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Inspection on 10/05/08 for Bedford Park Care Centre

Also see our care home review for Bedford Park Care Centre for more information

This inspection was carried out on 10th May 2008.

CSCI found this care home to be providing an Adequate service.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The admission process is good at the home. People who use the service and their relatives are provided with the information they need to decide whether Bedford Park is the right home for them to move into. The Statement of Purpose and Service User Guide contain detailed information for people to read before they come to the home. People are also welcome to visit the home before they make a decision to move into Bedford Park. The admission procedure used shows that staff make sure they can meet the persons needs before they are admitted to the home. Staff at the home liaise with community health staff very well and communicate effectively with health care professionals. The information staff at the home obtain from health care professionals and social workers is good and is used to base the initial care needs of the person. Staff at the home maintain professional links with health care professionals and NHS services in the community. Instructions from health care professionals are carried out well by staff at the home. The equipment used in the home is very good and appropriate to the care needs of the people who use the service. Equipment to promote mobility, independence and tissue viability is of good quality and reviewed when needed. The quality of nursing care is good at the home and the management of medicines is very good throughout the home. End of life and terminal care is good at the home with staff liaising with specialist health care professionals when appropriate. Community links and contact from friends and relatives are maintained at the home and visitors are welcomed at any time. People have choice of when to get up and go to bed, what to wear and where to eat their meals. The standard, presentation and quality of the food is very good at the home with good feedback from all people we spoke with. The garden areas are well maintained safe and attractive and accessible for some people. Staff training and recruitment processes are robust in the home which mean that people are cared for by well trained staff who have had sufficient pre employment checks carried out. Management within the home is well organised with each unit having a manager responsible for the day to day running of their unit or department, staff recruitment, training and supervision of staff. All managers are professional and cooperative. These managers report to the registered manager of the care home. There is an administrator who deals appropriately Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 7with daily correspondence, and personal `pocket monies`. The maintenance man is responsible for routine and ad hoc repairs. These systems, records and checks are also very efficiently managed with prompt attention to faults.

What has improved since the last inspection?

The admission process has improved since the last inspection. Infection control processes such as swabs taken from people who are likely to have come into contact with illnesses or infections are now done before people come to the home. This is to ensure people moving to the home are not bringing infections or illnesses into the home. The manager has introduced more structured approaches to reviewing care plans in the home. This means staff are reminded to review plans. The manager has also had discussions with head office about colour schemes and ways of making the lounge areas more homely. Signs have been introduced to help orientate with their environment, Financial requests have also been submitted by the manager to request finance for carpet installation and installation of suitable sluice facilities. A mini bus has been purchased by the home. Activities are beginning to improve with the introduction of mobile sensory boxes, and introduction of staff getting a social history so activities staff can ensure people who use the service receive appropriate activities. New documents are being introduced throughout the home. These include new health and safety based risk assessments for the use of bed rails. This will show that this equipment is used appropriately and safely. The manager has also organised dementia workshops for relatives, to answer questions and provide information. Training continues to be good at the home and in this year, staff have received health and safety training, accident recording and infection control training.

What the care home could do better:

The manager must always ensure that people who use the service are cared for in a safe way that respects their dignity. Work patterns must be reviewed to make sure they do not affect the safety of people or dignity of people within the home. The ways of working must be checked to ensure care is person focused rather than institutionalised.Staff must look at the ways in which they interact with people. The terms of address that are used and terms of endearment should be reviewed to ensure people are spoken about in a way that is appropriate and respectful. Staff must ensure they communicate with the person when they are providing personal care or assistance. Staff should look at the ways they use the communal areas where people sit to ensure they are used for the intended purpose. Staff should ensure the care that is given is done so at the correct pace and in a way that is appropriate for that person. Staff must at all times treat people with respect ensuring their care is provided in a safe and appropriate way. Staff should continue to take life histories at the home to ensure the activities are appropriate and enjoyed by each person. Records should be improved to show that activities are varied and offered to all people who use the service, rather than just those who are more able. The activities should also be advertised in a way that people understand. Staff must ensure people are asked about whether they would like to attend religious services in or out of the home. Repairs to the mini bus should continue to reintroduce the trips that people have enjoyed in the past. People should have access to outside space and gardens if they choose and should ensure this is not restricted because of staff workload. The protection and safety of people in the home should been seen as a high priority at the home. Accidents should be recorded in daily records so staff are aware of when a person has sustained a fall or injury. People who use the service should always have ways of calling for assistance. Staff must ensure people have a call bell within reach and are respectful when the bell is called. For those people who are unable to use a call bell, there must be systems in place to check their safety and well being. Care plans must be accurate and written in such a way that staff are aware of how to provide care in a consistent and safe way. Risk assessments for equipment used should show the decision to use such equipment has been made is in the best interest of the person. Protection of vulnerable adults training should be provided for all staff who come into contact with people who use the service. This will enable all staff to pick up on concerns or different forms of abuse. Systems should also be introduced to ensure the recruitment process is always followed and ways to chase up missing documents are introduced. The views and concerns of people, their families and staff should be acted on appropriately. The manager should ensure staff understand how to deal with concerns and complaints in her absence. The manager should also ensure senior staff listen to the views and concerns of staff to show their views are heard. The Provider must ensure there is sufficient finance available to meet the aims and objectives within the statement of purpose and ensure staff have sufficient budgets to meet these objectives. The manager should address outstanding recommendations made at the last inspection. Carpets in the Compton unit must now be replaced. Failure toBedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 9address the recommendations set at the last inspection has put people at risk of tripping. Sluices in the home should be appropriate and changes to colour schemes within the home would help orientate those with dementia type illnesses. Repairs to the extractor fan are needed to ensure the comfort of people having a bath in the Compton unit. Staff should be reminded about the use of protective equipment when handling dirty laundry and staff should also be reminded to remove products which are deemed COSHH (Control of Substances hazardous to health). Improvements are also recommended to the management of laundry in the Compton unit to ensure people receive the correct items of washed clothing promptly.

CARE HOMES FOR OLDER PEOPLE Bedford Park Care Centre Pearn Road Mannamead Plymouth Devon PL3 5JF Lead Inspector Clare Medlock & Stella Lindsay Unannounced Inspection 10:00 10 and 11th June 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bedford Park Care Centre DS0000003573.V366266.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. Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bedford Park Care Centre Address Pearn Road Mannamead Plymouth Devon PL3 5JF 01752 770477 01752 785090 manager.bedfordpark@aermid.com www.aermid.com Aermid Health Care Limited 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) Mrs Sally Anne Thornton Care Home with nursing 104 Category(ies) of Dementia - over 65 years of age (39), Old age, registration, with number not falling within any other category (65), of places Physical disability over 65 years of age (39) Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. PD(E) Maximum registered 39 service users DE(E) Maximum registered 39 service users OP Maximum registered 65 service users Maximum of 104 service users accommodated at any one time Registered for 65 years and over Date of last inspection 26th June 2007 Brief Description of the Service: Bedford Park Care Centre comprises of three separate units (known as the ‘nursing unit’, ‘Compton Gardens’ and ‘the residential unit’. All units are laid out over two floors with wheelchair access via ramps or passenger lifts. Bedford Park care centre is situated on the outskirts of Plymouth close to local amenities. Staff within the nursing unit provide 24 hour nursing care to a maximum of 38 people. Staff within the residential unit provide personal care to a further 38 people and staff within the Compton unit are able to provide personal care to a further 26 people. People with dementia are cared for in all units. The maximum number of people at the home should not exceed 104. Communal rooms are available in each unit and the home benefits from large landscaped gardens, which are accessible from the residential unit. The nursing wing has a sheltered patio area and people within the Compton Unit are able to access both areas when staff are free to accompany them. The home is owned by Aermid Health Care Group PLC a national care home provider (www.aermid.com). The current weekly fees in the residential unit and Compton unit range from £357 to £393 and in the nursing unit range from £468 to £562.65 (June 2008). All people living in the home are issued with a contract breaking down the fees so people can see who is paying what. The last inspection report and Statement of Purpose are on display in the entrance foyer to each unit. Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was unannounced and took place instead of our annual service review. The decision to inspect on this occasion was because feedback from questionnaires we sent to people living in the home and their relatives was so mixed. Prior to the unannounced inspection we sent twenty questionnaires to people who use the service. We received nine back. We also sent twenty questionnaires to relatives of people who use the service. We received seven of these back. We also sent ten questionnaires to staff and received six back. The visit to the home took place over two days. On the first day two inspectors visited the home and on the second day one inspector and an ‘expert by experience’ visited the home. An ‘expert by experience’ is a person who either has an experience of using services or understands how people in this service communicate. They visited the service with us to help us get a picture of what it is like to live in or use the service. During our visit we spoke to three people who use the service, the manager, two deputy managers, and ten staff members. The expert by experience spoke to ten people who use the service. We case tracked ten people who use the service. These included four from the nursing unit and three from each of the residential and Compton units. Case tracking means we looked in detail at the care three people receive. We spoke to staff about their care, looked at records that related to them and made observations if they were unable to speak to us. We looked at staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the safeguarding systems work and what this means for people who use the service. On the second day of the inspection we also performed a short period of observation in the nursing lounge. This enabled us to watch interactions between staff and people living at the home. All this information helps us to develop a picture of what it is like to live at Bedford Park Care Centre. What the service does well: Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 6 The admission process is good at the home. People who use the service and their relatives are provided with the information they need to decide whether Bedford Park is the right home for them to move into. The Statement of Purpose and Service User Guide contain detailed information for people to read before they come to the home. People are also welcome to visit the home before they make a decision to move into Bedford Park. The admission procedure used shows that staff make sure they can meet the persons needs before they are admitted to the home. Staff at the home liaise with community health staff very well and communicate effectively with health care professionals. The information staff at the home obtain from health care professionals and social workers is good and is used to base the initial care needs of the person. Staff at the home maintain professional links with health care professionals and NHS services in the community. Instructions from health care professionals are carried out well by staff at the home. The equipment used in the home is very good and appropriate to the care needs of the people who use the service. Equipment to promote mobility, independence and tissue viability is of good quality and reviewed when needed. The quality of nursing care is good at the home and the management of medicines is very good throughout the home. End of life and terminal care is good at the home with staff liaising with specialist health care professionals when appropriate. Community links and contact from friends and relatives are maintained at the home and visitors are welcomed at any time. People have choice of when to get up and go to bed, what to wear and where to eat their meals. The standard, presentation and quality of the food is very good at the home with good feedback from all people we spoke with. The garden areas are well maintained safe and attractive and accessible for some people. Staff training and recruitment processes are robust in the home which mean that people are cared for by well trained staff who have had sufficient pre employment checks carried out. Management within the home is well organised with each unit having a manager responsible for the day to day running of their unit or department, staff recruitment, training and supervision of staff. All managers are professional and cooperative. These managers report to the registered manager of the care home. There is an administrator who deals appropriately Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 7 with daily correspondence, and personal ‘pocket monies’. The maintenance man is responsible for routine and ad hoc repairs. These systems, records and checks are also very efficiently managed with prompt attention to faults. What has improved since the last inspection? What they could do better: The manager must always ensure that people who use the service are cared for in a safe way that respects their dignity. Work patterns must be reviewed to make sure they do not affect the safety of people or dignity of people within the home. The ways of working must be checked to ensure care is person focused rather than institutionalised. Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 8 Staff must look at the ways in which they interact with people. The terms of address that are used and terms of endearment should be reviewed to ensure people are spoken about in a way that is appropriate and respectful. Staff must ensure they communicate with the person when they are providing personal care or assistance. Staff should look at the ways they use the communal areas where people sit to ensure they are used for the intended purpose. Staff should ensure the care that is given is done so at the correct pace and in a way that is appropriate for that person. Staff must at all times treat people with respect ensuring their care is provided in a safe and appropriate way. Staff should continue to take life histories at the home to ensure the activities are appropriate and enjoyed by each person. Records should be improved to show that activities are varied and offered to all people who use the service, rather than just those who are more able. The activities should also be advertised in a way that people understand. Staff must ensure people are asked about whether they would like to attend religious services in or out of the home. Repairs to the mini bus should continue to reintroduce the trips that people have enjoyed in the past. People should have access to outside space and gardens if they choose and should ensure this is not restricted because of staff workload. The protection and safety of people in the home should been seen as a high priority at the home. Accidents should be recorded in daily records so staff are aware of when a person has sustained a fall or injury. People who use the service should always have ways of calling for assistance. Staff must ensure people have a call bell within reach and are respectful when the bell is called. For those people who are unable to use a call bell, there must be systems in place to check their safety and well being. Care plans must be accurate and written in such a way that staff are aware of how to provide care in a consistent and safe way. Risk assessments for equipment used should show the decision to use such equipment has been made is in the best interest of the person. Protection of vulnerable adults training should be provided for all staff who come into contact with people who use the service. This will enable all staff to pick up on concerns or different forms of abuse. Systems should also be introduced to ensure the recruitment process is always followed and ways to chase up missing documents are introduced. The views and concerns of people, their families and staff should be acted on appropriately. The manager should ensure staff understand how to deal with concerns and complaints in her absence. The manager should also ensure senior staff listen to the views and concerns of staff to show their views are heard. The Provider must ensure there is sufficient finance available to meet the aims and objectives within the statement of purpose and ensure staff have sufficient budgets to meet these objectives. The manager should address outstanding recommendations made at the last inspection. Carpets in the Compton unit must now be replaced. Failure to Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 9 address the recommendations set at the last inspection has put people at risk of tripping. Sluices in the home should be appropriate and changes to colour schemes within the home would help orientate those with dementia type illnesses. Repairs to the extractor fan are needed to ensure the comfort of people having a bath in the Compton unit. Staff should be reminded about the use of protective equipment when handling dirty laundry and staff should also be reminded to remove products which are deemed COSHH (Control of Substances hazardous to health). Improvements are also recommended to the management of laundry in the Compton unit to ensure people receive the correct items of washed clothing promptly. 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. Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 10 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 Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 11 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): 1,2,3,4,5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service and their relatives have the information they need to decide whether Bedford Park is the right home for them to move into. The admission procedure shows that staff make sure they can meet the persons needs. EVIDENCE: Questionnaires showed that people who use the service were able to take part in the decision to move into the home. Where this was not possible due to ill health, families are able to come and look at the home. One questionnaire read ‘My family chose the home for me, as I was unable to do this. My wife and daughter visited the home and discussed my care with the matron who then visited me in the hospital.’ Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 12 People who use the service and their relatives are able to visit the home before they make a decision to move into the home and are invited to stay for lunch as part of that process. The manager told us longer visits were possible but not common due to ill health. The Statement of Purpose and Service User Guide’s are issued to people who are considering Bedford Park as a new home. These documents are available from the manager and are on display within each home. Before people move to the home the manager makes sure information from health care professionals and social services is obtained. Following this staff from the home go to where the person is to perform an assessment to ensure the staff at the home are able to meet the persons needs. This information is then used to form the initial care plan. People are also given a copy of the homes terms and conditions. Staff at the home told us they are able to access specialist knowledge from health care professionals in the community to ensure staff have information and equipment for specialist care needs. The home do not provide intermediate care. Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care people receive is adequate but the way in which it is provided, is at times disrespectful. The care planning systems and documentation at the home are inconsistent mean people are at risk of not having health needs identified or met in a safe way. Medicines are well managed at the home. EVIDENCE: Feedback regarding care was mixed in the questionnaires. One comment read ‘I would say they have the skills and experience look after people adequately (rather than properly) and there is an uneven standard from day-to-day’. Another comment read ‘often when he rings the bell a carer will come in say Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 14 something and go away without knowing what he wants. He cannot always catch what is said or feels his needs are not assessed properly. He finds this upsetting even though he understands they are busy’. Feedback from more able people was more positive with comments such as ‘She is suitably dressed by the staff and is allowed the freedom to move around the home as she wishes’ Inspection confirmed these mixed findings. Some people appeared very well cared for whilst others appeared adequately cared for with the finer details of care being missed. Examples of this were people who had been dressed but not had their eyes cleaned and people left to eat breakfast without having their teeth put in. People told us they often had to wait for call bells to be answered. One questionnaire read ‘I often have to wait to be attended to. Staff are often at their break with only one person on the floor, staff were once at a training session with only one person on the floor.’ One relative commented ‘On occasions he has had to wait up to 20 to 30 minutes and also on occasions this has resulted in soiling and wetting himself.’ On the inspection one person said ‘I often don’t have my bell and at night am told I “You will have to wait” Some staff are better than others, but sometimes I feel like a piece of meat.’ Another person told us that staff did respond well to call bells, but then added ’you understand when they have to deal with someone else’. One person told us they had had a few accidents as a result of staff not coming quickly enough when they called. One relative said the staff were very good but that she had noticed that ‘sometimes there are not so many staff but you can understand when they have holidays or sickness.’ Other people we spoke with said staff were very kind. Staff told us there is a problem with the call bell system, which has been reported to the organisation. Staff said there is no indication of who called the bell first and the tone is the same throughout the home. Some people who use the service were seen without easy access to a call bell. One person was calling out and was ignored by staff that were sitting close by in the lounge. We saw this person did not have access to a call bell and we were told by a member of staff that she was unable to use a bell. There was no system in place to show this vulnerable person was being checked on a regular basis. During the inspection it was noted that people are left for periods of time whilst staff have tea breaks together. People were left without call bells within reach and in the care of one member of staff who was doing the medicine round. This care shows that the service is sometimes organised in the best interest of staff rather than of the people who use the service. Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 15 All staff we spoke with were knowledgeable about the current needs of the people they were caring for. However care plans did not always reflect this in depth knowledge or show how care should be given in a safe and consistent way. All people who use the service had an A4 ring binder file, which contained the pre admission assessment, information from health care professionals and social services, set of care plans and risk assessments. Risk assessments were available for such things as mobility, and nutrition (using MUST, Malnutrition Universal Screening Tool). Bed rail risk assessments were inconsistent. Some were none existent, some not adequately completed and others using the newly introduced health and safety executive based assessment. The quality of care plans and other records was also mixed. Three care plans within the Compton unit were well written and contained clear care plans that had been reviewed to show minor changes in care needs. These plans, risk assessments and documents had been completed and reviewed to show minor changes in condition and were seen as working documents. However care plans within the nursing unit and residential unit were poorly maintained. Care plans in the nursing and residential units contained out of date information, documents that had not been completed and reviews that had been performed but not reflecting the actual care staff were providing. Some care plans were not clearly written and did not provide clear guidelines for staff to consistently follow. Despite recent training in accident recording, accidents were not recorded in the daily activity records or care plans, which could mean that staff are not informed of accidents, or are unable to monitor trends in falls. Moving and handling risk assessments were present on each person’s bedroom door. Spot checks confirmed that not all of these were accurate which could mean new or inexperienced staff move a person in the incorrect way which places the person and staff at risk. The assessments also mean that anyone passing the door can read potentially personal information. Staff told us they do not read these forms regularly as they know each person and some people vary on a day-to-day basis. Moving and handling manoeuvres seen during the inspection appeared to be appropriate and safe. Aids and equipment are provided to encourage maximum independence for people using services. During the inspection teams of physiotherapists were visiting the home with specialist equipment and new equipment was being delivered to meet the changing needs of another person. Nursing beds were used where appropriate and pressure relieving cushions, mattresses and pads were seen throughout the home. Bed rails were in use for some people at the home, but the quality of risk assessment varied throughout the home. Some risk assessments were nonexistent or not adequate to show the bed rails were in use appropriately. One Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 16 care plan contained new in depth risk assessments that had been recently introduced by the home. People told us they are able to see the doctor whenever they needed to and felt staff were quick to respond to any illness. Staff told us they liaise with community health care professionals as needed. A visiting district nurse said communication between the residential unit and Compton unit and the community nurse team was very good. The community nurse said staff in both units follow instruction well and that care within the Compton unit was ‘exceptional’. The home has good systems in place for the management, receipt, administration, safekeeping, and disposal of controlled drugs and medicines. Registered Nurses manage the medication within the nursing wing and staff who have completed and passed an appropriate medication course manage medicines within the other units. New care supervisors are trained by staff in house to ensure each member of staff is competent to handle, record and administer medication properly. However, we saw one member of staff dispense medicines incorrectly without being corrected by the staff supervising her. There is evidence of some people administering their own medication safely. During the inspection the supplying pharmacist visited the home to discuss issues with the manager. The home has policies and procedures, which provide guidance for staff on how to support a person and their family when faced with a terminal illness. Feedback from relatives was very good regarding terminal care. Staff are not consistently trained in terminal care but are able to give a verbal account of good practice that includes the religious needs of the people they support. The wishes of individuals about terminal care and arrangements after death are not always recorded, but staff are able to give an account of the arrangements that are agreed at the appropriate moment. Feedback about privacy and dignity was mixed in questionnaires and throughout the inspection. Examples of extremely good practice and interactions were seen. However examples of extremely poor practice were also seen. Staff were heard using language that is not respectful to people in the home. Staff spoke of people as ‘ressies’, ‘doubles’ and ‘feeders. Staff used terms of endearment as a matter of routine rather than understanding whether the person accepted this term of address. Some examples of practice were very good with staff taking time to speak to the person with respect. Laughter was shared between some staff and people, whilst those people who were quieter and less able to communicate were often ignored for long periods of time. Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 17 Some staff communicated extremely well whilst providing assistance to people whilst at other times performed the task with no communication or interaction at all, or even conducting conversations with other staff without involving the person they were assisting. Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The improvements in activity programme are beginning to provide people with more meaningful stimulation. Further improvements are still needed to ensure that all people have access to more varied and appropriate activities. People who use the service are provided with a wholesome appetising diet. However improvements are needed to make sure people’s choices are acted upon. EVIDENCE: People told us they are able to request to get up and go to bed when they chose, but sometimes have to wait if staff are busy. People we spoke with said that staff were very good at maintaining privacy and dignity when carrying out personal care tasks. One person said ‘I don’t have a bath as I am too nervous, but they give me a strip wash most days and I am very happy with that.’ One relative told us that their father would prefer to have a male carer undertake Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 19 personal care tasks. We fed this back to the manager who informed us that attempts had been made to recruit male staff but with little success. Staff were seen knocking on peoples doors before entering and shielding people from view when a door was opened. Staff told us that people are seen in their room when the doctor or other health care professionals visit the home and are able to see their visitors either in communal areas or in the privacy of their rooms. Visitors are welcome at any time of the day and are welcomed by staff. One person living at the home told us in the survey that ‘there are social functions available if I wish to take part’. Other surveys told us that some people like their own company whilst others would like more. Comments included ‘We have bingo twice a week and morning of keep fit. Could do with a lot more to keep minds active’ and ‘I feel that more activities, including craft and memory stimulation in the residential centre would be an advantage’. Lists of activities were available showing what activities were available within the whole care centre. However these posters were confusing to read and were misleading. Other posters are also displayed throughout he home and were advertising a summer fete, clothes sale, reflexology and sing a long sessions. The activities coordinator told us records are kept regarding which person had attended which activity. Inspection, however, did not show whether people did not attend activities through choice or because they were not asked. More able people had many records however there was no evidence to show that the less able and less vocal people had been provided with appropriate physical or mental stimulation. One person told us she found life ‘quite tedious’ and added, ‘I can’t see very well and my hands can’t hold a pen to write, and I prefer not to join in the quizzes and bingo etc.’ She said she can just see some of her television and stayed in her room the whole time. We were told that no one came to read to her or spend time with her in her room. A staff member had said she would try and take her to the garden but had not re-appeared up to the time when we had finished speaking with her. The relative of another person said they used to do more and have more outings. She gave examples of how the museum used to bring in artefacts and held discussions, which her father enjoyed but that seemed to have stopped. She said he enjoyed the music and that she sometimes paid for a particular musician to come to the Home, but it wasn’t enough. Another person told us that she did not enjoy the bingo/quiz type of activity so did not join in. The activity coordinator told us that the activities within the home have now started to improve with the introduction of new activities and purchase of the Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 20 mini bus. Staff told us there had been problems with the mini-bus the home had purchased in since November. We were told there had been a leaking roof and no straps for the wheelchairs so trips had been limited. The activity coordinator told us these were now being repaired and more staff were being trained to drive the bus. We were also told more 1:1 activities were being planned to ensure all people at the home have access to some stimulation. We were also shown new mobile sensory boxes, which contained different objects for people to handle, which provides a good form of stimulation for those with sight restrictions or dementia type illnesses. There were no formal opportunities for religious services being held at the home. We were told that the Salvation Army come to the Home on occasions, and another person told us that she is collected and taken to a Methodist service. According to the manager the policy is to encourage people to go out to local religious services, although there was no evidence to show that people had been asked if they would like to go to a service. People who live within the residential unit have access to large well-maintained gardens and people living within the nursing unit have access to a wellmaintained courtyard area with sun umbrellas. However, people within the Compton unit do not have access to these areas unless staff are available to take them there. The feedback regarding food was generally good. The food sampled on the day of inspection was good and a sample of the pureed diet showed that food was attractively presented, hot and full of flavour. The expert by experience had lunch with people living within the Compton unit. There were a number of staff serving which did ensure the food given to people who use the service was still quite hot. Staff assisted those who needed help in cutting the food but had little interaction with people as they were doing so. Help was not given in cutting up the pudding and a number of people had difficulty managing independently. Feedback regarding the quantity of food was mixed with comments which included ‘the food is good but they give me too much even though I have asked for a smaller plate, there must be so much waste’ whilst another person told us that she ‘did not always have enough to eat and was not given anything after the ‘tea’ meal, and might like a biscuit at bed time’. There was no evidence to show that staff had asked or acted upon the specific wishes of people. People who use the service are able to select their choice of main meals and able to choose where they take their meals. Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that complaints and allegations of abuse would be dealt with appropriately. The staff training, specific recruitment procedures and staff knowledge help to protect people from abuse. However, changes are needed in work practices to show that care is person centred and not institutional. EVIDENCE: Complaints are generally well managed at the home. Feedback from relatives in the surveys showed that issues are well managed. Comments included ‘whenever issues are raised with the matron Ive received a positive response. She is practical and efficient. We can usually find a win-win solution. On the one occasion I completed a complaint form, procedures were followed satisfactorily and acceptable solution was reached’. Feedback regarding other staff was less positive with comments that include ‘the other senior staff do not share her understanding of managerial responsibility to the same degree. When I raise concerns is the normal course of events they tend to minimise the problem, mainly I think because they are often under pressure to get through daily routines and manage crises when they occur.’ Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 22 Complaints procedures are well displayed throughout the home and feedback from people who use the service on surveys showed they all knew whom they could complain to. Complaints records are kept by the matron and show that responses to formal complaints have been prompt and appropriate. The manager told us each unit now has a book to record all issues regardless of what they are. We were told this was to monitor trends. All senior staff we spoke to knew how to make alerts of abuse to the local safeguarding team. All staff said they would report to the manager any concerns or allegations of abuse. However discussion with non-care staff showed that ancillary staff and administrative staff do not have training in the protection of Vulnerable Adults training. Staff showed that they had an understanding that some equipment was classed as restraint such as bed rails. However, some reclining chairs were in use throughout the home but care plans did not show that the decision to use these were for comfort rather than restraint and agreed by the person. However, initial observation showed that the person was relaxed and appeared comfortable. Throughout the inspection examples of extremely good practice and interaction was seen between staff and people who use the service. However there were also examples of extremely poor practice seen. These are reported upon within other areas of the report. Staff told us they have recruitment checks performed before they are employed at the home. These checks include CRB (criminal records bureaupolice checks) and POVA register checks. Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a well maintained home, however improvements would improve the appearance and hygiene in the home. EVIDENCE: Feedback about the environment was mixed in the surveys we received. One person wrote ‘they support your efforts to customise the residents room and make it seem like home. It has been uplifting for my partner to enjoy visits from our dog. The dog is always made welcome.’ Whilst other comments read ‘There have been some occasions when dads room has been a poor standard of cleanliness, e.g. commode being dirty and his chair. This has been discussed with the staff on each occasion and in the main, standards have improved.’ And ‘On entering the home it smells very welcoming but the first floor always has an unpleasant odour which seems to be from the sluice area.’ Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 24 And ‘Some of the furnishings carpets and curtains and bedding of clean but looking very poor.’ There are outstanding Recommendations that were made at the previous inspection. Carpets within the Compton Unit have not been replaced and now have been repaired using tape, which poses a trip hazard to staff, visitors and people who use the service. Staff told us some carpets in bedrooms have been replaced. Sluice facilities have not been replaced. The home have one hand wash sluice and one macerator. During the inspection staff were seen to wear gloves and aprons appropriately although one member of staff was seen carrying dirty laundry with no gloves or apron. Toilets that were seen had liquid soap and paper towels, and suitable locks. Bathrooms were functional, though not attractive. The shower room had a carpet, which is not hygienic. The Manager said that refurbishment of this facility was on their capital spending list. We were told this is considered less of a priority than a new call bell system. One bathroom was noted to have a faulty extractor fan, which means that people who use the service would be cared for in a very hot room. Staff had use of a screen so that the door could be kept open but this does not protect the privacy of people who use the service. Communal areas were well maintained although the lounge area in the nursing unit was used regularly as a corridor and meeting place for staff, which provided excessive noise and distraction at times. Staff also used the lounge area to sit and have a drink or snack, often with no interaction with the people using the room. Each person has their own room with either ensuite or designated toilet facilities nearby. There were assisted baths throughout the care centre but some were not used because of layout and lack of space. Storage facilities has improved since the last inspection. Heating is adjustable in each person’s bedroom. Oil filled electric heaters have been provided, fixed to walls and covered, except in one bedroom where the occupant objected to the cover and was assessed as being not at risk from it. This risk assessment was not seen. Upstairs windows are restricted, except on stairways where people do not normally go, and in one person’s bedroom where the occupant had been assessed as not at risk. One person with a ground floor room had restrictors fitted so that they could have their windows ajar at night without risk of intruders. Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 25 There is a hairdressing salon on the first floor of the residential unit. There is a plan to develop this further. One person had a key to his door, so that he could lock it when he went out. He was concerned that other people come into his room. Doors are not lockable from indoors. The chef told us he was very pleased that a new cooker had just been installed. He said it was much quicker and more efficient, and he could now provide food cooked properly. He was just waiting for perforated containers so he would be able to provide steamed food. Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are generally cared for by staff who have had appropriate checks performed. Improvements to systems would mean that recruitment checks are robust. Further training would mean that all staff have the necessary skills to care for people. Staff work practices sometimes mean that people do not receive the care they need. EVIDENCE: Separate rotas are kept for the three units, for Activity organisers, kitchen staff, laundry staff, and domestics. These show that most absences were covered, and that staff time for training was extra. They also show the extent to which staff work regularly on more than one unit. Discussion with staff confirmed that this made difficulties for the team, as staff were not familiar with the different work patterns or the particular requirements of the people who use the service. One member of staff said ‘young staff work across units, and keep having to ask how to do things.’ Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 27 Feedback from staff surveys showed that generally there are enough staff but sometimes when the level of need of the people in the home increases, the staffing levels are not always increased equally. Work practices in the home were not always in the best interest of people who use the service. Feedback from relatives informed us that staff take breaks together leaving one member of staff to care for people. At this inspection, this was also seen. At one time four staff were sharing breaks together leaving one nurse on the floor. This nurse was doing medicine rounds and should not be interrupted. The people on this floor was also left without access to call bells. There were a total of 104 staff employed at Bedford Park at the time of this inspection. Recruitment was therefore continual. The procedure is a standard process and mostly followed well, though not entirely. The head of each department carries out recruitment of their own staff, with the support of the Registered Manager. Files of staff from care, domestic, and kitchen sections were inspected and contained application forms with employment histories, Criminal Record Bureau (CRB) clearances recorded, and two written references obtained, and proof of identity. However, in one file the CRB check was not on file, and it was found that additional information had been requested in connection with it. A second reference had not been obtained in one case where a family member had originally been given, but this had not been followed up. This member of staff did not have unsupervised access to people in the home. Feedback from surveys included comments including ‘It would be helpful if staff wore a name badge or a poster was put on the wall with the staff picture and their name. Staff told us that their induction training was satisfactory in preparing them to care for people at Bedford Park. Care staff have two to six weeks supernumerary, and a ‘classroom’ day. They receive in-house training in fire safety, basic moving and handling, communication, introduction to dementia care, and protection of vulnerable adults. Information about the percentage of staff who have achieved NVQ2 was not easily available but will be observed when the AQAA (annual quality assurance assessment) is received. One member of staff told us that she was well into her fifties, and had avoided NVQ training, but had been told she had to do it – and now was enjoying it! One assistant manager told us that she has NVQ4 in care and the assistant manager on the Compton Unit has NVQ4 in management. We were also told that most of the care supervisors have NVQ3 in care. Employee Training Plans were seen on each staff file. These showed that the home was rigorous in maintaining the provision of mandatory training. The residential unit had produced a chart for each staff member showing training Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 28 achieved and when up-dates were due, which is helpful for good monitoring. Feedback from staff surveys showed that staff are provided with sufficient training in order to perform their roles in a safe way. One comment read ‘we always having training to keep as up-to-date with all aspects of our job.’ The Chef had a certificate in management, and had qualifications as a vegetarian chef and diet chef. He had Advanced Food Hygiene training and said that the kitchen staff had basic food hygiene certificates. The aim was for all care staff to also receive this training, and the records seen showed that around 75 had achieved this. The home’s managers form a training team, and have trained as trainers with Healthcare Training Services (certificate seen). Two specialise in Moving and Handling, but still needed specific training as Moving and Handling trainers. Others specialised in First Aid, Health and Safety, and Dementia care. Discussions were held with the assistant manager regarding the use of dementia care mapping training to provide staff with specialist training in dementia care. Staff told us that they felt the training provided was good, and that they were confident with their moving and handling techniques, including use of the hoist. Manoeuvres seen during the inspection appeared safe and appropriate. Specific moving and handling training had been provided for ancillary workers. Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 29 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): 31,32,33,34,35,36,37,38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is run in an organised and efficient way. Improvements to the financial commitment of the providers and ethos of the managers is needed to show the service is being run in the best interest of people living in the home. EVIDENCE: Feedback regarding management was generally good. One care assistant said that there is a ‘fair management team, they tell you if you are doing anything wrong – or right.’ And that ‘they could go to seniors with any worries.’ However feedback from surveys showed that staff do not always feel that their Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 30 views and concerns are listened to. Staff were asked what could the home do better and the response read ‘. Listen to staff that they have concerns and act on it not being told they had asked head office and is out of our hands.’ Staff meetings and residents’ meetings are organised for the year with minutes provided of each meeting held. Staff told us that they receive regular supervision. We saw records of supervision sessions and annual appraisals. The assistant manager of the residential unit said that she supervises any staff who have performance issues and also day and night care supervisors. Supervisors supervise their own team of care assistants. Organisation of business records was good throughout the home. Office accommodation was good with staff being able to find documents promptly, and communicate easily with each other. Profit and loss statements are produced on a regular basis for the manager to see. Inspection of this showed that budgets for areas of routine expenditure had been cut. Throughout the inspection we were told choices had to be made about what was most important to spend money on rather than what was needed to make life for people who use the service safer and more fulfilling. Staff told us that things that needed to be ordered via the capital expenditure process were often delayed or not done. There are care offices in each unit; an administrator’s office, a manager’s office, and the chef had his own space with sufficient equipment needed for the smooth running of the business. The Administrator showed us the records maintained for all people who do not have family to deal with their daily cash. The money was kept securely and individually. Records were up to date and accurate, with two signatures for each transaction, receipts kept, and monthly checks by a team leader. There are methods for quality assurance in the home. We were told that representatives from the organisation to which then home belongs visit the home to carry out audits. Questionnaires are also sent to people who use the service every other month to obtain feedback regarding different subjects. Fire training had been provided, with six monthly visits from a professional fire safety trainer. Updates are provided 3 monthly for night staff, and for new staff members using a DVD. Moving and Handling training is provided at induction, and annually thereafter. First Aid is included as mandatory training for care staff, so there will always be staff on duty whose training is up to date. Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 31 The maintenance team leader had recent training in Health & Safety and Moving and Handling, which is good. He had trained to drive the minibus. He had not done First Aid training. The maintenance team leader showed us the records kept to show that the electrical circuit, the gas appliances had been checked and the lifts had their three monthly service. There are twice yearly check for Legionella in the water, and the maintenance team have a programme of check to water tanks and showers, sampling water and checking water temperatures. The fire log book showed that regular inspection and testing of the alarm system, fire extinguishers, emergency lighting and door guards are carried out. One door to the main office in the nursing unit was damaged and posed a risk of falling on people living, visiting or working at the home. It did not provide an adequate seal in event of fire so an immediate requirement was issued. The tour of the home showed that some shampoos and soaps were left in communal bath areas a The Maintenance team carry out a monthly check of all rooms, including window restraints, hospital beds, bed rails, water temperatures, the temperature of the room and the safety of furniture. There are also regular checks of all the wheelchairs in the home, checking their brakes, tyres, and general safety. The practice of reporting faults works well at the home. One person told us that faults are dealt with promptly. Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 32 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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 1 2 3 2 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 2 3 3 3 3 Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? No Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 34 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 OP7 Regulation 15(2)b Requirement Timescale for action 01/10/08 2 OP7 13(4)c 3 OP8 12(1)a 4 OP8 12(1)a 13(4)c The Manager must make sure care plans and risk assessments are: • Accurate • Reviewed to show changes • Contain accurate information to enable staff to provide care in a safe and consistent way The Manager must make sure 01/10/08 risk assessments contain accurate information to enable staff to provide care in a safe and consistent way. This relates to the inadequate bed rail assessment and moving and handling assessments The Manger must ensure 01/10/08 systems are in place to ensure people receive the finer details of care The Manger must ensure people 01/08/08 who use the service have access to a call bell or systems are in place to ensure people are safe if they are unable to access or use a call bell. Bedford Park Care Centre DS0000003573.V366266.R01.S.doc Version 5.2 Page 35 5 OP10 12(4)a 13(4)c 6 OP12 16(3) 7 OP18 12(4)a 8 OP19 23(2)b 9 OP19 13(2)b The manager must ensure staff work in a way that respects the privacy and dignity of people who use the service. This must be done by ensuring: • The language used that refers to people who use the service is appropriate. (i.e. not using expressions such as doubles and feeders) • Staff communicate when providing personal care or assistance to people who use the service. • Staff are aware of their actions when working with people who use the service. • Moving and handling assessments containing personal information are removed from bedroom doors • People who require assistance with cutting up meals are given adequate assistance The manager must show that people who use the service have access to the religious services of their choice The manager must ensure work practices within the home are performed in the best interest of people who use the service and show they are not institutional approaches. IMMEDIATE REQUIREMENT The manager must repair the nursing office door to reduce risk of it injuring people, visitors and staff and also to provide adequate protection in the event of a fire. The manager should ensure the carpet in the upstairs corridor in the Compton unit is replaced to DS0000003573.V366266.R01.S.doc 01/08/08 01/10/08 01/08/08 18/06/08 01/10/08 Bedford Park Care Centre Version 5.2 Page 36 10 OP27 12(1)a remove the trip hazard. The manager must ensure that work patterns and break times in the home mean that proper provision for the health and welfare of people who use the service. 01/08/08 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 manager should ensure care plans are used as working documents to show: • What accidents have occurred • How care can be given in a safe and consistent way • Changes and trends in a persons condition are monitored • The use of bed rails has been risk assessed adequately The manager must ensure poor practice can be corrected during medication training The manager should ensure wishes regarding terminal illness and care after death are recorded The manager should continue to improve the social activity programme by: • Ensuring life history and social history is taken on all people who use the service. • Ensuring records are kept for all people and language used in these records is appropriate • Providing people who use the service with clear information about what activities are being held • Ensuring people who use the service have access to out door spaces if they choose • Continuing with the mini bus repairs • Ensuring people who use the service can hear the TV or music in the communal lounge if they choose. The manager should ensure the requests from people in the home regarding food are acted upon. The manager should ensure that assistant managers and senior nursing staff are aware of how to effectively DS0000003573.V366266.R01.S.doc Version 5.2 Page 37 2. 3 4 OP9 OP11 OP12 5 6 OP15 OP16 Bedford Park Care Centre 7 8 9 OP18 OP18 OP19 manage complaints and concerns in her absence The manager should ensure the reasons, decisions and consent to use equipment, which could be classed as restraint is clearly recorded. The manager should consider providing vulnerable adults awareness training for non care staff to ensure abuse can be recognised, detected and reported. Outstanding recommendation The programme of renewal of carpets in the corridors of Compton gardens should continue until all of them have been renewed. The manager should ensure the nursing lounge is used for its intended purpose rather than a meeting room for staff or a corridor. Outstanding recommendation In order to provide a more suitable environment for people with dementia the provider should consider: Better colours and signage to allow for better orientation within the unit. 10 11 OP19 OP22 12 OP26 Outstanding recommendation The hand flushing sluices in the residential unit and Compton Gardens should be replaced to reduce the risk of cross infection from splashing. The manager should ensure staff are reminded to use personal protective clothing when dealing with dirty laundry The manager should introduce effective systems for the management of personal laundry items in the Compton unit The manager should ensure a system is in place to check that recruitment procedures are completed for all new staff The manager should consider accessing dementia care mapping training for staff. The manager should ensure systems are in place to ensure that staff feedback is taken seriously The Provider should ensure sufficient finance is available to achieve the aims and objectives set out in the statement of purpose The manager should remind staff that COSHH (Control of Substances hazardous to health) products should not be left in communal areas. DS0000003573.V366266.R01.S.doc Version 5.2 Page 38 13 14 15 16 17 18 19 OP26 OP26 OP29 OP30 OP32 OP34 OP38 Bedford Park Care Centre Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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