Inspection on 14/06/07 for Bankfield Residential Home

This inspection was carried out on 14th June 2007.

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

Other inspections for this house

Bankfield Residential Home 17/11/06

Bankfield Residential Home 03/01/06

Bankfield Residential Home 25/10/05

Bankfield Residential Home 07/03/05

Bankfield Residential Home 01/09/04

Bankfield Residential Home 19/03/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Bankfield Residential Home Hollins Lane Sowerby Bridge West Yorkshire HX6 2RS Lead Inspector Lynda Jones Key Unannounced Inspection 10:00 14 &15th June 2007 th 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 Residential Home DS0000057396.V343208.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 Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bankfield Residential Home Address Hollins Lane Sowerby Bridge West Yorkshire HX6 2RS 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) 01422 831333 01422 836331 Philip Bennet (Bankfield New Co) Ltd Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th November 2006 Brief Description of the Service: Bankfield provides personal care and support for up to 37 older people. The house is a detached Victorian property located approximately a quarter of a mile outside the centre of Sowerby Bridge. There is a steep drive up to the house. At the front of the house there is a garden with panoramic views of the surrounding countryside. Bedrooms are at ground, first and second floor level. All parts of the house can be accessed by a passenger lift. Most bedrooms are single, only two are double. Twenty-three rooms have en suite facilities; the remainder have a hand washbasin with toilets and bathrooms nearby. The weekly fee is between £387 and £463. Residents pay extra for hairdressing, chiropody and for newspapers and magazines of their choice. Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last key inspection took place on 17 November 2006. We also visited the home on 23 May 2007 to carry out a random inspection because of our concerns about the management arrangements at the home following the recent resignations of the manager and deputy manager. We were concerned that, because of the recent high turnover of staff, the needs of people living at the home were not being met. We also had concerns about the safety of the medication systems and practices in the home so we arranged for a specialist pharmacist inspector to visit the home on 22 May 2007. Our findings were that the personal care and healthcare needs of the people who use the service were not always being met. We could find no evidence of any activities taking place at the home. People were left for long periods sitting in the lounge. We found that there was very little interaction between staff and people living at the home. We were concerned that people living at the home were not adequately safeguarded and that the adult protection coordinator and ourselves were not being notified of incidents that affected the safety of people who live there. The pharmacist inspector was concerned about the lack of a robust system within the care home for the recording, storing and administration of medicines. This puts people at risk of not receiving medication as prescribed, and their health and wellbeing may be at risk of harm. We made a number of requirements in the report following that inspection. We decided to carry out this inspection to assess the quality of care provided to people living at the home and to see if any progress had been made since we last visited. Two inspectors carried out the inspection over two days. The pharmacist inspector also carried out a follow up visit to the home, which took place on 20 June 2007 over a period of five hours. The methods used in this inspection included discussions with people who live at Bankfield and with visitors to the home over the two days. Discussion also took place with staff on duty. We observed care practice, examined records, and toured the premises. The pharmacist inspector looked at medication records, storage and administration and spoke to the manager. Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 6 Surveys were sent to relatives and representatives of people who use the service; these provide an opportunity for them to share their views of the service with us. Comments received in this way are shared with the owner without revealing the identity of those completing them. Ten relatives wrote to us with their comments. Information from the surveys has been used in this report. What the service does well: What has improved since the last inspection? What they could do better: Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 7 Many relatives felt that the company should try to improve the way they communicate with relatives. People told us they had been concerned about the recent changes of staff and management but no one talked to them about how they planned to tackle these issues. They would like to meet the owner and the management team and get to know more about future plans for Bankfield. These are some of the comments people made “We want a happy atmosphere like there used to be when you visited”, “We want someone to organise things in a proper manner, I’m sure the new manager will do this”. Some people said the staff are very task focused, they felt that they were always in a hurry and didn’t have time to talk to people. One person said “Mum used to enjoy a chit chat with staff, now it is quiet and they just sleep”. Another said, “when I visit the staff who are about don’t appear to talk to the residents”. Almost everyone commented on the lack of activities and stimulation and felt that this was a priority for management to organise. More effort needs to be made to appoint an activities coordinator. We were told “they should have activities based on individual needs” and “any type of entertainment would be good”, “nothing is going on, the buzz has gone out of the home”. While we were at the home, staff were pleasant and polite to people but we saw no evidence of any organised activity during our visit. Two people commented on the lack of a safe outdoor area. They said they sit outside with their relatives when the weather is good but they felt that it was unlikely that this ever happened otherwise. One person said “make somewhere safe outside so that people can sit safely in the fresh air”. The quality of assessments needs to be improved to make sure that people know that their needs can be met before they move in. Care plans need to be reviewed to make sure that they reflect the current needs of each person. The plans must give clear instruction to staff so that they know what they must do to make sure that everyone gets the care and support that they require. The medication system needs to be improved further to make sure that people get their medication as it is prescribed. Some people do not think their concerns are taken seriously and they don’t think the company listens them to. The management team need to address this issue so that people have confidence in the home’s complaints procedure. Some health and safety issues that are highlighted in this report require urgent attention so that people who live at the home and the staff who work there are not at placed at risk of harm. Wheelchairs need to be checked to make sure they are used safely. Staff need up to date instruction on the use of safe Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 8 moving and handling techniques so that people are supported to move appropriately. All staff must receive fire safety training and fire alarms must be tested on a regular basis. Details of tests and names of staff undertaking training must be recorded to ensure that everyone knows what to do in the event of an emergency. 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 Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are being admitted to the home without being properly assessed. This means that people could be moving into a home which is unsuitable and where their needs may not be able to be met. The reasoning behind the weekly charges is not clear and could be confusing to some people. EVIDENCE: We looked at the records relating to three people who have moved into Bankfield since our last visit in May because we wanted to know if they had been assessed appropriately before they moved in. This is very important because this assessment should indicate whether Bankfield is suitable for them and whether their needs can be met at the home. Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 11 We found only one pre-admission assessment on the three files we looked at. One person had been admitted in an emergency for a short stay;when this occurs the registered person should carry out an assessment within 2-4 working days. This had not been completed. Moving into a care home can be a very unsettling experience for some older people. It is vital that both they and their relatives know that the home is suitable so that they can avoid further disruption of having to move again if they find their health, personal and social care needs cannot be met. In the last section of this report on Management and Administration, we have reported on the difficulty some people may have in using the lift at the home. This needs to be taken into consideration by anyone who is considering a place at Bankfield and should be made clear in the home’s Statement of Purpose. We were unable to locate any contracts/terms and conditions of residence on this inspection. We were told that these are in the process of being issued to people who do not have copies. There is a large variation in the cost of a place at Bankfield. The figures that we were provided with show that the weekly charge is between £347 and £463; very few people pay the same charge. According to the Responsible Individual (this is the person who acts on behalf of the company) the cost of each room is determined by the amount of care each person requires, whether the room is single or shared, and whether the room has en suite facilities. This means that the final cost of a place cannot be determined until each person’s needs have been assessed. This is not helpful to people who are making general enquiries about the charges. Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care plans are not up to date, they do not contain enough information about the people’s needs. This means that people’s health, personal and social care needs are not always being met. People are not being treated with the dignity and respect they are entitled to. There is a lack of consistency in the way medicines are administered. This puts people at risk of not receiving medication as prescribed. EVIDENCE: We looked at a selection of care plans relating to people who are new to Bankfield and people who have lived at the home for some time. We wanted to see what individual needs had been identified and what action staff were expected to take to meet these needs. One care plan related to a person who had recently moved into the home. No property sheet had been completed when he moved in therefore it was not Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 13 possible to determine what personal possessions and clothing he had brought with him. The plan stated that the staff should treat this person with respect while attending to intimate hygiene needs and maintain dignity by performing hygiene tasks with the door closed. We feel that these are basic rights that every person using the service is entitled to expect and should not need to be included in a care plan. The records said that this individual should be asked which day he would like to have a bath/shower, he had indicated that he wanted a bath or shower each week. When we visited Bankfield, this person had lived at the home for 12 days and he told us he had not had a bath. This means that his needs have not been met. No continence plan was in place although continence aids were in use, this means that either staff are passing important information by word of mouth or that this person’s needs are not being met in this area. A falls risk assessment had been completed indicating that there was a high risk of this person falling. No measures had been identified to try to reduce the risks in this area. This is poor practice and is unsafe. One fall had been recorded since he took up residence. The moving and handling plan indicated that this individual would need assistance from two staff and that a belt and hoist should be used when he was being moved. The plan did not include any details of the type of sling that should be used with the hoist. We witnessed some very poor and extremely unsafe practice when we observed staff moving this individual, who is unable to weight bear. He was moved, using a belt, by three staff who supported his entire body weight. One person stood at each side of him and one supported his outstretched legs. This is dangerous and could cause injury to the person being assisted and to the staff. We viewed the room that this person occupied to see if there was a hoist in situ. The room was long and narrow, there was no hoist and it would have been impossible to use one due to the space restrictions in the bedroom. If this individual had been correctly assessed before he moved in, the assessor would have been aware of how he was used to being moved safely, using the correct techniques. A hoist should have been available for his use and a more suitable room should have been offered to him. The home is failing in its duty by offering him a place if his needs cannot be met safely. We gave feedback about this to the responsible individual (who acts on behalf of the company) at the end of our visit. Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 14 We were told by relatives that we talked to, and by people who returned the surveys, that they had concerns about the way they saw people being moved. We were told that they often had to remind staff to use the moving belts. One person told us that she had repeatedly told staff not to move her mother in a wheelchair without the foot rests on because she was afraid her feet would drag along the floor and get trapped. During our visit we saw staff using wheelchairs without putting footrests on and without putting the brake on the chair before attempting to seat someone in it. This could cause an injury to any one of the people who need to use a wheelchair. We also saw staff place the moving belts around the breast areas of some females, which must have been uncomfortable and painful for those people. We looked at the records relating to an individual who moved into Bankfield, stayed for 11 days, then moved out to another care home. No care plan had been completed and her needs had not been identified during her stay. We looked at records relating to one person who had lived at the home since 2005. There was no continence plan in the care plan. We observed a member of staff telling him loudly that he was wet and he needed his incontinence pad changing. The member of staff touched his upper leg to indicate that he was wet. He refused to go to the toilet. We observed this person for two hours, no one returned to talk to him again and he was still in a wet pad after lunch. We also observed staff asking other people loudly if they wanted “to wee”. This is completely undignified and shows a lack of respect and understanding by staff. We know from the records that one person recently obtained two new pairs of glasses, one for distance, one for reading. We asked the staff how they knew which was which. They told us “it’s trial and error to see if he can see. He doesn’t read much anyway”. This means that he is not being assisted to wear the correct glasses to improve his eyesight. It is difficult to tell from the records whether appropriate action has been taken when particular issues have been highlighted. For example, we were aware that the district nurse involved in the care of one person advised that this individual should sit in a recliner chair because she was sliding out of the one that was in use. We could find no reference in the records to the chair in her bedroom ever being changed. One of the domestics was able to tell us that the chair had been changed but the new one was not a recliner. We noted that one person’s legs were swollen and, as she is unable to bend them, she cannot use the lift. The lift at the home is very small; someone in a wheelchair can only use it if the foot rests are removed from the chair and if the person in the chair can bend their legs. As a result, this person has spent most of her time in her room during the past month. A member of her family said she is a sociable individual and is missing chatting to people. We asked a member of staff why she was spending time in her room and we were told in Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 15 contrast “she prefers her own company”. Some staff appear not to know how she first became confined to her room. We read about one person who had fallen five times within seven days early in June 2007. The falls risk assessment on file was dated January 2007 and the last time the care plan had been reviewed regarding falls was February 07. Accident reports had been completed but no action had been taken to investigate why the falls had occurred. There was no evidence that any additional checks had been carried out to make sure this person was safe and there was no evidence that any action had been taken to reduce the risk of further falls. This means that this individual remained at risk of hurting herself. Nine days after the first fall, the GP prescribed antibiotics for an inner ear infection. In the surveys, we asked people if they felt that the care home meets the needs of their relatives. People told us they were met “usually” and “sometimes”. One person said “we have had to kick up on several occasions to make sure mum has reasonable care” another said “at this moment in time, and for the last 9 months, we as relatives, have been her only inspiration to live. The attitude of the home was much better two years ago”. We asked if the care home was providing the support and care that they agreed/expected. One person said “always”. Other relatives who returned surveys said “sometimes” and “usually”. One person said “no”. We were told “Due to all the management & staff changes in the last twelve months we find this is lacking. Disappointment is the key word”. We wanted to know if the relatives of people living at Bankfield felt that the staff kept them in touch with what was happening at the home. We asked if they felt that they were kept up to date about important issues affecting their relatives, such as accidents and hospital admissions. Four people said “usually” and went on to say that the need to be contacted had not yet arisen. Other people made the following comments “We have had to ask for GP visits on a few occasions” “how could we know of other things? no one ever says” and “we find that we have to inquire as we arrive to find out if anything has occurred since our last visit”. We asked people if they had been given enough information by the home to help them make decisions. Most people answered “sometimes” and “never”. One person commented “the only information received is after the event, we are not normally consulted before”, “key events eg. illnesses affecting large numbers of other clients, are not communicated systematically”. One person said, “The only info is via staff gossip, or as in the case of the manager leaving, after the event”. Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 16 Pharmacy inspection A pharmacy visit took place on 19 June 2007. The reason for this visit was to undertake an inspection of the service to look at arrangements within the home that support the safe handling of medicines. The visit would also see if the requirements and recommendations from the previous pharmacist visit had been met. The visit lasted 5 hours and involved looking at medicine records, storage and administration. During the visit the inspector spoke to the manager and one person. The outcomes are as follows: Whilst there has been improvement in storage of medication and in the completing of medication administration charts, there is a lack of a robust system to make sure there is consistency in administration of medicines. This puts people at risk of not receiving medication as prescribed. There are now adequate storage facilities for medicines requiring cold storage. This makes sure medicines are stored correctly and are safe to use. All medicines are stored in locked facilities within the treatment room. Record Keeping The previous and current month’s MAR charts were looked at. There is a list of staff authorised to administer medicines in the MAR folder. The list also contains an example of their signatures. This is an improvement made since the last pharmacy inspection. This means there is now a system to allow identification of who was involved in administration if a query or problem occurred. The recording of the administration of medication onto the Medication Administration Record (MAR) chart has improved there were fewer gaps. However, a tick was used to record administration of two creams used to treat skin infections. The manager advised the inspector that this was done to indicate that the cream had been applied by one of the staff under the supervision of the manager. The record of administration must be signed by the person administering the medication to make sure there is an accurate record of who applied the creams. There were details missing from handwritten entries. To make sure there is an accurate record the quantity supplied, the date of entry, the signature of the person making the entry and a witness signature where possible should be included. Similar requirements are needed for a change of dose or cancelled medicines. Details of the person authorising the change should also be included. This makes sure that there is an accurate record of any changes or new medicines. The quantity of medication that is used from one monthly cycle to another should be recorded on the new MAR. This makes sure there is a method of Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 17 tracking how much medication has been administered and to know how much stock there is. The use of codes to record why a medication was not given has improved. This means that there is an accurate record of why medication was not administered to provide information to the prescriber if a review is required. The timing of one person’s medication had changed but the MAR still had the old information on. It is important that the pharmacy is informed of any changes to medication to make sure there is an accurate MAR chart. The MAR chart entries for medication that is given once a week have the day it should be given written on and boxed to reduce the risk that this medication may be given wrongly. The recording of the administration of antibiotics was inconsistent. One MAR entry had signatures for administration greater than the quantity received. It is important to have an accurate record of the administration of antibiotics to show that the course has been given as prescribed. One person had regular refusal recorded for a calcium supplement. A referral for a review did not take place until the day of the visit when the inspector advised the manager to speak to the Primary Care Trust (PCT) pharmacist who was also visiting. It is important to refer people who regularly refuse their medication to make sure their medical condition is not seriously affected. There were dividers missing from a number of MAR charts. This means that there is a risk that the person doing the medicine round may read a MAR chart for one person and then administer to another. Administration The lunchtime round was observed. The administration of medicines has improved since the last pharmacy inspection. Medication is not left out during the round, which reduces the risk that medication may be removed or tampered with. This is an improvement since the last pharmacy inspection. An audit of current stock and records showed that some medication had been signed for but not given. This means there is a risk that people are not getting their medication as prescribed. One person self administers their inhalers. A risk assessment had not been done to check if the person was able to use the inhalers. A problem with how this person was using the inhalers had only recently been identified when the PCT pharmacist had done a medication review. It is important that an assessment is done when people wish to self administer to make sure that their medication is taken as prescribed and their medical condition is not affected. The assessment must be regularly reviewed to make sure there has been no change to how the person takes their medication. Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 18 Storage The storage of medication has improved. The medicines trolley, the cupboard and the fridge are all locked. The room is still warm though a fan has been installed. This puts people at risk of receiving medication that has been stored at temperatures greater than the manufacturers recommendation of 25 degrees. The inspector advised that a thermometer should be used to regularly check the room temperature. There was inconsistency in the recording of fridge temperatures. The temperature of the fridge should be recorded daily to make sure medication is safe to use. There has been an improvement in the in the recording of dates of opening on eye drops. This makes sure eye drops are not given after the date recommended by the manufacturer and are safe to use. Other medication with short dates of use once opened did not have opening dates recorded. It is good practice for all staff to check medication received into the home to see if there is a short time of use when opened. This makes sure people are getting medication that is safe to administer. Training The manager has arranged with the pharmacist from the PCT to provide training to all staff who will be involved in medication. The ordering of prescriptions has improved. Prescriptions are checked before sending to the pharmacy. This provides an opportunity to check if any new medicines or dose changes are included. Any problems with prescriptions can be addressed at this point rather than after the supply has been made. The checking of prescriptions is an important part of the management of medication. Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 19 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 poor. This judgement has been made using available evidence including a visit to this service. There is a lack of stimulating activity within the home and a lack of meaningful interaction between people who use the service and the staff. This means that individuals can be left for long periods without moving about and without anyone talking to them. People have very little control over their own lives, they tend to “fit in” with the routines of the home. EVIDENCE: We could find no evidence of any activities taking place at the home. The post of activities organiser is vacant, although it is being advertised. When we looked in the care plans for evidence of any activities taking place, the last time the records were completed was in October 2006. There is very little interaction between staff and people who use the service. The majority of contact occurs when people are assisted to the toilet, when they go for their meals or when they are given a drink. This means that people rarely move about and can be left for long periods sitting in the lounge. We Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 20 saw one resident sitting in the same chair in the dining room during the two days that we were there. She sitting alone at the table counting quietly to herself. The only time anyone talked to her was when she was asked if she would like a drink or something to eat. All of the staff are pleasant and polite to people who use the service and to visitors to the home. Some of the staff who are relatively new to the home are from overseas, they are very quietly spoken and some of the people who live there clearly have difficulty understanding what they are saying. This limits any meaningful conversations. This view was shared by visitors who we talked to. One of the people living at the home told us “everyday is the same here”. All of the people who completed surveys commented on the lack of stimulating activities at the home. These are some of the comments “there does not appear to be any stimulation for the residents. When I visit the staff who are about don’t appear to talk to residents”, “any type of entertainment would be good, not just music once a month” “people need more activities to stimulate them”, “more activities are needed to occupy residents’ minds” “Unfortunately things changed after mum moved in. Promises of physiotherapy, afternoon naps in her room, activities etc never happened”. Relatives do not think that people are helped to exercise control over their lives. One person wrote to us saying “Bankfield seem to run the home for their convenience – not the convenience of the clients”. “After 2 years of observing Bankfield, all (residents) sit - don’t wander round, don’t go outside. All eat -when we say at 9am, 12pm, 4pm. All go to the loo - when we say. All go to bed – when we say. All watch what we put on TV”. People told us they liked the food at the home. The cook knows what people like and she caters accordingly. Visitors to the home said they thought the food looked appetising. We asked to see the menus but the cook who was on duty when we were there told us there were no menus, as such. She said she decided herself what to make, from the ingredients that were available. The only record that could be found of the meals that had been served was on the food temperature records and these were not up to date. There was no menu on display in the dining room and no one had any idea what was available. When we looked in the kitchen in the afternoon of the second day of our visit, the kitchen was chaotic and untidy. Cream and flour had been spilled on the work surface and kitchen floor. A plated meal was left uncovered on the work surface and food from the mid day meal had been dropped on the floor. A new dishwasher had been recently installed and it was leaking, leaving a large pool of water around the base. This is unsafe and unhygienic and could have resulted in someone slipping and injuring themselves. Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 21 The cook had prepared cream scones to be served with a drink on one afternoon while we were there. We saw the staff serve them by picking them up off the plate and placing them directly into each person’s hand. No plates were offered and people were not given napkins. Some people found them difficult to eat. This practice is not only unhygienic; it also demonstrates a lack of regard for individual dignity. Some relatives thought some of the food served at tea time was not always to the liking of the people who use the service. They did not feel that potato wedges, pizzas and curries were the sort of foods favoured by some older people. One person said the meal at tea time “was not plentiful enough to see my mum through till morning”. People who live at the home need to be asked what they would like to eat for tea in order to make sure that what is on the menu is suitable for them. We noted that the dietary plan in respect of one person who is Polish stated that liked certain East European foods and that he should be given the opportunity to have the food that he liked. When we asked about this no-one seemed to know. We were told “he has the same as everyone else”. We were informed that his friends used to bring him food in. This means that the different needs and tastes of people who use the service are not being catered for. Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 22 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 poor. This judgement has been made using available evidence including a visit to this service. Some people do not have confidence in the complaints procedure, they feel that their concerns are not being listened to and taken seriously. Staff have not received training on abuse and are not clear about the procedures for safeguarding adults, this means that people are not being adequately protected. EVIDENCE: We have not received any complaints since the last inspection in November 2006. We have, however, been contacted by people who have concerns about the service because of the recent high turnover of staff. Concern has also been expressed to us about errors with medication administration. We were unable to look at the complaints record at the home as we were told that this was missing. A new record has been started. Eight relatives told us they knew what to do if they needed to make a complaint about the service. Two people who said they didn’t know about the procedure but said they would speak to the manager if they had any concerns. Some people do not think their concerns are taken seriously and they do not think they are listened to. We asked what the home does well and one person Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 23 wrote to us saying “they fob off complaints well, they agree with some complaints but don’t act on them in the long term”. The owner, responsible individual and the caretaker manager need to address this issue with relatives as a matter of urgency. People who use the service and their relatives need to know that complaints and concerns are taken seriously and dealt with appropriately. Before we carried out the random inspection in May 2007, we were told about an incident where the safety of one individual was placed at risk. This involved finding one individual in the room of another person who lives at the home. Following that inspection we asked for details of this incident and we have since been provided with notification. We have also been told about the action that will be taken to prevent this occurring again. We do not think that people living at the home are adequately protected because most of the staff have not received any training in adult protection procedures. We do not feel confident that they would know what to do if they suspected that someone was at risk of abuse. Training in this area must be arranged as a matter of urgency. Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 24 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 good. This judgement has been made using available evidence including a visit to this service. The home is comfortable and well furnished. The domestic team make sure that the home is clean, tidy and hygienic throughout. EVIDENCE: Bankfield has an excellent domestic team who take a pride in their work. They make sure home is always clean and tidy throughout. Many relatives commented on the high standard of their work. One person wrote to us saying “the cleanliness of the all rooms, including toilets, dining rooms and lounges is on the whole exceptional”. Bedrooms are arranged to suit individual needs. Each one is individually decorated and there is evidence that people have lots of their own possessions Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 25 around them such as photographs, ornaments and plants. Some people choose to spend time in their rooms during the day. All bedrooms are fully furnished although people are informed that they can bring items of their own furniture with them when they move into the home if they wish. Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 26 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 poor. This judgement has been made using available evidence including a visit to this service. The staff are not meeting the needs of the people using the service and this is having an impact on their health and welfare. The high turnover of staff has meant that people living at the home do not know the staff well. There is no comprehensive staff training plan and no up to date records of what training staff have undertaken. EVIDENCE: Continuity of care for people living at the home has been seriously disrupted this year because of the high turnover of staff. We looked at the staff rotas and staff timesheets and discovered that only two staff remain in post from a team of over twenty care staff. All of the senior staff have left the home and the manager and deputy manager have recently resigned and left. A caretaker manager is in post; she has been at the home for three weeks. Relatives that we met and those that returned surveys, all commented on this. Relatives said they found it difficult to keep up with all the changes, they said it must be extremely difficult for people who live at the home. Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 27 Relatives expressed concern about the use of agency staff at the home particularly in the evenings and at weekends. They felt that some agency staff did not know the people who live at Bankfield very well and in their opinion, they didn’t know about their routines and their likes and dislikes. Often, agency staff have been on duty with permanent staff who are also relatively new to the care home. This means that people who live at the home cannot be certain that the staff are fully conversant with their care needs. Some of the recently recruited staff are from overseas. Relatives said they sometimes found it difficult to understand what they were saying because of their accents and because they were very quietly spoken. They said they had noticed that it was sometimes difficult for people to make their needs known to staff. From our observations, some people had difficulty comprehending what was being said to them and in making their needs known to staff at times. Relatives who we talked to and those who returned surveys acknowledged that there is now a new manager in place and they look forward to seeing some positive improvements in the care proved at the home. The staff training records at the home are not up to date so we asked the staff on duty about the training they had received. Only one member of the team had received all of the required mandatory training. The remaining five staff that we talked to still required training in infection control, first aid, health and safety and adult protection procedures. None of the new staff are registered to undertake NVQ training. It was of some concern to us to hear that the staff had received moving and handling training as we had witnessed them using such unsafe techniques that could have caused injury to the people they were assisting and to themselves. We found some training records for some of the staff who were working nights. The records show that some of the training is out of date and needs to be revisited. The management team need to review the training needs of all of the staff. Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37,38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There has been a serious lack of monitoring of the running of the home in recent months and as a result the standard of care and record keeping in the home has fallen. Communication with people who use the service and their relatives is poor, they are not being consulted about the way the home is run. EVIDENCE: A new manager has started work at the home very recently. She is a qualified nurse who has moved from one of the other homes owned by the same company. She is not yet registered with the Commission but has already indicated that she will be making an application for registration. Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 29 She will need considerable support to address some of the shortfalls in the service that have been identified in this report and the report from the random inspection that took place in May 2007. The responsible individual (who acts on behalf of the company) told us that a team of senior staff from other homes in the group would work alongside the manager for the next few weeks to ensure that all records are up to date. In the absence of a manager recently, the company has failed to ensure that the home has been run in the best interests of the people who live there. There is very little evidence of consultation with people who live at the home and their relatives about the way the home is run. Communication between management and relatives has been poor; people do not feel they have been kept up to date with the recent changes of staff and plans for the future management of the home. Record keeping at the home has slipped recently. We were very concerned that some of the records that the home must keep could not be found on our last visit, we have been informed that some of these have since been located. Medication administration records, accident records and staff records must be retained by the home for inspection. Care plans are not up to date and have not been reviewed regularly. This means that the needs of people who live at the home are not always being met. The home does not hold any money on behalf of people who live there. Health and safety issues are not being dealt with appropriately, this means that people living at the home could be at risk of harm. We asked to see copies of the Landlord’s Gas Safety Certificate and the Electrical Wiring Certificate for the home but these could not be found. The fire alarms should be checked on a weekly basis from different actuation points around the home. According to the records that we looked at, the fire alarms were last tested on 1/5/07. The fire alarm went off during our visit, due to a fault in the system. All of the fire doors are on automatic closures which means that they should shut when the alarm sounds. On this occasion fire doors failed to close. The company responsible for maintaining the alarm system was contacted and they attended to the fault the same day. We noted that a fire drill had been conducted in May 2007 but there was no record of the names of staff that attended. A list of names needs to be maintained in order to make sure that all the staff undergo fire safety training so that they know what to do in the event of an emergency. We observed staff using wheelchairs to transport people without using the footrests. One person was moved in a wheelchair with a flat tyre. This practice is unsafe and could result in an injury. All wheelchairs must be checked to make sure they are safe for use. Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 30 We noticed that the footrests were being removed as a matter of routine because the staff had great difficulty manoeuvring a wheelchair into the lift with someone seated in it. The lift is very small and it is difficult to use by anyone tall, or who cannot bend their legs. One of us sat in the wheelchair and asked a member of staff to demonstrate how they would get us into the lift. It was a difficult manoeuvre, which involved tilting the chair to get it into position so that the doors could close. The accompanying member of staff had to wedge herself behind the chair. This is something that needs to be taken into consideration when anyone is considering moving into the home. The same factor must be taken into consideration when anyone is being assessed for a place. This is to make sure that everyone living at Bankfield can have safe and easy access to all areas. Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 X 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 2 Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 32 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 OP2 Regulation 5 Requirement Timescale for action 01/07/07 2 OP3 14 3 OP7 15 4 OP7 15 People must be provided with a statement of the terms and conditions of residence at the point of moving into the home, so that they are informed of their rights and responsibilities. People must be fully assessed 31/07/07 before they move in; to make sure that their needs can be met at the home. 31/07/07 Care plans must be reviewed to make sure they a) Contain up to date information about people’s needs. b) Indicate clearly the action that staff need to take to meet people’s needs. This will make sure that people’s needs are met appropriately. Previous timescale of 28/02/07 not met The daily records must provide 31/07/07 evidence of the care and support that staff provide. This will show what action staff have taken to meet people’s needs. Previous timescale of 12/01/07 and 15/06/07 DS0000057396.V343208.R01.S.doc Version 5.2 Bankfield Residential Home Page 33 5 OP7 13 6 OP9 13 7 OP9 13 8 OP10 18 9 OP12 16 not met Moving and handling plans must be reviewed to make sure they are up to date and relevant, so that people are assisted safely and appropriately. Medication must be administered and recorded in accordance with the directions of the prescriber. This means that people are getting their medication correctly. A risk assessment must be done when a person wishes to selfadminister their medication. This must be regularly reviewed. This makes sure that the person can safely take their medication. Staff must treat people who live at the home with dignity and respect. Previous timescale of 31/12/06 and 08/06/07 not met People who live at the home must be consulted about the sort of activities they wish to be involved in. This will enable them to take part in activities of their choice. Previous timescale of 31/12/07not met A record must be kept of all complaints made which includes details of investigation and any action taken. This is so that people can know their complaints will be taken seriously and acted upon. Staff must be available at all times in sufficient numbers to meet the assessed needs of people who live at the home. This is to make sure that the needs of each person will be met. Previous timescale of DS0000057396.V343208.R01.S.doc 01/07/07 22/06/07 22/06/07 31/07/07 31/07/07 10 OP16 Schedule 4 15/06/07 11 OP27 18 30/06/07 Bankfield Residential Home Version 5.2 Page 34 12 OP30 18 13 OP38 13(4) 14 OP38 15 OP38 23 23 16 OP38 13(5) 24/12/06 not met Some staff have not received all their mandatory training. The training needs of all staff must be reviewed to make sure that they are competent to carry out their work safely. Copies of the gas safety certificate and the electrical wiring certificate must be provided. This is to make sure that the health and safety of people who live at the home and the staff is protected. All staff must receive fire safety training. This is to make sure that they know what to do in an emergency. Arrangements must be made to test the fire alarms every week. To make sure that the system is working effectively and people who live at the home are safe. Previous timescale of 08/06/07 not met All staff must receive training on safe moving and handling techniques. This is to avoid injury to people who live at the home and to the staff. 31/08/07 31/07/07 31/08/07 20/07/07 31/08/07 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 OP9 OP9 Good Practice Recommendations Medication in use and in date should be carried over the next month and the quantity recorded on the new MAR. Handwritten entries and changes to MAR charts must be accurately recorded and detailed. This makes sure that the correct information and dose is recorded so a person receives their medication as prescribed. DS0000057396.V343208.R01.S.doc Version 5.2 Page 35 Bankfield Residential Home Bankfield Residential Home DS0000057396.V343208.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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. 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