CARE HOMES FOR OLDER PEOPLE
Bedford Charter House 1a Kimbolton Road Bedford Bedfordshire MK40 2NT Lead Inspector
Dragan Cvejic Unannounced Inspection 22nd November 2005 05:15 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 Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 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. Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Bedford Charter House Address 1a Kimbolton Road Bedford Bedfordshire MK40 2NT 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) 01234 359313 01234 352004 Bedford Citizens Housing Association Mrs Denise Hookham Care Home 64 Category(ies) of Dementia - over 65 years of age (64), Old age, registration, with number not falling within any other category (64), of places Physical disability over 65 years of age (64) Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th May 2005 Brief Description of the Service: Bedford Charter House was a purpose built home for older people situated next to the entrance to the Bedford hospital. This location ensured easy access to Bedford town centre and the roads leading to the centre. The home provided accommodation to 64 service users, 6 of those were reserved for intermediate care and two for respite care, and the rest for permanent service users. The home accommodated older people with dementia, some with physical disabilities and some generally affected by old age. The home was divided operationally into 3 areas: intermediate care unit, and one unit per each floor. Service users from the intermediate care unit were invited to use a dining room and activity room in the main part of the building, if they wished. The fact that home did not provide furniture, (except in circumstances of real hardship) for service users bedrooms, was used to advantage in creating a homely environment. Service users bedrooms were individualised and the communal areas provided a comfortable and pleasant home. A large and nicely maintained garden contributed to the homely atmosphere and provided an outdoor space for service users in safe surrounding. Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. Two inspectors visited the home from the very early morning hours until midday and spent 43/4 hours there. Inspectors talked to four night staff, 3 day staff and the manager. Five service users gave detailed opinions about their care and four more had a brief conversation with inspectors. The inspectors case tracked 3 service users, but checked some documents not related to the case tracked users, for example, records of controlled drugs, the general breakfast menu and activity plan. Apart from selected bedrooms, communal areas were inspected. The home had made progress since the last inspection, met the requirements and planned changes that would further improve the quality of care in a comfortable environment. What the service does well:
At the arrival of the inspectors the home was asleep. Several service users’ doors were slightly opened, as they preferred to feel as if they were in their own homes. Staff on duty stated that they were happy with the work, training, atmosphere and support they received at work. They stated that they worked as a team. A staff member was looking forward to a meeting of night and day staff. They all expressed relief after successful recruitment ensured more permanent staff were appointed. They thought that this would help reduce pressure on them in the peak period, from 6 to 8 in the morning. Service users were waking up and getting up in an organised way. Most of the users chose to have breakfast in their rooms and the night staff prepared their trays. Service users that got up on their own and came into the communal area were given morning tea and coffee while they were waiting for breakfast. As the day progressed, senior staff administered medication to those that needed help. A service user capable of doing so retained control of his own medication and even an insulin injection. He commented: “This is a very nice place to be in. If we need anything, they get it for us.” Two service users commented that the food was very good and that they had a choice. Breakfast offered contained nutritional food to choose from. A service user showed the home’s newsletters and stated that she had enjoyed a trip to Milton Keynes for shopping and was looking forward to a pantomime visit in Wellingborough. Activities offered in the home were varied and users had the freedom to join if they wanted. For their reminder, the activities were also listed on a board. The home had their newsletter translated into Italian, to meet the needs of two Italian service users. An on-going maintenance programme ensured the home was in a good state of repair and clean, and provided a comfortable place for service users to live in. Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
Although the format for care plans was good, there were a few files where not all the relevant information was transferred. One, in particular, related to the home came to the decision that the best option was for the use of cocoons and bed-rails, which as a form of restraint must be covered by appropriate evidence. The front pages in some service users’ files were not up-dated with the information contained inside the files and the transfer of this information to the front page would improve access to information. The suggested procedure for monitoring and determining review dates should be implemented. Staff stated that they were well supported and supervised and that one to one sessions were held about every three months, though some night staff stated it was not so often. There is a requirement to provide a minimum of 6 supervision sessions per year and with new working practice the home should aim to provide required level of these sessions. Medication process was significantly improved, but the better recording might be more precise if the date was recorded when new liquidised medication was opened. The receipt of medication for service users that self medicate should be signed by the person who receives the medication. Staff should be aware of
Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 Page 7 the potential effects of overdoses and missed doses for each particular prescribed medication for self medicated service users. In order to better protect staff and improve infection control, the ironing room must be thoroughly cleaned, including the ceiling fan. 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. Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 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 Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 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 the following standard(s): 3,4,6 The home carried out full preadmission assessments to ensure that service users and the home know that users’ needs would be met upon admission. Service users could decide themselves if they wanted to accept the offered place in this home. EVIDENCE: Service users files contained “tick” type assessment sheets that demonstrated that the full assessment was carried out prior to the offer of the place. A service user confirmed that he was assessed by the manager prior to admission. He continued, stating that social services were funding his placement in this home. Three service users spoken to confirmed that care plans were discussed with them and that they agreed to the recorded identified needs and how they would be met. They confirmed that the staff were very good and responded to their needs. Intermediate care unit was run by allocated staff. All specialist care in this unit was provided by external health professionals, and the staff from the home offered personal care and support that service users in this unit needed. A user stated: “This is really good place to be in.” His independence was respected,
Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 Page 10 promoted and encouraged. He remained self medicating and even administered his own insulin injection. The intermediate care unit had its own lounges allowing service users to stay separate if they wanted to, or to join the other permanent service users when they want. Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9,10 New format of care plans and service users’ files provided easy access to information necessary for service users’ care. Service users were involved in the process and knew their goals set in care plans. Medication process was much improved and safer. EVIDENCE: Care plans inspected showed clearly the assessed needs and the actions to respond to those needs. Service users confirmed that they knew their care plans. Care plans were held in users rooms and were made available to them and allowed them to decide who could see their plans. The plans for the users that had been in the home longer were reviewed on a monthly basis, while the new plans for recently admitted users did not indicate when they would be reviewed. The manager explained that the review pattern was going to be set by computerising the time scale, so that the administrator would remind staff when care plans would be due for review. Health care needs were appropriately addressed in users’ files. They covered general health, oral and foot care, risk of falls or skin problems. The decisions and reasons for particular interventions to reduce falls were not clearly documented in all inspected files. A service user stated: “I have some problems hearing. I’d better tell staff to call my doctor. He could give me a hearing aid.” She demonstrated that she
Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 Page 12 was in control of her health care needs and expected staff to ensure she gets the help and support how and when she needed. A service user in the intermediate care unit was self medicating and was proud to retain the control of his medication himself. Risk assessment was drawn up and kept in his file to ensure the safety of this process. Minor improvements regarding medication records could be achieved if staff started recording the date when liquidised medication started and if the receipt for self medicating service users were signed by the person receiving their medication. Records of medication were inspected and demonstrated accuracy. The level of respect for privacy and dignity was increasing with new working practices. Staff were observed treating service users with full respect, addressing them appropriately, attending to their calls and needs promptly and without delay, knocking on their doors before entering bedrooms, listening to them without rush and showing respect to users individuality. Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 12, The pace of life in the home allowed service users to lead the life that suited their abilities and conditions. The home offered a range of stimulating activities and allowed service users to choose when they wanted to take part. EVIDENCE: The list of activities was provided on the board and published in the home’s newsletters. The newsletter was translated into Italian and made available to two Italian service users. Activities included a trip to Milton Keynes, for shopping, to Wellingborough for a pantomime and many internal entertaining events. A visiting library service was appreciated by three service users that loved reading. Many service users chose to have breakfast in their rooms and the home arranged to serve them as they preferred. The choice of food for breakfast showed a wide variety and nutritional values. Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 18 The home was working on promoting users’ safety and on their protection, but needed to update users’ files to demonstrate that all measures implemented were beneficial to service users. EVIDENCE: The staff stated that they had attended training on abuse and found it very useful in their intentions to protect service users. The home used cocoons and bed rails to minimise the risk of falls for service users. However, the existing documentation did not provide a clear picture of the ways in which the decision of using cocoons and bed rails was reached. The risk assessments indicated the need for some measures to minimise the risk of falls, consent forms for the use of this equipment were signed by relatives, but there was a lack of information about other, less restrictive measures to minimise this hazard. A police officer was involved to protect service users financial interests in relation to the privately installed telephones and authorised the use of them. Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 Page 15 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 the following standard(s): 19,20,21,24,26 The home was suitable for its purpose and provided a nice and pleasant environment for service users. It was well maintained and clean, apart from the ironing room that affected staff. EVIDENCE: The home was located next to the entry to the hospital and benefited from this location in relation to obtaining specific health services, such as chiropody or physiotherapy. The location also benefited the home’s intermediate care unit where the external medical professionals delivered medical care and were based in the near vicinity of the home. The home was accessible throughout with a lift and sets of stairs. Intermediate care was organised at the two opposite corners of the building and the manager explained the plans to completely reorganise this unit. Corridors were re-carpeted. Regular maintenance programme was efficient in keeping the home in a good state of repair. Lounges were comfortable and service users enjoyed a choice of where they wanted to be. A smoking lounge had a special automatic door fitted to prevent the smoke affecting nearby bedrooms and the corridor.
Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 Page 16 In addition to en-suite bedrooms the home provided bathrooms and toilets in sufficient number and was well equipped to meet the needs of service users. En-suite toilets were accessible for wheelchairs. Individual bedrooms were arranged in a domestic style. The service users were encouraged and expected to bring their own furniture and make their bedrooms very homely. A service user that expressed some concerns about a slightly discoloured corner in her room could be consulted about the way to eliminate her concern by a minor painting repair or about the time scale for complete redecoration of her room. The premises were clean and bright. A laundry room was away from the food processing area. The ironing room needed a spring clean in order to minimise the effects of dust on staff. Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 The home had employed new staff and ensured consistency of care was provided to service users. A significant reduction in the use of agency staff and good training for permanent staff ensured that service users’ needs were met. EVIDENCE: Service users confirmed that the home employed skilled and experienced staff that met their needs. The home had reorganised the rota to improve working practice. Two new team managers managing each floor and a night time manager helped deliver better service. New rota ensured that enough staff were on duty for each shift. Staff stated that they could manage their workload, but that the peak period, between 6.00 and 8.00 was a difficult time as users’ needs increased. The management tried to cover this period with extra staff, but the plan did not work all the time. However, observing staff at the stated time showed that there were no delays and that they responded to the needs of service users. The home experienced difficulties in recruiting kitchen staff, but the management had tried different methods to fasten and improve recruitment for these positions. Staff training was appropriate. They attended moving and handling and other mandatory training. Staff stated that they benefited from Dementia training and that they had training on Protection of vulnerable adults for the first time. Recruitment was carried out according to the Association’s policy, but the manager stated that waiting for POVA and CRB checks still caused delays in offering the posts to new staff. Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,36,37 The home was well managed and the innovations in working practices introduced by the management team improved standards of care, staff satisfaction, communication, respect, dignity and safety of service users. EVIDENCE: The home was managed by a skilled and experienced manager. The communication had improved from the last inspection, but that was the main area that the management team had worked on in order to build a healthy, professional working environment where service users would be the focus of all their work. Staff stated that they felt supported and that they could say whatever they wanted to the management team. Senior staff meetings that combined day and night staff, were also perceived very positively and as an effective method to improve communication and the outcomes of staff work. Staff stated that they were supervised about every three months, but that support was available whenever they needed it.
Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 Page 19 Records kept in the home were kept up to date and generally were reviewed regularly. Service users’ files were kept in their bedrooms and were accessible to users if they wanted to read them. Several users stated that they knew what was written about them and kept in records. Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 3 3 X X 3 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 3 3 X X X 3 3 X Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? no 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 OP18 Regulation 13 Requirement Timescale for action 30/12/05 2. OP26 23 Service users’ files must contain clear evidence of why the cocoons and bed rails are used and present information about who decided on this potentially restraining measure. In order to better protect staff 30/12/05 and service users ironed items and improve infection control, the ironing room must be thoroughly cleaned, including the ceiling fan. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP9 OP9 Good Practice Recommendations Care plans and risk assessments for new service users should have a suggested date for review to clearly indicate the home’s timing plan for reviewing users’ documents. Liquidised and bottled medication should have an opening date recorded on the bottles. When staff receive medication delivered to the home to be
DS0000014999.V268083.R01.S.doc Version 5.0 Page 22 Bedford Charter House passed on to self medicating service users, the staff should sign receipt of medication. Bedford Charter House DS0000014999.V268083.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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