Inspection on 09/01/07 for Bartlett House

This inspection was carried out on 9th January 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 15/10/07

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 9th January 2007 09:40 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.V325142.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.V325142.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 manager.bartletthouse@osjctwilts.co.uk 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) The Orders Of St John Care Trust 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.V325142.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. 4th November 2005 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 5 or 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. Bartlett House DS0000028275.V325142.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 9th January 2006 between the hours of 9.40am and 5.30pm. Further visits to the home took place on the 8th February between 9.30am and 2.20pm and the 28th February between 10am and 3.35pm. On arrival at the home on the first day of the inspection, Mrs Heather Mudie, the organisation’s lead manager, was visiting the home. Mrs Rosemary Lusty, the registered manager was on sick leave. Mrs Mudie assisted the inspector initially through discussion and giving a tour of the building. Mrs Mudie left the home at lunchtime to attend a meeting at the organisation’s central office. Care leaders and the team leader, who has been seconded to provide management cover while the registered manager is away, then gave assistance as required. Ms Mudie was available throughout the remainder of the inspection and received full feedback. During the second day of the inspection, Ms Mudie was available throughout. The last day was arranged to ensure completion and also give full feedback to Mrs Lusty and Ms Mudie. On the first day of the inspection, discussion took place with residents in the communal areas and within the privacy of individual rooms. Discussion also took place with staff when further touring the accommodation. The inspector observed the serving of lunch and examined the medication systems. Staffing rosters, recruitment documentation, menus and the complaints log were also viewed. During the second and last part of the inspection, care-planning information, daily records and assessments were viewed. Quality assurance was discussed and the management of residents’ personal monies was examined. As part of the inspection process, surveys were sent to the home for residents to complete, if they wanted to. Comments cards were also distributed to residents’ relatives. Some GPs and care managers were contacted for their views. Feedback was generally positive with a number of residents expressing their satisfaction of living within the home. Individual comments included ‘I am very satisfied at Bartlett House. I have everything I need’ and ‘the food is nice and the grounds are lovely. Further feedback 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: Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 6 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. Residents are able to join in with various activities that are on offer and take part in regular residents meetings. 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. If the resident wishes, relatives are encouraged to be involved in the resident’s care. This may include assisting a resident to eat. A robust recruitment process is in place, which gives residents additional protection. 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: While visits to meet with prospective residents are undertaken, assessment documentation requires greater detail. Documentation must also be organised more efficiently, in order to demonstrate the prospective resident’s needs and the full assessment process. Any risks highlighted must form part of the resident’s care plan. Care plans are well written yet do not detail the management of specific health care conditions, such as diabetes. Potential risks including the risk of developing a pressure sore are also not fully addressed. Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 7 Staffing levels are currently being maintained at a minimum and therefore addressing residents’ individual needs is limited. The dependency levels of a number of residents are high with at least three residents needing the assistance of two members of staff for personal care needs. This means that within the evening for example, while two staff are supporting one resident with high dependency needs, there may be two staff allocated to the remaining 47 residents. In addition to this, the home is large and covers two floors. While this is insufficient, it is acknowledged that plans are in place to address staffing levels within the next financial year. The home has an activities organiser who works 20 hours a week. While a range of activities can be offered within this time, addressing residents’ individual needs are limited. Some residents are able to independently walk to the local shop, yet many residents would need staff support. Such opportunities and time to socialise with residents are restricted through existing staffing levels. Some areas of the environment including the corridors, some residents’ rooms and the toilets would significantly benefit from refurbishment. Although space is limited, storing wheelchairs and walking frames away from the communal telephone would enable easier access. Attention is also required to ensure that toilets are cleaned to infection control standards. The home is registered to accommodate thirteen residents with dementia. Consideration should therefore be given to ways in which orientation within the home could be made easier. Information, such as the complaints procedure would also benefit from being developed in a more-user friendly format. While the medication systems are ordered, staff must ensure that they verify all medication with the resident’s GP on admission. This would minimise the risk of error. Staff did not appear clear about their responsibilities in relation to an alleged incident of abuse. Adult protection material was not prominent. Greater focus is therefore required to ensure staff have the knowledge to respond effectively. 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.V325142.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.V325142.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 reported that they were able to visit Bartlett House. A member of staff reported that generally, the home manager and a care leader would undertake the assessment. This would be undertaken within the prospective resident’s own home or hospital setting. The assessment material of one of the latest residents to the home was viewed. The file contained a dependency assessment tool. This was a tick style format, giving a number, which indicated level of need within specific categories. Detailed information was not available. Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 10 The file also contained a disorganised number of loose sheets. These appeared photocopied segments of various assessments yet many of the pages were repeated and did not make up a completed assessment. The author or the date of the information was not evident and the content was minimal. A number of specific risks were within the information yet these had not been transferred to the resident’s care plan. Within another file, there was a dependency assessment tool and another form that had been devised by the organisation. The dependency tool highlighted ‘dementia quite advanced’ but there was no explanation of the meaning of the term or how the dementia was portrayed. Within the home’s assessment some areas of behaviours had been identified yet strategies to manage such behaviours were not evident. The shortfalls were discussed with Ms Mudie who reported that, with the latest resident, the staff had clearly not set up the resident’s file. Ms Mudie agreed that the file did not demonstrate an effective admission process although in practice, staff are generally very methodical. Ms Mudie reported that staff are encouraged to add additional information and not be restricted by the tick box system document. Mrs Lusty confirmed that she does this, yet agreed her experience, assists with this. Ms Mudie also reported that staff use a long-term assessment plan to record information. It was agreed however, that while various documents are currently used, the documentation viewed portrayed minimal information. Ms Mudie reported that members of the organisation are currently working on new assessment formats so it is anticipated that a more satisfactory system will soon be introduced. Through observation, it was noted that a number of residents have high dependency needs. A member of staff and a health care professional also confirmed this. The health care professional reported that staff aim to keep residents within the home, when their health needs have deteriorated. They continued to report, that positively, residents can often end their life in their home, yet in some instances, a nursing home would be more appropriate. The health care professional also reported that some residents are admitted with nursing care needs, yet the home is not registered for nursing care. Ms Mudie reported that residents appear to be frailer on admission and there are a number of residents who currently, have high care needs. This however has lessened due to a number of recent deaths. Ms Mudie confirmed that all residents’ dependency needs are assessed on a monthly basis and any changes are addressed with the required personnel. Bartlett House does not provide intermediate care so Standard 6 is not relevant to this service. Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans generally demonstrate a reflection of the resident’s needs and the support required. Greater detail in relation to specific conditions, pressure care management and specific risks would ensure residents further protection. Residents’ benefit from regular access to health care personnel. Medication systems are generally well managed yet greater attention, on admission would minimise any risk of error. Staff promote residents’ right to privacy and undertake interactions in a respectful manner. EVIDENCE: All residents have a care plan containing a long-term need and assessment form, together with short-term care plans. Of the care plans viewed, all were up to date and the information was well written. In some areas however, greater detail would be of benefit. For example, ‘needs assistance of two carers to wash and dress,’ was recorded within one plan yet the actual assistance required was not stated. Another plan stated ‘can be aggressive’ yet there was no explanation of the meaning of this term or strategies to minimise such behaviour. The management of some health care conditions such as diabetes Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 12 were also not evident. For example one resident self-administers their insulin yet there was no evidence of this within the plan. The support required, the overall management of the condition, potential risks and any monitoring systems were not stated. Mrs Lusty discussed this with a member of staff during the inspection and agreed further work would be undertaken. Other aspects of information, demonstrated good care practices. These included making sure a resident was offered drinks throughout the night and offering a wheelchair for long distances. It was also noted within one plan, that the resident liked staff to explain who they were. Each plan contained a number of identified risks. Some of these however had not been reviewed and were no longer relevant. For example, one assessment highlighted the risks associated with using a flask and teapot yet the resident received full assistance with eating and drinking. Potential risks associated with a health condition, were not however highlighted. There was also no reference to the implications of the condition within the resident’s care plan. This was discussed with Ms Mudie who reported that the matter would be addressed. Ms Mudie was also advised to ensure clear control measures within the risk assessments. For example in one assessment it was stated, ‘staff to ensure XX is safe when in room.’ It was not clear how this was being achieved. All plans viewed contained a manual handling assessment. Where applicable, the assistance of two members of staff or the hoist were stated. Ms Mudie was advised to ensure that all information within various forms of documentation followed through, as within one assessment, ‘aggressive behaviour’ was noted. There was no reference to this within the care plan. Some care plans identified the resident’s potential risk of developing a pressure sore. A full assessment showing how this conclusion was reached was not available. In one instance, it was recorded that staff should cream pressure areas and report any concerns. Further detail was not available although a pressure relieving mattress and cushion had been provided. There were records in place within some residents’ rooms demonstrating food and fluid intake and changes in position to minimise the risk of a pressure sore. Some care plans however did not mention tissue viability. This was discussed with Ms Mudie who reported that the organisation is currently developing an assessment tool for staff to use. This would take into account additional factors such as nutrition. Ms Mudie also reported that tissue viability training is being undertaken. It was noted that one resident, due to their frailty was assisted back to bed during the morning. The resident appeared comfortable and well groomed. Another resident who required full staff assistance remained in bed. They were eating a biscuit, but did not appear to be observed by staff. Due to a specific health condition with associated risks of choking, this was discussed with Ms Mudie. Ms Mudie reported she would investigate the practice to assure the resident’s safety. Ms Mudie also reported that she would ensure staff would fully document and adhere to identify management strategies. There was no Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 13 evidence that the resident had had any lunch. A member of staff confirmed this, stating that due to a large breakfast, the resident rarely has lunch. This was not identified within the resident’s plan of care. There were however, various food and fluid charts evidencing intake, yet an evaluation was not evident. Information detailing when specialised advice, in terms of the resident not eating or losing weight, was also not apparent. Ms Mudie reported that staff do review such documentation and would discuss any concerns with a health care professional. Ms Mudie was advised to ensure staff evidence the evaluation within the documentation. Within discussion with one resident, it was reported that they felt uncomfortable due to their positioning in their chair. A small yet sturdy table was positioned in front of the resident and their walking frame was not in reach. The resident confirmed that they needed to push the table out of the way with their foot, as it was heavy. They also confirmed that they had to ring the bell for staff assistance when they wanted to move. The resident reported that they had recently fallen out of bed causing injury from the bedside table. The bedside table remained in situ and there was no evidence that this had been assessed within the risk assessment process. Ms Mudie reported she would address these aspects. Within comment cards, one relative reported ‘Generally we are quite happy with XX’s care, but there are a few concerns about her general welfare. That is, teeth never cleaned, finger nails and toe nails need attention. Also concerned about disappearance of personal effects.’ One resident confirmed that staff do not have time to cut finger nails. Ms Mudie reported that she would look into these aspects. Within comment cards received from residents, nine reported that they always receive the care and support they require. Six said usually, two said sometimes and one said never. Within discussion with residents, it was reported that staff would call the GP as required. Another resident confirmed that they regularly have their blood pressure taken. Within daily records it was evident that residents are able to call or visit their GP independently, if they wish. Within comment cards twelve residents reported that they always receive the medical support they require. Four said usually and two said sometimes. Two GPs expressed general satisfaction with the home. However, on a negative note, there were comments about staff not always being aware of medical problems and staff not always communicating clearly or working in partnership with the GP. It was stated that there is not always a senior member of staff on duty in which to confer with and staff do not always demonstrate a clear understanding of the care needs of residents. Also staff do not take appropriate decisions when they can no longer manage the care needs of the resident. On a positive note, all confirmed that they are able to meet with residents in private and that medication is appropriately managed. One GP confirmed the home is ‘generally a very caring environment. Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 14 Medication was discussed with one of the care leaders who is responsible for the medication systems. A restricted number of staff administer medication. This follows medication training and competency testing. The home uses a monitored dosage system, which was satisfactorily stored. When completing the drug round, two drug trolleys are used. All medication storage was ordered. The medication administration records demonstrated the receipt of medication. A separate book was available for disposal. There were a small number of occasions, when staff had not signed the medication administered. It was documented that all topical creams are stored in residents’ bedrooms. A record of their application however, is required. Many handwritten instructions were countersigned although some were not. The dates of opening eye drops were clearly stated. Variable dosages of a medication and the times of ‘as required’ medication are not always stipulated. Protocols for ‘as required’ pain relief are in place, yet some medications such as insulin and its management need to be stated within care plans. The home has a homely remedies policy. This states that each individual resident should have a list of non-prescription medications, which have been agreed with their GP. There was no evidence of this. Mrs Lusty confirmed that although a policy is in place, she expects staff to contact a GP in the event of any resident being unwell. Homely remedies are therefore not promoted. Some residents are responsible for their own medication. This is addressed within the risk assessment process. Recently a medication error was reported to CSCI. It was evident that staff had not contacted the GP, as per their own admission and medication policy, to verify the medication, which a newly admitted resident was taking. While the error had been identified, an investigation had not been undertaken. Mrs Lusty reported that, due to her being absent, this had been missed. Mrs Lusty confirmed that she would now investigate the matter and inform CSCI accordingly. Within a tour of the accommodation, it was noted that all personal care was given in private. Positive interactions were evident and staff appeared to engage with residents well. Within discussion, 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. Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. While residents generally appear satisfied with the level of activity provided, the hours deployed to activity provision are minimal and do not enable individual needs of residents, both in the home and within the wider community to be promoted. Residents are able to follow their preferred routines and receive visitors when they wish. Meal provision is of a good standard and satisfactory to residents. EVIDENCE: Those residents spoken with reported that they are able to follow their preferred routines. One resident spoke of being assisted with their personal care by the night staff, as they like to wake up early. Another confirmed that it does not matter what time you get up and you can go to bed when you want to. A member of staff confirmed this and stated that residents are assisted with their personal care throughout the morning at a time, which they request. On a tour of the accommodation, many residents were observed sitting in their rooms. Some were watching television, reading or knitting. Others appeared to be unoccupied or sleeping. In the afternoon, a number of residents were resting in bed. Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 16 The home has an activities co-ordinator who works 20 hours a week. On notice boards around the home, activities such as beauty therapy, games and interactive, including reminiscence are advertised. One resident confirmed that they enjoyed bingo. Another enjoyed knitting. Others enjoyed reading and the television. A number of residents could not identify how they spent their day other than resting and watching the world go by. Discussion took place with the activities coordinator and enthusiasm to heighten the profile of activities was evident. The activities organiser explained the programme, yet commented on the difficulties in meeting the needs of all 49 residents. Holding the attention of residents, with mixed abilities within some group work, was also discussed as a challenge. The activities organiser reported that sometimes, additional support from another member of staff is given, which helps considerably. While it is acknowledged that various group activities are organised, due to the number of activity hours allocated, addressing residents’ individual needs is limited. It is therefore recommended that a review of activity provision be undertaken in line with residents’ individual interests. The allocation of activity hours should then be recalculated. Ms Mudie confirmed that within the organisation, activity provision is being given added focus. Residents reported that visitors are able to visit at any time and they are able to entertain them in their own room. Within comment cards, all nine relatives confirmed that they are welcomed into the home. They are also kept informed of important matters. One relative reported ‘it would be beneficial to have the door code for entry as very often staff are busy and have to wait. As we are regular visitors we feel we could be trusted with the code.’ Another stated ‘the staff are most welcoming and are always ready to offer a cup of tea. They have always been very helpful in contacting my friend with telephone messages.’ All residents spoke favourably about the food. There were positive comments about the variety, the choice and the ways in which the food was cooked. It was reported that some mornings, a cooked breakfast is available. One resident said ‘if you do not like the choice of the main meal, staff will get you something else.’ The menus were viewed and demonstrated a choice for each meal. At lunchtime during the inspection, there was homemade mince and onion pie, jacket potato with cheese or soup. Dessert involved crème caramel, ice cream, yoghurt or cheese and biscuits. Wine or water accompanied the meal and tea and coffee were served when residents had finished eating. One resident reported that staff come around and ask you what you want for your meal. The menu for the day is also displayed in the dining room. On the notice boards around the home, there is a copy of a sample menu. Rather than this, it may be beneficial for some residents to have a copy of the actual menu on display. Residents and staff reported that lunch is at 12.30. However on the day of the inspection, despite residents being seated in the dining room at 12.30, the meal was not served until 1.05pm. Residents reported that they are able to have their meal in their room although many chose not to do so, unless they are unwell. Regular drinks are served throughout the day. One resident reported that they have fresh fruit with their hot drink rather than a biscuit. Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 17 Within comment cards, eight residents confirmed that they always liked the meals. Seven said usually and three said sometimes. One resident reported that they enjoy the meals ‘very much indeed’ and another stated ‘the food is wonderful.’ Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Many residents are clear about making a complaint yet there is little evidence of how those residents, with limited communication skills, are able to do so. While a record of complaints is maintained, shortfalls with documenting the investigation processes remain. Enabling adult protection procedures to be more readily accessible and ensuring staff are confident with the referral process would ensure residents’ greater protection. EVIDENCE: The home has a detailed complaints procedure, which contains the information required by regulation. The procedure is displayed on notice boards around the home. While encouraging complaints and comments, the procedure is not in a user-friendly format, particularly for those residents with dementia. Consideration should therefore be given to additional ways in which views can be gained and potentially a user-friendlier format could be displayed. Many residents spoken with reported that they would tell a member of staff if they were unhappy. One resident confirmed that they were happy with the way things are. Ms Mudie reported that key workers are generally very good at discussing matters, which may be worrying a resident. Within comment cards, five relatives reported that they are not aware of the home’s complaint procedure. Four were aware. A complaint log is maintained and a monthly summary of complaints is sent to the organisation’s main office. At the last inspection, a requirement was made to ensure that outcomes of Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 19 complaints are sufficiently documented. This remains outstanding, as the investigation process and outcomes of two documented complaints, were not clear. Mrs Lusty addressed this with the staff on duty. The staff reported that the issues had been resolved, yet documentation had not been fully completed. Some staff did not appear confident when asked about adult protection policies and what they would do if an alleged incident were reported. One member of staff said that they would report the incident to a care leader and an incident form would be completed. After various discussions, the ‘No Secrets’ documentation was located. Ms Mudie confirmed that staff would contact her or the home’s buddy manager if an allegation was made. It was agreed that such procedures should be re-visited, in order to ensure appropriate responses. Ms Mudie confirmed that all staff receive adult protection training during induction. Further training is also planned. Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Refurbishment of areas, such as corridors and some residents’ bedrooms would enable residents’ greater comfort within their environment. Residents are encouraged to personalise their own rooms. A review of the procedure for cleaning toilets is required, to minimise the risk of infection. EVIDENCE: Many areas of the home including corridors, some residents’ bedrooms and toilets, would benefit from refurbishment. This includes re-decoration and new carpeting. Bathrooms would also benefit from new flooring. Mrs Mudie confirmed that she is aware of the need for various aspects of refurbishment. Money has been allocated in the next year’s budget although there are no specific dates to complete the work, at present. Mrs Lusty confirmed she has been notified that redecoration of the corridors has been agreed. Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 21 While bathrooms and toilets are adequate, consideration should be given to how they could be made more comfortable and homely. Within one bathroom, a sluice is in situ. Units that contain clinical waste are also stored within the room. Mrs Lusty confirmed that attention is being given to this matter. Bathrooms have specialist baths and there is also a walk in shower. Toilets have raised toilet seats, grab rails and frames to assist with mobility. Call bells are within easy access of residents. Soap dispensers and paper towels are in place. Toilet brushes however were being used without cleaning substances and when replaced in the holder contained brown deposits. The use of toilet brushes therefore needs to be reviewed in line with current infection control guidance. Ms Mudie reported that this is unusual practice, yet agreed to investigate the matter. There were also some toilet seats, which required a clean. Mrs Lusty immediately asked the maintenance person to address the issue. This was done speedily. Communal areas consist of a large dining room and an adjoining area, which has been developed into a seating area. There is a small activities room, a separate sitting room and a hairdressing room. A seating area has been created within the entrance hall. In the past, an area of the home was used as a staff flat. Mrs Mudie reported that some residents now use this as a smoking room. The rooms however do not present as welcoming with poor decoration and carpeting and additional storage of furniture. Consideration should be given therefore to developing this space. Residents’ rooms are personalised and demonstrate individuality. Many however would benefit from refurbishment. Radiator covers are in situ and hot water outlets have been fitted with temperature regulators. There is a communal pay phone, yet the location of wheelchairs, made access to the telephone difficult. There is a large well-maintained garden. One resident commented that ‘the grounds are lovely.’ On the first day of the inspection, a resident was noted to be walking around, aiming to look for his/her room. A member of staff gave assistance and provided positive interactions while doing so. As the home is large and on two floors with lengthy corridors, consideration should be given to how residents with dementia are orientated. All areas of the home appeared clean. The laundry was large with sufficient equipment to meet existing need. One member of staff was seen distributing clean laundry to residents in the afternoon. Those residents who mentioned the laundry expressed satisfaction. Within comment cards, ten residents reported that the home is always fresh and clean. Six said usually, one said sometimes and another said never. There was one negative comment regarding the cleanliness of the toilets. Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 22 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. Staffing levels are maintained at a minimal level enabling only residents’ basic needs to be met. A robust recruitment process is in place, which assures residents’ greater protection. Training is given priority yet consideration should be given to developing the home’s dementia care training. EVIDENCE: There are generally four or five carers and a care leader on duty in the morning. This reduces to three or four carers and a care leader on the evening shift. At night there are three waking night staff. At weekends, staffing levels remain the same. Housekeeping and catering staff support the team. There is also a laundry assistant, an activities coordinator, an administrator and a maintenance person. Within the inspection it was noted that staff were busy. One resident, as stated earlier in this report, was eating a biscuit in bed. A drink in a specialised cup was on the table but not in the residents reach. The biscuit had melted causing residue on the resident’s fingers and clothing. At 2.10pm, the resident had still not received assistance with washing. It was noted that the dependency of some residents was high. This meant that some needed the assistance of two members of staff. During these times, within existing staffing levels, two or sometimes three staff would be left to support 48 other residents. Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 23 The level of care staff on duty was discussed with Ms Mudie, as clearly, with the current levels of residents’ dependency, such levels are minimal. Ms Mudie reported that the organisation has identified this and more care hours have been allocated within the budget for the next financial year. The actual figure however, is not known at this time. Ms Mudie reported that while acknowledging additional care hours would be of benefit, she has also noted that better use of staff time, in some instances, is required. This applies in particular to the cross over of the morning and afternoon shifts, where Ms Mudie believes there are ample staff on duty. Insufficient staffing levels were also identified at the last inspection whereby a requirement was made. When asked about an increase in staffing levels, one member of staff reported that 25 hours had been taken from the housekeeping hours in order to create posts of care support. This post was aimed to undertake bed making and serving drinks to residents, which would enable care staff to focus entirely on care. Despite the intention, staff reported that in practice, it was not entirely satisfactory and more care staff are required. The domestic staff spoken to reported that they are very busy but help each other to get the job done. All expressed satisfaction with doing their job well and the importance of building relationships with residents who they clean for. Ms Mudie confirmed that there are additional domestic hours in the budget for next year. Many residents spoken with said that the home was short staffed. One resident said the staff are always rushing around and another said staff are too busy to talk. One further resident said staff answer the bell but sometimes it takes a long while, as they so busy. On asking one resident about caring for their fingernails and whether staff give assistance, they laughed, saying ‘you must be joking, they haven’t got time for things like that.’ Ms Mudie reported that she would discuss this with the staff team although reported that the activity organiser regularly spends time, undertaking manicures. Within comment cards, three residents stated that staff were always available when you need them. Seven said usually, six said sometimes and one said never. Two residents confirmed that staff take a long time to answer their call bell. In response do the question ‘do staff listen and act on what you say?’ Thirteen residents said yes, three said sometimes, one said no and one said mostly. Six relatives believed there to be enough staff on duty. Two said there were insufficient staff and another did not state their view. One confirmed ‘sickness has made them very short at times.’ Another stated, ‘staffing is usually quite good but now and then they have been short. It’s always down to illness.’ Mrs Mudie confirmed that at present the home has a care leader and night carer vacancies. A number of carers have recently been appointed yet have not commenced employment due to waiting for various checks. Recruitment Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 24 documentation of four staff was viewed. All files contained an application form, a POVAFirst check, a CRB and two written references. Not all contained details of medical fitness. Mrs Mudie reported that all new staff have an induction day at the organisation’s main office. A structured induction programme is also undertaken on the computer. Staff have access to regular training with particular attention given to mandatory subjects. Ten staff completed first aid training in July 2006 and night staff are in the process of receiving updates. Ten members of staff have NVQ level 2 and four members of staff are working towards the award. Four members of staff are waiting to start. Ms Mudie reported that tissue viability training is planned, which will assist in the development of assessing residents’ risk of developing a pressure sore. Medication training, moving and handling, mental health and dementia have also been undertaken. At present, the dementia care course covers a two-day period. Ms Mudie confirmed that attention is currently being given to developing this, to an on going programme. Staff reported that training opportunities are excellent and priority is given to this area. Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 25 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 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the benefit of an experienced manager who is motivated to further develop the home. Various systems are in place to assess service provision and gain residents views. Clear systems are in place to manage residents’ personal monies therefore reducing the risk of error. Health and safety is given priority although further consideration to individual risk, would ensure residents’ greater protection. EVIDENCE: Mrs Lusty has been in post for approximately 18 months and has many years experience of working with older people. Mrs Lusty is a Registered Nurse and is undertaking her Registered Managers Award. Mrs Lusty has been on sick leave although was returning to work during the inspection’s conclusion. In Mrs Lusty’s absence, a team leader was seconded from another care home within Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 26 the organisation. Ms Mudie also visited the home regularly to give support and address issues, as required. 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. As yet, questionnaires to target other stakeholders have not been developed. Residents however are able to seek support from their relatives when completing their forms. All feedback was coordinated and Mrs Lusty reported that the majority of identified issues have been addressed. As part of the home’s quality assurance system, regular residents meetings are held. Ms Mudie confirmed that additional audits covering health and safety, for example also fit into the system. Residents’ fees are generally paid through standing order. A number of residents have chosen to place small amounts of their personal monies, for the home to hold safely. The systems for managing this were examined. A number of cash amounts were checked against the balance sheets and all were found to correspond. Staff sign and check each transaction. The resident or another member of staff countersign the record. Receipts were also in place to demonstrate expenditures. Health and safety is given priority and the organisation has developed significant documentation within this area. There are a large number of policies, procedures and generic risk assessments. However, as stated earlier in this report, risk assessments in relation to the individuality of residents have not been addressed. Risk assessments regarding the environment also require updating. The maintenance person spoke of his responsibilities such as fire safety. He also explained the COSHH sheets and evidenced a very ordered, storage system for all chemicals, used within the home. The safety of the environment has been given consideration through the installation of radiator covers and hot water regulators. Various forms of equipment such as hoists are serviced regularly with documentation available to demonstrate such checks. Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 27 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 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 28 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. The registered person must ensure that all care plans reflect resident’s individual needs, including the management of health care conditions. The registered person must ensure that any potential risks are addressed within the risk assessment process. Risk assessments must be regularly reviewed and updated. The registered person must ensure that all residents have their risk of developing a pressure sore assessed. Outcomes and action to be taken must be identified in each care plan. The registered person must ensure that staff sign to denote the administration of each medication. This must also apply DS0000028275.V325142.R01.S.doc Timescale for action 28/02/07 2 OP7 15(1) 31/05/07 3 OP7 13(4)(c) 30/04/07 4 OP7 12(1)(a) 30/04/07 5 OP9 13(2) 28/02/07 Bartlett House Version 5.2 Page 29 6 OP9 13(2) 7 OP16 22(3) 8 OP18 13(6) 9 OP26 13(3) 10 OP27 18(1)(a) to topical creams. The registered person must ensure that the identified medication error is investigated and the outcome of such is forwarded to the CSCI. The registered person must ensure that the investigation and outcome of any complaint is documented within the complaints log. The registered person must evidence that all staff are aware of the procedures to follow in the event of an allegation of abuse. The registered person must ensure toilets are cleaned regularly to a satisfactory standard and the procedure for the use of toilet brushes is reviewed. The registered person must ensure staffing levels are sufficient to meet the individual needs of residents. The CSCI must be informed when the details of the increased staffing levels are known. This was identified at the last inspection. Additional care hours have been agreed although they have not, as yet, been implemented. 30/04/07 28/02/07 30/04/07 28/02/07 30/04/07 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 DS0000028275.V325142.R01.S.doc Version 5.2 Page 30 Bartlett House 2 3 4 OP7 OP7 OP9 5 OP12 6 7 8 9 10 11 12 13 OP15 OP15 OP16 OP18 OP18 OP19 OP26 OP33 aggressive’ are given greater clarity. The registered person should ensure that control measures within the risk assessment process are clarified to minimise the occurrence of a related incident. The registered person should ensure that all food and fluid charts are evaluated on a regular basis and this is documented accordingly. The registered person should ensure that the amount of any prescribed variable dose medication is clearly identified, within the medication administration record, when given. 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. 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. The registered person should review the serving of lunch to ensure that residents are not kept waiting at the table. The registered person should ensure that the complaints procedure is readily accessible to residents’ relatives and is also developed within a user-friendly format. The registered person should ensure that the ‘No Secrets’ documentation is more predominantly displayed. The registered person should ensure that all staff have adult protection training, facilitated by an external trainer, that takes into account local reporting procedures. The registered person should ensure that an alternative is found for the storage of wheelchairs, so that the communal telephone is more easily accessible. The registered person should ensure an alternative is found for the location of the clinical waste bins. 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. Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bartlett House DS0000028275.V325142.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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