Inspection on 25/04/07 for Bancroft Gardens

This inspection was carried out on 25th April 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 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

Bancroft Gardens 16/07/08

Bancroft Gardens 18/01/06

Bancroft Gardens 14/09/05

Bancroft Gardens 15/12/04

Bancroft Gardens 27/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Bancroft Gardens Waterside Stratford On Avon Warwickshire CV37 6BA Lead Inspector Lesley Beadsworth Key Unannounced Inspection 25th April 2007 11:00 25/04/07 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 Bancroft Gardens DS0000004204.V338115.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. Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bancroft Gardens Address Waterside Stratford On Avon Warwickshire CV37 6BA 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) 01789 269196 01789 263455 Mr D Barnfield Mrs Jeannette Sandra Barnfield Mrs Jeannette Sandra Barnfield Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th January 2006 Brief Description of the Service: Bancroft Gardens is situated in the centre of Stratford-upon-Avon, opposite the Royal Shakespeare Theatre, gardens and the river. All the facilities of the town are easily accessible for residents, either on foot or with the use of a wheelchair. Car parking can be difficult, but there are large public car parks within reasonable walking distance. Access to the home is at street level where the front door leads into a small lounge with a picture window onto the road. Apart from this all the accommodation is on the two upper floors. There is a shaft lift serving all levels, but there are a number of small flights of steps here and there. The home has two lounges and a dining room, a kitchen, two bathrooms, one separate lavatory and a small laundry area. There are ten single and three double bedrooms, all of which have en-suite facilities. The registered manager advised that the current fees are £425.00 to £575.00. Additional charges are made for hairdressing, chiropody and dry cleaning. Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Below is the report of this inspection including visits made to the service. Before the inspection the home was sent questionnaires to distribute to residents and visitors to seek their independent views about the home and the services provided. Completed questionnaires were received from ten relatives and ten residents and responses are included where appropriate in this report. In February the registered manager of the home completed and returned a pre-inspection questionnaire containing further information about the home as part of the inspection process. Some of the information contained within this document has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to them and/or their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, Regulation 37 notification reports, care records, staff recruitment records, training records, social activity records, staff duty rotas, health and safety records and medication records. The inspection process consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. This inspection took place between 11am and 7.30pm. What the service does well: The home provides sufficient information to enable prospective resident to make a choice about living at the home and this was confirmed in discussion with residents and from responses made in the completed surveys returned to us. Statement of Purpose and Service User Guide are available in bedrooms. A pre-admission assessment is carried out in order for the home to be able to assess if they can meet the needs of the prospective resident before a decision is made to do so. A care plan is devised from this assessment. Bancroft Gardens offers safe, comfortable and attractive surroundings for the people living at the home in a unique location overlooking the gardens, canal locks and theatres of Stratford. All communal and private areas of the home Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 6 are appropriately decorated and furnished and with good quality pictures and ornaments. Staff were seen to be treating residents respectfully and in a friendly and caring manner, using preferred names as identified at assessment and recorded in the care plans. When asked if staff treated her with respect one resident answered, “ They’re absolutely marvellous, they spoil me.” Residents spoken with said that they felt sufficiently occupied throughout the day and the sitting areas of the home appeared lively and interactive. Responses in the surveys completed by, or on behalf of residents varied with one resident saying that there was “always” activities arrange by the home that they could take part in; four residents saying “usually”; three saying “sometimes” and two making comments that it was the their choice not to join in. There was also some evidence of arts and crafts carried out by residents with Easter cards and Easter bonnets displayed in the home. Surveys, discussions and observations made showed that visitors are always made welcome. Comments in the completed surveys included, “the home is very friendly and happy place.” “ (The home) makes all of us –mum’s relatives - feel at home to pop in and out any time, any day. It has become an extension of our homes.” “They always make room for a relative to stay for lunch.” Residents were able to make choices in their daily lives, for example in what time they got up – one resident saying that she had “felt tardy” that morning and so had not wanted assistance to get up until 11am. The same resident and others spoken with said that they went to bed late if they wished, had a choice of meals, and were able to spend time in their rooms rather than communal areas if they preferred, including their meals being taken there. They could also choose for the relatives to join them for meals as was shown in discussion with residents and in the surveys completed by relatives. Residents spoken with during the meal said that they always enjoyed their meals and always had a choice. The completed surveys returned to us included many positive comments about the meals provided at Bancroft Gardens, further reinforcing that the meals provided are enjoyed, consisting of good home cooking made with fresh ingredients. Menus seen were varied and appeared nutritious. Staff have the knowledge and skills to meet some of the specialist needs of people living at the home, having attended recent training including Parkinson’s disease, and Dementia Awareness. Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 7 Records looked at and discussion with the residents showed that on going health needs of the people living at the home were being met by visits to or by a dentist, optician, chiropodist and GP and District Nurses. Specialist equipment was seen in use during the tour of the home. One resident had the use of a track hoist in the bedroom to be used for transfer from bed to chair and commode and back to bed. Residents spoken with and responses from our surveys showed that the staff were held in high regard, with them being described as, “dedicated”, “very attentive”, “kind, helpful”, “kind and caring”. Discussion with the manager and looking at training records showed that 87 of the care staff have undertaken National Vocational Qualification (NVQ) Level 2 or 3 in Care. The manager added that the cook and the housekeeper were undertaking a relevant NVQ. These qualifications demonstrate that staff are competent in the job that they carry out. What has improved since the last inspection? What they could do better: The weighing of residents was not consistent as part of the monitoring of their health. Whilst the unattended medication trolley was seen to be secured to the wall in the dining room the keys to the trolley had been left on top of it thus not safeguarding residents nor keeping the contents secure. When approached about this staff demonstrated that the keys were normally kept on a hook in the adjacent kitchen, which was not a safe practice. Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 8 The breakfast medication round on the day of inspection was noted to still be ongoing at 11.45am and staff said that the medication was given as residents got up. This could mean that those residents who are due a lunchtime medication would not have a sufficient gap in between doses. Handwritten entries on the Medication Administration Record Sheets had not been dated and signed so that it was clear when the medication had been prescribed and by whom. The source of the information and the verification that it is correct needs to be added to the Medication Administration Record Sheets. Medication was seen to be signed for on the Medication Administration Record Sheets before it had actually been taken to the resident whereas it should only be signed for immediately after it has been taken by the resident. There was some distress at lunch with two residents, one who said they had too much parsley sauce on the meal and the other who objected to someone on the same table having more vegetables. This sort of concern may be avoided if sauces and vegetables were available or served at the table rather than plated in the kitchen, which is considered to be institutional practice. The wheelchairs stored in the reception area were in a bad state of repair and could create a safety risk to anyone using them. A comment was made in the surveys returned to us about the poor condition of these wheelchairs, which need to be repaired or disposed of. The door to the boiler room was wedged open to allow it to dry out following a flood. However this created the risk of residents burning themselves on the unguarded hot pipes housed there. The manager locked the door promptly. There had been prolonged staff sickness in the home prior to the inspection visit and although there was a full complement of staff on that day some comments by residents and in the survey responses suggested that they felt that there were not always sufficient staff available. The staffing levels on the day of the visit and staff rotas indicated that the problem had passed. Observations made and responses in our surveys identified difficulties created in communication due to lack of English speaking and understanding skills in some staff from overseas. If staff are to meet the needs of residents it is necessary for them to be understood by residents and other people working or visiting the home and for them to be able to understand what is said to them. 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. Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 9 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 Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4 Quality in this outcome area is good. The home provides sufficient information to enable prospective resident to make a choice about living at the home. A pre-admission assessment is carried out in order for the home to be able to assess if they can meet the needs of the prospective resident before a decision is made to do so. Staff have the knowledge and skills to meet the specialist needs of people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Observations made, speaking with the residents and the manager showed that Service User Guide and Statement of Purpose, which inform residents about the home, were available to the residents, copies of which were in bedrooms. These documents were only briefly looked at on this occasion although previous inspections have assessed these documents as having the required information. Residents and relatives said in the completed surveys returned to us that they had sufficient information on which to make a decision about living at the home before moving in. Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 11 Three residents were case tracked and their care files examined. All three files contained a full pre-admission assessment in order for the home to be able to assess if they can meet the needs of the prospective resident. Further to this, discussion with the manager and residents and observations made in the care files showed that several residents had been clients of the Domiciliary Care Service and/or the meal delivery service that are run from the home, and therefore are well known to the manager. Whilst there are advantages to this, and it was evident in one survey returned to us that a family member of a resident had looked at several homes prior to choosing Bancroft Gardens, it needs to be demonstrated that all the residents have had the opportunity to have more than the one choice of where to live. Two of the care files were of residents who live permanently at Bancroft Gardens. A full daily living assessment was in each of these care files. The third care file looked at was that of a person living at the home on a temporary basis for respite care. Assessment in this file included sufficient information to inform staff of the needs but this was in less detail than those of the permanent residents. The staff spoken with said that the resident was able to convey needs as they communicated well. Specialist training that has been undertaken by staff at the home since January 2006 included, Parkinson’s Disease and Dementia Awareness, giving staff the opportunity to have the knowledge and skills to meet the specialist needs of people living at the home. Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 12 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 The quality in this outcome area is adequate. Care plans give staff the information required to be able to meet the residents’ needs but shortfalls in medication put residents at risk. Residents are cared for respectfully. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The three care files looked at contained care plans and as with assessments the third temporary resident’s file was in less detail than the other two for permanent residents. Each care plan included risk assessments on falls, occurrence of pressure sores, moving and handling, nutrition and oral health care and included care plans for all areas of care. The care plans were well detailed and were reviewed monthly. The reviews were also well detailed. These plans gave staff the information that they required to be able to meet the needs of the residents. Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 13 The third care file contained less specific detail but gave staff the basic information required to meet needs and had been reviewed monthly as the other care plans. One of the care plans belonged to a resident who was not weighed due to not being able to weight bear. Although the care plan stated that, “no sign of weight gain”, there was no information relating to what other signs were to be looked for or measures to take to check if the resident had lost or gained weight. The registered provider might also consider purchasing chair scales so that those residents who do not weight bear can still be weighed in order to monitor that nutrition is not a concern. There was no evidence to support residents or their representatives were involved in the drawing up of the care plans thereby not demonstrating that they had any input in how their care was to be delivered. Records looked at and discussion with the residents showed that on going health needs of the people living at the home were being met by visits to or by a dentist, optician, chiropodist, GP and District Nurses. Opportunities for appropriate exercise were also offered in the form of ‘movement to music’, which took place during the day of the inspection visit. Pressure sore risk assessments had been carried out in the care files examined, using the Waterlow assessment tool enabling action to be taken to prevent pressure sores developing. Preventative measures such as pressure relieving mattresses and cushions were being used appropriately in the home. The registered manager advised that there were no residents with pressure sores at the time of the visit. Whilst the unattended medication trolley was secured to the wall in the dining room the keys to the trolley had been left on top of it thus not safeguarding residents nor keeping the contents secure. When approached about this staff demonstrated that the keys were normally kept on a hook in the adjacent kitchen, which was not a safe practice. There needs to be a policy and procedure for the safe keeping of the medication keys which includes continuing to keep the keys separate from the rest of the keys for the home, and restricting access to authorised members of staff only by them being held by the senior person on duty. The breakfast medication round on the day of inspection was noted to still be ongoing at 11.45am and staff said that the medication was given as residents got up. This could mean that those residents who are due a lunchtime medication would not have a sufficient gap in between doses. One resident was receiving diuretics at this time and the usual instruction is that they are taken early morning. The delayed administration of medication could impact on the resident’s health and result in not being given as prescribed. Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 14 Handwritten entries on the Medication Administration Record Sheets had not been dated and signed so that it was not clear when the medication had been prescribed and by whom. The source of the information and the verification that it is correct needs to be added to the Medication Administration Record Sheets, for example, that medication brought from home has been checked with GP or prescription; that changes made by GP is in writing; that medication on discharge from hospital has the changes detailed in a discharge letter. Medication was seen to be signed for on the Medication Administration Record Sheets before it had actually been taken to the resident whereas it should only be signed for immediately after it has been taken by the resident the member of staff should be signing to say that the medication has been taken. The medication trolley cannot be taken around the home due to several sets of steps that would have to be negotiated and medication was being taken one at a time from the dining room to individual residents. This runs the risks of errors occurring and is time consuming. There were many unexplained gaps on the Medication Administration Record Sheets therefore it could not be evidenced if that medication had been administered and taken or not. A random medication audit was carried out and whilst the majority of the audit was satisfactory errors were identified. One resident was prescribed antibiotics. 40 capsules had been received, 33 capsules had been signed for, and 3 unexplained gaps were on the Medication Administration Record Sheets but 37 capsules had been taken from the container. This would indicate that there were 4 capsules missing and not accounted for. Even presuming that the three gaps were when a capsule had been taken but not signed for there was one capsule less in the container than there should have been. A staff drug audit needs to be carried out at frequent and random times to test the competence of staff and to make sure that the right medication is given to the right person at the right time. An open jar of emollient cream was in a communal toilet. This was not named or dated and carries the risk that it will be used communally and be a source of cross infection. Time was spent in the lounge and dining room observing interaction between staff and residents. Staff were seen to be treating residents respectfully and in a friendly and caring manner, using preferred names as identified at assessment and recorded in the care plans. When asked if staff treated her with respect one resident answered, “ They’re absolutely marvellous, they spoil me.” A notice to staff on a storeroom door to keep the door locked referred to what might happen to a resident if they accessed hazardous to health items stored there. Other notices for staff around the living areas of the home also risked Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 15 impinging the residents’ dignity and privacy as some of them referred to personal issues. Screening in shared (double) rooms was good and afforded privacy for both residents if any personal care was carried out. The registered manager advised that there were the facilities for every resident to have a personal phone in their room and several residents were seen to have chosen to do this, enabling them to take and make calls in private. Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 16 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 adequate. There are some activities that stimulate and occupy residents but these are limited and residents with dementia and/or are not in the lounge may not benefit. The lounge is lively and interactive. Visitors are always made welcome. Residents enjoy the meals provided; nevertheless some residents were not always supported appropriately with eating, which may affect their health. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Bancroft Gardens is located opposite the lawns, the canal locks and theatres, adjacent to shops and within easy walking distance of Stratford town centre. It is therefore ideally situated for staff to take resident on impromptu trips out of the home. the activity programme and the manager said that this occurs. An activity programme on display in the home and provided with the preinspection questionnaire showed that there is a variety of activities planned in the home each week, including visits by 6th Form pupils to play scrabble or cards, church services and visits from ‘Resident Companion’. Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 17 There were also planned activities from outside contractors, of Movement to Music, Music and Singing, and Aromatherapy sessions on alternate weeks. The hairdresser also visits the home each week and attends to the residents’ hair in the small lounge at the front of the home. There are other activities that are included in the activity programme on a less regular basis such as outings to the Cotswolds, trips to the market in the summer, visits to concerts and shows and each year residents who are able and wish to do so are taken on a seaside holiday. Staff interacted throughout the day with residents, with friendly one to one and group chat and banter and the lounge was lively. Residents spoken with said that they felt sufficiently occupied throughout the day. Responses in the surveys completed by, or on behalf of residents were – Question Are there activities arranged by the home that you can take part in? Always 1 Usually 4 Sometimes Never 0 3 Two residents did not answer the question but made the following comments – “My mother rarely participates in activities but there are plenty available.” “My mother does not want to mix that much but she is encouraged to join in activities.” Other comments made included – “A few more activities would be good.” “they come in and do things. Today a young man came and played cards.” There was also some evidence of arts and crafts carried out by residents with Easter cards and Easter bonnets displayed in the home. Whilst the interaction between residents and staff created a lively atmosphere in the lounge area there was no observations made of time spent with residents who were in their bedroom. However the manager informed us after the inspection of activities that took place that we were not aware of during the visit and which demonstrated that there were other interesting activities available to residents. One example given was of pets and small farm animals being brought into the home for residents to pet. A relative also wrote to us to further evidence this. It was evident during discussion with staff and residents and from the completed surveys returned to us that visitors were made to feel welcome in the home. Survey comments included: “the home is very friendly and happy place.” “ (the home) makes all of us –mum’s relatives feel at home to pop in and out any time, any day. It has become an extension of our homes.” “They always make room for a relative to stay for lunch.” Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 18 This was also seen on the day of the visit when refreshments were automatically offered to anyone visiting residents and when staff and visitors interacted comfortably. Residents were able to make choices in their daily lives, for example in what time they got up – one resident saying that she had “felt tardy” that morning and so had not wanted assistance to get up until 11am. The same resident and others spoken with said that they went to bed late if they wished, had a choice of meals, and were able to spend time in their rooms rather than communal areas if they preferred, including their meals being taken there. Food likes and dislikes were maintained by the cook and also recorded in their care file. Menus demonstrated a choice of meal each day, and this was evident on the day of the inspection visit with two main choices at lunch and a wide variety of vegetables and different types of potatoes available. There was also a choice of desserts. Residents spoken with during the meal said that they always enjoyed their meals, although one resident said that too much parsley sauce had been poured on the ham and another was upset that there was different and less vegetables on the plate than on that of another person on the table. This sort of concern may be avoided if sauces and/or vegetables were available or served at the table rather than plated in the kitchen, which is considered to be institutional practice. The surveys sent out by us and completed by, or on behalf of residents and surveys completed by relatives, carers or advocates included many positive comments about the meals provided at Bancroft Gardens, further reinforcing that the meals provided are enjoyed, some of which were– “Excellent food” “Home cooking- the best. Mother loved cooking home grown veg, fruit and meat from our farm and that is what they have at Bancroft Gardens – home from home cooking.” “Good food. All freshly cooked.” “They have taken care to give each residents what they like” “I would say they are quite good really.” “Fresh food every day. Special orders for breakfast.” “Help is available to eat if it is needed.” All of the ten service user surveys answered ‘always’ or ‘usually’ to the question, “Do you like the meals at the home?” A member of staff was assisting a resident to have breakfast. There was no verbal communication from either and the care assistant was feeding the person with inappropriately large spoonfuls of food. When asked about this there seemed to be little understanding and it emerged that the member of staff was from overseas and that her English was poor. At teatime another member of staff took a resident her meal and was unable to understand the resident’s request for a spoon instead of a knife and fork due to her poor grasp Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 19 of English. Both of these residents were at risk of their needs not being met in an appropriate manner. The kitchen was visited on the day of the inspection visit. This area is quite small considering that it also caters for approximately 20 meals that are taken out in the community but the cook said that she found it adequate. The manager advised that it was in the process of being refurbished and which accounted for its unkempt appearance. The home has received a good report following a recent inspection from Environmental Health. Bancroft Gardens DS0000004204.V338115.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): 16,18 Quality in this outcome area is adequate. Residents and relatives knew who to talk to about their concerns and these were dealt with appropriately. There are shortfalls in the adult protection policy and not all staff have had up to date training on this subject. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Surveys completed by relatives and returned to us showed that eight of the ten replies answered ‘Yes’, and one answered ‘usually’, to the question - “Has the care service responded appropriately if you or the person using the service has raised concerns about their care?” the remaining relative did not answer the question. One relative wrote, “any problem can be aired and sorted out straight away by chatting to the manager or carer.” Nine of the ten residents answered ‘Yes’ and one answered ‘Usually’ to the question, “Do you know who to speak to you if you are not happy?”. All but one of the relatives who responded to the question, ‘Do you know how to make a complaint?’ answered, “Yes”. Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 21 The home has a complaints procedure that is on display in the home. There had been one complaint since the last inspection related to a resident leaving the home inappropriately dressed and unaccompanied and brought back to the home by a member of the public. The Manager satisfactorily addressed this and steps were taken to reduce the risk of this happening again. One measure taken by the registered person was install an expensive video / digital lock to the front door which can only be opened from the inside by those who are able to operate the digital lock. This complaint and the action taken were reported appropriately. The home had an Adult Protection and Prevention of Abuse policy. This included some instructions that are not in line with current referral guidelines from the local authority and therefore the manager needs to revise this. Not many staff have attended recent training related to protection of vulnerable adults although the manager advised that there was more planned for the near future. Staff spoken with had an awareness of this subject. Previous inspections indicate that there have been no concerns about the ability of the home to protect residents from abuse and there have been no incidents of suspected or alleged abuse in the home. Bancroft Gardens DS0000004204.V338115.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, 22, 26 Quality in this outcome area is good. Bancroft Gardens offers safe, comfortable and attractive surroundings in a unique location. There are shortfalls due to the odour from the adjoining property, the steps around the home and the institutional-type notice boards. Apart from food odour in the reception from the adjoining fish and chip shop there were no unpleasant odours around the home. Infection control is managed satisfactorily. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is on three floors but the ground floor only houses the reception area and the passenger lift. On entering the home at this level there was a noticeable odour that was realised to be from the fish and chip next door to the home. Whilst this does not emanate from the home it is quite unpleasant. Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 23 A visitor entering the home was heard to comment on this “fishy” odour and a further comment was made by a relative in a completed survey returned to us, “the entrance has been repainted recently however there is a smell which I thought comes from the fish chip shop next door.” This area is furnished as a sitting area and is to become the location for the home’s secretary to be based. However residents and staff would find it quite uncomfortable to spend time here if the odour is not addressed. Investigation should take place to discover why the odour penetrates through to the reception area. On the first floor there are two lounges and a dining room, as well as shared and single bedrooms and toilets and bathroom. The small front lounge overlooks the gardens, the river and canal locks of Stratford but is not used on a frequent basis by residents. The staff advised that it is often used by visitors and at the time of the visit was also being used by the hairdresser. The main lounge is adjacent to the dining room with steps joining the two rooms. Whilst there is a passenger lift to all floors other areas are only accessible via a small number of steps. There are portable ramps for these steps to enable wheelchair access but these were not seen to be in use during the visit. At the time of the pre-inspection questionnaire there were five residents requiring the use of a wheelchair. Staff said that any current resident wishing to use the dining room or go from the bedrooms on the higher level to the lounge are able to manage the steps and that others choose to stay in their bedroom throughout the day and/or eat there or eat in the lounge. The dining room only had seating for twelve residents. A senior member of staff said that there are always some residents who do not eat in the dining room and that another table and chair could be brought into the room if needed. However this room could then be quite crowded. The first floor accommodates bedrooms, the laundry and a new walk in shower room. The laundry houses industrial-type machines with the required programmes and was well organised, although measures need to be put in place to avoid clean laundry needing to be sorted on the floor and risking cross infection. Some areas of the wall in the laundry were untreated plaster and this needs to be made impervious so that it can be easily cleaned in order to maintain infection control. All communal and private areas of the home are appropriately decorated and furnished and with good quality pictures and ornaments. The shared rooms viewed were particularly nicely furnished with good quality fitted wardrobes and storage. Collages of photos of resident past and present decorated the corridors alongside good quality pictures but the attractiveness of these was spoiled by the large number of notice boards, notices and certificates related to staff on the corridor walls. They would be more appropriately placed in space Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 24 designated for staff but the office for the home is also used for the domiciliary care part of the business and is small and cluttered. As there was not a staff room staff were also using it to store their belongings and to get changed into/out of uniform. One member of staff said that they sometimes use the residents’ bathroom for this but the use of resident space by staff should be avoided. The home does not have any garden area apart from a small roof garden. The door to this was locked at the time of the visit and not in use despite it being a very sunny day. Staff spoken to about this said that it was never used, as residents did not choose to sit outside. Staff confirmed that protective clothing, (disposable gloves and aprons) is available in the home and they were able to describe when they should be used to maintain infection control. No staff were seen to be walking around the home wearing these items indicating that they were aware of the need to dispose of them at the site of the infection/contamination. Protective clothing and incontinence pads were stored discreetly behind curtained storage space in ensuite bathrooms. All communal hand washing areas had disposable towels and soap dispensers thereby maintaining infection control. Specialist equipment was seen in use during the tour of the home. One resident had the use of a tracking hoist in the bedroom to be used for transfer from bed to chair and commode and back to bed. This resident also had an electrically operated chair that had been brought in from home and which enabled a person to be raised to an almost standing position and down to a reclining position. This also assisted in the maintenance of independence to look out of the window and to reach otherwise out of reach objects. The chair also enabled change of position to protect pressure areas and prevent sores. The manager advised that there are also profiling beds, and a waterbed provided by the home to prevent pressure sores. The home has a call bell system for residents to use to summon attention. There was evidence of this being maintained. It was noticed that the home had a wheelchair hire service that was available to visitors to Stratford for a small fee, although the records showed that none had been hired out for some time, nor were any in use on the day of the inspection. The wheelchairs stored in the reception area were in a bad state of repair and could create a safety risk to anyone using them. A comment was made in the surveys returned to us about the poor condition of these wheelchairs, which need to be repaired or replaced. Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 25 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. Staff are held in high regard by the people living and visiting at the home and have undertaken extensive training. There are some shortfalls in difficulties with communication between staff and residents due to lack of English speaking and understanding skills in some staff from overseas. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were adequate staff on duty at the time of the visit and rotas and preinspection questionnaire reflect this. However some residents spoken with said that they thought there needed to be more staff, one saying that this was the case in the morning when staff were so busy that they took a while to respond to her calls for attention. Comments made by relatives in our surveys included, “Increased staffing levels”, -in response to a question asking if the home could improve. “sometimes there are staff shortages which means my relative has to wait longer than would be expected for attention.” Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 26 - in response to the question, ‘Do you feel that the care home meets the needs of your friend/relative?’ The manager said that in general the home used more staff hours than required but that there had been some difficulties recently with higher than usual staff sickness, although staff had worked extra hours and bank staff had been used in an attempt to continue to meet the needs of residents. The staffing levels on the day of the visit and staff rotas indicated that the problem had been resolved. Residents spoken with and responses from our surveys showed that the staff were held in high regard, with them being described as, “dedicated”, “very attentive”, “kind, helpful”, “kind and caring”, “Marvellous”. Discussion with the manager and looking at training records showed that 87 of the care staff have undertaken National Vocational Qualification (NVQ) Level 2 or 3 in Care. The manager added that the cook and the housekeeper were undertaking a relevant NVQ. These qualifications demonstrate that staff are competent in the job that they carry out. The personnel files of four members of staff were looked at. These were randomly chosen but included staff that had been recently employed by the home. All files had the documents required and two contained evidence of extensive training, including mandatory training such as fire awareness, First Aid, Food Hygiene; and specialist training including Dementia Awareness, Parkinson’s Disease and Effective Communication. The file of a housekeeper employed for many years showed that there had been very little training during those years. During discussion this member of staff said that no further training had been requested as “only a domestic” and was getting “too old for training”. However domestic staff are required to undertake up to date training such as Health and Safety, fire awareness, Control of Substances Hazardous to Health, Moving and Handling and if handling food, Basic Food Hygiene, in order to work safely and effectively in the home. The fourth member of staff showed little evidence of training undertaken, as this was a very recent appointment. The manager advised, and the preinspection questionnaire further confirmed that all new staff undertake an induction programme. No induction programmes were viewed on this occasion. The contents and quality of this programme was not assessed on this occasion. Two examples of staff having poor English observed during the inspection visit are discussed in the ‘Daily Life and Social Activities’ section of this report. That this is an issue in the home is reinforced in responses to the question, “Do staff Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 27 have the right skills and experience to look after people properly?” in our completed surveys. “Some staff are from overseas which means my relative sometimes finds it difficult to understand what they say Communication problem, which I know is common to other homes as well.” “English is not always their first language which can sometimes be difficult with communicating with my mother.” “It is sometimes difficult to understand the different accents.” If staff are to meet the needs of residents it is necessary for them to be understood by residents and other people working or visiting the home and for them to be able to understand what is said to them. Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is adequate. The home is managed by a competent, well qualified person who is resident focused but has responsibility and extra workload for two other services as well as the home. The system for the holding of the safe key does not allow appropriate access to residents’ money. Staff supervision does not take place. Apart from not providing evidence that residents are protected from scalds health and safety and maintenance checks are in good order. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is a registered nurse who is appropriately qualified and experienced to manage the home. The deputy of the home is also suitably qualified and the week of the visit had started a phased return to work after a Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 29 long-term absence. The manager is also co-owner of the home and manages a registered domiciliary care agency and a service providing meals to clients in the community from the home. She also delivers most of these meals to individual homes and makes visits to Domiciliary Care Agency clients. The manager spoke of her dedication to the services and staff spoke highly of her. Discussion with the manager and observations made throughout the day’s visit showed that she is service user focussed whilst working closely with relatives, and expects the same from her staff. Comments in our surveys to residents and to relatives were positive, for example, “ I always speak to the manager or (deputy) and a difficulty is sorted out straight away.” “I rely on the matron to supervise and choose staff who have the skills and experience.” However the manager said that she found inspection visits very stressful and showed signs of this. There is evidence that not all management tasks are being completed, such as staff supervision and the auditing of medication. It is also of concern that the manager is away from the home whilst attending to Domiciliary Care clients and over the lunchtime period to deliver meals to the community. A senior care assistant was left in charge during her absence at the inspection visit and this needs to demonstrated each day. The manager was able to show that she was contactable at any time in case of an emergency. The manager advised and previous inspection reports evidenced that the home usually distributes surveys annually to residents for their views on the service they receive. The feedback for such surveys gives the registered persons the opportunity to ensure that the home is acting in the best interests of the residents. The manager advised that the surveys are planned for later in the year and that she is planning to use the annual quality assurance assessment provided by the Commission for Social Care Inspection as the Quality Audit tool for the home. The home holds some money on behalf of the residents. The manager said that an accountant employed by the home keeps individual accounts of this money and that the money is not pooled. The records were inspected and appeared to be in good order but could not be cross referenced with the money as the key to the safe was with the deputy manager who was not in the home that day. The key was not available at the last inspection as the accountant was holding it. The manager said that she does not take the responsibility for the safe key as being the owner of the home she felt that others could view it as inappropriate. She added that residents do not have to be without money during the time the safe key is not available as money is advanced to them in a petty cash type arrangement but access needs to be made available to residents’ money for purposes of inspection. Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 30 In the pre-inspection questionnaire the manager informed us that financial arrangements are made through family, a solicitor or an attorney. Fifteen of the 16 residents at the time of the pre-inspection questionnaire were subject to Power of Attorney to protect their finances. Other than a note of a meeting held between staff and the manager in two of the staff files, which were not dated or signed, there was no evidence of any staff supervision having taken place. Staff supervision gives staff the opportunity to discuss training, practice and development issues, which keeps staff up to date and ensures their professional development and should be provided at a minimum of six times a year. The room housing the boiler was wedged open at the commencement of the visit, posing a risk to residents, as there were several hot pipes that could be easily reached. The manager explained that there had been a flood and this room needed to be dried out but was prompt in locking the door to protect the residents once the hazard was pointed out. There was evidence in the home that all the equipment was being regularly serviced and that all in house checks on fire prevention systems were up to date, including fire drills and training. There was no evidence that all hot water at outlets accessible by residents are within the required ‘close to 43°C’ limit. These temperatures should be checked at regular intervals to prevent accidental scalding. The home’s water system had been risk assessed regarding legionella by an outside contractor. Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 31 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 3 3 3 x x x 2 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 2 2 x 3 Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 32 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. Standard OP9 Regulation 13 Requirement Medication used in the home must be stored securely, including a system for security of medication keys in order to protect the people living at the home. When medication is given to people who use the service it must be – • Clearly recorded and verified. • Signed for appropriately. • Administered at the prescribed and appropriate times. • Labelled and dated correctly. • The competence of staff administering medication must be monitored and recorded. This will ensure that the correct medication is given to the correct person at the correct time in order to main the health of the people using the service. Timescale for action 30/05/07 2. OP9 13 30/05/07 Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 33 3. OP10 12(4) Notices regarding personal care 30/05/07 or service user outcomes must not be displayed in the living areas of the home. This will protect the privacy and dignity of the people using the service. The policy for Adult Protection 30/06/07 must be updated to include the local authority procedure for referring an incident of suspicion or allegation of abuse. This will safeguard people using the service from inappropriate action following any incident of abuse. The laundry must have walls that 30/06/07 are readily cleanable and laundry must be sorted in an appropriate place. This will protect people using the service from cross infection. Staff working at the home must be able to be understood by and understand people using the service. This will ensure that the people using the service have needs met in an appropriate manner. 30/07/07 4. OP18 13(6) 5. OP26 13(4) 6. OP27 18(1) Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 34 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. 2. 3. 4. 5. Refer to Standard OP7 OP8 OP15 OP19 OP26 Good Practice Recommendations Care plans should be drawn up with the resident to their representative. This will give the resident the opportunity to make decisions about the care they receive. When a resident is unable to use standing weight scales alternative methods of monitoring weight loss or gain should be identified. Consideration should be given to enabling people using the service to be involved in the serving of all or part of their meal to give them more control of what is on their plate. Notice boards displaying staff information should be sited away from the living areas of the home to maintain the homely appearance for the people living at the home. Efforts should be made to investigate the source of the odour, and minimise its affect, from the adjacent property so that residents and staff are able to use the reception lounge in comfort. The registered manager should consider if she can continue to manage the three services that are run from the home without there being an impact on herself or the people using the service. The safe key should be available for inspection in order to safeguard the finances of the people using the service. The care staff working at the home should receive staff supervision six times a year in order for them to keep up to date and to ensure their professional development. It must be demonstrated that hot water accessible to residents is close to 43°C to ensure that people using the service are safeguarded from risk of scalds. 6. OP31 7. 8. 9. OP35 OP36 OP38 Bancroft Gardens DS0000004204.V338115.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Bancroft Gardens DS0000004204.V338115.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. Re-publishing this information is in breach of the terms of use of that website. 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