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Inspection on 29/03/06 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 29th March 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

CARE HOMES FOR OLDER PEOPLE Bedford Residential Nursing Care Home Battersby Street Leigh Lancashire WN7 2AH Lead Inspector Kath Smethurst Unannounced Inspection 29th March 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.V286809.R01.S.doc Version 5.1 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.V286809.R01.S.doc Version 5.1 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.V286809.R01.S.doc Version 5.1 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. 12th December 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.V286809.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two days. On both days two inspectors and a pharmacist inspector were present. Inspectors looked around parts of the building, checked care plans and some records as well as looking at how the medication was given out. In order to obtain information about the home, the manager, 12 residents, 3 visitors, 8 staff, 2 activity co-ordinators and laundry staff were spoken with. What the service does well: 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. Bedford Residential Nursing Care Home DS0000005673.V286809.R01.S.doc Version 5.1 Page 6 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.V286809.R01.S.doc Version 5.1 Page 7 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): 4 In the main residents care needs were being met, but more training is needed to ensure the specialist needs of residents are not overlooked. EVIDENCE: All residents spoken with felt their needs were being met. Relatives were also satisfied with the care given. A visitor spoken with described the home as being “ Smashing” and the staff as “Good”. From talking with residents, plus visitors and staff, and observing how staff worked, residents’ needs appeared to be generally met. The home provides care for people living with dementia and although some training has been provided more specialised training is needed. For example while some staff were very knowledgeable about dementia care issues some were not. For example how the importance of creating a more supportive environment. It was also noted (Pennington) that some residents displayed a high level of agitation, with a number appearing to be troubled and restless. While staff were friendly towards residents there was little evidence of staff intervening or using strategies to distract residents. Bedford Residential Nursing Care Home DS0000005673.V286809.R01.S.doc Version 5.1 Page 8 It was also noted that on arrival on Astley (day two) the breakfast meal was still being served at 9.45am. Concerns were raised with staff in regard to the time those residents who chose to get up early would have to wait for their meal or drink. Assurances were given that drinks/toast were provided prior to breakfast being served. However examination of one residents care plan showed this resident was regularly asleep when supper was served. Staff need to be mindful of this to ensure nutritional needs are not being compromised. Bedford Residential Nursing Care Home DS0000005673.V286809.R01.S.doc Version 5.1 Page 9 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&9 The care planning and risk assessment systems were satisfactory, providing staff with the information they needed to meet residents’ needs. EVIDENCE: Ten care plans were examined, two each from Astley, Lilford, Beech, Pennington and Croft houses. Each record set out 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. Progress has been made in ensuring care plans have been signed and agreed by residents and their representatives. For example one care plan clearly indicated that a resident did not wish to be involved in monthly reviews but would discuss her care with staff as required. All the files contained “relatives communication sheets” which contained details of consultation between residents their relatives and staff regarding care. Discussion with the manager indicated new care plans were being introduced. This is a positive initiative as it was evident staff were very knowledgeable about residents but this was not always reflected in all the care plans. Some of the care plans contained some very good information about residents past Bedford Residential Nursing Care Home DS0000005673.V286809.R01.S.doc Version 5.1 Page 10 lives, needs, likes/dislikes and chosen lifestyle but others were less detailed. Discussion took place regarding the development of more person centred care plans particularly though not specifically for residents with dementia. This is an area staff may wish to consider when developing the proposed new care plans. To be followed up during the next inspection. 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. During the last inspection the inspectors raised concerns regarding the use of a gate (Beech) in one residents bedroom door without a risk assessment having been completed. A requirement was made for a review of the gates use; record of other strategies used and a risk assessment to be completed. While a risk assessment is now in place concerns remain regarding the gates use. The inspectors remain concerned the use of this device could be seen as a form of restraint. The gates use could also be suggestive of there not being sufficient staff. It was also noted a section in the risk assessment refers to a discussion with an inspector (unnamed) from the CSCI. The way the entry is written suggests the CSCI are in agreement with the use of such a device. This section needs to be removed, as the decision is not in within the CSCI remit. The accident books on Astley, Lilford, Beech, Pennington and Croft were examined. Accidents to find accidents had been appropriately recorded. It was however noted that the individual records had not been removed from the books as stated in guidance. This was discussed with staff who offered assurances this would be addressed. Bedford Residential Nursing Care Home DS0000005673.V286809.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 14 Daily activities within the home are well managed but opportunities for pursuits outside the home are limited. In the main staff supported residents to make choices, enabling them to exercise some control over their lives. EVIDENCE: On the day of the unannounced inspection, the routines of daily living were observed to be flexible. Residents were seen to be getting up in the morning at times that suited them. Staff were observed to spend some time chatting with residents. Activity co-ordinators are employed in the home and the inspectors had an opportunity to meet with them at the inspection, and discuss the activity programme, produced to include residents’ expressed interests. An individual record is maintained of the activities 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. For example where residents don’t wish to join in-group activities this is Bedford Residential Nursing Care Home DS0000005673.V286809.R01.S.doc Version 5.1 Page 12 documented. Nevertheless staff take action to ensure time is spent on a one to one basis, evidence of which was observed during the inspection. Residents who were able to comment expressed satisfaction with the range and frequency of activities. While activities within the home take place frequently, opportunities for residents to access to peruse leisure activities within the community are more limited. Trips out take place but less often than staff would like. Staff advised that the cost of transport contributed to this. Many homes have use of a minibus and this is an area the company may wish to consider. While social inclusion is encouraged, individual choices and preferences are taken into account. Those who choose not to take part in activities are not pressurised to do so. Residents with religious beliefs are encouraged and enabled to maintain links. Care plans contain details of resident’s preferred religion. In general residents expressed satisfaction with care provided and organisation of life at the home. It should be noted that a high proportion of residents have some cognitive difficulties so were therefore unable to confirm they were able to exercise choice. Nevertheless, observation of care practice and information in care plans indicated residents are encouraged to make choices. For example in respect to where residents choose to spend their day. A number of residents were observed using the privacy of their own rooms. Menus offer a choice and residents were seen to choose from a number of different options. Care plans also make reference to choice. One care plan read “ X very independent, she will decide herself when she wishes to go to bed” a second instructed staff “ Allow Y to choose her own clothes”. Bedford Residential Nursing Care Home DS0000005673.V286809.R01.S.doc Version 5.1 Page 13 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): 16 The home has a satisfactory complaints system with some evidence that residents feel their views are listened to and acted upon. EVIDENCE: A complaints procedure is in place. The complaints procedure is displayed in the reception area. . Details of how to complain are contained in the “Service User Guide” which each resident has a copy of. A system is in place for recording complaints. The homes complaints book was examined and showed one complaint had been logged since the last inspection in December 2005. This complaint is currently in the process of being investigated by the manager. The CSCI have received one formal complaint. This related to poor care practices. The complaint was investigated by the provider but overseen by the CSCI. After a lengthy investigation some elements of the complaint were substantiated. Appropriate action has been taken by BUPA representatives to address issues highlighted during this investigation. Anecdotal evidence from the majority of residents spoken with indicated they felt able to approach staff with any concerns and these would be taken seriously. None of the residents or relatives spoken with had made a complaint, but in the main said they were aware of how to do so if the need arose. One resident indicated unawareness of the complaint procedure or who to approach if such a situation arose. Bedford Residential Nursing Care Home DS0000005673.V286809.R01.S.doc Version 5.1 Page 14 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 & 26 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, Lilford, Beech, Pennington and Croft Houses was examined. Each of the houses has a large communal lounge and dining area. 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. With the exception of Croft the communal areas in Lilford, Astley, Beech and Pennington would benefit from re-decoration. The wallpaper is damaged in parts and is beginning to look dated. The carpets (communal areas) are also showing signs of age. While this does not pose a risk to Bedford Residential Nursing Care Home DS0000005673.V286809.R01.S.doc Version 5.1 Page 15 residents safety consideration should be given to redecorate and replace carpets to ensure standards don’t fall below an acceptable level. A number of other areas require attention, in particular: Beech House-Five chairs are in a poor state of repair and need to be recovered or replaced. The majority of over bed tables are chipped and damaged and also need to be replaced. Astley-The dining chairs and tables are damaged and worn. It is understood these are to be replaced. On the patio a large number of cigarette butts were scattered on the floor and in a container filled with water. This creates a poor impression and should be tidied regularly. Beech and Pennington Houses provides nursing care for residents with dementia but as noted during the previous inspection the environment on both units does not meet good practice guidelines. There is still an absence of orientation aids, signage and visual clues. It essential that people with dementia have a supportive environment in order to compensate for cognitive difficulties and currently the unit does not provide this. Steps need to be taken to address this issue. 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. During the last inspection it was noted that in all the toilets, toilet seats had no lids. This is still to be addressed. During this inspection it was noted toilet and bathing facilities did not have locks. To ensure residents privacy locks (which can be overridden in an emergency) need to be fitted to bathroom and toilet doors. A sample of bedrooms on Astley, Lilford, Croft, Pennington and Beech was examined. Most showed evidence of personalisation with photographs and personal mementoes on display. It was noted that on Pennington some of the bedrooms were somewhat stark. All bedrooms are lockable and lockable storage space was available for residents to store items for safekeeping. It was noted that vinyl flooring was used extensively. Discussion with staff indicated this flooring was now routinely used when carpets are replaced. While the use of such flooring is acceptable in some instances consideration should be given to providing carpets wherever possible. The use of vinyl flooring can give a somewhat institutional appearance and should only be used if individually assessed. Feedback from staff also indicated that the new vinyl flooring was very slippery when wet. This needs to be investigated to ensure residents and staff safety. Bedford Residential Nursing Care Home DS0000005673.V286809.R01.S.doc Version 5.1 Page 16 During the last inspection staff commented that there was insufficient bed linen. A requirement was made to ensure sufficient stocks were available. This is still to be addressed. In the main the home was found to be clean and odour was in the main satisfactory. However as some malodours were noted in Astley, Beech and Pennington Houses. An infestation of ants was noted in the dining area (Astley). Discussion with staff indicated this was a common problem throughout the home. While staff addressed this once brought to their attention by inspectors no action appears to have been taken previously. Staff need to be clear that action needs to be taken promptly in such cases. No adverse comments were received from residents or visitors spoken with regarding hygiene standards in the home. Policies and procedures were in place with regard to infection control. Staff were provided with protective aprons and disposable gloves. Liquid soap and paper towels were provided near to hand washing facilities. Staff were observed to be maintaining good hygienic practices. All laundry is undertaken on site and residents spoken to had no complaints about the standard of laundry service provided. Bedford Residential Nursing Care Home DS0000005673.V286809.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 30 Staffing levels are satisfactory with low staff turnover. This ensures residents are provided with care by people they know and are familiar with. A training programme is in place, but some staff have not received specialist training which could compromise the quality of care provided for people living in the home who have complex needs. EVIDENCE: 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. Each of the six houses has different staffing ratios based on the dependency levels of the residents. For example Croft 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, four in the evening and two 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. Bedford Residential Nursing Care Home DS0000005673.V286809.R01.S.doc Version 5.1 Page 18 The majority of staff spoken with indicated staffing levels were sufficient. Discussion with the unit managers (Astley and Lilford) indicated that some supernumery hours would be beneficial in order to enable them to have sufficient time to review and update records. This is an area the person responsible is asked to consider. An induction programme is in place, which meets specifications, set by the National Training Organisation. The induction records of two staff (Astley) were examined. One induction record was fully completed. However the second induction record examined showed that all the sections had not been covered but had been signed off as completed. This is an area, which needs to be addressed. A staff development programme is in place and staff’s mandatory training needs have been on the whole met. Random samples of staff training files were examined to find suitable mandatory training was provided (fire safety, moving & handling, food hygiene and first aid). Other training undertaken by staff includes risk assessments, medication awareness, protection of vulnerable adults, nutrition and wound healing, nutrition support, tissue viability and palliative care. Staff spoken with indicated training provided was sufficient. An area, which needs to be addressed, is in regard to the provision of more specialist training for those staff caring for people with dementia (Beech and Pennington). While a number of staff has completed workbooks on how to understand dementia and challenging behaviour more formalised and structured training needs to be provided. As noted previously improvements in the way staff care for people living with dementia are needed. To achieve this it is essential that staff have specialist knowledge. Currently 53 of staff are in receipt of NVQ (National Vocational Qualification) level 2. A further nine staff are in the process of undertaking the award. As the percentage is just above the required target. The manager is advised to monitor the percentage to ensure the required is maintained. Bedford Residential Nursing Care Home DS0000005673.V286809.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 & 33 The manager has a good understanding of the areas that the home needs to improve upon and has plans in place how improvements are to be implemented. The home regularly reviews aspects of its performance through a programme of self-review and consultations, which include seeking the views of residents, staff and relatives. EVIDENCE: The registered manager is a registered general nurse with several years experience working working with older people in care home settings. The manager has overall responsibility for the six units supported by two heads of care. There is a clear line of accountability in the home which residents and staff that commented are aware of. At the time of this inspection the manager had recently returned from an extended period of sick leave. Therefore this standard was not explored fully. To be followed up during the next inspection. Bedford Residential Nursing Care Home DS0000005673.V286809.R01.S.doc Version 5.1 Page 20 A range of internal and external quality assurance systems is in place such as resident and staff meetings, reviews and visitor/relatives surveys. A sample of the most recent completed surveys was examined to find that the majority who responded were satisfied with the care provided at the home. A representative from BUPA visit the home on a monthly basis to audit records and speak to residents and staff. A written report is then produced of the findings. The home has a system for recording the complaints of those who don’t wish to complain formally. Residents are informed of CSCI inspections and inspection reports are available for visitors and residents to read. The Contracts Section of Wigan Social Services Department, in conjunction with a company called RDB Limited, has undertaken a voluntary star rating of homes in Wigan. As part of the rating process an annual audit of quality is undertaken. This includes consultation with service users and staff. Bedford House has been awarded 5 stars, which is the highest rating. Bedford Residential Nursing Care Home DS0000005673.V286809.R01.S.doc Version 5.1 Page 21 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 X 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X X Bedford Residential Nursing Care Home DS0000005673.V286809.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES 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 OP4OP30 Regulation 12,14,18 Requirement Additional training must be provided to care staff working with residents with specialised needs (dementia) As part of the planned programme of renewal and refurbishment the lounges in Astley and Beech Houses must be redecorated. As part of the planned programme of renewal and refurbishment the lounges in Lilford and Pennington Houses must be redecorated. The armchairs In Beech House must be recovered or replaced. The damaged over bed tables in Beech House must be replaced. As planned the dining tables and chairs in Astley House must be replaced. The pipe work in bathrooms must be boxed in. A review of bed linen must be undertaken to ensure there is an adequate stock. Timescale 31/01/06 not met. Steps must be taken to eradicate the infestation of ants in parts of DS0000005673.V286809.R01.S.doc Timescale for action 30/06/06 2. OP19 23 30/11/06 3 OP19 23 30/11/06 4. 5. 6 7. 8. OP19 OP19 OP19 OP25 OP24 16 & 23 16 & 23 16 & 23 24 16 01/06/06 01/06/06 01/06/06 01/06/06 31/05/06 9. OP26 23 30/04/06 Bedford Residential Nursing Care Home Version 5.1 Page 23 10. 11. OP26 OP30 23 12 & 18 12. OP37 17 the home. The cigarette butts/packets in 30/04/06 patio area (Astley) must be removed. Staff must complete all topics 30/04/06 specified in the induction programme before it is signed off as being complete. Records of accidents must be 30/04/06 maintained in accordance with current guidelines. See body of report for details. Bedford Residential Nursing Care Home DS0000005673.V286809.R01.S.doc Version 5.1 Page 24 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. 7. 8. 9. 9. 6. Refer to Standard OP7 OP7 OP12 OP18 OP20 OP20 OP21 OP21 OP27 OP24 OP35 Good Practice Recommendations Personal information should be added to core care plans to better reflect each residents individual care needs and how they and their family wish them to be met. Consideration should be given to using alternative strategies in ensuring the safety and comfort for the resident whose bedroom door has a gate installed. The activity programme should be reviewed to ensure ways of ensuring more trips outside the home are provided. 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. To ensure residents privacy consideration should be given to installing locks, which can be overridden in an emergency to toilet and bathroom doors. Toilet seats with lids should be installed. Consideration should be given to providing the unit managers (Astley & Lilford Houses) supernumery hours. 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.V286809.R01.S.doc Version 5.1 Page 25 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.V286809.R01.S.doc Version 5.1 Page 26 - 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. 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