Inspection on 15/10/07 for Bartlett House

This inspection was carried out on 15th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bartlett House 06/10/08

Bartlett House 09/01/07

Bartlett House 04/11/05

Bartlett House 13/05/05

Bartlett House 26/01/05

Bartlett House 19/05/04

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

St George`s

5 Seafield Road

Credence House

Poldhu

Queensmount

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

CARE HOMES FOR OLDER PEOPLE Bartlett House Bartlett House Old Common Way Ludgershall Andover Hampshire SP11 9SA Lead Inspector Alison Duffy Unannounced Inspection 09:40 15 October 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 Bartlett House DS0000028275.V343656.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. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bartlett House Address Bartlett House Old Common Way Ludgershall Andover Hampshire SP11 9SA 01264 790766 01264 791687 managerbartletthouse@osjctwilts.co.uk www.osjct.co.uk The Orders Of St John Care Trust 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) Ms Rosemary Evelyn Lusty Care Home 49 Category(ies) of Dementia - over 65 years of age (13), Learning registration, with number disability over 65 years of age (3), Old age, not of places falling within any other category (33) Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service user aged under 65 named in the application dated 22nd August 2006 may be accommodated at the home for a period of 3 months whilst the home is able to meet their needs. 9th January 2007 Date of last inspection Brief Description of the Service: Bartlett House is a purpose built residential home offering accommodation and personal care to a total of 49 residents over the age of 65 who require care primarily through old age, although the home is registered to accommodate 13 residents with dementia and 3 with learning disabilities. Five of the 49 beds are also used for respite care. The home also provides day care facilities for a further 20 clients. The home is one of a number of homes managed by the Orders of St John’s Care Trust. The registered manager is Mrs Rosemary Lusty. The home is situated in a residential area close to the centre of the small town of Ludgershall. Ludgershall is situated on the A342 between Andover and Tidworth. The home provides single accommodation, which is located on both the ground and first floor. There is a passenger lift giving easier access to the first floor. Staffing levels are generally maintained at 6 care staff including a care leader during the morning and 4 or 5 staff for the afternoon and evening. There are 3 waking night staff. The home also employs cooks, housekeepers, a maintenance person, an administrator and an activities co-ordinator. If the resident is self-funding, the fees for living at the home range between £410.00 and £485.00 a week. If a placing authority arranges the placement, the fees range between £386.61 and £455.16. One room has an additional supplement of £25.00 as it has an en-suite facility. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place initially on the 15th October 2007 between the hours of 9.40am and 6.10pm. The inspection was concluded on the 18th October between 9.30am and 5.10pm Mrs Rosemary Lusty was available throughout the inspection and received regular feedback. Ms Mudie, a lead manager within the organisation and Mrs Lusty received full feedback at the end of the inspection. Discussion took place with residents in the communal areas and within the privacy of individual rooms. Discussion also took place with various staff members. The management of residents’ personal monies was examined and the inspector observed the serving of lunch. Care-planning information, training records and recruitment documentation were viewed. Mrs Mary Collier, a CSCI pharmacy inspector, examined the medication systems. As part of the inspection process, surveys were sent to the home for residents to complete, if they wanted to. Surveys were also distributed by the home to residents’ relatives, their GPs and other associated health care professionals. The feedback received, is reported upon within the main text of this report. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Residents are able to follow their preferred routines. This includes how and where they spend their day, what time they get up and whether they have meals in their room. Meal provision is of good standard with a choice available at every mealtime. Residents have access, within the home, to a small bar and shop enabling an alcoholic drink to be taken with a meal, if required. Residents are able to personalise their own room and spend time, on their own as they wish. Visitors are welcomed and hospitality is evident. A robust recruitment process is in place, which gives residents additional protection. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 6 Staff have built positive relationships with residents and rights, such as privacy and dignity are promoted. Good teamwork was apparent and staff appeared friendly and motivated within their roles. Residents have regular access to health care professionals with district nurses visiting, almost on a daily basis. What has improved since the last inspection? What they could do better: Assessments continue to be insufficient in their content. All must be fully completed and sufficiently detailed to ensure the potential residents’ needs are fully identified. Care plans continue to require more detailed information to ensure individual needs are met. Key aspects such the management of pressure sores, for example, must be identified within the plan. Care, such as promoting a healthy food and fluid intake, must be evidenced within documentation. Greater detail must be given to preventative measures identified within tissue viability assessments. Encouraging staff to be alert to any changes in skin condition is insufficient, as the damage may already have taken place. Instructions, detailing the need to change a resident’s position, must be evidenced accordingly. Individual risk assessments relating to residents and their well-being, need to be given greater consideration. Aspects such as choking, dehydration and specific equipment, including the use of a reclining chair, have not been addressed. One resident did not have any risk assessments on their file. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 7 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. Bartlett House DS0000028275.V343656.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 Bartlett House DS0000028275.V343656.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While prospective residents are assessed before their admission to the home, assessment documentation gives limited information. This compromises the meeting of individual need and restricts the ability to create an effective care plan. EVIDENCE: Within discussion with staff and residents, it was evident that prospective residents are assessed prior to being offered a placement within the home. One resident said ‘they [the staff] came to see me in hospital and asked me lots of questions. I couldn’t go home so my XX found me this place.’ The resident stated that they did not visit Bartlett House before making a decision to move in. They relied on their family, to make the decision. One resident said they had lived in Ludgershall for years and therefore Bartlett House was their only choice. Another attended the home’s day centre so felt it was a straightforward move, to become resident at Bartlett House. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 10 Staff explained that the manager or a care leader always do an initial assessment. They said prospective residents and/or their families are also able to visit the home, before making their decision. The assessment documentation of the two most recent admissions to the home was viewed. Various formats had been used to assess the prospective residents’ needs. Within one file, there was a tick style, assessment format. Very little written information had been recorded to complement the tick boxes. For example, vision impaired was ticked yet there was no explanation of what this meant for the resident, in practice. Documentation highlighted a nutritional risk, but further detail or the intervention required, was not stated. The condition, vascular dementia was also identified but the implications of this, within the resident’s daily life was not expanded upon. The file contained a dependency assessment tool although this was not completed. On the day of the resident’s admission, a long-term needs assessment had been completed. This included a number of headings such as personal cleansing, dressing and wellbeing. Limited information was stated under each heading. For example under dressing, ‘likes clean clothes was stated.’ The documentation did not inform staff of the actual support the resident required. The second assessment viewed was not dated and did not detail key aspects of the resident’s needs. For example, the extent and the management of the resident’s ulcers were not identified. A body map was in situ, yet had not been completed. The assessment also gave unclear information regarding the support the resident required with daily living tasks. Terms such as ‘staff to assist XX to wash’ were stated. Mrs Lusty was advised to detail the exact support required. At the last inspection, assessment documentation was limited and a requirement was identified. Due to the above shortfalls, the requirement has not been met. Discussion took place with the team leader and a care leader regarding assessment documentation. The need to fully identify the resident’s needs and the support required was emphasised. The team leader confirmed that documentation is an area, which is currently being developed. Mrs Lusty reported that since the last inspection, a number of residents have been transferred to nursing care. Mrs Lusty believes that the level of dependency, in relation to existing staffing levels is currently satisfactory. Previous to the inspection, CSCI received two reports, that the home was exceeding its category of registration of residents with dementia. Within this inspection a number of similar comments were raised, through surveys. These included [as a means to improve the service] ‘needs qualified Registered Nurses. Needs Bartlett House to be either residential or nursing’ and ‘assessing whether clients should be in a nursing home rather than residential.’ Also ‘some patients need nursing care such as dressings or need urine testing. Often have to see the local practice nurse or get advice from the triage nurse. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 11 These requests can be almost daily, which makes you question whether some of the patients should really be in a nursing home.’ A GP also commented that management do not take appropriate decisions when they can no longer manage the care needs of residents. These views were forwarded to Mrs Lusty. Bartlett House does not provide intermediate care and therefore Standard 6 is not applicable to this service. Bartlett House DS0000028275.V343656.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are at risk of not having their needs fully met through key aspects not being addressed within care planning information. Residents are able to access regular support from health care professionals. Residents are protected by the home’s procedures for the safe handling of medicines and are supported to self medicate where appropriate. Staff promote residents’ rights to privacy and undertake interactions in a respectful manner. EVIDENCE: Mrs Lusty explained that the organisation has recently developed a new careplanning format. This is due to be introduced at the end of the month. Mrs Lusty believed the new format to be positive and explained that all staff would receive training on its use. The team leader explained that some existing care plans were in need of greater detail. However, as the new format was being introduced, additions had not been made. It was planned that the senior team would work together on the new format to ensure clear, specific, factual recording. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 13 At the last inspection, the management of conditions such as diabetes was not stated within care plans. Documentation identifying the support required was also limited, with terms such as ‘needs assistance of two carers.’ A requirement was therefore made to ensure that all care plans reflect resident’s individual needs, including the management of health care conditions. In response to this, the management of diabetes has been addressed. The parameters of the resident’s blood sugar levels to ensure wellbeing are stated. There are also guidelines for staff in relation to fluctuating blood sugar levels. The requirement has therefore been addressed in part. However, key aspects of a number of residents needs, were not evident in care plans. One resident had pressure sores, yet detail of the wounds or their management was not evidenced. Under the tissue viability section of the care plan, ‘staff to observe closely the condition of the skin’ was stated. This is insufficient and does not address the intervention required to promote healing and to minimise further skin deterioration. Although assessments identifying residents’ risk of developing pressure sores are in place, these require review. For example, specific statements such as ‘staff to be alert to any changes in skin condition and report any changes’ were recorded. This instruction is clearly too late, as pressure damage may already have occurred. Preventative measures need to be more clearly identified. Within one care plan, two hourly turns of the resident’s position were stated. These were not evidenced within the turning chart, located in the resident’s room. The resident had three topical creams in their room. None of these were addressed within the care plan. Mrs Lusty was advised to ensure guidelines are in place, for each cream and its use. Within daily records, it was stated that a resident had been severely dehydrated. Their care plan, stated ‘needs to drink at least 2 litres of fluid a day’ and ‘prompt XX to eat and drink regularly.’ There was no evidence of how food and fluid intake was being monitored. Another resident was also at risk of dehydration. Their care plan stated ‘drink plenty, clear fluids more than tea.’ There was also a care plan for food supplement drinks. The resident had a food and fluid chart in their room yet this was incomplete. Staff had not recorded all drinks given and had only recorded breakfast and the lunch time meal. There was no evidence that any food supplement drinks had been given. During the inspection, it was observed that this resident could not reach their morning drink on their over bed table. Later in the inspection, they were holding their drink but it had gone cold. Within the last care plan viewed, there were photographs of a recent injury. The photographs were not cross referenced to any information within the care plan. Measures to promote healing were therefore not identified. All residents now have risk assessments in relation to nutrition. If a risk has been identified, control measures such as encourage regular snacks and milky drinks are stated. This intervention is not evidenced however, within food and fluid charts. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 14 There were aspects of care planning, which demonstrated good care practice. This included offering a wheelchair to a resident if they were breathless when walking. Preferred times of getting up and going to bed were stated. The resident’s preference of a male or female carer was also detailed. All care plans are reviewed on a monthly basis. However, staff need to ensure they clearly identify changes in required provision. For example, one resident was observed to walk and use the lift independently. The resident’s care plan, even though it had recently been reviewed, stated the need for staff assistance. The team leader and Mrs Lusty confirmed that these issues would be addressed with staff. Mrs Lusty also anticipated the new care planning format would assist with these areas. Each care plan contains a record of all health care appointments. This may include the GP, the community nurse or chiropodist. Mrs Lusty explained that excellent support is received from all health care personnel. However, some negativity within surveys, from health care professionals was stated. This included ‘no chain of command, patients too demanding for facilities/staff, generally chaotic, residents arrive at surgery with carers unaware of the problem.’ Another health care professional also confirmed ‘there is a lack of communication and handover. Patients are often brought to the surgery and the carers have no idea why they have brought the patient, dressings are often left in patients room and appointments are often forgotten or patient is brought over late.’ Additional feedback from surveys stated that specialist advice is not incorporated into the care plan and medication is inappropriately managed. Within surveys, when asked about the strengths of the service, one health care professional stated ‘caring for their clients. They always request further help from the surgery if needed.’ These views were shared with Mrs Lusty. The pharmacy inspector looked at the arrangements for the handling of medicines. Medication was stored securely and appropriate records were kept. Staff are trained in medication handling. Reference sources and a comprehensive procedure, are available for staff reference. Particular care is taken with the medicines for respite residents and staff were seen to double check these administrations. Residents are supported to manage their own medicines if they chose to do so, to whatever level they are able. They said they liked to be able to do this. Risk assessments and reviews of selfmedication are undertaken. However, staff should ensure that their list for more independent residents’ medicines and doses is up to date. As a result of some confusion about medication during a staff change over, a new checklist has been produced. Unfortunately, the list had not been signed on the previous evening. Residents spoke positively about staff and did not raise any concerns in relation to their privacy or the way in which they were spoken to. All staff were observed to knock on doors and wait to be invited in, before entering. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 15 One resident confirmed that staff respected his/her space. Interactions were positive and staff appeared respectful within their communication. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 16 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A programme of activity provision is offered yet an increase of allocated activity hours would further enhance opportunities to residents. Residents are able to follow their preferred routines and receive visitors as they wish. Residents’ expressed enjoyment from a menu, which contains a varied selection of traditional meals. EVIDENCE: The home has an activity organiser who works 20 hours a week. Mrs Lusty explained that since the increase in care staff hours, care staff also have time to assist with activities. Mrs Lusty reported that the activity organiser gives structure to activity provision by organising events. This includes trips out to places of interest. A number of events, such as skittles are arranged with residents of other care homes within the organisation. During the inspection, a lead manager responsible for activity provision, suggested potential opportunities for residents. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 17 These included fishing, horse riding and sailing. On the night of the inspection, a party with belly dancers, as entertainment was planned. Within a comment card, a member of staff reported ‘the care team spend one to one time with all of the residents daily even if its just 5 minutes talking about the weather and this reflects through the relationships of the staff and residents.’ Within the notice board, an activity programme was displayed. This included games, creative activity, colouring and cooking. A member of staff explained that each weekend, a video afternoon is held. Another said time is given to looking at the newspaper. A request for items was displayed in order to develop a reminiscence corner. Dates had been arranged for a number of singers/entertainers. Residents had also attended a Harvest Festival. The home has a visiting hairdresser. Holy Communion and a monthly evening service also take place. Within a care plan, it was noted that a resident was Roman Catholic. There was an instruction to inform the resident of the services, taking place in the home. Mrs Lusty reported that the resident appears to enjoy any religious forums. However, she explained that provision to meet the resident’s Catholic needs would be investigated. The majority of residents spoken with said they spent their time, in their rooms watching television. They explained that they could join in with activities, although choose not to. One said ‘its not my cup of tea, so I stay in my room.’ When asked about going out, one resident said ‘I’ve not been out since I came here. I don’t need anything, like shopping.’ When asked if they would like to go out for a change of scenery or a coffee, the resident replied ‘yes, that would be nice.’ They then continued to explain how this would be difficult for staff as they are so short staffed. Within care plans, residents’ interests, goals and aspirations were not clear. Daily records also identified the provision of physical care rather than qualitative issues. Mrs Lusty explained that this had already been identified and would be addressed. Residents reported that visitors are able to visit at any time. One resident explained that they their grandchildren recently visited and ‘nobody seemed to mind.’ Residents are able to use their own room to entertain. A number of residents spoke of enjoying trips out with their families. All residents spoke favourably about the food. One resident explained ‘staff ask you what you want and it’s a good choice.’ Another said ‘there’s no problem with the food’ and another said ‘it’s good traditional food – things like cottage pie and casseroles.’ The menus were viewed and demonstrated a choice for each meal. At lunchtime during the inspection, there were chicken burgers or fish cakes with mashed potatoes and tinned tomatoes. Some residents had a salad. A choice of tea or coffee was served after dessert. The menu for the day is displayed in the dining room. At the last inspection, it was recommended that the weekly menu should be displayed on the notice boards, rather than a sample menu. There was no evidence that this had been addressed. During the Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 18 inspection, lunch was reported to be at 12.30. Residents were seated at this time, although the meal was not served until 12.45pm. Some residents spoke negatively, between themselves about this, as it appeared a usual occurrence. Mrs Lusty was advised to discuss timings with both residents and the catering staff. Residents reported that they generally went down to the dining room, for at least one meal a day. Two residents confirmed ‘staff expect you to do go down unless you are ill.’ One resident explained ‘getting ready in time for breakfast is difficult but I do it.’ Staff reported that residents are able to have meals in their room if they choose. However on occasions, an element of persuasion is used, in order to promote social contact. One staff member confirmed that if residents refuse after encouragement, this is respected. During discussions with residents, a member of staff was serving morning drinks. Biscuits accompanied the hot drink although these were being placed on the resident’s side tables. It was advised a small plate should be used. On the second day of the inspection, a serviette was used. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable concerns to be raised yet a user-friendlier procedure may assist those residents with dementia, to express their views. Clear focus is given to adult protection procedures, which enables residents to be further safeguarded from abuse. EVIDENCE: Residents reported that they would tell a member of staff if they were not happy. A number said they would speak to Rose [the manager] or their family. Another said ‘you can always go down to the office, if there is a problem.’ Within a survey, a relative confirmed they were aware of how to make a complaint. They explained that any concerns are usually addressed effectively. The home has a detailed complaints procedure, which contains the information required by regulation. However, updated information regarding the contact details of CSCI’s regional office is needed. At the last inspection, it was recommended that the procedure should be developed in a user-friendly format. This was particularly to meet the needs of residents with dementia. There was no evidence during this inspection, that this matter had been considered. Ms Mudie reported she would raise this with senior managers within the organisation. A record of all formal complaints is maintained. Documentation detailing the outcome, forwarded to the complainant, is located on file. Mrs Lusty submits a monthly summary, of received complaints, to the organisation. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 20 Within documentation sent to the CSCI before the inspection, it was confirmed eight complaints have been made to the home. Five were upheld. Mrs Lusty demonstrated a positive attitude to complaints, as a means of improving the service. On commencing employment, all staff are given an introductory information pack. This includes a copy of the ‘No Secrets’ documentation. Mrs Lusty reported that abuse awareness is discussed at interview. It also forms part of the home’s induction programme. All staff have received adult protection training. Within surveys, all staff confirmed they were aware of the home’s adult protection policies. During the inspection, one member of staff was asked a hypothetical question about abuse. They replied they would immediately inform a senior member of staff. If this was not taken seriously, they reported they would make contact with someone, in the ‘little book.’ The staff member was referring to ‘No Secrets’ documentation, which they kept in their handbag. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 21 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The recent redecoration of the main corridors significantly enhances the environment for residents. Areas are comfortable, clean and well maintained. The risk of infection has been minimised through greater cleanliness with toilet facilities. EVIDENCE: Since the last inspection, all corridors, a number of residents’ rooms and some communal toilets have been decorated. This has significantly improved the environment. All windows to the front of the property have been replaced. Mrs Lusty said that further residents’ rooms and the stairwells are due to be redecorated. The windows at the rear of the home are also due for replacement. New flooring to the dining room is planned and Mrs Lusty explained that new bathing facilities have been requested, within next year’s budget. Improvements to the garden have also been made. A raised garden is now in situ and a greenhouse is planned. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 22 At the last inspection, it was noted that one bathroom contained a sluicing facility and clinical waste bins. Mrs Lusty reported that plans are in place to separate the areas. Soap dispensers and paper towels are in use within communal facilities. Within one area, there was a bin with a lid, for waste paper towels. As this needed hand operation, which contravenes infection control guidelines, a foot-operated unit was recommended. Within the front area and downstairs corridor, an unpleasant odour was detected. One health care professional raised this within their survey. Mrs Lusty explained the potential reason for this and confirmed that staff were working hard to alleviate the problem. Residents were satisfied with the standard of cleaning within their room. On a tour of the accommodation, the standard of cleanliness with the toilets was much improved. Toilet brushes, which were not being maintained in line with infection control guidance, had been removed. Residents expressed satisfaction with the laundry service. However, the laundry facilities were not viewed on this occasion. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 23 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 good. This judgement has been made using available evidence including a visit to this service. Consideration is being given, with the introduction of more care hours, to enable care staff to spend more time with residents. It is the experience of some residents’ however, that staffing levels remain insufficient. Residents are protected through a clear, well-managed recruitment procedure. Training is given high priority yet greater focus regarding residents’ health conditions would enhance the training programme. EVIDENCE: Within discussion, a number of residents commented on the staff and how busy they are. One resident stated ‘I keep my door open so that I can see them coming and going. If I didn’t, I probably wouldn’t see them.’ The resident said they use the dining room for meals, as ‘there are not enough staff to deliver meals to rooms.’ Another resident reported that they had been told the call bell was for emergency use only. The resident explained that they had been told off for using the bell too much. They felt it was because staff were busy. The resident continued to explain that when they do ring the bell, there is sometimes a lengthy wait. Mrs Lusty reported that since the last inspection, the allocation of care hours has been increased by 120 hours. There are now 480 hours in total, allocated to the daytime carers. A new post of a full time team leader has also been created. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 24 Staffing levels are currently maintained at six carers including a care leader on duty during the morning shift. In the afternoons and evenings this reduces to four or five. Mrs Lusty explained two staff are currently working supernumerary due to undertaking their induction. A number of staff have recently been recruited but are waiting for their CRB disclosure. Once fully employed, Mrs Lusty believed staffing levels would be much improved. Mrs Lusty explained that the allocation of care support hours has been utilised to enable care staff to spend more time with residents. The care support staff serve meals and hot drinks to residents in their rooms. They ensure the dining room is prepared and deliver fresh drinking water to residents’ rooms. They also complete food and fluid charts for those residents, who require nutritional monitoring. There are generally three housekeeping staff on duty during the week. During the weekend this reduces to one. Mrs Lusty believed this to be satisfactory, as only ‘light’ cleaning is undertaken during this time. Night staff are responsible for the cleaning of communal areas. There is a laundry assistant who takes responsibility for residents’ clothing. This includes the return of all laundered clothing to residents’ rooms. Within surveys, as a means to improve the service, specific comments from staff included ‘I would like a little more ‘teamwork’ within the senior team,’ ‘to get more staff’ and ‘more staff meetings and more teamwork.’ Other comments included ‘all the staff to work as a team instead of forming ‘clicky’ groups and not always supporting each other, often back stabbing and causing friction’ and ‘that when mistakes are made everyone is treated the same way, following OSJ procedures, as this is not done (ref medication errors.) Care leaders support each other more instead of trying to out do the others. This has an effect on the team.’ Two members of staff explained the handover is not always clear. Within a survey, a health care professional stated ‘there is a lack of communication and passing of information to different shifts.’ They also commented ‘some carers do care for their patients well being but they are not there 24/7.’ These comments were forwarded to Mrs Lusty and Ms Mudie for their attention. Mrs Lusty explained that since the last inspection, a high level of recruitment has taken place. The recruitment documentation of three most recent members of staff was viewed. All files contained an application form, a POVAFirst check, a CRB disclosure and documentary evidence of identity. All except one contained two written references. Within the one file, there was one written reference. There was also a testimony, addressed to whom it may concern, with an unrelated date. Mrs Lusty explained that the member of staff had submitted this and she had in error, forgotten to verify it. Mrs Lusty reported that she would immediately address the matter. Within comment cards, all staff confirmed that their recruitment procedure was robust. All new staff have an induction day at the organisation’s main office. A structured elearning induction programme is also undertaken. Mrs Lusty believed this to be Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 25 an effective system. A number of new topics, including Protection of Vulnerable Adults have been added. Mrs Lusty reported that the home’s training matrix is currently being reviewed. The organisation offers a rolling programme of mandatory subjects. This includes first aid, adult abuse, manual handling, fire and food handling. Staff are generally up to date with these areas. Within the training records, there was evidence that some staff had undertaken medication, complaints and infection control training. A number had also undertaken ‘Yesterday, Today, Tomorrow’ training in dementia care. The organisation has a training manager and a request for specific training has recently been circulated to the home. Mrs Lusty had requested a number of courses. These included tissue viability, depression and sensory impairment. Within documentation sent to CSCI before the inspection, it was confirmed that twenty two care staff have NVQ level 2 or above. Seven are working towards the award. Within a survey, two health care professionals confirmed that staff sometimes, have the right skills and experience to support individual’s social and health care needs. One commented ‘although a lot of the carers hold NVQ certificates, they do not have the practical knowledge of care.’ This comment was forwarded to Mrs Lusty and Ms Mudie for their attention. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 26 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from an experienced manager who is motivated and resident focused. When dealing with the safekeeping of residents’ personal monies, staff must ensure that they follow procedures, to minimise the risk of error. Systems are in place to regularly audit and improve the service given to residents. Greater focus on individual risk assessments would further safeguard residents’ wellbeing. EVIDENCE: Mrs Lusty has been the registered manager of the home for approximately three years. Mrs Lusty is a Registered Nurse and has many years experience of working with older people. Mrs Lusty is undertaking the Registered Managers Award and anticipates its conclusion by February 2008. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 27 Mrs Lusty explained that due to recent periods of sick leave, she has not undertaken any other forms of training. Mrs Lusty appeared committed to the home and its future development. Those residents spoken with were clearly aware of Mrs Lusty and her role. During the inspection, a number of residents visited the office to discuss matters of importance to them. Mrs Lusty confirmed an ‘open door policy.’ Within a survey, one member of staff reported ‘the manager is very good. She is flexible and allows staff to communicate to her freely. She does one to one supervision to encourage staff and to improve any areas of concerns.’ The administrator reported that residents’ fees are generally paid through standing order. A number of residents or their relatives prefer however, to use cheques or cash. Many residents chose to place small amounts of their personal monies, within the home’s safe. One resident explained that they did not have lockable storage in their room. They said it was better to use the home’s safe. The systems for managing residents’ personal monies were examined. Receipts were in place to demonstrate expenditures. The resident or another member of staff had countersigned each transaction. Within one balance sheet an administrative error had been made. The amount of cash therefore did not correspond to the balance sheet. Mrs Lusty was advised to ensure staff check the amount of monies throughout each transaction. Another balance sheet identified a figure of £200 rather than £2.00. Staff must ensure accurate recording. There was evidence that the administrator and the manager had regularly audited the accounts. The administrator explained that external auditors, within the organisation, also check the systems. The home has a quality assurance system that is used within all of the homes within the organisation. The system consists of various audits. There are also questionnaires, which are sent to all residents on an annual basis. Mrs Lusty confirmed questionnaires were undertaken in June 2007. At the last inspection, it was recommended that questionnaires to target other stakeholders should be devised. This has not been addressed although Mrs Lusty reported she would discuss the matter at the next manager’s meeting. Feedback from the residents’ questionnaires had been coordinated yet not displayed. Mrs Lusty confirmed she would address this. Mrs Lusty reported that she would also ensure the findings were discussed at residents’ cluster group meetings. A number of residents’ meeting minutes were located on file. The organisation has developed a significant amount of documentation in relation to health and safety. This includes policies, procedures and generic risk assessments. However, risk assessments in relation to the individuality of residents continue to be limited. This shortfall was identified at the last inspection and although some progress has been made, further focus is required. Within discussion it was agreed that matters such as dehydration, choking and the use of equipment, should be addressed. The safety of the environment has been given consideration through the installation of radiator Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 28 covers and hot water regulators. Various forms of equipment such as hoists are serviced regularly. Documentation demonstrates such testing. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 29 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 30 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 OP3 Regulation 12(1)(a) Requirement The registered person must ensure that assessment documentation reflects the prospective resident’s individual needs and key factors such as risk are clearly addressed within the care plan. This was identified at the last inspection yet assessment documentation does not clearly detail the prospective resident’s needs. A revised timescale has been identified. The registered person must ensure that all care plans reflect resident’s individual needs, including the management of health care conditions. This was identified at the last inspection and while some progress has been made, shortfalls in information remain apparent. A revised timescale has been identified. The registered person must ensure that any potential risks such as choking and dehydration are addressed within the risk assessment process. Risk assessments must be regularly reviewed and updated. This was DS0000028275.V343656.R01.S.doc Timescale for action 31/12/07 2 OP7 15(1) 18/10/07 3 OP7 13(4)(c) 31/12/07 Bartlett House Version 5.2 Page 31 4 OP8 12(1)(a) 5 OP8 12(1)(a) identified at the last inspection yet shortfalls remain. A revised timescale has been identified. The registered person must ensure that preventative measures in relation to risk, identified within care plans are evidenced in practice. This must include food and fluid intake. The registered person must ensure that preventative measures within tissue viability assessments are more detailed and actually minimise the risk of any skin deterioration. 18/10/07 31/12/07 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 Refer to Standard OP7 Good Practice Recommendations The registered person should ensure that any terms, within documentation, such as ‘advanced dementia’ and ‘is aggressive’ are given greater clarity. This was identified at the last inspection yet some such terms continue to be used. The registered person should ensure that all food and fluid charts are evaluated on a regular basis and this is documented accordingly. This was identified at the last inspection but has not been addressed. The registered person should ensure that daily records contain qualitative information as well as on going daily physical care provision. The registered person should ensure the list of medicines for residents who self medicate should be updated as necessary. The registered person should ensure that a review of activity provision is undertaken in line with residents’ preferred interests. Following this, the amount of hours required to implement such provision should be recalculated. This was identified at the last inspection but has not been addressed. DS0000028275.V343656.R01.S.doc Version 5.2 Page 32 2 OP7 3 4 5 OP7 OP9 OP12 Bartlett House 6 OP15 7 OP15 8 OP16 9 OP26 10 11 OP26 OP33 12 OP33 13 OP35 The registered person should ensure, that as well as being displayed in the dining room, the current menu should be displayed on the notice board, rather than a sample. This was identified at the last inspection but has not been addressed. The registered person should review the serving of lunch to ensure that residents are not kept waiting at the table. This was identified at the last inspection but has not been addressed. The registered person should ensure that the complaints procedure is readily accessible to residents’ relatives and is also developed within a user-friendly format. This was identified at the last inspection but has not been addressed. The registered person should ensure an alternative is found for the location of the clinical waste bins. This was identified at the last inspection and is in the process of being addressed. The registered person should ensure that waste paper bins within the communal toilets are replaced with footoperated units, in line with infection control guidance. The registered person should ensure that systems are devised to enable other stakeholders to give their views as part of the home’s quality assurance system. This was identified at the last inspection but has not been addressed. The registered person should ensure that feedback from questionnaires sent out, as part of the home’s quality assurance system, is displayed and therefore available to residents and their representatives. The registered person should ensure that they check the amount of monies held for safekeeping during each transaction so that administrative errors do not occur. Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 33 Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol Bartlett House DS0000028275.V343656.R01.S.doc Version 5.2 Page 35 BS1 4UA 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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