Inspection on 10/08/05 for Bartlett`s

This inspection was carried out on 10th August 2005.

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

Other inspections for this house

Bartlett`s 05/02/08

Bartlett`s 12/09/06

Bartlett`s 09/01/06

Bartlett`s 07/02/05

Bartlett`s 01/06/04

Bartlett`s 08/01/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Bartletts Peveral Court Portway Road Stone Aylesbury, HP17 8RP Lead Inspector Moira Jones Unannounced 10 August 2005 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 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. Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Bartletts Address Peveral Court, Portway Road, Stone, Aylesbury, Bucks HP17 8RP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01296 747000 Peveral Court Ltd Gloria Ncube Care Home 24 Category(ies) of Old age not falling within any other category registration, with number of places Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 7th January 2005 Brief Description of the Service: Bartlett’s is registered to provide personal care and accommodation to twentyfour older people. The home is privately owned and is situated on the periphery of Aylesbury and Stone. There are some amenities within the village and ample opportunities to sample social and recreational facilities situated in the market town of Aylesbury Bartlett’s is a large, Victorian country house, which is set in its own grounds. Accessed via a set of electronic gates, the home has been refurbished to meet the needs of service users, while maintaining many of the original characteristics of the house. All but one of the bedrooms provides single room accommodation. A married couple reside in the remaining double bedroom. All bedrooms are fitted with en-suite facilities and there are ample bathrooms and toilets within close proximity to all sleeping and communal areas. One lounge is situated on the ground floor adjacent to the dining room and there is a quieter lounge, which is situated on the first floor. Most areas of the home are well decorated and furniture is of a good sopecification. The home has an ongoing programme of redecoration, evidence of which was seen during the course of the inspection. Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of the unannounced inspection that was conducted at Bartlett’s on Thursday 11th August 2005, commencing at 8.30am and concluding during the afternoon. All key standards were assessed as well as some supplementary standards. The inspection was assisted by Melanie Henderson (deputy manager) in the registered manager’s absence. The inspection consisted of meeting with service users and staff, a tour of the building, discussions regarding the current operation of the home and the assessment of a variety of documentation. In addition, the progress made towards meeting the requirements and recommendations issued as a result of the last announced inspection of the home was assessed and found to have been complied with. At the time of this inspection twenty-two permanent service users were in residence and one service user was staying at the home on a respite basis. What the service does well: The home has a conscientious approach regarding the assessment of service users needs prior to admission. Service users needs are formally re-assessed on an annual basis but also as changing needs indicate. Each service user has a plan of care that outlines their specific needs. The home ensures that service users health care needs are routinely met. There are robust systems in place to manage service users prescribed medications. Staff are inducted to observe the core values that underpin the care and support given to service users. Service users are supported to lead fulfilling lives by enabling them to access a range of leisure, occupational and recreational activities. Visiting times at the home are flexible. Service users are enabled to exercise their civic rights. Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 6 Service users nutritional needs are ensured via the provision of well-balanced meals that cater for individual requirements. The home has a policy and procedure that guides service users in how to make their comments known. Vulnerable service users are protected by means of policies, procedures and staff training. Bartlett’s provides service users with a comfortable environment. Most communal areas and all bedrooms are well decorated. Service users are encouraged to individualise their bedrooms. The home was clean, tidy and free from offensive odours at the time of this inspection. The kitchen is run to HACCP standards. Bartlett’s grounds are well maintained. There is a maintenance programme for the home. The staff compliment of the home ensures that service users needs are met. The home has a good arrangement for the appropriate and robust recruitment of staff. Staff have a good understanding of care, health and safety in initiatives, which are made known to them via a generally good approach to training. There are systems in place to ensure quality standards. There are guidelines in place that promote the protection of service users finances and personal affairs. The home is well maintained. What has improved since the last inspection? A protocol for the administration of any non-prescription medications has been developed. Replacement doors have been fitted to the lift. The kitchen has been tiled. A new dishwasher has been purchased. Ventilation in the kitchen has been improved. Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 7 Ramp and patio areas that lead to the garden have been constructed. Garden furniture has been purchased. Rooms where oxygen is in use are labelled. Service users are now provided with storage facilities to keep medications in their bedrooms. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4 and 6 The home has a conscientious approach regarding the assessment of service users’ needs prior to them being admitted for care and support. This means that staff have a good understanding of requirements ensuring that individual needs can be more effectively met. Service users needs are re-assessed formally on an annual basis but also as changing needs indicate, ensuring that changing needs are more efficiently and compassionately met. EVIDENCE: One service user has been discharged from the home during the time under review and three service users have been admitted to live at Bartlett’s on a permanent basis. As vacancies dictate, emergency admissions may be made to the home, further to assessment. During the same review period, three respite admissions have been made to the home. All admissions are made in line with the home’s admission policy and procedure, which remains unchanged since the time of the last inspection of the home when it was assessed as being compliant with the standard. Service Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 10 user’s needs are assessed by either or both the manager and/or deputy manager prior to admission to the home and are recorded on a ‘Residential Assessment Form’, which forms an integral part of the Standex system in use at the home and which holds all information pertaining to service users needs. The completed ‘Resident Assessment Forms’ for the three service users recently admitted into the home were seen. The forms require the assessor to record information that is in line with the outlined requirements of standard 3. Recording was noted to be thorough and gave a clear impression of individual needs. All assessments were acknowledged by the assessor via dates and signatures. The home has previously been required to ensure that regular re-assessments of service users needs are undertaken. It was ascertained during this visit that service users plans are summarised on a monthly basis and that needs are reviewed on a formal basis each year with notes on file to substantiate the activity. In order to meet service users changing needs the home is able to access the support of a number of healthcare professionals via service users general practitioner and reviews can be arranged to take place at any time, as individual needs indicate. No rehabilitative/intermediate care is provided at Bartlett’s. Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Each service user has a plan of care that outlines their specific needs, enabling staff to be able to temper the care and support provided to the individual. The home ensures that service users health care needs are routinely met. Although there are robust systems in place for managing the medications prescribed for service users, update training in its administration is required to take place if service users are to be fully protected. Staff are inducted to observe the core values that underpin the care and support given to service users. EVIDENCE: Three service users plans were seen. The home uses the Standex system of care planning, which was noted to contain all required information as outlined within standard 7 of the National Minimum Standards for care homes for older people and Regulation 17, schedule 3 of the Care Homes regulations 2001. All areas of the records seen were noted as being thoroughly completed and signatures and dates substantiated all entries made. The daily reports made in respect of each service user clearly outlined the activities of daily living and the Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 12 care and support provided by staff. All pertinent information including their dates of birth, next of kin, identity of their doctor, future wishes etc were noted on individual files, as were any known allergies, which were highlighted in red for staff’s immediate attention. Service users plans also include risk assessments, including moving and handling assessments that relate to the individually assessed vulnerabilities of service users. Service users plans are summarised each month. With the exception of one service user who is registered with an Aylesbury practice, all other service users are registered at a surgery in Haddenham. A good level of support from all health care professionals was reported. Routine healthcare appointments attended were well recorded on each service users plan, clearly indicating that the home takes its responsibility towards ensuring that service users NHS entitlements are assured. Audiology appointments take place at Stoke Mandeville Hospital and the home undertakes to maintain hearing aids on an interim basis. The home has access to a private dentist but also uses the services of an emergency dentist who is based at the Brookside Clinic and at Quarrendon in Aylesbury. A mobile optician visits the home. Service users are escorted to hospital appointments either by a member of staff or a family member. All hospital appointments attended are also recorded on the plans of care. The home receives advice regarding the management of tissue viability from the community nursing team. At the time of this inspection one person was noted as having tissue viability issues and the community nurse had ensured that pressure-relieving aids were in place to support the service users needs. There is also access to a tissue viability nurse via the community nurse. Continence advice is again received form the community nursing team. The nurse assesses the needs of service users and it was noted that the appropriate aids had been secured for service users as a result of her thorough assessment. Previously, the home self-assessed the continence needs of service users and it was reported that the revised system, which commenced in January 2005, was much improved, had less waste and put service users at less risk. Although there are currently no service users who require community psychiatric nurse (CPN) support residing at the home, a named CPN is attached to the home and access is relatively easy. A Psycho geriatrician visits the home to consult with his patients and a geriatrician visits the home as and when required. The doctor from the Haddenham practice visits the home each week and consults with service users within the privacy of their bedrooms. The doctor from the Aylesbury practice visits as and when required. Service users visit their respective practices for some consultations and procedures and it would appear that they are well supported by staff in their health care needs. Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 13 The home has a robust approach and attitude towards the storage and administration of all medications, be they prescribed or non-prescribed preparations. Medications are delivered each week from a pharmacy based in Haddenham using the Nomad system of administration. At the time of this inspection three service users self-administered their medications and lockable facilities had been provided in their bedrooms for this purpose. The self-administration of medications is outlined within the home’s medication policy and procedure, which was updated in February 2005 to include this protocol and staff check and note the self-administration of service users’ practices on a monthly basis. Medications prescribed for service users are noted on individual medication administration record (MAR) sheets, which are also used to record nonprescribed medications to ensure easy tracking. Medications received into the home are recorded on the MAR sheets. Any medications prescribed mid-cycle or any changes made to individual regimes are supported by the doctor who makes written instructions on the MAR sheets and acknowledges any changes via signature. Medications returned the pharmacy are recorded in a separate book, which is signed and dated by the pharmacist. Recording practices were noted to be good with no perceived gaps in staff’s practice. Six service users were being prescribed controlled drugs at the time of this inspection and these were recorded on an approved drugs register. The supplying pharmacist visits the home to audit the medications held there every three months. The last visit took place in July 2005. The resulting report indicated that the home was not issued with any requirements or recommendations. Medications held at the home were found to be adequately stored within a controlled environment and access is available to senior staff only. The number of medications held within the home was of a minimum number. Perishable medications are stored in a refrigerated environment and temperatures are recorded daily. Staff are trained to administer medications effectively, appropriately and safely. One staff member has attended a training course facilitated by a chain of national chemists and another staff member attended a Nomad training day in June 2005. Twelve staff members attended a training course, facilitated by the chemist who supplies the home, in June 2004. This training is now due for updating and this is therefore a requirement of the report. All staff are inducted to their posts in line with the TOPPs standards and the Foundation in Care Booklets. Staff are orientated to the layout and philosophy of the home and are encouraged to familiarise themselves with the home’s polices and procedures, which form a part of staff’s induction. The home has an expectation that staff will observe the core values and were observed to be knocking on service users bedroom doors, referring to them by their preferred title and speaking to individuals using a respectful tone. Personal care takes place within the privacy of bedrooms or bathrooms. Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 14 Service users individuality is promoted and they are encouraged to present The bedrooms seen were their bedrooms using personal possessions. evidential of individual personalities, hobbies, interests and family contact. By virtue of the fact that the majority of bedrooms provide single room accommodation and are fitted with en-suite facilities promotes privacy and dignity. The one bedroom that provides shared accommodation is resided in by a married couple and provides them with enough space to have a small lounge area. There are telephone points fitted in each bedroom and service user are able to choose whether they wish to have use of a telephone. Post is given directly to service users and staff are available to support them to manage the contents. Service users wear their own clothing and have hairstyles of their choice. The hairdresser visits the home each week. As previously reported service users meet with their doctor within the privacy of their individual bedrooms and this arrangement also applies to business and financial advisors. Service users were positive in their view of the home and the care, support and respect they receive. Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 Service users are supported to lead fulfilling lives by enabling them to access a range of leisure, occupational and recreational activities that are based on personal preferences and the promotion of personhood. Visiting at the home is flexible, which means that service users are able to maintain contact with friends and family. There are arrangements in place to ensure that service users are enabled to exercise their civic rights. Service users nutritional needs are promoted through the provision of a range of balanced and well prepared meals that take into consideration individual requirements. EVIDENCE: The home employs a part time activity co-ordinator for ten hours per week. Service users plans include a personal activity plan and, in addition, there is also a weekly plan of general activities in place, which is planned two weeks in advance. During the week of the inspection, the following activities had been arranged to take place: • Visiting soprano singers • Bingo Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 16 • • • • • • Holy Communion Manicures Board games Gentle chair exercises Video Walks around the garden. There was also a plan advertising the activities for the week after the inspection. On the first Tuesday of each month a mobile library visits the home. Every Tuesday morning the hairdresser visits and there is communion or praise every four weeks. The doctor visits the home every Thursday afternoon. WEA, a local history society, visits on a monthly basis to present historical talks about places of local interest, methods of traditional working etc. Three service users visit the Red Cross centres on a rotational basis, either at Haddenham or Waddesdon. The home purchases entertainment in and a theatre group visits the home periodically. Service users’ hobbies and interests are recorded on their plans of care and participation is optional. All activities undertaken by service users are recorded on their daily records. Access to the home, which is situated at the end of a long drive, is via a set of electronic gates. Visiting at the home is flexible and service users are able to meet with their friends, relatives, financial, personal and business advisers at any reasonable time, either within the privacy of their bedrooms or the less private communal areas. The quiet lounge, situated on the first floor does provide service users with privacy and it has an adjacent kitchenette where tea and coffee making facilities can be found. Visitors to the home are invited to sign the visitor’s book, which is situated in the main entrance of the home. Service users are supported in their decision of whom to see or not see. Age Concern visits the home every four weeks to provide an advocacy service to service users. All service users are registered on the electrical roll. During the recent general elections, some service users opted to vote by post while the home arranged transport for other service users so that they could exercise their civic right in person. Service users are enabled and encouraged to individualise their bedrooms using personal possessions and there was ample evidence of service user’s interests, hobbies and family contact on display in the rooms seen. Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 17 Service users are able to access the files that pertain to them, with prior notice. The home assumes no responsibility for managing service users’ financial or other personal business. The menus are planned by the Chef who takes likes, dislikes, preferences, any allergies, clinical needs and seasonal availability into consideration. On the day of the inspection the lunchtime choice was lemon chicken, fish cakes, new potatoes, mushrooms and Brie, cauliflower with raspberry brulee for pudding. The menus seen were evident of the combination of traditional and contemporary meals served. General feedback from service users was positive. The Chef records all deviations from the menu in a diary and the temperature of food served are also noted. The kitchen is run to HACCP standards. At the time of this unannounced inspection no service user had any specific cultural or religious requirements and the home was catering for two diabetics. Two service users required a soft diet. Service users nutrition is assessed on a regular basis. Weights are monitored every month and records are maintained on service users plans within a risk assessment framework for the purposes of tissue viability. The home has access to a dietician who is based at Manor House Hospital in Aylesbury. The dietician visits the home as required. The dietician advises the home about supplementary foods required for service users, which are thereafter prescribed by the person’s doctor. Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The policy and procedure that guides service users in how to make their comments known to the home is compliant with Standard 16 and Regulation 22 of the Care Homes Regulations 2001, ensuring that views are listened to and responded to within the designated time. Vulnerable service users are protected by means of policies, procedures and staff who receive training in their instigation, therefore ensuring that their safety and welfare is preserved. EVIDENCE: The complaints policy and procedure adopted at Bartlett’s has previously been assessed as being compliant with the requirements of Standard 16 and Regulation 22 of the Care Homes Regulations 2001. No changes were ascertained as having been made to the policy and procedure since the last inspection of the home, which was conducted in January 2005. No complaints have been made known to the home during the time under review and none have been received by the Commission for Social Care Inspection’s Aylesbury office. There is however, a file in place to record all comments made known to the home. During the same time span, seven written compliments have been received. The home’s adult protection policy was noted as having been reviewed and revised accordingly in April 2004. At the time of this unannounced inspection, the policy was in the process of being reviewed again, as part of the annual update of all policies and procedures. There is also a guidance in place for Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 19 service users and their relatives should they become concerned about matters of protection. In addition to the policy and procedure for the protection of vulnerable adults, the home also refers to the Bucks County Council adult protection policy and procedure. Seven staff were trained in the protection of vulnerable adults during February 2005 and one staff member attended an ‘Action on Elder Abuse’ training course during March 2005. There was evidence within the home of literature relating to the work of ‘Action on Elder Abuse’, for service user’s reference. The home has developed a policy to guide staff in the management of behaviours that challenge. Eight staff attended de-escalation training, which was held at the home, during June 2005. The home also has a finance policy that provides staff with information relating to the appropriateness of the type of support given to service users to manage their money and there is guidance on the acceptance of gifts and donations. This policy was developed in April 2004. Other policies that underpin the protection of service users (and staff) are: • The whistle blowing policy • The policy on mental health • The harassment and bullying policy • Aggression towards staff • Equal opportunities policy. No adult protection issues have been presented at the home and no service user made indicated that they were unhappy with any aspect of the support provided by the home. Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 Bartlett’s provides service users with a comfortable environment, although there are some remedial maintenance and refurbishment tasks that need to be undertaken to ensure that all areas of the home are presented to the highest specification. The home was clean, tidy and free from offensive odours, ensuring that service users health and welfare is promoted. EVIDENCE: Bartlett’s is a large Victorian country house, which is situated in its own grounds and accessed via a set of electronic gates. The home has been sympathetically arranged to accommodate the needs of older people and provides ample personal space within bedrooms and a well presented communal sitting room and dining room. With the exception of the entrance hall and the corridors on both ground and first floors, which are now showing signs of wear and tear, the home is well decorated and furnished in keeping with the style and manner of the home. Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 21 The lounge on the ground floor has recently been redecorated and the quiet lounge, situated on the first floor, has been refurbished with a new suite, TV cabinet and dresser. There is an ongoing programme of redecoration, refurbishment and maintenance, which is relative to the age and size of the building and the director needs to consider a contingency plan for redecorating the entrance hall and corridors to ensure that all areas of the home are maintained to the same standard. It was noted that there was a large crack in the wall from floor to ceiling on the wall opposite the quiet lounge and it is therefore required that this be investigated and remedial work undertaken to rectify the damage. The dining room, entrance hall and stairs that lead to the first floor and first floor corridor have been re-carpeted and the floorboards in the ground floor corridors have been replaced. With the exception of one shared bedroom, in which a married couple reside, all bedrooms provide single room accommodation and are fitted with en-suite accommodation that consist of a toilet and hand washbasin. Bedrooms are generously proportioned, well decorated and furnished and have been individualised by service users using their personal possessions. Bedrooms and communal areas are within close proximity of the communal toilets and there are also communal bathrooms. The home is fitted with a Parker bath that has an integral whirlpool and two baths that are fitted with manual hoists. All equipment is serviced every six months. During the time under review the lift, which transports service users between the ground, first and second floors has been re-fitted with new concertina type doors. The lift is also subject to six monthly services. The home is fitted at key assessed points with aids and adaptations to facilitate service users mobility and core care needs. The kitchen is centrally situated within the home and is run to HACCP standards. Since the time of the last inspection of the home most of the kitchen walls had been tiled to a good standard and it would appear that the remaining wall was also to be tiled. A new industrial type dishwasher has also been purchased during the time under review. There was evidence of good recording practices with the Chef maintaining temperature records for all storage facilities and the food served. A recent environmental health officer’s inspection of Bartlett’s resulted in the home being required to ensure that the kitchen was sufficiently ventilated. Whilst this requirement had been met, on the day of this unannounced inspection the temperature in the kitchen was in excess of 30 degrees Celsius and was reported as having been as high as 36 degrees Celsius at times. It is therefore strongly recommended that the director consider installing further ventilation in the kitchen so that working conditions are more bearable for staff. Although, as previously outlined, the kitchen is run to HACCP standards and was scrupulously clean the director would be prudent to commence contingency plans for the replacement of the kitchen. The worktops, cupboard and drawer fascias were showing signs of wear and tear and are no longer impervious. Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 22 The home is set in its own grounds, which were well maintained. A ramp that enables service users with limited mobility to access a patio area and the garden had been fitted since the last time the home was inspected. Garden furniture had been purchased for service users comfort and on the day of this visit was clearly being put to good use by service users and staff. While the tour of the building established that that the home was clean, tidy and free from any offensive odours, two areas, externally situated at the rear of the property evidenced that the staff smoking/sitting area required some tidying up and the ground around the bin area needs to be kept orderly with the need for screening around the bins a future consideration. The laundry is situated separately from the home, adjacent to the staff annexe. The tour of the laundry evidenced that it was well equipped, clean and well ordered. New flooring has been fitted in the laundry during the time under review. The laundry is fitted with one industrial washing machine, an industrial tumble dryer and one domestic type tumble dryer. There are hand-washing facilities and the home uses red alginate bags to separate foul laundry from other laundry. Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The staff compliment of the home ensures that service users’ needs are sufficiently supported at all times. The home has a good arrangement for the appropriate and robust recruitment of staff, which means that all candidates have been ‘screened’ for their posts so service users benefit from care and support from people who are deemed ‘fit for the job’ and that service users’ vulnerabilities are protected. Service users benefit from being cared and supported for by staff that have a good understanding of care, health and safety initiatives, which are made known to them via a generally good approach to training. EVIDENCE: With Bartlett’s registered to provide care and accommodation for up to twentyfour older service users, four care assistants and two senior members of staff (either the manager and deputy manager or senior staff member) are rostered to afford care and support during the early part of the day, four care assistants and a senior member of staff during the afternoon and four persons, including a senior member of staff during the evening. Two care assistants, one of whom has senior staff responsibility, provide care and support at night. The manager is generally supernumerary to the roster and the deputy manager is available to provide direct care and support to service users during the early shift and is supernumerary to the roster during the afternoon and evening shifts. Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 24 The Chef, who at the time of this unannounced inspection did not have a kitchen assistant to support him, manages the kitchen and the home was in the process of recruiting to this vacant post. The home employs one full time, two part time domestic workers and a part time laundress. In addition, the home employs a part time activity coordinator. Extra staff can be rostered to support service users, as their needs dictate. No staff under the age of twenty-one years are employed at Bartlett’s and all members of the senior staff team are aged twenty-one years or over, ensuring that the home is managed at all times by staff who are suitably experienced. The home endeavours not to employ agency staff to work there. When vacancies arise within the home, replacement staff are sourced via a recruitment agency. Applications received as a result of the advertisements placed by the agency are forwarded to the manager for short-listing purposes. Face to face interviews with candidates who are successfully short listed subsequently take place at the home. This activity is recorded and the noted held on file. All interviews are conducted by the manager and deputy manager. During the time under review, no member of the permanent staff team has left the home’s employment however, a member of the bank staff has resigned from their post. During the same time span three part time staff have been recruited to the staff team. The personnel files for all staff members were seen and were noted to contain: • Completed application forms • Two references • CRB/POVA clearances • Completed interview assessment forms • Contract of employment • A job description of the relevant post • Additional proof of identity (birth certificate, photo driving licence) • A copy of the home’s health and safety at work policy • A copy of the home’s grievance and discipline policy and procedure. All recruitment clearances are undertaken by the home. The information submitted by the recruitment agency is included on a form, which when completed includes: • Personal details of the staff/candidate screened • Name, address, landline telephone number, mobile telephone number, email address and date of birth of the staff/candidate screened • Career summary • Qualifications Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 25 • • Hobbies and interests Any other relevant information. All staff members employed at the home are provided with a copy of the home’s code of conduct and permanent staff are also given a copy of the General Social Care Council’s Code of Conduct. No volunteers are retained at the home. A pro forma acknowledged via signature substantiates the fact that all staff are inducted to their individual posts. There are mandatory training opportunities in place for staff that include: • Moving and handling: updates conducted in November 2004 and April 2005. All staff trained to within current timescales. • Fire awareness: facilitated by video, the home’s health and safety coordinator and the Fire Safety Instructor from Bucks Fire and Rescue. All staff are due for update training by the Fire Safety Instructor in September 2005. • Elderly abuse: all staff were trained to current standards in February 2005. • Care of medication: twelve staff were provided with update training in June 2005. • Health and safety: annual updates in place in addition to induction. All staff trained to current standards. • Infection control: eight staff updated during April 2005. All other staff trained to within current timescales. • Basic food hygiene: most staff qualified to this standard. Other, non-mandatory training is also made available to staff and includes: • First aid: thirteen staff trained to within current standards therefore ensuring that there is always a qualified first aider on duty. • Palliative care. • Customer care and effective communication. • Diabetes. • Managing challenging behaviour. • Dementia care. • Communication skills for people who have English as a second language (via Aylesbury College). The manager has qualified to Registered Manager Award standards. The deputy manager has attained NVQ Level 3 and is commencing the registered Manager Award in September 2005. Six staff members have completed the NVQ Level 2 award and three staff members have just completed the award and, at the time of this unannounced inspection, were awaiting receipt of their certificates. Four staff members have commenced NVQ Level 3. Generally, the provision of staff training is good. Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 and 38 There are systems in place to ensure quality standards however, if the home is to promote a holistic approach to service delivery and ultimately to the provision of care and support to service users, regular recorded Regulation 26 visits to the home must be conducted. There are guidelines in place that promote the protection of service users finances and personal affairs. The home is well maintained and there are systems in place to ensure that service users’ health, safety and welfare is protected. EVIDENCE: The home uses several methods for ensuring that quality standards are assured on an ongoing basis however, Regulation 26 visits made in line with the Care Homes Regulations 2001 appear to have stopped. As no written reports made by the person undertaking the visit have been received at the Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 27 Commission for Social care Inspection’s Aylesbury office it must be assumed that Regulation 26 visits do not take place although the deputy manager made assurances that the visits were conducted on a regular basis by one of Bartlett’s directors. It is therefore required that the director reinstates the Regulation 26 visits to the home, records the visits and submits a copy of the report to the Commission for Social Care Inspection’s Aylesbury office. The home surveys its service users and stakeholders on an annual basis. The questionnaires sent out by the home elicit responses to questions that focus on the following areas: • Nursing care (93 ) • Food (83 ) • Cleanliness and environment (89 ) • Staff (95 ) • Activities and entertainment (57 ) The responses received were expressed on the results as a percentage figure (as above). The last survey made received thirteen responses from service users or their relatives. The information gathered from the responses is used to instigate service improvement. Compared to the survey from the previous year there was evidence of the improvements made with food receiving a percentage score of 80 as opposed to this year’s score of 83 . The general trend was noted to be an upward one. Further means of measuring quality standards at the home include: • Three monthly audits of medications held at the home • Annual reviews of service users needs • Monthly summaries of service users plans • Staff supervision meetings every two months • Annual appraisals of staff’s performance • General staff meetings every two to three months • Monthly health and safety checks of the home • Daily checks of escape routes • The home’s complaints policy and procedure • Visits by an Age Concern Advocate. There are also ‘feedback’ forms posted in the home’s entrance hall so that service users and stakeholders may make more informal comments and, as appropriate, compliments. The home assumes no responsibility for managing service users finances, including personal allowances or their business affairs, these being the prerogative of their relatives and/or representatives. As previously reported there are financial policies in place that provide information to staff about the appropriateness of the type of support given to service users to manage their money and there is guidance on the acceptance of gifts and donations. Mandatory training is integral to staff’s development and, as previously reported, all staff have either been trained to this standard to within current Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 28 timescales or are due to attend update training, which has been arranged to take place at the home. In response to the requirement and recommendations issued as a result of the announced inspection of the home that was conducted in January 2005, the home now: • Has ensured all rooms storing oxygen are clearly identified. • Has window restraints fitted to the windows situated above the ground floor. The window restrictors are subject to monthly safety checks by the deputy manager and the initiative is recorded. The gas safety certificate that confirms the effectiveness of the boiler and central heating system was issued in September 2004 and is therefore not due for renewal until September 2005. There are COSHH data sheets with integral risk assessments for all chemicals in use at the home. There are also risk assessments that relate to service users assessed vulnerabilities and risk assessments that underpin safe working practices and the general environment. The generic risk assessments were in the process of being updated at the time of this unannounced inspection. All risk assessments were evident of good, considered control measures and all assessments were signed and dated by the assessor. There were also risk assessments in place that relate to fire and infection control. These were well recorded on a different pro forma to the generic assessments and the deputy manager stated that the home hoped to streamline all assessments by ensuring that they are recorded on a corporate pro forma. Clinical waste is subject to a weekly collection service and, within this report a requirement has been issued regarding its appropriate management. On the day of this unannounced inspection an external contractor was undertaking some portable electrical appliance testing: this was the third day of the process. It could not be confirmed when the home’s hardwiring and electrical systems had last been checked or when they were due for their next round of scheduled checks. Bacteriological analysis for the purposes of ensuring the safety of the home regarding Legionella was recorded as having taken place during September 2004 but it would appear that further tests have taken place during August 2005. The results were yet to be received by the home. Thermostatic valves are fitted to all hot water outlets. Their efficiency is tested each month and the results recorded. It was evident also, from records maintained by care staff, that water temperatures are recorded each time a bath is drawn. Showerheads are de-scaled and sterilised each month and again, the initiative is recorded. Fire drills are planned to take place every six months, the last one recorded as having been conducted during May 2005. The home’s fire fighting equipment is subject to annual services. The last service was recorded as having been undertaken during February 2005. The emergency lighting fitted throughout the home is discharged every month. Daily ‘means of escape checks’ are undertaken. The fire alarm is sounded Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 29 from a different call point each week and all initiatives are recorded. Smoke and heat detectors are fitted throughout the home, as appropriate. All accidents and incidents that occur within the home are recorded on a pro forma, which prompts good recording practices. There are separate records for staff and service users. All occurrences are recorded and none have resulted in RIDDOR notifications being made. The home is aware of its duty to report all adverse situations within the home in line with Regulation 37 of the Care Homes Regulations 2001. Overall, the health and safety of the home is well managed and conscientiously undertaken. Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 2 x 3 x x 3 Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 31 No9 Are there any outstanding requirements from the last inspection? 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 9 Regulation 13(2) Requirement It is required that staff update training in the administration of medications is arranged to take place. It is required that the large crack in the wall from floor to ceiling on the wall opposite the quiet lounge is investaigated and remedial work undertaken to recify the damage. The director is required to consider a contingency plan for the replacement of the kitchen. It is required that the staff smoking/sitting area and the ground around the bin area needs tidying up. It is required that the director reinstates the regulation 26 visits to the home, records the visitis and submits a copy of the report to the Commission for Social care Inspectors Aylesbury office. Timescale for action 1 October 2005 1 october 2005 2. 26 23(2)(b) 3. 4. 26 30 23(2)(b) 13(4)(a) (c) 26(1) 31 March 2006 1 October 2005 11 August 2005 5. 30 Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 26 26 Good Practice Recommendations The director needs to consider a contingency plan for the redecoration of the entrance hall and corridors. It is strongly recommended that the director considers installing further ventilation in the kitchen so that working conditions are more bearable for staff. Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 33 Commission for Social Care Inspection Cambridge House 8 Bell Business Park Smeaton Close Aylesbury, Bucks, HP19 8JR National Enquiry Line: 0845 015 0120 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 Bartletts H20053009 Bartletts X00015 UI Stage 5 S22953 V244710 H531.doc Version 1.40 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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