Inspection on 02/07/08 for Bamfield Lodge Care Home

This inspection was carried out on 2nd July 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bamfield Lodge Care Home 19/02/08

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

CARE HOMES FOR OLDER PEOPLE Bamfield Lodge Care Home 1 Bamfield Whitchurch Bristol BS14 0AU Lead Inspector Sandra Jones Unannounced Inspection 09:00 2 & 4th July 2008 nd 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.V364992.R02.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.V364992.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bamfield Lodge Care Home Address 1 Bamfield Whitchurch Bristol BS14 0AU 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 01275 839643 bamfieldlodge@averyhealthcare.co.uk Avery Homes Bristol Ltd 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.V364992.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registerd 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. 19th February 2008 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 £430.00 for residential - £550.00 per week for nursing. The aims and objectives of the home is to foster an atmosphere of care and support which both enables and encourages people living at the home to lead full, interesting and independent a lifestyle as possible. Bamfield Lodge Care Home DS0000070870.V364992.R02.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 key inspection was conducted unannounced in July 2008 over two days and focused on the assessment of key standards. 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 procedures. During the site visit, the records were examined and feedback was sought from individuals and staff. Prior to the visit some time was spent examining documentation accumulated since the previous inspection, including Regulation 37 notifications, information from other professionals and other regulatory activity. “Have your say” surveys were sent to people who use the service, their relatives, staff and health care professionals. Surveys were received at the Commission from nine people living at the home, five relatives, two staff and one health care professional. There were fifty-five individuals were living at the home at the time of the inspection and 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 people living at the home, their relatives, qualified nurses and care assistants were gathered through face-to-face discussions. What the service does well: Bamfield Lodge Care Home DS0000070870.V364992.R02.S.doc Version 5.2 Page 6 Individuals consulted during the inspection said that the home respected their rights in particular privacy and dignity. One person said the correct form of address is used which to them is important and shows respect from the staff. Comments received from the people at the home through the “Have your say” surveys included “ I think it’s a lovely place, staff are always there if I need them, I can’t fault it at all” and “This is a well run home and I am very happy here.” While relatives made critical comments about aspects of the care, positive comments about the home were also made through the surveys. This comment was echoed by many relatives “ A wide range of activities, pleasant surroundings, real commitment to providing good care and a positive attitude from the staff”. What has improved since the last inspection? What they could do better: Bamfield Lodge Care Home DS0000070870.V364992.R02.S.doc Version 5.2 Page 7 There are seven requirements arising from this inspection and they relate to care planning, medication, meals, staffing and risk assessments. Two of these requirements are repeated from the last inspection and they have been partially met. Care planning must be improved by making the reviewing process more structured to, where possible, review care plans with the person and their relatives. Individuals preferred routines, likes and dislikes must be incorporated into the care pan to adopt a more person centred approach to meeting needs. This will ensure that people are at the centre of their care and their needs are met in their preferred manner. Medications systems must be made safer for the people at the home. Gaps in the recording of medications administered are an indication that members of staff are not signing records soon after administration. Also to consistently and safely administer “when required” medications, protocols that guide the staff on when to administer the medications must be devised. Individuals must be more involved in the menu planning to ensure their preferences are reflected. Members of staff must have individual supervision with their line manager to discuss work performance and training needs. This is so that the people at the home can benefit from a well-supervised staff team. Fire risk assessments must include the checks of fire systems and practices for the staff to ensure the potential for fire is reduced. 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.V364992.R02.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.V364992.R02.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) Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. There is an effective admissions procedure in place, which enables people wishing to live at the home to make an informed choice about moving there. They can be reassured that the home will have the skills and resources to meet their assessed needs. EVIDENCE: The prepared Statement of Purpose says that the home’s objective is to foster an atmosphere of care and support which both enables and encourages people living at the home to lead full, interesting and independent a lifestyle as possible. Within the Statement of Purpose the Admission procedure is described and includes the criteria for admission at the home. The range of needs that can be met at the home is listed and confirms that assessments Bamfield Lodge Care Home DS0000070870.V364992.R02.S.doc Version 5.2 Page 10 precede any admission to the home. While the age range of people that can be offered nursing care is stated, the age range for people in the residential units are not stated. The age ranges of people for whom accommodation can be offered must be specified within the Statements of Purpose, this will ensure that people wishing to live at the home have accurate information to make decisions about living at the home. The case records of the most recent admissions to the home were examined to ensure that correct assessments took place, to determine that their needs can be met at the home. The assessment carried out by the home relates to their abilities with personal care, mobility and health care needs. Case records contain contact details, completed pre-admission assessments that establish the level of needs. It is evident from the case records examined that preadmission assessments are conducted and action plans are then developed from the assessments. Feedback about the admission process was sought from the two people most recently admitted to the home. Individuals said that they visited the home with their relatives and the manager undertook an assessment of need in advance of their admission to the home. Both individuals also confirmed that they discussed with the manager the way their needs were to be met by the staff. “Have your say” surveys from nine people at the home were received and eight people confirmed that they received enough information to make decisions about the home before moving in. “Have your say” surveys were received from five relatives and two people said that they always got enough information about the care home to help make decisions about the home. One relative made this comment “ On admission my mother was quite distressed and I was very impressed with how all the staff dealt with the situation”. Equally another person said, “ Though from time to time there appears to be some confusion with the management we usually obtain information required, staff are there to assist.” Regarding meeting the needs of their relative at the home, four said that the home always met the needs of their relative. There are signed Terms and Conditions of residency, which list the name of the person, their room number and weekly charge. Bamfield Lodge Care Home DS0000070870.V364992.R02.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 (adequate). This judgement has been made using available evidence including a visit to this service. There are effective care planning systems in place for individuals to benefit from receiving an individualised and consistent service but further improvements are needed. Individuals and their families must be invited to the review meetings, action plans must be more person centered and for people with dementia action plans must be detailed about safety and security. People living in the home can be confident that staff have a good awareness of their needs and that they will be treated with dignity and respect People at the home can expect sensitive and prompt support for their personal and health care needs from a skilled staff team. Medication systems must be made safer by the introduction of protocols for “when required” medications. Bamfield Lodge Care Home DS0000070870.V364992.R02.S.doc Version 5.2 Page 12 EVIDENCE: Case records examined show that from the pre-admission assessments, the individual’s needs are identified. Care plans are then developed from the assessments and generally guide the staff to meet the assessed need. The manager undertakes the initial review either at the hospital or the persons’ own home and the manager further stated that a senior nurse would delegate a qualified nurse to conduct the admissions and gather information to compile the care plan. “Have your say” surveys from six people state that they always receive the care and support they need, two said this was usual and one said it was sometimes. Two relatives that responded through the survey said the care home provides the expected care, two said it was usual and one said it was sometimes. The following comments were made through the surveys by relatives, “ I would like to have some more information about my mother’s care plan and keyworker.” Care plans are currently reviewed monthly with the key nurse or keyworker and the manager said that a greater emphasis would be placed on having structured reviews with the family and the person. Care plans will then be signed by the person to indicate agreement with the plan of action. Members of staff on duty during the inspection were consulted about their role. A qualified nurse said that their role is to organise shifts, administer medications develop care plans and some medical procedures. For example, dressings. Two care assistants giving feedback said that their role includes hands on care, read care plans and read reports. The two staff that responded through the survey said that they were usually given enough information about the needs of the people they support. The home accommodates people with residential and nursing care needs, which include physical impairments and dementia. For people with physical impairments, assessments and care plans specify the actions to meet the need. The care plans for people with dementia must where care focus on ways that promote independence, autonomy and choice. Individuals personal care need form part of their action plans care plan and generally guide the staff on meeting the need. The introduction of preferred routines into the action plans, care plan will be more person centred. The home undertakes handling, nutritional and other associated risk assessments. A scoring system is used to determine the level of risk, for example, high, medium and low. Where medium and high moving and handling risks are identified, it is the policy of the home to use aids and have two staff assist the individuals. Nutritional, pain and pressure area assessments are undertaken to assess the level of risk, so that an action plan Bamfield Lodge Care Home DS0000070870.V364992.R02.S.doc Version 5.2 Page 13 that reduces the level of risk can than be developed. Monthly evaluations are conducted to ensure the actions continue to reduce the level of risk. Members of staff record daily occurrences and events, activities, outcome of visits and observations of the individuals are also recorded. Daily reports show that the individual’s needs are assessed and the progress of the care plans are monitored. Visits from the GP, district nurse, dentist and optician are recorded separately and members of staff report on the purpose and outcome of the visit. Documentation held also shows that people at the home have input from specialists, dieticians, Speech and Language therapists and Community Psychiatrist Nurse (CPN). People giving feedback about health care said that visits to the GP are arranged and advice is followed. Six individuals stated through the survey that they always receive the medical support they need and three said this was usual. Three relatives stated through the survey that the home always kept them informed about important issues affecting their relative at the home. Comments from relatives included “ Generally they are very good with this but again there have been management mishaps,” and “ When mum slid out of her wheelchair, I was phoned an hour after it happened and then after the GP had been” The Privacy and Dignity procedure is included in the Statement of Purpose and relates to the person retaining their right to privacy, dignity and independence. The steps to be taken to ensure the individual’s rights are respected and relates to visiting and facilities. Individuals giving feedback said that the staff always respect their rights to privacy and dignity. One person also said that staff use the correct form of address, which is important to them. Members of staff were consulted about the way individuals rights are respected. Care assistants gave the following examples about the way individual’s privacy and dignity is respected. Staff said that they knock on bedroom doors before entering; they provide discreet personal care, seek permission before undertaking tasks and keep information confidential. Medications are administered from a monitored dosage system and overall medication systems are safe. Records of medication administration were checked and gaps in the recording were found, this means that records are not always signed immediately after. There is the correct use of codes for medication not administered. There are a number of individuals that have are prescribed “ When required” medications. However, protocols that guide staff on administering the medication safely are not in place. Protocols that guide staff on consistently administering medications must be devised. Bamfield Lodge Care Home DS0000070870.V364992.R02.S.doc Version 5.2 Page 14 Homely remedies include analgesics and anti-motility, which are administered from a stock supply when required by the person. While records of administration are kept, a running balance of the medications is not maintained. Running balances will allow for monitoring of medications held and ensure safe handling. A record of medications no longer required is kept and the signature of the pharmacist indicates receipt of the medicines for disposal. One person said that previous problem with medication had been resolved. The staff now administer the correct medication at the directed times. Although relatives raised concerns through the survey about medications not being given on time, there was not evidence that this was a recent issue. Bamfield Lodge Care Home DS0000070870.V364992.R02.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 individuals to lead active and interesting lifestyles. Visitors to the home are welcome. People living in the home receive a varied and they should be able to influence menus. EVIDENCE: The individual’s hobbies and interests are sought through the social assessment of the care planning process. A record of the activities undertaken is kept and monthly reviews are conducted to ensure the activities provided meet the needs of the people at the home. The home employs a full time member of staff to undertake activities and another member of staff will be undertaking the social activities coordinator role on a part-time basis. Activities programme include 1:1, slide shows, arts and crafts and quizzes. Outside facilitators visit the home to give talks, provide entertainment and “Singing for the brain”. Individuals also attend outside activities, for example, dance voice. Bamfield Lodge Care Home DS0000070870.V364992.R02.S.doc Version 5.2 Page 16 Individuals were consulted about participation in activities and a range of feedback was received. One person said that they would become more involved once they are more settled, another two said it was their choice to stay in their rooms and not participate and one said they participated in some activities. Four individuals reported through the survey that activities were always arranged by the home, three said this was usual and one said it was sometimes arranged. One person living at the home made the following comment “ I am particularly grateful for the activities team, one of my greatest joys is being taken to my local church every Sunday with others from Bamfield” Additional comments were made by two relatives through the surveys about the activities at the home. Comments made included “ My mother is rarely included in activities” and “ A good range of activities” The home recognises that individuals must maintain links with family and friends. This is supported by the Visitors policy, which states that there is open visiting. Visitors to the home record the nature of their visit and shows that individuals maintain contact with friends and family. Individuals giving feedback confirmed that their relatives are welcome and can visit in their bedroom for additional privacy. One person said a lounge was made available so that they could all have a meal together. Two relatives said through the surveys that the home always supports their relative to keep in touch and one said never. Additional comments made by relatives included “ The home have dialled the number so my mother could speak to me,” “ My mother has a phone installed in her room so can contact me at anytime” and “Only found out by accident that there is a mobile phone. Mum can speak to me if I ring the home.” Within the social assessments, the individual’s financial arrangements are described. The manager said that in future individuals would be invoiced for any additional extras to reduce the amount of cash held at the home. The cook devises menus and each day individuals are asked to make choices about the meals to be served. Records of food provided show that individuals can make meal choices. There is a wide range of fresh, frozen and tinned foods that confirms that people at the home have a varied diet. Individuals were consulted about the quality of the food served and there was a diverse range of comments made. One relative said that their mother is eating better and one person said that two courses are served at lunchtime and three in the evenings, this person also said that the food was good but the choice of meals are limited. Another person said that the food was good and it was varied, one person said the food is awful and, they serve liquid eggs and powdered mashed potato. These comments were discussed with both the chef and the manager and it was understood that liquid eggs are no longer used and powdered potatoes were never used at the home. A tour of the catering area confirmed that fresh eggs and potatoes are used at the home. Six people that responded through the survey said that the food was always good; one said Bamfield Lodge Care Home DS0000070870.V364992.R02.S.doc Version 5.2 Page 17 this is usual and two said it was sometimes. From the comments received individuals are not always satisfied with the food served, people at the home should be more involved with menu planning. Bamfield Lodge Care Home DS0000070870.V364992.R02.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. Individuals can expect their concerns to be listened to and to be protected from abuse. EVIDENCE: The home’s Complaints procedure is detailed in the Statement of Purpose and displayed in the foyer of the building. It states that complaints will be investigated within 28 days of receipt and confirms that complainants will be informed of the actions to be taken to resolve the complaint. Individuals at the home were consulted about making complaints. They said that they would approach the manager with complaints and felt confident to raise concerns. Seven people responding through the surveys said that they know who to speak to if they are not happy and one said this was usual. Six people also said that they knew how to make complaints and three said that they did not know. Five relatives indicated through the survey that they know how to make a complaint and four said that the home had responded appropriately to their complaints. Their comments included “ I know there is a formal complaints procedure and certainly staff have responded but I feel action has been patchy” and “ the new manager has asked for any concerns to be taken straight to her, there is contact details for CSCI.” Bamfield Lodge Care Home DS0000070870.V364992.R02.S.doc Version 5.2 Page 19 A record of complaints received is maintained and detailed are the actions taken to resolve the complaints. The level of satisfaction must be recorded to show that every step is taken to resolve complaints. The Abuse and Whistle Blowing policies illustrate the organisations commitment towards safeguarding individuals from abuse. The factors of abuse and the actions to be taken where alleged abuse occurs is included within the Abuse Policy and follows “No Secrets” guidance. The Whistle Blowing policy endorses that staff must raise concerns where poor practice is witnessed. People giving feedback about the home said that they felt safe. Members of staff consulted about their responsibilities towards safeguarding individual from abuse. Members of staff are clear about the factors of abuse and knew the actions to be taken. From the records examined it is evident that one person can become aggressive towards staff. While the action has been taken to address incidents, a strategy that is clear about the way staff must consistently manage these situation must be devised. Since the last inspection there were two Safeguarding Adults referrals for staff to ensure that individuals are safeguarded from abuse. Bamfield Lodge Care Home DS0000070870.V364992.R02.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) & (26) Quality in this outcome area is (excellent). This judgement has been made using available evidence including a visit to this service. People at the home benefit from living in a comfortable and clean 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 Bamfield Lodge Care Home DS0000070870.V364992.R02.S.doc Version 5.2 Page 21 equipment such as assisted baths, hoists and stand aids are provided to support individuals that have physical impairments. 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. The nine individuals that responded through the “Have your say” surveys said that the home was always clean and fresh. Bamfield Lodge Care Home DS0000070870.V364992.R02.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 (adequate). This judgement has been made using available evidence including a visit to this service. Adequate staffing levels help to ensure that people’s needs are met. Individuals are supported by a competent and skilled staff team who must be supervised. EVIDENCE: Overall the recruitment process is robust. Potential candidates must complete the home’s application form and through the application form provide the names of two referees and declare any criminal disclosures. The personnel files of staff employed were examined, completed and signed application forms are kept. Two references and Criminal Records Bureau (CRB) disclosures are obtained to ensure the person’s suitability to work with vulnerable adults. During the evaluation of the recruitment process, it was noted that where character references are accepted, there is no documented explanation for not pursuing employment references. Both staff that responded through the surveys said that the employer carried out checks before they started work. Bamfield Lodge Care Home DS0000070870.V364992.R02.S.doc Version 5.2 Page 23 The rota in place shows that the manager is taking steps to ensure that staffing levels are adequate to meet the needs of the people at the home. The manager said that the recent recruitment drive would take the home above the set establishment hours for care assistants and will reduce the use of agency staff. There are two registered nurses and between six and seven care assistants rostered throughout the day, with four staff awake at night. Surveys from four people at the home state that staff are always available when they are needed, four said this is usual and one said it was sometimes. One member of staff, through the survey said that it was usual for enough staff to be on duty to meet the needs of the people at the home and one said it was never. Additional comments from relatives through the surveys raised concerns about the staffing levels at the home. Individuals at the home agreed to give feedback about the staff and their ability to meet the needs of the people at the home. Comments about the staff were generally good, individuals praised the day and permanent staff but were critical about agency staff. The people giving feedback said, the staff had the skills to meet their needs. One relative consulted said there was a vast improvement with the staff and continuity was provided as a result. This relative said, “ The staff are more skilled in meeting needs. You can now relax, I used to hate coming here, it was awful but things have changed, and I don’t mind coming anymore.” Two responses from relatives through surveys state that the staff always have the right skills and two said this was usual. New staff must complete an in-house induction programme and the manager said that in future the Skills for Care Common Induction programme would be followed. The manager said that new staff have an induction day and are supernumerary for two shifts and if they are new to the care environment will have five days supernumerary. Mandatory training is the main focus of training for the staff until August when more specific training will be offered. In-house training is generally through videos, handouts and discussions and outside courses for Dementia and syringe drivers will be provided to staff. The two staff that responded through the survey gave varied responses about the induction provided. One member of staff said that the induction covered everything that they needed to know to do the job and one said that an induction was carried out. Members of staff on duty were consulted about training during the inspection. A qualified nurse said that training is accessible to all staff and two care assistants consulted listed the training attended since the last inspection. Staff comments confirmed that statutory training is being provided to all staff. Both staff that responded through the survey said that the training is accessible. There are eight staff currently undertaking NVQ level 2 and nine have already achieved NVQ to level 2. Ancillary and activities coordinators are encouraged to undertake vocational qualification. Bamfield Lodge Care Home DS0000070870.V364992.R02.S.doc Version 5.2 Page 24 Bamfield Lodge Care Home DS0000070870.V364992.R02.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (31), (33), (35) & (38) Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. Individuals can expect to live in a safe environment and can be re-assured that standards will be the subject of ongoing monitoring. EVIDENCE: The manager has been successful in the application to register as manager and has been approved as registered manager of Bamfield Lodge. Bamfield Lodge Care Home DS0000070870.V364992.R02.S.doc Version 5.2 Page 26 The manager explained that the role involves day-to-day participation in a handover, managing staffing and training. It is an expectation of the role to know the specific needs of the people living at the home and to encourage relatives to discuss issues with the individual that can affect change. Regarding consistency of care, the manager said that good communication, rapport with trained staff, undertaking spot check being available ensures that individuals benefit from a consistent approach. Members of staff consulted during the inspection said that handovers take place when shift changes occur. Through the survey one member of staff said that handovers always take place when shift changes occur and one said handovers did not take place. Individuals were asked to make comments about the management of the home. One person said that there was a nice atmosphere and felt there were some teething problems that were being address. Another explained that soon after admission his wife was admitted to hospital and praised the staff for keeping him informed about his wife’s progress. Members of staff giving feedback about the management of the home said, that the manager is friendly yet professional. Comments were made about the positive changes that the manager has implemented. For example, any equipment needed is provided. Regarding the team, staff said there is good team spirit. The manager confirmed that the external manager visits the home monthly and reports on the conduct of the home. Reports of the monthly visits’ supports the comments made by the manager. The manager said that supervision was to be introduced, senior staff will be delegated responsibility to undertake 1:1 supervision with staff that they line manage. Facilities for the safekeeping of cash and valuables exist at the home. The manager said that this policy will change to reduce the amount of cash held at the home. Relatives and people at the home are being informed that in future, an invoice will be raised for any extra charges. The records of cash held in safekeeping were checked against the balances held and were found to correspond, receipts kept further evidenced the purchases made on behalf of the person. Fire risk assessments are conducted to develop an action plan that reduces the potential of fire at the home. While fire risk assessments action plans are specific, the checks and practices that will take place to prevent a fire are not included in the risk assessment. This was required at the last inspection and the requirement has been partially met. Fire risk assessments must include the fire systems check and training that will be provided to the staff, this will further show that the home takes adequate precautions against the risk of fire. Since the last inspection The Avon & Fire Rescue visited the home to inspect Bamfield Lodge Care Home DS0000070870.V364992.R02.S.doc Version 5.2 Page 27 the premises and it was understood that the recommendations made as a result of the visit were actioned. The home also complies with associated legislation to ensue the building is safe for staff and people living at the home. Outside contractors undertake gas central heating, portable equipment, hoists and passenger lift, checks annually. The organisation operates a Quality Assurance system. It functions through a series of audits that the manager must undertake and is linked to the annual development plan. The annual development plan looks at complaints received, visits from the operational manager, questionnaires and audits such as care plans and Health & Safety. Bamfield Lodge Care Home DS0000070870.V364992.R02.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 x x x x x x 4 STAFFING Standard No Score 27 2 28 2 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 2 Bamfield Lodge Care Home DS0000070870.V364992.R02.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? no 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. 2. Standard OP7 OP7 Regulation 15 (2) (c) 12 (3) Requirement Where possible care plans must be reviewed with people living at the home and their relatives. Individuals preferred routines, likes and dislikes must be incorporated into the care plan to adopt a more person centred approach to meeting needs. Medication protocols must be devised for people that have prescribed when required medications. This will ensure that medications are safely and consistently administered Members of staff must be supervised. This will ensure that performance and training needs are discussed and he people at the home will then benefit from well-supervised team. Fire risk assessments must include the checks of fire alarm systems and equipment to prevent an outbreak of fire in the home. (Partially met from last inspection) Arrangements must be made for the recording, handling, DS0000070870.V364992.R02.S.doc Timescale for action 30/12/08 30/12/08 3. OP9 13 (2) 30/07/08 4. OP30 18 (2) 30/01/09 5. OP38 23 (4) (A) 30/07/08 6. OP9 Reg 13.2 std 9 30/07/08 Bamfield Lodge Care Home Version 5.2 Page 30 safekeeping and safe administration of medicines received into the home. (Partially met from last inspection) 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 OP15 Good Practice Recommendations People at the home should be more involved with menu planning. Bamfield Lodge Care Home DS0000070870.V364992.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West 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. Extracts may not be used or reproduced without the express permission of CSCI Bamfield Lodge Care Home DS0000070870.V364992.R02.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!