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Inspection on 24/05/05 for Bank House Residential Home

Also see our care home review for Bank House Residential Home for more information

This inspection was carried out on 24th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users choice is given a high priority. The home is a family run business, which offers comfortable accommodation and has a calm and pleasant atmosphere. There is a low turn over of staff; members of staff work as a team and the manager is well respected. The home employs an activities coordinator and offers a varied range of activities for the residents. Attention is paid to residents` choice of food, all the food provided is freshly cooked, and alternatives are always available. Service users comments about the food provided, was very positive.

What has improved since the last inspection?

Significant work has been undertaken since the last inspection and in response to requirements placed on the home during the last inspection. New heating system is to be fitted in 2weeks time; temperature valves will be fitted as part of this work. Service users and relatives are now involved in care plans, there is now an allocated care worker to have responsibility for this and care plans are updated. There is a quality assurance system in place, service users feed back is positive.Risk assessments have been completed and there was a plan of work for maintenance and refurbishment available for examination. There is an activities organiser in post and there was a record of activities available for examination. Current levels of staffing were seen to be sufficient to meet the care needs of service users resident at the time of the visit. Individual residents monies are now kept and recorded separately as required. Service users wishes relating to death have been identified since the last inspection. Written references have been requested and received for all new staff. Training and induction programme for staff was in place and the majority of the members of care staff have completed or are undertaking NVQ qualifications.

What the care home could do better:

Medication administration practices were found to be unsafe. An immediate requirement was placed on the home and the situation was brought to the attention of the manager, who resolved the mal administration during the visit. Medication records had some gaps in authorisation signatures On a tour of the premises it was noted that one bedroom was in need of redecoration and the water pipes in the corridor were not boxed in. There was tape on a trap door in the downstairs corridor, and one toilet was out of order awaiting the attentions of a plumber.

CARE HOMES FOR OLDER PEOPLE Bank House Residential Home Bank House Gosberton Bank, Gosberton Lincolnshire PE11 4PB Lead Inspector Ann Day Unannounced 24 May 2005 11:00 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 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 Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bank House Residential Home Address Bank House Gosberton Bank Gosberton Lincolnshire PE11 4PB 01775 840297 01775 840297 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Miss J L Moore Miss J L Moore Care Home 30 Category(ies) of DE(E) Dementia - over 65 (1) registration, with number LD(E) Learning Disability - over 65 (3) of places OP Old Age - (26) Bank House Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The Home is registered to provide personal care for service users of both sexes whose primary needs fall within the following categories:Old age, not falling within any other category (OP) 26 Dementia - over 65 years of age (DE(E)) 1 Learning Disability - over 65 years of age (LD(E)) 3 The maximum number of service users to be accommodated is 30. Date of last inspection 10.11.04 Brief Description of the Service: Bank House is a 30 place private family run care home for 26 older persons, 1 older person with dementia and 3 older persons having a learning disability. The home is located approximately a half of a mile from the village of Gosberton near Spalding. There is no public footpath from the home to the main road. Accommodation is situated on the ground and first floors. There are five lounges and a separate lounge designated for service users who wish to speak with visitors in a more private setting. There are five double bedrooms and all other bedrooms are single. Bank House Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and mainly focuses on the standards where requirements were placed upon the home during the previous inspection. Two inspectors undertook the inspection, which included a tour of the premises. Case tracking was employed as the main inspection tool, which involves following the experience of a sample of service users and assessing the service they receive. All service users spoken to during the inspection were complementary about the service they receive. The manager and staff on duty were interviewed and personnel files and the home’s documentation were examined. What the service does well: What has improved since the last inspection? Significant work has been undertaken since the last inspection and in response to requirements placed on the home during the last inspection. New heating system is to be fitted in 2weeks time; temperature valves will be fitted as part of this work. Service users and relatives are now involved in care plans, there is now an allocated care worker to have responsibility for this and care plans are updated. There is a quality assurance system in place, service users feed back is positive. Bank House Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 Page 6 Risk assessments have been completed and there was a plan of work for maintenance and refurbishment available for examination. There is an activities organiser in post and there was a record of activities available for examination. Current levels of staffing were seen to be sufficient to meet the care needs of service users resident at the time of the visit. Individual residents monies are now kept and recorded separately as required. Service users wishes relating to death have been identified since the last inspection. Written references have been requested and received for all new staff. Training and induction programme for staff was in place and the majority of the members of care staff have completed or are undertaking NVQ qualifications. 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 Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Bank House Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 Page 8 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 standard(s) 1,2,3 Prospective service users have the information they need to make an informed choice about living in the home. Service users are provided with a written contract and have their needs assessed before moving into the home. EVIDENCE: The home has a Statement of Purpose and Service User Guide, which were available for examination. Three service users were interviewed and their care records were examined. A number of the service users have been resident at Bank House for a long time. One service user commented that they “liked the activities and arranged outings, the food is very nice” and if they had a problem they would go to Jane, the manager “ because she wants to know and will put things right, because it is my home and I don’t want to go anywhere else” All care records examined contained an assessment undertaken before the individual’s admission and a written contract/statement of terms and conditions. Older terms and conditions are being reviewed. The home does not provide intermediate care. Bank House Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7,8,9,10,11 Service users health needs are sensitively met and are identified in detailed care plans. Service users and their relatives are treated with dignity and respect at all times. However, medication administration and recording was unsafe and did not meet National Minimum Standards. EVIDENCE: All service users’ care records examined contained detailed and comprehensive care plans, which are regularly reviewed. Records evidence the involvement of service users and those spoken to were aware of their care plans and if they had needed changes. One service user commented that, “A nurse called Carol comes to see me, she is coming again in a fortnight. They went on to explain that they were being assessed for a hearing aid and how the staff had explained that they would need to visit Pilgrim Hospital, but not to stay overnight. Individual service users; care staff and records confirmed the attendance of district nurses, chiropodist, community psychiatric nurses, general practitioners and the assessment of individual mobility, tissue viability and nutritional needs. Bank House Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 Page 10 Medication recording has been improved since the last inspection, however Medication for the following morning administration round had been potted up in advance on the afternoon of the visit and the medication was stored on a tray in the external remedies cupboard. An immediate requirement was placed on the home and the situation was brought to the attention of the manager, who removed and disposed of the “potted up” medicines. Medication records had some gaps in authorisation signatures; which was brought to the attention of the manager. Individual service users spoken to thought that all the home’s staff, were very nice and that they were looked after very well. Members of the home’s staff spoken to were able to demonstrate a thorough understanding of individual service users needs and how they were able to ensure individuals’ privacy, dignity and respect. Members of staff were observed providing personal care to service users whilst ensuring their privacy, dignity and with sensitivity. Members were observed knocking on bedroom doors and awaiting an invitation before entering. Individual service users wishes relating to death are recorded. Care staff demonstrated a sensitive approach to this area of their work and an understanding of the needs of relatives when faced with the imminent death of a loved one. Bank House Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12,13,14,15 Service users are encouraged to exercise choice and control over their lives. They are offered a wide range of activities and arranged outings; and they are in receipt of a wholesome and pleasing diet. EVIDENCE: The home employs an activities coordinator who works 12 hours per week and both service users and members of staff confirmed that the home offers a range of activities and outings for its residents. Members of staff told the inspector that there are regular religious services arranged at the home, this was confirmed by a service user “I go to the service with the minister, not every week though” One service user commented that this was their home and they didn’t have to do anything unless they wanted to. The service user went on to say that their brother and sister in-law and friends from the local Old Age Pensioners club visit and that they come whenever they want to. Other service users; care staff members and the home’s “Visitors Book” confirmed that visitors are encouraged and are made welcome at the home. Service users and care staff confirmed that service users are encouraged to exercise choice in relation to time of rising and going to bed. Bank House Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 Page 12 The cook has worked at the home for over six years, she explained how she goes around the home each week to record choices and respond to requests for changes. The home provides special diets: diabetic, low fat and the cook confirmed that if the need arose they could respond to a need for a gluten free diet. The cook went on to explain that almost all vegetables and fruit are freshly delivered twice per week. “Good old fashioned home cooking, home made desserts and occasional frozen gateaux” A service user commented: “The food is very nice, I had fish today, but there is always two things at least. Staff ask us what we want, and tell us what is going to be made. My favourite is crème caramel” Bank House Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 16,18 Service users are protected from abuse and can be confident that any concerns will be listened to, taken seriously and acted upon. EVIDENCE: The home has a complaints policy and procedures in place and available for examination. Both service users and care staff were clear as to when and to whom they should speak if they are dissatisfied. The home has adult protection policy and procedures in place and a copy of the current Local authority vulnerable adults guidance. All members of staff spoken to had attended adult abuse training and were aware of what and to whom they should report any suspicions of abuse. Bank House Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19,24,25,26 Service users live in comfortable, clean, tidy and hygienic surroundings. Service users safety is assured by the home’s maintenance and repair programme. EVIDENCE: On a tour of the premises it was noted that the home was clean, tidy, individual bedrooms were comfortably furnished with personal possessions, and well decorated. The home was free from any offensive odours. A member of cleaning staff spoken to confirmed that there was sufficient cleaning staff and time allotted to clean the home. Service users said that they were happy that it was their ” home for life”. A number were happy to show their rooms to the visiting inspector. Exposed heating pipes and tape on a trap door and the fact that one toilet was out of order were drawn to the attention of the manager. The manager explained that the pipes are all part of the new heating system installation and will be boxed in, in the near future. The manager informed the inspectors that Bank House Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 Page 15 they were waiting for the carpet fitter to mend the edge to the trap door and that a plumber had been contacted to visit the home and repair the toilet. A number of rooms have been redecorated since the last inspection; one room still awaiting redecoration was identified for work in the plan of work that was available for inspection. The plan of work also identifies, the provision of new windows for a number of rooms in the home. All work has been carried out in such a way as to minimise disruption to the home and many residents were oblivious to the changes. Bank House Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Service users are cared for, by sufficient numbers of competent and trained staff. Service users are protected by the home’s current recruitment policy and practices but records for longstanding employees are incomplete. EVIDENCE: Service users commented that they enjoy living at Bank House; they think the “care is good and the staff are very helpful”. One service user commented that they came to live at the home because they were” becoming frail and needed a bit of help with some things” No service users expressed any concerns with regard to the number or skills of the staff. Staff rosters were examined, there were sufficient numbers of staff on duty and the registered manager confirmed that previously the home was employing agency staff frequently but currently the use of agency staff is occasional, staff roster confirmed this. The home has a robust recruitment policy and procedures, which were available for examination. Staff files examined were found to contain, application forms, Criminal Record Bureau and POVA Checks. Written references had been requested and received for all new staff; however long standing members of staff’s files did not contain two written references. Advice was given to the manager, discussed how references can be obtained, either from previous employers or by seeking character reference or reference from current employer. Bank House Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 Page 17 The home employs 11 care staff, 9 have completed NVQ Level 2 and 1 member of staff is completing foundation/TOPPS induction. Staff interviewed during the visit confirmed that they had undertaken NVQ training, attended statutory training sessions, adult abuse training and training sessions on specialist subjects e.g. Parkinson’s Disease, Caring for people who have suffered a stroke and a session on Learning Disability awareness. A member of staff told the inspector that a Dementia awareness training session was planned. Bank House Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,35,36, The home is run in the best interests of the service users. Service users financial interests are safeguarded and they benefit from the management style adopted by the home manager and appropriately supervised staff. EVIDENCE: Service users commented that they would have no hesitation in going to Jane, the manager or any of the staff about anything and they were confident that they would be listened to and taken seriously. Staff described the management style of the manager as “ Likes to do everything properly, talks things through; can be forthright”. Other members of staff and service users described the manager as approachable, flexible and supportive. A member of staff commented: “Best, friendliest, atmosphere absolutely lovely; good team.” Bank House Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 Page 19 “ I get satisfaction from looking after the residents, make their lives more comfortable, they have done their work and deserve to be looked after.” The home has very little turn over of staff; staff spoken to during the visit had worked at Bank House from between 27 and 3 years. Service users monies are now kept and recorded individually. Individual sheets and receipts maintained for residents with details of expenditure and monies received. Monies retained on behalf of residents are labelled and kept separately. These were found to be accurate on examination. Staff supervision records are in place for this year in line with regulations. Bank House Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 3 x 3 3 x x Bank House Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 Page 21 yes 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 9 Regulation Reg 13(2) Requirement Medicines potted up for 8am administration round (2pm) medicines for disposal, action taken whilst inspector present. Safe recording, handling, administration of medication. Requirement outstanding from last inspection Nov. 04 Two written references must be obtained for all staff. Some action has been taken since the last inspection Nov. 04 Timescale for action Immediate Action taken 31st August 2005 31st August 2005 2. 9 Reg.(13) 3. 29 Reg 18(1) 19 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 38 Good Practice Recommendations Recommended that the home identifies a First Aider for each day. Bank House Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection CSCI, Unity House The Point, Weaver Road off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 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 Bank House Residential Home C53 C04 S61113 Bank House V226204 240505 Stage 4.doc Version 1.30 Page 23 - 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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