18) Quality in this outcome area is (poor). This judgement has been made using available evidence including a visit to this service. People at the home can expect their concerns to be listened to and must be protected from abuse. EVIDENCE: A Complaints procedure is appended onto the Statement of Purpose and on display in the foyer of the property. One complaint was received at the home and the manager has responded to the complainant within the specified timescale. There were insufficient records to show that the registered manager had conducted a thorough investigation manager or the complainant’s level of satisfaction with the outcome. Two anonymous complaints and one concern were received at the Commission from relatives of people at the home and from staff about medication, health care and staffing levels. As a result of the complaints received a Safeguarding Adults strategy meeting with outside agencies and professionals was held and this key inspection undertaken. The Responsible Individuals and operational managers are involved in the investigation of issues identified through the inspection. Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 18 People that live at the home were consulted about the manner in which complaints are handled by the home. Individuals at the home said that they would approach the nurses or the manager with complaints. The Protection of Vulnerable Adults and Whistleblowing policies demonstrate that the organisation is committed to safeguarding adults from abuse. Given the very serious issues arising from this inspection policies must be reviewed to follow local “No Secrets” procedures and to inform staff about their responsibilities to report poor practice and the implications for not reporting allegations of abuse. Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (19), (20), (21), (24) & (26). Quality in this outcome area is (excellent). This judgement has been made using available evidence including a visit to this service. The accommodation is well maintained and individuals accommodated benefit from living in a clean and well-decorated environment. EVIDENCE: Bamfield Lodge was purpose built in 2007, it is arranged over three floors with a passenger lift to assist individuals to move easily around the home. The property is light and decorated to a high standard that has a “Hotel” style appearance and on each floor there are lounges, dining areas and bedrooms. There is level access into the home, wide corridors, toilet facilities and bedrooms that are accessible to people that use wheelchairs. Specialist equipment such as assisted baths, hoists and stand aids are provided to support individuals that have physical impairments. Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 20 The home has a large lounge/dining room on the ground floor with smaller lounge/dining room and refreshment areas on second and third floor. Up to sixty people can be accommodated and bedrooms are single with en-suite facilities that include shower, toilet and hand basin. Individuals giving feedback said that the accommodation was very good and they could move around the home easily. The laundry is sited away from the kitchen, the walls are tiled and painted and there is vinyl flooring for easy cleaning. There are two industrial washing machines with sluicing cycles and two industrial tumble dryer for laundering the individual’s clothes. Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (poor). This judgement has been made using available evidence including a visit to this service. The staffing levels and lack of induction training has compromised the safety of the people living at the home. EVIDENCE: Staffing levels were discussed with the Responsible Individual and Operational Support Managers and it was stated that the ratio of staff for the home is 1:8 in the residential unit and 1:5 for nursing patients. The rotas examined show that not all shifts were covered and on some occasions staffing levels had fallen, compromising the safety of the people living at the home. The Responsible Individual and Operational Support Managers gave assurances during the inspection that shifts would be covered and staffing levels would be maintained. Members of staff giving feedback made the following comments about the staffing levels, “A few weeks ago we were very short, sometimes it was only me” and “The first week we opened was awful, but it has since improved.” People giving feedback during the latter part of the inspection said that since the inspection started staffing levels had improved. Three members of staff were consulted about the induction provided. One person said that they had not received an induction and had no previous experience of working in a caring environment, the second member of staff said that an induction was provided by the deputy and the third said that a quick one day induction was provided. Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 22 The operational manager acknowledged that this was unacceptable and said that Skills for Care Induction programme will be used in future with all staff and will include familiarisation of the building and the allocation of a mentor. The operations manager said that because of the recent situation at the home, staff would be undertaking refresher training. A training programme that includes care planning, medication, infection control, dementia care and challenging behaviour will be provided to all staff from March to April. Statutory training in Basic Food Hygiene, Protection of Vulnerable Adults, Fire and First Aid will also be provided to all staff. This will ensure that staff have the right skills and insight to meet the needs of the people at the home. Individuals consulted about the skills of the staff said that they were very good and were able to meet their needs. The personnel files of eleven staff at the home were examined during the inspection and completed applications forms, written references and Criminal Records Bureau (CRB) disclosures are held in the file. Through the application forms, candidates must provide a full employment history, the names of two referees and disclose any convictions. It is evident from the information held within the files viewed that the recruitment process must be more robust. For example, a CRB disclosure was returned with convictions, yet the person had not declared the convictions on the application form. The manager must follow up such issues and ensure that staff employed to work with vulnerable people are honest and have integrity. References from the most recent employer must be sought. Character references were accepted for a number of staff and must only be accepted when there are no other alternatives. Where the organisations request for reference forms are used, the returned form must be validated with a company stamp, compliment slip or letter head to show that the reference is authentic. It transpired during the discussion with the operational support managers that the registered manager was using the incorrect form. Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 23 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 (poor). This judgement has been made using available evidence including a visit to this service. The organization must reassure individuals that the environment is safe and that standards will be the subject of ongoing monitoring. EVIDENCE: The manager is currently on a period of absence from the home and the operational managers are in day-to-day control while the manager is absent. The operational support manager said that the organisation uses an audit system to maintain consistency of care at the home. It is the operational managers’ that conduct monthly visits and records show that finances, Human Resources, Quality Assurance, Health and Safety form part of the monthly visits. Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 24 From the areas of discussion an action plan is then developed which the manager and line manager sign. However, the manager did not sign the January’s report. The organisation has a supervision policy which states that staff will receive from the line manager six supervision sessions per year. Members of staff consulted said supervisions have not occurred but were informed the operational directors that it be instigated. Also handovers at shift changes had not occurred but since the beginning of the inspection, it was stated and staff confirmed that handovers are now taking place. The organisation operates their own Quality Assurance System and purports to adhere to the Annual Quality Assurance Assessment and National Minimum Standards. It functions through an annual development plan based on the home’s business plan, feedback from people at the home, relatives and staff. The annual development plan looks at complaints received, visits from the operational manager, questionnaires and audits such as care plans and Health & Safety. From the annual development plan, a plan for quality improvements will then be devised to focus on measurable standard. The range of fees is stated within the Statement of Purpose, which ranges between £415.00 for residential - £515.00 per week for nursing. Facilities for the safekeeping of cash on behalf of the people at the home are provided. While cash is held separately for each person, a record of each transaction, with amounts deposited and withdrawn is not maintained. A record of cash held in safekeeping on behalf of the people living at the home must be maintained so that their interests are protected and to reduce the risk of financial abuse. The manager has ensured that clinical waste is correctly removed. Fire risk assessments were developed to reduce the potential of fire at the home. The risk assessments must be reviewed to include the checks of fire systems and equipment that will be undertaken to prevent the outbreak of fire at the home. The building is new and all equipment is under guarantee. From the information recorded within the Register of Residents it is evident that the manager failed to inform the Commission of events, incidents and accidents as legislation requires. It transpired through discussion with the manager that the reports of accidents and incidents from the day the home opened till the previous day had been emailed the day before the start of the inspection. The Commission must be informed as soon as possible of any events, accidents, and incidents affecting individuals at the home. Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 25 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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 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 1 17 X 18 1 4 4 X X X 4 X 4 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 3 X 1 X 1 2 Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 26 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 OP3 Regulation 14 (1) (a) Requirement The manager must ensure that the assessments of needs for people wishing to live at the home are conducted by suitably qualified or competent staff A written care plan with the person must be developed for each person living at the home. Risk assessments must be completed for individuals that must be supported from staff with Moving and Handling. People living at the home must be registered with a local GP Complaints received at the home must be recorded and investigated. Safeguarding and Whistleblowing policies must inform staff about their responsibilities to report poor practice and the implications for not reporting poor practice. The manager must ensure that staffing levels are maintained at all times The manager must ensure that staff employed at the home are of good character and integrity. DS0000070870.V359670.R01.S.doc Timescale for action 30/04/08 2 3 OP7 OP8 15 (1) 13 (4) (c) 30/05/08 30/05/08 4 5 6 OP8 OP16 OP18 13 (1) (a) 22(3) 13 (6) 30/03/08 30/04/08 30/03/08 7 8 OP27 OP29 18 (1) (a) 19 (5) (a) 30/03/08 30/03/08 Bamfield Lodge Care Home Version 5.2 Page 27 9 10 OP29 OP37 10 (1) (c) 37 11 12 OP37 OP38 26 23 (4) (A) 13 OP35 17 (2) Sch. 4.9(a) Reg 13.2 std 9 14 OP9 The authenticity of the referee must be validated. The manager must inform the Commission about any accidents, incidents and events that affect the welfare of the people at the home. A copy of the monthly reports on the conduct of the home must be provided to the Commission Fire risk assessments must include the checks of fire alarm systems and equipment to prevent an outbreak of fire in the home. A record of money deposited or withdrawn from safekeeping with the dates, amounts, purpose and signatures must be maintained. Arrangements must be made for the recording, handling, safekeeping and safe administration of medicines received into the home. 30/04/08 30/03/08 30/04/08 30/05/08 30/03/08 20/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bamfield Lodge Care Home DS0000070870.V359670.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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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