Inspection on 17/12/07 for Bamford Grange Care Home

This inspection was carried out on 17th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Bamford Grange Care Home 07/02/07

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

CARE HOMES FOR OLDER PEOPLE Bamford Grange Care Home 239 Adswood Road Cheadle Stockport Cheshire SK3 8PA Lead Inspector Steve O’Connor Unannounced Inspection 17 December 2007 10:00 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 Bamford Grange Care Home DS0000068318.V350887.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. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bamford Grange Care Home Address 239 Adswood Road Cheadle Stockport Cheshire SK3 8PA 0161 477 8496 0161 477 8269 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) Four Seasons (Bamford) Limited Mr Steven Robert Moore Care Home 79 Category(ies) of Past or present drug dependence over 65 years registration, with number of age (61), Dementia (60), Mental disorder, of places excluding learning disability or dementia (19), Mental Disorder, excluding learning disability or dementia - over 65 years of age (15) Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 79 users to include: up to 61 service users in the category of DE(E) (Dementia over 65 years of age); up to 60 service users in the category of DE (Dementia under 65 years of age); up to 15 service users in the category of MD (E) (Mental disorder excluding learning disability or dementia over 65 years of age); up to 19 service users in the category of MD (Mental disorder excluding learning disability or dementia under 65 years of age). No more than 19 service users aged 35 and above with mental disorder, may be accommodated. No more than 60 service users aged 55 and above with dementia may be accommodated. 7th February 2007 2. 3. Date of last inspection Brief Description of the Service: Bamford Grange Nursing Home is a purpose built care home that provides 24hour nursing care and accommodation to 79 service users. It is owned and managed by Four Seasons (Bamford) Limited. The home is split into three separate units. Kensington Unit on the ground floor has 40 beds and provides care for people over 65 years of age suffering from dementia but who are of a lower physical dependency. The first floor has two units; the Windsor Unit which is a high dependency dementia care unit, and the Balmoral Unit which provides a care service to people with a functional mental health disorder and who are generally under the age of 60. Each unit has its own lounge/dining area. Bedrooms are spacious single rooms providing en-suite facilities. A choice of bathroom or shower is available on each floor. The furnishing, carpeting and decoration are of a satisfactory standard. The home has its own hairdressing room, an activity room and Snoezlen room. Smoking is not permitted in the building. Bamford Grange has car-parking facilities at the main entrance to the home and garden areas are available at the rear of the home. The home is situated in the Adswood area of Stockport and is close to Cheadle and Davenport. Local amenities such as shops, pubs and GP surgeries are close by. Bus services are available and a local train station is approximately a ten minute walk away. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 5 The current weekly fees range from £495 to £720 dependent on the package of care required. Further details regarding fees are available from the deputy manager. Additional charges may also be made for hairdressing and other personal requirements. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection report is based on information and evidence gathered by the Commission for Social Care Inspection (CSCI) since the home last had a key inspection in February 2007. Additional information that was taken into account included any incidents notified to the CSCI and information provided by Four Seasons Ltd (the organisation that owns and runs the home) and other relevant agencies. Before the site visit, we also asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home view the service they provide in the same way that we see the service. Before the site visit people and relatives were sent surveys asking them to comment on the service. A number of surveys were returned and the information used to inform the inspection report. It was decided that two inspectors would undertake the site visit. During the inspection site visit time was spent talking to people, staff and the deputy manager and observing how they work with people. Documents and files relating to people and how the home is run were also seen and a tour of the building was made. In addition, after the site visit, the opportunity was taken to speak to a senior manager from within Four Seasons to discuss some of the issues raised during the site visit. The inspection was an opportunity to look at all the core standards of the National Minimum Standards (NMS) and was used to make a judgement on the quality of the service provided by the home and to decide how much work the CSCI needs to do in the future. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? The way that people’s needs and support were identified and recorded has made significant improvements. Samples of people’s care plans were seen that were detailed, contained clear and descriptive information and were person centred, in that, they focused on what was important for the person and not just for the service. Access to training events has improved with staff having participated in and scheduled to attend a range of core training events. Recently, a number of care staff attended a training event around understanding people’s challenging behaviour. Staff spoken to said they had found this training very helpful in the way that they work with people. A number of nurses had also participated in a training event around dementia care. An improvement that was noted by staff and relatives was in the support and accessibility of the manager. Staff spoken to during this visit said that there had been ‘great improvements’ since the new manager had been appointed. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 8 Staff said, “before, we were just left to get on with it. Now there is much more support for the units, and the manager listens to the residents and the staff”. Staff also said that where it was identified that the unit was not meeting needs, there was more emphasis on discussing issues with the other professionals. A relative commented that they felt that the home was improving ‘since the new manager was appointed.’ They said that the setting up of relative and resident meetings was seen as a chance for her to find out more information about the home and to raise any concerns. What they could do better: The issue of people being supported by sufficient staff who have the time to engage with people and to meet their needs has been raised consistently throughout this inspection report and was also an issue highlighted in the previous inspection report in February 2007. One relative spoken to during the site visit said she felt that sometimes there was a shortage of staff and that it was only because she visited daily that she could be confident her mum got a good meal because she helped her with her meals. She was not confident that staff would have the time. She said that though staff were very good, it was only because she was there to tell them what her mother needed that all her mum’s needs were met. A number of other relatives expressed similar concerns and one member of staff confirmed that a number of relatives visited at lunchtime to help and support people to eat their meal. She said that without this support it would be very difficult to ensure that everyone had a proper meal. Staff on the Windsor unit expressed concern over their ability to meet the needs of everyone because they were supporting a person who required one to one support for almost 24 hours each day in order to maintain his own safety and the safety of other people and staff in the home. The Balmoral unit of the home supports 19 people with enduring mental health problems. The brochure promoting the unit suggests that a qualified nurse acts as a keyworker leading a team of staff providing support and encouragement for small groups of people. It was found at the time of the site visit that the 19 people were being supported by one qualified nurse and one care worker. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 9 Comments from management and staff on the Balmoral unit highlighted that they felt that shortages of staff and time meant that the lack of positive one to one interaction and social stimulation could be contributing to people’s ongoing behaviour problems demonstrated on the unit. Also, as staff time was taken up supporting people who expressed more challenging behaviours, other people were withdrawn and lacked motivation. As a result of the concerns in relation to staffing levels on the Balmoral unit, an Immediate Requirement was issued for management to look at people’s needs and to make sure that sufficient staff were on duty to keep people and staff safe. People are prescribed medication to keep them well and healthy. The management and staff team should follow a medication administration system that aims to make sure this happens. The medication administration system was assessed and it was found that some staff responsible for administering medication were making fundamental errors in the recording and checking of medication given to people. Medication was being administered by qualified nurses and the number and range of errors found during the site visit brought into doubt the staff’s competence in administering and recording medication so that people were safe. Although it has been highlighted that the manager had made and was seen to be making improvements to the service, from discussions with management on duty at the home and a senior manager of Four Seasons, it was clear that there was a lack of understanding about several key areas in the management and running of the home that had contributed to the concerns raised throughout the inspection report. The management and senior management team have to ensure that there are clear lines of communication and shared understanding on the issues facing the home and the solutions to achieve the stated aims and objectives of the service. The inspection report highlights that the issue of how staffing levels and supporting people with very high levels of need and dependency has had a negative impact on the provision of any structured programme of meaningful social and leisure activities. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 10 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. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 11 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 Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 12 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 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Some decisions to offer people a place at the home were made on the basis of insufficient pre-admission assessment information. EVIDENCE: A number people’s files were sampled and it was found that the quality of preadmission assessment information, carried out by management, varied across the three units. Four care plan files were examined from the Balmoral Unit. All of these did contain an in-house assessment of care needs but information contained within them varied. In one case, the assessment for a person who was admitted 6th December 2007 was incomplete and only consisted of two care needs. However, an assessment of a person’s needs from another unit was sampled and found that it contained a range of detailed information about a person’s personal and healthcare needs. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 13 The local authority had an agreement with the home that they had access to six beds in any of the three units. The pre-admission assessment information for two people admitted under this agreement was very brief. In addition, the management were under the understanding that they had to admit those people even if it was felt that they could not meet the person’s needs. This was contradicted by the senior manager spoken to from Four Seasons, who confirmed to the inspector that the same process of assessment and decision making applies to the contracted beds. The issue of communication is addressed in the Management section. Of all the files sampled no evidence could be found of any pre-admission assessment documentation from a purchasing local authority. The issue of not obtaining sufficient pre-admission information had been raised as an issue at the previous inspection. The management, prior to making a decision as to whether they can meet a prospective person’s support needs, must gather sufficient pre-admission assessment information, including, where appropriate, an assessment of need from the purchasing authority. Intermediate care was not provided by the home. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Care plans did reflect people’s support needs and their general healthcare was supported by the staff team. However, people’s emotional and mental health care needs were not being fully addressed. Some use of language by staff was not respectful and, overall, poor practices in the administration and safe keeping of medication could potentially put the health of residents at risk. EVIDENCE: The previous inspection report highlighted concerns regarding the care planning process and the need for improvements to be made. Samples of people’s care plans were seen and it was found that a lot of work had been done in the care planning process. Information was much more focused on the person and what they needed, rather than problems to be solved. The care plans were more detailed and focused on how to support people in the way they wanted but there was little evidence to show that people had been involved in the care planning process. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 15 The plans also included strategies for staff to follow to manage difficult behaviour patterns presented by some people. Each plan was monitored and reviewed on a monthly basis. Issues of health care, such as nutrition, mobility, skin and oral care, were identified through the assessment process and ongoing monitoring. Input from healthcare services, such as the Community Nurse service, Continence Nurse service, General Practitioners and others, were recorded in individuals’ files. Those people with specific health conditions, such as diabetes, were supported to access the relevant community health services, such as chiropody. The Balmoral Unit provides support and accommodation for people with enduring mental health problems. Although people’s care plans identified the support required to maintain their mental and emotional health, evidence from the records and staff on duty indicated that those people who expressed challenging behaviour continued to present that behaviour. Incidents of aggression towards other people and staff continue and staff spoken to acknowledged that these incidents were common and they often did not record them all. There was evidence that care plans were being reviewed on a regular basis, however, one care plan review highlighted that the behavioural strategies and plans to manage some behaviour problems were ineffective and yet no action had been taken to change this. This issue will also be addressed through the staffing section of the inspection report. The previous inspection report highlighted some concerns in relation to how medication was administered. The Medication Administration System was examined on the Balmoral Unit and a number of areas of concern were found. The medication administration records (MAR) contained gaps in the records where staff were supposed to sign when they had administered medication. This indicated that medication was either not given, or not signed for when administered. There were also examples where staff had pre-recorded the outcome of administering medication on the MAR sheet. Hand written entries on the MAR sheets had not been countersigned by a second member of staff to ensure the accuracy of the transcription. On one MAR sheet, the timing of the medication had been altered by hand, and there was no indication of who had authorised this. Medication in one blister pack had been taken out randomly and did not correspond with the MAR sheets. This indicated that some staff were not adhering to medication policies and procedures, or using the blister pack system in the manner it was designed for. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 16 There was no formal auditing system to check that recording was being carried out correctly and that people had received the medication they required. Controlled drugs were examined, and the stock levels balanced with the records. The requirements regarding medication practices were reiterated. In relation to how people were respected; overall, interaction between people and staff was generally positive. Some staff were observed engaging in meaningful interactions with people, however, most of the interactions were task driven. Some institutional practices were observed. For example, one member of staff stated, “we have a lot of feeders on this unit” in referring to the high dependency levels of some residents. Another member of staff referred to some residents as ‘Wanderers’. On one of the units a staff member was positioned in a way that suggested they were ‘keeping watch’ over people, rather than engaging with them. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Social and leisure activities and stimulation did not meet the diverse needs of people living at the home. Some lifestyle preferences were respected, but meals and mealtimes were not relaxed or social events. Visitors were made welcome. EVIDENCE: The previous inspection report highlighted concerns in relation to the level and type of leisure and social interaction that people experience, particularly on the Windsor and Kensington Units. The evidence found during the current site visit indicated that the situation had not improved. Observations on the dementia care units indicated that there was very little social stimulation being provided by the staff. Care staff spoken with said people’s current dependency levels did not allow them to spend much personal time with people because they were too busy carrying out the personal and healthcare. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 18 Staff on the Windsor Unit expressed concern over their ability to meet the needs of all the people because they had someone who required one to one support for almost 24 hours each day, in order to maintain his own safety and the safety of other residents in the home. This left little or no time for social interaction. Several relatives also made comments in the surveys returned to the CSCI that a lack of activities and personal attention was a concern. There was evidence that some people on the Balmoral Unit had been supported to go on holiday to Blackpool, and one person said that he had enjoyed recent trips out. The unit manager said that some residents were independent and able to go out without staff support. Where appropriate, residents were supported to access a range of courses at Stockport college and there had recently been a Body Shop party. During this visit, a group activity of bowling was taking place on the Balmoral Unit. Discussion took place with the activity organiser and this provided evidence that, potentially, a wide and varied activities programme could be developed, as stated in the Balmoral service user guide. However, this has not been possible at the present time due to limitations on the hours provided for activities. The activities organiser works on the Balmoral Unit one day each week and only 39 hours of activity are provided for all 79 residents, the majority of which have high dependency or complex mental health needs. During the site visit people’s families and friends were seen visiting and spending time either in the privacy of bedrooms or communal areas. Several visitors were able to confirm that they were welcomed to the home at any reasonable time and that staff and management were open and approachable. People received their personal letters direct, without them being opened unless otherwise agreed. People who were independently mobile were able to access all the communal areas on the unit where they live. The main doors to units were controlled through a keypad lock and people were given the code to come and go unless this was considered to be a risk to the person. However, people were supported who had high dependency levels and limited verbal communication and therefore had the least level of control over their own lives. It is recommended that management and care practices promote people’s right to choose and to be involved in decisions that affect him or her. The chef described how they developed the menus through talking to people, staff and his knowledge of people from working at the home for several years. The menus showed that a range of breakfast items were offered. The lunch consisted of a light hot meal or sandwiches and the evening meal was a choice of two hot dishes. Sandwiches, snacks and fruit were also said to be available through the day. He stated that a full breakfast/brunch was offered on a Saturday and a roast dinner on a Sunday. The chef was aware of people’s dietary needs and the need for soft diets. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 19 Lunchtime was observed in one unit and found that the issue raised at the previous inspection of the tables not being set for meal-times was still happening. The reasons for this were explained that people may pull off tablecloths and harm themselves or others. An alternative to tablecloths had been looked at but was deemed unsuitable. When the inspectors first entered the lounge/dining room, the two staff were sitting together away from people, most of whom were already seated at dining tables. Once it was noticed that an inspector and management were present, the staff got up and started to interact with people. It was the deputy manager who explained to some people that it was lunchtime and what they were going to have to eat. Staff were observed serving meals and helping some people to eat their meal. It was difficult to find out from people on the Windsor and Kensington Units what they thought of the meals. However, comments from three relatives who returned surveys to the CSCI suggested that the quality and choice of meals needed to be improved. One member of staff said that a number of relatives visited at lunchtime to help and support people to eat their meal. She said that without this support, it would be very difficult to ensure that everyone had a proper meal. In addition, a relative spoken to at the time of the site visit said she felt that sometimes there was a shortage of staff and that it was only because she visited daily that she could be confident her mum got a good meal because she helped her with her meals and she was not confident that staff would have the time. This comment reflected similar ones made by relatives and staff at the previous inspection and again raises the issue of how staffing levels can impact on people’s dietary needs and experience of meal-times. This issue will be addressed in the Staffing section of the report. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 20 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 policies, procedures and staff practices were in place to allow people to raise their concerns and to try to make sure that people were protected from harm. EVIDENCE: The Complaint Policy and procedure were available through information provided to people and/or their relatives at the time of admission. The manager had introduced meetings where people and their relatives could meet the management and raise any concerns or worries they had about the service. A copy of minutes from these meetings could not be provided at the time of the site visit. Comments from people’s visitors suggested that they could raise their concerns and worries with the staff and management and were aware of the complaint policy. Information provided in the AQAA document highlighted that seven complaints had been received over the past 12 months. A standard format for recording complaints was used and samples of these were seen where the complaint, the actions taken and the outcome of the complaint were recorded. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 21 The manager of the Balmoral Unit was responsible for organising and recording staff training. The training records showed that the majority of staff had received safeguarding adults training which was provided by the local authority social services training team. Training in adult protection was also included in the induction programme. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 22 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 adequate. This judgement has been made using available evidence, including a visit to this service. The infection control procedures and laundry facilities appeared sufficient to maintain people’s health and safety. The premises were generally clean and well maintained but not always free from poor odours. EVIDENCE: Overall, the home appeared to be clean and tidy, although unpleasant smells were noted on the Balmoral Unit and, as the day progressed, these were noted on the ground floor as well. Domestic staff spoken to said that it has become difficult to maintain the carpets to a clean and acceptable standard. The home previously employed an external company to deep clean the carpets on a regular basis. This service has been stopped, and domestic staff had to manage this problem. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 23 The company employs a maintenance man to carry out routine repairs and general maintenance of the home. Bedrooms were made to feel homely and a number of bedrooms were furnished to reflect personal tastes. The security door was not working on the Balmoral Unit. Some corridors throughout the building were in need of redecoration to ensure that the environment was maintained to an acceptable standard and provide people with a pleasant place to live. A number of people on the Balmoral Unit are smokers, however, there is no designated smoking room on that unit. If people wish to smoke, they have to leave the unit and walk through another unit to access the outdoor garden areas. Although the company are required to meet the requirements of smoking legislation, arrangements need to be in place to meet the needs of those residents who smoke and who have been accepted into the home on a needs based assessment, which should have already identified smoking issues. If the home cannot meet the needs of smokers, this should be included in the statement of purpose and be a major consideration when undertaking a needs based assessment for prospective people wishing to move into the home. The infection control procedures and laundry facilities appeared sufficient to maintain people’s health and safety. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 24 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 poor. This judgement has been made using available evidence, including a visit to this service. The recruitment process makes sure that staff are safe to work with vulnerable people. The standard of care was generally seen as positive but some examples of poor staff practice was seen and there were insufficient staff on duty to meet people’s needs. EVIDENCE: The previous inspection report highlighted how comments from relatives and staff members reflected that staff did not have sufficient time to spend with people in relation to social and leisure activities or personal interaction. This report has already highlighted the concerns raised by relatives and staff in relation to them not being able to spend much time engaged with people in social interaction and activities, such as help with eating meals, implementing behavioural programmes and supporting people to access meaningful leisure activities. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 25 During the site visit staff were observed in their interaction with people and some positive examples were seen of how staff encourage and support people and how many staff had developed good relationships with people living in the home. However, it has already been noted in the report that areas of concerns in staff practice were highlighted with little personal interaction and the use of institutional language such as ‘feeders’ and ‘wanders’ being used to describe people. Relatives spoken to during the site visit and through the surveys were generally positive about the standard of care that staff provided, given the demands of people with very high levels of need. At the time of the site visit the Balmoral unit had a qualified nurse and care worker supporting 19 people with complex mental health needs. A high number of people on the unit presented challenging behaviour that could be aggressive towards other people and staff. The issue of people’s behaviours not improving and the staff team not having sufficient time to implement support programmes has been raised previously in this report. The Windsor Unit supported 20 people with high levels of physical and emotional needs as a result of dementia. At the time of the site visit, there was one qualified nurse and four care staff on duty. One person’s needs were so high that they required almost 24-hour one to one support which had a negative impact on the time available for supporting other people’s needs. The issue of staff interaction with people and the focus on tasks has been previously raised in this report. The Kensington Unit supports 38 people experiencing dementia but who are of a lower physical dependency. The unit was staffed by two qualified nurses and five care staff. The deputy manager, who also manages this unit, confirmed that staffing levels in all units did at times fall below the minimum levels set by the home due to problems filling shifts from within the existing staff team. She stated that instruction had been given by Four Seasons management not to use agency staff to fill these shifts. However, this issue was raised with a senior manager from Four Seasons who stated that this was a misunderstanding by staff at the home and that the home’s management could employ agency staff on such occasions. This issue of communication between management will be addressed in the Management section of the report. As a result of the serious concerns for people living in the home and staff safety in relation to people’s level of needs and the staffing levels on the Balmoral unit, an Immediate Requirement was issued requiring management to undertake a review of people’s needs and to make sure that sufficient, experienced staff were on duty to meet those needs. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 26 There was slow progress being made to ensure that at least 50 of staff were qualified to at least level 2 in the National Vocational Qualifications (NVQ). The AQAA document provided by the home identified that 12 out of 37 care staff held the qualification. It was found that staff must access the in-house Four Seasons company training for NVQ’s. There were financial penalties for staff who decided to leave the company prior to completing their training. Since the last inspection, there has been some improvement in the staff training programme. There was a training matrix in place to monitor assessed training needs and to ensure that staff had received all mandatory training. Each member of staff had a training and development file which contained evidence and records of certificates gained from training. Staff on the Balmoral Unit had recently received an in-house training package that focused on challenging behaviour. The course took place over four days, and staff spoken to said that they had found this useful. A number of nurses had attended a training course in dementia mapping. Fire training was not up to date; the manager was aware of this and in the process of addressing this shortfall. This must be done as a matter of urgency, so that all residents in the home can be confident that the staff know the procedures in the event of a fire. The issues raised in this report in relation to staff engagement with people and the use of institutional language highlight the need for training needs to be constantly reviewed and it is recommended that all staff are provided and supported to attend training which will promote people’s, health and wellbeing. Recruitment procedures were based on the corporate policies from Four Seasons. All appropriate checks, records and documentation had been gained prior to staff working with vulnerable people. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The management structure of the home did not ensure that people’s needs were met. EVIDENCE: The manager registered with the CSCI left the home just prior to the last inspection in February 2007. A new manager had been appointed but they had not yet submitted an application to the CSCI to become the registered manager. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 28 The management team consisted of the manager of the home and a manager for each of the three units with the manager of the Kensington Unit being the deputy manager who acted up in the absence of the home manager. At the time of the site visit the home manager had been away for six weeks. The deputy manager was acting up, in addition to managing the Kensington Unit supporting 38 people. She stated that she also had to be rostered on to cover the unit and worked various shifts. She had also been providing on-call cover for the home on her own for the last six weeks. The deputy manager clearly stated that the only supernumerary hours they could take for administrative duties was one day a week. However, the senior manager, spoken to a few days after the site visit, clearly stated that the deputy manager could take more supernumerary hours for their acting up duties. Apart from the responsibilities appeared that manager role. function of the the home at all administration duties it was unclear what specific management and role the deputy manager had for the whole service. It their role was in managing their unit, rather than a deputy As such, it was not clearly evidenced that the structure and management team was sufficient or robust enough to manage times. The issue of the management teams contradictory understanding on certain key issues, such as the admission process for contracted beds, the use of agency staff and management supernumerary hours, brings into question the communication within the overall management of the home about the problems being faced. Unfortunately, as has been mentioned, the home manager was not available during the site visit. Staff spoken to during this visit said that there had been ‘great improvements’ since the new manager had been appointed, with much more support for the units, and the manager, “listens to the residents and the staff”. However, this report has raised serious issues and concerns in relation to the management of adequate staffing to meet people’s needs and to keep them safe and in monitoring arrangements that have failed to identify errors in the medication administration system. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 29 Quality assurance was discussed with the deputy manager. The deputy manager said that recent service users surveys had been sent out to residents and their relatives to obtain feedback about how the service was doing. There was no documentation available for inspection during this visit. The deputy manager said that all areas of care practice are reviewed regularly by the management team. Designated staff are given specific areas of responsibility to audit. Areas of practice which are audited include: clinical supervision, medication, staff records and health and safety. The deputy said that the process was currently being undertaken. Each unit maintains an individual record of people’s personal spending on items. Records were accurate and receipts or invoices were available. The records were regularly monitored and checked to make sure they were accurate. The administrator maintains a computerised record system of all monies that come into the home for people. Either families or the purchasing local authority held the appointeeship for most people. Some people living on the Balmoral Unit did keep full control of their own personal finances. According to the AQAA document provided by the home, equipment and services were being serviced and checked on an ongoing basis. Policies and procedures relating to health and safety were in place. Fire log records of the required checks was being made. Kitchen safety was being monitored and recorded according to the relevant health and safety regulations. Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 30 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X 3 X X 3 Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 31 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) Requirement Timescale for action 31/12/07 2 OP8 12(1) (a)(b) 3 OP9 13(2) The management, prior to making a decision as to whether they can meet a prospective person’s support needs, must gather sufficient pre-admission assessment information, including, where appropriate, an assessment of need from the purchasing authority. To improve/maintain people’s 01/02/08 mental health, the programmes and strategies agreed through the assessment and care planning process must be implemented. To make sure that people 28/12/07 receive the medication they need to remain healthy, the medication administration system must be recorded accurately and follow the policies and procedures and good practice guidance for the safe administration of medication. To check that the medication recording system is accurate and that people receive the medication they need at the right times, a formal system of Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 32 4 OP9 5 OP12 6 OP19 7 OP27 8 OP27 9 OP30 10 OP31 11 OP33 auditing must be implemented. To make sure that staff have the skills and knowledge required to implement the medication administration system safely, they must be assessed as competent. 16 (m)(n) To provide people with meaningful activity and/or as part of an agreed therapeutic programme, people’s social and leisure interests must be identified and a range of meaningful activities be arranged to meet those needs with sufficient staff to implement such events and engagement with people. 23 (1)(a) So that people live in a pleasant and (2)(d) and safe environment: the home must be free of poor smelling odours and the security door must be working on the Balmoral Unit. 18 (1) So that people are safe, the support needs of people living on the Balmoral Unit must be assessed and sufficient staff must be on duty to meet those needs. 18 (1)(a) So that people receive the support and personal engagement they need and involvement in any therapeutic or rehabilitation programme, sufficient experienced staff must be on duty at all times. 18 (c)(i) To make sure that staff know what to do in the event of a fire, they must receive the relevant training in relation to their role and responsibility. 9(1) To determine the fitness of the manager, they must submit an application to become the registered manager of the home. 24(1)(2). To allow people and/or their representatives to express their 18(1)(a) DS0000068318.V350887.R01.S.doc 31/12/07 01/02/08 31/12/07 21/12/08 01/02/08 01/02/08 01/02/08 01/02/08 Page 33 Bamford Grange Care Home Version 5.2 views on the quality and direction of the service, a system of quality assurance must be employed to establish that information and provide the basis for any improvement plan. So that the progress of how the home is improving can be monitored, Regulation 26 inspection visit records must be submitted to the CSCI every month until further notice. 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 OP7 Good Practice Recommendations It is recommended that people and/or their representatives are consulted about their care and care plan interventions are developed further to include more person centred information about each resident’s needs and preferences, and explains how these needs are met. It is recommended that management and care practices in the home promote people’s right to choose and to be involved in decisions that affect him or her. It is recommended that presentation and use of the dining areas be reviewed to make this a more pleasant dining experience for people. It is recommended that a planned programme of decoration and refurbishment be developed with reasonable timescale for action. It is recommended that the needs of people who smoke and wish to continue to do so are addressed and, taking into account the relevant regulations and legislation, suitable facilities be provided that do not impact on other people. It is recommended that at least 50 of care staff on duty DS0000068318.V350887.R01.S.doc Version 5.2 Page 34 2 3 4 OP14 OP15 OP19 5 OP28 Bamford Grange Care Home 6 OP30 have a NVQ 2 qualification or equivalent. It is recommended that management review the provision of training in the home ensuring all staff are provided and supported to attend training which will promote people’s health and wellbeing. It is recommended that staff are made aware and understand their role in valuing and respecting the people they work with and the issues of use of language in their work. It is recommended that the management structure, roles and responsibilities be reviewed to ensure that the home has suitable operational management cover. It is recommended that the management and senior management team have clear lines of communication and shared understanding on the issues facing the home and the solutions to achieve the stated aims and objectives of the service. 7 OP31 Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Manchester Local Office 11th Floor, West Point 501 Chester Road Old Trafford Manchester M16 9HU 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 Bamford Grange Care Home DS0000068318.V350887.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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