CARE HOMES FOR OLDER PEOPLE
Bankfield Premier Care Gigg Lane Bury Lancs BL9 9HQ Lead Inspector
Julie Bodell Unannounced Inspection 4th December 2007 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 Bankfield Premier Care DS0000008398.V355744.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. Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Bankfield Premier Care Address Gigg Lane Bury Lancs BL9 9HQ 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) 0161 764 8552 0161 761 3689 donnabrowne@bankfield.org www.bankfield.org Mr David Arthur Hopkins Denise Rimmer Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47) of places Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 47 service users to include:*Up to 47 service users in the category of OP (old age not falling within any other category). 12th July 2007 Date of last inspection Brief Description of the Service: Bankfield Premier Care Home is a care home providing personal care for older people over 65 years of age. It is a large purpose-built detached home situated in a residential area of Bury, close to Bury football club. It is close to main bus routes and is approximately 3 miles away from Bury town centre. There is limited parking to the front of the home for the use of staff and visitors. There is a large enclosed courtyard at the back of the home. This has a well-stocked garden area and plenty of seating for the residents. The home is registered to care for 47 residents and provides accommodation on the ground and first floor. Most of the bedrooms are single rooms and 22 of the single rooms have an en-suite facility of toilet and wash hand basin. The bedrooms on the first floor are reached either by stairs or a passenger lift. There is one large dining room and several lounge areas. Several of the toilets and bathrooms have aids to assist any resident with a disability or mobility problem. Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second key inspection, which took place over one day and focussed on what improvements had been made to address the shortfalls in standards identified at the previous inspection. The home did not know that the inspector was going to visit. During the inspection, time was spent, talking to the registered manager, the general manager and the deputy manager, as well as looking at paperwork and parts of the home. Three days after this visit a CSCI pharmacist inspector examined the medication system. On 5th September 2007 a meeting took place with the registered providers and we shared are concerns about some care practices and management issues that needed to be addressed by this second key inspection. We made it clear to the registered providers that this situation could not continue. The registered providers accepted our findings and had already taken action to address the issues. As part of the inspection process the registered manager completed a quality review of the service (AQAA) as requested. Feedback surveys were received from four relatives of people using the service, which were very complimentary about the service provided. Improvements had been made in many areas of the service but there is more work to be done to continue to raise standards in some areas. What the service does well:
Before people move into the home the registered manager or deputy manager visits them in their own homes or in hospital to make sure that the care they needed can be provided by the home. Four relatives returned surveys to us. They were in the main highly complimentary about the home and the service provided. One survey stated, “Mum was very ill at the beginning of this year with pneumonia, she was looked after very well and made a full recovery. Another stated, “Over the past five years we have been very happy with the care provided at Bankfield for Mum.” There are enough staff members available to meet the needs of the people living at the home. They make sure that people are clean, comfortable and well dressed. A relative stated under what the home does well, “They provide a nice environment with friendly and helpful staff and management. The staff are always willing and able to help.” Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection?
There is a clear policy and procedure about what should happen at the point when a person comes to live at the home to ensure that all necessary information to support the person effectively is in place. There is a new recording format for care planning, risk assessment and daily records. Care staff members have received training on how to complete the documents. The deputy manager said that the new documentation had improved the way they think about prevention and support of the health needs of people living at the home. The deputy manager stated that the records were, “much better once you got used to them and helped to engage with staff around people’s individual care needs.” Medicines were now securely stored, this helps ensure they are not mishandled or misused. A clear medicines audit trail had been developed and the manager now carries out regular checks to help ensure medicines are administered to people living at the home, correctly. Medicines were usually administered to people as prescribed this helps maintain their good heath and well being There are more opportunities for people to become involved in activities to encourage stimulation and interaction with other people such as talking about bygone days, reading poetry and monologues out loud, encouraging touch and smell, holding coffee mornings, watching old films and writing Christmas cards. New and up-to-date policies and procedures for both complaints and the safeguarding of vulnerable adult procedures are now in place. There is an ongoing programme of redecoration and refurbishment being carried out throughout the home to improve the living conditions for people living at the home. To ensure the protection of people living at the home, safer recruitment practices are now in place with evidence that either a POVA check or a satisfactory CRB check are undertaken prior to staff starting employment. The registered providers continue to take a more active involvement in the running of the home to ensure that all necessary improvements continue to be made for the benefit of people who live there. There is a new pack of policies and procedures and albeit they are from a nursing perspective, they are a significant improvement on the previous pack making clear links to the standards and the law. To ensure the health and safety of people living at the home and to prevent the risk of scalding, thermostatic mixer valves have been fitted to the baths and water temperatures are checked regularly and action taken immediately to rectify any problems, if they arise. Paper towel holders and liquid soap
Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 7 dispensers are to be fitted in the bathrooms to improve control of infection measures. 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. Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 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 Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Attention is now being paid to obtaining all the correct information about a person before they move into the home to ensure that they can be supported and cared for effectively by the staff team from the point they arrive. EVIDENCE: Bankfield has had two permanent admissions to the home since the last inspection. The registered manager said that the staff put a pack of toiletries and information in the new person’s bedroom, at the time of their arrival, as a welcoming gesture. There is also a receptionist to greet all visitors as they arrive at the home. There is a new policy and procedure in place that gives the staff team more direction about what needs to happen before and during the move into the
Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 10 home to help to ensure a smooth transition for people at what is a difficult time for many. We talked with the registered manager and the deputy manager whilst examining the admission documentation for one of the two people who had most recently moved into the home. The person had moved from their family home. There is much more detail in the new assessment documentation about the person’s needs that transfers easily to develop their care plan. The new assessment format covers all personal care needs including, physical wellbeing, personal hygiene, breathing, mobilisation, eating and diet, elimination, continence, vision, hearing, dentures, chiropody, history of falls, personal safety and risk, weight, hobbies and orientation. It was noted that there had been significant improvement in the health and wellbeing of the person since they had moved into the home. An underlying infection had been successfully treated, the person was happier and their mobility had greatly improved. Standard 6 does not apply to Bankfield, as they do not provide an Intermediate Care Service. Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and the management of medications has significantly improved to help ensure the health, safety and protection of people living at the home, however, risk assessments would benefit from further development. EVIDENCE: A new care planning and risk assessment system has been introduced at the home since the last inspection. The system is based on a nursing model. The care staff team have received some training to help them to complete the records in an effective way. The deputy manager stated that the records were, “much better once you got use to them and helped to engage with staff around people’s individual care needs.” The care records of three people were examined and discussed with the registered manager and the deputy manager. The first record was for the new person who has come to live at the home, the second was for the person who
Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 12 had the highest level of need and the third was for a person who had recently been involved in a safeguarding incident at the home. Overall the information written in the care plans and risk assessments about these people matched what was discussed. Care plans were signed by a relative, where possible and kept under regular review by the staff team. However, it was clear that more work was needed around the scoring on the risk assessments to ensure consistent practice. It was agreed that initially the scoring on risk assessments would be done by the registered manager and the deputy manager to ensure that the risk level was accurate and as a means of developing thinking about a more person centred approach to their work. Unfortunately some of the documentation needed by the home had not been included within the new care records. The most important of these was the Waterlow assessment for the prevention of pressure sores. Five people had pressure sores. District nurses were involved in treating the pressure sores. Monitoring charts for fluid intake, turning charts, pain management and other documents were also missing. It was agreed that the deputy manager would consult with the general manager as to what needed to be purchased. The requirement around pressure care risk assessment has been outstanding for a long time and it is unfortunate that the matter was not addressed when the new documentation was put in place. The commission will be considering what further action to take. We also discussed with the registered manager and the general manager during the walk around the building, the need to check that all bedrails currently in use meet the current regulations, as one appeared old and that they were safe to use. The servicing arrangements, for rise and fall beds also needs to be checked out. As part of this inspection the pharmacist inspector visited on 7th December 2007 to ensure improvements in medicines handling had been made since the last key inspection. The procedures for handling medicines had been reviewed and staff, were now ordering, recording and administering medicines in a much safer way. Improvements in the systems of stock control and record keeping had been developed that made checking medicines much simpler. This is important because it helps show if medicines have been administered correctly. The manager carried out regular audits in which she had found some mistakes and had acted upon them to ensure they did not happen again. We gave some further advice on how to improve the recording of these audits. We checked medicines records against current stock and found that they were usually administered as prescribed. Previous inspections had found this not to be so. The new ordering systems and increased checks by the manager along
Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 13 with more training and an assessment of staff competence had helped improve the way staff administered and recorded medicines. Although the majority of medicines had been given at the correct time we found that some medicines were given after food instead of before, this can affect the way medicines work and in some cases increase the chances of side effects. We also found that some people were usually asleep when staff administered the 9pm doses of medicines and so they were regularly omitted. Staff should have acted to give these medicines at an earlier time because missing medicines can seriously affect the health and well being of people. Medicines prescribed as ‘when required’ did not have detailed written care plans. In particular, several medicines used for agitation did not have enough information to support their safe use, which could result in people getting medicines that they do not need. The general storage arrangements had been improved, all medicines were now securely stored and were better organised. This helps prevent mishandling and misuse. We looked at the handling of controlled drugs (medicines that could be misused), which had been a concern at the last inspection. Although some improvements had been made we gave some further advice to help improve the way the records were completed. Having clear detailed records helps prevent misuse. Four relatives returned surveys to us. They were in the main highly complimentary about the home and the service provided. One survey stated, “Mum was very ill at the beginning of this year with pneumonia, she was looked after very well and made a full recovery. Another stated, “Over the past five years we have been very happy with the care provided at Bankfield for Mum.” Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are more opportunities for people to become involved in activities to encourage stimulation and interaction with other people. EVIDENCE: This section of the report was not the main focus of attention at this second key inspection of the home. More information can be gained from the inspection report of July 2007. The registered manager said that there were now more opportunities for people to become involved in activities. There is now an activities organiser at the home for two days a week. Details in people’s care records confirm that there are activities going on in the home. Activities include talking about bygone days, reading poetry and monologues out loud, encouraging touch and smell, holding coffee mornings, watching old films and writing Christmas cards. There are plans for the activities organisers across the group to meet to share ideas. This in is an area for continued development and will be looked at in more detail at future inspections. Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. To ensure the protection of people who live at the home training needs to be undertaken by the staff team so that they are clear about what action to take should there be an incident of abuse. EVIDENCE: There has been one formal complaint made to CSCI, about the home since the last inspection relating to the allegation below. The complaints policy and procedure has been reviewed and revised to ensure that it complies with legislation. All the relatives who returned surveys said that they knew how to make a complaint. There has been one allegation of abuse at the home since the last inspection. We looked at this matter in more detail and it is clear that the correct safeguarding procedures were not followed in this case, highlighting the need for training. The people involved in this matter were poorly advised by others as too the right way to act. The home has a copy of the new local safeguarding procedures. The registered manager and deputy manager are booked to attend training in safeguarding procedures at an investigation level in January 2008. Some staff members have not yet been on the safeguarding awareness course. The necessary training is planned on a rolling programme basis.
Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 16 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 21 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Bankfield provides a comfortable and homely environment for the people living there with ongoing improvements being undertaken to maintain good standards. EVIDENCE: We looked around parts of the building with the registered manager and the general manager. It was noted that ongoing work to improve standards at the home were being undertaken. Corridor areas were being repainted to improve their visual appearance. People living at the home have the use of any of two lounges, two conservatories and a large dining room, which has just had a new floor covering laid to good effect. These rooms were pleasant and very
Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 17 homely. Some corridor carpets, which were ill fitting have been either replaced or temporarily repaired until decorating has been completed to stop them presenting as a trip hazard for people. A new fence has recently been erected around the building at the rear to improve security. A smoke detector has been fitted in the archive room. The home has a detailed maintenance and refurbishment plan in place. The registered manager has also undertaken an inspection check and complied a list of areas of action for the housekeeping and maintenance staff. Toilets are within close proximity of communal spaces. Each toilet and bathroom had a lock on the door to ensure privacy and the facilities were all clearly marked. Plans are in place to upgrade the bathrooms and this work has already started to be undertaken. New specialist baths, including a Parker bath, have been identified to ensure that all people can have a bath, safely. We discussed, given the substantial investment being made, the benefits of asking advise from a suitably qualified person, about the positioning of the baths to ensure that space was sufficient for moving and handling people by staff members to ensure that the baths could be used effectively. There are now hand-washing facilities in place for staff in the bathrooms. In line with good practice there are water thermometers in the bathroom and thermostatic mixer valves have been fitted to help control the water temperatures at the taps, to prevent them becoming too hot. We also discussed safety and protection issues relating to locks on the outside of the bathroom doors and how they might be improved during the upgrade of the bathrooms. The bedroom doors were fitted with locks and each bedroom had a lockable space. The bedrooms were in many cases nicely arranged, particularly those overlooking the courtyard and most were highly personalised by families, some with fresh flowers. Many had televisions and a number had private phones. New mattresses and plastic protective covers have been purchased for some bedrooms as well as new bedding. There are plans in place to replace some bedroom furniture. The home was clean and tidy throughout. The home was odour free but there is an unpleasant smell in a bedroom that is currently not in use. Closer inspection revealed the source of the problem and the inspector was confident that the general manager would take action to resolve the matter. The home has installed a new laundry system that kills all known germs including MRSA. All staff members are in the process of undertaking control of infection training. The cleaning products provided for the home are marked as office cleaning products in some cases. These products must be checked out to ensure that they are suitable for cleaning all areas within the home particularly, bathrooms, toilets and the kitchen, to a good hygienic standard. Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A lack of health and safety training for staff, could, potentially put people who use this service at risk. EVIDENCE: The rota for the week was examined and showed that there are generally six care staff members on duty in the morning, six in the afternoon and four in the evening including the registered manager and the deputy. There are three carers on duty at night. Cooks, kitchen assistants, laundry assistants, domestics and business administration support care staff members. At previous inspections major shortfalls were noted in respect of criminal record checks. This matter has now been addressed by the organisation and a complete list of start dates, Povafirst clearance details and criminal records checks, with disclosure numbers and the issue date was given to the inspector. Four recruitment files for night carers were checked and no further issues were raised. The inspector had some concerns about the disciplinary process and asked the organisation to look at the procedure and to seek advice as to how to carry out the procedure in a fair and even-handed way. Clear records of what disciplinary action was taken and why also need to be maintained.
Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 19 The registered manager holds the Registered Managers Award as well as the NVQ Level 2 and 3. The deputy manager and two of the three senior staff hold NVQ Level 2. Of the 14 daytime staff employed at the home only 3 have completed NVQ Level 2 training. The registered manager said that a further six staff members enrolled on NVQ Level 2 training in September 2007 with Bury College. A training skills audit has been undertaken and information put into a spreadsheet. Arrangements have been made where shortfalls have been identified in mandatory health and safety training. As this training is completed, what is learnt must be adopted as good day-to-day occupational practice for the benefit of people who live at the home. The organisation is a member of the local training partnership, which provides this type of training through Skills for Care and is now fully utilising this facility. The registered manager is now attending the partnership meetings and was due to attend the partnership development day to look at plans for future training opportunities for the staff team. A relative stated in a returned survey that, “It is clear that residents have a diverse range of challenging and complex needs, and from what I have seen, all staff work hard to meet these needs.” Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 20 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are no clear lines of accountability within the management team to ensure that the home is run smoothly and in the best interest of the people living there. EVIDENCE: The registered manager has 30 years experience of providing care to older people within the private sector and the NHS. She has been with the company for 5 years and has been the manager at Bankfield for 2 years and holds the Registered Manager’s Award. The registered manager competed the fit person process with CSCI in September 2006. It was recommended at the interview that the registered manager as part of her continuous professional
Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 21 development look at undertaking NVQ Level 4 in care, as well as looking at doing more work around the Regulations and National Minimum Standards, equality and diversity and quality assurance. Due to being absent due to ill health recently the registered manager has not been able to attend all the planned training that she had intended, but has training planned in the near future. A middle management team, who need to be clear about their roles, responsibilities and accountability to ensure that they do not unwittingly compromise the registered providers and the registered manager and their legal responsibilities in respect of their registration, supports the registered manager. Although we have noted many ongoing improvements in most areas of the service, we are concerned about a number of areas of practice at the home as stated above. The registered providers must assure themselves that the registered manager is competent in all areas of practice, by training or other means. Time must be made available to ensure that the manager can monitor tasks delegated to others e.g. the deputy and senior staff to ensure that they have been completed and to a good standard. The safeguarding issue and other matters lead the inspector to be concerned about practices by the staff during the night. It was clear that the home had taken some action about the incident but it had needed a complaint to be made before action was taken and then the matter was not dealt with correctly. The registered manager must undertake a review of all health and safety practices carried out during the night to ensure that standards are being consistently maintained through direct observation and supervision. The registered manager completed an AQAA. The form was understated and did not reflect all the areas of improvement that had been carried out. This should be taken into account when completing the next form. It was noted that the registered manager had not completed the National Minimum Data Set for Skills for Care. The outgoing head of care had been undertaking the monthly Regulation 26 monitoring visits and a copy of the report completed was being sent to CSCI. The external consultant is now undertaking this role. The outgoing head of care has purchased a new set of policies and procedures and albeit that they are from a nursing perspective they are a vast improvement on the previous pack. Certificates and records were seen in relation to the health and safety of the environment and equipment and were found to be in good order. Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 22 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 X X 3 X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X X X 2 Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13 Requirement The risk assessments for residents with a high level of need must be reviewed covering areas of pressure care and nutrition. These must be done in detail and provide more information about the risk involved and clear guidance to the staff team on how they are to care and support people to ensure their health and safety. (Previous timescales of 31/12/05 and 31/08/06 and 31/08/07 not complied with in part) Medicines must be given to people at the right time, particularly in relation to food intake, because receiving medicines at the wrong time can affect their health and wellbeing. That all managers’ who might become involved in abuse investigations need to undertake the necessary training to ensure that they respond appropriately to allegations. All members of the staff team must receive training in safeguarding procedures to ensure that protection of people living at the
DS0000008398.V355744.R01.S.doc Timescale for action 31/01/08 2. OP9 13(2) 07/12/08 3. OP18 13 31/03/08 Bankfield Premier Care Version 5.2 Page 24 4. OP26 13 5. OP30 18 6. OP31 13 7. OP31 12 8. OP38 13 home. (Outstanding 30/09/07) All staff must undertake control of infection training. The cleaning products provided in the kitchen that are marked as office cleaning products in some cases must be checked to ensure that they are suitable for commercial kitchen cleaning. (Outstanding in part 31/07/07) To ensure that the people that live at the home are in safe hands the shortfalls in mandatory health and safety training identified on the skills audit must be addressed. (Outstanding in part 30/09/07) The registered providers must assure themselves that the registered manager competency in areas of health and safety by training or other means to ensure safe management and monitoring of the service at all times. To ensure that the home is run smoothly and in the best interest of residents, the registered providers must ensure that there are clear lines of accountability within the home and with any external management. (Outstanding 31/08/07) The registered manager must undertake a review of all health and safety practices carried out during the night to ensure that standards are being consistently maintained through direct observation and supervision. 31/03/08 30/03/08 31/01/08 31/03/08 31/01/08 Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 25 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. Refer to Standard OP9 OP9 OP28 Good Practice Recommendations Medicines prescribed as “when required” or, as a “variable dose” should have clear written instructions for staff to follow to ensure they are given correctly. A review of the timings of all medicines should be carried out to ensure they are administered at the most suitable time for each individual resident. The registered provider needs to increase the level of NVQ Level 2 training to cover all areas across the staff team. Bankfield Premier Care DS0000008398.V355744.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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