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Please note that the information on this website is now out of date.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 17/10/06 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 17th October 2006.

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

Before residents went into the home one of the senior members of staff visited them in their own homes or in hospital to make sure that the care they needed could be provided by the home.The qualified nurses and care staff were very good at caring for the residents who were very ill and needed lots of specialised care. The nurses and senior care staff make sure that they continually look at anything that may be a risk to the residents. They then make sure that they write down in the residents care plan when they have done this, and what action they have taken to reduce the risk. People visiting the home are made welcome and can visit at any time. The staff teams worked well together and good systems were in place for sharing information about residents. Comments were made to the Inspectors such as: " You only have to sneeze and they come to you". "They go all the way to help." The BUPA Company has a commitment to ongoing staff training and learning and has provided the care team with the knowledge and skills they need to protect and meet the needs of the residents.

What has improved since the last inspection?

Most of the things that needed doing from the last inspection hade been done.

What the care home could do better:

Management and staff must understand the importance of preserving and protecting a residents` privacy by ensuring that toilet and bathroom doors have locks on that work. The environment could be improved so that it is a more pleasant place to live in. Management and all the staff employed within the home must be aware of their responsibilities in relation to health and safety issues. They must make sure that they have a safe system in place to control any cross infection .

CARE HOMES FOR OLDER PEOPLE Bedford Residential Nursing Care Home Battersby Street Leigh Lancashire WN7 2AH Lead Inspector Grace Tarney Unannounced Inspection 17th & 18th October 2006 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.V308662.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 Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 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 www.bupa.com BUPA Care Homes (CFHCare) Limited 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.V308662.R01.S.doc Version 5.2 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. 29th March 2006 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 residents. 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.V308662.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home was not told that this inspection was to take place although the home was aware that an inspection was due. This was because several weeks before the inspection questionnaires were sent out to the residents, their relatives and to the home itself. These questionnaires asked what people thought of the quality of the service and the facilities provided. 52 questionnaires were returned. 25 from residents, 25 from relatives and 2 from visiting GPs. 3 Inspectors visited the home. 1 Inspector spent 1 day at the home and the other 2 were there over 2 days. A total of 35 inspection hours was spent at the home. During this time the Inspectors looked at care and medicine records to ensure that the health and care needs of the residents were being met. The Inspectors then looked around the building at the bedrooms, bathrooms toilets and sitting areas on each unit to check if they were clean and well decorated. They then visited residents in their own bedrooms and lounge areas. This was to check out the care that was being provided for them. The Inspectors also looked at what the residents had for their lunch and evening meal. They also looked at how many staff were provided on each shift to make sure the residents needs were being met, and also looked at how management recruit and train their staff. How the home manages the residents’ spending money was also looked into. To make sure that the home and the equipment in it were safe some of the maintenance and service records were looked at. In order to get further information about the home the Inspectors also spent time speaking to 12 residents, 9 relatives, 3 qualified nurses, 5 care assistants, the activities organisers and the manager. A copy of the last inspection report is kept in the reception area. The provider informed the inspector that the fees within the home ranged from the following: Privately funded residents: £415.50 to £584.00 Local Authority funded: £312.15 to £347.64. This information was received on the 17/10/06 What the service does well: Before residents went into the home one of the senior members of staff visited them in their own homes or in hospital to make sure that the care they needed could be provided by the home. Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 6 The qualified nurses and care staff were very good at caring for the residents who were very ill and needed lots of specialised care. The nurses and senior care staff make sure that they continually look at anything that may be a risk to the residents. They then make sure that they write down in the residents care plan when they have done this, and what action they have taken to reduce the risk. People visiting the home are made welcome and can visit at any time. The staff teams worked well together and good systems were in place for sharing information about residents. Comments were made to the Inspectors such as: “ You only have to sneeze and they come to you”. “They go all the way to help.” The BUPA Company has a commitment to ongoing staff training and learning and has provided the care team with the knowledge and skills they need to protect and meet the needs of the residents. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 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.V308662.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service The system for ensuring that all prospective residents had a detailed assessment undertaken before their admission to the home, gave an assurance both to residents, relatives and staff, that a resident was only admitted if the home could meet their needs EVIDENCE: Beech House and Pennington House All residents admitted to Beech House and Pennington House have undergone a formal pre-admission assessment conducted by the home manager or care manager (both are registered nurses – the latter is a qualified psychiatric nurse). Pre-admission assessments were detailed and are used to ensure that the home is suitable for prospective resident and able to meet their particular needs appropriately. The formal assessment conducted by the home is also supplemented by assessments conducted by other health and social care professionals including psychiatrists and social workers. Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 9 The information gained from all the above assessments is used in developing a plan of care when the prospective resident is admitted. Residents on both houses were unable – due to their particular illnesses – to comment on their experience before and during admission to the home. However a number of resident’s relatives stated that they felt they were fully involved and consulted throughout the whole assessment and admission process. Kenyon House and Croft House Inspection of 3 resident care files showed that the staff at the home had undertaken assessments before the residents were admitted. The assessments gave a very clear overall picture of the resident’s needs. Assessments undertaken by other professionals requesting a residents’ admission i.e. care manager/social worker were also in place. Also 1 resident had a detailed assessment undertaken by the hospital that she was admitted from. Astley House The assessment documentation of the most recently admitted resident was examined. The assessment contained personal details, past medical/mental health history Assessments also included details of personal care, well being, diet, dietary preferences, sight, communication, oral care, foot care, mobility, dexterity, history of falls, continence, mental state, social interests, hobbies, carers, family and personal safety. Lilford House The assessment documentation of the most recently admitted resident was examined. A Social Services assessment and care plan were in place and the homes’ own assessment. The assessment document covered all relevant areas (personal details, past medical/mental health history, personal care, well being, diet, dietary preferences, sight, communication, oral care, foot care, mobility, dexterity, history of falls, continence, mental state, social interests, hobbies, carers, family and personal safety). This resident was able to describe his admission process. He had not been able to visit prior to coming to live at the home but relatives had looked around. He said that staff made him feel very welcome and had asked about the things he needed help with and his chosen lifestyle. Staff spoken with confirmed prospective residents are able to visit prior to admission. If this was a not possible, a relative usually looked around. Residents are also allocated a key worker. The Inspector saw a new resident being admitted to Lilford. Staff were all aware of this new residents imminent arrival: the admission document was completed and the resident’s room was prepared. A welcome pack containing information about the home and services provided was ready for the resident on her arrival. Standard 6 does not apply. The home does not provide Intermediate Care Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall the care plans reflected the support needs of the residents ensuring their health and social care needs were met. EVIDENCE: Beech House and Pennington House 6 residents care records were inspected – 3 from Beech house and 3 from Pennington house. Care records are organised in a standard format throughout the home. All contained detailed pre and post admission assessments that clearly identified the care needs of residents. All areas of the resident’s life are considered in such assessments including their physical, mental and social needs. All care records contained a life and social history of the resident. This enables staff to relate the care and support they provide to an individual resident who is a unique person and not just ‘one of many’. Care plans clearly identified how resident’s assessed needs (including their religious and cultural needs) were to be met by identifying exactly what actions Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 11 and support needs to be provided to care for these residents properly. Care plans were formally reviewed at least monthly Particular areas of risk are formally ‘risk assessed’ on a regular basis to protect resident’s health and safety. Examples of such risk assessments include those completed in relation to preventing pressure sores, mobility and moving and handling and nutrition (including regular weight monitoring). All residents are registered with a local GP and it was evident that all were enabled to access opticians, chiropodists, district nurses and other specialist services that individual resident’s require (such as community psychiatric nurses and psychiatrists). Relatives said they were kept informed of all significant changes in their relation’s health and were happy that residents are enabled to attend appointments away from the home for example at hospital outpatients departments. Kenyon House & Croft House The care plans of 6 of the residents were inspected,3 from each house. The care plans gave a lot of good information and clear instruction and guidance on how the care needs of the residents were to be met when problems had been identified. The staff also looked at whether or not there was any risk in relation to the residents developing pressure sores and also if they were at risk due to problems with their diet and fluid intake. These are called risk assessments. They also assessed if it was safe to use bed rails and looked at any other general safety risks. Risk assessments were in place for whether a resident was at risk of falling. Two of the residents on Croft had pressure sores and a good plan of care was in place for the treatment of the wounds. The home had also sought advice and guidance from a wound care nurse specialist to ensure that the residents were receiving the correct care and treatment. The residents were being cared for properly on pressure relieving mattresses but this was not documented in their care plans. Neither of these residents had a pressure sore prevention plan in place. 1 of these residents also had diabetes. There was a good plan of care in relation to the administration of insulin but no information about what to do if the residents’ blood sugar levels dropped and urgent attention was needed. They also looked at and they wrote down, how any resident was to be assisted with being moved around and by how many members of staff and what equipment, if any, was to be used to assist in safe moving and handling. From the care plans inspected it was evident that the residents were weighed at least on a monthly basis and action taken if any weight loss had occurred. A discussion with the residents and relatives identified that the residents had access to other health care services including hearing, sight tests and a visiting chiropodist. Evidence of these visits was kept in the residents’ individual files. Equipment necessary for the prevention and treatment of pressure sores was available on all the units Astley House 3 care plans were examined. Each set had information relating to personal, health and social care needs including (personal care, dressing/undressing, Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 12 mobility, diet, communication, socialisation, sleep/rest). The care plans had been reviewed monthly and there was evidence of the plans being signed and agreed with residents or their representatives. While residents were being weighed regularly there was no indication in care plans what action had been taken if weight loss was found. 1 resident had been steadily losing weight since June 2006. Neither the care plan nor the nutritional risk assessment had been updated to reflect this weight loss. Clarification was sought regarding the provision of continence products. The Head of Care advised that the continence promotion nurse had assessed 2 of the residents. Each was supplied with free continence pads during the day but apparently the nurse indicated that night pads could not be provided. The residents had to purchase night pads. It is understood that a new continence promotion nurse is now looking into this situation. Kylie sheets or disposable sheets were not provided. The provision of these products could reduce the need for night pads in some cases and should be considered. Lilford House 2 care plans were examined. Each set out the health, personal and social cares needs of each resident. Daily entries in care notes were completed in all the plans examined. The plans had been regularly reviewed. A full range of risk assessments were in place covering mobility, nutrition, falls, moving & handling and skin integrity and were reviewed and updated on a regular basis. Individual care records inspected showed evidence of visits from General Practitioners, chiropodist, optician and district nurse. Records of weight showed residents were weighed on a regular basis. A discussion with 1 resident indicated that his health had improved since coming to live at the home. He had gained weight and his mobility had improved. The Head of Care confirmed that free continence products were provided during the day but not at night. She also confirmed there were no kylie sheets. This member of staff felt they would be useful and that in the past they had been provided. No residents had pressure sores on either Astley or Lilford units. A resident described how a carer came in on his day off to fix his freeview/digital box. Two visitors spoken with on Lilford House were very happy with the care provided. One said she was “Booking her room”. Both visitors indicated that staff were very good and felt their relatives were well looked after. Both felt however that staffing should be increased. Of the 25 survey comment cards received from residents throughout the home, 23 said that they always received the medical support that they needed and 2 said they usually receive it. Of the 25 comment cards received from relatives the following comments were made: “The staff on Beech House have given my relative some quality of life”. “The standard of care and support is excellent”. “The care and support received on Pennington is wonderful”. Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 13 Beech House and Pennington House The systems for the receipt, recording, storage, handling, administration and disposal of resident’s medicines were appropriate and safe. The qualified nurses are responsible for all aspects of looking after resident’s medicines in the home. Medicine records had been completed properly. Kenyon House & Croft House Overall a safe system of medicine management was in place. The medicine rooms were kept locked, the medication keys were held securely and the trolleys were secured to the wall when not in use. Medicines, including controlled drugs were securely stored and accurately recorded. The following areas of concern were identified however: Throughout the home the system for ordering and the dispensing of medications was not as safe as it should be. The staff told the Inspector that they ordered the repeat prescriptions from the GPs’ and then the pharmacist collected them from the surgery. This meant that the staff did not check what had been prescribed. It also meant that several of the dispensed medications and the MAR sheets stated “as directed” and staff stated that they found this directive unacceptable and unsafe. The “figure of eight” system should be in place whereby the prescriptions are returned to the home for checking and then sent to the pharmacy. There was a policy in relation to homely remedies but no remedies in place. Kenyon House & Croft House When a prescription stated that one or two tablets were to be given, staff were not documenting just how many tablets had been administered. The actual times of administering the medications were not recorded as accurate as they should be. The code on the MAR sheet stated Morning Tea and Bedtime. These times could vary enormously. Management must contact the dispensing pharmacist to ask them to write the times on the computer generated MAR sheets or a code needs to be devised to show just what times they are referring to. Croft House The MAR sheet of 1 resident stated to give 2 tablets 4 hourly but the container they were dispensed in stated 1 or 2. There was no date of opening on a bottle of eye drops. Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 14 Astley House & Lilford House The medication storage rooms on both units were secure and orderly and there was no evidence of overstocking. Medication requiring refrigeration was stored within dedicated medication refrigerators. The medicine trolleys on both units were securely stored when not in use. Records of medicines received into and leaving the home were maintained. The medication fridge temperatures were recorded at least daily. Staff responsible for the administration of medication had undertaken training. A list of signatures for staff administering medication is maintained. On Astley no residents have been prescribed controlled drugs. Only one resident on Lilford had been prescribed a controlled drug. In this case the medication was securely stored. The handling of this drug was recorded and witnessed appropriately. On both units medication was administered to one resident and records completed before beginning administration to another resident. It was however noted that on both units the medication round took some time to complete. On Astley House the morning medication round had not been completed until 11am. A sample of MAR sheets (medication administration sheets) were examined and found to be up to date and accurate. Heads of care on both units indicated that the pharmacist undertakes regular audits however neither of these staff were aware if written reports of these visits were maintained. A monitored dosage system was in place. Staff on both units felt this worked well. Both staff also felt the service from the pharmacist was good. Astley House Two issues were noted: • The date when eye drops came into use was not written on the container • Hand written prescriptions were not checked and countersigned by two staff. Beech House and Pennington House Discussion with relatives and staff revealed that residents were treated with respect and that their right to privacy was upheld. Comments made included; ‘the staff are attentive and very caring’, ‘my mum always looks well groomed and cared for when I visit’, ‘I have always felt welcome when I have come to visit’. Discussion with staff indicated that they received appropriate training and support to meet the health and personal care needs of residents. Kenyon House and Croft House The staff were seen to deal with the residents in a friendly, comfortable and respectful way. Those residents spoken with said that the staff were “patient”, “respectful” and that “they (the staff) talk to us properly”. It was identified during the inspection of both houses that several toilet and bathroom door locks did not close properly. The Inspector was told “It is OK because not many of the residents can go to the toilet themselves”. This indicated to the Inspector that staff do not lock the toilet or bathroom door when assisting residents, thereby compromising their dignity and privacy. Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 15 Lilford House and Astley House Staff were seen to be discreet when providing assistance. Residents on both units were well groomed and dressed. Staff demonstrated by example privacy and dignity, knocking on doors, closing toilet doors etc. Residents were able to comment indicated that staff treated them with respect and maintained their privacy. For example 1 resident said he liked to spend time most of the day in his room and this was all right. This residents care plan also reflected this preference. Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 16 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 adequate. This judgment has been made using available evidence including a visit to this service The home enabled residents to exercise as much personal freedom and choice as possible and most of the residents were able to find some enjoyment with the range of activities available. The meals at the home were adequate, offering choice and variety but the presentation of meals could be improved. EVIDENCE: Beech House and Pennington House Observation and discussion with some residents, staff (including the activities organisers who spend time on Beech house and Pennington house) and residents relatives indicated that residents are provided with a suitable stimulating programme of leisure and social activities that they can participate in if they wish. A timetable of activities was displayed. Both houses are equipped with a wide variety of suitable games, books, arts and crafts and other recreational equipment. The leisure and social activities programme also included trips out into both the local community and places of interest – a number photographic collages documenting these outings were displayed throughout Beech house. The inspector was informed that it is intended to create such displays on Pennington house in the near future. Residents in both houses were supported both individually and as a group to engage in the leisure activities on offer. Entertainers periodically visit the home and themed Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 17 events are held at regular intervals – for example at Halloween, Christmas and Easter. Outside each resident’s bedroom ‘memory boxes’ have been introduced and contain small personal items/photographs that are personal to that particular resident. This development along with activities that concentrate on resident’s abilities to reminisce are important in helping residents in their daily lives. Kenyon & Croft The residents spoken to said that they were satisfied with the way they were allowed to spend their day, more or less as they pleased. The residents’ routines of daily living and their social interests were recorded in detail in their care plans The staff described how they assisted residents with choices such as choosing clothing and food etc. Activities organisers are allocated to the 2 houses. The nursing staff told the Inspector that the activities include such things as bingo, manicures, film shows, armchair exercises, sing-along and musical entertainment. 1 resident spoken to felt that there was not enough for him to do and there were not many people that he could speak to on the unit. He did say that he visited other units at times. A relative said that she wished that the activity staff could spend a little more “1 to 1 time” with her mother. Astley House & Lilford House Two part time activity organisers are employed on Astley and Lilford Houses and the Inspector spent time talking to them. Individual records are maintained in respect of the activities the residents take part in. Activities provided include bingo, manicures, film shows, dominoes, reminiscence, walks, armchair exercises, sing-along and musical entertainment. It was evident from speaking with the activity co-ordinators that they were very knowledgeable regarding residents social interests and that they work hard to ensure social needs are met. The activities arranged on Lilford were impressive. On both days of the visit activities took place (sing-a-long and coffee morning). It was evident that the residents enjoyed the activities arranged. The Activity coordinator seemed very enthusiastic about her role. And she has recently undertaken reminiscence training. Following this training she has undertaken a reminiscence project involving residents, their families and staff. She requested old photos and has made a display. It was evident that residents and visitors found the display of interest. On both days of the visit residents and visitors were seen to stop, look and discuss the display. Relatives are very involved in the activities on Lilford. For example a number came to the coffee morning. Details of the activities provided are displayed. Staff advised that BUPA now fund any external entertainers. Staff said this had been positive in that they did not have to do as much fundraising. Some trips out are provided but not on a regular basis. Of the 25 comment cards received the question in relation to “Are there activities arranged by the home that you can take part in?” 12 said always, 6 usually and 5 sometimes. Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 18 Relatives confirmed that there were no unreasonable restrictions to them visiting their relation at the home and that visits could be conducted in the privacy of the resident’s room or quieter areas of the home. Examination of visitor’s books on all units showed evidence of people visiting at various times of the day. Visitors spoken with indicated that the staff made them feel welcome when visiting. Staff were seen offering visitors refreshments and also took time to speak to them. On the second day of the visit a number of visitors went to a coffee morning held on some of the units. . Residents are encouraged to bring personal possessions into the home. Many of their bedrooms were highly personalised with small pieces of their own furniture, pictures, photographs and ornaments etc. Beech House and Pennington House The general view was that meals were of a reasonably good quality. Meal times are reasonable and residents were served and assisted with their lunch appropriately on the day of inspection. Menus are balanced, varied and provide choice. Resident’s likes and dislikes are established directly and through discussion with resident’s relatives. Kenyon House and Croft House The residents have a lighter lunch and a more substantial meal in the evening. Residents can have a cooked breakfast every morning and staff told the Inspector that residents do have a supper that includes a milky drink if they wish. The Inspector did not dine with the residents but observed lunch being served on both houses. Some residents were having a pureed diet however staff were not sure what the pureed meals were. Staff also commented that the residents who received a pureed meal normally had the same content of the meal in the evening. The residents spoken to said that the food was “good” & “you get enough to eat” The way that the meals were served on Kenyon House was not acceptable. There were no tablecloths or place mats on the tables, no napkins and no condiments on the table. This was in sharp contrast to how meals were served on Croft House. There the tables were nicely set. Hot and cold drinks were served during and after the meal and fresh fruit was available and on display. Staff were wearing protective clothing and those residents who needed assistance with eating were helped in an unhurried and discreet way. Astley House and Lilford House On arrival on Astley House residents were still having breakfast at 10.30am. It was noted that tablecloths were not used at either breakfast or lunch time. When staff were asked about this the Inspector was told this was because there were not enough. This was not the case on Lilford House where at teatime tablecloths had been used. The lunchtime meal on Astley was observed. It was noted some residents had been brought to the table some Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 19 time before the meal was served. Menus were not displayed. When staff were asked about this the inspector was told that residents “would not remember”. However residents are asked the day before what choice of meal they want. . Lunch consisted of soup/sandwiches, bacon & tomatoes, quiche or jacket potato followed by bakewell tart. Portion sizes were good and the residents were not rushed. Most residents were able to eat independently. One resident required assistance with eating/drinking. The member of staff assisting did not rush this resident, maintained eye contact and took time to assist her. Those residents able to comment had no adverse comments about the food. In regard to the food one visitor said it was “not up to scratch” and should be “more varied” and felt there were too many “stews”. One visitor also felt the terminology used in menus was not always easily understood by some older people (e.g. stroganoff). Of the 25 comment cards received from residents in answer to the question “Do you like the meals at the home?” 13 said always 3 usually 8 sometimes Comment cards from relatives were mostly positive although 1 comment was that there could be an improvement in the meals. Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 20 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 judgment has been made using available evidence including a visit to this service. The complaint system in place enabled residents to feel that their views were listened to and acted upon. Staff had a good knowledge and understanding of what abuse was, thereby reducing the possible risk of harm or abuse to residents. EVIDENCE: A detailed complaints procedure was in place and was displayed in the reception area. A discussion with residents and relatives indicated that there was a general awareness of how to make a complaint. Replies from the comment cards showed that the residents knew how to make a complaint if they had to. It was clear in discussion with staff that they also knew what steps to take should a resident make a complaint. None of the residents or visitors spoken with had made a complaint. The Service User Guide that is given out to all residents/families also explained the complaints procedure. A policy and procedure was in place in relation to the detection of abuse and neglect (including whistle-blowing) and how to respond to suspected abuse. The home had a copy of the Local Authorities procedure for protection of vulnerable adults. Not all staff have received training in abuse awareness although staff spoken to were very clear about what to do if an allegation of abuse had been made. The Inspector was informed that training in this area is an ongoing process and that training sessions have been planned for the future. Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 24 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Although the residents were living in a clean and safe home, in parts it was in need of redecoration and refurbishment. EVIDENCE: There is level access to the front of the home and to each unit. All the houses provide ground floor bungalow style accommodation. This allows easy access for wheelchair users and people who have problems climbing steps. There is plenty of parking to the front of the home. Beech House and Pennington House Beech house and Pennington house were generally in a good state of repair and decoration throughout and provide a secure environment for residents. However some environmental issues were identified and are detailed below. . Communal lounge and dining areas were clean, suitably heated, comfortably and appropriately furnished. Appropriate provision of televisions, music centres and other leisure equipment has been made. The inspector was informed that Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 22 the communal lounge/dining area on Pennington house was to be redecorated and be provided with new floor covering soon. Residents are also enabled to access the pleasant, secure and substantial garden areas adjacent to both houses when the weather permits. Appropriately adapted WC/bathing/shower areas are provided. However the privacy lock on WC 6 and the bath panels in bathrooms 11 and 18 on Beech house were in need of repair/replacement. The home has generally been suitably adapted to meet the needs of residents in relation to specialist equipment. Individual resident’s specialist needs are met following referral to the relevant health care professional. Resident’s bedrooms that were inspected were clean, suitably furnished and equipped and in many cases very personalised. All bedrooms are provided with fitted robes and a washbasin. However the floor covering in bedroom 34 in Beech house had partly lifted and was in need of attention. The home was very clean and in the main free of malodour at the time of this unannounced inspection. However one carpet corridor on Pennington unit was particularly malodorous. The inspector is aware that the manager was in the process of addressing this at the time of this inspection. However it is a significant problem and detracts from an otherwise clean environment on Pennington House. Suitable arrangements and equipment were in place to manage the laundry requirements of residents at the home. Storerooms and sluice areas are provided for storing equipment and cleaning materials and these areas were securely locked at the time of this inspection. Kenyon House and Croft House The Inspector walked around both houses and looked at several bedrooms, the lounges/ dining rooms, bathrooms and toilets. The communal lounge and dining areas were clean, suitably heated, comfortably and appropriately furnished. Each unit had assisted bathing facilities and the toilets had aids to assist any resident with a disability or mobility problem. It was identified during the inspection of both houses that several toilet and bathroom door locks did not close properly. The bedrooms on all the units were clean and each bedroom had fitted wardrobes and a washbasin. The majority of the bedrooms however looked very sparse. Most of the floor coverings were vinyl and the metal bed frames were visible as the beds were void of a valance. Each bedroom had a lockable space for the residents’ use but the bedroom doors were not fitted with over-riding safety door locks. The rooms were individually and naturally ventilated and radiators were suitably protected. Staff hand washing facilities were not in place in the bedrooms and the majority of the residents were receiving intensive personal care. The Inspector was told that the staff use the toilets and bathrooms to wash their hands before and after attending to the residents. The Inspector saw no evidence of this happening. One of the toilets on Kenyon House actually had faeces on the door handle. Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 23 There were no pedal bins in use in the bathrooms and toilets. The bins in use were with a flip top lid, which meant that staff were contaminating/being contaminated with the lid surfaces. Astley House and LilfordHouse The communal lounges and dining areas were clean and suitably heated although some of the dining chairs and tables in Astley House were damaged and worn. The lounge carpet in Astley House was stained, however the housekeeper confirmed that she was returning to work in the evening to clean it. The units had assisted bathing facilities and the toilets had aids to assist any resident with a disability or mobility problem. It was identified that the pipes were not boxed in the bathrooms. The bath panels in two of the bathrooms in Astley House were damaged and need to be replaced. The blind in bathroom 18 in Astley House was torn and also needs to be replaced. The toilets/bathrooms had overriding door locks and staff/resident hand washing facilities were in place in toilets and bathrooms. There was a bad odour in the sluices due to poor or lack of ventilation. The Inspector looked at several bedrooms on each unit. The majority of the bedrooms looked very sparse although several had been personalised with photographs, pictures and ornaments. Most of the floor coverings were vinyl and the metal bed frames were visible as the beds were void of a valance. The rooms were individually and naturally ventilated and radiators were suitably protected. Emergency lighting is provided throughout the home and the lighting in resident areas was domestic in character. The laundry was clean well equipped and looked very well organised. Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 24 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 judgment has been made using available evidence including a visit to the service. The residents’ needs were being met although the staffing levels provided on some units, at times were the minimum. The residents were cared for by staff that were safely recruited, who were suitably experienced and trained, and therefore had the knowledge and skills to meet the residents’ needs. EVIDENCE: Beech House and Pennington House Inspection of staffing rotas provided by the home indicated that staffing provision at the home complied with the current minimum requirements that apply to care homes for older people. Discussion with the manager and other senior staff at the home indicated that they were of the view that current staffing levels for Beech house and Pennington house were appropriate to meet the dependency levels of resident’s. Discussion with senior staff and care staff on both houses indicated that staff were being provided with training in ‘dementia awareness’ to provide them with the knowledge and skills required to meet the needs of residents who require care on Beech and Pennington house. Kenyon House and Croft House Examination of the duty rotas, a discussion with staff and residents showed that there was a sufficient number of nurses and care staff on duty to meet the needs of the residents. Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 25 AstleyHouse and Lilford House On both Astley and Lilford staff turnover is low with a number of staff having worked at the home for a number of years. Astley House A written rota is maintained. Between the hours of 8am and 8pm there are 4 care staff on duty and between 8pm to 8am 2 care staff. A housekeeper supports staff during the day. On the first day of the visit one of the care staff became ill and had to go home. This resulted in the unit being short staffed. Throughout the visit staff were observed to be very busy. The head of care indicated that it was unusual not to cover absences but on this occasion it had not been possible because of the short notice. A discussion with the head of care indicated that currently there were no supernumerary hours whereby she could review and update care plans etc. There was a difference of opinion in regard to whether staffing levels (when fully staffed) were sufficient. While the head of care felt ratios were about right, one of the care staff felt dependency levels were such that additional staff (at peak periods) would be beneficial. Lilford House Staff ratios are the same as Astley House (4 staff between 8am to 8pm and 2 at night). The unit was staffed as the rota indicated. All staff spoken with felt additional staff were needed as did the two visitors spoken with. The visitors indicated that staff cared for residents well but were always very busy. Staff spoken with indicated that the dependency levels of residents were now much higher than a few years ago. Supernumerary hours are not built into the head of care shift pattern. Staff spoken with on Lilford all liked working at the home and felt teamwork was good. Comments from the questionnaires showed that in answer to the question “Are the staff available when you need them?” 11 said always, 6 usually & 8 sometimes. There were several male residents living at Bedford House and also several male carers and nurses. This gave the residents, at times, a choice of whom they wished to care for them. Of the 85 care staff employed 60 have obtained their NVQ level 2 or above in care. This is a percentage of 71 and therefore the home has exceeded the Standard. The personnel files of 3 staff members were inspected. All were in order and these staff had been properly and safely employed. They had a completed application form, 2 professional references, an enhanced criminal records disclosure (CRB) check and a health status declaration A detailed induction-training programme was in place. This was in accordance with the Skills for Care Induction Standards. Each staff member is provided with a very detailed induction/training portfolio. Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 26 All members of staff receive induction training within six weeks of appointment to their post and further training within the first six months of appointment Training records were in place. These showed training had been undertaken in the following areas: Moving and Handling. Fire Safety. First Aid. Food Hygiene. Infection Control. Health & Safety Medication Management. Nutrition Not all staff had received training in the Protection of Vulnerable Adults. As previously stated the Inspector was informed that training in this area is an ongoing process and that training sessions have been planned for the future Staff spoken with on all units said sufficient training was provided Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service The manager provided effective leadership and support to staff and was aware there were still areas to be improved upon which would benefit the residents. Most practices within the home in relation to the maintenance of a safe environment, promoted and safeguarded the health, safety and welfare of the people using the service. EVIDENCE: The manager is a Registered General Nurse who has extensive experience in care of the elderly both in the NHS and the private sector. She has been working for BUPA for over 9 years and has been at Bedford Care Home for four and a half years. She has obtained the Registered Managers Award. There was evidence to show that she has undertaken periodic training to update her knowledge, skills and competence. Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 28 BUPA has its own Quality Assurance division and internal audits are undertaken on a regular basis. Management make sure that checks are undertaken on all areas of the home in relation to health and safety and fire issues. Regular checks are also undertaken of care plans, the incidence of any pressure sores, medications, the kitchen, accidents, incidents, and anything else that affects the safety and well-being of the residents and staff. Questionnaires have been developed and given out to residents and relatives. The system for the safekeeping of residents’ finances was good. The management of residents’ finances are generally undertaken by their families or designated representative. Generally only personal allowances are held by the home in a residents’ account. Individual computer records are made of all transactions and balances. Receipts are held for any purchases made and receipts are given to relatives when they deposit any “spending money” for their relative. The home had a detailed Health & Safety Policy. Regular weekly checking and testing of fire detection system, fire exits and emergency lights was undertaken and documented. Any accidents that happen are properly recorded and monitored. As previously stated there are some issues in relation to infection control i.e. insufficient staff hand washing facilities and the incorrect disposal of clinical waste in flip top waste bins The information taken from the pre inspection questionnaire showed that the equipment and services within the home were serviced on a regular basis in accordance with the individual requirements. In addition the Inspector checked the documentation in relation to the servicing of the thermostatic control valves. These were serviced in accordance with requirements. Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 29 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 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x 2 x x 2 3 2 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 12 (1) & 15 (1) Requirement When it has been identified that a resident is at risk of developing pressure sores, then a care plan for prevention of pressure sores must be put in place. Staff must also document in the care plan the type of pressure relieving equipment being used. A care plan must be in place that details how the resident with diabetes is to be cared for. This must include what to do in the event of an emergency situation, such as hypoglycaemia. When it is identified that a resident is losing weight a plan of care to address the problem, must be implemented Staff must accurately record the times that medications are administered and staff must document the actual amount/number of tablets being given. That the registered person details in writing (to the CSCI) how each of the environmental issues that are detailed in this report are to be addressed. DS0000005673.V308662.R01.S.doc Timescale for action 18/10/06 2 OP7 15(1) 18/10/06 3. OP8 12(1)(a) & 15(1) 13(2) 18/10/06 4 OP9 18/10/06 5 OP19 16(1)(2) & 23(1)(2) 31/12/06 Bedford Residential Nursing Care Home Version 5.2 Page 31 6 OP21 23(1)(a) 12(4)(a) To ensure residents privacy, the locks that are fitted to toilet and bathroom doors must be repaired or replaced. Staff hand washing facilities must be provided in any resident areas where personal care is being delivered. 31/12/06 7 OP26 13(3) 31/12/06 8 9 OP26 OP27 13(3) 18(1)(a) Appropriate receptacles must be 31/12/06 in place for the disposal of clinical waste. The staffing levels must be kept 18/10/06 under constant review. Staffing must be provided according to the needs and dependency of the residents, not in accordance with the numbers. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP9 Good Practice Recommendations To ensure the accuracy of a transcription, handwritten transcriptions should be checked with another member of staff, signed and countersigned The “figure of eight” system should be in place whereby the prescriptions are returned to the home for checking and then sent to the pharmacy. Serious consideration needs to be given to introducing homely remedies for the residents use. The date of opening should be written on eye drops. Serious consideration needs to be given to improving the setting of the dining tables to detract from the institutionalised look. Tablecloths/placemats and condiments should be in use. When vinyl flooring is being replaced in bedrooms consideration should be given to fitting carpets if DS0000005673.V308662.R01.S.doc Version 5.2 Page 32 3. 4. 5. OP9 OP9 OP15 6. OP24 Bedford Residential Nursing Care Home 7. 8 OP25 OP27 appropriate. Adequate ventilation should be provided in the sluices. Consideration should be given to providing the unit managers (Astley & Lilford Houses) supernumerary hours. Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 33 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: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bedford Residential Nursing Care Home DS0000005673.V308662.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!