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Inspection on 07/01/09 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 7th January 2009.

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

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

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

CARE HOMES FOR OLDER PEOPLE Bank House Residential Home Bank House Gosberton Bank Gosberton Lincs PE11 4PB Lead Inspector Alison Jessop Unannounced Inspection 7th January 2009 09:30 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 Residential Home DS0000061113.V373688.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. Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bank House Residential Home Address Bank House Gosberton Bank Gosberton Lincs PE11 4PB 01775 840297 01775 840297 janemoore1@talk21.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) Miss Jane Louise Moore Miss Jane Louise Moore Care Home 30 Category(ies) of Dementia - over 65 years of age (1), Learning registration, with number disability over 65 years of age (3), Old age, not of places falling within any other category (26) Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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. 2. Date of last inspection 10th July 2008 Brief Description of the Service: Bank House is a two-storey, private, family-run care home located in a rural setting approximately a half of a mile from the village of Gosberton and 6 miles from the town of Spalding. The Georgian building has been extended to provide personal care for up to thirty older persons of both sexes, including one older person with dementia and three older persons having a learning disability. Accommodation consists of twenty-two single rooms, none of which is en-suite, and four shared rooms, on the ground and first floors. The first floor is accessible by stairs or a passenger lift. The home overlooks lawns and garden areas and has car parking spaces at the front of the home. The home’s philosophy, which is displayed around the building, is that residents are treated as individuals and that there is an ongoing development of best practice in clinical and social care. The fees for the home range from £348 to £431 with additional charges made for hairdressing, chiropody and newspapers. This and other information, such as the statement of purpose and a copy of the last inspection report is available from the office. Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced visit and it formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms we and us refer to The Commission for Social Care Inspection (CSCI). The visit lasted approximately six hours and was carried out by a Regulation Inspector and a Regulation Manager. We took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. The main method used to carry out the inspection is called case tracking, this includes following the care of a sample of six people through their records and assessing their care. We spoke to six people who use the service and saw rooms of those people who said we could and spoke to two staff members. The registered manager was present throughout some of the visit and the general outcomes of the visit were discussed with her. The Registered Manager and the deputy Manager were available throughout the day to answer any questions. We spoke to 6 residents, and three staff working at the home. What the service does well: What has improved since the last inspection? Generally the care of the residents is more person centred and this was demonstrated by staff throughout this visit. Residents who have dementia are provided with various items such as dolls and teddy’s, which provide them with Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 Page 6 comfort. Residents looked more calm and relaxed as they had access to stimulation. Residents had received medical attention as required. Some of the lounges in the home have been redecorated and have had new carpets fitted. Staff have received more training and the Manager is planning to attend a training course on dementia care and new legislation such as the Mental Capacity Act and the Deprivation of Liberty Safeguards. 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. The summary of this inspection report can be made available in other formats on request. Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken, ensuring that so far as possible service users needs can be met. EVIDENCE: The Manager or the deputy Manager completes an assessment of need, where possible prior to being admitted to the service. We saw that information is also gained from the referring agent and other sources. This service does not provide intermediate care. Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live at the home are well cared for by a team of staff who assist them to maintain their dignity. Care plans and risk assessments provide inconsistent and incomplete information, which could place residents at risk. EVIDENCE: We looked at a sample of six care plans. The Manager told us that she has developed a new care planning system which is more person centred. We looked at three of the new care plans. The care plans are generally more detailed about the day-to-day needs of the person receiving care. However we identified that the care plans did not fully identify how the person’s needs in respect of their health and welfare were going to met. An example of this was that a resident had expressed during a review that they would like to be more independent. An action plan on how this was to be achieved had not been recorded and there had not been any follow up. Another example was where a resident had displayed agitated and aggressive behaviour towards staff. There was nothing in the care plan to say what the Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 Page 10 triggers for this are and how this can be alleviated. Care plans had not been reviewed to reflect the current care needs of the person, one resident had developed a pressure sore and although this was being treated and records made in the daily notes about what care had been given, the care plan had not been reviewed. Risk assessments were not available on four areas of risk that we identified from peoples daily notes. Care plans did not show evidence that the persons mental capacity has been considered. Feedback from the people who use the service was very good. One person said ‘I am well looked after and the staff are very good. I feel free to live how I want to.’ Another person said ‘the staff are very caring, I can see the GP or nurse when I want to, I feel safe in the home.’ One resident was unwell and had decided to stay in bed that day. When we entered the room the resident was coughing but did not have access to a drink. We asked how they would get a drink? The resident said that she would get up and get a drink from the tap in her bedroom. We asked the staff to take a jug of water up to the resident’s bedroom. The staff had responded to resident’s health issues and had regular contact with GP’s, nurses, chiropodists and other health services. Residents looked well cared for and said that they are treated with dignity and respect. We observed that residents who have some confusion were not agitated and were relaxed in their environment. Staff spent time chatting to people and items, which provide people with some comfort, were available. We looked at the medication procedures and checked a sample of records for people who have assistance with medication administration. We made a couple of recommendations, which were immediately implemented by the deputy Manager. Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with appropriate stimulation to meet individual needs and choices. People are provided with food that they enjoy and there’s plenty of choice. EVIDENCE: The home employs an activity co-ordinator who provides a range of activities in order to provide stimulation to people. There is also a dedicated activity room where residents can participate in games, crafts, card making and have nail manicures. The activity co-ordinator spends time with people on a one to one reading newspapers or chatting. One resident said ‘I like to participate in the sing a long.’ Another resident was observed doing a jigsaw puzzle at the dining table. For those people who have memory loss the residents are offered doll therapy. This provides them with comfort. We saw one resident holding a doll looking very relaxed. A religious service is held at the home once a week. Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 Page 12 Feedback about the food was very good. Residents told us ‘yes the food is very good.’ And ‘we get a good choice of food and the chef comes to talk to us to see what we would like.’ Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are adequate systems in place help to ensure that residents are not at risk. EVIDENCE: The service has received one complaint, which was also sent to CSCI. The concerns raised were in relation to medication administration and a general lack of action and communication following an accident. The matter was referred to the Adult Safeguarding Team for investigation. No abuse or neglect was found to have occurred however some practice issues were identified. The matter has now been resolved and no further complaints have been received. residents told us that they are aware of how to raise concerns or complaints if they needed to. Staff told us that they have received training recently on how to safeguard vulnerable adults and when questioned they were able to tell us what they would do if they suspected any abuse or neglect had occurred. One resident said ‘I feel safe here.’ Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The refurbishment of the lounges provides a cleaner and fresher appearance although the décor has not been planned to be suitable for the needs of people who may develop or have dementia. Other parts of the homes décor looked tired and worn. EVIDENCE: Since the previous inspection in July 2008, parts of the home have been refurbished. The small lounges and the activity room have been redecorated and new carpet has been fitted. Some other areas of the home are in need of redecoration, particularly some of the décor in bedrooms and hallways. We asked the Manager if there is an on-going development plan for the home. The Manager stated that the outside of the building has been redeveloped and the inside of the home will be started in the next six months. Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 Page 15 We saw in one bedroom that a sink was leaking and a bucket was being used to catch the dripping water. We were told that this has been like this for a few days. One carpet in a bedroom was heavily stained. We did not detect any unpleasant odours and we noticed that staff observed good infection control procedures. Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team demonstrated that they have a better understanding of how to care for people who have dementia. This ensures that people’s needs are met. EVIDENCE: We gained feedback from three staff that work in the home. All said that the home is well staffed the majority of the time however there may be times when staff go off sick that staffing levels are low. Residents told us that they do not have to wait for long periods of time to be assisted. The Manager told us that four care staff are currently undertaking an National Vocational Qualification (NVQ) at level 2. One person is completing a level 3 and the deputy Manager is completing a Registered Managers Award. Overall approximately fifteen staff have an NVQ. We did not look at staff recruitment procedures fully on this occasion as this was fully inspected in July 2008. Staff confirmed that they were vetted prior to being employed. There is a staff training programme and the staff we spoke to confirmed that they receive regular training in order to keep up to date with current good practice. All staff have recently received training on how to safeguard adults. Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 Page 17 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, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager has taken steps to ensure that new procedures are implemented, which will help to improve the quality of the service being provided to the people who use the service. EVIDENCE: The Manager has gained a Registered Managers Award. We spoke to the Manager who said that she has gained some training on new legislation such as the Mental Capacity Act and Deprivation of Liberty Act. She told us that she is due to attend a study day on this and a three-day training course on dementia care. The Manager has notified the Commission of any deaths or incidents that have occurred since the last inspection. Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 Page 18 Procedures relating to the storage of residents finances were not fully inspected however records were observed on resident’s files, which account for income and expenditure. There have been no previous or current concerns about this and therefore this standard will be fully inspected during the next key inspection. An annual quality audit had been completed in April 2008. Questionnaires had been given out to residents and visitors. One visitor said ‘I have nothing but praise for the management and staff especially during my fathers recent illness, care and concern was outstanding.’ Several compliments had been recorded. Although staff have improved their record keeping skills, we found it difficult to audit care plans as records had been made in various places. Personal information about residents had been written in the daily-shared diary. This practice is not consistent with the Data Protection Act 1998. Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 Page 20 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 OP7 Regulation 15(1) Requirement The current needs of the person must be recorded in such a way that anyone caring for the person will fully understand their current individual needs. Action must be taken so that unnecessary risks to the health and safety of any person receiving the service are identified, recorded and so far as possible minimised or eliminated. The care home must be kept in a good state of repair and kept reasonably decorated to ensure that residents live in comfortable surroundings. Individual records relating to the residents must be stored securely and in accordance with the Data Protection Act 1998, to enable residents to access what has been written about them. Timescale for action 07/05/09 2 OP7 13(4)(c) 07/03/09 3 OP19 23(2)(b)& (d) 07/08/09 4 OP37 17 (3)(a) 07/03/09 Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 Page 21 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 Refer to Standard OP7 OP19 Good Practice Recommendations Staff need to record/show evidence that the resident’s mental capacity has been considered when reviewing their care. It is recommended that information and advice is sought on styles of décor that are appropriate to the needs of people who have dementia. Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Bank House Residential Home DS0000061113.V373688.R01.S.doc Version 5.2 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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