CARE HOMES FOR OLDER PEOPLE
Bank House Nursing Home Shard Lane Hambleton Near Blackpool Lancashire FY6 9BX Lead Inspector
Mrs Christine Marshall Unannounced Inspection 15th November 2005 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 Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 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. Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Bank House Nursing Home Address Shard Lane Hambleton Near Blackpool Lancashire FY6 9BX 01253 701635 01253 701751 hargreciupa.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care First Limited Care Home 50 Category(ies) of Dementia (15), Old age, not falling within any registration, with number other category (35) of places Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection To accommodate five (5) named people under 65 years of age within a maximum of 50 people. 18th April 2004 Date of last inspection Brief Description of the Service: Bank House Nursing Home is situated within its own grounds. Village shops and facilities are a short distance away. The home provides accommodation for 50 people and offers nursing and dementia care. All accommodation is in single bedrooms that meet the minimum space requirements. Each room is furnished to a good standard. Nine bedrooms have en-suite facilities. There are adequate bathrooms and toilets throughout the home. The home comprises of ground and first floor accommodation and the lounge and dining areas are decorated and furnished to a good standard. There are three dining/lounge areas, two on the general nursing unit and one on the dementia unit. There is a passenger lift and wheelchair access throughout the home. The gardens are well maintained. There is adequate car parking space. Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the second of two unannounced inspection visits, scheduled from 1st April 2005 to 31st March 2006. All of the people spoken to and who were able at the home said that they preferred to be called residents. This unannounced inspection took place during the morning and was carried out by the home’s designated lead inspector Christine Marshall who was accompanied by Pharmacy Inspector Simon Hill and inspector Janet Spink. The lead inspector undertook a tour of the home, including bedrooms, lounge and dining areas, and bathrooms. All areas were clean, hygienic and pleasantly furnished: Administration records were also examined. Simon Hill looked at the home’s medication systems and Janet Spink spent time with the residents and staff on the dementia unit that is called Garden Court. Comment cards were left at the home for the residents and relatives and the inspector is waiting for the return of these to assess the level of satisfaction at the home. The inspector spoke with a number of the residents; all appeared to be satisfied with their environment and care. There were three visiting relatives available during the inspection visit who said that they were happy with the care being given at the home, however they did express concerns at the levels of staffing, particularly at the weekend. The manager, nurses and care staff spoke with the inspector and showed that there is a gentle approach to the care given to the residents. Again staff told the inspector that they felt unable to give the care that the residents’ needed because they did not have enough time. Everyone was very friendly, welcoming and co-operative with the inspectors throughout the visit. Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection?
Residents care plans now have sufficient detail to provide clear guidance to staff on the actions to be taken to meet their health and welfare needs. Residents on Garden Court are now provided with appropriate meals according to their ability to chew and swallow. With the exception of four new members of staff, training has been given in the protection of residents from abuse. The four new carers are enrolled on the next training session. Registered nurses now have a programme for supervision sessions 6 times a year. Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 The information that the home provides for prospective residents is in need of updating with the names of the new registered manager and responsible individual. Contracts of care are provided so that residents know what to expect from the home and what is expected of them. EVIDENCE: The home’s Statement of Purpose and Service Users Guide is a set of written information that tells you about the care service that is offered; who the manager and staff are and what the resident can expect if he or she decides to live at the home. This needs to be updated with the names of the new registered manager Mrs Viv Ogden and the new responsible individual for the organisation. The inspector sampled the contracts of care in the residents’ files and found them to be satisfactory. Two visiting relatives and a small number of residents were able to tell the inspector that they had contracts of care with the home and that they were happy with these.
Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 11 The information contained in the residents’ files indicates that all their basic health and social care needs are met and that people are treated with dignity and respect at this home. Residents are reasonably supported in their daily lives. Medication systems need to be monitored more closely to ensure that residents are given their drugs safely. EVIDENCE: The inspectors examined five care plans, which are records of the care that is given to residents, and generally these reflected the care that was actually being given, and access to health care such as GP and chiropody; they were also reviewed on a regular basis. Some residents were able to tell the inspector that they knew about their plans of care and were satisfied with them. Signatures of either the resident of their relatives are also in place on the care plans. Current Medication Administration Record (MAR) sheets were examined in all units, staff are signing when administering drugs and the records were clear and detailed. The receipt of medication into the home was not always accurately recorded, staff often left off the date of receipt.
Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 Page 11 The nurse in charge was not aware that consent had been obtained for one resident’s covert administration of medication; this means that tablets and/or medicine is given in food or in drinks. Some “when required” medication was not accurately reflected in care plans especially antipsychotic (sedatives) and analgesic (pain-killing) medication. Currently the home has an incorrect procedure for medication disposal and the manager was advised to make new arrangements with a licensed waste management company as a matter of priority. Controlled Drugs records need to be checked to make sure that a second signature is in place for transferring balances of stock. General advice was given by the pharmacy inspector, to the manager and nurses, I respect of these issues. Policies and procedures for death and dying remain in place and the manager assured the inspector that full support is given at this most sensitive of times. Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 15 Social activities are provided for the residents on the nursing side of the home, however those living on Garden Court are not fully supported in this. There is a good choice of menu and the food is good, but Garden Court mealtime routines do not fully support the people living there. EVIDENCE: There is a good social activities program on the nursing side of the home: These include regular activities such as bingo, quizzes, memory lane, coffee mornings, Beetle drives and flower arranging. The social activities co-ordinator arranges a “Theme of the month” and these have included Hawaiian Day, Back to School Day and Remembrance Day. A PAT (pro-active therapy) dog visits the home twice a month and the local United Reformed Church holds a full church service every two months. The residents on Garden Court do not have such a full programme and the activities co-ordinator told the inspector that this is because they need more personal and spontaneous one-to-one interaction. The inspector advised the manager that the people living on Garden Court must have an appropriate activities plan and that all staff on this unit should be aware of the various activities and interactions that can promote a better quality of life for those people with dementia.
Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 Page 13 Generally the food was said to be good by the residents that could talk to the inspector. The accompanying inspector Janet Spink stayed with the people on Garden Court for their lunchtime meal and advised that although the food was nourishing and appropriate for the residents eating preferences, the actual routine of the meal was disjointed. Residents were taken to the tables a good ten minutes before the food was served and thus the residents were agitated and not really settled for their meal when it arrived. Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 Residents are registered to have postal votes and supported in there preferences. Advocacy service information is available to anyone needing assistance. EVIDENCE: A small number of residents were able to confirm that they were able to vote if they wished and the manager assured the inspector that each person at the home was registered for a postal vote. There are advocacy leaflets available for those residents who might need some help with legal advice. Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X No standards were assessed on this inspection visit. EVIDENCE: All of these standards were assessed on the previous inspection visit and all were met. Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 30 Staffing levels are in need of review to make sure that residents’ are being given the care that they need: National Vocational Qualifications (NVQ) training programmes need to be promoted so that 50 of the carers have the knowledge and competence to do their job of caring for the residents. Induction and training programmes are in place but not all staff have the benefit of this. EVIDENCE: Although the duty roster showed that there were adequate levels of staff on duty, the carers themselves told the inspector that they did not have enough team members to be able to do their jobs properly. They said that they did not have enough time to give the care that each resident needed, or to look at care plans or to talk to the residents. Three relatives also told the inspectors that they didn’t feel that there were enough staff on duty and that the carers seemed to be rushed and under pressure. The inspectors advised the manager that this must be addressed to make sure that the people living at the home were given the care that they were assessed as needing. NVQ programmes are in place, but there are still less than the required 50 carers trained to level 2.
Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 Page 17 The manager should be providing a definite plan for the achievement of this target to make sure that the carers are knowledgeable and competent to give care to the residents. Although there are induction and training programmes in place, which are good, one member of staff who had worked at the home for a week had not been given either induction or fire training. The inspector advised the manager that this must be attended to as a matter of priority to make sure that the member of staff and the residents were safe and secure. The inspector watched the staff on Garden Court, which is the dementia unit, and noted that there was a very good interaction between them and the residents, however not all of the staff have had training in dementia awareness. Again the inspector told the manager that this must be addressed to make sure that the people living on this unit were given the care that their condition demanded. Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33 & 36 A qualified and experienced person, who is in the process of becoming registered with the Commission for Social Care Inspection, manages the home. EVIDENCE: The manager, Mrs Viv Ogden is a Registered Nurse who holds the Registered Managers Award. She is in the process of becoming registered with the Commission for Social Care Inspection (CSCI). The care staff told the inspector that there is an open and clear leadership within the home and residents said that they knew who the manager was and that they saw her every day. Staff meetings are held for trained nurses and carers and minutes of these are kept. Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 Page 19 There is a quality monitoring system in place which is called Investors in People (IIP): This is a recognised method of checking the quality of the care systems in the home. The home also sends out surveys on customer satisfaction and the results of these surveys are left by the visitors signing in book or displayed on the notice board. Plans for staff supervision programmes are in place for all staff, however, these are not fully used and the inspector advised the manager about the various supervision practises that can be done. The manager readily accepted this advice. Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 Page 20 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 2 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 3 X X X X X X X X STAFFING Standard No Score 27 2 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X 2 X X Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? 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 OP2OP1 Regulation 4&5 Requirement The Statement of Purpose and Service Users Guide must be updated to include current information about the manager and the responsible person for the home. The manager must ensure an accurate record of receipt of medication into the home is made. The manager must ensure medication is disposed of via a licensed waste management company. Residents on Garden Court must have access to personal and social activities according to their assessed needs. Residents on Garden Court must be provided with mealtime routines that are suitable for their assessed needs. Staffing levels must be reviewed to make sure that the residents are being given the care that they have been assessed as needing. This is a requirement from the previous inspection visit
DS0000006023.V265471.R01.S.doc Timescale for action 21/12/05 2 OP9 13 (2) 21/12/05 3 OP9 13 (2) 21/12/05 4 OP12 16 21/12/05 5 OP15 16 21/12/05 6 OP27 18 21/12/05 Bank House Nursing Home Version 5.0 Page 22 7 OP28 18 8. 9 OP30 OP36 18 18 that has not been fully complied with. A written plan must be developed for 50 of care staff to achieve NVQ level 2. This is a requirement from the previous inspection visit that has not been fully complied with. New staff members must have induction and safety training. A written plan for staff supervision programmes, six times a year must be developed. This is a requirement from the previous inspection that has not been fully complied with. 21/12/05 21/12/05 21/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations All medication that is prescribed on a “when required” basis, especially antipsychotic and analgesic preparations, should be clearly outlined in the care plan stating the criteria for administration. Handwritten records should be double-checked by another member of staff; two signatures to evidence this would be good practice. The manager is advised to carry out regular monitoring of the records and medication to ensure no mishandling. Training for the personal and social activities needs of the dementia resident should be provided for all carers on Garden Court. 2. 3. 4 OP9 OP9 OP12 Bank House Nursing Home DS0000006023.V265471.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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