Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 12/12/05 for Bedford Residential Nursing Care Home

Also see our care home review for Bedford Residential Nursing Care Home for more information

This inspection was carried out on 12th December 2005.

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

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

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

Residents and a visitor spoken to like the staff that work in the home and were happy with the care provided. Residents described staff, as being "good", "grand" and "lovely" while a visitor said the care at the home was "very good". One relative wrote, " May I thank all the staff for the care they have shown". Before people come to live at the home the manager will visit residents, either at home or in hospital, to make sure the care needed can be provided. The care plans looked at were very detailed and gave people reading them a clear picture of what each person needs help with, as well as the things that are important to them. People visiting the home are made welcome and can visit at any time. Visitors said staff always made them feels welcome.

What has improved since the last inspection?

Good progress has been made by the manager to make sure that the things, which needed improving from the last inspection, have been done. Improvements to the environment have been made and new furniture has been bought for some of the houses.

What the care home could do better:

The staff need to make sure they record the things they do to make sure residents who have lost weight, are eating enough and don`t continue to lose weight.More evidence is needed in care plans to show that residents and their relatives have been involved in deciding about what care is needed. Although risk assessments are very detailed, staff need to make sure the use of equipment such as gates to bedrooms is assessed and reviewed regularly. To ensure residents live in welcoming, pleasant and homely environment parts of the home need to be redecorated and have furniture replaced. Improvements are needed to the parts of the home where people with dementia live, so they can find their way to bedrooms and toilets more easily. Not all staff have received the training they need for example some staff need updated training on how to move people safely.

CARE HOMES FOR OLDER PEOPLE Bedford Residential Nursing Care Home Battersby Street Leigh Lancashire WN7 2AH Lead Inspector Kath Smethurst Unannounced Inspection 12th December 2005 09:30 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 Residential Nursing Care Home DS0000005673.V272152.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 Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bedford Residential Nursing Care Home Address Battersby Street Leigh Lancashire WN7 2AH 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) 01942 262202 01942 605901 atkinson@bupa.com Care First Group PLC Mrs Susan Atkinson Care Home 180 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (60), Old age, not falling within any other of places category (180), Physical disability (8) Bedford Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the maximum registered number 180, there can be:BEECH HOUSE - up to 30 service users in the category DE(E) (Dementia over 65 years of age) to include 5 service users in the category DE (Dementia between 55 - 65 years of age) PENNINGTON HOUSE - up to 30 service users in the category DE(E) (Dementia over 65 years of age) to include 5 service users in the category DE (Dementia age between 55 - 65 years of age) KENYON HOUSE - up to 30 service users in the category OP (Older People over 65 years of age) for nursing care; to include up to 2 service users in the category PD (Physical Disability, but between the ages of 55 - 65 years of age) CROFT HOUSE - up to 30 service users in the category OP (Older People over 65 years of age), for nursing care; to include up to 2 service users in the category PD (Physical Disability for nursing care) between the ages of 55 - 65 years of age LILFORD UNIT - up to 30 service users in the category OP (Older People over 65 years of age) to include up to 2 service users in the category PD (Physical Disability) between the ages of 55 - 65 years of age ASTLEY UNIT - up to 30 service users in the category OP (Older People over 65 years of age) for personal care, to include up to 2 service users in the category of PD (Physical Disability) between the ages of 55 - 65 years of age.) The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 15th March 2005 2. Date of last inspection Brief Description of the Service: Bedford Nursing and Residential home is situated on the outskirts of Leigh town centre close to shops and other amenities and is close to the main bus route. Bedford consists of six separate units each providing care to meet the differing needs of the service users. Two houses are registered to provide nursing care, two provide social care and two houses provide nursing care for people with dementia. The personal accommodation is provided in single rooms with a large communal lounge and dining room. There is access to garden and patio areas. There is ample car parking at the front of the home. Bedford Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two days and was undertaken by two inspectors. Inspectors looked around parts of the building, checked care plans and some records. In order to obtain more information about the home comment cards were sent to residents, relatives, care managers, district nurses and general practitioners. Twelve residents, five relatives, four care managers and six health care professionals returned comment cards to the CSCI. During the inspection twelve residents, three visitors, twelve staff and the manager were spoken to. What the service does well: What has improved since the last inspection? What they could do better: The staff need to make sure they record the things they do to make sure residents who have lost weight, are eating enough and don’t continue to lose weight. Bedford Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 6 More evidence is needed in care plans to show that residents and their relatives have been involved in deciding about what care is needed. Although risk assessments are very detailed, staff need to make sure the use of equipment such as gates to bedrooms is assessed and reviewed regularly. To ensure residents live in welcoming, pleasant and homely environment parts of the home need to be redecorated and have furniture replaced. Improvements are needed to the parts of the home where people with dementia live, so they can find their way to bedrooms and toilets more easily. Not all staff have received the training they need for example some staff need updated training on how to move people safely. 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 Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 7 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 Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 8 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 The admission procedure is satisfactory and systems are in place to ensure proper assessments are completed prior to people moving in. EVIDENCE: The admission procedure is satisfactory and individual assessments are kept for all residents. If possible the manager or senior staff visit prospective residents prior to admission at home or hospital whether they are paying for themselves or the local authority funds their care. Twelve residents files, two from each of the six separate houses were examined. All files showed a full assessment of care needs had been completed and where applicable social work assessments had been taken note off. The assessment document included information relating to physical needs and personal preferences. A visitor spoken to described how her relative had been visited prior to admission and had been asked about his needs and preferences. Staff were aware of the need to undertake pre-admission assessments, in order important Bedford Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 9 and significant information is recorded. Feedback in returned cards from care managers indicated they had no concerns in respect to the admission and assessment process in the home. Bedford Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 10 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 & 10 In the main care plans were detailed, up to date and reflected the care needed, but some relevant records had not been completed, which meant important information had not been documented. Health care needs were on the whole well met with evidence of multi disciplinary working taking place. Personal support is offered in such a way as to promote residents privacy. EVIDENCE: Twelve care plans were examined, two from each of the six houses. Each record set out in detail the aspects of health, personal and social care needs of each resident. Daily entries in care notes were completed in all the plans examined. The plans were easy to read and had been regularly reviewed. The care plans examined contained some very good information in respect to residents past lives, needs, likes/dislikes and chosen lifestyle. For example one care plan instructed staff “ Encourage X to express her feelings” and “Uneasy with men”. All the files contained “relatives communication sheets” which contained details of consultation between residents their relatives and staff. While this is a positive initiative there was no evidence in the care plans to show they had Bedford Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 11 been signed or agreed with residents or their representatives. This needs to be addressed in order to demonstrate residents and their representatives are fully involved in the care planning process. It was noted in one care plan that a resident had indicated dissatisfaction with the food provided. While it is good that this information is recorded there was no indication as to the action taken to resolve this situation. Records of resident’s weights were examined. In the main all had been completed on a regular basis. However one residents record showed she had not been weighed since September because of ill health. This residents record showed between June and September this resident had lost 4kg. However there was no indication in the care records how this residents weight was being monitored. This needs to be addressed to ensure nutritional needs are being met and are not compromised. Comprehensive risk assessments were in place in all files examined. They covered areas such as nutrition, pressure areas, moving and handling, bedrails and falls. All had been reviewed and updated on a regular basis. It was however noted on Beech House a gate had been installed in the door of one residents bedroom. Concerns were raised about this as it could be seen as a form of restraint and could suggest insufficient staffing levels. This was discussed with the head of care responsible for Beech House. She advised the gate had been installed because of concerns raised by the resident’s family about other residents entering the room and because of the physical and cognitive needs of the resident. While it is understandable relatives had concerns this practice is not recommended. It was evident from discussions that a multi-disciplinary review involving the resident’s social worker and health care professionals had not taken place nor had the gates use been reviewed. Additionally there was no record of other strategies having been tried. This issue needs to be addressed as a priority. An urgent review needs to be undertaken involving all relevant professionals in order to discuss the use of such a device and whether or not other strategies could be used. If after the review the use of the gate is agreed detailed records need to be kept and regular reviews undertaken. The health care needs of residents were on the whole being met. Individual care records inspected showed evidence of visits from General Practitioners, chiropodist, optician, tissue viability nurse, physiotherapists, dieticians, hospital consultants and community psychiatric nurses. Health care professionals who returned comment cards indicated they had no serious concerns about healthcare provision in the home. One response indicated that at times “ communication can be difficult due to language barriers on occasions”. Anecdotal evidence from residents indicated that staff respected their privacy and dignity. During the inspection staff were seen to treat residents with Bedford Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 12 respect and consideration, were attentive to individual needs and discreet when providing assistance. Written evidence in care plans showed that resident’s needs in respect to dignity were considered important. For example in one plan staff were instructed to ensure that a resident is bathed “ when she requests it” while another “ensure X is bathed by female staff”. Bedford Residential Nursing Care Home DS0000005673.V272152.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): 13 & 15 Visiting arrangements are good ensuring links between residents and their relatives and friends are maintained. The meals in the home are well balanced and nutritious, offering choice and variety, and catering for special dietary needs. EVIDENCE: The home has an open visiting policy. There are no restrictions on the time people visit and this was evident, with visitors observed during the whole of the period of the inspection. Further evidence was highlighted in the visitor’s book where entries showed residents friends and relatives visiting at different times during the day and evening. Relatives and visitors that returned comment cards also confirmed they were able to visit at any time. The only time restrictions would be imposed is when requested by residents. Anecdotal evidence from both residents and relatives indicated the manager and staff encouraged links to be maintained. Visitors spoken to (Astley and Kenyon Houses) confirmed they were always made to feel welcome by staff when they visited as did those who returned comment cards. Further evidence of this was also observed, staff greeted visitors politely, offered them refreshments and took time to talk to them. Bedford Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 14 Residents with religious beliefs are encouraged and enabled to maintain links. Care plans contain details of resident’s preferred religion. The menus were inspected and were found to be well balanced and varied. A choice is offered at every meal. Discussion with the cook indicated he was aware of the nutritional needs of older people and menus were compiled with this in mind. Meals are served in the lounge dining areas but residents are able to eat their meals in their rooms if they prefer. Breakfast consists of a choice of cereals, fruit and toast. A cooked breakfast is available on request should residents prefer this option. The main meal of the day is served at teatime with a lighter meal being served at lunchtime. Lunch on the day of inspection consisted of a choice of soup, sandwiches, bacon and tomatoes, quiche and salad or jacket potato and cheese. The lunchtime meal was observed on Astley and Kenyon Units. Dining tables were tastefully set so ensuring a congenial atmosphere. The meal was well presented and in adequate quantities. Staff were sensitive and discreet when providing assistance, no one was rushed and second helpings were offered. It was noted that on Astley Unit residents were being asked what choice of meal they wanted for the following day while they were still finishing their lunch. While it is good residents are offered a choice it would be more appropriate to ask residents their meal options once the meal had been completed. This was discussed with both heads of care and assurances were given this would be addressed. The majority of residents who commented expressed satisfaction with the food provided. Four residents who returned comment cards said the liked the food “sometimes”. One resident spoken to described the food as being “very good”. Bedford Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 15 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 policies and procedures of the home ensure residents are safeguarded from abuse or harm, but some staff need updated training so they are fully conversant with procedures to ensure they are aware of the steps to take in a case of suspected abuse. EVIDENCE: The Home holds a copy of the Local Authority “Protecting Vulnerable Adults” policy. All other relevant policies and procedures are in place. The home ensures all staff completes a POVA and CRB (Protection of Vulnerable Adults Register/Criminal Records Bureau) before they commence work. Staff spoken to understood the potential indicators of abuse and were aware of the steps they needed to take if there was a suspicion or allegation of abuse. Abuse awareness is covered during induction training. However it was noted in training records that staff had not routinely undertaken refresher training in the protection of vulnerable adults. This needs to be addressed in the staff development programme to ensure staff are fully aware of the new abuse procedures and their responsibilities if such a situation arises. Bedford Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 16 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. In the main the standard of the environment within the home is satisfactory but some improvements are needed to ensure residents continue to live in an attractive, safe, homely and supportive environment. EVIDENCE: During this inspection the environment on Astley, Kenyon and Beech Houses were examined. Each of the houses has a large communal lounge and dining area. Ornaments, pictures and flowers enhance the homeliness of each of the houses. The inspection took place before Christmas and each of the houses were nicely decorated with festive decorations. Residents within the individual houses have access to patio and garden areas, some of which lead directly from the residents own rooms. None of the residents or visitors spoken to had any adverse comments about environmental standards within any of the houses. In the main environmental standards are satisfactory but some improvements are needed. It was pleasing to see that on the day of inspection Astley House had taken delivery of new chairs and furniture. This will greatly enhance the Bedford Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 17 general appearance in this unit. It was however noted that the chairs in Beech House were showing signs of wear and tear and need to be either replaced or recovered. Some redecoration is needed in the communal lounge/dining areas and corridors in both Astley and Beech houses as the wallpaper and paintwork is damaged. Beech House provides nursing care for residents with dementia but the environment does not meet good practice guidelines. Some efforts have been made to improve the environment with the introduction of memory boards. However there is an absence of orientation aids, signage and visual clues. It is essential that people with dementia have a supportive environment in order to compensate for cognitive difficulties and currently the unit does not provide this. For example all doors are the same colour. Research has found that brightly coloured doors are useful aids for orientation. If toilets are painted in bright distinctive colours this is beneficial to help residents find their way around the home. Whereas doors not for the use of service users should tone into the walls. It is also recommended that multi-sensory stimulation be provided for residents living with dementia are provided for example a snoozelum facility. Toilet and bathing facilities are provided on each of the individual houses. There are accessible toilets for service users that are clearly marked close to the communal areas and each service user has a toilet within close proximity to their personal accommodation. It was noted that in all the toilets, toilet seats had no lids. Pipe work in bathrooms in all three houses had not been boxed in. This needs to be addressed in the planned programme of renewal as it was found some of the pipes were very hot to the touch, which could be potentially hazardous to residents. A sample of bedrooms on Astley, Kenyon and Beech was examined. All showed evidence of personalisation with photographs and personal mementoes on display. All bedrooms are lockable and lockable storage space was available for residents to store items for safekeeping. While the majority of bedrooms were carpeted in Astley House vinyl flooring was widely used on both Beech and Kenyon Houses. Staff advised this was due to resident’s continence difficulties. While the use of such flooring is acceptable in such cases consideration should be given to providing carpets wherever possible. The use of vinyl flooring can give a somewhat institutional impression and should only be used if individually assessed. In Astley House it was noted that valances were not provided. This created a poor impression as the metal frames on the beds were on show once again giving a somewhat institutional appearance. It was also noted that some of the duvets were old and worn. Some staff spoken to suggested there was insufficient bed linen available (not related to the difficulties the home was experiencing due to the interrupted water supply). As a rule each resident should have three sets. To ensure there Bedford Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 18 is sufficient quantity of good quality bedding and duvets a review of stocks needs to be undertaken. Bedford Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 19 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 Staffing levels are satisfactory with low staff turnover. This ensures residents are provided with care by people they know and are familiar with. Recruitment policies and procedures are robust and staff delivering care have been appropriately vetted, so ensuring residents are protected. EVIDENCE: Feedback from residents spoken to and those who returned comment cards indicated staff looked after them well. Relatives and visitors were also complimentary about the care provided. For example one relative wrote, “ She is well cared for, the staff are caring and friendly”. Staff turnover in the home is relatively low and a number of staff has worked in the home for many years, which provides residents with consistent level of care. On both days of the inspection sufficient staff were on duty to meet residents needs. A written rota is maintained. The rotas for all six houses were examined to find that in the main when staff are of sick or on leave absences are covered. It was noted those on some occasions shifts were not covered, but this was rare and could be due to staff reporting sick at short notice. Agency staff is used rarely as the homes own staff usually provide cover, as this was considered better for the residents. Each of the six houses has different staffing ratios based on the dependency levels of the residents. For example Kenyon and Pennington (Nursing) have six staff in the morning, five in the evening and three at night, while Astley and Lilford (Residential) have four staff in the morning, our in the evening and two Bedford Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 20 at night. Domestic and catering staff supports nursing and care staff seven days a week. This means that nursing and care staff do not have to engage themselves in activities, which take them away from the direct care and supervision of residents. During the visit staff were observed to respond speedily to requests for assistance made by residents and they also spent time socialising with them. Staff spoken to said ratios was adequate, as did residents and visitors. In the main feedback from residents and visitors in returned comment cards indicated staffing levels were sufficient. However two relatives felt more staff would be beneficial. One wrote, “ Not sufficient staff on the dementia unit”, a second “ More staff needed to watch residents so they don’t go in other peoples rooms, also to take people out for walks”. The manager was able to demonstrate staff are selected and recruited following a robust recruitment procedure. Twelve staff files were examined to find that thorough pre-employment checks had been carried out. All contained 2 satisfactory references, Criminal Records Bureau Check, verification of identity and a signed declaration of physical and mental fitness. POVA (Protection of Vulnerable Adults Register) and CRB (Criminal Records Bureau) checks are completed prior to staff commencing their duties. Bedford Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 21 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): 35 & 38 The accounting system ensures residents financial interests are protected but a system needs to be developed to ensure residents are able to access their monies at all times. In the main Health and safety practices are satisfactory, but not all staff had undertaken moving and handling refresher training, which could put residents at potential risk. EVIDENCE: Staff could determine exactly how much money the home was holding for each resident. Currently only two residents manage their own finances. The remainder of residents prefer to handover over responsibility for the management of their finances to their representatives. Detailed records are held of all transactions. Each resident has an individual bank account into which his or her personal allowance is held and interest accrued. A record is kept of monies credited and debited and receipts are obtained for financial transactions. Secure facilities are provided for the safe Bedford Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 22 keeping of money. Regular audits are undertaken to ensure monies balance with corresponding receipts and invoices. For example each month two staff check the monies. The company’s finance and operations manager complete further independent checks. During office hour’s residents can access their monies without any difficulty. However discussion with staff indicated that when administrative staff were not working residents could not access their personal allowance. While this does not appear to be an issue currently it could be in the future. A system needs to be developed which will enable residents to obtain their monies at any time. In the main, health and safety issues were satisfactory with regular maintenance checks of equipment being undertaken. The home employs a maintenance manager who has the responsibility for ensuring general health and safety checks of water temperatures, bedrails, portable appliances etc. The maintenance manager completes detailed records of all these checks. These records were found to be very well organised and easy to read. All accidents and incidents were being correctly recorded. Fire safety records showed that that all fire tests and maintenance procedures had been undertaken regularly. From checking staff records, it was noted that while most staff had undertaken recent moving and handling some staff required updated training in this area. For example four of the twelve staff records examined showed staff had last completed moving and handling training in 2004. Bedford Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 23 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 X 2 X X 3 X X STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 2 X X 2 Bedford Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 24 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 OP7 Regulation 15 Requirement Care plans must be drawn up with, agreed and signed by residents and/or their representatives. Where weight loss has been identified care records must contain information of how residents nutritional needs are being monitored. The use of devices, which could be construed as being restraint, must only be used following agreement at a multi-disciplinary meeting with all relevant professionals. And If agreed detailed records must be maintained, a risk assessment completed with regular reviews undertaken. As part of the planned programme of renewal and refurbishment the lounges in Astley and Beech Houses must be redecorated. The armchairs In Beech House must be recovered or replaced DS0000005673.V272152.R01.S.doc Timescale for action 01/03/06 2 OP7 15 31/01/06 3 OP7 15 31/01/06 4 OP19 23 30/11/06 5 OP19 16 & 23 01/06/06 Bedford Residential Nursing Care Home Version 5.0 Page 25 6 7 8 OP25 OP24 OP38 24 16 23 The pipe work in bathrooms must be boxed in. A review of bed linen must be undertaken to ensure there is an adequate stock. All staff must undertake refresher training in safe moving and handling techniques annually. 01/06/06 31/01/06 01/06/06 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 4 5 6 Refer to Standard OP18 OP20 OP20 OP21 OP24 OP35 Good Practice Recommendations To ensure staff are conversant with the protection of vulnerable adults procedures updated training should be provided every two years. As an aid to orientation improvements to signage and visual cues in Beech House should be made. Consideration should be given to improving stimulation for residents living with dementia with the provision of a snoozelum facility. Toilet seats with lids should be installed. When vinyl flooring is being replaced in bedrooms consideration should be given to fitting carpets if appropriate. A system whereby residents can access their personal allowance at any time should be implemented. Bedford Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bedford Residential Nursing Care Home DS0000005673.V272152.R01.S.doc Version 5.0 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!